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BackgroundModerate correlation exists between the imaging quantification of brain white matter lesions and cognitive performance in people with multiple sclerosis (MS). This may reflect the greater importance of other features, including subvisible pathology, or methodological limitations of the primary literature.ObjectivesTo summarise the cognitive clinico-radiological paradox and explore the potential methodological factors that could influence the assessment of this relationship.MethodsSystematic review and meta-analysis of primary research relating cognitive function to white matter lesion burden.ResultsFifty papers met eligibility criteria for review, and meta-analysis of overall results was possible in thirty-two (2050 participants). Aggregate correlation between cognition and T2 lesion burden was r = -0.30 (95% confidence interval: -0.34, -0.26). Wide methodological variability was seen, particularly related to key factors in the cognitive data capture and image analysis techniques.ConclusionsResolving the persistent clinico-radiological paradox will likely require simultaneous evaluation of multiple components of the complex pathology using optimum measurement techniques for both cognitive and MRI feature quantification. We recommend a consensus initiative to support common standards for image analysis in MS, enabling benchmarking while also supporting ongoing innovation.

This paper describes a cross-sectional case control study to measure the prevalence of psychological morbidity in first year medical students and compare it to the prevalence in in a randomly selected control group of other first year students at Edinburgh University. The study was conducted anonymously using the 60 item General Health Questionnaire. Participation rates were over 90% in both subjects and controls. A total of 17% of medical students had symptoms of psychological morbidity which may benefit from treatment and a further 29% of medical students had symptoms of psychological distress which would be expected to remit spontaneously. A similar rate was found in the control group of students. This suggests that if medical students or doctors, later in their careers, fare badly in terms of mental health then this may well be related to aspects of their lives and is not an intrinsic characteristic.

The benefit of adding tyrosine kinase (TK) inhibition to intensive chemotherapy (IC) has not been demonstrated in patients aged >60yrs with newly diagnosed AML. Quizartinib (Quiz) is a class III receptor TKI with potent activity against FLT3 and clinical activity in relapsed/refractory FLT3-ITD+ AML. We have previously demonstrated that Quiz can be safely given sequentially after IC in older AML patients (Burnett et al, Blood 2013; 122:622).