5-year Cumulative Survival Rate Research Articles

A novel quantitative grading system to further characterize the prognosis of patients with functional tricuspid regurgitation

Abstract Background Recent studies have suggested that current grading of tricuspid regurgitation (TR) has significant limitations and specifically cannot identify the various grades of severe TR (such as torrential). New cut-off values for the recommended measures of vena contracta (VC) width and effective regurgitant orifice area (EROA) have been proposed but not yet validated. Purpose To test the prognostic utility of new cut-offs for VC width and EROA in a large registry of patients with functional TR (FTR) and to integrate them into a novel comprehensive grading system. Methods FTR severity was evaluated in 1148 patients (mean age: 69±13 years, 50% male) with significant FTR (≥ moderate). Patients with congenital heart disease or who underwent tricuspid valve repair during follow-up were excluded. The primary endpoint was all-cause mortality. Based on Kaplan-Meier survival analyses, VC width significantly differentiated the prognosis of patients with moderate FTR vs severe FTR (with a cut-off value of 7 mm), whereas EROA was able to further stratify patients with more than severe (torrential) FTR. Therefore these two parameters were combined into a novel grading system (Figure: Upper Panel) to define: moderate FTR (VC <7 mm), severe FTR (VC ≥7 mm, EROA <80 mm2) and torrential FTR (VC ≥7 mm, EROA ≥80 mm2). Results According to our novel grading system a total of 146 patients (13%) showed moderate FTR, 547 patients (48%) had severe FTR and 454 patients (39%) presented with torrential FTR. Patients with torrential FTR had greater right ventricular (RV) dimensions, lower RV systolic function and were more likely to receive diuretics. The cumulative 10-year survival rates were significantly different among the groups: 54% for moderate FTR, 43% for severe FTR and 32% for torrential FTR (P=0.004 Figure – Lower Panel). After adjusting for potential confounders, torrential FTR retained its association with worse prognosis compared with other FTR grades (HR 1.28; 95% CI 1.07–1.54; P=0.007) together with age, coronary artery disease, diabetes, severe renal impairment, lower RV or left ventricular systolic function, higher pulmonary artery pressures, and dilated tricuspid annulus. Differently, severe FTR graded according to current guidelines did not show any association with the primary outcome (HR for severe FTR vs moderate FTR 1.17; 95% CI 0.96–1.42; P=0.128). Conclusion The proposed novel grading system combining measures of VC width and EROA is able to further risk stratify patients with FTR and specifically to identify patients with torrential FTR, a new clinical condition associated with even worse mortality than severe FTR. Figure 1 Funding Acknowledgement Type of funding source: None

A matter of proportions: a novel framework to classify functional tricuspid regurgitation

Abstract Background Current approaches for the assessment of tricuspid regurgitation (TR) severity do not correct for right ventricular (RV) size. Similarly to what recently proposed for the left heart, we hypothesized that TR severity can be proportional or disproportional to RV dilation. Purpose To characterize the clinical features and the prognosis of patients with disproportionate vs proportionate functional TR (FTR). Methods A total of 345 patients (mean age: 70±12 years; 40% male) with significant (≥ moderate) FTR, preserved left ventricular systolic function and who did not undergo tricuspid valvular repair during follow-up were included. Proportional and disproportional FTR were defined according to the ratio between TR severity (vena contracta [VC] width) and RV size (tricuspid annulus [TA] diameter). A prognostic relevant cut-off for VC/TA was identified with spline curve analysis. The primary end-point was all-cause mortality and the event rates were compared between patients with proportionate and disproportionate FTR. Results The cut-off for disproportionate FTR associated with an increase in all-cause mortality was identified at 0.24 (Figure 1: left panel). According to this cut-off, 172 (50%) patients showed disproportionate FTR, while the remaining had proportionate FTR. Patients with disproportionate FTR were more frequently symptomatic, had smaller RV basal diameter, higher TR severity, greater left atrial volume, higher prevalence of mitral regurgitation, and higher pulmonary artery pressures compared to those with proportionate FTR. During a median follow-up of 61 (interquartile range, 28–101) months, 135 (39%) patients died. The cumulative 5-year survival rate was significantly worse in patients with disproportionate FTR (57% vs 74%, P=0.001; Figure 1: right panel) and on multivariable Cox regression analysis disproportionate FTR was independently associated with poor outcome (HR 1.56; 95% CI 1.06–2.29; P=0.023) together with age, coronary artery disease, renal impairment, reduced RV systolic function, and increased pulmonary artery pressures. Importantly, this novel framework outperformed the TR grading system recommended by current guidelines, which in this population was not able to effectively stratify the prognosis (HR for severe FTR vs moderate FTR 1.09; 95% CI 0.72–1.64; P=0.694). Conclusions In patients with significant FTR, characterization of TR severity in relation to RV size significantly improves risk-stratification since disproportionate FTR if left untreated is associated with worse prognosis compared with proportionate FTR. Figure 1 Funding Acknowledgement Type of funding source: None

Three-Year Outcomes of Second-generation Trabecular Micro-bypass Stents (iStent inject) With Phacoemulsification in Various Glaucoma Subtypes and Severities.

This longitudinal case series provides valuable long-term data on the safety and efficacy of iStent inject with concomitant cataract surgery. Patients experienced significant and durable reductions in both intraocular pressure (IOP) and medication burden through 3 years postoperative. The purpose of this study was to examine the 3-year effectiveness and safety of iStent inject second-generation trabecular micro-bypass stent implantation with concomitant phacoemulsification cataract surgery in eyes with various glaucoma subtypes and severities. This was a single-center consecutive case series. Three-year outcomes included mean IOP and medications, the proportions of eyes with IOP ≤18, ≤15, and ≤12 mm Hg, and success (absence of secondary glaucoma interventions). Safety included best-corrected visual acuity (BCVA), cup-to-disc ratio, visual field (VF) mean deviation, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) thickness, and adverse events. A total of 124 eyes with different glaucoma subtypes and severities were included. At 3 years postoperative, mean IOP reduced from 16.90±3.85 mm Hg preoperatively to 13.17±2.83 mm Hg (22% reduction, P<0.001) and mean medication burden decreased from 2.38±1.29 medications preoperatively to 1.16±1.22 medications (51% reduction, P<0.001). At 3 years, 96% of eyes achieved IOP ≤18 mm Hg (vs. 69% preoperatively), 80% of eyes achieved IOP ≤15 mm Hg (vs. 40% preoperatively), and 42% of eyes achieved IOP ≤12 mm Hg (vs. 7% preoperatively) with 76% of eyes eliminating ≥1 medication and 37% of eyes eliminating ≥2 medications versus preoperative medication burden. The 3-year cumulative survival rate was 74%. Postphacoemulsification BCVA improvement was preserved, and cup-to-disc ratio, VF mean deviation, and RNFL and GCIPL thickness remained stable. A favorable safety profile included no intraoperative complications and few, transient, postoperative adverse events. Significant and sustained IOP and medication reductions were achieved through 3 years after iStent inject implantation with cataract surgery in a real-world clinical population with mild-to-severe glaucoma, along with favorable safety including stable BCVA, VF, and RNFL and GCIPL thickness.

Prognostic value of 18F-fluorodeoxyglucose positron emission tomography in patients with small hepatocellular carcinoma treated by radiofrequency ablation

Background18F-fluorodeoxyglucose (18F-FDG) uptake in hepatocellular carcinoma (HCC) is significantly associated with early recurrence and survival after curative surgical resection. However, there are no reports regarding the relationship between 18F-FDG uptake and outcomes after radiofrequency ablation (RFA). A prospective cohort study was conducted to evaluate the prognostic value of 18F-FDG positron emission tomography (PET) in HCC patients after RFA.MethodsA total of 121 consecutive patients with primary HCC (≤3 tumors, of diameter ≤ 3 cm) without vascular invasion on imaging were examined by 18F-FDG-PET computed tomography prior to RFA. An HCC with a component of 18F-FDG uptake visibly stronger than that of surrounding liver was defined as 18F-FDG-PET positive.ResultsThe median follow-up period was 1267 days. There were 110 18F-FDG-PET negative and 11 positive tumors. The cumulative 1-year recurrence rates in the 18F-FDG negative and positive groups were 30 and 64% (P = 0.017), respectively, and cumulative 1-year metastatic recurrence rates were 6 and 36% (P < 0.001), respectively. The cumulative 5-year survival rates were 88 and 22% (P < 0.001), respectively. Multivariate analysis revealed 18F-FDG-PET positivity and tumor size as independent factors related to metastatic recurrence and survival after RFA.Conclusions18F-FDG-PET positivity was significantly associated with outcomes after RFA. RFA should not be readily selected as the first-line treatment for small HCC that includes a component of visually strong 18F-FDG uptake.

Outcomes of Combined Liver and Pancreas Transplantation: A Review of the SRTR National Database and a Report of the Largest Single Center Series.

Purposes: This study was intended to summarize the characteristics and clinical outcome of Liver and Pancreas (LPTx) recipients in the Scientific Registry of Transplant Recipients (SRTR) database vs. the largest series from the First Affiliated Hospital (FAH), Sun Yat-sen University.Methods: The clinical data of 23 patients who underwent LPTx from 2000 to 2016 in the United States and 31 patients who underwent modified LPTx procedure (known as simplified multivisceral transplantation [SMT]) from 2008 to 2017 in our center were reviewed. The indications, surgical techniques, patient and graft survival, and complications were compared between the two groups.Results: All recipients in the FAH group were diagnosed with type 2 diabetes mellitus, while 10 of 23 recipients were diagnosed with type 1 diabetes mellitus in the SRTR group. The 1-, 3-, and 5-year cumulative patient survival rates were 81, 74, and 74% in the FAH group, respectively, and 51, 47, and 37% in the SRTR group, respectively (P = 0.023). No diabetes was observed during follow-up in the FAH group, while the diabetes recurrence rate was 22.2% in the SRTR group (P = 0.03).Conclusion: With multiple techniques modified and indications changed, the SMT procedure yielded a preferable outcome compared to that of the traditional LPTx procedure in records of SRTR. SMT has become a treatment option for patients with end-stage liver disease and concurrent diabetes.

A comparison of prognoses between surgical resection and radiofrequency ablation therapy for patients with hepatocellular carcinoma and esophagogastric varices

There has been insufficient investigation of the differences in long-term outcomes between surgical resection (SR) and radiofrequency ablation (RFA) among patients with hepatocellular carcinoma (HCC) and esophagogastric varices (EGV). We retrospectively enrolled 251 patients with treatment-naïve HCC and EGV who underwent SR or RFA as a first-line treatment. Prognostic factors were analyzed using a Cox proportional hazards model. A total of 68 patients underwent SR, and the remaining 183 patients received RFA. Patients who underwent SR were younger, had better liver functional reserves, and had larger tumors. After a median follow-up duration of 45.1 months, 151 patients died. The cumulative 5-year overall survival (OS) rate was significantly higher among patients who underwent SR than those treated with RFA (66.7% vs. 36.8%, p < 0.001). Multivariate analysis showed that age > 65 years, multiple tumors, RFA, albumin bilirubin grade > 1, and the occurrence of major peri-procedural morbidity were the independent risk factors that are predictive of poor OS. In conclusion, SR could be recommended as a first-line treatment modality for HCC patients with EGV if the patients are carefully selected and liver function is well preserved.

Clinical outcome of metal- and all-ceramic resin-bonded fixed dental prostheses.

The aim of this retrospective cohort study was to investigate the long-term outcome of metal- and all-ceramic resin-bonded fixed dental prosthesis (RBFDP) up to 17 years, and to evaluate potential factors influencing the risk for complications. Patients who were treated with RBFDP to replace teeth in the anterior or first premolar region in an university setting were identified from electronic records. Data collection comprised dental and periodontal parameters, periapical radiographs, and assessment of the RBFDP. Patient-reported satisfaction was evaluated on visual analog scales (VAS), and 5-year cumulative survival and success rates were calculated. Cox regression models were used to compare metal- versus all-ceramic RBFDPs. Seventy-one patients with RBFDP replacing 65 anterior teeth and 6 premolars were included with a mean observation period of 56.1 (±42.7) months. RBFDP cumulative survival rate was 86.7% and cumulative success rate 71.7% after 5 years, with no significant difference between metal-and all-ceramic RBFDPs. The risk for RBFDP failure was significantly higher with more than one pontic (OR 6.1; p=0.033), or negative pulp vitality testing of abutments (OR 7.3; p=0.042), while complications tended to be increased with two-wings compared to one-wing RBFDP (OR 5.4; p=0.054). Metal- and all-ceramic RBFDPs facilitated good long-term results, particularly with one-wing, one-cantilever, and vital abutment teeth.

Curative Efficacy and Survival Analysis of Low-Intensity Traditional Chemotherapy Regimen in the Elderly Patients with Acute Myeloid Leukemia (non-M3)

To investigate the short-term and long-term curative efficacy of low-intensity traditional chemotherapy regimen for elderly patients with acute myeloid leukemia (AML, non-M3) and related adverse reactions, in order to explore whether low-intensity traditional chemotherapy regimen still has application value in the treatment of elderly AML patients today. The clinical characteristics, treatment response and prognosis of 67 elderly patients with AML (non-M3) admitted to our hospital from June 2008 to December 2018 were retrospectively analyzed. All patients received low-intensity conventional chemotherapy (i.e. lower standard dose, and without new drugs listed in China since the 21st century), including DA, HA, CAG, etc. The CR rate, median survival time and 5-year cumulative survival rate of patients were evaluated, and the related indexes were compared with the data reported in domestic and foreign literatures at the same time. The CR rate was 55.2% (37/67), the median survival time was 13.7 months, and the 5-year cumulative survival rate was (24.4±6.3)% in patients received low-intensity tradional chemotherapeutic regimens. The CR rates of high-risk group and non-high-risk group were 38.7% (12/31) and 69.4% (25/36), respectively; the median survival time of high-risk group and non-high-risk group was 8.9 months and 25.2 months respectively; the 5-year cumulative survival rate of high-risk group was (10.2±6.6)% and that of non-high-risk group was (36.0± 9.4)%. Compared with the data reported in the literature at the same time, the data obtained from the low-intensity traditional chemotherapy regimen for the elderly AML did not have an obvious disadvantage, morever had relatively short bone marrow suppression time, low induction early mortality rate and low incidence of severe infection. At present, the low-intensity traditional chemotherapy regimen still has good curative effect and survival advantages for elderly AML patients, especially for non-high-risk patients. The adverse reactions are controllable, and the physical and economic conditions of the vast majority of patients can bear the treatment regimen.

Incidence of and Mortality Due to Human Prion Diseases in Taiwan: A Prospective 20-Year Nationwide Surveillance Study from 1998 to 2017.

IntroductionEpidemiologic studies of Creutzfeldt-Jakob disease (CJD) have been undertaken worldwide since the new variant CJD outbreak in 1996 in the United Kingdom. A nationwide report system, the Creutzfeldt-Jakob Disease Surveillance Unit (CJDSU), directed by the Centers for Disease Control of Taiwan, was established in 1997 to identify human prion diseases.MethodsFrom 1998 to 2017, 647 cases were referred to the committee for confirmation. The report to CJDSU included a structured questionnaire recording the clinical, demographic data, and potential iatrogenic exposure, and the results of the clinical and laboratory examination, including tests of blood and cerebrospinal fluid, electroencephalography, and brain magnetic resonance imaging.ResultsIn total, 356 cases (women, n=178) were ascertained to be human prion diseases, and 97.4% (n=347) were sporadic CJD, including three definite, 314 probable, and 30 possible cases; one probable variant CJD and 8 cases of the genetic form human prion diseases. The age- and gender-specific average annual incidence were also significantly higher in the second decade (0.95/1,000,000) than in the first decade (0.63/1,000,000), with an incidence rate ratio of 1.51. The incidences increased with increasing age, reaching a peak at the age of 70–79 years. The 10-year survival curve for sCJD patients showed that the 1-, 5-, and 10-year cumulative survival rate were 52%, 5%, and 1%, respectively. PRNP polymorphisms in 170 patients showed that 98.8% were M129M and 97.6% E219E.DiscussionThe significant increase in incidence after 2008 suggests the increase in the awareness of this rare disease among physicians. The longer disease duration in patients with sCJD in Taiwan than in other countries indicates that the comprehensive support of the health care system, as well as the end-of-life care culture in Taiwan, may prolong survival time in patients with such a progressive and fatal disease.

Long-Term Survival after Stroke in 1.4 Million Japanese Population: Shiga Stroke and Heart Attack Registry.

Background and Purpose Although numerous measures for stroke exist, stroke remains one of the leading causes of death in Japan. In this study, we aimed to determine the long-term survival rate after first-ever stroke using data from a large-scale population-based stroke registry study in Japan. MethodsPart of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based registry study of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in Japan. A total 1,880 patients with non-fatal first-ever stroke (among 29-day survivors after stroke onset) registered in 2011 were followed up until December 2016. Five-year cumulative survival rates were estimated using the Kaplan-Meier method, according to subtype of the index stroke. Cox proportional hazards models were used to assess predictors of subsequent all-cause death. ResultsDuring an average 4.3-year follow-up period, 677 patients died. The 5-year cumulative survival rate after non-fatal first-ever stroke was 65.9%. Heterogeneity was present in 5-year cumulative survival according to stroke subtype: lacunar infarction, 75.1%; large-artery infarction, 61.5%; cardioembolic infarction, 44.9%; intracerebral hemorrhage, 69.1%; and subarachnoid hemorrhage, 77.9%. Age, male sex, Japan Coma Scale score on admission, and modified Rankin Scale score before stroke onset were associated with increased mortality during the chronic phase of ischemic and hemorrhagic stroke. ConclusionsIn this study conducted in a real-world setting of Japan, the 5-year survival rate after non-fatal first-ever stroke remained low, particularly among patients with cardioembolic infarction and large-artery infarction in the present population-based stroke registry.

Risk Factors for Mortality in Patients with Aortoesophageal Fistula Related to Aortic Lesions.

Objective Aortoesophageal fistula (AEF) related to aortic aneurysm and dissection is an uncommon but life-threatening condition. We performed a systematic review of risk factors for mortality and factors associated with the prognosis of AEF. Methods A systematic search of the PubMed, Embase, and Cochrane Library databases was performed. Clinical characteristics, diagnostic methods, and treatments were assessed in terms of their ability to predict mortality. Results The systematic review identified 184 eligible articles including 219 patients with AEF. Multivariable Cox regression revealed positive correlations of hemorrhagic shock (hazard ratio (HR): 1.824, 95% CI: 1.217-2.735, P = 0.004), sepsis (HR: 1.714, 95% CI: 1.112-2.641, P = 0.015), multiorgan failure (HR: 3.060, 95% CI: 1.470-6.368, P = 0.003), and conservative treatment (HR: 5.257, 95% CI: 3.405-8.116, P < 0.001) with mortality and a negative correlation between combination therapy (aortic graft replacement and esophagectomy) and mortality (HR: 0.319, 95% CI: 0.125-0.813, P = 0.017). Kaplan–Meier survival analysis showed that the 1-year cumulative survival rate was 42.5 ± 3.8%. The overall fistula-related mortality rate was 47.0% (103/219). The most common causes of death were bleeding (54.9%) and infection (29.2%). Conclusions We found that hemorrhagic shock, sepsis, and multiorgan failure were risk factors for death in patients with AEF. Additionally, conservative treatment was associated with a higher rate of mortality, while combined aortic graft replacement and esophagectomy improved the prognosis.

Fate of Patients With Intraductal Papillary Mucinous Neoplasms of Pancreas After Resection According to the Pathology and Margin Status: Continuously Increasing Risk of Recurrence Even After Curative Resection Suggesting Necessity of Lifetime Surveillance.

This study evaluated the associated factors and prognosis according to pathology and margin after surgical resection of intraductal papillary mucinous neoplasms (IPMN). There is limited information on recurrence patterns according to pathology and margin in IPMN. Total 577 patients who underwent operation for IPMN at a tertiary center were included. Factors associated with recurrence, survival, and recurrence outcomes according to pathology and margin were analyzed. Among 548 patients analyzed, 353 had low-grade dysplasia (LGD), 78 had high-grade dysplasia (HGD), and 117 had invasive IPMN. Total 50 patients developed recurrences, with 4 resection margins, 10 remnant pancreas, 11 locoregional, and 35 distant recurrences. Invasive IPMN showed worse 5-year cumulative recurrence risk (LGD vs HGD vs invasive: 0.7% vs 4.3% vs 37.6%, P < 0.001) and 5-year survival rate (89.0% vs 84.0% vs 48.4%, P < 0.001). Recurrence risk increased after 5 years, even in LGD and HGD. Malignant margin (HGD and invasive) had worse 5-year cumulative recurrence rate (R0 vs LGD vs malignant: 8.3% vs 5.9% vs 50.6%, P < 0.001) and 5-year survival rate (80.7% vs 83.0% vs 30.8%, P < 0.001). Carbohydrate antigen 19-9 >37 ( P = 0.003), invasive IPMN ( P < 0.001), and malignant margin ( P = 0.036) were associated with recurrence. Invasive IPMN developed more recurrences and had worse survival than LGD or HGD, indicating the need for more efficient postoperative treatment strategies. Patients with LGD and HGD also need regular follow-up for recurrence after 5 years. Malignant margins need additional resection to achieve negative or at least LGD margin.

Prognostic Implications of Increased Right Ventricular Wall Tension in Secondary Tricuspid Regurgitation

Secondary tricuspid regurgitation (TR) imposes a chronic volume overload on the right ventricle (RV) which can increase RV wall tension (RVWT). The aim of this study was to investigate the prognostic implications of increased RVWT in patients with significant secondary TR. A total of 1,142 patients with moderate-to-severe secondary TR were included. Based on the simplified Laplace-Young's law, RVWT was defined as the product between pulmonary artery systolic pressure (PASP) and RV base-to-apex length. The association between RVWT and risk of all-cause death was identified with spline curve analysis and patients were divided according to the cut-off of RVWT beyond which the hazard ratio (HR) and 95% confidence interval for all-cause mortality were above 1. Four hundred sixty-five (41%) patients had RVWT >3,300 mm Hg x mm and formed the group with increased RVWT. Patients with increased RVWT were more likely male, had more frequent heart failure symptoms and presented with more co-morbidities, larger RV and left ventricular (LV) dimensions, worse LV function, more severe secondary TR and higher PASP compared with patients with nonincreased RVWT. During a median follow-up of 51 (17 to 86) months, 586 (51%) patients died. The cumulative 5-year survival rate was significantly worse in patients with increased RVWT as compared with patients with nonincreased RVWT (38% vs 63% p <0.001). After correcting for potential confounders, increased RVWT retained an independent association with all-cause mortality (HR 1.555; 95% CI 1.268 to 1.907; p <0.001). In conclusion, increased RVWT is independently associated with worse prognosis and its evaluation may improve risk stratification in patients with significant secondary TR.

Trend of Survival of a Cohort of Chinese Patients With Systemic Lupus Erythematosus Over 25 Years.

Objectives: To revisit the trend of survival of systemic lupus erythematosus in a cohort of Chinese patients over 25 years.Methods: Patients who fulfilled the 1997 ACR criteria for SLE and were followed in our hospital since 1995 were included. Patients were stratified into two groups according to the year of diagnosis: (1) 1995–2004 and (2) 2005–2018. Survival of patients was studied by Kaplan–Meier analysis. Organ damage as assessed by the Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) and causes of death in the first 10 years of SLE onset was compared between the two groups. Cox regression was used to study factors associated with survival.Results: A total of 1,098 SLE patients were registered in our database. After excluding 157 patients diagnosed outside the time period of 1995–2018, 941 patients were studied (92% women). All were ethnic Chinese. The mean age of SLE onset was 35.1 ± 14.4 years, and the mean duration of observation was 13.1 ± 6.6 years. Seventy-seven (8.2%) patients were lost to follow-up. Groups 1 and 2 consisted of 364 and 577 patients, respectively. The mean SDI score at 10 years of disease onset was significantly higher in group 1 than group 2 patients (1.01 ± 1.43 vs. 0.57 ± 0.94; p < 0.01), particularly in the neuropsychiatric, musculoskeletal, and gonadal domains. Within 10 years of SLE onset, 32 (8.8%) patients in group 1 and 25 (4.3%) patients in group 2 died (p = 0.005). The 5- and 10-year cumulative survival rates were 93.6 and 91.0% in group 1 and 96.5 and 94.2% in group 2 patients, respectively (log-rank test p = 0.048). Infection accounted for more than half of the deaths in both groups. More group 1 than group 2 patients died of vascular events, but the difference was not statistically significant. Cox regression showed that the age of SLE onset and damage score accrued at 10 years, but not the time period in which SLE was diagnosed, were significantly associated with mortality.Conclusions: The improvement in survival of our SLE patients is probably related to the accrual of less organ damage in the past 15 years.

Is it enucleation or organ-sparing techniques for choroid melanoma treatment?

Choroid melanoma belongs to malignant tumors. The choice of treatment modality depends on a tumor size and site, ocular tunics conditions, clinic logistics, and the patient’s will. The aim of the study was to evaluate the effectiveness of treatment of patients with choroid melanoma. The data of the Belarusian Cancer Registry and the case histories of patients with choroid melanoma (C69.3, ICD-10) over the period of 1999–2018 were studied. The incidence rates were evaluated on the basis of the analysis of the absolute number of persons taken ill with the disease, crude intensive rates calculated per 1,000,000 of population. To calculate the survival, the disease-specific cumulative 5-year survival rate was used. Significance evaluation was made applying the chisquare test. The incidence rates varied over the 20-year period and were 0.9 ‰ on the average. Enucleation was performed in 724 patients, 13.9 % (101 patients) being registered with synchronous and metachronous cancer. Patients with a sole tumor of choroid melanoma were analyzed. The amount of enucleations performed decreased by a factor of 1.8. To evaluate the survival, the groups of patients with large tumors were formed after enucleation and combination treatment was carried out. Of 623 patients subjected to enucleation, disease progression was established in 159 (25.5 %). Of 159 patients, the onset of disease progression occurred in 25 (15.7 %) in the 1st year, in 50 (31.5 %) in the 2nd year, and in 84 (52.8 %) in the 4th year and later. In the combination treatment group, consisting of 58 patients, decease progression was ascertained in 10 (17.2 %): in the 1st year – in 1 (10.0 %), in the 2nd year – in 6 (60.0 %), and in the 4th and later – in 3 (30.0 %). The survival rate after the organ-sparing treatment is insignificantly higher and increases to the 5th year of the follow-up, although the data are statistically insignificant (p &gt; 0.5). At present, enucleation does not play the leading role in the choice of treatment modality for patients with clinical diagnosis of choroid melanoma. The disease-specific cumulative 5-year survival rate in patients receiving organ-sparing treatment was 85.7 ± 5.1 %, and in those subjected to enucleation – 67.2 ± 2.2 %, the data being statistically insignificant (p &gt; 0.5). The promising trend in treating choroid melanoma patients is the development of organ-sparing treatment techniques.

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome.

BackgroundAcute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR).MethodsBetween January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented.ResultsIn patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%–42.6%) and 85.7% (95% CI, 81.9%–88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge.ConclusionsPatients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.

Neonatal surgical outcomes after prenatal diagnosis of complex congenital heart disease: experiences of a perinatal integrated diagnosis and treatment program.

This study aimedto evaluate neonatal surgical outcomes of patients diagnosed with complex congenital heart disease (CHD) during pregnancy and treated by the newly initiated "perinatal integrated diagnosis and treatment program (PIDTP)". We reviewed clinical data of 207 neonates (surgical age ≤ 28days) who underwent cardiac surgeries in a single center from January 2017 to December 2018, including 31 patients with referrals from the "PIDTP" (integration group) and 176 patients with routine referral treatment (non-integrated group). In the integration group, median admission age was 0days and median age at surgery was 4days. In the non-integrated group, median admission age was 8days (P = 0.001) and median age at surgery was 13days (P = 0.001). The emergency surgery rate in patients with duct-dependent defects was 36% in the integration group and 59% (P = 0.042) in the non-integrated group, respectively. The in-hospital mortality was 16% in the integration group and 14% (P = 0.78) in the non-integrated group. The 2-year cumulative survival rate after surgery was 83.9% ± 6.6% in the integration group and 80.3% ± 3.1% (P = 0.744) in the non-integrated group. According to multivariable regression analysis, independent risk factors for early mortality of overall neonatal cardiac surgery were low body weight, high serum lactate level, postoperative extracorporeal membrane oxygenation (ECMO) support and prolonged cardiopulmonary bypass (CPB) time. PIDTP shortens the postnatal transit interval, reduces the emergency operation rate of neonatal critical CHD, and provides better preoperative status for surgery. Patients treated by the PIDTP tend to have more complicated anatomical deformity and a greater requirement for the operation and postoperative management, but early outcome and follow-up prognosis are satisfactory.

Implant failures before and after peri‐implantitis surgery: A retrospective study on 207 consecutively treated patients

This study aimed to report implant failures before and after peri-implantitis surgery (P-IS) and to compare the pattern of implant failures with in untreated at-risk patients during the same period. A total of 5628 untreated at-risk patients (7240 jaws) and 207 consecutively patients treated with P-IS (212 jaws) were included in two groups. Implants were placed and followed-up between 1986 and 2018. Cumulative survival rates (CSR) for patients treated with P-IS after 2003 were calculated before and after P-IS and compared with those for nontreated patients. The overall 15-year CSR was 91.2% (CI 95%; 90.5%-91.9%) and 68.5%, (CI 95%, 62.1%-75.5%) for untreated patients at risk and P-IS patients, respectively (P < .05). The 10-year CSR (baseline 1 year after implant surgery) was 97.2% (CI 95%, 95.2%-100%) for treated patients before P-IS which was comparable with that for untreated patients: 95.4% (CI 95%, 94.8%-97.7%). The corresponding 10-year CSR for P-IS patients after surgery was significantly lower (71.6%: CI 95%, 63.1%-81.3% (P < .05)). CSR for patients/jaws without implant failures was comparable between untreated and treated P-IS patients before, but lower for P-IS patients after P-IS (P < .05). A negative effect of P-IS on implant survival after treatment cannot be disregarded.

Immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses: a retrospective analysis of 225 cases

Objective: To evaluate the outcomes of immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses and analyse the risk factors of the complications. Methods: This retrospective study included 273 patients treated with immediate rehabilitation of the edentulous and potential edentulous jaws with implant-supported full-arch prostheses from April 2008 to December 2018 in Department of Implantology, Peking University School and Hospital of Stomatology. The patients' sex, age, place of residence, jaw position, opposing dentition, number of implants, diameter and length of implants, abutment height and abutment angle were recorded. The survival rate of implants and marginal bone loss were calculated and analyzed. Cox proportional hazards ratio model was adopted to analyze the potential risk factors of prosthetic complications. Results: A total of 225 patients (288 jaws) and 1 260 implants were included, with 126 males and 99 females, aged (57.3±11.0) years, with a following time of (5.04±3.08) years. The 1-year cumulative survival rate of implants was 98.0% (1 235/1 260). Forty-eight implants were lost during the follow-up, with 39 implants in the maxillae and 9 implants in the mandible. The risk of implant failure of the maxillae ［7.2% （39/541）］ is significantly higher than that of the mandible ［1.3% （9/719）］ (P<0.01). Average marginal bone loss at 1 and 5 years was (0.7±0.2） mm and （1.1±0.3） mm. One hundred and twenty patients experienced prosthetic complications including screw/abutment loosening (44 cases), screw/abutment fracture (2 cases) and artificial tooth/denture base fracture (99 cases). The possibility of immediate prosthesis fracture within 6-8 months was high but declined over the following years with the final prosthesis delivered. Cox regression analysis showed that the use of 17° abutments in the anterior region was significantly related to the prosthetic complications （hazard ratio=1.797, P=0.002）. Conclusions: Immediate rehabilitation of the edentulous jaws with implant-supported full-arch prostheses can be a predictable technique. The immediate prosthetic mechanical complication prevalence was high. The use of 17° abutments in the anterior region may increase the risk of screw/abutment loosening. It is necessary to review in time.

Long-term renal survival and related risk factors for primary membranous nephropathy in Chinese children: a retrospective analysis of 217 cases.

Primary membranous nephropathy (PMN) is a rare pathological finding in paediatric patients. Data on PMN in children have been restricted to studies with small samples and fairly short follow-up periods. Therefore, we conducted this single-centre study to evaluate the long-term renal survival and related risk factors for PMN in children, and the clinical and histological characteristics were also described. Two hundred and seventeen children with PMN were enrolled from July 2008 to September 2017. Patients with follow-up durations < 12months were excluded, except for patients who progressed to end-stage kidney disease (ESKD) or experienced a related death within 12months. Long-term renal survival and related risk factors were analysed. The sex ratio was 1.33:1 (male vs female), and the median age was 15.0 (14.0-17.0) years old. The most prominent clinical manifestation was nephrotic syndrome (130 59.9%), which was accompanied by various degrees of oedema (142 65.4%), hyperlipidaemia (151 69.6%), hypoalbuminemia (130 59.9%), and nephrotic proteinuria (135 62.2%). Hypertension occurred in 36.4% of children with PMN. After a median follow-up of 45.0 (23.5-74.0) months, 11 patients (5.1%) developed ESKD, and the cumulative kidney survival rates of ESKD at 5 and 10years after renal biopsy were 95.3% and 67.8%, respectively. The cumulative kidney survival rates of the combined event of ESKD and/or 30% decline in estimated glomerular filtration rate (eGFR) at 5 and 10years after renal biopsy were 92.6% and 59.5%, respectively. Cox multivariate regression and Kaplan-Meier analysis demonstrated that hypertension and proteinuria ≥50mg/kg/day were associated with renal outcome. In this study, the 5-year and 10-year cumulative renal survival rates of ESKD in children with PMN were reported for the first time as 95.3% and 67.8%, respectively. In addition, this is the first report to find that hypertension and proteinuria ≥50mg/kg/day are associated with renal outcome in children with PMN.