Additional Information In Patients Research Articles

Intrastriatal gradient analyses of 18F-FDOPA PET scans for differentiation of Parkinsonian disorders.

L -3,4-dihydroxy-6-18F-fluorophenylalanine (18F-DOPA PET may be used to distinguish subjects with Parkinsonism fromthose with symptoms not originating from impaired dopaminergic transmission. However, it is not routinely utilized to discriminate Idiopathic Parkinson's disease (IPD) from Atypical Parkinsonian Disorders (APD). We investigated the potential of FDOPA PET to discriminate between IPD and APD, with a focus on the anterior-to-posterior decline in het striatum, considered to be more specific for IPD. 18F-DOPA PET data from a total of 58 subjects were retrospectively analyzed. 28 subjects had idiopathic Parkinson's disease (14 male, 14 female; age at scan 61 +- 11,5), 13 atypical Parkinsonian disease (7 male, 6 females; age at scan: 69,6 +- 6,4) and 17 were controls (6 male, 11 female; age at scan 65,3 +-8,6). Regional striatal-to-occipital ratio's (RSOR's) were calculated, as well as multiple in-line VOI's from the caudate nucleus to the posterior part of the putamen. The linearity of anteroposterior decline was determined by a linear regression fit and associated R squared values. ROC curves were calculated to assess the diagnostic performance of these measurements. Data contralateral to the clinically most affected side were used for analysis. ROC curve analysis for differentiation between controls and Parkinsonism patients showed the highest AUC for the caudate nucleus-to-posterior putamen ratio (AUC=0.930; p<0.00) and for the R squared value for the linear regression fit (AUC=0.948; p=0.006). For discrimating IPD from APD, the highest AUC was found for the caudate nucleus-to-anterior putamen ratio (0.824; p<0.001) CONCLUSIONS: Subregional analysis of the striatum in F-DOPA PET scans may provide additional diagnostic information in patients screened for a presynaptic dopaminergic deficit. A more linear decrease from the head of the caudate nucleus to the posterior putamen was present in patients with IPD, although this feature did not have additional diagnostic value over the RSOR analysis.

The inappropriateness of left ventricular mass and echoreflectivity in males with essential hypertension and different CYP11B2 gene polymorphisms

Background. The CYP11B2 gene as the main controller of aldosterone plasma activity is likely to be responsible as for the BP level as for the expression of different traits of hypertensive cardiac remodeling such as increased left ventricular mass and myocardial fibrosis. The main objective of our study was to define the differences in myocardial remodeling depending on CYP11B2 gene polymorphism. It was shown that some special techniques of echocardiography such as the assessment of inappropriate left ventricular mass and myocardial echoreflectivity proved additional information in patients with hypertensive heart disease. That’s why these techniques were used for a more precise assessment of hypertensive cardiac remodeling. Material and methods. Our study involved 150 males aged 45–60 years. They were divided into three groups: Group 1–50 patients with normal BP without any echocardiographic abnormalities, Group 2–52 patients with essential hypertension without left ventricular hypertrophy, and Group 3–48 patients with essential hypertension and left ventricular hypertrophy. Results. It was found that in patients with inappropriate LVM the prevalence of CC genotype was almost twice higher than among those with appropriate LVM. On the other hand, hypertensive patients with CC genotype and LVH demonstrated higher echoreflectivity parameters. Conclusions. We assume that CC polymorphism of CYP11B2 may be an indicator of more expressed signs of hypertensive cardiac remodeling, in particular myocardial hypertrophy and myocardial fibrosis, in males with essential hypertension.

Immunocytochemical expression of Ki-67/p16 in normal, atypical, and neoplastic cells in urine cytology using BD SurePath™ as preparation method.

Objective:The objective of this study was to investigate the expression of Ki-67/p16 in urothelial cells in cytological material.Materials and Methods:There were 142 urines including normal controls, anonymous rest urine, controls after treatment for urothelial carcinoma (UC) and newly diagnosed UC. Immunocytochemistry for ki-67/p16 dual staining kit was performed on all specimens.Results:Eight high-grade UC and six anonymous specimens showed dual positivity. None of the low-grade UC or the control specimens after treated UC showed dual staining. Fifteen of 84 (17.8%) symptomatic cases were negative for both markers, and 59/84 (70.2%) showed positivity for both but not dual staining. Twenty-seven of 84 cases were positive for either Ki-67 (n = 22) or p16 (n = 5). Normal controls and benign specimens were negative for p16.Conclusions:Co-expression of p16/Ki-67 in the same cells was found in 16.6% of the cases. All were high grade, and co-expression seems to have limited practical impact as an additional marker in urine cytology. Any positivity for p16 alone strongly indicates malignancy. Negative p16 accompanied by a positive Ki-67 rate at 5% or more could be considered as an additional marker for further clinical follow-up. Both markers, co-expressed and separate, can give additional information in follow-up patients after treatment for UC.

Role of Gastric Emptying in Symptoms of Gastroparesis

The symptoms of gastroparesis, such as nausea, vomiting, postprandial fullness, early satiety and abdominal pain, frequently impair the quality of life of the affected individuals. The diagnosis of gastroparesis is made after structural etiologies are ruled out and an assessment of gastric function shows delayed gastric emptying. The role of the delay in gastric emptying in the pathogenesis of symptoms of gastroparesis has been debated, with some studies suggesting an association between delayed gastric emptying and the upper gastrointestinal symptoms, while others do not. The recent literature supports the importance of using reliable methods to assess gastric emptying, as delay in gastric emptying measured on a reliable test (4-h scintigraphy or breath test) is associated with the severity of upper gastrointestinal symptoms. In addition to measuring total gastric emptying, evaluation of regional gastric retention in the proximal and distal stomach and whole gut transit to assess small intestinal and colonic transit may provide additional useful information in patients with more generalized symptoms of gastrointestinal dysmotility.

P4551Prognostic utility of Palliative Prognostic Index for prediction of 30-day and 1-year outcome in patients with acute decompensated heart failure

Abstract Background The prognosis of heart failure remains poor similar to the terminal cancer patients, although recent progress in medical treatment. Palliative Prognostic Index (PPI) is a widely used prognostic index for terminal cancer patients (PPI includes: Palliative Performance Scale, oral intake, oedema, dyspnea at rest and delirium), suggesting the short-term prognostic marker of terminal cancer patients. Purpose The purpose of this study was to evaluate the impact of PPI on 30-day mortality, 1-year mortality and 1-year events (including all-cause mortality, readmission due to heart failure and new onset of cerebral infarction after hospital discharge) among acute decompensated heart failure (ADHF) patients. Method Study subjects comprised of consecutive 764 patients who admitted due to ADHF and followed up for 1-year. PPI were calculated at the time of hospital admission. Study subjects were divided into two groups based on the PPI: L-PPI (PPI&lt;6) and H-PPI (6≤PPI). We calculated the C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) to evaluate the improvement of prediction ability on 30-day mortality. Result H-PPI showed significantly higher 30-day mortality than L-PPI [7.9% vs 2.0%, log rank p&lt;0.001, Hazard retio (HR): 1.26, 95% confidential interval(CI): 1.14–1.37, p&lt;0.001], 1-year mortality [20.0% vs 12.7%, log rank p=0.022, HR 1.15, 95% CI 1.09–1.21, p&lt;0.001]and 1-year events [45.5% vs 31.1%, log rank p&lt;0.001, HR 1.13, 95% CI 1.09–1.17, p&lt;0.001]. Multivariate cox proportional hazard models adjusted with several covariates revealed that PPI was an independent predictor of 30-day mortality (HR: 1.23, 95% CI: 1.10–1.36, p&lt;0.001), 1-year mortality (HR: 1.10, 95% CI: 1.04–1.16, p&lt;0.001) and 1-year events (HR: 1.11, 95% CI: 1.07–1.15, p&lt;0.001), respectively. A reference model for prediction of 30-day mortality was determined including left ventricular ejection fraction and serum albumin concentration by multivariable logistic regression analysis. (P&lt;0.05) (C-index: 0.720) Adding PPI to the reference model (C-index: 0.773) significantly improved both NRI (0.458, p=0.038) and IDI (0.046, p=0.007), respectively. Conclusion We suggest that assessment of PPI showed good prognostic ability for 30-day and 1-year outcome, while PPI provided additional prognostic information in patients with ADHF.

P306 Double balloon enteroscopy in paediatric Crohn’s disease and 10 years follow-up

Crohn’s disease can occur throughout the entire gastrointestinal tract, often discontinuously, with the ileum and colon being the most common site. However, CD may involve any region of the small bowel (SB) other than the ileum and colon and isolated SB CD can present a diagnostic challenge. Double Balloon Enteroscopy (DBE) is an endoscopic modality for children that allow the diagnostic and therapeutic procedures of SB disease. Our aim was to evaluate the SB by DBE in children refractory to CD treatment Between 2007 and 2010, 20 paediatric patients (age 2–17 years) with CD diagnosis, refractory to treatment were selected to undergo SB by DBE. The main objective was to evaluate SB inflammation-related, narrowing, malignancy or other diseases. Previously, all had performed radiological imaging to exclude stricturing. Only one experienced endoscopist performed all the DBE. In addition, 10 years follow-up with therapy was analysed The mean patient age was 12 years (range 2–17 years). Four patients (5%) had SB CD solely in jejunum, which was not detected by either colonoscopy or radiological examination (Table) Sociodemographic data. Sociodemographic data. DBE lesions were: Active duodenojejunal ulcers, mucosal healing and/or pseudo polyps and mucosal granularity. General anaesthesia was performed in 6 children from 2 to 7 years and deep sedation with propofol in 14 patients. Mean length of SB examined was 220 cm beyond the ligament of Treitz (range 120 to 360 cm). Mean duration of the procedure: 48 min (range 30 to 60). No significant complications were related to the procedure. One patient had a malignancy diagnosis extra-intestinal; one had IL-10 and/or IL-10R gene mutation and one change the diagnosis to ulcerative colitis. Currently, 14 patients are in follow-up, 5 children in paediatric GI clinic and the other 9 at adult GI clinic. Curiously, the proportion of patients free of long-term therapy has decreased. We conclude DBE is a safe and useful tool to clarify SB pathologies in paediatric patients like CD. DBE can provide additional information in patients who require therapeutic decision or to make differential diagnosis. In addition is allows biopsy sampling. General anaesthesia or sedation and should be considered

Validation of PROTIA™ Allergy-Q 64 Atopy® as a Specific IgE Measurement Assay for 10 Major Allergen Components.

PurposeComponent-resolved diagnostics (CRD) is expected to provide additional diagnostic information in allergic patients. PROTIA™ Allergy-Q 64 Atopy®, a recently developed CRD-based multiplex specific immunoglobulin E (sIgE) assay, can quantitatively measure sIgE to major allergen components.MethodsThe sIgE detection by PROTIA™ Allergy-Q 64 Atopy® and ImmunoCAP® assays was compared using the sera of 125 Korean allergic patients. Group 1 and 2 allergens of house dust mites (HDMs; Dermatophagoides farinae (Der f) 1 and Der f 2 in PROTIA™ Allergy-Q 64 Atopy®, Dermatophagoides pteronyssinus (Der p) 1 and Der p 2 in ImmunoCAP®), Bet v 1, Fel d 1, Que a 1, ω-5 gliadin, α-lactalbumin, β-lactoglobulin, casein and α-Gal were measured by both assays.ResultsComparing the results from the 2 assays, the agreement rate for all the 10 allergens was > 88% (group 1 HDM allergen, 100%; group 2 HDM allergen, 94.6%; Bet v 1, 97.4%; Fel d 1, 90.5%; Que a 1, 89.2%; α-lactalbumin, 96%; β-lactoglobulin, 88%; casein, 88%; ω-5 gliadin, 96%; α-Gal, 100%). Correlation analysis indicated that, all the 10 allergen sIgEs showed more than moderate positive correlation (Pearson correlation coefficients > 0.640). Additionally, intra-class comparison showed more than high correlation for all the 10 allergens (Spearman's rank correlation coefficients > 0.743).ConclusionsPROTIA™ Allergy-Q 64 Atopy® is reliable and comparable to the ImmunoCAP® assay for component-resolved diagnosis.

The combination of PTEN deletion and 16p13.3 gain in prostate cancer provides additional prognostic information in patients treated with radical prostatectomy

Prostate cancer is a clinically heterogeneous disease and accurately risk-stratifying patients is a key clinical challenge. We hypothesized that the concurrent identification of the DNA copy number alterations 10q23.3 (PTEN) deletion and 16p13.3 (PDPK1) gain, related to the PI3K/AKT survival pathway, would improve prognostication. We assessed PTEN deletion status using fluorescence in situ hybridization (FISH) and evaluated its clinical significance in combination with the 16p13.3 gain in a set of 332 primary radical prostatectomy cases on a tissue microarray with clinical follow-up. The PTEN deletion was detected in 34% (97/287) of the evaluable tumors and was significantly associated with high Gleason grade group (P < 0.0001) and advanced pathological tumor stage (pT-stage, P < 0.001). The PTEN deletion emerged as a significant predictor of biochemical recurrence independent of the standard clinicopathologic parameters (hazard ratio: 3.00, 95% confidence interval: 1.81–4.98; P < 0.0001) and further stratified patients with low and intermediate risk of biochemical recurrence [Gleason grade group 1–2 (≤3 + 4), Gleason grade group 2 (3 + 4), pT2, prostate-specific antigen ≤ 10, low and intermediate CAPRA-S score; log-rank P≤ 0.007]. A PTEN deletion also increased the risk of distant metastasis (log-rank, P = 0.001), further supporting its role in prostate cancer progression. Combining both 16p13.3 gain and PTEN deletion improved biochemical recurrence risk stratification and provided prognostic information beyond the established CAPRA-S score (co-alteration: hazard ratio: 4.70, 95% confidence interval: 2.12–10.42; P < 0.0001). Our study demonstrates the potential clinical utility of PTEN genomic deletion in low-intermediate risk patients and highlights the enhanced prognostication achieved when assessed in combination with another genomic biomarker related to the PI3K/AKT pathway, thereby supporting their promising usefulness in clinical management of prostate cancer.

Difference of Dynamic Morphometric Changes Between in Patients with Ossification of Posterior Longitudinal Ligament and Patients with Cervical Spondylosis: Assessment by Cervical Dynamic Magnetic Resonance Imaging

To evaluate differences between thicknesses of the ligamentum flavum (LF) and diameter of the spinal canal in different neck positions in patients with ossification of the posterior longitudinal ligament (OPLL) and patients with cervical degenerative spondylosis (CDS) using cervical dynamic magnetic resonance imaging (MRI). Eighty-eight patients (66 CDS and 22 OPLL) who underwent neutral and dynamic MRI at our institute from February 2014 to July 2017 were the subjects of this retrospective study. Canal diameters and LF thicknesses were measured and Muhle's grades were determined in neutral and dynamic MRI from C2-C3 to C7-T1. Patients with CDS and OPLL were compared with respect to changes in morphometric parameters. Statistical analysis was performed using SPSS software and statistical significance was accepted for P values < 0.05. Mean ages in the CDS and OPLL groups were 68.2 ± 12.27 and 63.1 ± 9.36 years, respectively. Mean canal diameters were smaller in extension than in neutral at all measured levels, especially between C3-C4 and C6-C7 in patients with CDS. LF thickness in extension was significantly greater than in neutral and flexion positions in the CDS group, but not in the OPLL group. In addition, positional changes in Muhle's grades in the CDS group were significantly greater than in the OPLL group (P= 0.042). Dynamic morphometric changes were found to be significantly greater in the CDS group than in the OPLL group. The study shows dynamic MRI may provide additional information in CDS patients.

WT1 mRNA Expression in the Peripheral Blood of Patients with MDS Yields Additional Prognostic Information within the IPSS-R Risk Categories “Very Low”, “Low” and “Intermediate”

Introduction:The revised version of the International Prognostic Scoring System, (IPSS-R), is an accepted standard for assessing the prognosis of patients with MDS. Its usefulness may be further improved by integrating molecular findings. However, such efforts are impeded by limited access to molecular diagnostics, lack of standardized methodology, and a relatively low frequency of individual gene mutations in MDS. The Wilms' Tumor-1 (WT1) gene is overexpressed on mRNA level in the peripheral blood (PB) in about 50% of patients with MDS. The aim of this analysis was to determine whether PB WT1 expression status yields additional prognostic information.Methods:For this purpose, PB WT1 mRNA expression was measured in 91 newly diagnosed patients with MDS (WHO: MDS del5q, n=7; RARS, n=1; RCUD, n=4; RCMD, n=37; RAEB-I, n=16; RAEB-II, n=23; MDS/MPN unclassifiable, n=3 / IPSS-R: very low risk, n=3; low risk, n=28; intermediate risk, n=27; high risk, n=13; very high risk, n=20), using the Ipsogen® WT1 ProfileQuant® Kit. This standardized, commercially available assay uses a validated cut-off level of 50 WT1 copies/104ABL copies for discrimination between normal and overexpression of WT1 in PB. MDS patients in our study cohort were stratified accordingly (normal WT1 expression with <50 WT1 copies versus overexpression with >50 WT1 copies). WT1 expression status was correlated with clinical parameters and outcome.Results:Overall, 53 MDS patients (58%) showed WT1 overexpression, which correlated significantly with WHO 2008 disease category and IPSS-R risk groups, as indicated by both the absolute WT1 levels (correlation with WHO 2008 type, p=0.0028, and IPSS-R, p=0.0075) and the frequency of WT1-overexpressing patients within the respective MDS subgroup (correlation with WHO 2008 type, p=0.0029, and IPSS-R, p=0.0027). Regarding the entire cohort, patients with elevated WT1 expression had a significantly lower progression-free survival (PFS) and overall survival (OS) compared to those with normal WT1 expression (p<0.0001 and p=0.0306). Furthermore, within the IPSS-R risk groups ‘very low’, ‘low’ and ‘intermediate’, PFS differed significantly between patients showing normal vs. elevated WT1 expression status (IPSS-R very low/low: median PFS 30.1 months vs. not reached, for WT1 high vs normal, respectively, p=0.0127; IPSS-R intermediate: median PFS 14.4 months vs. 59.5 months, for WT1 high vs. normal, respectively p=0.0240). These differences in PFS retained their prognostic significance in multivariate analysis after adjusting for IPSS-R (HR 0.306; 95% CI 0,156-0,598, p=0.001). However, they did not translate into a difference in overall survival, which was probably due to a relevant number of patients proceeding to allogeneic stem cell transplantation. Given the large proportion of patients displaying WT1 overexpression in the IPSS-R high and very high risk groups, it was not surprising that no significant prognostic subdivision by WT1 expression level was seen in these risk categories.Conclusion:Our results show that PB WT1 expression offers additional prognostic information in patients belonging to the IPSS-R risk groups ‘very low’, ‘low’ and ‘intermediate’. Assessment of WT1 expression status at diagnosis is a relatively time and cost efficient method that can be performed without patient discomfort and may help to identify MDS IPSS-R low and intermediate patients at risk for early progression. DisclosuresRautenberg:Celgene: Honoraria. Germing:Janssen: Honoraria; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Research Funding. Kobbe:Roche: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Celgene: Honoraria, Other: Travel Support, Research Funding. Schroeder:Celgene: Consultancy, Honoraria, Research Funding.

The diagnostic value of three-dimensional echocardiography and speckle tracking echocardiography in patients after myocardial infarction with right ventricle involvement (clinical case)

The inferior myocardial infarctions (MI) of left ventricle (LV) are often complicated with right ventricle (RV) involvement. The traditional echocardiographic parameters lack diagnostic accuracy in assessment of RV function. Speckle tracking echocardiography and three-dimensional echocardiography are promising diagnostic tools in quantification of RV.The purpose of the study was to present the role of speckle tracking echocardiography and three-dimensional echocardiography in patients after inferior MI with RV involvement.It was described a clinical case of a 67-year old male after recent inferior MI with RV involvement. The speckle tracking analysis and three-dimensional echocardiography was performed one and six months after coronary event. The initial study revealed decreased longitudinal strain of RV free wall segments, especially in the apical region. The RV global longitudinal strain was -8,8 % (normal range ≤ -20 %). The RV end-diastolic volume index was 100.9 ml/m2 (normal range &lt;87 ml/m2) and RV end-systolic volume index was 69.8 ml/m2 (normal range &lt;44 ml/m2), indicating its severe enlargement. The three-dimensional RV ejection fraction (EF) was 31 % (normal range &gt;45 %).The analysis on the sixth month revealed improvement of RV contractility in all segments with global longitudinal strain of -14.2 %. The RV volumes decreased by 10 % and EF was raised from 31 to 33 %, reflecting positive cardiac remodeling during follow-up period.Conclusions. Speckle tracking echocardiography and three-dimensional echocardiography provide additional diagnostic information in patients after MI with RV involvement and can be used for patients’ follow-up.

Relation between prognostic impact of hyperuricemia and sympathetic overactivation in patients with heart failure

BackgroundUric acid (UA), which could provide additional prognostic information in patients with heart failure (HF), can activate sympathetic nerve activity and vice versa, thus creating a vicious cycle in the cardiovascular system. However, it remains unclear whether hyperuricemia (UA>7.0mg/dl) can provide prognostic information independent of sympathetic nerve activity. MethodsUA and potential prognostic variables including sympathetic nerve activity using microneurography (MSNA) were evaluated in 139 patients with HF (ejection fraction<45%). Primary composite cardiovascular endpoints included cardiovascular death and hospitalization due to HF. Predictors for outcomes were analyzed using univariate, multivariable, and Kaplan–Meier analyses. To determine whether the negative impact of hyperuricemia on outcomes is homogenous, prognostic impacts of hyperuricemia were compared in subgroups of HF. Ejection fraction was followed for 9 months after MSNA measurement in 102 patients. ResultsDuring a follow-up period of 1636 days, 54 patients fulfilled the primary composite endpoint of cardiovascular death or HF hospitalization. Patients with hyperuricemia had a higher cardiovascular event rate than those with normouricemia (p=0.006). On multivariable Cox proportional hazard analysis, hyperuricemia, higher MSNA, and β-blocker dose were independent predictors of cardiovascular events. In subgroup analyses, impact of hyperuricemia on outcome was similar in all subgroups except sympathetic nerve activity (interaction, p=0.033). Hyperuricemia had negative impact on cardiovascular event rates (hazard ratio=3.44) in group with higher MSNA (p=0.0002), but not in those with lower MSNA. Additionally, the change in LVEF was also significantly lower in patients who had a higher MSNA burst incidence and hyperuricemia. ConclusionHyperuricemia might have detrimental effect on prognosis and cardiac function in HF patients with sympathetic overactivation.

Advanced Imaging Techniques in Evaluation of Colorectal Cancer.

Imaging techniques are clinical decision-making tools in the evaluation of patients with colorectal cancer (CRC). The aim of this article is to discuss the potential of recent advances in imaging for diagnosis, prognosis, therapy planning, and assessment of response to treatment of CRC. Recent developments and new clinical applications of conventional imaging techniques such as virtual colonoscopy, dual-energy spectral computed tomography, elastography, advanced computing techniques (including volumetric rendering techniques and machine learning), magnetic resonance (MR) imaging-based magnetization transfer, and new liver imaging techniques, which may offer additional clinical information in patients with CRC, are summarized. In addition, the clinical value of functional and molecular imaging techniques such as diffusion-weighted MR imaging, dynamic contrast material-enhanced imaging, blood oxygen level-dependent imaging, lymphography with contrast agents, positron emission tomography with different radiotracers, and MR spectroscopy is reviewed, and the advantages and disadvantages of these modalities are evaluated. Finally, the future role of imaging-based analysis of tumor heterogeneity and multiparametric imaging, the development of radiomics and radiogenomics, and future challenges for imaging of patients with CRC are discussed. Online supplemental material is available for this article. ©RSNA, 2018.

Coronary risk equivalence of diabetes assessed by SPECT-MPI

BackgroundSeveral publications and guidelines designate diabetes mellitus (DM) as a coronary artery disease (CAD) risk equivalent. The aim of this investigation was to examine DM cardiac risk equivalence from the perspective of stress SPECT myocardial perfusion imaging (MPI). Methods and ResultsWe examined cardiovascular outcomes (cardiac death or nonfatal MI) of 17,499 patients referred for stress SPECT-MPI. Patients were stratified into four categories: non-DM without CAD, non-DM with CAD, DM without CAD, and DM with CAD, and normal or abnormal perfusion. Cardiac events occurred in 872 (5%), with event-free survival best among non-DM without CAD, worst in DM with CAD, and intermediate in DM without CAD, and non-DM with CAD. After multivariate adjustment, risk remained comparable between DM without CAD and non-DM with CAD [AHR 1.0 (95% CI 0.84–1.28), P =0.74]. Annualized event rates for normal subjects were 1.4% and 1.6% for non-DM with CAD and DM without CAD, respectively (P = 0.48) and 3.5% (P = 0.95) for both abnormal groups. After multivariate adjustment, outcomes were comparable within normal [AHR 1.4 (95% CI 0.98–1.96) P = 0.06] and abnormal [AHR 1.1 (95% CI 0.83–1.50) P = 0.49] MPI. ConclusionsDiabetic patients without CAD have comparable risk of cardiovascular events as non-diabetic patients with CAD after stratification by MPI results. These findings support diabetes as a CAD equivalent and suggest that MPI provides additional prognostic information in such patients.

Prognostic value of tissue necrosis, hypoxia-related markers and correlation with HPV status in head and neck cancer patients treated with bio- or chemo-radiotherapy

Background and purposeThe aim of the present study was to investigate the role of three hypoxia-related biomarkers in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) treated with concurrent chemoradiotherapy (3-weekly cisplatin) or bioradiotherapy (weekly cetuximab). Material and methodsIn tumor tissue material from 100 patients with known HPV status, we evaluated the extent of tumor necrosis, the expression level of CA-IX and the microvascular density (MVD) measured as the density of CD34+ vascular structures. The correlations between biomarker expressions and clinicopathological characteristics and treatment outcomes were analyzed. ResultsWe found a significant correlation of MVD with UICC stage (p = 0.02) and T classification (p = 0.05), of CA-IX with UICC stage (p = 0.03) and N classification (p = 0.04) and a significant inverse correlation of MVD with CA-IX expression (r = −0.22, p = 0.03). Multivariate analysis showed that low MVD combined with high CA IX-expression was a significant independent prognostic factor for worse loco-regional control (HR = 2.6, 95%CI 1.1–5.0, p = 0.02) in the whole population but not in the p16+ subgroup. Patients treated with CRT had a better LRC than those with BRT independent of MVD or CA-IX expression. ConclusionsThe combination of MVD and CA-IX expression might give additional prognostic information in HNSCC patients with known HPV status.

Controlling Nutritional Status (CONUT) score as a predictor of all-cause mortality in elderly hypertensive patients: a prospective follow-up study

ObjectivesThe aim of this study was to elucidate the impact of nutritional status on survival per Controlling Nutritional Status (CONUT) score and Geriatric Nutritional Risk Index (GNRI) in patients with...

Multicenter comparison of CD34+ myeloid cell count by flow cytometry in low-risk myelodysplastic syndrome. Is it feasible?

Accuracy of bone marrow (BM) blast count in low-risk myelodysplastic syndromes (MDS) still remains a challenge though it is essential for prognosis. We investigated whether the enumeration of CD34+ myeloid cells by flow cytometry immunophenotyping (FCI) could be used as a consistent parameter for clinical MDS studies. Six clinical centers entered the study and information on their FCI protocols was recorded. Sixty-seven flow cytometry listmodes from BM samples of patients with low-risk MDS with <5% BM blasts were exchanged among participants in two different rounds. Interlaboratory variations on the quantification of CD34+ myeloid cells were calculated and strategies to solve differences were evaluated. An overall "very good" agreement on CD34+ cell count among participants (intraclass correlation coefficient = 0.720) was observed, but agreement was "low" in 22 files. No single parameter could fully explain all discrepancies, but 3 technical issues were identified as relevant: the use of the CD34/CD45/CD117/HLA-DR mAb combination, acquisition of ≥50,000 events and a low percentage of debris/aggregates. The frequency of discordant results increased with the accumulation of pitfalls (none, 16%; 1 pitfall, 40%; 2 pitfalls, 83%; P = 0.006). Finally, the use of a common gating strategy for analysis increased the percentage of files with "very good" agreement to 100%. Prevention of specific technical pitfalls is mandatory to reach a good reproducibility of CD34+ cell count among centers. These recommendations set the basis for laboratory standardization and enable the use of CD34+ cell enumeration as additional information in low-risk MDS patients. © 2017 International Clinical Cytometry Society.

Clinical Relevance of Serum HER2 and Circulating Tumor Cell Detection in Metastatic Breast Cancer Patients.

Presence of circulating tumor cells (CTCs) is associated with impaired survival in metastatic breast cancer (MBC). This study was designed to evaluate whether assessment of serum HER2 (sHER2) levels provide additional prognostic information in MBC. Two hundred and fifty-three MBC patients were enrolled in this multicentre trial. CTCs were detected before the start of first- or later-line treatment using the CellSearch system. sHER2 was determined using ELISA. ≥5 CTCs were detected in 122 of 245 evaluable patients (49.8%). One hundred and nineteen of 251 patients (47%) had sHER2 levels above 15 ng/ml. Median overall survival (OS) was 16.3 months in patients with elevated sHER2; median OS in patients with non-elevated sHER2 has not been reached (p=0.001). Patients with ≥5 CTCs were more likely to present with elevated sHER2 (61% vs. 33% in those with <5 CTC; p<0.001). In patients with HER2-negative tumors, elevated sHER2 was associated with shorter OS and PFS; in HER2-positive patients with OS only. Including sHER2, CTC status and established prognostic factors into a multivariate analysis, only the presence of CTCs and higher-line of therapy remained independent predictors of OS. Elevated levels of sHER2 are associated with worse survival, irrespective of the HER2 status of the tumor. However, sHER2 does not provide additional prognostic information in patients with known CTC status.

264 - Serum Albumin Level at Diagnosis May Provide Additional Prognostic Information in Patients with Myelodysplastic Syndromes

There is limited information regarding NLR-PLR (the combination of the neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) in hepatocellular carcinoma (HCC). This study aimed to assess the predictive ability of NLR-PLR in patients with resectable hepatitis B virus-related HCC within Milan criteria after hepatectomy.Two hundred thirty-six consecutive HCC patients were included in the study. The postoperative NLR-PLR was calculated based on the data obtained on the first postoperative month after liver resection as follows: patients with both an elevated PLR and an elevated NLR, which were detected by receiver operating characteristic curve analysis, were allocated a score of 2, and patients showing one or neither of these elevations were allocated a score of 1 or 0, respectively.During the follow-up period, 113 patients experienced recurrence and 41 patients died. Multivariate analyses suggested that tumor-node-metastasis stage, preoperative alpha-fetal protein, and postoperative NLR-PLR were independently associated with recurrence, whereas microvascular invasion and postoperative NLR-PLR adversely impacted the overall survival. The 5-y recurrence-free and overall survival rates of the patients with a postoperative NLR-PLR of 0, 1, or 2 were 43.6%, 35.6%, or 8.3% (P < 0.001) and 82.1%, 73.0%, or 10.5% (P < 0.001), respectively.The postoperative NLR-PLR predicted outcomes of hepatitis B virus-related HCC patients within Milan criteria after liver resection.

Motor unit potentials of the erector spinae muscle by concentric needle electromyography.

IntroductionThe needle electromyography (EMG) serves to supply additional information in patients with suspected neuromuscular disorders. We aimed to provide motor unit potential (MUP) data by concentric needle EMG in the erector spinae (ES) in comparison with biceps brachii (BB) and lateral vastus (LV).MethodsElectromyography MUP data (n) were obtained in ES (517), BB (539), and LV (627) in 32 healthy volunteers (16f).ResultsMotor unit potential data: amplitude (μV) 393 ± 174 (ES), 375 ± 162 (BB), and 577 ± 304 (LV); duration (ms) 10.4 ± 2.4 (ES), 10.1 ± 2.1 (BB), and 11.1 ± 2.3 (LV), area (μV × ms) 585 ± 327 (ES), 538 ± 267 (BB), and 881 ± 492 (LV); phase number 3.23 ± 0.94 (ES), 2.98 ± 0.76 (BB), and 3.19 ± 0.81 (LV); size index 0.60 ± 0.56 (ES), 0.51 ± 0.53 (BB), and 0.96 ± 0.55 (LV). LV displayed higher values (p at least <.001) for MUP amplitude, duration, area, and size index as compared to both, BB and ES.ConclusionConcentric needle EMG investigations in healthy adult human subjects revealed similar MUP parameters in the ES and BB muscles, while in the LV muscle MUP amplitude, duration, area, and size index were significantly larger. Different neuromuscular disorders display a predominant involvement of proximally located muscles such as truncal muscles. The present results given here may facilitate the diagnosis of neuromuscular disorders.