Adverse Functional Outcomes Research Articles

C-Reactive protein as a biomarker affecting neurorehabilitation outcomes in post-stroke patients: state of knowledge and global trends in research

Background: C-reactive protein (CRP) is a commonly determined biomarker of inflammation and may reflect the progression of a vascular disease. CRP values within 12 to 24 hours of stroke symptom onset are an independent predictor of adverse functional outcome in terms of the level of motor recovery in the first year of follow-up. Objective: This study aims to provide a complementary analysis of the scientific literature and critically review studies on the use of CRP as a potential biomarker associated with stroke and affecting the achievement of neurorehabilitation progress in post-stroke patients. Methods: This critical review of the literature was prepared based on the following inclusion criteria: (1) original research, (2) studies indexed in PubMed, Scopus and PEDro databases, (3) full-text articles in English, (4) papers published in 2012 – 2022, and (5) papers addressing the use of PCR assay as a biomarker of rehabilitation effectiveness. Results: Based on a review of PubMed, Scopus and PEDro databases, 47, 56 and 9 papers, respectively, were selected based on precisely selected keywords and included in full for further full text review. In this review, the most important scientific rationale was included in response to the aim of this paper. Summary: Recognition of the role of inflammatory and immunological factors in the development of atherosclerosis and the occurrence of ischaemic stroke provides scope for the search for new methods of stroke risk assessment and the development of new methods to prevent stroke. Further empirical validation and unequivocal demonstration of the levels of CRP as a potential marker that affects the health status of a post-stroke patient are needed to ensure the greatest possible level of motor recovery and ability to function independently in terms of all activities of daily living.

Social Wellbeing in Cancer Survivorship: A Cross-Sectional Analysis of Self-Reported Relationship Closeness and Ambivalence from a Community Sample.

Improvements in early screening and treatment have contributed to the growth of the number of cancer survivors. Understanding and mitigating the adverse psychosocial, functional, and economic outcomes they experience is critical. Social wellbeing refers to the quality of the relationship with partners/spouses, children, or significant others. Close relationships contribute to quality of life and self-management; however, limited literature exists about social wellbeing during survivorship. This study examined positive and negative self-reported changes in a community sample of 505 cancer survivors. Fourteen items assessed changes in communication, closeness with partner/children, stability of the relationship, and caregiving burden. An exploratory factor analysis was conducted using a robust weighted least square procedure. Differences by sociodemographic and clinical characteristics were investigated. Respondents were mostly male, non-Hispanic white, and ≥4 years since diagnosis. Two factors, labeled Relationship Closeness and Ambivalence, emerged from the analysis. Women, younger survivors, individuals from minority groups, and those with lower income experienced greater negative changes in social wellbeing. Variations by treatment status, time since diagnosis, and institution were also reported. This contribution identifies groups of cancer survivors experiencing affected social wellbeing. Results emphasize the need to develop interventions sustaining the quality of interpersonal relationships to promote long-term outcomes.

Multimodal ultrasound-based carotid plaque risk biomarkers predict poor functional outcome in patients with ischemic stroke or TIA

BackgroundCarotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.MethodsThis study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.ResultsSMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59, P = 0.041) and 0.51 (95% CI 0.31–0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95).ConclusionIntraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

The association between stress hyperglycemia and unfavorable outcomes in patients with anterior circulation stroke after mechanical thrombectomy.

Stress hyperglycemia is common in critical and severe diseases. However, few studies have examined the association between stress hyperglycemia and the functional outcomes of patients with anterior circulation stroke, after mechanical thrombectomy (MT), in different diabetes status. This study therefore aimed to determine the relationship between stress hyperglycemia and the risk of adverse neurological functional outcomes in anterior circulation stroke patients with and without diabetes after MT. Data of 408 patients with acute anterior circulation stroke treated with MT through the green-channel treatment system for emergency stroke at the First Affiliated Hospital of Jinan University between January 2016 and December 2020 were reviewed retrospectively. The stress hyperglycemia ratio (SHR) was calculated as fasting plasma glucose (mmol/L) divided by glycosylated hemoglobin (%). The patients were stratified into four groups by quartiles of SHR (Q1-Q4). The primary outcome was an excellent (nondisabled) functional outcome at 3 months after admission (modified Rankin Scale score of 0-1). The relationship between stress hyperglycemia and neurological outcome after stroke was assessed using multivariate logistic regression. After adjusting for potential confounders, compared with patients in Q1, those in Q4 were less likely to have an excellent outcome at 3 months (odds ratio [OR], 0.32, 95% confidence interval [CI], 0.14-0.66, p = 0.003), a good outcome at 3 months (OR, 0.41, 95% CI, 0.20-0.84, p = 0.020), and major neurological improvement (OR, 0.38, 95% CI, 0.19-0.73, p = 0.004). Severe stress hyperglycemia increased risks of 3-months all-cause mortality (OR, 2.82, 95% CI, 1.09-8.29, p = 0.041) and ICH (OR, 2.54, 95% CI, 1.21-5.50, p = 0.015). Stress hyperglycemia was associated with a reduced rate of excellent neurological outcomes, and increased mortality and ICH risks in patients with anterior circulation stroke after MT regardless of diabetes status.

Stakeholders' Views on Information Needed in a Patient Decision Aid for Microtia Reconstruction.

To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important. A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents.

Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

BackgroundIn-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown.PurposeTo assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center.MethodsAll trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale.ResultsIn total, 433 patients (median age 50 years, 67% male, 89% ASA 1–2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.ConclusionCoronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.

Oncological and Renal Function Outcomes in Patients Who Underwent Simultaneous Radical Cystectomy and Nephroureterectomy for Synchronous or Metachronous Panurothelial Carcinoma

To assess clinical outcomes of patients who underwent simultaneous radical cystectomy (RC) and radical nephroureterectomy (RNU) for panurothelial carcinoma (PanUC). A retrospective analysis of 67 patients who underwent simultaneous RC and unilateral RNU for PanUC, from 1996 to 2017. Kaplan-Meier estimates for remnant urothelium recurrence-free survival, metastasis-free survival, overall survival (OS), and cancer-specific survival (CSS) were performed. Cox multivariate models were constructed. The median follow-up was 38 months, 29.8% of patients had a recurrence, 34.3% had metastasis, 67.2% of patients died from any cause, and 37.3% died from urothelial carcinoma. Overall survival and CSS rates at 5 years were 44% and 61%, respectively. In multivariate analysis, progression to muscle-invasive bladder cancer before surgery, presence of muscle-invasive stages at RC and/or RNU, and prostatic urethra involvement were predictors for worse metastasis-free survival and CSS. Forty-one patients (61.2%) had an estimated glomerular filtration rate (eGFR) <60 mL/min beforesurgery and the number rose to 56 (83.5%) after surgery; 29.8% patients needed renal function replacement therapy after surgery (16 haemodialysis and 4 renal transplant). Patients with PanUC who undergo simultaneous surgery have adverse oncological (only 4 out of every 10 remain alive at 5 years) and functional outcomes (1 out of 3 will need renal function replacement therapy after surgery). Up to a third of the patients had a recurrence (urethra or contralateral kidney) within 18 months, justifying close surveillance or considering prophylactic urethrectomy. These data should help in counsel on morbidity and life expectancy.

The difference in red blood cell distribution width from before to after thrombolysis as a prognostic factor in acute ischemic stroke patients: A 2-year follow-up.

PurposeThe aim of our study was to determine whether delta red blood cell distribution (ΔRDW) improves neurological outcomes in acute ischemic stroke (AIS) patients 2 years after intravenous thrombolysis (IVT) therapy.MethodsAIS patients who received IVT between January 2013 and December 2019 were retrospectively analyzed. In accordance with their mRS scores, the patients were divided into two groups. A binary logistic regression analysis was conducted to determine the influencing factors of adverse functional outcomes. It was decided to evaluate the variables' the predictive ability by using the area under the receiver operating characteristic. For the poor neurological recovery risk model, features were selected using the LASSO regression model. We also developed a predictive model based on logistic regression analysis, which combined the features selected in the minimum absolute contraction and selection operator regression models. An evaluation of the discrimination, calibration, and clinical applicability of the predictive model was conducted using the C index, calibration chart, and decision curve analysis. Internal validation was evaluated via bootstrapping.ResultsBinary logistic regression analysis showed that ΔRDW was an independent influencing factor for poor neurofunctional outcomes. The most appropriate ΔRDW cut-off value for predicting the recovery of poor neurological outcomes was 18.9% (sensitivity: 89.9%, specificity: 78.6%, p < 0.001). The predictive factors included in the nomogram were age, the occurrence of CHD, stroke, AF, ΔRDW, NIHSS score at onset, interval time from onset to IVT, and whether there were indwelling urine catheters and gastric tubes. The model has not only a good discrimination ability, which was indicated by an overall C index of 0.891 (95% confidence interval: 0.829–0.953), but also a considerable calibration ability. Decision curve analysis showed that the nomogram of adverse neurological outcomes recovery was useful in the clinical practice when intervention was implemented above the threshold of 1% possibility of adverse neurological outcomes recovery.ConclusionIn patients with AIS after thrombolysis, the ΔRDW is a potential influencing factor that can be readily used to predict the likelihood of poor neurological function recovery.

Do oral nutritional supplements effectively reduce malnutrition or its adverse outcomes in older people with frailty?

Although malnutrition and frailty are distinct conditions, they are related syndromes with notable overlap, each one aggravating the other with similar adverse functional and health outcomes. For example, unintended weight loss, a characteristic of malnutrition, is associated with the loss of skeletal muscle mass and function with age and is a key risk factor for developing frailty.1 Estimates of malnutrition prevalence and malnutrition risk in older people with frailty varies widely. Among malnourished older adults, prevalence of frailty ranged between 27%2 and 68%,3 and for older people with frailty, prevalence of malnutrition ranged between 10%3 and 16%, increasing to 66% if the risk of malnutrition was included.

A complicated Glenn procedure: risk factors and association with adverse long-term neurodevelopmental and functional outcomes.

To determine potentially modifiable risk factors for a complicated Glenn procedure (cGP) and whether a cGP predicted adverse neurodevelopmental and functional outcomes. A cGP was defined as post-operative death, heart transplant, extracorporeal life support, Glenn takedown, or prolonged ventilation. All 169 patients having a Glenn procedure from 2012 to 2017 were included. Neurodevelopmental assessments were performed at age 2 years in consenting survivors (n = 156/159 survivors). The Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) and the Adaptive Behavior Assessment System-2nd Edition (ABAS-II) were administered. Adaptive functional outcomes were determined by the General Adaptive Composite (GAC) score from the ABAS-II. Predictors of outcomes were determined using univariate and multiple variable linear or Cox regressions. Of patients who had a Glenn procedure, 10/169 (6%) died by 2 years of age and 27/169 (16%) had a cGP. Variables statistically significantly associated with a cGP were the inotrope score on post-operative day 1 (HR 1.04, 95%CI 1.01, 1.06; p = 0.010) and use of inhaled nitric oxide post-operatively (HR 7.31, 95%CI 3.19, 16.76; p < 0.001). A cGP was independently statistically significantly associated with adverse Bayley-III Cognitive (ES -10.60, 95%CI -17.09, -4.11; p = 0.002) and Language (ES -11.43, 95%CI -19.25, -3.60; p = 0.004) scores and adverse GAC score (ES -14.89, 95%CI -22.86, -6.92; p < 0.001). Higher inotrope score and inhaled nitric oxide used post-operatively were associated with a cGP. A cGP was independently associated with adverse 2-year neurodevelopmental and functional outcomes. Whether early recognition and intervention for risk of a cGP can prevent adverse outcomes warrants study.

Predictive value of the apolipoprotein B/A1 ratio in intracerebral hemorrhage outcomes.

Background and AimsThe apolipoprotein B (apoB)/apolipoprotein A1 (apoA1) ratio is a key indicator in predicting future cardiovascular outcomes. However, it is still unclear whether the ratio of apoB/apoA1 is a better predictor of the outcomes after intracerebral hemorrhage (ICH). Therefore, we aimed to assess the relationships between the ratio of apoB/apoA1 and functional outcomes, all‐cause mortality, and stroke recurrence in ICH patients.MethodsTwo hundred and sixteen Chinese ICH patients participated in this study from December 2018 to December 2019. Laboratory routine tests including hematology analysis, coagulation tests, and lipid levels were examined. The clinical outcomes included functional outcomes evaluated by the modified Rankin Scale score (mRS), all‐cause death, and stroke recurrence 1 year after discharge. Associations between the apoB/apoA1 ratio and the outcomes were evaluated using logistic regression analysis. Based on multivariate analysis, we constructed a nomogram. Univariate survival analysis was performed by the Kaplan–Meier method and log‐rank test. All the patients were classified into two groups by the median value of the apoB/apoA1 ratio: B1 < 0.8 and B2 ≥ 0.8.ResultsOf the 216 patients, 107 had an apoB/apoA1 ratio ≥ 0.8. Eighty‐five patients had poor functional outcomes (mRS ≥ 3), and 32 patients had severe functional outcomes (mRS ≥ 4). During the 1‐year follow‐up, a total of 18 patients died, and 13 patients had apoB/apoA1 ratio levels ≥0.8 during the 1‐year follow‐up period. Moreover, 16 recurrent strokes were recorded. Adjustments for age, sex, smoking, alcohol, body mass index, lipid levels, and hematoma site and volume showed that a high apoB/apoA1 ratio was significantly related to adverse functional outcomes and all‐cause mortality. The ORs for B2 versus B1 were 3.76 (95% CI: 1.37 to 10.40, p = 0.010), 22.74 (95% CI: 1.08 to 474.65, p = 0.044), and 7.23 (95% CI: 1.28 to 40.88, p = 0.025) for poor functional outcomes with mRS ≥ 3, mRS ≥ 4, and all‐cause mortality, respectively.ConclusionAn increased apoB/apoA1 ratio at admission was independently related to poor functional outcome and all‐cause mortality in ICH patients at the 1‐year follow‐up.

Predictors and outcome of early neurological deterioration after endovascular thrombectomy: a secondary analysis of the DIRECT-MT trial

BackgroundThere is uncertainty regarding the predictors of early neurological deterioration (END) after endovascular thrombectomy in patients with acute ischemic stroke (AIS). Limited studies have focused on the effect of END...

Neoadjuvant and adjuvant therapy for local excision of rectal cancer

Local excision (LE) for early-stage rectal cancer is an attractive option compared to total mesorectal excision (TME), as it avoids many of the significant comorbidities and adverse functional outcomes associated with TME. However, LE for tumors with high-risk histopathologic features can lead to unacceptably high rates of local and distant recurrence. Neoadjuvant or adjuvant chemoradiotherapy can mitigate those risks in certain clinical settings and may expand the number of patients who can be safely treated with an organ-preserving approach. In this chapter, we will explore the available date supporting the use of neoadjuvant and adjuvant chemoradiation (CRT) for the treatment of high-risk early-stage rectal cancer and will discuss future studies that aim to answer some of the ongoing clinical questions related to this practice.

Does Nefopam Provide Analgesic Effect and Reduce Morphine Consumption After Primary Total Knee Arthroplasty? A Prospective, Double-Blind, Randomized Controlled Trial.

One of the most undesirable results after total knee arthroplasty (TKA) is severe immediate postoperative pain, resulting in patient dissatisfaction. We aimed to evaluate nefopam's analgesic efficacy after primary TKA along with related outcomes, including morphine consumption and adverse events. We conducted a double-blind, randomized controlled trial of patients undergoing unilateral primary TKA, comparing 24hours of 80 mg of continuous intravenous nefopam to placebo infusion. A 100-mm Visual Analog Scale (VAS) for pain-at-rest and in-motion ≤48hours was the primary outcome measure. Secondary outcomes were morphine and antiemetic consumption, adverse events, and functional outcomes: time-to-walk, timed up-and-go test, postoperative knee range of motion at 24 and 48hours, time-to-discharge, and patient satisfaction scores. Patients in the nefopam group had significantly lower VAS at rest 6hours postop (20.3±27.3 vs 35±24.3, P= .01). Other timepoints and in-motion VAS did not significantly differ. Total morphine consumption (0-48hours) was 37% less, significantly lower, in the nefopam group (5.3±4.5 vs 8.4±7.5 mg, P= .03). Antiemetic consumption was also 61% lower in the nefopam group but not statistically significant (0.8±2.3 vs 2.0±3.8 mg, P= .08). There were no variations in adverse events, functional outcomes, and satisfaction scores between groups. Continuous nefopam administration as part of multimodal analgesia for 24hours post-TKA produced a significant analgesic effect but only within the first 6hours. However, there was a notable reduction in morphine use 48hours postop. Nefopam is a useful agent for contemporary pain control after TKA. Therapeutic Level I.

MP55-02 REPEAT FOCAL THERAPY OF PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP55-02 REPEAT FOCAL THERAPY OF PROSTATE CANCER Nima Nassiri, Caroline Wallner, David Kupperman, Shannon Richardson, Samantha Gonzalez, Lorna Herbert, and Leonard Marks Nima NassiriNima Nassiri More articles by this author , Caroline WallnerCaroline Wallner More articles by this author , David KuppermanDavid Kupperman More articles by this author , Shannon RichardsonShannon Richardson More articles by this author , Samantha GonzalezSamantha Gonzalez More articles by this author , Lorna HerbertLorna Herbert More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002634.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Repeat focal therapy (FT) may be a viable treatment option in appropriately selected men who fail initial cryoablation or high-intensity focused ultrasound (HIFU). Herein, we sought to determine complications, functional outcomes, and short-term oncological outcomes after repeat FT for localized prostate cancer (CaP). METHODS: Subjects were all men with localized CaP diagnosed by MRI/US fusion biopsy who underwent cryoablation or HIFU, complicated by treatment failure (Grade Group 2 or greater CaP on follow-up biopsy, or detectable disease recurrence). The primary endpoint was peri-operative, 30, and 90 day complications. Secondary endpoints were month continence and erectile function, and oncological outcomes up to one year. RESULTS: 23.5% (43/183) required repeat FT after initial cryoablation or HIFU (Table 1). There were zero class III or higher Clavien-Dindo complications after repeat FT at any timepoint. All men were continent. There were zero reports of worsening urinary symptoms by Internationalized Prostate Symptom Score (IPSS), and urinary bother improved by an average of 0.33 points (S.D. 0.87). Of men who remained sexually active, erectile function by the International Index of Erectile Function (IIEF-5) declined by an average of 1.17 points (S.D. 4.2). 28 men have at least 6 months of follow up after retreatment, of which 12 (43%) had persistent disease. CONCLUSIONS: Repeat FT for treatment failure after initial cryoablation of HIFU yields excellent adverse event and functional outcome profiles. Longer follow up is needed to evaluate oncological efficacy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e937 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nima Nassiri More articles by this author Caroline Wallner More articles by this author David Kupperman More articles by this author Shannon Richardson More articles by this author Samantha Gonzalez More articles by this author Lorna Herbert More articles by this author Leonard Marks More articles by this author Expand All Advertisement PDF DownloadLoading ...

Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair

The aim of this study was to investigate the adverse impact of elevated postprocedural mitral valve pressure gradient (MPG) on outcome in a real-world population of patients with severe mitral regurgitation (MR) who underwent transcatheter mitral valve edge-to-edge repair (TEER). TEER has become a routine treatment alternative for patients with severe MR at high surgical risk. The consequences of elevated MPG after TEER have been subject to controversial debates. All consecutive patients undergoing TEER for either severe degenerative MR (DMR) or functional MR (FMR) at a high-volume center between September 2008 and January 2020 were prospectively included and followed periodically. Postprocedural MPG by discharge transthoracic echocardiography was considered elevated at≥5mmHg. The primary combined endpoint was death or heart failure rehospitalization after 5 years. A total of 713 patients undergoing TEER (DMR, n=265; FMR, n=445) were included. Elevated postprocedural MPG was present in 37.0% of those with DMR (n=98) and 22.0% of those with FMR (n=98). In contrast to patients with FMR, 6-minute walk distance did not improve in patients with DMR with elevated MPG. Kaplan-Meier analyses did not demonstrate significant differences for the primary endpoint in patients with DMR (low vs elevated MPG, 67.3% vs 74.4%; P=0.06) and those with FMR (78.6% vs 74.8%; P=0.54). After adjustment, elevated MPG was an independent predictor of the primary endpoint in patients with DMR (HR: 1.59; 95%CI: 1.03-2.45; P=0.034) but not in those with FMR (HR: 0.87; 95%CI: 0.63-1.22; P=0.43). Elevated postprocedural MPG is an independent predictor of adverse clinical and functional outcomes in patients with DMR but not in those with FMR.

Standardized reporting of adverse events and functional status from the first 5 years of awake surgery for gliomas: a population-based single-institution consecutive series.

To report our experience and investigate frequencies of adverse events and functional status from the first 5 years of performing awake surgery for gliomas in a single-center population-based setting. We conducted a review of all patients with a glioma treated with awake surgery during the first 5 years following introduction of awake surgery at our center (February 2015 to February 2020). We assessed functional and radiological outcome, with adverse events classified according to the Landriel-Ibanez classification for neurosurgical complications, while neurological deficits were further subdivided into transient vs permanent. We sought to analyze our initial results and learning curve, as well as compare our results with literature. Forty-two patients were included. The median age was 38 years (range 18-66) and 13 (31%) were female. The indication for awake surgery was a presumed glioma in or near an eloquent area. The overall 30-day complication rate was 25 (59%), with 19 (45%) grade I complications, 3 (7%) grade II complications, and 3 (7%) grade III complications. Fifteen patients (36%) experienced transient neurological deficits, and 11 (26%) permanent neurological deficits. At 3-month follow-up, the Karnofsky Performance Score was 80 or higher for the entire cohort. The median extent of resection was 87%, with GTR achieved in 11 (26%). In search of potential learning curve difficulties, patients were divided into the 21 patients treated first (Early Group) versus the remaining 21 patients treated later (Late Group); no statistically significant difference in operating time, amount of tumor removed, or incidence of long-term postoperative neurological deficit was identified between groups. No awake surgery was aborted due to seizures. Comparison to the literature was limited by the diverse and unsystematic way in which previous studies have reported adverse events after awake craniotomy for gliomas. We provide a standardized report of adverse events and functional status following awake surgery for glioma during a single-center 5-year learning period, with similar rates of severe adverse events and functional outcome compared to literature without concerns of substantial learning curve difficulties. However, this comparison was flawed by non-standardized reporting of complications, highlighting a demand for more standardized reporting of adverse events after awake craniotomies.

Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder

BackgroundPosttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder. MethodsThis study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey. ResultsVeterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD. LimitationsThis study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts. ConclusionsFindings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population.

The longitudinal associations of sarcopenia definitions with adverse outcomes: a comparative study

Frailty, sarcopenia and fragility fractures are closely related to epidemiologically, biologically and clinical impactions. Fragility fracture is observed more frequently in sarcopenic older adults. Older persons who have had a fragility fracture should be assessed for sarcopenia to better develop prevention and recovery after fractures. For these reasons global consensuses tried to create the definition of sarcopenia that best predicts clinical outcomes in the recent years. There is no global consensus definition of sarcopenia despite the great efforts in the recent years. We aimed to study the longitudinal associations of different sarcopenia definitions with functional outcomes. We recruited participants admitted to geriatrics outpatient clinics of a university hospital. The patients that have follow-up evaluation for usual gait speed (UGS), activities of daily living (ADL) and instrumental ADL and frailty included. Body composition was assessed by bioimpedance analysis (TANITA BC532). HGS, UGS, ADL, IADL were assessed by Jamar hydraulic hand dynamometer, gait speed at 4m course, Katz and Lawton scales, respectively. Frailty was screened by FRAIL questionnaire. Sarcopenia was defined by EWGSOP1, EWGSOP2 and the two alternative FNIH definitions. EWGSOP2-sarcopenia was evaluated by universally suggested cut-offs (i.e. 27 and 16 kg). EWGSOP2-probable sarcopenia was assessed also by Turkish cut-offs (i.e. 32 and 22 kg) as an additional parameter alternatively. The patients were assessed for detoriation in UGS, ADL, IADL, FRAIL scores and also for decrease in UGS to <= 0.8 m/s and detoriation to frailty. Among a total of 1881 patients, 264 patients had follow-up data for functional measures and included in the study. The mean age was 75.3+6.3, 195 (73.9%) patients were female with a mean and median follow-up days of 600 and 511 days (Table 1a, 1b). In the first evaluation, the prevalence of sarcopenia ranged between 0.8%-6.1% with standard definitions while it increased to 37% when EWGSOP2-probable sarcopenia was assessed by Turkish cut-offs (probable sarcopenia EWGSOP2-Turkish) (Table 1). The EWGSOP1 or EWGSOP2-confirmed/probable sarcopenia was not associated with adverse outcomes. The EWGSOP2-probable sarcopenia by Turkish cut-offs was associated with detoriation in IADL and decrease in UGS to <= 0.8 m/s (p=0.049 and pearson chi square=3.9; p=0.044 and pearson chi square=4.1, respectively) (Table 2). The FNIH sarcopenia definition including slow UGS was associated with detoriation in IADL (p=0.045, pearson chi square=5.0) (Table 2). In the regression analysis including age, MNA-SF, number of chronic diseases and drugs, dementia and diabetes none of the regression parameters were associated with adverse outcomes. In this follow-up study of about 1.5 years, the adverse outcomes associated with sarcopenia were decrease in UGS to <= 0.8 m/s and detoriation in IADL. The sarcopenia definitions associated with adverse functional outcomes were EWGSOP2-probable sarcopenia by Turkish cut-offs and FNIH sarcopenia definition including the slow gait speed. EWGSOP2-probable sarcopenia by Turkish cut-offs came forward as having more extensive association with adverse functional outcomes.

Association of metabolic acidosis with fractures, falls, protein-calorie malnutrition and failure to thrive in patients with chronic kidney disease.

ABSTRACTBackgroundThe risk of adverse geriatric outcomes such as falls and fractures is high among patients with chronic kidney disease (CKD). Metabolic acidosis is associated with protein catabolism and bone loss in experimental animal and human studies. We sought to quantify the independent association of metabolic acidosis with adverse muscle, bone and functional outcomes in a large US community-based cohort.MethodsThe Optum's de-identified Integrated Claims-Clinical dataset of US patients (2007–2017) was used to generate a cohort of patients with nondialysis-dependent CKD who had estimated glomerular filtration rate >10 to <60 mL/min/1.73 m2 and two serum bicarbonate values 12 to <22 mmol/L or 22–29 mmol/L. The primary outcomes were failure to thrive, protein-calorie malnutrition, and fall or fracture. Cox proportional hazards models were used for the primary outcomes for up to 10 years, while logistic regression models were used at 2 years.ResultsA total of 51 558 patients qualified for the study, with a median [Interquartile Range (IQR)] follow-up time of 4.2 (2.5–5.8) years. Over a ≤10-year period, for each 1 mmol/L increase in serum bicarbonate, the hazard ratios (adjusted for age, sex, race, estimated glomerular filtration rate, serum albumin, hemoglobin, diabetes and cardiovascular comorbidities) for failure to thrive, protein-calorie malnutrition and fall or fracture were 0.91 [95% confidence interval (CI): 0.90–0.92], 0.91 (95% CI: 0.90–0.92) and 0.95 (95% CI: 0.95–0.96), all P < 0.001, respectively.ConclusionsThe presence and severity of metabolic acidosis was a significant, independent risk factor for failure to thrive, protein-calorie malnutrition and fall or fracture in this large community cohort of patients with stage 3–5 CKD.