Bad Outcome Group Research Articles

Screening for viral infection and anemia among pregnant women with bad pregnancy outcome in Egyptian population

Hepatitis C virus (HCV) is a major public health concern worldwide and in Egypt. Viral hepatitis during pregnancy is closely related to high risks of maternal complications Human Cytomegalovirus (CMV) is considered the most common cause of congenital malformation that results from viral intrauterine infection in developed countries. Anemia is one of the common complications that is associated with increased risk of bad pregnancy outcome including low birth weight and preterm birth. The aim of this study was to screen for HCV, CMV and anemia among pregnant women in Egyptian population. This prospective study was conducted at the Prenatal Diagnosis clinic in the National Research Centre between April 2013 and August 2015 and a total of 200 pregnant women during their second trimester of pregnancy were enrolled and divided into case group (150/200) with current or history of bad pregnancy outcome and control group (50/200) with no previous history of bad pregnancy outcome. All blood samples were tested for complete blood picture and liver enzyme tests and were screened by ELISA for Anti-HCV and CMV-IgG and IgM. After all investigations including medical and family history for all pregnant women included in the study, all data was statistically analyzed using spss version 19. Anemia was diagnosed in pregnant women with hemoglobin level below 11 g/dl and it was detected in 24 % (48/200) of the total pregnant females included in the study. Five cases tested positive for Anti-HCV antibody among all cases enrolled in the study and was found in the cases group 3.33% (5/150) while all pregnant women in the control group showed negative results. Screening for CMV showed 100 % CMV-IgG while we found 0 % CMV-IgM. Screening for anemia and serological screening for CMV and HCV antibodies should be routine tests especially among pregnant women.

The association between post resuscitation hemoglobin level and survival with good neurological outcome following Out Of Hospital cardiac arrest

Aimsto explore the association between post return of spontaneous circulation (ROSC) hemoglobin level and survival with good neurological outcome following out-of-hospital cardiac arrest. MethodsWe studied adults with non-traumatic out-of-hospital cardiac arrest who achieved ROSC within 50min of collapse. We quantified the association between post ROSC hemoglobin level and good neurological outcome (defined as Cerebral Performance Category score of 1or 2), using multivariate logistic regression analyses. The impact of Post ROSC hemoglobin level ≥10gdl−1 and time varying hemoglobin level ≥10gdl−1 on time to Survival with good outcome was assessed using Cox proportional hazard models. ResultsOf 931 cardiac arrest patients, 146 (16%) achieved ROSC and 30 survived to discharge with a good neurological outcome. Of those with post ROSC hemoglobin level ≥10gdl−1, 28% (27/98) had good outcome, whereas of those with level <10mgdl−1 only 6% (3/48) had good outcome (CPC<3, P=0.003). The use of blood transfusions and therapeutic hypothermia were comparable in both good and bad outcome groups. An immediate post ROSC hemoglobin level ≥10gdl−1 was significantly associated with good neurological outcome (AOR 8.31 95% CI 1.89–36.52 P=0.005). Patients with post ROSC hemoglobin ≥10gdl−1 were more likely to achieve good outcome earlier (HR 6.02 95% CI 1.75–20.72 P=0.004). ConclusionsPost ROSC hemoglobin level ≥10gdl−1 is associated with survival with good neurological outcome. The importance of time to achieve such level and the role of blood transfusion warrants further investigation.

Abstract T P289: Long-term Outcome Analysis in Patients With Malignant Middle Cerebral Artery Stroke Who Underwent Decompressive Hemicraniectomy

Background and Purpose: Decompressive hemicraniectomy (DHC) reduces mortality and improves physical outcome in selected patients with malignant middle cerebral artery (mMCA) stroke. In this study, we performed comprehensive functional evaluation in mMCA stroke patients who underwent DHC, and attempted to identify the pre-surgical factors that correlated with long-term physical outcome. Methods: We identified mMCA stroke patients treated with DHC in our institution between January 2007 and April 2013. Functional outcome was assessed in survivors through clinic visit or telephone interview using modified Rankin Scale (mRS), Barthel Index, Geriatric Depression Scale, Stroke Impact Scale, Satisfaction of Life Scale, and retrospective consent. In addition, all patients including survivors and deceased were classified into acceptable outcome (mRS&lt;=4) and bad outcome (mRS&gt;4) groups. Pre-surgical factors including age, gender, stroke risk factors, time to surgery, cerebral vessel involvement, cause of stroke, use of intravenous tPA or endovascular intervention were compared between two groups. Results: 37 patients were identified meeting our study criteria. 11 out of 16 survivors were enrolled for functional assessment (mean age 54.7 years, 73% male, 27% left hemisphere stroke, and mean time after stroke 3.4 years). Psychosocial aspect scored much higher than physical outcome in comprehensive functional evaluation. The majority of participants were satisfied with life and agreed for the retrospective consent. Comparing two groups with acceptable (n=9) and bad (n=23) outcomes, pre-surgical characteristics including age&gt;60, anterior cerebral artery involvement, hemorrhagic transformation, history of diabetes and coronary artery diseases were potentially associated with worse long-term outcome. Conclusions: A better psychological recovery suggests that appropriate mMCA stroke patients should not be deprived a DHC only based on a presumed unfavorable physical outcome. Some pre-surgical factors may be predictive for a worse outcome, which will assist physicians and families making critical decisions.

The importance of proximal fusion level selection for outcomes of multi-level lumbar posterolateral fusion.

BackgroundThere are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited to three or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateral fusion and to search for possible risk factors for poor surgical outcomes.MethodsWe retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateral fusion with posterior instrumentation. The outcomes were deemed either 'good' or 'bad' based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test, Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis was used to exclude confounding factors.ResultsTwenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). The overall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (group A: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted as possible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximal fusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomes than those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203).ConclusionsThe overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped it would be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar or lumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determined when multi-level lumbar fusions are considered.

Satisfaction Outcomes in Open Functional Septorhinoplasty

This study aimed to prospectively evaluate patient satisfaction by means of the Rhinoplasty Outcome Evaluation (ROE) questionnaire before and after functional septorhinoplasty. We carefully selected 62 patients (mean age, 31.8 years; 28 men, 34 women) who underwent open functional septorhinoplasty in the Otorhinolaryngology and Head Neck Surgery Department of Suşehri State Hospital. Satisfaction analyses were carried out by means of the ROE questionnaire both before the surgery and at least 4 weeks after the surgery. Patients were divided according to age (≤ 25 vs >25 years) and follow-up duration (≤ 6 vs >6 months). In addition, patients were grouped according to their satisfaction scores: 0 to less than 50, bad outcome (group B); 50 to less than 75, good outcome (group G); and 75 or greater, perfect outcome (group P). The mean satisfaction score in all the patients significantly increased after functional septorhinoplasty (from 24.8 ± 14.6 to 70.1 ± 17.3; P < 0.001). Moreover, the increment in mean satisfaction scores did not differ with age or follow-up duration. We conclude that the ROE questionnaire can help surgeons select suitable candidates for functional septorhinoplasty who will most benefit from the surgery.

Abstract T MP37: Fractional Anisotropy Changes in the Acute Stroke Phase Only Modestly Predict Motor Outcome at 3 Months

Background: A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to ischemic stroke lesions in chronic stroke patients has been associated with poor motor outcome, but in the acute phase no clear FA trends have been observed or used to make outcome predictions. Methods: This study followed 40 patients with first-ever ischemic stroke, measuring motor impairment with the Upper Extremity Fugl-Meyer (UE-FM) acutely and at 3 months. Images obtained &lt;3 days after stroke, including FA, were overlaid with a probabilistic CST (blue in Figure 1) derived from healthy subjects to define a cerebral peduncle region of interest ROI and a “nearest slice” ROI (green line in Figure 1), the second slice downstream from the stroke lesion (red in Figure 1). Ipsilesional and contralesional CST FA values as well as Apparent Diffusion Coefficient (ADC) values of regions of interests were compared using a laterality index and related to 3-month motor outcome. Results: Asymmetry between ipsilesional and contralesional CST FA values was significant different between patients with bad motor outcome and good outcome, with lower FA of the ipsilesional CST in the bad outcome group. No such asymmetry was seen for the cerebral peduncle ROI using either FA or ADC values. The FA laterality index for the nearest slice ROI was a significant but modest predictor of 3-month motor outcome (R2=0.186, p=.02), with the best predictive value offered by the combination of this imaging variable and the initial motor impairment (R2=0.696, p=.01). Conclusion: FA changes of the CST can be detected near the ischemic lesion in the acute phase after stroke, but these changes offer only modest predictive value for eventual motor outcome.

Predictors of good functional outcome in counterpulsation-treated recent ischaemic stroke patients

ObjectivesExternal counterpulsation (ECP) is a non-invasive method being investigated for ischaemic stroke. We aimed to explore predictors of good functional outcome for ECP-treated ischaemic stroke patients who completed a minimum...

Baseline Fibroblast Growth Factor-2 (FGF2) and Syndecan-1 (SDC1) Expression in Circulating CD15+/CD30+ Cells Correlate with Very Poor Outcome in Hodgkin Lymphoma

Abstract 3638Although the vast majority of patients with Hodgkin Lymphoma (HL) do well with standard frontline therapy, about 20% will continue to relapse and have poor clinical outcome, even with high dose therapy and autologous stem cell transplant. Recent progress in the understanding of HL has led to an increasing awareness of the importance of the microenvironment and the cross-talk with cytokines and chemokines (JCO, Steidl et.al. 2011). However, given a low number of HL tumor cells present in lymph node biopsies, it is difficult to develop predictive biomarkers criteria for clinical outcome solely based on the characteristics of Reed Sternberg cells.To identify potential HL biomarkers, a bioinformatics approach was used to derive 151 genes that are potentially related to lymphomagenesis and outcome. These genes were screened against a library of non-tissue (mostly effusions) derived 9 HL cell lines that originated from refractory/relapsing HL patients. Two genes, Fibroblast Growth Factor-2 (FGF2/bFGF) and Syndecan-1 (SDC1/CD138), were found consistently overexpressed across all HL cell lines when compared to normal purified B-cells from PBL.We then tested a panel of lymphoma tissues including Hodgkin and non-Hodgkin subtypes by immunohistochemistry. FGF2 and SDC1 again were found overexpressed only in HL against 148 other lymphoma tissue samples (p<0.005). To evaluate the potential prognostic significance of these two genes for HL, we selected two groups of patients in the frontline setting; the first group is “good outcome” (n=12) with no relapse over 4 years and the second group is “bad outcome” (n=7) with multiple relapses/primary failures/deaths. When PBL collected at baseline, (IRB approved signed ICF) prior to chemotherapy was analyzed, FGF2 and SDC1 were overexpressed 25 fold (p<0.005) and 7150 fold (p<0.005) respectively in chemo-naive HL samples of the “bad outcome” versus “good outcome” patient subsets. In these PBL samples, the primary HL markers CD30 and CD15 were also upregulated by 70 fold (p<0.005) and 50 fold (p<0.005) respectively in the “bad outcome” versus “good outcome” groups, suggesting that those CD30+/CD15+ cells are potentially representing circulating HL tumor cells. This finding is further supported by significant downregulation of established markers that represent other common PBL cell subtypes, including CD4 (Helper T cells, −93 fold, p<0.005), CD8 (cytotoxic T cells, −6 fold, p<0.005), CD14/63 (monocytes, −467 fold (p<0.005) and −190 fold (p<0.005) respectively) and CD38 (plasma cells, −55 fold, p<0.005), CD19 (normal B cells, −200 fold with p<0.005) in the chemo-naive group with the “bad outcome” over the “good outcome” groups. These molecular signatures of immune cells and FGF2/SDC1 were not found in the PBL of chemo-exposed relapsed/refractory HL patients (n=8), suggesting that these expression signatures are limited to chemo-naive HL patients. To investigate FGF2 and SDC1 expression at tissue level, 67 archived HL samples (unrelated to the PBL samples) were analyzed by qRT-PCR and immunohistochemical methods. Tissues that fit the criteria of the bad outcome (n=9) group showed an intense immunostaining of FGF2 and SDC1 while the good outcome (n=20) group showed a moderate staining. The bad outcome group also showed significantly higher (65 fold, p<0.005) expression of CD68 mRNA over the good outcome group, indicating greater accumulation of cells of macrophage lineage as previously reported. FGF2 and SDC1 are overexpressed 25 fold (p<0.005) and 45 fold (p<0.005) respectively, in the bad outcome over the good outcome group when normalized against the normal lymph nodes, suggesting that only selected populations of CD30+ cells overexpress FGF2 and SDC1. When the relationship between the overexpression of FGF2/SDC1 and the metastatic potential was analyzed, the tissues derived from the “bad outcome” group showed very strong immunohistochemisty results for both MMP9 and TGF-β and overexpressed MMP9 (53 fold, p<0.005) and TGF-β (60 fold, p<0.005) mRNAs when compared to the “good outcome” group. Double immunofluorescent studies showed that CD30+ cells from the “bad outcome” group coexpressed FGF2 and SDC1 and that the same cells frequently coexpressed MMP9 and TGF-β suggesting that selected HL tumor cells may undergo shedding from the microenvironment and then be found as circulating tumor cells at baseline and correlate with very poor outcome. Disclosures:Mato:Celgene: Speakers Bureau; Millennium: Speakers Bureau; Seattle Genetics: Speakers Bureau; Genentech: Speakers Bureau.

Time jitter of somatosensory evoked potentials in recovery from hypoxic–ischemic brain injury

Impaired neural conductivity shown by delayed latency and reduced amplitude of characteristic peaks in somatosensory evoked potentials (SSEPs), has been used to monitor hypoxic–ischemic brain injury after cardiac arrest (CA). However, rather than characteristic peak deferral and suppression, the time jitter of the peak in SSEP related with time-variant neurological abnormalities is diminished by the commonly used ensemble average method. This paper utilizes the second order blind identification (SOBI) technique to extract characteristic peak information from one trial of SSEPs. Sixteen male Wistar rats were subjected to 7 or 9 min of asphyxial CA ( n = 8 per group). The SSEPs from median nerve stimulation were recorded for 4 h after CA and then for 15 min periods at 24, 48 and 72 h. Neurological outcomes were evaluated by neurologic deficit score (NDS) at 72 h post-CA. The SSEP signal was analyzed offline with SOBI processing in Matlab. The N10 feature of SSEP was compared between good (NDS ≥ 50) and bad (NDS < 50) outcomes. After processed by SOBI, the N10 detection rate was significantly increased ( p < 0.001) from 90 min post-CA. Statistical difference of the latency variance of the N10 between good and bad outcome groups existed at 24, 48 and 72 h post-CA ( p ≤ 0.001). Our study is the first application using SOBI detecting variance in neural signals like SSEP. N10 latency variance, related with neurophysiological dysfunction, increased after hypoxic–ischemic injury. The SOBI technique is an efficient method in the identification of peak detection and offers a favorable alternative to reveal the neural transmission variation.

Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

To identify the relationship between admission hyperglycemia and outcome in children with severe brain injury at hospital discharge and 6 months later. A retrospective analysis of blood glucose levels was conducted in 61 children with severe brain injury admitted to the Pediatric Intensive Care Unit between November 1, 2005 and October 30, 2009. Hyperglycemia was considered for a cut off value of > 150 mg/dL, based on literature. Outcome was measured with the Glasgow Outcome Scale at hospital discharge and 6 months after discharge. Death was also analyzed as an outcome measure. Mean admission blood glucose of the patients was 251 mg/dL (68-791). Hyperglycemia was noted on admission in 51 (83.6%) patients. A moderately significant positive correlation was found between admission blood glucose and severity of head trauma according to Abbreviated Injury Score (r = 0.46). Mean admission glucose level of non-survivors was significantly higher (207 mg/dL vs. 455 mg/dL, p < 0.001). Mean blood glucose level of the patients in bad outcome group was found significantly higher compared to that of the patients in good outcome group at hospital discharge and 6 months after discharge (185 mg/dL vs. 262 mg/dL, p < 0.15 and 184 mg/dL vs. 346 mg/dL, p < 0.04, respectively). Hyperglycemia could be considered as a marker of brain injury and, when present upon admission, could reflect extensive brain damage, frequently associated with mortality and bad outcome. Further studies are needed to investigate the effect of strict glycemic control on mortality and outcomes.

Abstract 2000: Biological function annotation of microarray data using correlated gene indices

Abstract Although whole-genome microarray analysis has become a routine tool in biomedical research, extracting meaningful information remains a challenge. We describe a method for assessing biological information in microarray data that relies on the observation that genes common to a biological function often exhibit correlated expression within a microarray dataset. This method comprises the identification of gene sets representing a biological process of interest, determining the subset of genes that exhibit significantly correlated/anti-correlated expression, followed by the quantitative cumulated expression of the set of correlated genes. We applied the pathway index approach by using available gene lists, Pearson correlation, and mean of correlated gene expression values to estimate the pathway status. We then annotated a renal cancer dataset with pathway index scores of 183 canonical pathways, to identify hypoxia deregulation in Renal Cell Carcinoma samples. Using the pathway index approach, we also established a biological correlation between previously identified chromosomal instability signature and proliferation signature in human cancer, and revealed relationships between two distinct prognostic breast cancer signatures, Mammaprint, Oncotype DX, and basal subtypes within a breast tumor dataset. Our analysis indicated that both Mammaprint and Oncotype DX are good prognostic biomarkers and both biomarkers correlated with basal signature score. However, we also demonstrated that both Mammaprint and Oncotype Dx predicted patient outcome in non-basal type cohort respectively, which suggested that in addition to identify basal subtype as bad outcome group, both Mammaprint and Oncotype DX were good prognostic biomarkers in non-basal type cohort. We also applied this approach to analyze genes collinear along chromosome 7 to identify EGFR locus of chromosomal amplification using only transcriptome microarray data. Thus, gene index methodology provides a new tool to annotate microarray data with biological pathway information. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2000.

Outcome in childhood Guillain-Barré syndrome

To prospectively assess the outcome of children diagnosed with Guillain-Barré syndrome (GBS), followed up for a median duration of 25 months. Tertiary center, prospective follow up of children with GBS enrolled between, Dec 2003 to Sep 2006. Functional recovery was determined at 12 months and later using Hughes scale (0-6). Clinical, electrophysiological variables were compared between the good outcome (grade 0/1) and bad outcome groups (died or functional grade >1). Among 52 children with a median age of five yr there was male preponderance (75.4%). Mortality during acute phase was 11.5% (6/52). Among the survivors long term data was obtainable in 40 of the 46 children. At one year follow up 87.5% children had fully recovered or had minimal symptoms, beyond one year this rose to 95%. Only 2 among 40 had significant symptoms at last follow up (1 grade-2 and 1 grade-3). Factors significantly associated with poor outcome were: need for artificial ventilation, inexitable nerves on nerve conduction testing and delayed independent walking. Children needing ventilation have the worst short-term prognosis. However, irrespective of severity during acute phase, good long-term recovery can be expected in most children.

Outcome prediction in adult male germ cell tumor patients through expression profiling

5084 Background: Germ cell tumors (GCTs) are the most common solid malignancy in young adult men. Although GCTs are highly curable, when patients do succumb to disease, they have the greatest average number of life years lost of any adult cancer. Currently, patients are risk-stratified using clinical markers defined by the International Germ Cell Cancer Consensus Group (IGCCCG). Identification of molecular markers could improve outcome prediction. Methods: Expression profiling was performed on 74 non-seminomatous tumors (NSGCT) from patients who had received cisplatin based chemotherapy (training set) and 34 similarly treated NSGCT patients (test set). A modified version of Prediction Analysis for Microarrays (PAM) was used to develop a classifier for the binary endpoint of 5 year overall survival (5yOS). We also developed a predictive score for overall survival (OS) based on a weighted sum of the top genes derived using the univariate Cox model. Results: PAM identified a set of 170 transcripts that predicted 5yOS in the training set with a cross-validated classification rate of 60%. In the test set, the predictive gene set correctly classified 90% of the specimens. The predicted good and bad outcome groups showed significant separation in a Kaplan-Meier analysis. For the OS endpoint, we developed a 10 gene model that had a cross-validated predictive accuracy (concordance index, CI) of 0.66. Application of this model to the test set resulted in a CI of 0.83. Dichotomization of the samples based on the median score resulted in significant separation of the patients based on outcome in a Kaplan-Meier analysis. For both endpoints, the gene-based predictor was an independent prognostic factor in a multivariate model that included IGCCCG risk stratification (P<0.01 for both). Conclusions: We have developed and validated two gene-based models that predict outcome in GCT patients. These gene sets should have clinical utility for outcome prediction in GCT patients and should provide novel targets for therapeutic intervention. No significant financial relationships to disclose.

Language outcomes of toddlers with autism spectrum disorders: a two year follow‐up

Thirty-seven children 15-25 months of age received clinical diagnoses of autism spectrum disorder (ASD) and were re-evaluated two years later. All subjects were judged to have retained a diagnosis of ASD at the follow-up evaluation. Communication scores for the group as a whole during the first visit were significantly lower than nonverbal IQ. However, by the second visit, verbal and nonverbal scores were no longer significantly different. The group was divided into two subgroups, based on expressive language (EL) outcome at the second visit. The two groups were similar in the second year of life in terms of expressive communication skills and autistic symptoms, except for a trend toward more stereotypic and repetitive behavior in the worse outcome group. By the second visit, however, the groups differed significantly on all standard measures of expression and reception, as well as on autistic symptomotology and nonverbal IQ. When assessed during their second year, children who ended up in the better outcome group showed higher average nonverbal cognitive level, receptive language (RL) scores, number of sounds and words produced, use of symbolic play schemes, and response to joint attention bids. Regression analysis revealed that the variables for which significant differences between the two outcome groups in their second year of life were found provided significant prediction of EL outcome at age four. Stepwise regression identified RL and presence of stereotypic and repetitive at the first visit as significantly associated with EL outcome. Implications of these findings for early identification and intervention are discussed.

Relationship between the Arg72Pro Polymorphism of p53 and outcome for patients with traumatic brain injury

To determine the relationship between the Arg72Pro polymorphism of p53 and the outcome after traumatic brain injury (TBI) in humans. A prospective study was carried out in a ten-bed surgical intensive care unit (SICU) of a university hospital. The study included 90 caucasian patients who had experienced a severe TBI within the previous 24 h. The exclusion criterion was a previous deficit in the central nervous system. The main recorded outcomes were values on the Glasgow Outcome Scale (GOS) at discharge from the SICU (GOS-0) and 6 months later (GOS-6). A blood sample was taken from each patient and all samples were analyzed by an allele-specific polymerase chain reaction for detection of Arg72Pro polymorphism of p53. These polymorphisms were tested for their association with values of GOS-0 and GOS-6. A two-tailed value of p<0.05 was considered statistically significant. The frequency of the argine/argine (Arg/Arg) genotype was greater among the patients who had a bad outcome at GOS-0 (69 vs 31% in the bad-outcome group; p=0.029). A multiple logistic regression analysis showed that patients with the Arg/Arg variation had a 2.9-fold greater risk of having a bad outcome at discharge from the SICU (95% confidence interval, 1.05-8.31; p=0.039 ). There was no similar relationship with respect to GOS-6. The Arg/Arg genotype of the Arg72Pro polymorphism in p53 is associated with increased likelihood of a bad outcome at discharge from the SICU.

Brain tissue pO2 and outcome after severe head injury

Although the use of on-line monitoring of brain ti-p02 is increasing, so far the critical level of 70 mmHg is derived from animal experiments and clinical analyses: no hard proof on outcome basis has been given . until now. The authors present an outcome analysis of35 patients with severe head injury. Inclusion criteria were: start of ti-p02 monitoring ≤40 h post-injury, the probe lying in CT scan normal tissue and the COS at 6 months being available. The good outcome group (COS 4+5/ n = 77) showed a 77.7± 9.1 h delay from the injury to the monitoring compared to the bad outcome group (COS 7-3/ n = 78) with (74.2 ± 9. 7 h) (p < 0.05). Age and initial Glasgow Coma Score were not different. In the bad outcome group there were more patients with a diffuse injury type 3 and 4. The distribution of the ti-pO2 values show in all the examined time intervals (day 0-6/ 0-72 h/ 0-48 hand 0-24 h) a left shift in the bad outcome group with most pronounced difference for ti-pO2≤ 10 mmHg. For the period from 0-48 h and even more from 0-24 h post-injury, the difference between both groups was significant (p = 0.036 and p = 0.013). In the bad outcome group 35.5% of the values from 0-24 h were ≤ 10 mmHg (compared to 70.6% in the good outcome group. ti-p2 values 250 mmHg were seen more often in the bad outcome group; this occurred mainly after 48–72 h post-injury. The authors concluded that brain ti-p2 monitoring is able to detect the occurrence of early hypoxic insults. Brain ti-p2 monitoring is an important parameter in the multimodality monitoring system. [Neural Res 1998; 20 (Suppl 1): 571–575]

Proton magnetic resonance spectroscopy in children with acute central nervous system injury

Single voxel proton magnetic resonance spectroscopy ( 1H-MRS) was used in 30 infants and children with acute central nervous system injuries to determine the value of changes in specific metabolite ratios in predicting outcome. The mean age of all patients was 38 ± 52 months and the mean time of study after insult was 7 ± 5 days. 1H-MRS was determined in the occipital gray and parietal white matter (8 cm 3 volume, STEAM sequence with TE = 20 ms, TR = 3,000 ms). Data were expressed as ratios of different metabolite peak areas including N-acetylaspartate (NA), choline-containing compounds (Ch), creatine and phosphocreatine (Cr), and lactate (Lac). Statistically significant differences were observed when patients with good/moderate ( G M ) outcomes (n = 17; mean age: 46 months) were compared to patients with bad outcomes (n = 10; mean age: 26 months). NA Cr and NA Ch were significantly lower in the bad outcome group ( NA Cr = 1.15 ± 0.38 ; NA Ch = 1.18 ± 0.52 ) compared to the G M group ( NA Cr = 1.41 ± 0.28 , P < .05; NA Ch = 1.98 ± 0.81 , P < .01). Lactate was present in 80% of bad outcome patients and in none of the G M group ( P < .0001). Using a linear discriminant analysis and combining 4 clinical variables (Glasgow Coma Scale score, initial pH and glucose, number of days unconscious at time of 1H-MRS) allows classification of 94% of patients into their correct outcome group. Use of spectroscopy variables ( NA Cr , NA Ch , Ch Cr , presence of lactate) alone correctly classified 81% of patients. The combination of clinical and 1H-MRS variables correctly classified 100% of patients. Our findings suggest that 1H-MRS adds information which, in combination with clinical examination, may be useful in outcome assessment in children with serious acute central nervous system injury.

EEG reactivity in the prognosis of severe head injury

We compared reactivity of EEG to external stimuli--an easily and quickly available measure--with the central conduction time (CCT) of the somatosensory evoked potentials, currently the most-used electrophysiologic method to predict outcome in severe head injury (SHI), and with the initial Glasgow Coma Scale (GCS) score. In 50 patients, comatose subsequent to SHI, we measured EEG reactivity and CCT within 48 to 72 hours and compared them with the outcome after 1.5 years. Using discriminant analysis, EEG reactivity correctly classified 92%, CCT classified 82%, and both measures together classified 98% of the patients into globally good or bad outcome groups. GCS allowed a correct classification in only 72% and, combined with either of the two electrophysiologic measures, did not further increase predictability. EEG reactivity is an excellent long-term global outcome predictor in SHI, superior to CCT and GCS. When the two electrophysiologic measures are combined, a prognostic accuracy is achieved that is better than that of any other reported method.

The Prognostic Value of Deoxyribonucleic Acid Flow Cytometric Analysis in Stage D2 Prostatic Carcinoma

AbstractThis study was designed to compare the prognostic potential of tumor grade and ploidy status in patients with stage D2 prostate cancer. Two outcome groups were selected on the basis of survival after orchiectomy: a bad outcome group consisting of 66 patients who died of the disease within 12 months and a good outcome group comprising 37 patients who survived beyond 5 years. Tumors were classified histologically as well (17%), moderately (17%) or poorly (66%) differentiated. Tumor grade was a significant predictor of outcome, with 76% of poorly differentiated tumors in the bad outcome group and 65% of well differentiated tumors in the good outcome group (p <0.005).Deoxyribonucleic acid (DNA) ploidy analysis was performed on formalin fixed, paraffin embedded samples of the primary tumor to yield 97 final tracings that were classified using set criteria for DNA ploidy status. Over-all, 54% of the tumors were nondiploid (33% aneuploid and 21% tetraploid) and the remaining 46% were diploid. DNA ploidy status was a significant indicator of outcome (p <0.001), with 64% of diploid tumors in the good outcome group and 88% of the nondiploid tumors in the poor outcome group. Tetraploid tumors behaved no differently from other nondiploid tumors. We conclude that DNA ploidy status and tumor grading are significant independent predictors of outcome after orchiectomy and when combined yield important additional prognostic information.