Predictor Of Good Clinical Outcome Research Articles

Handgrip strength: Reference values and its relationship with bioimpedance and anthropometric variables

Summary Background & aims Handgrip strength by dynamometry is an anthropometric measurement used to estimate muscle function in healthy adults, predict functional limitations, disabilities and survival in older people. Low handgrip strength is considered a better predictor of clinical outcomes than low muscle mass when it is measured in standard conditions and compared with reference populations. It is well known that age, sex and height are the most important factors correlated with handgrip strength. The aim of this study was to establish reference values for handgrip strength in Mexican adults for both genders and identify its relationship with anthropometric factors. Methods Cross-sectional study with 902 apparently healthy adults (478 women and 424 men) older than 20 years old from Mexico City. Personal data, dietary information and anthropometry were assessed. Handgrip strength was measured in dominant hand with a Smedley Hand Dynamometer (Stoelting, Wood Dale, UK). Results Mexican population presented the maximum strength at 30 years of age decreasing continuously further on ( p r = 0.757, p r = 0.397, p r = 0.057, p = 0.123). We present reference values of handgrip strength for each gender and age categories. Also, we proposed tables with the index of handgrip strength adjusted by the squared of height. Conclusions Height is the anthropometric factor with higher correlation to handgrip strength. Factors such as nutrition and occupation had a weak correlation with handgrip. Use of these reference values stratified by age and sex will allow us to have an assessing tool to evaluate muscle functionality in Mexican people with characteristics similar to this study.

Efficacy of Balloon-Guiding Catheter for Mechanical Thrombectomy in Patients with Anterior Circulation Ischemic Stroke.

ObjectiveTo evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke.MethodsSixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated.ResultsSuccessful recanalization was more frequent in BGC than in non-BGC (83% vs. 66%, p=0.13). Distal emboli occurred less in BGC than in non-BGC (23.1% vs. 57.1%, p=0.02). Good clinical outcome was more frequent in BGC than in non-BGC (50% vs. 16%, p=0.03). The multivariate analysis showed that use of BGC was the only independent predictor of good clinical outcome (odds ratio, 5.19: 95% confidence interval, 1.07–25.11). More patients in BGC were successfully recanalized in internal carotid artery (ICA) occlusion with small retrieval numbers (<3) than those in non-BGC (70% vs. 24%, p=0.005). In successfully recanalized ICA occlusion, distal emboli did not occur in BGC, whereas nine patients had distal emboli in non-BGC (0% vs. 75%, p=0.001) and good clinical outcome was superior in BGC than in non-BGC (55.6% vs. 8.3%, p=0.01).ConclusionA BGC significantly reduces the number of retrievals and the occurrence of distal emboli, thereby resulting in better clinical outcomes in patients with anterior circulation ischemic stroke, particularly with ICA occlusion.

Endovascular Stroke Treatment of Acute Tandem Occlusion: A Single-Center Experience

PurposeTo evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment. Materials and MethodsCharacteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality. ResultsA total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04–0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01–1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37–84.13; P = .02). ConclusionsEndovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.

Abstract TMP3: Which is a Better Predictor of Clinical Outcome After Endovascular Thrombectomy, Pre-treatment DWI ASPECTS or CT Perfusion?

Introduction: Optimal imaging before endovascular thrombectomy for large vessel occlusion remains unclear. We compared pre-treatment DWI ASPECTS and CT perfusion (CTP) to identify which imaging better predicted clinical outcome after endovascular thrombectomy. Methods: Prospectively collected date for consecutive patients treated with endovascular thorombectomy for acute intracranial internal carotid artery or M1 occlusion and underwent both MRI and CTP before endovascular thrombectomy was analyzed retrospectively. CTP maps were assessed for relative values (rCBF, rCBV and rMTT) obtained for the MCA cortical regions. Pre-treatment DWI ASPECTS and each relative CTP values were compared between good clinical outcome group and poor clinical outcome group. Receiver operating characteristic (ROC) curve analysis was performed to determine the most accurate imaging parameter for the prediction of good clinical outcome. Results: Sixty-nine patients were eligible for this study. Average age was 74.4 years, median NIHSS on admission was 17. The median time from MRI to CTP was 21 minutes. TICI 2B or more recanalization was achieved in 44 patients. Twenty-four patients achieved good clinical outcomes. DWI ASPECTS (9 vs. 6, p=0.003) and rCBV (0.99 vs. 0.83, p=0.017) were significantly higher in the good clinical outcome group. The area under the ROC curve for good clinical outcome was 0.714 for DWI ASPECTS and 0.676 for rCBV. In the patients with TICI 2B or more recanalization, DWI ASPECTS were significantly higher (9 vs. 6.5, p=0.027) and rCBV tended to be higher (1.01 vs. 0.83, p=0.071) in the good clinical outcome group. The area under the ROC curve was 0.693 for DWI ASPECTS and 0.659 for rCBV in the patients with TICI 2B or more recanalization. Conclusions: DWI ASPECTS and rCBV could predict clinical outcome after endovascular thrombectomy. DWI ASPECTS better predicted clinical outcome than CTP.

Perioperative echocardiography-derived right ventricle function parameters and early outcomes after tetralogy of Fallot repair in mid-childhood: a single-center, prospective observational study.

Right ventricular (RV) function alterations are invariably present in all patients after tetralogy of Fallot (TOF) repair. Unlike the developed world where most of the patients with TOF are corrected in infancy, average age of presentation and thus surgery for these patients in the developing world may be higher. We aimed to study the correlation between RV function parameters such as tricuspid annular peak systolic excursion (TAPSE), fractional area change (FAC), and tricuspid annular peak systolic velocity (S') with early outcome variables after intracardiac repair for TOF. Fifty patients with a preoperative diagnosis of tetralogy of Fallot scheduled for corrective surgery were included in this single-center, prospective observational study. A preoperative transthoracic echocardiogram was performed to measure RV function parameters (FAC0, TAPSE0, S'0). Transthoracic echocardiography was repeated postoperatively to measure FAC1, TAPSE1, S'1 (day 1) and FAC2, TAPSE2, and S'2 (day 3). The relationship between preoperative and postoperative RV function parameters with in-hospital mortality, duration of mechanical ventilation, and intensive care unit stay was studied. The median age of patients was 6years (range 1-14years). Multiple stepwise logistic regression analysis showed RV FAC as best predictor of clinical outcome. Area under the receiver operating characteristic curve for postoperative RV function parameters, that is, FAC, TAPSE, and S' to predict early or delayed recovery was 0.944, 0.875, and 0.655, respectively. Among the RV function parameters studied, RV FAC best predicted the early outcome variables after TOF repair, followed by TAPSE while lateral tricuspid annular velocity S' being the least predictive.

Endovascular Therapy for Large Vessel Stroke in the Elderly: Hope in the New Stroke Era

Background and Purpose: Acute ischemic stroke (AIS) in the elderly encompasses approximately one-third of all AIS cases. Outcome data have been for the most part discouraging in this population. We aim to evaluate the outcomes in a large contemporary series of elderly patients treated with thrombectomy. Methods: Retrospective analysis of a single-center endovascular database for consecutive elderly (≥80 years) patients treated for anterior circulation large vessel occlusion AIS between September 2010 and April 2015. Univariate- and multivariate analyses were performed to identify the predictors of good clinical outcome (90-day modified Ranking Scale [mRS] ≤2). Receiver operating characteristic curves were used to calculate the optimal final infarct volume (FIV) threshold to predict good outcomes. Results: A total of 111 patients met our inclusion criteria (mean age 84.8 ± 4.2 years; National Institutes of Health Stroke Scale [NIHSS] score 19.1 ± 5.6; time from last-known normal to puncture, 349.6 ± 246.6 min; 33% male; 68% Alberta Stroke Program Early CT Score [ASPECTS] ≥8). The rates of successful reperfusion (modified treatment in cerebral ischemia ≥2b), symptomatic intracranial hemorrhage and 90-day mortality were 80%, 7% and 41%, respectively. The overall rate of good outcome was 29% (n = 32/111) but was 52% (n = 13/25) in patients with baseline mRS score of 0-2 who were selected based on CT perfusion and treated with stent retrievers. On multivariate analysis, only ASPECTS (OR 2.17; 95% CI 1.28-3.67.7; p = 0.004) and baseline NIHSS score (OR 0.87; 95% CI 0.77-0.97; p = 0.013) were independently associated with good outcome. A FIV ≤16 ml demonstrated the greatest accuracy for identifying good outcomes (sensitivity 75.0%, specificity 82.6%). Conclusions: Our results are encouraging demonstrating nearly one-third of elderly patients achieving full independence at 90 days. Contemporary treatment paradigms employing optimized patient selection and modern thrombectomy technology may result in even better outcomes.

Estimated aortic blood pressure based on radial artery tonometry underestimates directly measured aortic blood pressure in patients with advancing chronic kidney disease staging and increasing arterial stiffness

Central blood pressure (BP) can be assessed noninvasively based on radial tonometry and may potentially be a better predictor of clinical outcome than brachial BP. However, the validity of noninvasively obtained estimates has never been examined in patients with chronic kidney disease (CKD). Here we compared invasive aortic systolic BP (SBP) with estimated central SBP obtained by radial artery tonometry and examined the influence of renal function and arterial stiffness on this relationship. We evaluated 83 patients with stage 3 to 5 CKD (mean estimated glomerular filtration rate [eGFR] 30 ml/min/1.73 m(2)) and 41 controls without renal disease undergoing scheduled coronary angiography. BP in the ascending aorta was measured through the angiography catheter and simultaneously estimated using radial tonometry. The mean difference between estimated central and aortic SBP was -13.2 (95% confidence interval -14.9 to -11.4) mmHg. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cf-PWV) and was significantly increased in CKD patients compared with (versus) control patients (mean 10.7 vs. 9.3 m/s). The difference in BP significantly increased 1.0 mmHg for every 10 ml/min decrease in eGFR and by 1.6 mm Hg per 1 m/s increase in cfPWV. Using multivariate regression analysis including both eGFR and cfPWV, the difference between estimated central and invasive aortic SBP was significantly increased by 0.7 mmHg. For the entire cohort brachial SBP significantly better reflected invasive SBP than estimated SBP. Thus, tonometry-based estimates of central BP progressively underestimate invasive central SBP with decreasing renal function and increasing arterial stiffness in CKD patients.

Association of anthropometric measures with kidney disease progression and mortality: a retrospective cohort study of pre-dialysis chronic kidney disease patients referred to a specialist renal service.

BackgroundAlthough elevated body mass index (BMI) is a predictor of better clinical outcomes in dialysis patients, the evidence in pre-dialysis chronic kidney disease (CKD) is conflicting. Clinical measures of central obesity may be better prognostic indicators, although investigation has been limited. The aim of this study was to assess the predictive value of anthropometric measures for kidney failure progression and mortality in stage 3–4 CKD.MethodsThe study included newly referred stage 3–4 CKD patients at a single centre between 1/1/2008 and 31/12/2010. The associations between clinical measures of obesity (BMI, waist circumference [WC] and conicity index [ConI]) and time to a composite primary outcome of doubling of serum creatinine, commencement of renal replacement therapy or mortality were evaluated using the Kaplan-Meier method and multivariable Cox regression models.ResultsOver a median follow-up period of 3.3 years, 229 (25.4 %) patients of a total population of 903 experienced the composite primary renal outcome. When compared to normal BMI (18.5-24.9 kg/m2, n = 174), the risk of the composite primary outcome was significantly lower in both the overweight (BMI 25–29.9 kg/m2, n = 293; adjusted hazard ratio [HR] 0.50, 95 % CI 0.33-0.75) and obese class I/II groups (BMI 30–39.9 kg/m2, n = 288; HR 0.62, 95 % CI 0.41-0.93), but not in the obese class III group (BMI ≥40 kg/m2, n = 72; HR 0.94, 95 % CI 0.52-1.69). All-cause mortality was also lower in the overweight group (HR 0.50, 95 % CI 0.30-0.83). WC and ConI were not associated with either the composite primary outcome or mortality.ConclusionBMI in the overweight range is associated with reduced risks of kidney disease progression and all-cause mortality in stage 3–4 CKD. WC and ConI were not independent predictors of these outcomes in this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0290-y) contains supplementary material, which is available to authorized users.

Factors Affecting Clinical Outcome in Patients With Structural Failure After Arthroscopic Rotator Cuff Repair

(1) To compare clinical outcomes between patients with large or massive rotator cuff tears who have healed cuffs and patients with postoperative structural failure (retear after complete or partial repair) and (2) to identify factors associated with clinical outcomes in patients with postoperative structural failure. We conducted a retrospective study of consecutive patients with large or massive cuff tears who underwent arthroscopic repair at our institution between 2005 and 2012. On the basis of intraoperative findings and magnetic resonance imaging at final follow-up, the patients were divided into 3 groups: healed group, retear group (after complete repair), and partial-repair group. The outcome measures comprised the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA) scores; muscle strength; and range of motion. The tear length, tear width, muscle atrophy, and fatty degeneration were evaluated by preoperative and postoperative magnetic resonance imaging. The extent of tendon reattachment to the superior, middle, and inferior facets and the lesser tuberosity was examined on magnetic resonance images at final follow-up. In total, 74 patients (healed, 41; retear, 19; and partial repair, 14) were included in this study. The mean age was 63.8 ± 8.5 years, with a mean follow-up period of 3.6 ± 1.4 years. The postoperative JOA and UCLA scores significantly improved in all 3 groups, but the differences were not significant. In the retear and partial-repair groups, postoperative tendon preservation at the middle facet significantly affected the JOA and UCLA scores (P= .003 and P=.014, respectively). The JOA and UCLA scores were significantly improved in patients with structural failure. Under these conditions, the only clinical factor that affected patient outcome was tendon healing at the middlefacet. Thus tendon preservation at the middle facet was a predictor of good clinical outcomes in patients who underwent arthroscopic rotator cuff repair of large or massive tears and had postoperative structural failure. Level III, case-control study.

Abstract WMP8: Results of Trevo Acute Ischemic Stroke Thrombectomy Registry: Predictors of Clinical Outcome

Background and Purpose: Recent randomized clinical trial (RCTs) demonstrated efficacy of mechanical thrombectomy using stent-retrievers in acute ischemic stroke (AIS) patients. The main purpose of TRevo ACute Ischemic StroKe (TRACK) stent-retriever thrombectomy multicenter registry is to demonstrate safety and efficacy in real life clinical practice. Methods: The investigator-initiated TRACK multicenter registry recruited 24 sites in north America to submit demographic, clinical, site-adjudicated angiographic, and outcome data on consecutive AIS patients treated with Trevo stent-retriever device as the first treatment option. Standard clinical safety (symptomatic intracranial hemorrhage (sICH), and mortality) and efficacy (revascularization and disability) outcomes and predictors of clinical outcome were analyzed. Results: 624 patients were enrolled in the TRACK registry. Median age was 68 years (range 16-94, 118 (18.1%) &gt;80), male gender was 51.4%, and 67.7% were white. The median National Institutes of Health Stroke Severity Scale (NIHSS) was 17 (IQR 13-22). Transfer cases were 50.6% with IV-rtPA use in 318 cases (51.3%). Median onset to groin puncture (OTG) time was 283 min (IQR 198.5-443), and groin puncture to revascularization was 66 min (IQR 37.5-103). Anterior circulation occlusion was 86.2% (MCA/M2 in 55.2% followed by ICA in 15.9% and M2 in 12.7%). Use of GA was in 389 cases (62.3%), number of passes were ≤ 3 in 92% of the cases (1: 45.2%, 2:28%, and 3:18.7%), 291 (46.7%) had BGC use. Rescue use was seen in 21.7%. Revascularization of ≥ TIMI 2 was 81.8% and ≥ TICI 2b was 70%. The primary outcome of mRS of ≥ 2 was 48.3% in the full cohort, and 50.6% in TREVO-2 like group. sICH and mortality were 7.2%, and 20.1% in the full cohort vs 6.9% and 17.5% in the TREVO-2 like group, respectively. The independent predictors of clinical outcome were lower baseline NIHSS, younger age, use of BGC, successful recanalization, and no general anesthesia (GA). Conclusions: The real life clinical practice Trevo registry demonstrated good clinical outcome and high rate of recanalization. Younger age, lower baseline NIHSS, use of balloon guide catheter, successful recanalization, and avoiding endotrachaeal GA independent predictors of good clinical outcome.

Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment

IntroductionThe capability of CT perfusion (CTP) Alberta Stroke Program Early CT Score (ASPECTS) to predict outcome and identify ischemia severity in acute ischemic stroke (AIS) patients is still questioned.Methods62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT), recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS) at 3 months after onset were recorded.ResultsSemi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001). CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS≤2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001). CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02) only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome.ConclusionsOur findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size.

The chemokine CXCL9 expression is associated with better prognosis for colorectal carcinoma patients.

The chemokine CXCL9 has been demonstrated to play an important role in the development of human malignancies. However, its prognostic significance in cancer patients remains unclear and less is known about its role in colonrectal carcinoma (CRC) patients. In this study, we found that the relative mRNA expression level of CXCL9 in primary colorectal tumor tissues was significantly higher than that in corresponding normal colon tissues. CXCL9 protein expression was also detected in 102 of 130 primary CRC patients by immunochemistry. Thus, CXCL9 might play a vital role in the progression of colorectal cancer. By analyzing the correlation between clinicopathological factors of patients and expression of CXCL9 protein, we showed that the expression of CXCL9 was significantly associated with tumor differentiation, tumor invasion, lymph node metastasis, distant metastasis, and vascular invasion, but not with other factors of CRC patients including age, gender, tumor location and tumor size. Furthermore, by performing Kaplan-Meier method as well as Cox's univariate and multivariate hazard regression model, we found that the higher the CXCL9 expression, the higher overall survival rate was observed, and CXCL9 expression was a significant independent prognostic factor for CRC patients. Therefore, CXCL9 is a useful predictor of better clinical outcome in CRC patients.

Neuroimaging in Craniocerebral Trauma

In the present era, trauma is the commonest cause of death in the middle aged group. Cranio Cerebral Trauma (CCT) is common in both urban and rural areas and is associated with high morbidity and mortality rates. In any case of trauma, the outcome depends on two major issues: detection of type and extent of injury and the time taken for management. Though, the presenting neurologic status of the patient is the single best predictor of clinical outcome, but imaging determines the prognosis of these patients especially when the Glasgow coma scale (GCS) is high. There have been major advancements in the field of neuroimaging for CCT over the last decade.

Volumetric Parameters on Interim PET Predict Clinical Outcomes Better Than SUVmax in Patients with Diffuse Large B-Cell Lymphoma

Background: Immunochemotherapy has improved the clinical outcome of patients diagnosed with diffuse large B-cell lymphoma (DLBCL), but only 60% of all DLBCL patients are potentially cured. A response-adaptive imaging strategy that accurately determines the initial response to therapy could improve clinical outcomes. Although there has been an increasing trend to perform interim PET/CT to monitor response, the optimal interpretation method for interim PET analyses remains uncertain. Studies using maximum standard uptake value (SUVmax), have not defined a uniformly applicable SUVmax reduction cutoff that accurately predicts clinical outcome. Here, we hypothesized that a method that maximized the detection of all metabolically active regions within the tumor mass, defined as the metabolic tumor volume (MTV), could serve as a better predictor of clinical outcome than SUVmax measurement.Methods: All patients with DLBCL that were treated from Dec 2006 to Dec 2014 at the University of Cincinnati were studied, retrospectively. Interim PET analysis was performed after 2-4 cycles of chemotherapy. SUVmax and MTV on the initial and interim PET CT for each patient was determined. To evaluate the contribution of metabolic activity within the tumor periphery in assessing clinical outcomes, MTV was measured by two separate methods: fixed-threshold and gradient-segmentation using MIMSoftware, OH, USA. The primary end point of the study was progression free survival (PFS). To identify an optimal threshold cutoff that could predict PFS more accurately, the receiver operating characteristic (ROC) curve analysis was used.Results: A total of 197 patients with pathology confirmed diagnosis of DLBCL were recognized. Of the 197 patients, 167 underwent interim PET analysis. All patients fasted >6 h before intravenous injection of 18F-glucose, had glucose levels >90 and <160 mg/dl at the moment of injection, scans were performed within 90 min after injection and granulocyte-colony stimulating factor was stopped >48 h before imaging. The median follow-up period for patients in the study was 37 months. R-CHOP (Rituximab, Cyclophosphamide, doxorubicin/Hydroxydaunomycin, vincristine/Oncovin and Prednisone) and R-DA-EPOCH (Dose-Adjusted Etoposide, Prednisone, Oncovin, Cyclophosphamide and Hydroxydaunorubicin) were the first line of therapy in 74% and 26% of patients, respectively. On interim PET/CT, 69% of patients achieved complete response with the remaining patients showing partial response based on visual assessment. Dichotomous visual interpretation of interim PET did not correlate with PFS (log-rank P= 0.37). Compared with the threshold-based method, the gradient-based method resulted in a statistically significant greater MTV in pretreatment, as well as interim PET images. However, no significant difference was noted between the reduction in MTV determined by the threshold-based (ΔMTVT) or gradient-based (ΔMTVG) methods (median 34% vs 36%, P =0.29). Thresholds of ΔSUVmax and ΔMTV by ROC curve were 72% and 52%, respectively. ΔMTV predicted PFS better than ΔSUVmax as the AUC for ΔMTV was significantly larger compared with that for ΔSUVmax (Figure 1). All patients who achieved a SUVmax reduction greater than the cutoff value determined by the ROC analysis (ΔSUVmax>72%) were then stratified into two groups based on a ΔMTV cutoff value > or <52%. From a total of 115 patients who achieved a ΔSUVmax >72% on interim PET/CT imaging, 77 (67%) had a ΔMTV >52%. Importantly, patients who achieved a ΔMTV >52% had a statistically significantly greater PFS compared with patients who achieved a ΔMTV <52% (Figure 2). Among 115 patients who achieved a ΔSUVmax >72% on interim PET and those who demonstrated a ΔMTV >52% exhibited greater PFS.Conclusion: Our study highlights the importance of MTV assessment for patients who achieved background SUVmax on the interim PET to better predict the clinical outcome of DLBCL patients. The MTV measurement with the gradient-based method renders a larger volume of tumor than the threshold-based method; however, these two methods report a similar percentage reduction and are interchangeable in terms of interim PET interpretation. Metabolic activity of the peripheral area of the tumor should be incorporated into response-adaptive strategies and prospective trials that evaluate the response to current and novel therapeutic regimens to treat DLBCL patients. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Change in quality of life, disability, and well-being after decompressive surgery: results from a longitudinal study.

The aim of this study is to evaluate quality of life (QoL), disability, and psychological well-being (PWB) in patients with disc herniation and stenosis before and after decompressive surgery and to investigate factors associated with an improvement in the postoperative disability level. An observational longitudinal study was carried out to collect preoperative and postoperative data on QoL, disability, and PWB using European Health Interview Survey-Quality of Life (EUROHIS-QoL), WHO Disability Assessment Schedule, second version (WHODAS-II), and Psychological General Well-Being Index-Short (PGWB-S) questionnaires. Friedman's analysis of variance was performed to compare preoperative and postoperative test scores, whereas a one-sample t-test was calculated to compare the mean test scores with the general population. A hierarchical logistic regression was developed to investigate the association between the change in the disability level after surgery, sociodemographic and clinical characteristics, and preoperative test scores. Complete data were available for 55 patients. PGWB-S and WHODAS-II scores improved significantly (P=0.004 and 0.003), even if the disability level remained high after surgery. The logistic regression showed that patients with worse preoperative WHODAS-II scores had higher odds achieving improvement in their disability level after surgery. This study showed that disability and PWB improve significantly after surgery, but further treatment and a healthy lifestyle are expected and recommended as the disability level remains high. In addition, more severe preoperative disability was a predictor of better clinical outcome.

Patients with chronic lymphocytic leukaemia (CLL) differ in the pattern of CTLA-4 expression on CLL cells: the possible implications for immunotherapy with CTLA-4 blocking antibody.

Recently, systemic administration of a human monoclonal antibody directed against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) expressed on circulating T cells in patients with chronic lymphocytic leukaemia (CLL) has been considered. Also, CLL cells have been shown to express CTLA-4, increased levels of which in the leukaemic compartment are a predictor of good clinical outcome. Since both CLL and Treg microenvironment cells can be targeted by the CTLA-4 blocking antibody in this immunotherapy approach, the investigation of the functional effect of CTLA-4 blockade on CLL cells might be of potential clinical relevance. The main aim of this study was to examine the effect of CTLA-4 blockade on proliferation activity and apoptosis of CLL cells in patients with low and high CTLA-4 expression. We found that in the high CTLA-4-expressing CLL group, CTLA-4 blockade on the CLL cell surface resulted in a significant increase in the median percentages of Ki67+ cells and a tendency to decrease in the proportion of apoptotic cells. In contrast, in the low CTLA-4 expressors, CTLA-4 blockade did not affect the proliferation activity or the frequency of apoptosis. This study reports for the first time the different effect of CTLA-4 blockade on CLL cells in CLL patients depending on the levels of CTLA-4 expression. CTLA-4 blockade seems to induce pro-survival signals in leukaemic cells from CLL patients exhibiting high CTLA-4 expression, suggesting that an immunotherapy approach based on the systemic use of monoclonal anti-CTLA-4 antibodies could be an unfavourable strategy for some CLL patients.

Classification of neurological abnormalities in children with congenital melanocytic naevus syndrome identifies magnetic resonance imaging as the best predictor of clinical outcome.

SummaryBackgroundThe spectrum of central nervous system (CNS) abnormalities described in association with congenital melanocytic naevi (CMN) includes congenital, acquired, melanotic and nonmelanotic pathology. Historically, symptomatic CNS abnormalities were considered to carry a poor prognosis, although studies from large centres have suggested a much wider variation in outcome.ObjectivesTo establish whether routine MRI of the CNS is a clinically relevant investigation in children with multiple CMN (more than one at birth), and to subclassify radiological abnormalities.MethodsOf 376 patients seen between 1991 and 2013, 289 fulfilled our criterion for a single screening CNS MRI, which since 2008 has been more than one CMN at birth, independent of size and site of the largest naevus. Cutaneous phenotyping and radiological variables were combined in a multiple regression model of long‐term outcome measures (abnormal neurodevelopment, seizures, requirement for neurosurgery).ResultsTwenty‐one per cent of children with multiple CMN had an abnormal MRI. Abnormal MRI was the most significant predictor of all outcome measures. Abnormalities were subclassified into group 1 ‘intraparenchymal melanosis alone’ (n = 28) and group 2 ‘all other pathology’ (n = 18). Group 1 was not associated with malignancy or death during the study period, even when symptomatic with seizures or developmental delay, whereas group 2 showed a much more complex picture, requiring individual assessment.ConclusionsFor screening for congenital neurological lesions a single MRI in multiple CMN is a clinically relevant strategy. Any child with a stepwise change in neurological/developmental symptoms or signs should have an MRI with contrast of the brain and spine to look for new CNS melanoma.

Distinguishing Low-Risk Luminal A Breast Cancer Subtypes with Ki-67 and p53 Is More Predictive of Long-Term Survival.

Overexpression of p53 is the most frequent genetic alteration in breast cancer. Recently, many studies have shown that the expression of mutant p53 differs for each subtype of breast cancer and is associated with different prognoses. In this study, we aimed to determine the suitable cut-off value to predict the clinical outcome of p53 overexpression and its usefulness as a prognostic factor in each subtype of breast cancer, especially in luminal A breast cancer. Approval was granted by the Institutional Review Board of Samsung Medical Center. We analyzed a total of 7,739 patients who were surgically treated for invasive breast cancer at Samsung Medical Center between Dec 1995 and Apr 2013. Luminal A subtype was defined as ER&PR + and HER2- and was further subclassified according to Ki-67 and p53 expression as follows: luminal A (Ki-67-,p53-), luminal A (Ki-67+, p53-), luminal A (Ki-67 -, p53+) and luminal A (Ki-67+, p53+). Low-risk luminal A subtype was defined as negative for both Ki-67 and p53 (luminal A [ki-67-, p53-]), and others subtypes were considered to be high-risk luminal A breast cancer. A cut-off value of 10% for p53 was a good predictor of clinical outcome in all patients and luminal A breast cancer patients. The prognostic role of p53 overexpression for OS and DFS was only significant in luminal A subtype. The combination of p53 and Ki-67 has been shown to have the best predictive power as calculated by the area under curve (AUC), especially for long-term overall survival. In this study, we have shown that overexpression of p53 and Ki-67 could be used to discriminate low-risk luminal A subtype in breast cancer. Therefore, using the combination of p53 and Ki-67 expression in discriminating low-risk luminal A breast cancer may improve the prognostic power and provide the greatest clinical utility.

Chest compression fraction: A time dependent variable of survival in shockable out-of-hospital cardiac arrest.

The role of chest compression fraction (CCF) in resuscitation of shockable out-of-hospital cardiac arrest (OHCA) is uncertain. We evaluated the relationship between CCF and clinical outcomes in a secondary analysis of the Resuscitation Outcomes Consortium PRIMED trial. We included patients presenting in a shockable rhythm who suffered OHCA prior to EMS arrival. Multivariable logistic regression was used to determine the relationship between CCF and survival to hospital discharge, return of spontaneous circulation (ROSC), and neurologically intact survival. We also performed a secondary analysis restricted to patients without ROSC in the first 10 min of EMS resuscitation. Among the 2011 patients, median (IQR) age was 65 (54, 75) years, 78.2% were male, and mean (SD) CCF was 0.71 (0.14). Compared to the reference group (CCF<0.60), the odds ratio (OR) for survival was 0.49 (95% CI: 0.36, 0.68) for CCF 0.60-0.79 and 0.30 (95% CI: 0.20, 0.44) for CCF≥0.80. Results were similar for outcomes of ROSC and neurologically intact survival. Conversely, when restricted to the cohort who did not achieve ROSC during the first 10 min (n=1633), compared to the reference group (CCF<0.60), the OR for survival was 0.79 (95% CI: 0.53, 1.18) for CCF 0.60-0.79 and OR 0.88 (95% CI: 0.56, 1.36) for CCF≥0.80. In this study of OHCA patients presenting in a shockable rhythm, CCF was paradoxically associated with lower odds of survival. CCF is a complex measure and taken by itself may not be a consistent predictor of good clinical outcomes.

Abstract P4-11-43: Ki-67 and p53 are useful factors to predict long term survival in low-risk luminal A breast cancer patients

Abstract Overexpression of p53 is the most frequent genetic alteration in breast cancer. Recently, many studies have shown that the expression of mutant p53 differs for each subtype of breast cancer and is associated with different prognoses. In this study, we aimed to determine the suitable cut-off value to predict the clinical outcome of p53 overexpression and its usefulness as a prognostic factor in each subtype of breast cancer, especially in luminal A breast cancer. Approval was granted by the Institutional Review Board of Samsung Medical Center. We analyzed a total of 7739 patients who were surgically treated for invasive breast cancer at Samsung Medical Center between Dec 1995 and Apr 2013. Luminal A subtype was defined as ER&amp;amp;PR + and HER2- and was further subclassified according to Ki-67 and p53 expression as follows: luminal A (Ki-67-,p53-), luminal A (Ki-67+, p53-), luminal A (Ki-67 -, p53+) and luminal A (Ki-67+, p53+). Low-risk luminal A subtype was defined as negative for both Ki-67 and p53 (luminal A (ki-67-, p53-)), and others subtypes were considered to be high-risk luminal A breast cancer. A cut-off value of 10% for p53 was a good predictor of clinical outcome in all patients and luminal A breast cancer patients. The prognostic role of p53 overexpression for OS and DFS was only significant in luminal A subtype. The combination of p53 and Ki-67 has been shown to have the best predictive power as calculated by the area under curve (AUC), especially for long-term overall survival. Table 1. Factors associated with overall survival in luminal A subtype breast cancer patients (N=3918). Univariable Multivariable* Factors HRP-value95% CI for HRHRP-value95% CI for HRBreast surgery TM- (ref.)- (ref.)- (ref.) BCS0.4430.03180.211-0.932 Presence of LVI No- (ref.)- (ref.)- (ref.) Yes4.783&amp;lt;0.00012.163-10.578 RM Positive2.7260.32690.367-20.244 Negative- (ref.)- (ref.)- (ref.) NG 1&amp;2- (ref.)- (ref.)- (ref.) 33.7930.00041.806-7.969 AJCC Stage 1- (ref.)- (ref.)- (ref.)- (ref.)- (ref.)- (ref.) 22.2830.16970.703-7.4161.7840.33800.546-5.833 312.967&amp;lt;0.00014.303-39.0839.912&amp;lt;0.00013.265-30.096Ki-67 Positive4.2940.00321.631-11.3032.5870.06030.960-6.971 Negative- (ref.)- (ref.)- (ref.)- (ref.)- (ref.)- (ref.)p53 Positive6.107&amp;lt;0.00012.905-12.8374.494&amp;lt;0.00012.105-9.594 Negative- (ref.)- (ref.)- (ref.)- (ref.)- (ref.)- (ref.)BCS, breast-conserving surgery; LVI, lymphovascular invasion; NG, nuclear grade; RM, resection margin; TM, total mastectomy; NG, LVI and total mastectomy were not significant in multivariable Cox analysis;* Cox-proportional hazard regression model. In this study, we have shown that overexpression of p53 and Ki-67 could be used to discriminate low-risk luminal A subtype in breast cancer. Therefore, using the combination of p53 and Ki-67 expression in discriminating low-risk luminal A breast cancer may improve the prognostic power and provide the greatest clinical utility. Citation Format: Ha Woo Yi, Se Kyung Lee, Soo Youn Bae, Jun Ho Lee, Hyun-Chul Lee, Won Ho Kil, Jeong Eon Lee, Seok Won Kim, Seok Jin Nam. Ki-67 and p53 are useful factors to predict long term survival in low-risk luminal A breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-11-43.