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Cardiac magnetic resonance to predict appropriate therapies in secondary prevention

Abstract Introduction Implantable cardioverter-defibrillator (ICD) therapy plays a pivotal role in the management of patient’s survivors of life-threatening ventricular arrhythmias (secondary prevention). Risk of recurrence may be related to presence of myocardial scar and its components (including core mass, border zone (BZ) mass, and BZ channels) assessed with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Purpose Our study aims to analyze the role of imaging in predicting the risk of recurrent ventricular arrhythmias and improving the risk stratification for appropriate ICD therapy in patients receiving an ICD for secondary prevention. Methods From 2015 to 2020, a total of 111 patients with LGE-CMR before ICD implantation for secondary prevention. Scar tissue including core, BZ and BZ channels were automatically detected by specialized investigational software in patients with LGE-CMR. Patients were followed until a new event was detected. Results The mean age was 65.4 ± 11.4 years; 87% were men; 55% had ischemic cardiomyopathy. The mean left ventricular ejection fraction was 37.8 % ± 14.31%. Patients were followed for a median of 3.26 years (IQR 1.4-4.9). Within the first year of follow-up 22% of patients had received an appropriate therapy, 39% within 3 years and 53% within 6 years. Chronic kidney disease and New York Heart Association (NYHA) class were associated with the primary endpoint [HR 1.94(1.06-3.55), P-value 0.032)] and [HR 1.86 (1.19-2.91), P-value 0.006)], respectively. Regarding CMR characteristics, BZ percentage was also associated with appropriate ICD therapy in the follow up [HR 1.04(1-1.08), P-value 0.048)]. Other CMR parameter, such as BZ mass, BZ core %, BZ core mass and core mass showed a trend to predict ICD therapies during follow-up. ROC curve analysis with Youden’s index defined an optimal BZ percentage cutoff value for recurrence prediction of 9.5% [HR 0.49 (0.28-0.85)]. Conclusion In patients receiving an ICD for secondary prevention, chronic kidney disease, NYHA class and BZ percentage analyzed by LGE-CMR were predictors of recurrent ventricular arrhythmia. A cutoff of BZ of 9.5% could be used to select patients with high risk of recurrence.

A Novel Classification for Predicting Chronic Total Occlusion Percutaneous Coronary Intervention

AimsChronic total occlusion (CTO) percutaneous coronary intervention (PCI) is characterized by a low success rate and an increase in complications. This study aimed to explore a new and simple classification method based on plaque composition to predict guidewire (GW) crossing within 30 min of CTO lesions.MethodsThis study consecutively enrolled individuals undergoing attempted PCI of CTO who underwent coronary computed tomographic angiography (CCTA) within 2 months. Lesions were divided into soft and hard CTO groups according to the necrotic core proportion.ResultsIn this study, 207 lesions were divided into soft (20.3%) and hard CTO (79.7%) groups according to a necrotic core percentage cutoff value of 72.7%. The rate of successful GW crossing within 30 min (57.6 vs. 85.7%, p = 0.004) and final success (73.3 vs. 95.2%, p = 0.001) were much lower in the hard CTO group. For patients with hard CTO, previous failed attempt, proximal side branch, bending > 45 degrees calcium ≥ 50% cross-sectional area (CSA), and distal reference diameter ≤ 2.5 mm were demonstrated to be associated with GW failure within 30 min. For patients with soft CTO, only blunt entry was proved to be an independent predictive factor of GW failure within 30 min.ConclusionsGrouping CTO lesions according to the proportion of necrotic core is reasonable and necessary in predicting GW crossing within 30 min. A soft CTO with a necrotic core is more likely to be recanalized compared with a hard CTO with fibrous and/or dense calcium. Different plaque types have variable predictive factors.

Blood eosinophil count combined with asthma history could predict chronic rhinosinusitis with nasal polyp recurrence

Background The use of non-invasive clinical markers for predicting CRS recurrence is still not well investigated. Objective The aim of this study was to investigate the comprehensive effects of non-invasive clinical markers on the recurrence of CRS with nasal polyps (CRSwNP). Materials and methods A total of 346 consecutive CRSwNP patients undergoing endoscopic functional sinus surgery were recruited. The demographic characteristics and clinical parameters were recorded. Machine learning algorithm were used for evaluating the predictive value of asthma history and blood eosinophils percentage. Results Finally, 313/346 patients completed the study. The average follow-up time was 24 months after the first surgery. For the CRSwNP with asthma patients, the blood eosinophils percentage cut-off value was 3.7%. However, for the CRSwNP without asthma patients, the blood eosinophils percentage cut-off value was high, at 6.9%. Conclusion Combined asthma history and blood eosinophils percentage can predict CRSwNP recurrence, while asthma history can reduce the threshold of blood eosinophils percentage to predict CRSwNP recurrence. Significance For the CRS patients, combined asthma history and blood eosinophils percentage can predict recurrence, while asthma history can reduce the threshold of blood eosinophils percentage to predict recurrence.

MP11-19 LYMPHOVASCULAR INVASION AND PRESENCE OF EMBRYONAL CARCINOMA AS RISK FACTORS FOR OCCULT METASTASES IN CLINICAL STAGE I NONSEMINOMATOUS GERM CELL TUMOR: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer I (MP11)1 Apr 2020MP11-19 LYMPHOVASCULAR INVASION AND PRESENCE OF EMBRYONAL CARCINOMA AS RISK FACTORS FOR OCCULT METASTASES IN CLINICAL STAGE I NONSEMINOMATOUS GERM CELL TUMOR: A SYSTEMATIC REVIEW AND META-ANALYSIS Joost Blok*, Ilse Pluim, Gedske Daugaard, Thomas Wagner, Katarzyna Jozwiak, Erica Wilthagen, Leendert Looijenga, Ruud Bosch, Simon Horenblas, and Richard Meijer Joost Blok*Joost Blok* More articles by this author , Ilse PluimIlse Pluim More articles by this author , Gedske DaugaardGedske Daugaard More articles by this author , Thomas WagnerThomas Wagner More articles by this author , Katarzyna JozwiakKatarzyna Jozwiak More articles by this author , Erica WilthagenErica Wilthagen More articles by this author , Leendert LooijengaLeendert Looijenga More articles by this author , Ruud BoschRuud Bosch More articles by this author , Simon HorenblasSimon Horenblas More articles by this author , and Richard MeijerRichard Meijer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000831.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The presence of lymphovascular invasion (LVI) and embryonal carcinoma (EC) are important factors that aid clinical decision-making in patients with clinical stage I (CS I) nonseminomatous germ cell tumor (NSGCT). Several studies have investigated the association between these predictors and occult metastasis. A systematic review with meta-analysis is necessary to quantify the strength of these predictors more precisely. Our aim was to review the literature on the prognostic value of LVI and EC for occult metastasis in CS I NSGCT. In particular, we aimed to compare the prognostic value of two different methods of EC assessment. METHODS: The Pubmed, Embase (OVID) and SCOPUS databases were searched up to March 2019. Studies reporting on the association between LVI and/or EC and occult metastasis were considered for inclusion. EC was assessed as EC predominance (presence of >50% EC in the primary tumor) or as EC presence (without a percentage cut-off value). The meta-analysis was performed using Cochrane's Review Manager tool. The PRISMA guidelines were followed and risk of bias was evaluated using the Quality in Prognosis Studies tool. RESULTS: We screened 5,287 abstracts and 207 full-text articles. We included 35 studies in the narrative synthesis and 24 studies in one of the meta-analyses. LVI showed the strongest effect. Pooled rates of occult metastasis were 47.5% and 16.9% for LVI positive and LVI negative patients, respectively (OR 4.33; 95% CI 3.55-5.30; p<0.001). Presence of EC showed a significantly higher pooled rate of occult metastasis (33.2%), compared to EC absence (16.2%; OR 2.49; 95% CI; 1.64-3.77; p<0.001). For EC predominance, defined as >50%, the pooled rate of occult metastasis was 40.0%. This was significantly higher than patients without EC predominance (20.0%; OR 2.62; 95% CI 1.93-3.56; p<0.001). The risk of bias was moderate or high for all studies. CONCLUSIONS: LVI is the strongest risk factor for relapse. The prognostic value of EC is high, but there is no common agreement on how to define this risk factor. EC presence and EC>50% have similar ORs for occult metastasis. This suggests that the assessment of EC presence is sufficient for risk stratification. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e142-e143 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joost Blok* More articles by this author Ilse Pluim More articles by this author Gedske Daugaard More articles by this author Thomas Wagner More articles by this author Katarzyna Jozwiak More articles by this author Erica Wilthagen More articles by this author Leendert Looijenga More articles by this author Ruud Bosch More articles by this author Simon Horenblas More articles by this author Richard Meijer More articles by this author Expand All Advertisement PDF downloadLoading ...

PERIPHERAL BLOOD TH17 SUBSETS IN PATIENTS WITH MULTIPLE SCLEROSIS

Using multicolor flow cytometry four main Th17 subsets were identified within total CCR6-expressing Th cell in peripheral blood from patients with multiply sclerosis (MS, n = 26) and healthy control subjects (HC, n = 44). MS showed significantly higher frequencies of CCR6+DP and “classical” Th17 subsets, while the level of Th17.1 was significantly decreased if compared to HC. Correlation analysis revealed a significant relationship between the decrease of CCR6+DN Th17 subset and EDSS worsening (r = -0.456, p = 0.022). The area under the ROC curve (AUC) for the percentage of “classical” Th17 within CCR6+ Th as a predictor of MS was 0.948 (0.882 to 1.014, p &lt; 0.001) and for Th17.1 cells - 0.937 (0.863 to 1.011, p &lt; 0.001). The optimal cutoff value for percentage of “classical” Th17 for predicting MS was 31.55% within CCR6+ Th cells with 88.0% sensitivity and 95.45% specificity, while for Th17.1 - 38.66% within CCR6+ Th cells with 88.0% sensitivity and 95.45% specificity. Our data indicate that the relative numbers of “classical” Th17 and Th17.1 within CCR6+ Th cells were effective in discrimination between MS and HC groups.

Immunohistochemistry Study of P53 and C-erbB-2 Expression in Trophoblastic Tissue and Their Predictive Values in Diagnosing Malignant Progression of Simple Molar Pregnancy.

BackgroundFinding a tumor marker to predict the aggressive behavior of molar pregnancy in early stages has yet been a topic for studies.ObjectivesIn this survey we planned to study patients with molar pregnancy to 1) assess the p53 and c-erbB-2 expression in trophoblastic tissue, 2) to study the relationship between their expression intensity and progression of a molar pregnancy to gestational trophoblastic neoplasia, and 3) to determine a cut off value for the amount of p53 and c-erbB-2 expression which might correlate with aggressive behavior of molar pregnancy.Patients and MethodsIn a prospective cross sectional study by using a high accuracy technique EnVision Tm system for immunohistochemistry staining of molar pregnancy samples, we evaluated p53 and c-erbB-2 expression in cytotrophoblast and syncytiotrophoblast and the correlation of their expression with progression of molar pregnancy to gestational trophoblastic neoplasia (GTN). Normal prostatic tissue and Breast cancer tissue were used as positive controls.ResultsWe studied 28 patients with simple molar pregnancy (SMP) and 30 with GTN. Cytotrophobalst had significantly higher expression of p53 and c-erbB-2 and syncytiotrophoblast had greater expression of p53 in GTN group as compared to SMP group. The cut off values for percentage of p53 positive immunostained cytotrophoblast and syncytiotrophoblast were 5.5% and 2.5%. In c-erbB-2 positive membranous stained cytotrophoblast the cut off was 12.5%.ConclusionsOur data suggests that over expression of p53 and c-erbB-2 is associated with malignant progression of molar pregnancy. We encountered that high expression of p53 and c-erbB-2 in trophoblastic cells could predict gestational trophoblastic neoplasia during the early stages.

The Cutoff Value in Body Fat Percentage for Increased Risk of Metabolic Syndrome in Elderly People With Normal Body Weight

Background: In this study, we identified the cutoff value for the percentage in body fat related to metabolic syndrome in elderly people with normal body mass index (BMI). We also found the correlation between body fat percentage and metabolic syndrome. Methods: We used data from the Korean National Health and Nutrition Examination Survey conducted from 2008 to 2011. Our subjects were elderly people aged 65 or above, with BMI less than 23.0 kg/m 2 . We determined the cutoff value for body fat percentage through receiver operating characteristic analysis. Results: The cutoff value for percentage body fat related to metabolic syndrome was 19.5% for men (sensitivity 68.0%, specificity 62.9%) and 30.0% for women (sensitivity 55.1%, specificity 62.0%). Based on the cutoff value, 43.3% in men and 43.1% in women were classified into the high body fat percentage group. After adjusting for age, smoking status, alcohol consumption, and exercise status, the men with higher than normal body fat percentage had an odds ratio of 3.61 (95% confidence interval [CI], 2.10-6.22; p<0.001) for developing metabolic syndrome, whereas women had an odds ratio of 1.95 (95% CI, 1.30-2.92; p<0.001). Conclusion: The cutoff value for body fat percentage related to metabolic syndrome was lower in elderly. In the elderly with normal body mass index, high percentage of body fat percentage was associated with a high risk of metabolic syndrome.

Weight Loss Percentage Prediction of Subsequent Neonatal Hyperbilirubinemia in Exclusively Breastfed Neonates

The incidence of neonatal hyperbilirubinemia in our hospital has increased since the implementation of breastfeeding promotion. Inadequate breastfeeding results in reduced calorie intake, weight loss and neonatal hyperbilirubinemia. Supplementary feeding is required if breastfeeding proves inadequate. However, the optimal weight loss cut-off value for supplementary feeding is unknown. We collected records for all healthy neonates with a gestational age ≥35 weeks and birth body weight (BBW) above 2500g, born between March 2002 and July 2005, from our nursery. A total of 1979 neonates were reviewed, 874 of whom were exclusively breastfed and subsequently enrolled in this study. Only infants who were breastfed exclusively were enrolled; 219 of these infants (25.1%) presented significant hyperbilirubinemia after 72 hours of age. Infants with early-onset (<48 hours) hyperbilirubinemia or any known risk factors for neonatal hyperbilirubinemia were excluded. We analyzed the association between weight loss percentage and hyperbilirubinemia and investigated the best weight loss percentage cut-off value for the prediction of subsequent hyperbilirubinemia before 2 weeks of age. Neonates with lower gestational age and greater weight loss percentage were associated with hyperbilirubinemia. By using weight loss ≥8% of BBW after 48 hours and weight loss ≥11% of BBW after 72 hours as the cut-off values for the prediction of subsequent hyperbilirubinemia, negative predictive values were 77.7% and 76.8%, respectively. This study documented the relationship between weight loss percentage and subsequent hyperbilirubinemia incidence. Our data provide a basis for determination of an optimal weight loss percentage cut-off value that indicates supplementary feeding.

Fat mass threshold associated with a significant deterioration of insulin sensitivity in postmenopausal women

The aim of this study was to establish a cut-off value of percentage of fat mass (%FM) at which insulin sensitivity (IS) is significantly altered in sedentary postmenopausal women. Our results suggest that maintaining a %FM below 41% would minimize the deterioration of IS and its associated risks.

NT-ProBNP Reduction Percentage During Admission for Acutely Decompensated Heart Failure Predicts Long-Term Cardiovascular Mortality

Background N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied. Methods and Results This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond ( P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors ( P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03). Conclusion NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.

Evaluation of a blocking ELISA for the detection of bovine viral diarrhoea virus (BVDV) antibodies in serum and milk

The performance characteristics of a blocking ELISA test applied to serum and individual milk for the detection of antibodies to bovine viral diarrhoea virus (BVDV) were assessed using 1189 matched milk/serum samples collected from cows of 42 dairy herds located in Brittany (west of France). This test was based on a monoclonal antibody directed against non-structural protein NS2-3 of pestiviruses. All tests were performed blind. For each type of sample, negative/positive cut-off values were determined using receiver operating characteristic (ROC) analysis. Sensitivity and specificity were estimated using the virus neutralisation test as a reference. For sera, the ROC analysis provided a negative/positive inhibition percentage cut-off value of 50% giving a sensitivity and a specificity of 96.9 and 97.8%. For individual milk samples, the cut-off was fixed at 30%, leading to a sensitivity and a specificity of 96.9 and 97.3%. Using this test, a good overall agreement was found between results obtained on matched milk/serum samples ( Kappa value =0.95) . The present results indicate that this blocking ELISA test is reliable enough for use in a mass screening and control scheme on BVDV.