Effects Of Clinical Characteristics Research Articles

Temporal change of DNA methylation subclasses between matched newly diagnosed and recurrent glioblastoma

The longitudinal transition of phenotypes is pivotal in glioblastoma treatment resistance and DNA methylation emerged as an important tool for classifying glioblastoma phenotypes. We aimed to characterize DNA methylation subclass heterogeneity during progression and assess its clinical impact. Matched tissues from 47 glioblastoma patients were subjected to DNA methylation profiling, including CpG-site alterations, tissue and serum deconvolution, mass spectrometry, and immunoassay. Effects of clinical characteristics on temporal changes and outcomes were studied. Among 47 patients, 8 (17.0%) had non-matching classifications at recurrence. In the remaining 39 cases, 28.2% showed dominant DNA methylation subclass transitions, with 72.7% being a mesenchymal subclass. In general, glioblastomas with a subclass transition showed upregulated metabolic processes. Newly diagnosed glioblastomas with mesenchymal transition displayed increased stem cell-like states and decreased immune components at diagnosis and exhibited elevated immune signatures and cytokine levels in serum. In contrast, tissue of recurrent glioblastomas with mesenchymal transition showed increased immune components but decreased stem cell-like states. Survival analyses revealed comparable outcomes for patients with and without subclass transitions. This study demonstrates a temporal heterogeneity of DNA methylation subclasses in 28.2% of glioblastomas, not impacting patient survival. Changes in cell state composition associated with subclass transition may be crucial for recurrent glioblastoma targeted therapies.

Factors affecting long-term prognosis in adult patients with psychogenic non-epileptic seizures.

<p>Among epileptic patients who are monitored using the video-electroencephalography monitoring (VEM) technique, in some patients a psychogenic non-epileptic seizure (PNES) can be identified as a definitive diagnosis. The long-term prognosis of these patients is not well known. In this study, we aimed to determine the factors that affect the prognosis of PNES.</p>. <p>Forty-one PNES patients diagnosed using VEM between 2012 and 2022 were questioned about their PNES frequencies in the last 12 months. According to their semiological characteristics, PNES types were divided into motor and non-motor seizures. The effects of clinical characteristics (e.g. age, gender, marital status, education level and PNES type) on the prognoses were identified.&nbsp;</p>. <p>Twenty-one PNES patients (51.2%) had long-term seizure freedom after VEM. Thirteen of them (31.7%) entered the seizure-free period immediately after VEM, and the other eight (19.5%) continued suffering from PNES for several years and became seizure free in the last 12 months. In the poor-prognosis group, female cases showed worse prognoses than male cases. The prognoses of motor and non-motor PNES types did not show significant differences.&nbsp;</p>. <p>This study showed that 51.2% of the PNES patients examined had long-term seizure freedom and that female patients had worse prognoses than male patients.</p>.

남성의 텔로미어 길이에 임상적 특성, 혈압 및 심폐체력이 미치는 영향

이 연구는 혈압과 심폐체력 수준이 텔로미어 길이에 미치는 영향을 분석하기 위하여 실시되었다. 20세 이상의 남성 308명을 대상으로 실시되었으며, 혈압수준에 따라 정상군, 고혈압 전단계군, 고혈압군으로 분류하고, 심폐체력 수준은 각 연령대의 50% 수준을 기준으로 체력수준이 낮은군과 체력수준이 높은군으로 구분하여 신체구성, 혈압, 심폐체력 및 텔로미어 길이를 분석하였다. 혈압수준에 따라 연령, 신체구성, 심폐체력 및 텔로미어 길이는 유의한 차이를 나타내었으며, 정상군이 고혈압 전단계군과 고혈압군에 비하여 연령, 신체구성 요인(체중, 체질량지수, 근육량, 체지방률, 허리둘레) 및 혈압수준은 낮은 것으로 나타났고(p.01), 심폐체력은 높고 텔로미어 길이는 긴 것으로 나타났다(p.001). 심폐체력 수준을 20대 젊은 남성(20~29세)과 40세 이상 중년 남성(40~52세)으로 구분하여 분석한 결과, 20대 젊은 남성은 체력수준에 따라 체지방률과 텔로미어 길이를 제외한 모든 변인에서 유의한 차이를 나타냈으며(p.001), 40세 이상 중년 남성은 연령, 허리둘레, 텔로미어 길이가 유의한 차이를 나타내었다(p.05). 혈압, 심폐체력 및 텔로미어 길이는 전체 대상자 분석에서 연령, 신체구성, 혈압 및 심폐체력과 관련성이 있는 것으로 나타났으며(p.05), 연령별로는 20대 젊은 남성은 신체구성이 텔로미어 길이에 영향을 주고, 40세 이상 중년 남성에서는 심폐체력이 텔로미어 길이에 영향을 주는 것으로 나타났다(p.05). 이상의 결과를 종합해보면, 연령 증가에 따라 텔로미어 길이는 감소하지만 연령대별로 영향을 주는 변인들은 다르게 나타나며, 신체구성이 혈압이나 심폐체력뿐만 아니라 텔로미어 길이와도 관련성이 있는 것으로 나타났으므로 규칙적인 운동을 통한 전반적인 변인들에 대한 관리가 필요할 것으로 생각된다.

Effect of clinical characteristics on terminal ileum length in right hemicolectomy for primary right colon adenocarcinoma

Effect of clinical characteristics on terminal ileum length in right hemicolectomy for primary right colon adenocarcinoma

The influence of clinical characteristics on prism adaptation training in visuospatial neglect: A post-hoc analysis of a randomized controlled trial

Previous studies indicate that the effect of prism adaptation training (PAT) on unilateral neglect may depend on clinical characteristics. In this explorative work, we re-analyzed data from a previously conducted randomized controlled trial (N = 23) to investigate whether age, etiology, severity of motor impairments, and visual field deficits affect the efficacy of PAT. Additionally, we reviewed PAT studies that reported lesion maps and distinguished responders from non-responders. We transferred these maps into a common standard brain and added data from 12 patients from our study. We found patients suffering from subarachnoid bleeding appeared to show stronger functional recovery than those with intracranial hemorrhage or cortical infarction. Furthermore, patients with visual field deficits and those with more severe contralateral motor impairments had larger after-effect sizes but did not differ in treatment effects. In addition, patients with parietal lesions showed reduced recovery, whereas patients with lesions in the basal ganglia recovered better. We conclude that PAT (in its current form) is effective when fronto-subcortical areas are involved but it may not be the best choice when parietal regions are affected. Overall, the present work adds to the understanding on the effects of clinical characteristics on PAT.

Evaluation of the effect of clinical characteristics and intensive care treatment methods on the mortality of covid-19 patients aged 80\u2009years and older

BackgroundOlder adults have an increased risk of mortality from Coronavirus disease 2019 (Covid-19). Despite the high number of publications on the topic of Covid-19 pandemic, few studies have focused on the intensive care treatments of Covid-19 patients aged 80 years and older.The goal of our study is to investigate the effect of the intensive care treatments on the mortality of Covid-19 patients aged 80 years and older based on their clinical features, laboratory findings and the intensive care treatments methods.MethodsThe data of 174 patients aged 80 years and older treated from Covid-19 in intensive care unit were assessed retrospectively. The patients were divided into two groups as survivor and non-survivor. The effects of age, gender, length of stay, comorbid diseases, laboratory values, thoracic computed tomography findings, having invasive mechanical ventilation (IMV), high flow nasal cannula (HFNC) and/or non-invasive mechanical ventilation (NIMV), hemodiafiltration (HDF), anti-cytokines and plasma therapy on mortality have been investigated.ResultsThe mean age and mean values of CRP, PCT, Ferritin, LDH were statistically significantly high in the non-survivor group. The mortality rate of the patients who had IMV was also statistically significantly higher compared to patients who had HFNC and/or NIMV. Albumin level and the rate of treatment with HFNC and/or NIMV were statistically significantly low in non-survivor group compared to the Survivor group.ConclusionICU treatments may be beneficial for the Covid-19 patients aged 80 years and older. Increased age, high levels of CRP, PCT, ferritin, and having IMV are detected as poor outcome markers.

Outcomes for cancer patients on systemic anti-cancer therapies during the COVID-19 pandemic from the CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London) cohort study.

10567 Background: One of the major challenges with COVID-19 has been the changes to cancer services, including changes to the type of systemic anti-cancer treatment being delivered to patients. There needs to be a better understanding of which cancer patients are at the greatest amount of risk to make informed decisions on how cancer treatment can be altered to protect patients from COVID-19 infection. The CAPITOL (COVID-19 CAncer PatIenT Outcomes in North London) study investigated the outcomes of patients receiving systemic anti-cancer therapies (SACT) with regards to COVID-19 infection, as patients with cancer are hypothesised to be at higher risk. Methods: CAPITOL collected data from all patients receiving SACT at two cancer centres. The effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT was the primary outcome, and we used univariable and multivariable models in our analysis, adjusting for age, gender and comorbidities. Results: 2871 patients were analysed from 2nd March to 31st May 2020, all of whom received SACT; during this time period 68 (2.4%) were diagnosed with COVID-19. Receiving SACT increased the risk of death when contracting COVID-19 (adjusted (adj.) OR 9.84; 95% CI 5.73 – 16.9). The risk of contracting COVID-19 was increased by receiving chemotherapy (adj. OR 2.99; 95% CI = 1.72 - 5.21), with the risk significantly increased by high dose chemotherapy (adj. OR 2.36, 95% CI 1.35 – 6.48). Patients with comorbidities (adjusted OR 2.29; 95% CI 1.19 - 4.38), or with a respiratory or intrathoracic neoplasm (adj. OR 2.12; 95% CI 1.04 - 4.36) were also at increased risk of contracting COVID-19. Cancer patients who received targeted treatment had a reduced risk of contracting COVID-19 (adj. OR 0.53; 95% CI 0.30 – 0.95), while there was no significant change in risk caused by treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers. Conclusions: To the best of our knowledge, this is one of the first investigations into the risk of contracting COVID-19 in a cohort of all cancer patients on SACT. We found that patients on SACT are more likely to die if they contract COVID-19. The type of SACT received by cancer patients can affect their likelihood of contacting COVID-19, with chemotherapy increasing risk, targeted therapy decreasing risk and a potential protective effect for hormonal and immunotherapy.

Outcomes of newly diagnosed acute myeloid leukemia with myelodysplasia related changes and elderly acute myeloid leukemia following decitabine therapy in combination with priming regimen

ABSTRACT Objectives This study investigates efficacy of decitabine and priming regimen in treating newly diagnosed acute myeloid leukemia with myelodysplasia related changes (AML-MRC) and elderly AML. Methods Totally 69 newly diagnosed AML-MRC and elderly AML treated with decitabine and priming regimen were enrolled. The effects of clinical characteristics, gene mutations and karyotype on remission rate and overall survival were investigated, as well as the effects of allogeneic hematopoietic stem cell transplantation on survival after remission. Results There were 39 and 10 cases achieving complete remission (CR) and partial remission (PR), respectively, with CR rate of 56.5% and overall response (OR) rate of 71%. Moreover, 15 cases had no response (NR), with NR rate of 21.7%. There were 5 cases of death within 4 weeks after treatment, with early mortality rate of 7.2%. The factors of peripheral white blood cell count, bone marrow blast proportion, doubling of platelets after treatment, and co-mutation of three or more myeloid genes, significantly affected CR and OR rates, while age significantly affected OR rate. TP53 mutation and platelets not doubling after treatment were independent prognostic factors affecting overall survival. Conclusion Combination of decitabine and priming regimen is effective in treating newly diagnosed AML-MRC and elderly AML.

Predictors of discordance between fractional flow reserve and resting full-cycle ratio in patients with coronary artery disease: Evidence from clinical practice

BackgroundFractional flow reserve (FFR) is an established method for assessing functional myocardial ischemia. Recently, the resting full-cycle ratio (RFR) has been introduced as a non-hyperemic index of functional coronary stenosis. However, the effects of clinical characteristics on discordance between RFR and FFR have not been fully evaluated. We aimed to identify clinical characteristics that influence FFR–RFR concordance. MethodsWe included 410 patients with 573 intermediate coronary lesions who underwent clinically indicated invasive coronary angiography, as well as assessments of FFR and RFR. Receiver-operating characteristic (ROC) curves were created to assess the optimal cut-off values of RFR for predicting FFR ≤0.80. ResultsRFR exhibited a strong correlation with FFR (r = 0.66, p < 0.0001). ROC analysis identified an optimal RFR cut-off value of 0.92 for categorization based on an FFR cut-off value of 0.8. The discordance of FFR >0.8 and RFR ≤0.92 (high FFR/low RFR) was observed in 112 lesions (20.9%), whereas the discordance of FFR ≤0.8 and RFR >0.92 (low FFR/high RFR) was observed in 35 lesions (6.5%). Higher rate of hemodialysis and lower hemoglobin levels were observed in the high FFR/low RFR group. Multivariate analyses identified female sex, left anterior descending artery (LAD) lesions, and hemodialysis as significant predictors of high FFR/low RFR. Conversely, body surface area and non-LAD lesions were significantly associated with low FFR/high RFR. Hemodialysis [odds ratio (OR): 2.41, 95% confidence interval (CI) 1.31–4.41; p = 0.005] and LAD lesions (OR: 1.86, 95% CI: 1.25–2.79; p = 0.002) were identified as independent predictors of overall FFR–RFR discordance. ConclusionsRFR exhibited good diagnostic performance in the identification of functionally significant stenosis. However, RFR may overestimate functional severity in patients undergoing hemodialysis or in those with LAD lesions. Further prospective trials are required to demonstrate the non-inferiority of RFR to FFR.

COVID-19 in Cancer Patients on Systemic Anti-Cancer Therapies – Outcomes from CAPITOL (COVID-19 Cancer PatIenTOutcomes in North London)

Background: Patients with cancer are hypothesised to be at increased risk of contracting COVID-19, leading to changes in treatment pathways in those treated with systemic anti-cancer treatments (SACT). We investigated the outcomes of patients receiving SACT to assess whether they were at greater risk of contracting COVID-19 or having more severe outcomes. Methods: We collected data on all patients receiving SACT in two cancer centres as part of CAPITOL (COVID-19 CAncer PatIenT Outcomes in North London). The primary outcome was the effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT. We used univariable and multivariable models to analyse outcomes, adjusting for age, gender and comorbidities. Findings: We analysed 2871 patients receiving SACT from 2nd March to 31st May 2020; 68 (2.4%) were diagnosed with COVID-19. Cancer patients receiving SACT were more likely to die if they contracted COVID-19 than those who did not (adjusted (adj.) OR 9·84; 95% CI 5·73 – 16·9). Receiving chemotherapy increased the risk of developing COVID-19 (adj. OR 2·99; 95% CI = 1·72 - 5·21), with high dose chemotherapy significantly increasing risk (adj. OR 2·36, 95% CI 1·35 – 6·48), as did the presence of comorbidities (adjusted OR 2·29; 95% CI 1·19 - 4·38), and having a respiratory or intrathoracic neoplasm (adj. OR 2·12; 95% CI 1·04 - 4·36). Receiving targeted treatment had a protective effect (adj. OR 0·53; 95% CI 0·30 – 0·95). Treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers had no significant effect on risk. Interpretation: Patients on SACT are more likely to die if they contract COVID-19. Those on chemotherapy, particularly high dose chemotherapy, are more likely to contract COVID-19, while targeted treatment appears to be protective. Funding: None.Declaration of Interests: NJH reports grants from CRUK Clinical Trial Fellowship, outside the submitted work. VEC, WW, TAF, SD, JB KK, DH, KKS, RK, NC, MD, EB, JB, MF and DH have no conflicts of interest to disclose. Ethics Approval Statement: Research and development approval were sought from University College Hospital, which is where the study was primarily conducted, the ethical approval was granted by the ethics committee of University College London Hospital NHSFoundation Trust.

Determinants of cerebral radiological progression in Fabry disease

Background and aimIt is unclear which patients with Fabry disease (FD) are at risk for progression of white matter lesions (WMLs) and brain infarctions and whether enzyme replacement therapy (ERT)...

What are the determinants of explicit and implicit motor imagery ability in stroke patients?: a controlled study

Purpose: The purposes of the study were to (a) investigate both explicit and implicit motor imagery ability (MIA) impairment after stroke, (b) examine predictive effects of clinical characteristics for MIA after stroke.Materials and Methods: Forty one patients with stroke (PwS) (mean age 59.41 ± 10.19 years; %41 female) and 36 healthy participants (mean age 62.47 ± 9.29 years; %47 female) completed Chaotic Motor Imagery Assessment-Hand Rotation for implicit MIA and Movement Imagery Questionnaire-3 (MIQ-3) and Box and Block Test (BBT) for explicit MIA. The severity of motor and sensory impairments were determined by the Fugl-Meyer Assessment-Upper Extremity (FMAUE) scores. The Turkish version of Motor Activity Log-28 was used to assess amount of use (AUS) and quality of movement in daily life.Results: Our results indicated that both implicit and explicit MIA (except kinaesthetic imagery of MIQ-3) in PwS were statistically impaired compared to controls (p < 0.05). The sensorimotor impairment level, amount of use and movement quality of the affected upper limb were found to be correlated with MIA in various degrees. Total motor scores in FMAUE and AUS were significant predictors of explicit MIA (p < 0.01). Additionally, explicit MIA scores of stroke subgroups were statistically different between severely and mildly impaired patients, in favour of mildly impaired group (p < 0.05).Conclusion: In conclusion, both motor impairment level and amount of daily use of upper extremity were found to be predictive factors for explicit MIA. Further investigation with brain imaging techniques is needed to explore the validity of these findings in establishing MIA.

Cognitive function characteristics in patients with myasthenia gravis

Objective To evaluate the cognitive function characteristics in patients with myasthenia gravis(MG). Methods The cognitive function of 83 MG patients and 39 healthy controls (HC) were evaluated by MMSE, California verbal learning test( CVLT), brief visuospatial memory test revised(BVMT-R), symbol digit modalities test(SDMT), benton judgment of line orientation test(BJLOT), paced auditory serial addition Test(PASAT) and verbal fluency test(VFT). The depression state was assessed by beck depression inventory (BDI). The results were compared between MG and HC groups.The effect of clinical characteristics such as disease type, comorbidities, course of disease, disease severity, and drug treatment on cognitive impairment in MG group was further analysed. Results The scale scores of MMSE(28(26, 29), 29(28, 30)), CVLT, BVMT-R, SDMT((37.06±12.18), (47.54±14.91)) and PASAT((32.86±10.23), (37.00±8.82)) in MG were significantly lower than those in control group (P 0.05). Spearman correlation analysis showed that QMG scores were negatively correlated with SDMT scores(r=-0.234, P<0.05). MG-ADL scores were inversely correlated with total BVMT-R scores of three trials(r=-0.283, P<0.05). Conclusion Patients with MG suffered from cognitive impairment, mainly in memory, attention, processing speed and visual memory, which supported the hypothesis of CNS involvement in MG.Dysfunction in some cognitive domains may be related to the disease severity.Clinicians need take morce attention to early assessment, developing long-term follow-ups and appropriate intervention. Key words: Myasthenia gravis; Neuropsychology; Cognitive function; Depression

COVID-19 in cancer patients on systemic anti-cancer therapies: outcomes from the CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London) cohort study.

Background:Patients with cancer are hypothesised to be at increased risk of contracting COVID-19, leading to changes in treatment pathways in those treated with systemic anti-cancer treatments (SACT). This study investigated the outcomes of patients receiving SACT to assess whether they were at greater risk of contracting COVID-19 or having more severe outcomes.Methods:Data was collected from all patients receiving SACT in two cancer centres as part of CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London). The primary outcome was the effect of clinical characteristics on the incidence and severity of COVID-19 infection in patients on SACT. We used univariable and multivariable models to analyse outcomes, adjusting for age, gender and comorbidities.Results:A total of 2871 patients receiving SACT from 2 March to 31 May 2020 were analysed; 68 (2.4%) were diagnosed with COVID-19. Cancer patients receiving SACT were more likely to die if they contracted COVID-19 than those who did not [adjusted (adj.) odds ratio (OR) 9.84; 95% confidence interval (CI) 5.73–16.9]. Receiving chemotherapy increased the risk of developing COVID-19 (adj. OR 2.99; 95% CI = 1.72–5.21), with high dose chemotherapy significantly increasing risk (adj. OR 2.36, 95% CI 1.35–6.48), as did the presence of comorbidities (adj. OR 2.29; 95% CI 1.19–4.38), and having a respiratory or intrathoracic neoplasm (adj. OR 2.12; 95% CI 1.04–4.36). Receiving targeted treatment had a protective effect (adj. OR 0.53; 95% CI 0.30–0.95). Treatment intent (curative versus palliative), hormonal- or immunotherapy and solid versus haematological cancers had no significant effect on risk.Conclusion:Patients on SACT are more likely to die if they contract COVID-19. Those on chemotherapy, particularly high dose chemotherapy, are more likely to contract COVID-19, while targeted treatment appears to be protective.

Effects of Clinical Characteristics, Laboratory Parameters and Treatment Regimens on Prognosis of Patients with Multiple Myeloma

To study the effects of clinicopathological features, laboratory parameters and treatment regimens on the prognosis of patients with multiple myeloma. The clinical data of 97 patients with multiple myeloma treated with chemotherapy in Department of Hematology, the 1st Hospital of Hainan Medical College were analyzed retrospectively. The clinicopathological features (age, sex, severe anemia, light chain type, hypoproteinemia, paraplegia, renal injury, amyloidosis, complex karyotype, bone disease classification, Eastern Cooperative Oncology Group (ECOG) physical status score, complete remission, etc.), laboratory parameters (C-reactive protein, lactate dehydrogenase, blood calcium, serum β2 microglobulin, etc.), and treatment schemes (thalidomide maintenance treatment) were recorded. The patients were followed up for 1-60 months, and their total survival time were recorded. A single factor and multiple factors were used to analyze the factors affecting the total and early mortality of the patients. The survival curves were plotted by the Kaplan-Meier method and the survival analysis was carried out by Log-rank test. Among 97 patients, 29 cases (29.90%) achieved complete remission, and 56 cases (57.73%) achineved partial remission. The total effective rate was 87.63% (85/97). At the end of the follow-up, 19 cases (19.59%) died, and 1, 3 and 5 year survival rates were 80.41%, 71.13% and 37.11% respectively. The median overall survival time was 29 (1-60) months. The results of single factor analysis showed that age, hypoproteinemia, severe anemia, paraplegia, renal injury, amyloidosis, complex karyotype, complete remission and thalidomide maintenance therapy were the factors affecting the prognosis of the patients (all P＜0.05). Further multiple factor Logistic regression analysis showed that age and hypoproteinemia, severe anemia, paraplegia, amyloidosis, complex karyotype and thalidomide maintenance treatment were factors affecting the prognosis (P＜0.05). Of the 97 patients, 8 cases died early. The results of single factor analysis showed that amyloidosis and severe anemia were risk factors for early death (all P＜0.05), and further multivariate Logistic regression analysis showed that amyloidosis was an independent risk factor for early death (P＜0.05). There are many adverse factors affecting the prognosis of patients with multiple myeloma, such as age, hypoproteinemia, severe anemia, paraplegia, amyloidosis, complex karyotype and so on. The risk of early death in the patients with amyloidosis is higher, and salidomide maintenance therapy can help to prolong the life span of the patient.

Prediction of Aneurysm Stability Using a Machine Learning Model Based on PyRadiomics-Derived Morphological Features.

Background and Purpose- Discrimination of the stability of intracranial aneurysms is critical for determining the treatment strategy, especially in small aneurysms. This study aims to evaluate the feasibility of applying machine learning for predicting aneurysm stability with radiomics-derived morphological features. Methods- Morphological features of 719 aneurysms were extracted from PyRadiomics, of which 420 aneurysms with Maximum3DDiameter ranging from 4 mm to 8 mm were enrolled for analysis. The stability of these aneurysms and other clinical characteristics were reviewed from the medical records. Based on the morphologies with/without clinical features, machine learning models were constructed and compared to define the morphological determinants and screen the optimal model for predicting aneurysm stability. The effect of clinical characteristics on the morphology of unstable aneurysms was analyzed. Results- Twelve morphological features were automatically extracted from PyRadiomics implemented in Python for each aneurysm. Lasso regression defined Flatness as the most important morphological feature to predict aneurysm stability, followed by SphericalDisproportion, Maximum2DDiameterSlice, and SurfaceArea. SurfaceArea (odds ratio [OR], 0.697; 95% CI, 0.476-0.998), SphericalDisproportion (OR, 1.730; 95% CI, 1.143-2.658), Flatness (OR, 0.584; 95% CI, 0.374-0.894), Hyperlipemia (OR, 2.410; 95% CI, 1.029-5.721), Multiplicity (OR, 0.182; 95% CI, 0.082-0.380), Location at middle cerebral artery (OR, 0.359; 95% CI, 0.134-0.902), and internal carotid artery (OR, 0.087; 95% CI, 0.030-0.211) were enrolled into the final prediction model. In terms of performance, the area under curve of the model reached 0.853 (95% CI, 0.767-0.940). For unstable aneurysms, Compactness1 (P=0.035), Compactness2 (P=0.036), Sphericity (P=0.035), and Flatness (P=0.010) were low, whereas SphericalDisproportion (P=0.034) was higher in patients with hypertension. Conclusions- Morphological features extracted from PyRadiomics can be used for aneurysm stratification. Flatness is the most important morphological determinant to predict aneurysm stability. Our model can be used to predict aneurysm stability. Unstable aneurysm is more irregular in patients with hypertension.

Effect of clinical characteristics on relapse of alcohol dependence: a prospective cohort study

To investigate whether craving and demographic factors to predict relapse in alcohol dependence. This study was a prospective cohort study. From August 2017 to August 2018, 158 Han male inpatients who met the diagnositic and statistical manual disorders-fourth version(DSM-IV) alcohol dependence diagnostic criteria were recruited from three mental hospitals in China. The participants were interviewed at baseline and followed up by telephone after 3 months for assessment. The baseline assessment after the acute withdrawal period included demographic data and alcohol-related data, clinical institute withdrawal assessment-advanced revised (CIWA-Ar), withdrawal and cue-induced craving on visual analog scale (VAS), Michigan alcoholism screening test (MAST), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and alcohol urge questionnaire (AUQ). According to the follow-up results, "relapse" was defined as the consumption of beverages containing ethanol at any time during the follow-up study, and "time to relapse" was defined as the number of days from the first drinking to the baseline. Whether relapse occurred and the time to relapse were the primary endpoints. Cox proportional hazard regression model was used to analyze the factors affecting the relapse of alcohol dependence. In the study, 158 alcohol dependence patients were finally included, age from 21 to 60 years, with the mean age of (40.31±9.14) years. The relapse rate was 63.7% three months after baseline assessment. According to Cox univariate analysis and multivariate analysis, the age (OR=0.975, P=0.030) and CIWA-Ar scores (OR=1.126, P=0.010) significantly predicted relapse. And there was no significant difference in education level, marital status, withdrawal and cue-induced craving on VAS, SAS and SDS between the relapse group and the non-relapse group (P>0.05). Age and severity of alcohol-dependent withdrawal symptoms during hospitalization are significantly related to relapse for alcohol in alcohol-dependent patients. To be exact, the older age is a protective factor, that is to say, the younger patients are prone to relapse, while the risk of relapse is raised by the higher severity of withdrawal symptoms. However, neither cue-induced nor withdrawal craving can predict relapse of alcohol-dependent patients.

One and done?: Utility of PSA density as a predictor of number of cores needed to detect clinically significant prostate cancer.

104 Background: MRI/US fusion guided prostate biopsy (FBx) has been shown to detect clinically significant prostate cancer (csCaP) at higher rates and with fewer cores than standard prostate biopsy. However, the number of targeted cores needed to accurately characterize lesions identified on multiparametric MRI (mpMRI) is unknown. This study sought to determine factors that predict the number of cores needed to accurately characterize lesions during FBx of patients on active surveillance. Methods: A retrospective analysis of a prospectively maintained database of all patients undergoing FBx at an academic referral center between May 2014 and January 2018 was conducted. At least two FBx cores were taken from each lesion identified on mpMRI. Patient and lesion specific factors were analyzed to determine factors that predict the necessity to obtain additional cores to detect csCaP. GEE-based univariate logistic regression model with exchangeable correlation was used to estimate the effects of clinical characteristics including race, BMI, PSA, PSA density (PSAD), lesion location, and PI-RADS score on the proportion of positive and negative agreement. Predictability of a significant continuous predictor was quantified by AUC. The most significant patient-level predictor (PSAD) was further analyzed to determine thresholds at which multiple cores per lesion are needed to avoid missing csCaP. Results: An analysis of a total of 1141 FBx were performed during the study time interval. PSA (OR=1.57, 1.20-2.05, p&lt;0.01) and PSAD (OR=1.43, 1.11-1.85, p&lt;0.01) significantly predicted positive agreement of csCaP. AUC for positive and negative agreement was 57.4 and 61.0 for PSA and 56.4 and 72.3 for PSAD, respectively. Using these thresholds, only 56% lesions would need double core targeted biopsy. In other words, up to 44% of lesions would be accurately characterized with a single biopsy core of the targeted lesion. Conclusions: These data indicate that in patients with a PSAD less than 0.11 ng/ml2 or greater than 0.26 ng/ml2, lesions may be acceptably characterized with a single targeted biopsy core.

The Effect of Clinical Characteristics and Subtypes on Amyloid Positivity in Patients with Amnestic Mild Cognitive Impairment.

Background and PurposeMild cognitive impairment (MCI) is a prodromal stage of dementia. Amyloid deposits in positron-emission tomography (PET) imaging of MCI patients imply a higher risk for advancing to dementia, with rates of 10%–15% yearly. The purpose of this study was to investigate the clinical characteristics of subgroups of amnestic MCI (aMCI) that may have a higher impact on amyloid positivity.MethodsWe recruited 136 aMCI patients. All patients underwent a 20-minute F-18 florbetaben or flutemetamol PET scan. We classified amyloid PET images as positive or negative according to a semi-quantitative method. We evaluated the amyloid positivity of subgroups of aMCI (early vs. late type, single vs. multiple amnestic type, verbal vs. verbal, and visual amnestic type), and compared baseline clinical characteristics including key risk factors, apolipoprotein E4 (apoE4) genotype, and neuropsychological assessments with amyloid positivity in aMCI.ResultsThe amyloid positivity in total aMCI was 41%. The positivity rate according to subgroup of aMCI were as follow: Late aMCI (49%) vs. early aMCI (33%) (p=0.13), multiple aMCI (40%) vs. single aMCI (38%) (p=0.51), and verbal and visual aMCI (59%) vs. verbal aMCI (35%) (p=0.01), respectively. The mean age and the frequency of apoE4 allele of the amyloid-positive group was higher than that of the amyloid-negative group in aMCI (p<0.01).ConclusionsWe found that the amyloid positivity was related to patterns of clinical subtypes, characteristics, and risk factors in patients with aMCI.

Early Intensive Therapy in Multiple Myeloma Using Tandem Transplantation with Novel Conditioning and Two Years Maintenance: A Single Institution Experience

IntroductionThe role of early intensive treatment of multiple myeloma, including tandem autologous stem cell transplantation( ASCT) with bortezomib, thalidomide, dexamethasone( VDT) and melphalan 200mg/m2 as a preparative regimen, followed by 2 years of combination agent maintenance therapy, is being studied. We sought to analyze a cohort of patients who received early intensive treatment at the University of Iowa between 2012 and 2016.Patients and MethodsAll consecutive patients who received early( < 12 months since diagnosis) tandem ASCT and have completed at least 2 years of maintenance therapy between 2012 and 2016 were included for analysis. Planned maintenance therapy consisted of a combination of VDT in 28 day cycles for year 1 and bortezomib, cyclophosphamide and dexamethasone(VCD) in 28 day cycles for year 2. Alternate regimen were used in case of toxicities. The patients were considered to have high risk cytogenetics if they had 17p deletion, t(14;16), amp 1q, or t(4;14) by FISH. Event-free (EFS) and overall survival (OS) probabilities were estimated and plotted using the Kaplan-Meier method. For EFS, time was calculated from date of first transplant to relapse or death due to any cause. Treatment-related mortality was defined as death during transplant phase or maintenance phase due to causes other than disease relapse.The effect of clinical characteristics on outcomes was evaluated using Cox regression models. Estimated effects of predictors are reported as hazard ratios (HR) along with 95% confidence intervals. All statistical testing was two-sided and assessed for significance at the 5% level using SAS v9.4 (SAS Institute, Cary, NC). Responses were measured using IMWG consensus criteria.ResultsA total of 135 patients met the criteria for inclusion. Key patient characteristics are shown in table 1. The median age at first transplant was 58 years. HCT-CI was high in 68% of patients. 36% of the patients were ISS stage III, and high risk cytogenetics were present in 56%. Preparative regimen was VTD-Mel 200 in 88.9% of patients. Following the first transplant, 59% of patients had achieved CR, and following the second transplant 94.4% of patients achieved CR. At the time of median follow up, 27.4% of patients had died. The cause of death was infection (25%), organ failure (11%), relapsing myeloma (28%) or other (36%).Univariable analysis identified a statistically significant association only for age with risk of progression or death. Kaplan-Meier curves for progression free survival and overall survival in patients with high risk or low risk cytogenetics are shown in Figures 1 and 2 respectively. The hazard ratio for progression free survival and overall survival in patients with high risk vs low risk cytogenetics was 0.86 (95% confidence interval 0.45 - 1.64, p=0.65), and 0.88 (95% confidence interval 0.45 - 1.73, p=0.71), respectively. The 3 year EFS and OS of patients who received early tandem ASCT followed by 2 years of maintenance were 73% and 72%, respectively.Following the 2nd autologous transplant, 128 of 135( 94%) patients were started on maintenance therapy. VTD ( 74%) and VRD (6%) were the most common regimens used. Fifty six patients completed maintenance therapy for 1 year without regimen change, and 60 required regimen change due to toxicities. VRD (20), VPomD (9) and VRMp (8) were the most commonly used alternative regimens in the case of toxicities. Following year 1 of maintenance, 96 patients (75%) started a second year of maintenance. VCD (30%) or RD (23%) were the most common regimens. 63(43%) patients completed 2 years of combination maintenance therapy. Grade III-V non-hematologic toxicities during the combined maintenance phase were infection (56%) and peripheral neuropathy (23%) and hematologic toxicities were thrombocytopenia (13%), neutropenia (12%) and anemia (8%).ConclusionAccording to our results, patients with high risk cytogenetics did not have an inferior PFS and OS. These results suggest that in newly diagnosed MM patients, upfront treatment using novel conditioning regimen and tandem ASCT followed by intensive maintenance therapy can result in a very high CR rates, particularly in patients with high risk cytogenetics. Infections and peripheral neuropathies were the most common non-hematologic toxicities during maintenance. Longer follow up will determine further impact of maintenance therapy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.