Estimated Survival Rates Research Articles

MYH16 upregulation is associated with lung adenocarcinoma aggressiveness and immune infiltration.

Myosin heavy chain 16 (MYH16) may significantly affect cell cycle progression. Nevertheless, there is a lack of evidence about the clinical relevance of MYH16 upregulation in pan cancers, including lung adenocarcinoma (LUAD). MYH16 expression patterns were evaluated in various bioinformatics databases using The Cancer Genome Atlas data set. Clinical and pathological factor data were employed to risk-stratify patients. The Kaplan-Meier plotter approach was used to estimate survival rates. Tumor immune infiltration was explored via the TIMER tool, and gene set enrichment analysis (GSEA) was used to identify the pathways involved in MYH16 upregulation. The results showed that MYH16 was abnormally upregulated in pan cancers, including LUAD. MYH16 expression induction in LUAD was found to be related to the tumor stage. Furthermore, MYH16 upregulation was correlated with LUAD development and worse overall survival, particularly in women. Notably, MYH16 overexpression in LUAD tissues corresponded to the amount of immune infiltration in the tumor. Additionally, univariate Cox hazard regression analysis revealed that MYH16 may be an independent prognostic indicator for LUAD. Furthermore, a nomogram was constructed according to MYH16 expression and clinical characteristics. BMP6 expression deficiency may be a key factor contributing to MYH16 upregulation in LUAD. Finally, GSEA demonstrated that MYH16 might mediate meiosis and gene silencing through RNA signaling pathways. This study, for the first time, showed that MYH16 upregulation in LUAD is associated with various risk factors, increased cancer aggressiveness, enhanced infiltration of tumor immune cells, and reduced survival rates.

Total Rehabilitation Using Adhesive Dental Restorations in Patients with Severe Tooth Wear: A 5-Year Retrospective Case Series Study.

Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials. The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria. Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences (p < 0.005) on the survival of the restorations. According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure.

One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience.

The use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement. In this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year. A total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported. This is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability.

Extramedullary haematopoiesis in patients with thalassemia: a cross-sectional description of its prevalence, clinical features and survival

IntroductionDespite knowledge advances on extramedullary haematopoiesis (EMH) in thalassemic patients, the real picture remains an open issue. ObjectivesTo assess EMH prevalence in patients with thalassemia major (TM) and intermedia (TI), to describe magnetic resonance imaging (MRI) findings and to explore clinical risk factors. MethodsIn this cross-sectional study, images and clinical records of 184 consecutive patients with thalassemia who underwent T2* MRI between 2004 and 2011 were reviewed. Association of EMH with survival was investigated for patients with available follow-up charts. ResultsEMH was detected in 16/168 (9.5%) patients with TM (aged 19-49 years) and in 3/16 (18.8%) with TI (aged 36-41 years). Most (88%) had paravertebral thoracic and/or abdominal masses. Age was significantly associated with EMH risk (hazard ratio, [HR] 1.10/year; confidence interval [CI]: 1.03-1.18; p-value < 0.001), while lower pancreatic iron content by T2*MRI (HR: 0.94/ms; CI: 0.89-0.99; p-value = 0.049) was a protective factor. Estimated survival rate was superior for EMH-positive (n = 19) when compared to EMH-negative patients (n = 75) (p-value = 0.013). ConclusionsThe prevalence of EMH was 10.3% (19/184), presented mainly as tumoral masses of 3 to 10 cm. Age was a risk factor for EMH development, while lower pancreatic iron might be a protective factor in this cohort.

Updates on accelerated and blast phase myeloproliferative neoplasms: Are we making progress?

Management approaches for accelerated and blast phase myeloproliferative neoplasms remain challenging for clinicians and patients alike. Despite many therapeutic advances, outcomes for those patients who are not allogeneic haematopoietic cell transplant eligible remain, in general, very poor. Estimated survival rates for such blast phase patients is frequently reported as less than 6 months. No specific immunological, genomic or clinicopathological signature currently exists that accurately predicts the risk and timing of transformation, which frequently induces a high degree of anxiety among patients and clinicians alike. Within this review article, we provide an up-to-date summary of current understanding of the underlying pathogenesis of accelerated and blast phase disease and discuss current therapeutic approaches and realistic outcomes. Finally, we discuss how the horizon may look with the introduction of more novel agents into the clinical arena.

Tumor infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in relation to pathological complete remission to neoadjuvant therapy and prognosis in triple negative breast cancer

ObjectiveTo explore the correlation between the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and tumor infiltrating lymphocyte (TIL) before neoadjuvant therapy (NAT) and the prognosis of patients with triple negative breast cancer. MethodA total of 126 patients with TNBC who received NAT were screened out. TILs, CD8+TIL and FOXP3+TIL were detected by immunohistochemistry in core needle biopsy specimens before treatment, and NLR was calculated. Kaplan-Meier analysis was used to estimate survival rates. Univariate and multivariate analyses were performed using Cox proportional hazards regression. ResultsNLR was negatively correlated with TILs density (p = 0.040) and FOXP3+ TIL was positively correlated with NLR (p = 0.019). Patients with low NLR/high TILs density showed the highest pCR rate (46/48, 95 %), while only 6/22 patients (21 %) with high NLR/low TILs density achieved pCR. Multivariate analysis showed that high NLR was independently associated with pCR ((HR = 5.043, 95 %CI = 1.637–15.535, p = 0.005). High T stage, lymph node involvement, lymphovascular invasion, high NLR, low TILs density and low CD8+ TIL were associated with poor OS and BCSS. Multivariate Cox regression analysis showed that high NLR (HR = 36.182, 95 %CI = 4.120–317.759, p = 0.001), high CD8+ TIL density (HR = 0.182, 95 %CI = 0.044–0.754, p = 0.019) were independently associated with poor OS. Similarly, high NLR (HR = 23.989, 95 %CI = 2.275–252.131, p = 0.008) was independently associated with worse BCSS. ConclusionsNLR may help to screen the high-risk population of TNBC patients after neoadjuvant therapy.

Flexible transition probability model for assessing cost-effectiveness of breast cancer screening extension to include women aged 45-49 and 70-74.

Breast cancer is the most common cancer among Western women. Fortunately, organized screening has reduced breast cancer mortality. New recommendation by the European Union suggests extending screening with mammography from 50-69-year-old women to 45-74-year-old women. However, before extending screening to new age groups, it's essential to carefully consider the benefits and costs locally as circumstances vary between different regions and/or countries. We propose a new approach to assess cost-effectiveness of breast cancer screening for a long-ongoing program with incomplete historical screening data. The new model is called flexible stage distribution model. It is based on estimating the breast cancer incidence and stage distributions of breast cancer cases under different screening strategies. The model parameters, for each considered age group, include incidence rates under screening/non-screening, probability distribution among different stages, survival by stages, and treatment costs. Out of these parameters, we use the available data to estimate survival rates and treatment costs, while the modelling is done for incidence rates and stage distributions under screening policies for which the data is not available. In the model, an ongoing screening strategy may be used as a baseline and other screening strategies may be incorporated by changes in the incidence rates. The model is flexible, as it enables to apply different approaches for estimating the altered stage distributions. We apply the proposed flexible stage distribution model for assessing incremental cost of extending the current biennial breast cancer screening to younger and older target ages in Finland.

Semi-supervised calibration of noisy event risk (SCANER) with electronic health records

ObjectiveElectronic health records (EHR), containing detailed longitudinal clinical information on a large number of patients and covering broad patient populations, open opportunities for comprehensive predictive modeling of disease progression and treatment response. However, since EHRs were originally constructed for administrative purposes not for research, in the EHR-linked studies, it is often not feasible to capture reliable information for analytical variables, especially in the survival setting, when both accurate event status and event times are needed for model building. For example, progression-free survival (PFS), a commonly used survival outcome for cancer patients, often involves complex information embedded in free-text clinical notes and cannot be extracted reliably. Proxies of PFS time such as time to the first mention of progression in the notes are at best good approximations to the true event time. This leads to difficulty in efficiently estimating event rates for an EHR patient cohort. Estimating survival rates based on error-prone outcome definitions can lead to biased results and hamper the power in the downstream analysis. On the other hand, extracting accurate event time information via manual annotation is time and resource intensive. The objective of this study is to develop a calibrated survival rate estimator using noisy outcomes from EHR data. Materials and MethodsIn this paper, we propose a two-stage semi-supervised calibration of noisy event rate (SCANER) estimator that can effectively overcome censoring induced dependency and attains more robust performance (i.e., not sensitive to misspecification of the imputation model) by fully utilizing both a small-labeled set of gold-standard survival outcomes annotated via manual chart review and a set of proxy features automatically captured via EHR in the unlabeled set. We validate the SCANER estimator by estimating the PFS rates for a virtual cohort of lung cancer patients from one large tertiary care center and the ICU-free survival rates for COVID patients from two large tertiary care centers. ResultsIn terms of survival rate estimates, the SCANER had very similar point estimates compared to the complete-case Kaplan Meier estimator. On the other hand, other benchmark methods for comparison, which fail to account for the induced dependency between event time and the censoring time conditioning on surrogate outcomes, produced biased results across all three case studies. In terms of standard errors, the SCANER estimator was more efficient than the KM estimator, with up to 50% efficiency gain. ConclusionThe SCANER estimator achieves more efficient, robust, and accurate survival rate estimates compared to existing approaches. This promising new approach can also improve the resolution (i.e., granularity of event time) by using labels conditioning on multiple surrogates, particularly among less common or poorly coded conditions.

An Opportunity to Increase Access to Pyometra Treatment

Pyometra in dogs and cats is a common and severe problem encountered by private practice (PP) clinicians that requires urgent treatment. This interruption can disrupt the clinic day's flow and result in pet owners facing high expenses for treatment. In many cases, there is a risk of economic euthanasia. Referral to high quality, high volume, spay/neuter (HQHVSN) clinics may be helpful for cases where treatment would be disruptive to clinic operations and referral to an emergency room is not feasible. A previous survey of pyometra practices of PP veterinarians demonstrated that, despite 66% of respondents finding pyometra to be majorly or moderately disruptive to their clinical day, 44% would be unwilling to refer to an HQHVSN clinic. This survey, conducted from June to July 2021 (142 respondents), and a similar survey of HQHVSN clinics conducted from June to July 2020 (118 respondents) were analyzed for opportunities for increased partnership. Proportions were compared using two-sided tests of proportions, while non-normal data were compared using Wilcoxon rank-sum. The three primary reasons indicated by PP with a reluctance to refer to HQHVSN (beyond a lack of local HQHVSN clinics) were a perceived lack of prompt appointment availability (20%), lack of aftercare (18%), and lack of adequate equipment (14%). In contrast, most HQHVSN clinics estimated that they generally accept referrals the same day (50%) or the next day (42%). Ninety-five percent of HQHVSN clinics reported having the resources needed to treat most presenting pyometras. Median estimated survival rates for patients presenting BAR/QAR were 100% for both PP and HQHVSN, with IQR of 95-100% and 100-100%, respectively. For patients presenting dull or nonambulatory, the median estimated survival was 80% (IQR 70-95%) for PP and 95% (IQR 95-100%) for HQHVSN. The median estimated survival for patients presenting obtunded or lateral was 15% (IQR 0-50%) for PP and 20% (IQR 2-80%) for HQHVSN. Estimated survival was only different for patients presenting dull or lateral (P = 0.018, z = 2.4). The estimated cost to treat a pyometra in dogs in PP, a median of $1,000 (IQR $700-1500), was significantly (P &lt; 0.0001, z = 8.4) higher than HQHVSN clinics with a median of $200 (IQR $125-300). The estimated cost to treat a pyometra in cats, a median of $725 (IQR $450-1,000) in PP and $125 (IQR $58-200) in HQHVSN clinics, was also significantly different (P &lt; 0.0001, z=8.6). PP ranked economic euthanasia as the most likely alternative outcome to surgery at their PP clinic 32% of the time, while HQHVSN indicated it only 11% of the time. Given that PP clinicians estimate that economic euthanasia is the most likely outcome for approximately one-third of patients not treated by their clinic, there is an opportunity for greater collaboration. The concerns with HQHVSN clinics expressed by PP should be addressed knowing that HQHVSN clinics typically accept referrals within 48 hours, believe that they have adequate equipment, and are generally estimated to have good survival outcomes. For those patients requiring significant aftercare, there is an opportunity to refer the patient for surgery and then accept them back for hospitalization at the PP.

Estimation of demographic parameters of some plant species accounting for imperfect detection probabilities

AbstractDetection probability (p) in plants is imperfect in natural conditions due to several factors. This imperfect detectability is rarely accounted for in the estimation of demographic parameters, such as survival probabilities (S) or transition rates between different life states or size classes (ψ), which may result in inaccurate quantitative information about plant populations. In this study, we used previously collected data of five plant species belonging to different families with contrasting life forms and habitats (Flaveria chlorifolia,Mammillaria hernandezii,Neobuxbaumia macrocephala,Govenia lagenophora, andCastilleja tenuiflora), data simulations, multi‐state models (a demographic tool that explicitly accounts forp), and direct estimation of survival and transition rates (i.e., assuming perfect detection) to identify in which species, states, or demographic parameters the bias caused by ignoring our imperfect detectability is more severe. Detection was imperfect (p &lt; 1) for all our study species. In general, ignoring detection probabilities yielded underestimated survival and transition rates in all five species. Biases caused by assuming perfect detection were also large and significant, mainly in inconspicuous life states and size classes, such as seedlings and dry individuals. In contrast, considering detection probabilities resulted in fewer underestimated survival and transition rates, with smaller and mostly nonsignificant biases. Intriguingly, some transitions were overestimated even when accounting for detection probabilities. Our findings highlight the importance of considering that detection of most plant species is imperfect in the field, even in species that are apparently conspicuous, to avoid incorrect inferences about plant populations.

Temporal and inter-individual changes in the integrated biochemical condition of the gonads of female swordfish (Xiphias gladius) from the Southeastern Pacific Ocean.

The integrated biochemical condition (IBC) of gonads is closely related to the reproductive success of highly migratory marine species. The IBC of gonads can be influenced not only by size and/or age, but also by environmental conditions. Here, female swordfish, Xiphias gladius, that migrate to temperate regions with a marked seasonality (e.g., the Southeastern Pacific Ocean, SEPO) were compared in relation to the IBCs (lipids, proteins, glucose and, fatty acid profiles) of their gonads; individuals with two body size ranges and distinct degrees of sexual maturity were evaluated, and considered as: small and/or virginal (SV: <170 cm lower jaw fork-length (LJFL), oocyte size (OS) <0.08 mm) vs large and/or maturing females (LM: >190 cm LJFL, OS >0.133 mm). This comparison was conducted in two environmentally contrasting seasons (winter vs spring). Our results showed that the gonadosomatic index (GSI) was significantly higher in LM than SV. Lipid contents varied significantly between seasons and body sizes. The highest lipid concentrations were recorded in the spring in large females. No significant differences were found when comparing the protein and glucose contents of the two evaluated seasons or body size ranges of the studied females. In turn, the fatty acid (FA) profiles of female gonads significantly varied for both seasons and body size ranges. A high content of saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs) and poly-unsaturated fatty acids (PUFAs) were recorded in female gonads in the spring. The SFAs C16:0 and C18:0, the MUFA C18:1n9, and the essential PUFA C22:6n3 were the main contributors to the observed differences between spring and winter. These results could be used as indicators of the nutritional condition and health status of swordfish individuals. Hence, the IBC of female swordfish gonads have great potential to aid in estimating survival rates and stock abundances of this species. The integration of this information constitutes an asset in fishery management models with an ecosystem approach.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Predicting Alzheimer’s disease progression in healthy and MCI subjects using multi‐modal deep learning approach

AbstractBackgroundAlzheimer’s disease (AD) is a complex disorder influenced by many factors, but it is unclear how each factor contributes to disease progression. An in‐depth examination of these factors may yield an accurate estimate of time‐to‐conversion to AD for patients at various disease stages. Recent advances in deep learning have enabled researchers to predict patient’s disease onset time by exploring the influencing factors in AD progression.MethodWe used 543 subjects with 63 features from 3 data modalities from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. The following modalities were used: 1) MRI, 2) genetic and 3) DTC (Demographic, cognitive Tests and Cerebrospinal fluid). The 21 most important features were automatically selected for the three modalities.We used a Deep Learning‐based survival analysis model that extends the classic Cox regression model to predict the subjects' disease onset time. Here we re‐define the non‐AD‐progression as “survivor”, and AD‐progression as “non‐survivor”. The subjects were divided into two groups: progressive subjects (non‐survivor), who were either healthy or diagnosed with Mild Cognitive Impairment (MCI) at initial clinical visit and later developed AD, and non‐progressive subjects ("survivor”), who were either healthy or MCI at initial visit but did not develop AD later. We used 10 random sub‐samples, selecting 80% of the subjects for training and 20% for testing each time; 20% of training data was used for internal validation.ResultFigure 1 shows the estimated survival rates over 10 years. Both groups had a high survival chance at the start. The progressive group’s survival chance dropped much faster and fell below 20% by the end of the period. The non‐progressive group’s survival chance remained around 50%.Feature importance analysis is displayed in Figure 2. Eight of the top ten most important features are from the cognitive tests, demonstrating their importance in survival analysis. Amygdala and Hippocampus regions, as well as age, are also notable features.ConclusionOur study demonstrated that using powerful predictive models on multi‐modal data can improve prediction of time‐to‐conversion. This not only leads to a better understanding of AD, but also provides essential tools for practitioners who wish to follow their patients' disease progression.

Ocular Survival Following Intravitreal Melphalan as Adjuvant Treatment for Vitreous Retinoblastoma Seeding.

To evaluate the efficacy of intravitreal chemotherapy for vitreous seeding in patients with retinoblastoma (Rb). Retrospective, single-arm cohort study. This study was conducted at a tertiary eye center. Between 2013 and 2021, 27 patients (27 eyes) with vitreous Rb receiving adjuvant intravitreal melphalan (IVM) as secondary/salvage treatment in one eye were included. Patients who were unable to follow-up or treated elsewhere were excluded. Survival analysis was performed to assess the incidence of enucleation in the melphalan-treated group, as well as in bilateral cases with eyes receiving melphalan and those receiving standard treatment, consisting of chemotherapy, thermotherapy, and enucleation according to the disease stage. The median (interquartile range) follow-up time was 65 months (range, 34-83 months). Seventeen patients (63%) had bilateral disease. Sixteen eyes (59%) were saved. The Kaplan-Meier survival estimates for eyes receiving melphalan were 100% at 1 year (95% confidence interval [CI]:11.2-14.3), 75% (95% CI:14.2-48.9) at 3 years, and 50% at 5 years. Melphalan-treated patients with bilateral disease showed a significantly higher number of saved eyes than the standard treatment group (P=0.002). Tumor recurrence was the primary cause of enucleation, accounting for 36% of the cases. In the vitreous hemorrhage group, the odds of enucleation were 13 times higher (95% CI:1.04-165.28) than in the group without this condition. IVM is an effective treatment option for vitreous seeds. After 3 years of follow-up, the estimated survival rate for saved eyes decreased, and vitreous hemorrhage significantly increased the likelihood of enucleation. Further studies are required to determine the precise effects of IVM.

Preoperative factors affecting long-term mortality in patients survived to ruptured abdominal aortic aneurysm repair.

Aim of this study was to retrospectively evaluate preoperative factors affecting long-term mortality in patients survived to surgical repair for ruptured abdominal aortic aneurysms (rAAAs). From January 2007 to December 2021, 444 patients have been treated for symptomatic or ruptured aortoiliac aneurysms in two tertiary referral centers. Only 405 with diagnosis of rAAA at computed tomography were included in the present study. Initial outcome measures were assessed during at 30 and 90 days post-treatment. Estimated 10-year survival of patients survived after 90 days from the index procedure was evaluated with Kaplan-Meier Test. Uni- and multivariate analyses of the preoperative factors affecting 10-year survival in survivor patients was performed by means of log-rank and multivariate Cox regression analysis. Among included patients, 94 (23.3%) underwent endovascular aortic repair (EVAR) and 311 (76.8%) open surgical repair (OSR). Intraoperative death occurred in 29 patients (7.2%). At 30 days, overall death rate was 24.2% (98/405 cases). Hemorrhagic shock (HR 15.5, 95% CI 3.5 to 41.1, P<0.001) was an independent predictor for 30-day mortality. The overall rate of 90-day mortality was 32.6%. In survivors estimated survival rates at 1, 5, and 10 years were 84.2%, 58.2%, and 33.3%, respectively. Type of treatment (OSR vs. EVAR) did not affect long-term freedom from AAA-related death (HR 0.6, P=0.42). In survivor patients, multivariate analysis confirmed the association between late mortality and female sex (HR 4.7, 95% CI 3.8 to 5.9, P=0.03), age >80 years (HR 28.5, 95% CI 25.1 to 32.3, P<0.001), and chronic obstructive pulmonary disease (HR 5.2, 95% CI 4.3 to 6.3, P=0.02). Late freedom from AAA-related death was not affected by the type of treatment (EVAR vs. OSR) in patients undergoing urgent repair for rAAA. In survivors, female gender, elderly age, and chronic obstructive pulmonary disease negatively affected long-term survival.

Survival outcomes with CPX-351 vs 7+3 by baseline bone marrow blast percentage in older adults with newly diagnosed high-risk or secondary acute myeloid leukemia: A 5-year follow-up study.

7027 Background: CPX-351, a dual-drug liposomal encapsulation of daunorubicin and cytarabine in a synergistic 1:5 molar ratio, is approved for newly diagnosed therapy-related acute myeloid leukemia (AML) or AML with myelodysplasia-related changes in the US and Europe following positive efficacy and safety data from the pivotal phase 3 clinical trial (NCT01696084). A previous exploratory analysis of the trial data (median follow-up 20.7 months) showed improved survival outcomes with CPX-351 vs conventional 7+3 chemotherapy in adults with newly diagnosed high-risk or secondary AML (sAML) irrespective of baseline bone marrow (BM) blast percentage. Here we report 5-year follow-up data (median follow-up 60.9 months) to provide insights into the longer-term efficacy and safety of CPX-351 in these patient subgroups. Methods: Patients (60–75 years) with a pathologic diagnosis of AML (high-risk/sAML) per the WHO 2008 criteria (≥20% blasts in peripheral blood or BM) and an ECOG PS of 0–2 were randomized to receive CPX-351 or 7+3 chemotherapy. In these post hoc subgroup analyses at 5 years follow-up, overall survival (OS), event-free survival (EFS) and complete remission (CR) were assessed by baseline BM blast percentage. The analysis included patients with low ( &lt; 20%) BM blasts to account for changes in blast count thresholds in the updated WHO AML classification. Results: Overall, median OS and EFS were longer with CPX-351 vs 7+3 in each subgroup; median OS was greatest in low blast subgroups for both treatments (Table). Higher CR rates were observed with CPX-351 vs 7+3 irrespective of baseline BM blasts. Median Kaplan-Meier (KM)-estimated survival rates increased with CPX-351 vs 7+3 across BM blast subgroups. The CPX-351 safety profile was comparable across BM blast subgroups and consistent with the known safety profile of 7+3. Conclusions: These 5-year follow-up data suggest that CPX-351 results in improved outcomes irrespective of baseline BM blast percentage vs conventional 7+3 chemotherapy in older adults with AML. Clinical trial information: NCT01696084 . [Table: see text]

Fate of target visceral vessels in fenestrated and branched complex endovascular aortic repair

ObjectiveTo assess branch vessel outcomes after endovascular repair of complex aortic aneurysms analyzing possible factors influencing early and long-term results. MethodsThe Italian Multicentre Fenestrated and Branched registry enrolled 596 consecutive patients treated with fenestrated and branched endografts for complex aortic disease from January 2008 to December 2019 by four Italian academic centers. The primary end points of the study were technical success (defined as target visceral vessel [TVV] patency and absence of bridging device-related endoleak at final intraoperative control), and freedom from TVV instability (defined as the combined results of type IC/IIIC endoleaks and patency loss) during follow-up. Secondary end points were overall survival and TVV-related reinterventions. ResultsWe excluded 591 patients (3 patients with a surgical debranching and 2 patients who died before completion from the study cohort) were treated for a total of 1991 visceral vessels targeted by either a directional branch or a fenestration. The overall technical success rate was 98.4%. Failure was related to the use of an off-the-shelf (OTS) device (custom-made device vs OTS, HR, 0.220; P = .007) and a preoperative TVV stenosis of >50% (HR, 12.460; P < .001). The mean follow-up time was 25.1 months (interquartile range, 3-39 months). The overall estimated survival rates were 87%, 77.4%, and 67.8% at 1, 3, and 5 years, respectively (standard error [SE], 0.015, 0.022, and 0.032). During follow-up, TVV branch instability was observed in 91 vessels (5%): 48 type IC/IIIC endoleaks (2.6%) and 43 stenoses-thromboses (2.4%). The extent of aneurysm disease (thoracoabdominal aortic aneurysm [TAAA] types I-III vs TAAA type IV/juxtarenal aortic aneurysm/pararenal aortic aneurysm) was the only independent predictor for developing a TVV-related type IC/IIIC endoleak (HR, 3.899; 95% confidence interval [CI]:, 1.924-7.900; P < .001). Risk of patency loss was independently associated with branch configuration (HR, 8.883; P < .001; 95% CI, 3.750-21.043) and renal arteries (HR, 2.848; P = .030; 95% CI, 1.108-7.319). Estimated rates at 1, 3, and 5 years of freedom from TVV instability and freedom from TVV-related reintervention were 96.6%, 93.8%, and 90% (SE, 0.005, 0.007, and 0.014) and 97.4%, 95.0%, and 91.6% (SE, 0.004, 0.007, and 0.013), respectively. ConclusionsIntraoperative failure to bridge a TVV was associated with a preoperative TVV stenosis of >50% and the use of OTS devices. Midterm outcomes were satisfying, with an estimated 5-year freedom from TVV instability and reintervention of 90.0% and 91.6%, respectively. During follow-up, the larger extent of aneurysm disease was associated with an increased risk of TVV-related endoleaks, whereas a branch configuration and renal arteries were more prone to patency loss.

First field-based estimates of bumblebee diapause survival rates showcase high survivorship in the wild.

Bumblebee (Bombus spp.) queens overwintered in artificial settings tend to have low survival rates, raising concerns that diapause may be a particularly sensitive life cycle stage for this ecologically and economically valuable group of pollinators. However, it remains unclear whether lab-based estimates of diapause survival are comparable to survival rates of natural populations. In this study, we monitored the survival of Bombus impatiens queens overwintering in the field in Ipswich, MA, and conducted a meta-analysis of studies that estimate queen diapause survival in the lab to compare our field-based estimates of survival to those of lab-based studies. We found that queen B. impatiens had relatively high rates of overwintering survival after about six months (> 60%), especially when compared to estimates of six-month survival from lab studies (< 10%). We also observed a trend that broadly corroborates many lab studies of bumblebees, in that overwinter survival of queens was related to colony origin. In addition to providing the first estimate of diapause survival for bumblebee queens in nature, our study emphasizes the need to verify patterns observed in the lab to field-based studies. Although protecting target species during sensitive life cycle stages is a fundamental goal of conservation ecology, it is first necessary to identify at what stages of the life cycle populations are most vulnerable. Our results suggest that, at least in some study systems, diapause survival of queen bumblebees in the field may be higher than suggested by lab studies. The online version contains supplementary material available at 10.1007/s10841-023-00478-8.

PO-02-038 LESION SIZE PREDICTION MODULE-GUIDED RADIOFREQUENCY ABLATION VERSUS CRYOBALLOON ABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION: A PROPENSITY SCORE MATCHED ANALYSIS

In previous studies show cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are similar results. However, RFA technology has progressed in few years, lesion size assessment module developed to improve lesion durability. The aim of this study was to compare clinical outcome of RFA guided by lesion size prediction module and second or fourth-generation CBA in patients with paroxysmal atrial fibrillation (PAF). We enrolled 1905 patients with PAF (65.2 ± 11.3years, male 68.0%). 205 patients after RFA who underwent ablation guided by lesion size prediction module, Ablation Index or Lesion Size Index, and 1700 patients after second or fourth-generation CBA in September 2014 to August 2020, and evaluated retrospectively. We performed pulmonary vein isolation with CBA or RFA followed by additional non-pulmonary vein foci ablation. We selected 194 patients treated with RFA (follow-up period 14.1 ± 7.9months) and 194 patients treated with CBA (follow-up period 23.9 ± 12.9months) using propensity score matching. During a follow-up period, atrial tachyarrhythmia recurrence was documented in 34 patients (17.5%) in RFA and 38 patients (19.6%) in CBA. Freedom from atrial tachyarrhythmia recurrence without anti-arrhythmic-drugs after single procedure was a similar in 2 groups (1-year Kaplan–Meier survival rate estimates, RFA:84.9% and CBA:88.9%, p=0.358). The mean total procedure time was shorter in CBA than in RFA (109 ± 45 vs 148 ± 54 minutes, P<0.001), and the mean total fluoroscopy time was shorter in RFA than in CBA (20 ± 18 vs 33 ± 21 minutes, P<0.001). The proportion of non-pulmonary vein foci was slightly higher for CBA (42patients, 21.7%) than for RFA (36patients, 18.6%), but this difference was not significant (P=0.447). Similarly, there was no significant difference in ablation of non-pulmonary vein foci in the left atrium, although CBA was slightly more common (CBA: 16 patients, 8.3% and RFA: 10 patients 5.2%, p=0.223). [image] And, A second procedure was treated to 20 patients in the RFA and 32 in the CBA. The number of people with pulmonary vein reconnection in each was 10 patients (50.0%) in RFA and 15 patients (46.9%) in CBA, respectively, with no difference as a percentage(P=0.83). We found that in the treatment of patients with PAF, lesion size prediction module-guided procedure was not statistically significant efficacy to CBA. CBA and RFA are still similar results even today.

Total Knee Arthroplasty (TKA): When Do the Risks of TKA Overcome the Benefits? Double Risk of Failure in Patients up to 65 Years Old.

The aim of this study was to document the survival rate in the middle-aged patient group up to 65 years old and to compare it with other age groups of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis (OA). The Register of Orthopaedic Prosthetic Implants (RIPO) regional registry was used to analyze the results of patients <80 years old affected by primary OA and treated with TKA from 2000 to 2019. The database was investigated according to the age group: younger than 50 years, 50-65 years, or 66-79 years, with the aim to estimate revision surgeries and implant survivorship. A total of 45,488 TKAs for primary OA were included in the analysis (M: 11,388; F: 27,846). The percentage of patients <65 years old increased from 13.5% to 24.8% between 2000 and 2019 (P < 0.0001). The survival analysis showed an overall influence of age on the implant revision rate (P < 0.0001), with an estimated survival rate of 78.7%, 89.4%, and 94.8% at 15 years in the 3 groups, respectively. Compared with the older-aged group, the relative risk of failure was 3.1 (95% confidence interval [CI] = 2.2-4.3; P < 0.001) higher in patients <50 years old and 1.8 (95% CI = 1.6-2.0; P < 0.001) higher in patients 50-65 years old. TKA use in the middle-aged patient population up to 65 years old increased significantly over time. These patients present a double risk of failure with respect to older patients. This is particularly important considering the increasing life expectancy and the emergence of new joint preserving strategies, which could postpone the need for TKA to an older age.