Treatment Outcome Factors Research Articles

Use of a virtual environment to promote self-management and lifestyle changes in persons with bipolar disorder

PurposeSelf-management and lifestyle interventions are a key factor in treatment outcomes for persons with bipolar disorder (BD). A virtual environment (VE), due to it's ability to provide flexibility of involvement in its platform, may be an alternative to face-to-face treatment to provide support for self-management. The purpose of this study is to explore how a VE, developed for chronic illness self-management, may be modified to promote self-management and lifestyle changes in those with BD. MethodThis study used a qualitative description design with focus groups. Data were collected via minimally structured interviews and analyzed using thematic content analysis. A total of seven focus groups were conducted, and the sample consisted of 30 adults with BD. Age range was 21–77 years with 21 females, seven males, and two non-binary individuals. ResultsFive themes emerged from the findings: Self-management and lifestyle interventions with regards to (1) mental health; (2) holistic health; (3) role of peers; (4) involvement of the family; (5) technological aspects of the VE. ConclusionsFocus group participants suggested that the VE may be an efficacious way to enhance self-management and promote lifestyle interventions in those with BD. Research is needed to adapt such platforms to the need of the patients and examine its' effect on health outcomes.

On the treatment of melanoma: A mathematical model of oncolytic virotherapy

We develop and analyze a mathematical model of oncolytic virotherapy in the treatment of melanoma. We begin with a special, local case of the model, in which we consider the dynamics of the tumour cells in the presence of an oncolytic virus at the primary tumour site. We then consider the more general regional model, in which we incorporate a linear network of lymph nodes through which the tumour cells and the oncolytic virus may spread. The modelling also considers the impact of hypoxia on the disease dynamics. The modelling takes into account both the effects of hypoxia on tumour growth and spreading, as well as the impact of hypoxia on oncolytic virotherapy as a treatment modality. We find that oxygen-rich environments are favourable for the use of adenoviruses as oncolytic agents, potentially suggesting the use of complementary external oxygenation as a key aspect of treatment. Furthermore, the delicate balance between a virus’ infection capabilities and its oncolytic capabilities should be considered when engineering an oncolytic virus. If the virus is too potent at killing tumour cells while not being sufficiently effective at infecting them, the infected tumour cells are destroyed faster than they are able to infect additional tumour cells, leading less favourable clinical results. Numerical simulations are performed in order to support the analytic results and to further investigate the impact of various parameters on the outcomes of treatment. Our modelling provides further evidence indicating the importance of three key factors in treatment outcomes: tumour microenvironment oxygen concentration, viral infection rates, and viral oncolysis rates. The numerical results also provide some estimates on these key model parameters which may be useful in the engineering of oncolytic adenoviruses.

Association between CYP2B6 genetic variability and cyclophosphamide therapy in pediatric patients with neuroblastoma

Cyclophosphamide, an oxazaphosphorine prodrug is frequently used in treatment of neuroblastoma, which is one of the most prevalent solid organ malignancies in infants and young children. Cytochrome P450 2B6 (CYP2B6) is the major catalyst and CYP2C19 is the minor enzyme in bioactivation and inactivation pathways of cyclophosphamide. CYP-mediated metabolism may contribute to the variable pharmacokinetics of cyclophosphamide and its toxic byproducts leading to insufficient response to the therapy and development of clinically significant side effects. The aim of the study was to reveal the contribution of pharmacogenetic variability in CYP2B6 and CYP2C19 to the treatment efficacy and cyclophosphamide-induced side effects in pediatric neuroblastoma patients under cyclophosphamide therapy (N = 50). Cyclophosphamide-induced hematologic toxicities were pivotal in all patients, whereas only moderate hepatorenal toxicity was developed. The patients’ CYP2B6 metabolizer phenotypes were associated with the occurrence of lymphopenia, thrombocytopenia, and monocytopenia as well as of liver injury, but not with kidney or urinary bladder (hemorrhagic cystitis) toxicities. Furthermore, the patients’ age (< 1.5 years, P = 0.03) and female gender (P ≤ 0.02), but not CYP2B6 or CYP2C19 metabolizer phenotypes appeared as significant prognostic factors in treatment outcomes. Our results may contribute to a better understanding of the impact of CYP2B6 variability on cyclophosphamide-induced side effects.

Assessing Candidacy for Conversation Training Therapy: The Role of Patient Perception

Voice therapy is the primary treatment modality for voice rehabilitation. Specific patient-ability factors beyond patient-characteristic factors (eg, disorder diagnosis, age, etc.), that influence individual patient responses to voice treatment remain largely unknown. The goal of the current study was to determine the relationship between patient-perceived improvements in both the sound and feel of voice during stimulability assessment and voice therapy outcomes. Prospective Cohort study. This study was a single-arm, single-center, prospective study. Fifty patients with primary muscle tension dysphonia and benign vocal fold lesions were enrolled. Patients read the first four sentences of the Rainbow Passage and were asked if they experienced a change in the feel or sound of their voice following the stimulability prompt. Patients then completed four sessions of conversation training therapy (CTT) voice therapy and followed up one-week and three-months after their last therapy session, for a total of six time-points. Demographic data were collected at baseline, and voice handicap index 10 (VHI-10) scores were collected at each follow-up time-point. The primary exposure variables were CTT intervention and patient perception of voice change to stimulability probes. The primary outcome was change in VHI-10 score. On average, VHI-10 scores improved for all participants following CTT treatment. All participants heard a change in the sound of voice with stimulability prompts. Descriptively, patients who reported a positive change in the feel of their voice after stimulability testing recovered faster (ie, experienced a sharper decline in VHI-10) compared to those who did not note a change in feel of voice during stimulability testing. However, the rate of change over time was not significantly different between groups. Patient self-perception of a change in the sound and feel of voice in response to stimulability probes during initial evaluation is an important factor in treatment outcomes. Patients who perceive an improved feel of their voice production after stimulability probes may respond to voice therapy more quickly.

Treatment Planning for Cardiac Radioablation: Multicenter Multiplatform Benchmarking for the RAdiosurgery for VENtricular TAchycardia (RAVENTA) Trial

Cardiac radioablation is a novel treatment option for patients with refractory ventricular tachycardia unsuitable for catheter ablation. The quality of treatment planning depends on dose specifications, platform capabilities, and experience of the treating staff. To harmonize the treatment planning, benchmarking of this process is necessary for multicenter clinical studies such as the RAdiosurgery for VENtricular TAchycardia trial. Planning computed tomography data and consensus structures from 3 patients were sent to 5 academic centers for independent plan development using a variety of platforms and techniques with the RAdiosurgery for VENtricular TAchycardia study protocol serving as guideline. Three-dimensional dose distributions and treatment plan details were collected and analyzed. In addition, an objective relative plan quality ranking system for ventricular tachycardia treatments was established. For each case, 3 coplanar volumetric modulated arc (VMAT) plans for C-arm linear accelerators (LINAC) and 3 noncoplanar treatment plans for robotic arm LINAC were generated. All plans were suitable for clinical applications with minor deviations from study guidelines in most centers. Eleven of 18 treatment plans showed maximal one minor deviation each for target and cardiac substructures. However, dose-volume histograms showed substantial differences: in one case, the planning target volume ≥30 Gy ranged from 0.0% to 79.9% and the ramus interventricularis anterior V14Gy ranged from 4.0% to 45.4%. Overall, the VMAT plans had steeper dose gradients in the high-dose region, while the plans for the robotic arm LINAC had smaller low-dose regions. Thereby, VMAT plans required only about half as many monitor units, resulting in shorter delivery times, possibly an important factor in treatment outcome. Cardiac radioablation is feasible with robotic arm and C-arm LINAC systems with comparable plan quality. Although cross-center training and best practice guidelines have been provided, further recommendations, especially for cardiac substructures, and ranking of dose guidelines will be helpful to optimize cardiac radioablation outcomes.

The Clinical Characteristics of New-Onset Epilepsy in the Elderly and Risk Factors for Treatment Outcomes of Antiseizure Medications.

ObjectiveTo describe the clinical characteristics of elderly patients with new-onset epilepsy in a Class A tertiary comprehensive hospital in north China and evaluate the treatment outcomes of antiseizure medications (ASMs). This study focuses on investigating the factors affecting the treatment outcomes, guiding the drug treatment, and judging the prognosis of elderly epilepsy patients.MethodsWe included patients aged 60 years or older at the time of their first seizure between January 2014 and August 2020. Demographic characteristics, effects of ASM, and the proportion of 1-year and long-term seizure freedom were reported. The univariate analysis and binary logistic regression were used to identify factors potentially influencing treatment outcomes.ResultsA total of 326 patients (median age 65 years, 67.2% men) were included. Moreover, 185 (56.7%) patients who received the first ASM monotherapy achieved 1 year of seizure freedom in the early stage. Compared with structural etiology, unknown etiology was associated with a higher likelihood of early seizure freedom (odds ratio [OR] = 0.545; p < 0.05). Conversely, comorbid intracranial malignant tumors, taking carbamazepine (CBZ), and sodium valproate (VPA) were associated with a lower likelihood of seizure freedom (OR = 3.527 vs. 6.550 vs. 8.829; p < 0.05). At long-term follow-up, 263 (80.6%) patients achieved seizure freedom, with 79.8% on monotherapy.ConclusionsElderly patients with new-onset epilepsy responded well to the initial ASMs treatment. Patients with intracranial malignant tumors and prescribed VPA and CBZ were less likely to achieve early seizure freedom, while those with unknown etiology had higher probabilities of achieving early seizure freedom than those with structural etiology.

Percutaneous Radiofrequency Rhizotomy Is Equally Effective for Trigeminal Neuralgia Patients with or Without Neurovascular Compression.

Neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) can be a factor of treatment outcome, especially in microvascular decompression and stereotactic radiosurgery. No such effect has been reported in percutaneous radiofrequency rhizotomy (RF). This study aims to investigate whether NVC affects the efficacy of RF in patients with TN. We retrospectively reviewed patients with TN who received RF in our institution. Pretreatment magnetic resonance imaging was performed in every patient, and the presence of NVC was reviewed independently by two physicians. The patients were followed up at least for a year after the treatment. Pain severity was assessed with a numeric rating scale (NRS). Sixty-two patients were included in the study. All of the patients had single-sided lesions, and 35 patients had NVC. There were no significant differences between these two groups of patients in terms of gender distribution, age, and pretreatment pain severity. Comparable pain severity improvement was found at 1-year follow-up between these two groups (NRS 7.93 ± 0.492 without compression vs 7.57 ± 0.451 with compression, P = 0.600). No significant difference in posttreatment pain severity at 1 year was found between these two patient groups (NRS 1.37 ± 0.466 without compression vs 1.66 ± 0.458 with compression, P = 0.667). For patients with TN treated by RF, the presence or absence of NVC is not likely to affect the 1-year pain control rate.

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand.

Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

Therapist Self-Efficacy in Delivering Cognitive Processing Therapy in a Randomized Controlled Implementation Trial

Efforts to improve the implementation of evidence-based treatments (EBT) have recently made important strides. One such example is understanding the vital role that weekly consultation plays as therapists learn to deliver an EBT. Because mechanism-based research can further support EBT implementation, the present study sought to examine the potential relationship between therapist self-efficacy in relation to treatment fidelity and outcomes.We examined therapist self-efficacy ratings from 80 therapists working with 188 patients. These data were collected as part of a randomized controlled implementation trial testing cognitive processing therapy (CPT). Across post-workshop training conditions, we ran multilevel models to assess (1) changes in therapist self-efficacy, (2) therapist self-efficacy in relation to treatment fidelity, and (3) therapist-self-efficacy in relation to patient PTSD symptom outcomes.We found that therapist self-efficacy significantly improved over the course of 6 months of CPT training. Baseline therapist self-efficacy was differentially associated with client outcomes based on post-workshop training condition. Specifically, therapists with low self-efficacy that did not receive post-workshop consultation tended to have poorer outcomes than therapists with low self-efficacy that received consultation. In the present sample, therapist self-efficacy was not related to treatment fidelity.As this was the first study to examine therapist self-efficacy in the implementation of an evidence-based treatment, our findings suggest that self-efficacy may be an important implementation factor in treatment outcomes and worthy of ongoing research.

Impact of technology use in type 2 diabetes distress: A systematic review.

BACKGROUNDDiabetes distress is an important factor in treatment outcomes and results in poor behavioral and biological consequences. Technology has been used in management programs of diabetes to improve communication between patients and health care providers and to promote education about the disease and its psychological aspects, which can impact the self-efficacy of the programs. However, the true impact of technological approaches on the management of type 2 diabetes distress remains controversial.AIMTo investigate the effectiveness of technology interventions on the management of type 2 diabetes distress.METHODSStudies published from 2014 to 2019 were searched in five databases: MEDLINE, PubMed, Library and Information Science Source, Academic Search Ultimate and PsycINFO. The Boolean logic search terms were: (1) T2Diabetes; (2) diabetes distress; and (3) technology OR mobile OR phone OR application OR web. We also systematically searched the reference lists of the included studies and relevant reviews. Randomized controlled trials with technology interventions, type 2 diabetes patients and diabetes distress as the outcome were selected. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed.RESULTSOf the 88 studies selected, nine full articles met the inclusion criteria and were subjected to final careful review. On the JADAD scale, one article was classified as having poor quality and eight as having good quality. Six out of nine articles showed that technology interventions had a positive impact on diabetes distress scale scores when compared with the initial data. Among the six articles, five showed a greater reduction in the diabetes distress scores from control interventions. Web-based interventions had good results when users received personalized feedback and routine caregiver support and attention.CONCLUSIONTechnology interventions can contribute positively to the management of type 2 diabetes distress, especially with a tailored approach in conjunction with caregiver interaction with patients.

How to select older patients with acute myeloid leukemia fit for intensive treatment?

Outcomes of the treatment of older patients with acute myeloid leukemia (AML) are unsatisfactory due to a higher incidence of negative patient- and disease-related risk factors connected with aging. Prediction of poor tolerance to aggressive treatment and low response to standard intensive chemotherapy are the main root causes why the treatment decision is challenging. For a long time, negative prognostic factors for treatment outcomes, overall survival, and early death such as the age itself, low-performance status, high-comorbidity burden, adverse cytogenetics, and secondary AML have been known, and they are routinely taken into account during therapeutic balance. In consideration of the risk factors and specific laboratory results, prognostic models have been created. Despite the abovementioned facts, the survival of older patients with AML remains very poor, that holds true even for the intensive therapy. For that reason, there is an increased effort to find a better approach how to select patients who would benefit from intensive treatment without decreasing their quality of life through severe complications with risk of high treatment-related mortality. Based on the results of clinical studies, the geriatric assessment could be the missing step which would help select older patients who are really fit for intensive treatment and who will benefit from it the most. This review focuses on the risk factors that should be taken under advisement when the decision about the treatment is made. With reference to the published information, we propose an algorithm how to identify fit, vulnerable, and frail patients.

Tuberculosis treatment outcomes: a fifteen-year retrospective study in Jos-North and Mangu, Plateau State, North - Central Nigeria

BackgroundGlobally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos-North and Mangu Local Government Areas of Plateau State, North-Central Nigeria.MethodsThe retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State. Data were collected from 10,156 TB patient’s health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariate and multivariate logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA.ResultsDuring the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ± SD was 35.5 ± 15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. The factors associated with treatment success were gender, age, year of enrollment, and HIV status. Extrapulmonary TB was less likely associated with treatment success (AOR:95% CI- 0.72:0.61–0.84, p < 0.001).ConclusionWith the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

Comparisons of Non-Surgical Interventions for Frozen Shoulder: A Systematic Review and Network Meta-Analysis

Background: Frozen shoulder is a common musculoskeletal disorder, characterised by pain and movement restriction. Non-surgical approaches are the mainstay therapy for frozen shoulder. Our aim was to compare the effect of different non-surgical interventions, and to identify potential moderating variables of treatment effect. Methods: The following databases were searched, from their inception to October 18, 2018: PubMed, EMBASE, Cochrane Library, and Web of Science. The search was supplemented by manual review of relevant reference lists. Randomised controlled trials (RCTs) of non-surgical interventions, with a clear comparison group and measured outcomes, were selected. All records were screened by two independent reviewers, and the quality of studies assessed. Study characteristics and outcome data were extracted for pairwise and network meta-analyses. Measured outcomes included pain, shoulder function in activities of daily living, and range of motion (ROM). The mean change in value from baseline was the primary outcome measure, with the pooled standardised mean difference (SMD), and its 95% credible interval (CrI), used to compare outcomes between two groups. Findings: Of 2953 records identified, 92 RCTs were eligible, evaluating 32 non-surgical interventions, in 5946 patients. Of these, intraarticular injection improved pain (steroid injection, SMD 1·68 [95% CrI, 1·03-2·34]; capsular distension, SMD 2·68 [1·32-4·05]), and shoulder function (steroid injection: SMD 2·16 [1·52-2·81]; distension: SMD 2·89 [1·71-4·06]) to a greater extent than either a placebo or conventional physical therapy. Subgroup analyses revealed steroid injection combined with conventional physical therapy yielding improvement during the painful freezing phase, with joint manipulation yielding more benefits in the adhesive phase. Disease stage, female sex, and diabetes were identified as moderating factors of treatment outcome. Interpretation: Intra-articular injection is the prevailing non-surgical treatment for frozen shoulder. Factors (disease stage, sex, and diabetes) should be considered for individualised optimal options. Funding Statement: This work was funded by the grants from National Natural Science Foundation of China (No.81902278), and Zhejiang Provincial Natural Science Foundation (No. LY15H170002) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension statement, incorporating network meta-analyses. The study protocol has been submitted to PROSPERO (registration number CRD42018112971).

Predictive factors of treatment outcomes after percutaneous ablation of hepatocellular carcinoma in the caudate lobe: a retrospective study

BackgroundHepatocellular carcinomas (HCC) arising in the caudate lobe is rare and the treatment is difficult. The aim of this study is to summarize the experience of ultrasound-guided percutaneous ablation therapy for HCC located in the caudate lobe and to investigate the predictive factors of the treatment outcomes.MethodsFrom August 2006 to June 2017, 73 patients (63 males and 10 females; mean age, 54.9 ± 11.6 years; age range, 25–79 years) with 73 caudate lobe HCCs (mean size, 2.6 ± 1.1 cm; size range, 1.0–5.0 cm) were treated with percutaneous ablation, including 33 patients with radiofrequency ablation (RFA), 23 patients with ethanol ablation (EA), and 17 patients with combination of RFA and EA. The treatment outcome and survival after ablation for caudate lobe HCC were assessed and the predictive factors were calculated by univariate and multivariate analyses.ResultsA total of 72 patients achieved complete ablation after the first or second session of ablation. The treatment effectiveness was 98.6% (72/73). During the follow-up, 16 tumors developed local tumor progression (LTP) and a total of 61 patients (61/73, 83.6%) were detected distant recurrence (DR). According to univariate and multivariate analyses, tumor size > 2 cm (hazard ratio[HR] = 3.667; 95% confidence interval[CI], 1.043–12.889; P = 0.043) was a significant prognostic factor of LTP after ablation for HCC in the caudate lobe, while tumor number (HR = 2.245; 95%CI, 1.168–4.317; P = 0.015) was a significant prognostic factor of DR. The mean overall survival time after ablation was 28.7 ± 2.8 months, without independent predictive factors detected. Four patients (4/73, 5.5%) were detected treatment-related major complications, without independent predictive factor detected.ConclusionUltrasound-guided percutaneous ablation is a feasible treatment for a selected case with HCC in the caudate lobe. Tumor size > 2 cm increases the risk of LTP and intrahepatic tumor number is associated with DR after ablation.

Youth With Chronic Pain and a History of Adverse Childhood Experiences in the Context of Multidisciplinary Pain Rehabilitation.

Previous research has shown that youth with chronic pain who presented for a multidisciplinary evaluation report a history of adverse childhood experiences (ACEs) (eg, abuse, neglect, parent/guardian separation or divorce) at a high rate (over 80%) and that those with pain and ACEs experience increased psychosocial impairment. Outside of chronic pain, evidence also suggests that youth with a history of ACEs experience poorer treatment outcomes. However, no study to date has examined treatment outcomes in youth with chronic pain and a history of ACEs. The current study aimed to examine the role of ACEs in multidisciplinary intensive pain rehabilitation treatment outcomes for youth with chronic pain. The sample included 305 youth who had undergone intensive pain rehabilitation. Outcomes examined included pain-related and psychosocial impairment measured at baseline and discharge from the program. Results indicated that ∼59% of this sample reported a history of ACEs with ∼21% reporting a history of ≥2 ACEs. At baseline, youth with an ACEs history reported higher somatic symptoms. However, no significant interaction was found across treatment timepoints between ACEs history and time. ACEs history was not a significant factor in treatment outcomes for youth with chronic pain who presented to intensive pain rehabilitation. However, the difference in report of ACEs history across treatment settings indicates that ACEs may be a barrier for youth to engage in recommended outpatient treatment before presenting to pain rehabilitation. Research is needed to further examine this phenomenon.

The Effects of If-Then Plans on Weight Loss: Results of the McGill CHIP Healthy Weight Program Randomized Controlled Trial.

The NIH-developed Diabetes Prevention Program (DPP) is successful in achieving clinically significant weight loss in individuals with overweight/obesity when delivered one-on-one. The group-based DPP is less effective, with average weight losses of only 3.5%. The objective of this study was to increase weight loss outcomes of the group-based DPP by integrating habit formation tools (i.e., if-then plans). This two-arm randomized controlled trial tested the efficacy of the habit formation-enhanced group-based DPP compared with the standard group-based DPP on changes in body weight (primary outcome). This study presents the 3- and 12-month results of this 24-month trial. A total of 208 participants were randomly assigned to the standard or enhanced DPP, and 172 participated. Participants were men and women with overweight/obesity who self-reported less than 200 min/wk of exercise. Both groups achieved high weight losses at 3 (5.76%) and 12 (9.98%) months, with no differences between groups (χ2 < 1). Both groups improved in blood pressure and physical activity. If-then plans did not result in higher weight loss. Both program versions resulted in higher weight loss than the group-based DPP. This may suggest that cognitive behavioral therapy skills of the coaches (clinical psychology doctoral students) was a key factor in treatment outcome.

Survival Outcomes Improved in Contemporary Cohort of Patients With Pelvic or Abdominal Recurrence After Treatment for Stage I/II Endometrial Carcinoma

Pelvic and abdominal recurrences in stage I/II endometrial carcinoma are associated with poor outcomes, yet prognostic factors for survival after recurrence are not well described. Herein, we identify patients with pelvic or abdominal recurrence after surgery for stage I/II endometrial carcinoma and describe symptoms at presentation, prognostic factors, and salvage treatment toxicity. This is a retrospective cohort of 20 consecutively treated patients with recurrence after treatment for stage I/II endometrial carcinoma followed by our Institution's Radiation Oncology Department from 1998 to 2015. The median time to pelvic or abdominal recurrence was 18.1 months (range, 4.2 to 59.6 mo), with 50% of recurrences at extranodal locations. Two-year progression-free survival (PFS) was 44% and 2-year overall survival (OS) was 82%. Salvage treatments varied widely, including chemotherapy and radiotherapy (RT) (7), surgery and RT (3), and surgery, chemotherapy, and RT (3). On univariate analysis of PFS, symptoms at recurrence (P=0.04) and extranodal recurrences (P<0.01) were found to be statistically significant negative prognosticators for PFS. On univariate analysis of OS, increasing age at recurrence and presence of symptoms were found to have a trend toward statistically significant association with negative OS outcomes (P=0.08 and P=0.10, respectively). Our study demonstrates that long-term survival for pelvic or abdominal recurrences is possible with curative salvage therapy. The presence of symptoms is a negative prognostic factor in treatment outcome, and imaging may be effective for diagnosis in symptomatic and asymptomatic patients. Larger studies need to be performed to confirm these findings.

Abstract 1134: Tissue transglutaminase is a new therapeutic target to overcome steroid resistance in T cell acute lymphoblastic leukemia

Abstract Background: The treatment response to steroid is the most important predictive factor for treatment outcome of T-cell acute lymphoblastic leukemia (T-ALL). To improve survival for steroid-resistant T-ALL patients, it is necessary to develop innovative therapeutic strategies to overcome steroid resistance. This study attempts to determine new therapeutic strategies to overcome steroid resistance for patients with T-ALL. Tissue transglutaminase (TG2) is a intracellular calcium-dependent protein cross-linking enzyme reported to be highly expressed in various metastatic or drug-resistant cancer cells, and chronic expression of TG2 constitutively activates nuclear factor kappa B (NF-kappaB). Methods: We used biochemical and molecular methodologies to demonstrate that TG2 modulation leaded to overcome the steroid resistance in T-ALL. Results: We generated the steroid-adapted subclones of T-ALL cell lines that were extremely less sensitive to steroid than their parent T-ALL cells. We found that steroid-resistant subclones of T-ALL cells expressed much higher levels of TG2 than their parent cells and the modulation of TG2 activities altered NF-kappaB expression in this steroid-resistant cells. Inhibition of TG2 suppressed steroid resistance and improved the cytotoxicity of leukemia cells in steroid-adapted subclones of T-ALL. Conclusion: This study shows that TG2 expression is elevated with steroid resistance in T-ALL and the modulation of TG2 induces the cytotoxicity of steroid-adapted T-ALL. TG2 could be a new therapeutic target to overcome steroid resistance in T-ALL. Furthermore, change of TG2 expression could serve as markers of induced steroid resistance in T-ALL. Citation Format: Hyun Joo Jung. Tissue transglutaminase is a new therapeutic target to overcome steroid resistance in T cell acute lymphoblastic leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1134. doi:10.1158/1538-7445.AM2017-1134

Treatment Outcomes of Mandibular Advancement Devices between Rapid-Eye-Movement (REM)-Related and Not-REM-Related OSA Patients

Purpose: Mandibular advancement devices (MAD) are used effectively and widely for the treatment of obstructive sleep apnea (OSA) and rapid-eye-movement (REM) dependency of the patients can affect the treatment outcome of OSA. The aim of this study was to compare treatment outcomes of MAD between REM-related and not-REM-related OSA patients. Methods: Fifty-six consecutive patients with OSA who received MAD therapy were evaluated using full night polysomnography before and after insertion of the MADs. The patients were divided into REM-related (REM apnea-hypopnea index [AHI] at least two times higher than their non-REM AHI) and not-REM-related (REM AHI less than two times higher than their non-REM AHI) OSA groups. Results: MAD is used for the treatment of OSA effectively. In respect of AHI, MAD therapy were effective both in REM-related OSA and not-REM-related OSA, but MAD therapy was more effective in not-REM-related OSA than REM-related OSA in overall sleep and non-REM sleep. SpO2 saturations were improved after MAD therapy, but were not different between two groups. Epworth sleepiness scale scores were not improved after MAD therapy. Percentage of REM sleep was increased after MAD therapy but was not different between two groups. Conclusions: MAD therapy was more effective in not-REM-related OSA than REM-related OSA and REM dependency can be a predictive factor of treatment outcome of oral appliance for OSA patients.

Dynamic motor control is associated with treatment outcomes for children with cerebral palsy.

To estimate the impact of dynamic motor control on treatment outcomes in children with cerebral palsy. We used multiple regression on a retrospective cohort of 473 ambulatory children with cerebral palsy who underwent conservative treatment, single-level orthopaedic surgery, single-event multi-level orthopaedic surgery, or selective dorsal rhizotomy. Outcomes included gait pattern, gait speed, energy cost of walking, and the Pediatric Outcomes Data Collection Instrument. Explanatory variables considered were pre-treatment levels of each outcome, treatment group, prior treatment, age, and dynamic motor control computed from surface electromyography using synergy analysis. Effect sizes were estimated from the adjusted response. Pre-treatment levels had effect sizes 2 to 13 times larger than the next largest variable. Individuals with milder pre-treatment involvement had smaller gains or actual declines. Dynamic motor control was significant in all domains except energy cost. The effect size of dynamic motor control was second only to pre-treatment level, and was substantially larger than the effect size of treatment group for outcomes where both were significant (gait pattern 2:1, gait speed 4:1). The effect of dynamic motor control was independent of treatment group. Dynamic motor control is an important factor in treatment outcomes. Better dynamic motor control is associated with better outcomes, regardless of treatment.