Five-year Prognosis Research Articles

Research progress on ferroptosis in colorectal cancer.

Ferroptosis is a new form of cell death that differs from traditional forms of death. It is ferroptosis-dependent lipid peroxidation death. Colorectal cancer(CRC) is the most common tumor in the gastrointestinal tract with a long occultation period and a poor five-year prognosis. Exploring effective systemic treatments for CRC remains a great challenge worldwide. Numerous studies have demonstrated that ferroptosis can participate in the biological malignant process of various tumor, including CRC, so understanding the role and regulatory mechanisms of ferroptosis in CRC plays a crucial role in the treatment of CRC. In this paper, we reviews the mechanisms of ferroptosis in CRC, the associated regulatory factors and their interactions with various immune cells in the immune microenvironment. In addition, targeting ferroptosis has emerged as an encouraging strategy for CRC treatment. Finally, to inform subsequent research and clinical diagnosis and treatment, we review therapeutic approaches to CRC radiotherapy, immunotherapy, and herbal therapy targeting ferroptosis.

Targeted proteomics of plasma extracellular vesicles uncovers MUC1 as combinatorial biomarker for the early detection of high-grade serous ovarian cancer

BackgroundThe five-year prognosis for patients with late-stage high-grade serous carcinoma (HGSC) remains dismal, underscoring the critical need for identifying early-stage biomarkers. This study explores the potential of extracellular vesicles (EVs) circulating in blood, which are believed to harbor proteomic cargo reflective of the HGSC microenvironment, as a source for biomarker discovery.ResultsWe conducted a comprehensive proteomic profiling of EVs isolated from blood plasma, ascites, and cell lines of patients, employing both data-dependent (DDA) and data-independent acquisition (DIA) methods to construct a spectral library tailored for targeted proteomics. Our investigation aimed at uncovering novel biomarkers for the early detection of HGSC by comparing the proteomic signatures of EVs from women with HGSC to those with benign gynecological conditions. The initial cohort, comprising 19 donors, utilized DDA proteomics for spectral library development. The subsequent cohort, involving 30 HGSC patients and 30 control subjects, employed DIA proteomics for a similar purpose. Support vector machine (SVM) classification was applied in both cohorts to identify combinatorial biomarkers with high specificity and sensitivity (ROC-AUC > 0.90). Notably, MUC1 emerged as a significant biomarker in both cohorts when used in combination with additional biomarkers. Validation through an ELISA assay on a subset of benign (n = 18), Stage I (n = 9), and stage II (n = 9) plasma samples corroborated the diagnostic utility of MUC1 in the early-stage detection of HGSC.ConclusionsThis study highlights the value of EV-based proteomic analysis in the discovery of combinatorial biomarkers for early ovarian cancer detection.

Five-year prognosis of patients with acute myocardial infarction and out-of-hospital cardiac arrest

Five-year prognosis of patients with acute myocardial infarction and out-of-hospital cardiac arrest

The landscape of immune checkpoint-related long non-coding RNAs core regulatory circuitry reveals implications for immunoregulation and immunotherapy responses

Long non-coding RNAs (lncRNAs) could modulate expression of immune checkpoints (ICPs) by cooperating with immunity genes in tumor immunization. However, precise functions in immunity and potential for predicting ICP inhibitors (ICI) response have been described for only a few lncRNAs. Here we present an integrated framework that leverages network-based analyses and Bayesian network inference to identify the regulated relationships including lncRNA, ICP and immunity genes as ICP-related LncRNAs mediated Core Regulatory Circuitry Triplets (ICP-LncCRCTs) that can make robust predictions. Hub ICP-related lncRNAs such as MIR155HG and ADAMTS9-AS2 were highlighted to play central roles in immune regulation. Specific ICP-related lncRNAs could distinguish cancer subtypes. Moreover, the ICP-related lncRNAs are likely to significantly correlated with immune cell infiltration, MHC, CYT. Some ICP-LncCRCTs such as CXCL10-MIR155HG-ICOS could better predict one-, three- and five-year prognosis compared to single molecule in melanoma. We also validated that some ICP-LncCRCTs could effectively predict ICI-response using three kinds of machine learning algorithms follow five independent datasets. Specially, combining ICP-LncCRCTs with the tumor mutation burden (TMB) improves the prediction of ICI-treated melanoma patients. Altogether, this study will improve our grasp of lncRNA functions and accelerating discovery of lncRNA-based biomarkers in ICI treatment.

Identification of CD8+ T-cell exhaustion signatures for prognosis in HBV-related hepatocellular carcinoma patients by integrated analysis of single-cell and bulk RNA-sequencing

BackgroundHBV infection is the leading risk factor for HCC. HBV infection has been confirmed to be associated with the exhaustion status of CD8+ T cells and immunotherapeutic efficacy in HCC. In this study, we aimed to investigate the prognostic value of the CD8+ T-cell exhaustion signature and immunotherapy response in patients with HBV-related HCC.MethodsWe identified different clusters of HBV-related HCC cells by single-cell RNA sequencing (scRNA-seq) and identified CD8+ T-cell exhaustion-related genes (TERGs) by pseudotime analysis. We conducted differential expression analysis and LASSO Cox regression to detect genes and construct a CD8+ T-cell exhaustion index (TEI). We next combined the TEI with other clinicopathological factors to design a prognostic nomogram for HCC patients. We also analysed the difference in the TEI between the non-responder and responder groups during anti-PD-L1 therapy. In addition, we investigated how HBV induces CD8+ T lymphocyte exhaustion through the inhibition of tyrosine metabolism in HCC using gene set enrichment analysis and RT‒qPCR.ResultsA CD8+ T-cell exhaustion index (TEI) was established with 5 TERGs (EEF1E1, GAGE1, CHORDC1, IKBIP and MAGOH). An AFP level > 500 ng, vascular invasion, histologic grade (G3-G4), advanced TNM stage and poor five-year prognosis were related to a higher TEI score, while HBV infection was related to a lower TEI score. Among those receiving anti-PD-L1 therapy, responders had lower TEIs than non-responders did. The TEI also serves as an independent prognostic factor for HCC, and the nomogram incorporating the TEI, TNM stage, and vascular invasion exhibited excellent predictive value for the prognosis in HCC patients. RT‒qPCR revealed that among the tyrosine metabolism-associated genes, TAT (tyrosine aminotransferase) and HGD (homogentisate 1,2 dioxygenase) were expressed at lower levels in HBV-HCC than in non-HBV HCC.ConclusionGenerally, we established a novel TEI model by comprehensively analysing the progression of CD8+ T-cell exhaustion, which shows promise for predicting the clinical prognosis and potential immunotherapeutic efficacy in HBV-related HCC patients.

Identifying immune checkpoint-related lncRNA biomarkers for immunotherapy response and prognosis in cancers

Long non-coding RNAs (lncRNAs) could modulate expression of immune checkpoints (ICPs) in tumor-immune. However, precise functions in immunity and potential for predicting ICP inhibitors (ICI) response have been described for only a few lncRNAs. Here, a multiple-step pipeline was developed to identify cancer- and immune-context ICP and lncRNA cooperative regulation pairs (ICPaLncCRPs) across cancers. Immune-related ICPs and lncRNAs were extracted follow immune cell lines and immunologic constant of rejection groups. ICPaLncCRP networks were constructed, which likely to modulate tumor-immune by specific patterns. Common and specific hub ICPaLncs such as MIR155HG, TRG-AS1 and PCED1B-AS1 maybe play central roles in prognosis and circulating. Moreover, these hub ICPaLncs were significantly correlated with immune cell infiltration based on bulk and single-cell RNA sequencing data. Some ICPaLncCRPs such as IDO1-MIR155HG could predict three- and five-year prognosis of melanoma in two independent datasets. We also validated that some ICPaLncCRPs could effectively predict ICI-response follow six independent datasets. Collectively, this study will enhance our understanding of lncRNA functions and accelerate discovery of lncRNA-based biomarkers in ICI treatment.

Five-Year Prognosis Model of Esophageal Cancer Based on Genetic Algorithm Improved Deep Neural Network

ObjectivesEsophageal cancer is a high occult malignant tumor. Even with good diagnosis and treatment, the 5-year survival rate of esophageal cancer patients is still less than 30%. Considering the influence of clinical characteristics on postoperative esophageal cancer patients, the construction of a neural network model will help improve the poor prognosis of patients in the five years. Material and methodsIn this study, genetic algorithm optimized deep neural network is exploited to the clinical dataset of esophageal cancer. The independent prognostic factors are screened by Relief algorithm and Cox proportional risk regression. FTD prognostic staging system is established to assess the risk level of esophageal cancer patients. ResultsFTD staging system and independent prognostic factors are integrated into the genetic algorithm optimized deep neural network. The Area Under Curve (AUC) of FTD staging system is 0.802. FTD staging system is verified by the Kaplan-Meier survival curve, and the median survival time is divided for different risk grades. The FTD staging system is superior to the TNM stages in the prognosis effect. The AUC of deep neural network optimized by genetic algorithm is 0.91. ConclusionThe deep neural network optimized by genetic algorithm has good performance in predicting the 5-year survival status of esophageal cancer patients. The FTD staging system has a significant prognostic effect. The FTD staging system and genetic algorithm optimized deep neural network can be successfully availed in clinical diagnosis and treatment.

Effects of chronic obstructive pulmonary disease on long-term prognosis of patients with coronary heart disease post-percutaneous coronary intervention.

BACKGROUNDChronic obstructive pulmonary disease (COPD) and cardiovascular diseases are often comorbid conditions, their co-occurrence yields worse outcomes than either condition alone. This study aimed to investigate COPD impacts on the five-year prognosis of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).METHODSPatients with CHD who underwent PCI in 2013 were recruited, and divided into COPD group and non-COPD group. Adverse events occurring among those groups were recorded during the five-year follow-up period after PCI, including all-cause death and cardiogenic death, myocardial infarction, repeated revascularization, as well as stroke and bleeding events. Major adverse cardiac and cerebral events were a composite of all-cause death, myocardial infarction, repeated revascularization and stroke.RESULTSA total of 9843 patients were consecutively enrolled, of which 229 patients (2.3%) had COPD. Compared to non-COPD patients, COPD patients were older, along with poorer estimated glomerular filtration rate and lower left ventricular ejection fraction. Five-year follow-up results showed that incidences of all-cause death and cardiogenic death, as well as major adverse cardiac and cerebral events, for the COPD group were significantly higher than for non-COPD group (10.5% vs. 3.9%, 7.4% vs. 2.3%, and 30.1% vs. 22.6%, respectively). COPD was found under multivariate Cox regression analysis, adjusted for confounding factors, to be an independent predictor of all-cause death [odds ratio (OR) = 1.76, 95% CI: 1.15–2.70, P = 0.009] and cardiogenic death (OR = 2.02, 95% CI: 1.21–3.39, P = 0.007). CONCLUSIONSCOPD is an independent predictive factor for clinical mortality, in which CHD patients with COPD are associated with worse prognosis than CHD patients with non-COPD.

Five-year prognosis of life in patients with peripartum cardiomyopathy

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить особенности течения и прогноза жизни больных перипартальной кардиомиопатией (ПКМП) за пятилетний период наблюдения. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включен 51 пациент с ПКМП. Выполнен анализ стандартных клинико-функциональных, инструментальных и лабораторных показателей.<b></b> Разделение на группы произведено в зависимости от исходов, зафиксированных через 5 лет наблюдения: 1-я группа — с восстановлением фракции выброса левого желудочка (ФВ ЛЖ) до нормальных значений (более 50%) и нивелированием клинических признаков сердечной недостаточности (СН); 2-я группа — летальный исход по причине прогрессирования СН или развития внезапной сердечной смерти (ВСС); 3-я группа — пациенты, имеющие отклонения со стороны эхокардиографии (увеличенные размеры сердца, низкая ФВ ЛЖ менее 50%). <h3>РЕЗУЛЬТАТЫ</h3> Восстановление ФВ отмечено у 22 (43%) женщин. К концу первого года летальность от прогрессирования СН наблюдалась в 3 (5%) случаях. В 1 случае — ВСС. В течение 2-го года умерли еще 3 больных вследствие прогрессирования СН. Общая летальность составила 11% (<i>n</i>=6). Общая летальность за 5 лет — 12 (24%), где ВСС установлена лишь в 3 случаях, причем одна из них после повторных родов спустя 1 год после начала заболевания. Возраст пациентов, высокие значения частоты сердечных сокращений, уровень гемоглобина при ПКМП не оказывали существенного влияния (<i>p</i>&lt;0,05). В 1-й группе исходно наблюдалась более высокая толерантность к физической нагрузке.<b><i></i></b> Наиболее худшие параметры эхокардиографии отмечены у больных с летальным исходом (конечный диастолический размер ЛЖ во 2-й и 3-й группах — 67,73±8,11 и 66,71±5,83 соответственно, <i>p</i>&lt;0,05). В этих же группах в 33,3% регистрировались наибольшая частота встречаемости полной блокады левой ножки пучка Гиса (ПБЛНПГ) и отсутствие зубца R или Q-S в 58,3% случаев. <h3>ВЫВОДЫ</h3> Пациенты с неблагоприятным течением заболевания (умершие или имеющие персистирующую СН) характеризуются низким функциональным статусом с тяжелой систолической дисфункцией. Изменения на электрокардиограмме в виде ПБЛНПГ и отсутствия зубца R чаще отмечались в группе умерших пациентов.

Role of MRI in Breast Cancer Staging: A Case-Based Review.

Breast cancer is the most commonly diagnosed cancer in women in the United States and is also the second leading cause of cancer deaths in women. The five-year survival rate and overall prognosis are largely dependent on the stage at diagnosis. Our article highlights the role of magnetic resonance imaging (MRI) in breast cancer staging and updates to the American Joint Committee on Cancer (AJCC) 8th edition guidelines regarding breast cancer staging that are relevant to radiologists. It provides a case-based approach to emphasize the key findings that the radiologist should report on a breast MRI to aid the clinicians in staging and management.

Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study

Objectives The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. Methods A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score ≥10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. Results Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69–2.95) for participants with moderate LTPA and 0.92 (CI 0.42–2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (β=0.14 [95% CI: 0.02–0.26] for linearity = 0.024). Conclusion Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

Five-Year Prognosis After TIA or Minor Ischemic Stroke in Asian and Non-Asian Populations.

To determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asian patients with those of non-Asian patients, in the context of modern guideline-based prevention strategies. This is a subanalysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome. No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.88-1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90-1.51; p = 0.24) between Asian and non-Asian patients. Asian participants were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09-4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11-3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02-1.90; p = 0.037) patients. The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asian participants had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups. This study provides Class I evidence that among people who experienced TIA or minor stroke, Asian patients have a similar 5-year risk of cardiovascular death, stroke, and acute coronary syndrome as non-Asian patients.

Kinetics of IgG Antibodies in Previous Cases of Dengue Fever-A Longitudinal Serological Survey.

Guangzhou is believed to be the most important epicenter of dengue outbreaks in southern China. In this study, a longitudinal serological investigation of previous cases of dengue fever in Guangzhou was conducted to explore the persistence of IgG antibodies and related factors affecting the changes of antibody level. We recruited 70 dengue virus type 1 (DENV-1) primary infection cases at two years post infection for serological investigation and conducted a second follow-up in the 5th year of prognosis. An enzyme-linked immunosorbent assay (ELISA) for DENV IgG antibody was examined in all study subjects. Potential factors associated with the concentration of serum total IgG antibody were determined by the generalized estimation equation (GEE). No significant difference in serum total IgG antibody positive rate between two follow-ups was observed (χ2 = 3.066, p = 0.080). However, there was a significant difference in the concentration of serum total IgG antibody between the two follow-ups (Z = 7.154, p < 0.001). The GEE showed that the antibody level in the five-year prognosis was mainly affected by the antibody level in the two-year prognosis (OR: 1.007, 95%CI: 1.005–1.009). In conclusion, the serum IgG antibodies of previous dengue fever cases can persist for a long time.

Plasma soluble human leukocyte antigen G predicts the long-term prognosis in patients with colorectal cancer.

BackgroundColorectal cancer (CRC) is the third most common tumor in the world. It is crucial to further screen for indicators that are strictly related to long-term prognosis. Human leukocyte antigen G (HLA-G) is closely involved in tumor development. This study aims to evaluate the long-term predictive value of soluble HLA-G (sHLA-G) in CRC through a double-center retrospective study.MethodsPatients who underwent radical CRC surgery in two hospitals from April 2010 to March 2015 were included. Baseline data of the patients were collected. The patients’ preoperative baseline plasma sHLA-G level was detected. According to whether they survived during five years of follow-up, these patients were divided into two groups. Univariate and multivariate analysis were used to find factors associated with survival. The receiver operation curve (ROC) was performed to analyze the relationship between sHLA-G level and five-year survival, and the cutoff value was obtained. The baseline data and follow-up results of the two groups of patients were compared, and the Kaplan-Meier survival curve was used to analyze the difference in the long-term prognosis of the two groups of patients.ResultsA total of 1,037 cases were included and followed up for more than five years. Three hundred two cases (29.1%) died during the five-year follow-up. The baseline data of the survival group and the death group showed that the baseline level of sHLA-G in the survival group was significantly lower than the death group (41.4±16.9 vs. 64.7±23.2, P<0.05). Univariate and multivariate analyses suggest that age, differentiation, family history, TNM stage, and baseline sHLA-G levels are important factors affecting the survival of CRC patients. The area under ROC of sHLA-G with five-year survival is 0.766, and the cutoff value is 50.8 U/mL. The specificity at this point is 78.1%, and the sensitivity is 72.3%. The Kaplan-Meier survival curve showed that the five-year prognosis of patients in the low-level group was better than that in the high-level group.ConclusionsLower baseline sHLA-G level predicts better prognosis during a five-year follow-up in colorectal cancer patients.

P1802 Prevalence and prognostic significance of pulmonary artery aneurysms in patients with pulmonary artery hypertension

Abstract Background Pulmonary artery aneurysm (PAA) occurs in some patients with pulmonary arterial hypertension (PAH) and can be accompanied by various complications. Objective The aim of the this study is to evaluate the characteristics of cardiac dysfunction and the prognostic impact of PAA by analysing the outcome of patients with PAH complicated by PAA. Methods We performed echocardiography and right-heart catheterization in 130 PAH patients. We measured the maximum dimensions of the main pulmonary artery (MPA) trunk. We evaluated the right ventricular (RV) function and the five-year prognosis of patients with PAA. Results The maximum MPA trunk diameter of &amp;gt;40 mm by echocardiography was defined as PAA. PAA appeared in 32 of the 130 PAH patients (24.6%: Group PAA), other 98 patients were defined as Group non-PAA. Systolic pulmonary artery pressure (76 ±18 vs. 61 ± 21 mmHg, P = 0.0008) and mean right atrial pressure (10.0 ± 8.1 vs. 5.4 ± 3.8 mmHg, P &amp;lt; 0.0001) were significantly higher in Group PAA than in Group non-PAA. RV end-diastolic area index was significantly larger (37.3 ± 8.8 vs. 32.3 ± 7.8 mmHg, P = 0.0048), and RV fractional area change (32 ± 8 vs. 36 ± 9 %, P = 0.0176) and RV longitudinal strain amplitude (-16 ±5 vs. -20 ± 6, P = 0.0017) were significantly lower in Group PAA than those in Group non-PAA. During the five-year follow-up period, 20 patients (15%) died. The five-year mortality rate was significantly higher in Group PAA compared to Group non-PAA (30% vs. 10%, P = 0.007). Conclusion In PAH patients with PAA, RV dysfunction was more severe and the prognosis was poor. Assessment of PAA can be a useful index for the extraction of high-risk PAH patients.

Five-year prognosis and impact of adolescent knee pain: a prospective population-based cohort study of 504 adolescents in Denmark

ObjectivesInvestigate the prognosis of adolescent knee pain, and evaluate its impact on health, care-seeking and career choices 5 years later.DesignPre-registered, prospective cohort study.SettingPopulation-based cohort initiated in school setting.ParticipantsFrom a cohort...

The presence of bacteria varies between colorectal adenocarcinomas, precursor lesions and non-malignant tissue

BackgroundA causal association has been suggested between certain bacteria and colorectal cancer (CRC). Only a few studies have, however, investigated the presence of these bacteria directly in colon tissue with conflicting results. It is thus uncertain which role they may have in prognosis and carcinogenesis of CRC.MethodsFormalin-fixed and paraffin-embedded (FFPE) colorectal tissue samples from patients diagnosed with colorectal cancer (CRC)(tumor and paired normal tissue, n = 99), adenomas (n = 96), or diverticular disease (n = 104) were tested for the presence and bacterial load of Streptococcus gallolyticus (S. gallolyticus), Fusobacterium nucleatum (F. nucleatum), and Bacteroides fragilis (B. fragilis) using quantitative PCR. A subsequent broader search was conducted on a subset of samples using 16S ribosomal RNA gene sequencing. Finally, to evaluate the prognostic value, the bacterial status was compared to patient outcome.ResultsS. gallolyticus was not detected by qPCR in any of the investigated tissue samples and F. nucleatum and B. fragilis were found to be equally distributed in tumors, paired normal tissue, and diverticula, but significantly less present in adenomas compared to both tumors and diverticula. Neither, F. nucleatum nor B. fragilis status affected the five-year prognosis of the patients. The 16S rRNA gene sequencing data revealed that tumors were associated with the Prevotella genus while conversely adenomas and diverticula were associated with Acinetobacter genus.ConclusionThese findings do not support a role of F. nucleatum or B. fragilis during colorectal beginning, while S. gallolyticus was not implicated in the colorectal tissue of a Danish population. A potential role of the bacterial genera Prevotella and Acinetobacter was indicated, and requires further investigations.

High five-year mortality rates of ischemic stroke subtypes: A prospective cohort study in Brazil.

Studies regarding long-term outcomes of ischemic stroke subtypes are scarce in low- and middle-income countries. We aimed to measure the five-year prognosis of ischemic stroke subtypes in Joinville, Brazil. All first-ever ischemic strokes that occurred in Joinville in 2010 were followed-up for five years. We included 334 ischemic stroke patients. Over five years, 156 died, 51 had a recurrent stroke, and 128 were free of recurrent stroke. The overall cumulative risk of death was 17% (95% CI, 13% to 22%) at 30 days and 47% (95% CI, 41% to 52%) after five years. Undetermined with incomplete investigation ischemic stroke had a significantly worse survival probability (β -4.91; 95% CI, -6.31 to -3.50; p < 0.001), followed by cardioembolic ischemic stroke (β -3.07; 95% CI, -4.32 to -1.83; p < 0.001) and large artery disease ischemic stroke (β -1.95; 95% CI, -3.30 to -0.60; p = 0.005). The survival probability of undetermined with negative investigation or cryptogenic ischemic stroke did not differ significantly from small artery disease ischemic stroke (β -1.022; 95% CI, -3.37 to -1.43; p = 0.414). The five-year mortality for small artery disease ischemic stroke was 30% (95% CI, 22% to 39%) and 47% (95% CI, 35% to 60%) for large artery ischemic stroke. The risk of stroke recurrence was 2% in the first year and 5% in the second year. The proportion of disability among survivors in the first month ranged from 8% (95% CI, 3-15) for small artery disease ischemic stroke to 40% (95% CI, 30-52) for cardioembolic ischemic stroke patients. Cardioembolic and undetermined with incomplete investigation ischemic stroke sub-types have a poor long-term prognosis. An alarming finding was that our patients with both small and large artery ischemic stroke had higher five-year mortality rates compared with subjects from high-income countries.

Clinical and radiological predictors for persistent complaints five years after a lateral ankle sprain: A long-term follow-up study in primary care

ObjectivesTo examine the five-year prognosis and potential prognostic factors of patients with an acute lateral ankle sprain in primary care setting. DesignObservational study. Methods206 patients who participated in a cross-sectional study and visited their general practitioner with an acute lateral ankle sprain 6–12 months prior to inclusion were approached for a 5-year follow-up measurement consisting of an online questionnaire. At baseline patients completed standardized questionnaires, underwent a standardized physical examination and radiological examination (radiography and Magnetic Resonance Imaging) and scored their perceived recovery. Logistic regression analysis was used to examine potential predictive factors at baseline for the presence of persistent complaints after 5 years. Results132 (64.1%) patients completed the 5-year follow-up. 18.2% reported persistent complaints and 30.3% had a re-sprain during follow-up. Baseline persistent complaints 6–12 months after an acute lateral ankle sprain (OR 6.38; CI 95% 1.54–26.44), dominant leg injury (OR 4.89; CI 95% 1.16–20.62) and a recurrent ankle sprain (OR 9.81; CI 95% 2.17–44.47) were significant predictors for persistent complaints 5 years after an acute ankle sprain. Physical examination and radiological findings did not add to the predictive value of the prognostic model. ConclusionsAlmost 20% of patients with an acute lateral ankle sprain experience persistent complaints after 5 years follow-up. Predictive factors for persistent complaints can be identified.

Changes in arrhythmogenic properties and five-year prognosis after carbon-ion radiotherapy in patients with mediastinum cancer.

Carbon-ion irradiation of rabbit hearts has improved left ventricular conduction abnormalities through upregulation of gap junctions. However, to date, there has been no investigation on the effect of carbon-ion irradiation on electrophysiological properties in human. We investigated this effect in patients with mediastinum extra-cardiac cancer treated with carbon-ion radiotherapy that included irradiating the heart. In April-December 2009, eight patients were prospectively enrolled (including two male, aged 72.5±13.0years). They were treated with 44-72 Gray equivalent (GyE), with their hearts exposed to 1.3-19.1 GyE. High-resolution ambulatory electrocardiography was performed before and after radiotherapy to investigate arrhythmic events, late potentials (LPs), and heart rate variability. Five patients had pre-existing premature ventricular contraction (PVC)/atrial contraction (PAC) or paroxysmal atrial fibrillation (PAF)/AF; after irradiation, this improved in four patients with PVC/PAF/AF and did not deteriorate in one patient with PAC. Ventricular LP findings did not deteriorate and improved in one patient. In eight cases with available atrial LP findings, there was no deterioration, and two patients showed improvements. The low frequency/high frequency ratio of heart rate variability improved or did not deteriorate in the six patients who received radiation exposure to the bilateral stellate ganglions. During the five-year follow-up for the prognosis, six of the eight patients died because of cancer; there was no history of hospitalization for cardiac events. Although this preliminary study has several limitations, carbon-ion beam irradiation to the heart is not immediately cardiotoxic and demonstrates consistent signals of arrhythmia reduction.