Good Prognostic Sign Research Articles

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125) and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First Trimester Pregnancy Loss in Patients with Threatened Miscarriage

Background: Pregnancy loss before 20 weeks is considered a miscarriage, as is the loss of a fetus weighing less than 500 grams before viability. A medical emergency, threatened miscarriage affects 15–25% of pregnancies. 
 Aim and objectives: The goal of this study was to assess the predictive value of maternal blood levels of Cancer Antigen 125 (CA-125) and beta-human chorionic gonadotropin (B- HCG) in individuals at risk of miscarriage during the first trimester. 
 Subjects and methods: This study was a prospective cohort study. This study included 120 pregnant women with threatened abortion between (6-11 weeks) and followed up till end of 14th week. Results: 36(30%) of pregnant women aborted, while 84(70%) of women continued till 14th weeks of pregnancy. At a cut-off value of 45 U/ml, the CA125 test was shown to have a sensitivity of 88.9% and a specificity of 77.5%, respectively, while also having a positive predictive value of 79.8% and a negative predictive value of 87.5%. At a cut-off value of 18.501 mlIU/ml, the B-HCG test's sensitivity and specificity were determined to be 96.3 and 88.9, respectively, with a positive predictive value of 89.7% and a negative predictive value of 96%. 
 Conclusion: Even before fetal morphology can be investigated sonographically, abnormalities in the size of the yolk sac can be utilized as a good prognostic sign of early pregnancy loss. Pregnancy viability can be estimated from first trimester serum CA 125 and Beta HCG measurements.

Autosplenectomy may be a good prognostic sign in sickle cell diseases

Background: Sickle cell diseases (SCDs) are inborn and destructive processes on vascular endothelium, particularly at the capillaries. Methods: Patients with red blood cells (RBCs) transfusions of less than 50 units in their lives were put into the first and 50 units or higher were put into the second groups. Results: There were 224 patients in the first and 92 patients in the second groups. Mean ages were similar in them (28.9 vs 30.0 years, respectively, p>0.05). The male ratio was higher in the second group (45.5% vs 64.1%, p<0.001). In contrast to the lower prevalence of autosplenectomy (56.2% vs 45.6%, p<0.05), painful crises per year, digital clubbing, chronic obstructive pulmonary disease (COPD), leg ulcers, stroke, chronic renal disease (CRD), and coronary heart disease (CHD) were all higher in the second group (p<0.05 for all). Conclusion: The sickled or just hardened RBCs-induced capillary endothelial damage initiates at birth, and terminates with multiorgan failures even at childhood. Although RBCs suspensions and corticosteroids in acute, and aspirin with an anti-inflammatory dose plus low-dose warfarin plus hydroxyurea both in acute and chronic phases decrease severity, survivals are still shortened in both genders, dramatically. In contrast to the lower prevalence of autosplenectomy, painful crises per year, digital clubbing, COPD, leg ulcers, stroke, CRD, and CHD were higher in the second group. So there may be an inverse relationship between prevalence of autosplenectomy and severity of SCDs, and spleen may act as a chronic inflammatory focus as a filter of blood for these abnormally hardened RBCs. Key words: Sickle cell diseases, sickled or just hardened red blood cells, capillary endothelial edema, myocardial infarction, stroke, sudden deaths, autosplenectomy

As a good prognostic sign, Autosplenectomy is higher in females in Sickle Cell Diseases

Background: Sickle cell diseases (SCDs) are inborn and destructive processes on vascular endothelium, particularly at the capillaries. Methods: All patients with the SCDs were included. Results: We studied 222 males and 212 females with similar ages (30.8 vs 30.3 years, p>0.05, respectively). Although the higher prevalence of autosplenectomy (50.4% vs 53.3%, p<0.05), transfused units of red blood cells (RBCs) in their lives (48.1 vs 28.5, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), cirrhosis (8.1% vs 1.8%, p<0.001), leg ulcers (19.8% vs 7.0%, p<0.001), clubbing (14.8% vs 6.6%, p<0.001), coronary heart disease (CHD) (18.0% vs 13.2%, p<0.05), chronic renal disease (CRD) (9.9% vs 6.1%, p<0.05), chronic obstructive pulmonary disease (COPD) (25.2% vs 7.0%, p<0.001), and stroke (12.1% vs 7.5%, p<0.05) were all lower in females. Conclusion: The sickled or just hardened RBCs-induced capillary endothelial damage initiates at birth, and terminates with multiorgan failures even at childhood. Although RBCs suspensions and corticosteroids in acute, and aspirin with an anti-inflammatory dose plus low-dose warfarin plus hydroxyurea both in acute and chronic phases decrease severity, survivals are still shortened in both genders, dramatically. Although the higher prevalence of autosplenectomy, transfused units of RBCs in their lives disseminated teeth losses, ileus, cirrhosis, leg ulcers, clubbing, CHD, CRD, COPD, and stroke were all lower in females. So there may be an inverse relationship between autosplenectomy and severity of SCDs, and spleen may act as a chronic inflammatory focus as a filter of blood for these sickled or just hardened RBCs. Key words: Sickled or just hardened red blood cells, capillary endothelial edema, myocardial infarction, stroke, sudden deaths, autosplenectomy, female gender

Abstract 10270: Association Between Hypertension and Aortic Stenosis Mortality in a Large Unselected Hospital Population

Introduction: Hypertension (HTN) is common for patients with AS. However, whether it is a sign of a healthy ventricle and therefore a good prognostic sign, or a risk factor remains unclear. We sought to evaluate the effect of HTN on survival in AS patients at a large referral center. Methods: Echocardiograms conducted at Tufts Medical Center (Boston, MA) were screened and parameters were extracted from a central database. NLP was used on unstructured clinical visit notes to fill in missing data. AS severity was defined as [mild (Vmax: 2.5- 2.9 m/s, MG: 10-20 mmHg, AVA: > 1.5 cm2), moderate (Vmax: 3.0-3.9, MG: 20-40, AVA: 1.0-1.5) or severe (Vmax: > 4.0, MG: > 40, AVA: < 1.0)]. Cox proportional hazard regression models assessed the association between hypertension stage [Normotensive: SBP < 120 mmHg, Elevated: SBP 120-129 mmHg, Stage 1: 130-139 mmHg, Stage 2: > 140 mmHg] taken at the time of the echocardiographic exam and death. Models were adjusted for age, sex, ejection fraction, BMI, and degree of mitral regurgitation. The last echocardiographic time point prior to death or being censored alive was used for modeling. Results: Of the 160,491 echocardiographic exams performed between 2006-2021 2,699 had mild AS or greater. Patients were followed for a median of 533 days for mild (N = 319), 593 days for moderate (N = 1070), and 76 days for severe (N = 1310). Overall mortality was lowest for moderate and severe AS (log-rank test: P < 0.001). HTN was associated with decreased mortality relative to a normotensive state at moderate (HR: Elevated 0.67 CI: 0.35-1.26, Stage 1 0.35 CI: 0.19-0.63, Stage 2 0.52 CI: 0.31-0.87) and severe stenosis (HR: Elevated 0.64 CI: 0.25-1.59, Stage 1 0.29 CI: 0.12-0.66, Stage 2 0.42 CI: 0.22-0.81). Conclusions: Contrary to other cardiovascular diseases HTN was associated with decreased mortality for this large cohort with significant AS. This observation raises questions about whether traditional HTN treatment targets are appropriate for patients with AS.

Overt Hyperthyroidism May Be a Good Prognostic Sign in Immune Checkpoint Inhibitor Treatment

Overt Hyperthyroidism May Be a Good Prognostic Sign in Immune Checkpoint Inhibitor Treatment

Charge Syndrome Hallmarked with Wolff-Parkinson-White Syndrome and Patent Ductus Arteriosus; 20 Years Post-Repairing; An Extreme Combination

Rationale: CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity. Patient concerns: A young female girl patient presented to the physician’s outpatient clinic with acute confusion status with a past repaired patent ductus arteriosus. Diagnosis: CHARGE syndrome hallmarked with Wolff-Parkinson-White syndrome and patent ductus arteriosus; 20 years post-repairing. Interventions: Plain chest x-ray, electrocardiography, oxygenation, and echocardiography. Outcomes: A dramatic clinical improvement post-oxygenation had happened. Lessons: CHARGE syndrome with Wolff-Parkinson-White syndrome and repaired patent ductus arteriosus is an extreme combination. The existence of infantile electrocardiographic Tee-Pee sign of hypocalcemia and adult low ionized calcium with CHARGE syndrome is highly suggestive of associated DiGeorge phenotype syndrome. An absence of tachycardia post- repairing of patent ductus arteriosus from 11 mo until the 20th-year-old is a good prognostic sign. The presence of an infantile T-wave alternance will strengthen both the risk of serious arrhythmia and the efficacy of patent ductus arteriosus repairing.

Treating Family Members of Transgender and Gender-Nonconforming People: An Interview With Eric Yarbrough, M.D.

Treating Family Members of Transgender and Gender-Nonconforming People: An Interview With Eric Yarbrough, M.D.

Prognostic Significance of Thyroglobulin Antibodies in Differentiated Thyroid Cancer

Objective To investigate whether variations in thyroglobulin autoantibodies (TgAb) are related to the recurrence or persistence of differentiated thyroid carcinoma (DTC) and may therefore be useful as surrogate tumor markers. Design and Methods. We retrospectively studied 98 subjects (83 women, 47 ± 15 years old) from an initial cohort of 1017 patients treated for DTC in five hospitals, with positive TgAb at any time during the follow-up. Patients presented five different patterns of evolution of serum TgAb concentrations: (1) stable positive TgAb, (2) de novo appearance, (3) an increase of more than 50%, (4) TgAb levels from positive to negative, and (5) a decrease of more than 50%. Results In the group of 11 patients with stable TgAb, four cases presented persistence of the disease with structural incomplete response. In the group of 22 patients with sustained increasing trend rising more than 50% or de novo detectable TgAb levels, three patients were diagnosed with structural incomplete response. There was no evidence of recurrence or persistence of the disease in any of the 65 patients who showed a significant decrease in (n = 35) or disappearance of (n = 30) TgAb. Conclusions Our results suggest that not only the appearance of a significant increase in TgAb but also stable concentrations of TgAb should be regarded as a sufficient risk condition for an active search for recurrent or persistent disease. Conversely, a significant decrease in TgAb levels can represent a good prognostic sign.

Eosinophilic Fasciitis Following Checkpoint Inhibitor Therapy: Four Cases and a Review of Literature.

Checkpoint inhibitor therapy is widely known to cause a number of immune-related adverse events. One rare adverse effect that is emerging is eosinophilic fasciitis, a fibrosing disorder causing inflammatory infiltration of subcutaneous fascia. It is characterized clinically by edema and subsequent induration and tightening of the skin and subcutaneous tissues. The condition is rare, yet at our institutions we have seen four cases in the past 3 years. We describe our 4 cases and review 11 other cases reported in the literature. We present four cases of eosinophilic fasciitis following treatment with programmed cell death protein 1 or programmed cell death-ligand 1 blockade. All patients had extremity involvement with characteristic skin changes ranging from peripheral edema to induration, tightening, and joint limitation. The patients had varying degrees of peripheral eosinophilia. In two of our patients, the diagnosis was made by full-thickness skin biopsy showing lymphocytic infiltration of the subcutaneous fascia, with CD4+ T cells predominating in one case and CD8+ T cells in the other. In the other two cases, the diagnosis was made on the basis of characteristic imaging findings in the context of clinical features consistent with the diagnosis. All four patients were treated with glucocorticoids with varying degrees of success; immunotherapy had to be discontinued in all four. Patients with advanced melanoma who experienced this adverse effect had either a partial response or a complete response to therapy. Eosinophilic fasciitis can occur as a result of checkpoint inhibitor therapy. Although a tissue diagnosis is the gold standard, imaging studies may facilitate the diagnosis in the presence of consistent clinical features, but a degree of suspicion is key to recognizing the condition early. Therapy requires a collaborative approach by oncology, rheumatology, and dermatology; physical therapy is an important adjunct in treatment. For advanced melanoma, it may be a good prognostic indicator. It is important for clinicians to recognize that eosinophilic fasciitis is a potential immune-related adverse event (irAE) as a consequence of immune checkpoint inhibitor therapy. The presentation is quite stereotypical; the diagnosis can be made by imaging in the absence of a full-thickness skin biopsy. Early intervention is important to limit morbidity. This irAE may be a good prognostic sign among patients with melanoma.

2718 Gastric Pneumatosis in the Setting of Underlying Gastric Ulcer: An Uncommon Case Report Presentation

INTRODUCTION: Gastric Pneumatosis (GP) is a rare entity that is usually caused by emesis with forceful retching and inoculation of intraluminal gas into the stomach wall. GP is divided into two subtypes: emphysematous gastritis (EG) and gastric emphysema (GE). EG is a result of both direct inoculation and hematogenous dissemination of gas forming bacteria in the setting of immunosuppression, alcoholism, diabetes mellitus, and NSAID use. The clinical outcome tends to be septic shock and death. GE is less fatal and is diagnosed radiographically as air within the stomach wall. Conservative management is the treatment of choice. GE is commonly associated with gastric outlet obstruction, pulmonary injury, and other traumatic events. CASE DESCRIPTION/METHODS: A 56-year-old male nursing home resident, with Wernicke’s encephalopathy was sent to the ED after multiple episodes of hematemesis. On presentation, vital signs of HR:116, RR: 26. Physical exam exhibited diffuse abdominal tenderness, distension, decreased bowel sounds with noted involuntary guarding, but no rebound or rigidity. Decline in mental status and respiratory failure, prompted intubation. Initial labs showed leukocytosis of 15.2, normal Hb of 16.2, and AKI with Creatinine: 2.93. CT scan revealed severely distended stomach with gastric pneumatosis; distended small bowel loops, with a decompressed distal ileum and no discrete transition zone. CT showed also showed a large stool burden in the colon (Figure 1). EGD was initially deferred given high risk of gastric perforation. The patient was treated with bowel rest, NG tube decompression, IV fluids, PPI drip, and empiric Ceftriaxone and Metronidazole. Consequently, CT scan with IV contrast repeated on day 4 showed resolution of GP with patent mesenteric vasculature (Figure 2). EGD done on same day with evidence of diffuse moderate inflammation characterized by congestion (edema) in the entire stomach, and one non-bleeding linear gastric ulcer in the upper body, with a clean ulcer base (Forrest Class III) (Figure 3). Biopsies showed signs of chronic inflammation and reactive changes, as well as focal intestinal metaplasia in stomach antrum. DISCUSSION: Self-resolution of gastric pneumatosis after medical management is consistent with the benign course of GE, with reported positive clinical outcomes and low risk of recurrence. In this case, the patient’s gastric ulcer and vomiting associated with constipation contributed to his gastric emphysema. Absence of hepatoportal venous gas was a good prognostic sign.

Prognostic indicators of outcome for patients with skeletal metastases from carcinoma of the prostate.

The purpose of this study was to identify prognostic indicators of outcome at presentation to the orthopaedic surgeon, in patients with metastatic prostate cancer. Our aim was to use this information in a pragmatic, clinic-based approach so that surgical decision making could be optimized to benefit the patient in their remaining lifetime. A cohort analysis was undertaken of all patients with metastatic disease of the prostate who presented to a regional orthopaedic centre in the United Kingdom between 2003 and 2016. Biochemical data were collected in addition to disease and demographic data. These included: prostate-specific antigen (PSA) at orthopaedic presentation; haemoglobin (Hb); platelets (plt); alkaline phosphatase (ALP); albumin (Alb); and corrected calcium (CaC). Statistical analysis included Kaplan-Meier survival analysis, and a Cox proportional hazards model was fitted to the data. From the departmental database, 137 episodes were identified in 136 patients with a median age at presentation of 72 years (interquartile range (IQR) 66 to 78). Most patients had stage IV disease (n = 98, 72%), and most did not undergo surgical intervention. At one-year follow-up, 50% of patients had died. Biomarkers found to be independently associated with poor survival were: low Hb, low Alb, relatively low PSA (< 30 mmol/l), and a raised ALP. Patients who needed surgical intervention had a poorer survival rate than patients who were managed nonoperatively. The study findings are important for orthopaedic clinical practice in the management of patients with metastatic prostate cancer. The interpretation of routine blood tests can help to predict survival in patients who present with orthopaedic manifestations of prostate cancer. A lower PSA is not necessarily a good prognostic sign. We believe that simple blood testing should be carried out routinely when assessing a patient, guiding potential surgical management and palliative care in the future.

Prognostic subtyping based on estrogen receptor, progesterone receptor, and human epidermal growth factor receptor2 expression in breast cancer cases among north Indian females

Background: Cancer of breast has recently become the leading cancer among women in Kashmir. Worse prognosis of this disease is with the features of higher grade, positivity for Her-2/neu, negativity for ER, PR, and presence of BRCA gene. Thus the receptor status like are a very useful tool for rapid diagnosis, treatment as well as for prognosis of the disease. The objective of the study was to analyze the pattern of expression of hormone receptors which include ER, PR and Her-2/neu in breast cancer cases among Kashmiri females and to find their association with various clinicopathological parameters.Methods: A cross sectional hospital based study done in a tertiary health care centre of Kashmir valley. We selected 102 consecutive breast cancer cases for the period of one year. Cases were sent for biopsy of the tumour lesion and for receptor status analysis.Results: In about 50.9%of cases tumour had spread to T2 stage. There was a significant difference in the tumor stage and the age groups at presentation. The HER 2 status was positive in 85.5% of cases. About 65% were ER positive and 51.9 were PR positive. Only 8 were triple negative and 42 were triple positive for receptors. We did not found any significant relationship between grade, stage of disease and age when compared for receptor status.Conclusions: We found a high percentage being receptor positive tumours which has been found to be a good prognostic sign.

ROSC kod non VT/VF srčanog zastoja - EuReCa_Srbija 2014-2017

Aim: The paper aims to analyze the outcome of emergency medical intervention by the Emergency medical sevices (EMS) in out of hospital cardiac arrest, with a non-shockable rhytms of PEA / Asystole. Methodology Data was collected during the prospective clinical trial of EuReCa_ONE and through a single questionnaire related to the out-of-hospital cardiac arrest (OHCA) in the period of September 2014 June 2017 - Clinical Trial NCT02236819. The collected datas were analyzed by the use of a standard statistical methods (SPSS). Results In mentioned period 4172 EuReCa events – OHCA occurred. In 1618/4172 (38%), the EMS initiated CPR . The initial non-shockable rhythm (PEA / asystole) were recorded on the monitor by the EMS in 1279/1618 (79%) cases. Return of spontaneous circulation (ROSC) was recorded in 170/1279 (13%) patients. Conclusion The non-shockable rhytms (PEA / asystole) as the first detected rhythm in patients with cardiac arrest recorded outside the hospital is not a good prognostic sign and is associated with the survival rate. Although the rate is low, a number of patients survived and there is no a reason to withhold any resuscitation measures by the EMS.

Lipid profile pattern in chronic viral hepatitis C in Makurdi, Nigeria

Context: Hepatitis C virus (HCV) infection with a worldwide distribution causes liver disease. The liver is the principal site for formation and clearance of lipoproteins. Aim: The purpose of this study is to assess the influence of HCV on lipid metabolism and the effect of the stages of this disease on lipid pattern in infected patients. Materials and Methods: The study involved the selection of 36 chronic hepatitis C (CHC) patients attending the clinic at a tertiary hospital in Makurdi, Nigeria. After fulfilling the inclusion criteria, 36 anthropometrically matched apparently healthy individuals were selected as a control to the CHC group. CHC is defined as patients, who continuously tested positive for anti-HCV antibody for up to 1 year during their periodic visit to the clinic. Results: There was no significant (P > 0.05) difference between the mean systolic blood pressure (BP), diastolic BP, age, waist circumference, body mass index of chronic HCV, (CHCV) and controls. There was a significantly lowered total cholesterol (P = 0.029) and high-density lipoprotein cholesterol (HDL-C) (P = 0.000) in CHCV patients compared to the matched controls. There was a significantly lowered total cholesterol (P = 0.004) and HDL-C (P = 0.000) in asymptomatic CHC compared to the matched controls. Conclusion: Lipid profile monitoring may help in the diagnosis of hepatic infection severity and may also act as a good prognostic sign, so it must be analyzed in all advanced hepatic infection cases.

Late Graft Rejection in Association With T-Large Granular Lymphocyte Expansion of Recipient Origin After Human Leukocyte Antigen–Haploidentical Stem Cell Transplantation: A Case Report

Large granular lymphocyte (LGL) expansion occasionally occurs after allogeneic stem cell transplantation (allo-SCT), and is thought to be a good prognostic sign that is associated with a lower relapse rate. However, there have been no reports of late graft failure (LGF) due to graft rejection in association with oligoclonal LGL expansion. We herein report a case of LGF associated with the transient expansion of recipient-derived T-LGL after allo-SCT. A 65-year-old man underwent peripheral blood stem cell transplantation (PBSCT) from his human leukocyte antigen (HLA)-haploidentical son for the treatment of acute myeloid leukemia, which had evolved from a myelodysplastic syndrome (MDS). Neutrophil engraftment occurred on day 20. A chimerism analysis on day 29 showed both granulocytes and mononuclear cells in the peripheral blood to be completely of donor origin. However, his neutrophil count gradually decreased and a chimerism analysis on day 61 showed that 84% of the patient's T cells were of recipient origin while the granulocytes were 100% donor-derived. His LGLs rapidly increased to 4.01× 109/L on day 113 and decreased thereafter. The percentage of donor cells in his granulocytes gradually decreased, and the patient's leukocytes were completely replaced by recipient cells on day177. The clinical course suggests that the expansion of recipient-derived T-LGLs after allo-SCT can be a sign of graft rejection. Early intervention may be needed if the LGL expansion is recipient-derived.

Hemorragia pulmonar, una complicación poco frecuente en una niña con púrpura de Schönlein-Henoch

Henoch-Schonlein purpura (HSP) is the most common vasculitis in children. Vasculitic processes can involve the lung. Although diffuse alveolar hemorrhage may be seen as one of the manifestation of HSP, it is not a frequent presentation. Here we reported the case of a 10-year-old girl with HSP nephritis who developed pulmonary hemorrhage. The patient was treated successfully with intravenous methylprednisolone. A review of the literature revealed that young age may be a good prognostic sign and that immunosuppressive drugs and supportive management are essential in the treatment.

LOSS OF EXTERNAL LIMITING MEMBRANE INTEGRITY PREDICTS PROGRESSION OF HYDROXYCHLOROQUINE RETINAL TOXICITY AFTER DRUG DISCONTINUATION.

To quantify external limiting membrane (ELM) disruption and photoreceptor volume over time, using spectral domain optical coherence tomography in eyes with hydroxychloroquine (HCQ) toxic effects after discontinuation. We performed a retrospective chart review of patients who were screened for toxic effects of HCQ between January 1, 2009 and August 31, 2014, and identified 10 patients diagnosed as having HCQ retinal toxic effects. Intact ELM and the Bruch membrane were manually traced using ImageJ software and their lengths from each scan of the spectral domain optical coherence tomography macular volume were summed. The ratio of intact ELM length/Bruch membrane length was calculated. We measured the two-dimensional photoreceptor area between the intact ELM and Bruch membrane in every cross-sectional B-scan. We calculated the total volume of photoreceptors in a volumetric OCT by multiplying photoreceptor area by the distance between B-scans. Of the 10 patients (120 eyes), 1 eye was excluded because of the presence of vitreomacular traction. The mean cumulative dose of HCQ was 1,951 g (range, 584-3,650 g). The mean follow-up duration was 34.1 months (range, 11-64 months). Based on the extent of ELM integrity at diagnosis of HCQ toxicity, we classified eyes into 2 groups: 1) 12 eyes showed severe ELM disruption and 2) 7 eyes had intact ELM. All 19 eyes showed characteristic signs of HCQ toxicity on the visual field examination at the baseline. Seven of 12 eyes with ELM disruption showed progressive ELM changes, including 7 eyes that additionally developed progressive photoreceptor volume decline, whereas 5 eyes remained stable. All 7 eyes with intact ELM remained stable over time. Intact ELM status at the time of HCQ discontinuation is a good prognostic sign, and ELM status may allow clinicians to predict patients at risk for progression of retinopathy. Quantitative measurements of ELM disruption and photoreceptors volume may provide an objective tool to monitor outer retinal changes due to HCQ.

Predictors for Recurrence of Chronic Subdural Hematoma.

This prospective study was designed to analyze the dependence of different factors on the recurrence rate of chronic subdural hematoma (cSDH) after surgical treatment. Seventy-three consecutive patients, who were surgically treated at our department due to cSDH between 2009 and 2012, were included. The following parameters were analyzed: patient age and gender, occurrence of trauma, time between trauma and admission, neurological symptoms, presence of minor diseases, intake of anticoagulation medication. We classified the results of diagnostic imaging and determined the space-consuming effect via the cerebral midline shift. In addition, we scrutinized intraoperative findings and the dependence of the position of subdural drainage on the recurrence rate of cSDH. In our patient group, cSDH recurrence was significantly associated with aphasia (p=0.008). Moreover an increased cSDH recurrence rate was observed in the patient group that had a separated manifestation of the cSDH in the preoperative diagnostic imaging (p=0.048) and received no drainage implant (p=0.016). Homogeneous isodense cSDH was associated with no apparent recurrence (p=0.037). Within the scope of this study, we detected aphasia and separated cSDH as predictors of cSDH recurrence. Homogeneous isodense cSDH seems to be a good prognostic sign regarding the risk of recurrence development. Furthermore, our data clearly emphasize the importance of surgically applied drainage implants to prevent a recurrence of cSDH.

Second Hepatectomy Improves Survival in Patients With Microvascular Invasive Hepatocellular Carcinoma Meeting the Milan Criteria.

Microvascular invasion (MVI) is a strong risk factor for patients with hepatocellular carcinoma (HCC) meeting the Milan criteria and who have received curative hepatectomy. The relevance of a second hepatectomy in patients with MVI-positive recurrent HCC remains controversial.We had 329 cases of HCC hepatectomy meeting the Milan criteria and compared data on patient demographics, liver function, and tumor pathology between MVI-positive and MVI-negative group. We analyzed potential risk factors of overall survival (OS) and disease-free survival (DFS). Furthermore, newly developed pathological features following the second hepatectomy were also analyzed.The median OS and DFS were significantly superior in the MVI-negative group than in the MVI-positive group, 61 (10–81) versus 49 (11–82) months (P < 0.01) and 41 (7–75) versus 13 (3–69) months (P < 0.01), respectively. The presence of MVI and a total tumor diameter >3 cm were independent risk factors associated with both OS and DFS. Overall survival was significantly improved by a second hepatectomy in the MVI-positive group compared with the original MVI-positive group, 60 (26–82) versus 49 (11–82) months, respectively. This was now comparable to the MVI-negative group, 60 (26–82) versus 61 (10–81) months (P = 0.72). A second hepatectomy was consistently associated with better survival in the MVI-negative group as compared to the MVI-positive group.A second hepatectomy improves survival in patients with MVI HCC meeting the Milan criteria. The biology of MVI may change following a second hepatectomy. The absence of MVI is a good prognostic sign for patients undergoing second hepatectomy.

Cannabis and stimulant disorders and readmission 2 years after first-episode psychosis

Few studies have examined the impact of stimulant use on outcome in early psychosis. Ceasing substance use may lead to positive outcomes in psychosis. To examine whether baseline cannabis or stimulant disorders and ongoing drug use predict readmission within 2 years of a first psychosis admission. Predictors of readmission were examined with Cox regression in 7269 people aged 15-29 years with a first psychosis admission. Baseline cannabis and stimulant disorders did not predict readmission. A stimulant disorder diagnosis prior to index psychosis admission predicted readmission, but a prior cannabis disorder diagnosis did not. Ongoing problem drug use predicted readmission. The lowest rate of readmission occurred in people whose baseline drug problems were discontinued. Prior admissions with stimulant disorder may be a negative prognostic sign in first-episode psychosis. Drug use diagnoses at baseline may be a good prognostic sign if they are identified and controlled.