Important Patient Factors Research Articles

Association between serum phosphate levels and anemia in non-dialysis patients with chronic kidney disease: a retrospective cross-sectional study from the Fuji City CKD Network

BackgroundPatients with chronic kidney disease (CKD) present high mortality and morbidity rates despite the availability of various therapies. Although CKD-mineral and bone disorder (MBD) and renal anemia are important factors in patients with CKD, only few studies have analyzed the relationship between them. Therefore, this study aimed to evaluate the relationship between CKD-MBD and anemia in patients with CKD who did not receive erythropoiesis-stimulating agent or iron therapies.MethodsThis retrospective cross-sectional study included patients with CKD aged ≥ 20 years with estimated glomerular filtration rate (eGFR) categories G2a to G5 who were referred to the Fuji City General Hospital between April 2018 and July 2019. The exclusion criterion was ongoing treatment for CKD-MBD and/or anemia.ResultsThe data of 300 patients with CKD were analyzed in this study. The median age of patients was 71 (range, 56.5–79) years. The median eGFR was 34 (range, 20–48) mL/min/1.73 m2, and the mean hemoglobin (Hb) level was 12.7 g/dL (standard deviation, 2.3), which decreased as the CKD stage increased. In a multivariate linear regression analysis of anemia-related factors, including age, renal function (eGFR), nutritional status, inflammation, and iron dynamics (serum iron level, total iron-binding capacity, ferritin levels), the serum phosphate levels were significantly associated with the Hb levels (coefficient [95% confidence interval], -0.73 [-1.1, -0.35]; P < 0.001). Subgroup analysis revealed a robust association between serum phosphate levels and Hb levels in the low-ferritin (coefficient [95% confidence interval], -0.94 [-1.53, -0.35]; P = 0.002) and advanced CKD groups (coefficient [95% confidence interval], -0.89 [-1.37, -0.41]; P < 0.001).ConclusionsWe found an association between high serum phosphate levels and low Hb levels in patients with CKD not receiving treatment for anemia. These results underscore the possibility of a mechanistic overlap between CKD-MBD and anemia.

Prognostic Significance of Sentinel Lymph Node Status in Thick Primary Melanomas (> 4 mm)

BackgroundThe key prognostic factors for staging patients with primary cutaneous melanoma are Breslow thickness, ulceration, and sentinel lymph node (SLN) status. The multicenter selective lymphadenectomy trial (MSLT-I) verified SLN status as the most important prognostic factor for patients with intermediate-thickness melanoma (Breslow thickness, 1–4 mm). Although most international guidelines recommend SLN biopsy (SLNB) also for patients with thick (> 4 mm, pT4) melanomas, its prognostic role has been questioned. The primary aim of this study was to establish whether SLN status is prognostic in T4 melanoma tumors.MethodsData for all patients with a diagnosis of primary invasive cutaneous melanoma of Breslow thickness greater than 1 mm in Sweden between 2007 and 2020 were retrieved from the Swedish Melanoma Registry, a large prospective population-based registry. A multivariable Cox proportional hazard model for melanoma-specific survival (MSS) was constructed based on Breslow thickness stratified for SLN status.ResultsThe study enrolled 10,491 patients, 1943 of whom had a Breslow thickness greater than 4 mm (pT4). A positive SLN was found for 34% of these pT4 patients. The 5-year MSS was 71%, and the 10-year MSS was 62%. There was a statistically significant difference in MSS between the patients with a positive SLN and those with a negative SLN (hazard ratio of 2.4 (95% confidence interval CI 1.6–3.5) for stage T4a and 2.0 (95% CI 1.6–2.5) for satage T4b.ConclusionSentinel lymph node status gives important prognostic information also for patients with thick (> 4 mm) melanomas, and the authors thus recommend that clinical guidelines be updated to reflect this.

Factors associated with 10-m walking speed in outpatients undergoing hemodialysis: a multicenter cross-sectional study

IntroductionWalking ability is an important prognostic factor for patients undergoing maintenance hemodialysis (HD). Since complications such as poor nutrition, anemia, malnutrition, and inflammation in patients undergoing HD may affect walking ability, the factors affected by 10-m walking speed must be investigated. This cross-sectional study enrolled 1205 outpatients undergoing HD and measured their 10-m walking speed.MethodsLower extremity muscle strength (LES), grip strength, one-leg standing time (OLST), and short physical performance battery (SPPB) score were measured as physical functions. Age, sex, body mass index, dialysis history, comorbidities, and hematological data were collected.ResultsA multiple regression analysis revealed that the 10-m walking speed was significantly associated with LES, grip strength, OLST, SPPB, and % creatinine production rate, even after adjusting for corresponding variables (R2 = 0.69, p < 0.05).ConclusionMuscle strength and muscle mass may be essential factors for the 10-m walking speed in patients undergoing HD.

Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score for predicting outcomes of breast cancer: A systematic review and meta-analysis.

To assess prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score could predict overall survival (OS) and disease-free survival (DFS) in patients with breast cancer. PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were searched from 1st January 2000 to 10th October 2021 for studies assessing the association between PNI or CONUT and outcomes of breast cancer by following the PRISMA guidelines. Keywords used were "Prognostic nutritional index", "Controlling nutritional status", "CONUT", and "Breast cancer". Nine studies were included. On pooled analysis, we noted a statistically significant improved OS in patients with high PNI as compared to low PNI. Meta-analysis revealed no significant difference in DFS between patients with high PNI and low PNI. However, on the exclusion of one study, we noted that high PNI was associated with significantly improved DFS as compared to low PNI. On pooled analysis, we also noted that a high CONUT score was associated with significantly reduced OS in breast cancer patients. Our results indicate that PNI is an important prognostic factor for patients with breast cancer. Pre-treatment low PNI is associated with worse OS and DFS. Scarce data also indicates that a high CONUT score is predictive of poor OS in breast cancer.

Quality of Life of Patients with Stiff Person Syndrome

Aim: This study aimed to identify the factors that significantly affect the quality of life (QoL) of patients with Stiff-Person syndrome (SPS) by examining their physical, psychological, and social aspects using questionnaires. Methods: This cross-sectional study included 23 patients with SPS. Data were collected using several questionnaires. Patient QoL was quantified using the EuroQoL-5-Dimention 5-Level; sociodemographic characteristics and other relevant variables were examined. Results: QoL was poorer for patients with SPS than those with moderate to severe Alzheimer’s disease. Several important factors for patients’ QoL have been identified, including difficulty in breathing, pain, mobility issues leading to difficulty performing daily activities, depressive symptoms inherent to SPS, and insufficient social support. Conclusion: Factors that significantly influenced the QoL of patients with SPS were related to multiple aspects of their lives. We evaluated all previously used methods. A disease-specific evaluation form is required to assess these patients thoroughly.

A Proxy Approach to Family Involvement and Neurocognitive Function in First Episode of Non-Affective Psychosis: Sex-Related Differences.

Schizophrenia spectrum disorders (SSD) often show cognitive deficits (CD) impacting daily life. Family support has been shown to be protective against CD, yet the relationship between these in psychotic patients remains complex and not fully understood. This study investigated the association between a subdomain of family support, namely, family involvement (estimated through a proxy measure), cognitive functioning, and sex in first-episode psychosis (FEP) patients. The sample included 308 patients enrolled in the Program for Early Phases of Psychosis (PAFIP), divided into 4 groups based on their estimated family involvement (eFI) level and sex, and compared on various variables. Women presented lower rates of eFI than men (37.1% and 48.8%). Higher eFI was associated with better cognitive functioning, particularly in verbal memory. This association was stronger in women. The findings suggest that eFI may be an important factor in FEP patients' cognitive functioning. This highlights the importance of including families in treatment plans for psychotic patients to prevent CD. Further research is needed to better understand the complex interplay between family support, sex, and cognitive functioning in psychotic patients and develop effective interventions that target these factors.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

Machine Learning Models Based on a National-Scale Cohort Identify Patients at High Risk for Prolonged Lengths of Stay Following Primary Total Hip Arthroplasty

BackgroundExisting machine learning models that predicted prolonged lengths of stay (LOS) following primary total hip arthroplasty (THA) were limited by the small training volume and exclusion of important patient factors. This study aimed to develop machine learning models using a national-scale data set and examine their performance in predicting prolonged LOS following THA. MethodsA total of 246,265 THAs were analyzed from a large database. Prolonged LOS was defined as exceeding the 75th percentile of all LOSs in the cohort. Candidate predictors of prolonged LOS were selected by recursive feature elimination and used to construct four machine learning models—artificial neural network, random forest, histogram-based gradient boosting, and k-nearest neighbor. The model performance was assessed by discrimination, calibration, and utility. ResultsAll models exhibited excellent performance in discrimination (area under the receiver operating characteristic curve [AUC] = 0.72 to 0.74) and calibration (slope: 0.83 to 1.18, intercept: −0.01 to 0.11, Brier score: 0.185 to 0.192) during both training and testing sessions. The artificial neural network was the best performer with an AUC of 0.73, calibration slope of 0.99, calibration intercept of −0.01, and Brier score of 0.185. All models showed great utility by producing higher net benefits than the default treatment strategies in the decision curve analyses. Age, laboratory tests, and surgical variables were the strongest predictors of prolonged LOS. ConclusionThe excellent prediction performance of machine learning models demonstrated their capacity to identify patients prone to prolonged LOS. Many factors contributing to prolonged LOS can be optimized to minimize hospital stay for high-risk patients.

LUNG CANCER DETECTION IN LOW-RESOLUTION IMAGES

One of the most important prognostic factors for all lung cancer patients is the accurate detection of metastases. Pathologists, as we all know, examine the body and its tissues. On the existing clinical method, they have a tedious and manual task. Recent analysis has been inspired by these aspects. Deep Learning (DL) algorithms have been used to identify lung cancer. The developed cutting-edge technologies beat pathologists in terms of cancer identification and localization inside pathology images. These technologies, though, are not medically feasible because they need a massive amount of time or computing capabilities to perceive high-resolution images. Image processing techniques are primarily employed for lung cancer prediction and early identification and therapy to avoid lung cancer. This research aimed to assess lung cancer diagnosis by employing DL algorithms and low-resolution images. The goal would be to see if Machine Learning (ML) models might be created that generate higher confidence conclusions while consuming fractional resources by comparing low and high-resolution images. A DL pipeline has been built to a small enough size from compressing high-resolution images to be fed into an or before CNN (Convolutional Neural Network) for binary classification i.e. cancer or normal. Numerous enhancements have been done to increase overall performance, providing data augmentations, including augmenting training data and implementing tissue detection. Finally, the created low-resolution models are practically incapable of handling extremely low-resolution inputs i.e. 299 x 299 to 2048 x 2048 pixels. Considering the lack of classification ability, a substantial reduction in models’ predictable times is only a marginal benefit. Due to an obvious drawback with the methodology, this is disheartening but predicted finding: very low resolutions, essentially expanding out on a slide, preserve only data about macro-cellular structures, which is usually insufficient to diagnose cancer by itself.

Patient priorities and expectations of systemic therapy in metastatic renal cell carcinoma.

4560 Background: As treatment options for metastatic Renal Cell Carcinoma (RCC) have increased in number, selecting therapy has become more complicated. When prioritizing agents today, guidelines recommend selection based primarily on risk classification, as well as consideration of efficacy data, patient characteristics, quality of life, cost, and patient preference. Understanding how patients prioritize treatment selection and define treatment success is crucial to improving patient/provider communication and to improving future drug development. Methods: The survey was developed by the Kidney Cancer Research Alliance (KCCure) and was broadcast between 07/2022 and 09/2022 to patients via website, mailing lists and social media platforms. Those who agreed to participate were surveyed for demographics (age, gender, race, income, country) and clinical characteristics (date of the diagnosis, disease stage, treatment history). Descriptive statistics summarized the survey data. Results: 399 out of 1,062 patients surveyed had metastatic disease. 80% of patients were receiving or had received systemic therapy, 20% of patients had not yet received systemic therapy. 52% were female and 48% were male, with a median age of 57 years (range 28-86). Patients identified as white (89%) and living in the United States (86%). 69% of patients reported that they did not know their IMDC or risk status, 10% were favorable risk, 11% were intermediate risk and 10% were poor risk. When asked to select the most important outcome for treatment selection on a rank-choice scale from 1 to 8, the chance to eliminate all evidence of disease (complete response) scored highest (6.6), followed by durability of response (5.1), improved quality of life (5.0), rapid reduction of tumors (4.9), ability to go off therapy (4.2), low risk of toxicity (4.0) and reduction of tumor symptoms (4.0). Patients ranked low cost as the least important factor in selecting treatment (2.3). 70% of patients defined “long-term" response to therapy as five years or longer, and over a quarter of patients (26%) defined long-term response as 10 years or longer. When asked to define treatment success, patients rank radiological reduction in tumor size (83%) as the most important factor, followed by stable disease (67%), improved quality of life (48%) and the ability to return back to work (22%). The lowest ranked choice was “I just trust my doctor” (17%). Conclusions: Most patients are not familiar with their risk classification and may not realize the significance of this factor in treatment selection. Patients rank complete response as the most important outcome/desire when considering treatment options. Cost is the least important factor for patients in selecting treatment. Patient perceptions of long-term response to therapy may differ from provider perceptions. More research is needed to improve patient/provider communication in the therapy selection process.

Relationship of preoperative oral hypofunction with prognostic nutritional index in gastric cancer: A case-control retrospective study.

Preoperative nutritional status is an important prognostic factor in gastric cancer patients. This study will evaluate whether preoperative oral dysfunction is associated with prognostic nutrition index (PNI). This case-control study analyzed 95 patients who underwent oral function management. We assessed the following parameters: body mass index, stage of gastric cancer, C-reactive protein, total lymphocyte count, albumin, and prognostic nutritional index. The patients were divided into groups with prognostic nutritional indexes <45 and >45. Logistic regression analysis was used to assess the association between the measurements of oral function and the prognostic nutritional index. Univariate analysis of factors associated with decreased oral function and prognostic nutritional index showed significant differences between the two groups in C-reactive protein, neutrophils, and tongue pressure (p<0.01). However, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, masticatory function, and swallowing function were not significantly different. Multivariate analysis showed that C-reactive protein (odds ratio: 0.12, 95% confidence interval: 0.30-0.45, p<0.01) and tongue pressure (odds ratio: 3.62, 95% confidence interval: 1.04-12.60, p<0.05) were independent risk factors for oral hypofunction. Oral function decreased in perioperative patients with gastric cancer, and decreased tongue pressure is associated with a decreased prognostic nutritional index.

Is Age the Most Important Risk Factor in COVID-19 Patients? The Relevance of Comorbidity Burden: A Retrospective Analysis of 10,551 Hospitalizations.

To assess the contribution of age and comorbidity to the risk of critical illness in hospitalized COVID-19 patients using increasingly exhaustive tools for measuring comorbidity burden. We assessed the effect of age and comorbidity burden in a retrospective, multicenter cohort of patients hospitalized due to COVID-19 in Catalonia (North-East Spain) between March 1, 2020, and January 31, 2022. Vaccinated individuals and those admitted within the first of the six COVID-19 epidemic waves were excluded from the primary analysis but were included in secondary analyses. The primary outcome was critical illness, defined as the need for invasive mechanical ventilation, transfer to the intensive care unit (ICU), or in-hospital death. Explanatory variables included age, sex, and four summary measures of comorbidity burden on admission extracted from three indices: the Charlson index (17 diagnostic group codes), the Elixhauser index and count (31 diagnostic group codes), and the Queralt DxS index (3145 diagnostic group codes). All models were adjusted by wave and center. The proportion of the effect of age attributable to comorbidity burden was assessed using a causal mediation analysis. The primary analysis included 10,551 hospitalizations due to COVID-19; of them, 3632 (34.4%) experienced critical illness. The frequency of critical illness increased with age and comorbidity burden on admission, irrespective of the measure used. In multivariate analyses, the effect size of age decreased with the number of diagnoses considered to estimate comorbidity burden. When adjusting for the Queralt DxS index, age showed a minimal contribution to critical illness; according to the causal mediation analysis, comorbidity burden on admission explained the 98.2% (95% CI 84.1-117.1%) of the observed effect of age on critical illness. Comorbidity burden (when measured exhaustively) explains better than chronological age the increased risk of critical illness observed in patients hospitalized with COVID-19.

Metabolic syndrome as risk factor for left ventricular hypertrophy in children with chronic kidney disease.

The metabolic syndrome (MS), a cluster of clinical and biochemical abnormalities including insulin resistance, dyslipidemia and hypertension, is often diagnosed in chronic kidney disease (CKD) children. Left ventricular hypertrophy (LVH) is a major target organ damage in hypertension and an important cardiovascular risk factor in CKD patients. We aimed to identify the most significant risk factors of LVH in children with CKD. Children with CKD stage 1-5 were enrolled in the study. MS was diagnosed according to De Ferranti (DF) as ≥3 from 5 criteria. Ambulatory blood pressure measurements (ABPM) and echocardiographic evaluation were performed. LVH was defined as ≥95th percentile of LV mass index related to height and age. Clinical and laboratory parameters included: serum albumin, Ca, HCT, cystatin C, creatinine, estimated glomerular filtration rate (eGFR) based on Schwartz formula, triglycerides, high-density lipoprotein (HDL), proteinuria, BMI standard deviation score (SDS), height SDS, waist circumference, ABPM data. 71 children (28 girls/43 boys) with median age 14.05 (25%-75%:10.03-16.30) years and median eGFR 66.75 (32.76-92.32) ml/min/1.73m2 were evaluated. CKD stage 5 was diagnosed in 11 pts (15.5%). MS (DF) was diagnosed in 20 pts (28.2%). Glucose ≥ 110 mg/dL was present in 3 pts (4.2%); waist circumference ≥75th pc in 16 pts (22.5%); triglycerides ≥ 100 mg/dL in 35 pts (49.3%); HDL < 50mg/dL in 31 pts (43.7%) and BP ≥ 90th pc in 29 pts (40.8%), respectively. LVH was detected in 21 (29.6%) children. In univariate regression the strongest risk factor for LVH was CKD stage 5 (OR 4.9, p=0.0019) and low height SDS (OR 0.43,p=0.0009). In stepwise multiple logistic regression analysis (logit model) of the most important risk factors for LVH in CKD children, only three were statistically significant predictors: 1)MS diagnosis based on DF criteria (OR=24.11; 95%CI 1.1-528.7; p=0.043; Chi2=8.38,p=0.0038); 2), high mean arterial pressure (MAP SDS) in ABPM (OR=2.812; 95%CI 1.057-7.48; p=0.038;Chi2=5.91, p=0.015) and 3) low height SDS (OR=0.078; 95%CI 0.013-0.486;p=0.006; Chi2=25.01, p<0.001). In children with chronic kidney disease LVH is associated with the cluster of multiple factors, among them the components of MS, hypertension, stage 5 CKD and growth deficit were the most significant.

Frailty and survival among veterans treated with abiraterone or enzalutamide for metastatic castration-resistant prostate cancer

IntroductionAbiraterone and enzalutamide are treatments for metastatic castration-resistant prostate cancer (mCRPC). Due to a lack of head-to-head trials, they are prescribed interchangeably. However, the drugs have different pharmacokinetics and thus may have differing efficacy and adverse effects influenced by patient functional status and comorbid diseases. Additionally, mCRPC mainly affects older adults and since the prevalence of frailty increases with age, frailty is an important patient factor to consider in personalizing drug selection. Materials and MethodsWe conducted a retrospective observational study of US veterans treated with abiraterone or enzalutamide for mCRPC from September 2014 to June 2017. Frailty was assessed using the Veterans Affairs Frailty Index (VA-FI), which utilizes administrative codes to assign a standardized frailty score. Patients were categorized as frail if VA-FI scores were > 0.2. The primary outcome was difference in overall survival (OS) between the two treatment groups. Cox regression modeling and propensity score matching was used to compare between abiraterone and enzalutamide treatments. ResultsWe identified 5,822 veterans, 57% of whom were initially treated with abiraterone and 43% with enzalutamide. Frail patients (n = 2,314; 39.7%) were older, with a mean age of 76.1 versus 74.9 years in the non-frail group (n = 3,508; 60.3%, p < 0.001) and had shorter OS compared to non-frail patients regardless of treatment group (18.5 vs. 26.6 months, p < 0.001). Among non-frail patients there was no significant difference in OS between abiraterone and enzalutamide treatment (27.7 vs 26.1 months, p = 0.07). However, frail patients treated with enzalutamide versus abiraterone had improved OS (20.7 vs 17.2 months, p < 0.001). In a propensity score matched analysis of frail patients (n = 2,070), enzalutamide was associated with greater median OS (24.1 vs 20.9 months, p < 0.001). In patients with dementia, enzalutamide was associated with longer OS (19.4 vs. 16.6 months, p = 0.003). DiscussionIn this study of 5822 US veterans with mCRPC, treatment with enzalutamide was associated with improved OS compared to abiraterone among frail veterans and veterans with dementia, but not among non-frail veterans. Future studies should evaluate interactions between frailty and cancer treatments to optimize selection of therapy among frail adults.

Surgical Practice Parameters for the Definitive Management of Sacrococcygeal Pilonidal Sinus Disease: Surgeons' Perspective.

Background Sacrococcygeal pilonidal sinus disease (SPD) is a common general surgical condition encountered in practice and predominantly affects young males. Surgical practice parameters for the management of SPD are variable. This study aimed to review current surgical practice parameters for SPD management in Western Australia. Methodology This study conducted a de-identified 30-item multiple-response ranking, dichotomous, quantitative, and qualitative survey of self-reported surgeon practice preferences and outcomes. The survey was sent to 115 Royal Australian College of Surgeons - Western Australia general/colorectal surgical fellows. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results The survey response rate was 66% (N = 77). The cohort comprised mostly senior collegiate (n = 50, 74.6%), and most were low-volume practitioners (n = 49, 73.1%). For local disease control, most surgeons perform a complete wide local excision (n = 63, 94%). The preferred wound closure method was an off-midline primary closure (n = 47, 70.1%). Self-reported SPD recurrence, wound infection, and wound dehiscence rates were 10%, 10%, and 15%, respectively. The three high-ranked closure techniques were the Karydakis flap, Limberg's flap (LF), and Z-Plasty flap. Each surgeon's median annual SPD procedures were 10 (interquartile range = 15). The surgeons could utilize their preferred SPD closure technique (mean = 83.5%, standard deviation = ±15.6). Univariate analysis showed significant associations between years of experience and SPD flap techniques utilized, with senior surgeons significantly less likely to use either the LF (p = 0.009) or the Bascom procedure (BP) (p = 0.034). Instead, there was a preference for using healing by secondary-intention technique (SIT) compared to younger fellows (p = 0.017). A significant negative correlation existed between practice volume and SPD flap technique utilization, with low-volume surgeons less likely to prefer the gluteal fascia-cutaneous rotational flap (p = 0.049) or the BP (p = 0.010). However, low-volume practice surgeons were significantly more likely to use SITs (p = 0.023). The three most important patient factors in choosing SPD techniques were comorbidities, likely patient compliance, and attitude toward the disease. Meanwhile, factors influencing local conditions included the proximity of the disease to the anus, the number and location of pits and sinuses, and previous definitive SPD surgery. Key informants for technique preference were perceived low recurrence rate, familiarity, and overall good patient outcomes. Conclusions Surgical practice parameters for managing SPD remain highly variable. Most surgeons perform midline excision with off-midline primary closure as the gold standard.There is a clear and present need for clear, concise, and yet comprehensive guidelines on managing this chronic and often disabling condition to ensure the delivery of consistent, evidence-based care.

Apnea-Hypopnea Index an indicator of increased right cardiac preassures

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Obstructive sleep apnea (OSA) is a disorder frequently associated with clinical conditions and complications such as refractory hypertension, atrial fibrillation, nocturnal angina, dysrhythmias, congestive heart failure and stroke. Polysomnography is the gold standard test required to diagnose OSA, along with a targeted history and comprehensive examination of the patient. It involves the recording of various physiologic variables during sleep. Sleep related obstructive events may be measured using two indices: the apnea-hypopnea index (AHI) and the respiratory disturbance index, an AHI≥15 being diagnostic for OSA. The aim of this study was to determine the interaction between sleep apnea and demographic or echocardiographic markers. Material and methods This was a prospective study that included 33 patients with sleep apnea. Polysomnography was performed using a VitalNight cardiorespiratory polygraph to determine the apnea hypopnea index (AHI) and echocardiography was performed using a Vivid E95 scanner to determine the left ventricular ejection fraction (LVEF), the peak systolic right ventricular to right atrial pressure gradient (Gmax) and the right ventricular diameter and function (TAPSE and s’). Results The mean age of the patients was of 63±8 years and 14 patients (42%) had a Gmax&amp;gt;25mmHg. Regarding cardiovascular risk factors, 31 patients (94%) had arterial hypertension and 26 (79%) were smokers. Out of all patients, 25 (76%) had an appropriate echocardiographic acoustic window. The patients had mean values of AHI of 45±19. Mean values for the LVEF, Gmax, TAPSE and s’ were 53 ± 11%, 25± 14 m/s, 22 ± 4 mm, and 14 ± 3 cm/s, respectively. AHI showed moderate correlations to age (r=0.27), cervical perimeter (r=0.38) and BMI (r=0.30), but also to echocardiographic parameters as LVEF (r=0.29), Gmax (r=0.42), RV diameter (r=0.39), TAPSE (r=0.38) and s’ (r=0.34). ROC curves were determined to calculate the value of AHI to predict a Gmax &amp;gt;25 mmHg. A significant Gmax, as an indicator for increased right cardiac pressures, was predicted with a high sensitivity (86%) and specificity (84%) by a value of AHI &amp;gt; 45 (AUC=0.81, 95%CI = 0.64-0.927, p&amp;lt;0.001). Conclusion In conclusion the study demonstrated that smoking and hypertension are important risk factors in patients with sleep apnea syndrome. There was a significant correlation between AHI and echocardiographic parameters of the right heart. AHI can be used as a predictor of increased right cardiac preassure when the value is above 45.

Dishevelled segment polarity protein 2 promotes gastric cancer progression through Wnt/β-catenin pathway

Dishevelled family proteins (DVL1–3), key scaffold proteins, act on canonical and non-canonical Wnt/β-catenin signaling pathway. DVL has been implicated in various tumor progression. However, its role and underlying mechanisms in gastric cancer (GC) remain unclear. The aim of this study was to investigate the role of DVL in GC development using cell lines and 209 GC specimens. We analyzed three orthologs of DVL in GC tissues and paired adjacent non-tumor tissues, and only DVL2 is highly expressed in GC tissues. We also analyzed clinicopathological data on DVL2 expression in gastric cancer specimens. In immunohistochemistry, DVL2 expression was up-regulated in GC tissues compared with paired adjacent non-tumor tissues (153/209, 73.2%). DVL2 expression level was significantly correlated with many clinicopathological parameters such as T stage (P < 0.001) and N stage (P < 0.001). Survival analysis showed that the overall survival (OS) of patients with high expression of DVL2 was significantly shorter than those with low expression. Multivariate Cox regression analysis revealed that DVL2 expression was an important and independent prognostic factor for gastric cancer patients (P = 0.011, HR=1.78, 95%CI (1.14–2.79). Depletion of endogenous DVL2 using short hairpin RNA (shRNA) inhibited GC cell proliferation, migration, and invasion. The abnormal activation of Wnt/β-catenin signaling pathway is mainly achieved through the abnormal expression of DVL2. DVL2 is highly expressed in gastric cancer tissues, which may be a new independent risk factor for the prognosis of gastric cancer patients. In gastric cancer, DVL2 overexpression plays a crucial role in the occurrence and development of gastric cancer, so it may become a new, effective and complementary therapeutic target for gastric cancer.

Impact of diagnosis to treatment interval in patients with newly diagnosed mantle cell lymphoma.

The prognostic relevance of diagnosis to treatment interval (DTI) in patients with newly diagnosed mantle cell lymphoma (MCL) is unknown. Hence, we sought to evaluate the impact of DTI on outcomes in MCL using 3 large datasets (1) the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource, (2)patients enrolled in the ALL Age Asthma Cohort/CALGB 50403, and (3) a multisitecohort of patients with MCL. Patients were a priori divided into 2 groups, 0 to 14 days (short DTI) and 15 to 60 days (long DTI). The patients in whom observation was deemed appropriate were excluded. One thousand ninety-seven patients newly diagnosed with MCL and available DTI were included in the study. The majority (73%) had long DTI (n=797). Patients with short DTI had worseeastern cooperative oncology group performance status (ECOG PS ≥2), higher lactate dehydrogenase, bone marrow involvement, more frequent B symptoms, higher MCLInternational Prognostic Index (MIPI ≥6.2), and were less likely to receive intensive induction therapy than long DTI group. The median progression-free survival (2.5 years vs 4.8 years, p<0.0001) and overall survival (7.8 years vs. 11.8 years, p<0.0001) were significantly inferior in the short DTI group than the long DTI cohort and remained significant for progression-free survival and overall survival in multivariable analysis. We show that the DTI is an important prognostic factor in patients newly diagnosed with MCL and is strongly associated with adverse clinical factors and poor outcomes. DTI should be reported in all the patients newly diagnosed with MCL who are enrolling in clinical trials and steps must be taken to ensure selection bias is avoided.

Usability and accuracy of polygraphy devices as a screening tool for obstructive sleep apnea in an atrial fibrillation population

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Obstructive sleep apnea (OSA) is an important modifiable risk factor in patients with atrial fibrillation (AF). Unfortunately, it is underdiagnosed in daily clinical practice, although up to 62% of AF patients may have OSA. Early detection of OSA is essential for rhythm control in AF patients. Currently, the gold standard for diagnosing OSA is polysomnography (PSG), but besides being an expensive method, it also requires a supervised hospitalization of one night. There is a lack of accurate and easy-to-use tools to test for OSA that can be implemented in daily ambulatory care. Purpose This study examined the accuracy and user-friendliness of several (cardiorespiratory) polygraphy devices (PG) as a simple screening tool for OSA in an outpatient AF population. Methods This prospective cohort study determines the accuracy of 4 PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR), SpiderSAS (SpS), and Noxturnal T3 (Nox-T3)] in AF patients who underwent a PSG evaluation at two Belgian sleep clinics. All the patients were instructed and asked to use a PG for one night at home. The Apnea-Hypopnea Index (AHI) was used to identify if moderate to severe OSA was present, i.e. AHI ≥15. Moreover, specific AHI cut-off values for each PG were derived based on the receiver operating characteristics (ROC) curves (best Youden's J Index and an accuracy of more than 0.7 compared to PSG). In addition, patients completed a Comfort Questionnaire (CQ) in order to assess the PG’s user-friendliness. Results In total, 130 AF patients undergoing a PSG were included (100 who tested the three devices ALA, STR, SpS and 30 patients who only tested Nox-T3). Only the successful measurements (i.e. ≥4 hours of data on automated analysis; n=250, 75.8%) were examined. The success rate for the ALA, STR, SpS, and NOX-T3 devices was 72.0%, 73.0%, 79.0% and 86.7%, respectively. The optimal AHI cut-off value for each PG in screening for clinically relevant OSA (i.e. AHI ≥15 on PSG) was 7.0, 10.0, 19.5, and 11.1 for the ALA, STR, SpS, and Nox-T3, respectively. The Nox-T3 PG had the highest sensitivity (92.9%), specificity (75.0%) and accuracy (0.85) in comparison to the other three PGs (Table 1). In addition, the scores of three important questions of the CQ were higher for the patients with Nox-T3 compared to the other PGs (Table 2). Conclusion Our results demonstrate the usability of PGs as early OSA screening tools in AF patients. The Nox-T3 with an optimized AHI cut-off value of 11.1 seems to be the best option for ambulatory OSA screening, based both on accuracy and user-friendliness.

The relationship between frailty and HRQoL in elderly cardiovascular patients in Phase II Cardiac Rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Background With an aging cardiovascular disease population, frailty is become an important prognostic factor in patients, which is associated with poor quality of life outcomes, such as fatigue, and decreased physical activity. However, the relationship between frailty and health-related quality of life (HRQOL) in elderly patients undergoing cardiac rehabilitation (CR) remains unclear. Methods In this study, 217 patients (mean age: 74.6 ± 5.8 years; male: 67%) were recruited who participated in early phase II CR at a university hospital between November 2015 and December 2016. As part of the CR processed, patients were asked to complete the Kihon Checklist (KCL) and 36-Item Short Form Survey (SF-36). We divided patients into three groups according to their KCL results: the frailty group (n = 81; 37%), the pre-frailty group (n = 71; 32%), and the non-frailty group (n = 65; 29%). The three groups were compared based on their basic characteristics and SF-36 scores. Results Among the three groups, sex, body mass index, 6-minute walking distance (6MWD), hemoglobin level, and low-density lipoprotein cholesterol level varied significantly (p&amp;lt;0.05). The frailty group scored significantly lower than the other two groups on all items of the SF-36, the Physical Component Summary (PCS), and the Mental Health Component Summary (MCS) (p&amp;lt; 0.05). In all groups, the PCS scores were below the standardized mean scores. Interestingly, MCS score in the frailty group was below the standardized mean scores. Additionally, the significant correlations were found between the PCS and 6MWD in the non-frailty group (p=0.006, r=0.38) and pre-frailty group (p=0.002, r=0.52), but no correlation was found in the frailty group (p=0.14, r=0.22). On the other hand, there was no significant correlation between MCS score and 6MWD in all groups. Conclusions HRQOL as well as physical and mental domains declined in frail elderly patients undergoing CR, which suggests that an intervention program considering social life and daily roles is necessary.