Independent Clinical Parameters Research Articles

Photoacoustic Imaging with Attention-Guided Deep Learning for Predicting Axillary Lymph Node Status in Breast Cancer.

Preoperative assessment of axillary lymph node (ALN) status is essential for breast cancer management. This study explores the use of photoacoustic (PA) imaging combined with attention-guided deep learning (DL) for precise prediction of ALN status. This retrospective study included patients with histologically confirmed early-stage breast cancer from 2022 to 2024, randomly divided (8:2) into training and test cohorts. All patients underwent preoperative dual modal photoacoustic-ultrasound (PA-US) examination, were treated with surgery and sentinel lymph node biopsy or ALN dissection, and were pathologically examined to determine the ALN status. Attention-guided DL model was developed using PA-US images to predict ALN status. A clinical model, constructed via multivariate logistic regression, served as the baseline for comparison. Subsequently, a nomogram incorporating the DL model and independent clinical parameters was developed. The performance of the models was evaluated through discrimination, calibration, and clinical applicability. A total of 324 patients (mean age ± standard deviation, 51.0 ± 10.9 years) were included in the study and were divided into a development cohort (n = 259 [79.9%]) and a test cohort (n = 65 [20.1%]). The clinical model incorporating three independent clinical parameters yielded an area under the curve (AUC) of 0.775 (95% confidence interval [CI], 0.711-0.829) in the training cohort and 0.783 (95% CI, 0.654-0.897) in the test cohort for predicting ALN status. In comparison, the nomogram showed superior predictive performance, with an AUC of 0.906 (95% CI, 0.867-0.940) in the training cohort and 0.868 (95% CI, 0.769-0.954) in the test cohort. Decision curve analysis further confirmed the nomogram's clinical applicability, demonstrating a better net benefit across relevant threshold probabilities. This study highlights the effectiveness of attention-guided PA imaging in breast cancer patients, providing novel nomograms for individualized clinical decision-making in predicting ALN node status.

Deep learning radiomics based prediction of axillary lymph node metastasis in breast cancer

This study aimed to develop and validate a deep learning radiomics nomogram (DLRN) for the preoperative evaluation of axillary lymph node (ALN) metastasis status in patients with a newly diagnosed unifocal breast cancer. A total of 883 eligible patients with breast cancer who underwent preoperative breast and axillary ultrasound were retrospectively enrolled between April 1, 2016, and June 30, 2022. The training cohort comprised 621 patients from Hospital I; the external validation cohorts comprised 112, 87, and 63 patients from Hospitals II, III, and IV, respectively. A DLR signature was created based on the deep learning and handcrafted features, and the DLRN was then developed based on the signature and four independent clinical parameters. The DLRN exhibited good performance, yielding areas under the receiver operating characteristic curve (AUC) of 0.914, 0.929, and 0.952 in the three external validation cohorts, respectively. Decision curve and calibration curve analyses demonstrated the favorable clinical value and calibration of the nomogram. In addition, the DLRN outperformed five experienced radiologists in all cohorts. This has the potential to guide appropriate management of the axilla in patients with breast cancer, including avoiding overtreatment.

An ultrasound-based radiomics model for survival prediction in patients with endometrial cancer.

To establish a nomogram integrating radiomics features based on ultrasound images and clinical parameters for predicting the prognosis of patients with endometrial cancer (EC). A total of 175 eligible patients with ECs were enrolled in our study between January 2011 and April 2018. They were divided into a training cohort (n = 122) and a validation cohort (n = 53). Least absolute shrinkage and selection operator (LASSO) regression were applied for selection of key features, and a radiomics score (rad-score) was calculated. Patients were stratified into high risk and low-risk groups according to the rad-score. Univariate and multivariable COX regression analysis was used to select independent clinical parameters for disease-free survival (DFS). A combined model based on radiomics features and clinical parameters was ultimately established, and the performance was quantified with respect to discrimination and calibration. Nine features were selected from 1130 features using LASSO regression in the training cohort, which yielded an area under the curve (AUC) of 0.823 and 0.792 to predict DFS in the training and validation cohorts, respectively. Patients with a higher rad-score were significantly associated with worse DFS. The combined nomogram, which was composed of clinically significant variables and radiomics features, showed a calibration and favorable performance for DFS prediction (AUC 0.893 and 0.885 in the training and validation cohorts, respectively). The combined nomogram could be used as a tool in predicting DFS and may assist individualized decision making and clinical treatment.

Circulating hsa-miR-5096 predicts 18F-FDG PET/CT positivity and modulates somatostatin receptor 2 expression: a novel miR-based assay for pancreatic neuroendocrine tumors.

Whole miRNOme NGS profiling was conducted on plasma samples obtained from well-differentiated advanced, metastatic, inoperable G1, G2 and G3 GEP-NET patients enrolled in the non-randomized LUX (NCT02736500) and LUNET (NCT02489604) clinical trials prior to PRRT (screening set, n= 24). Differential expression analysis was performed between 18F-FDG positive (n=12) and negative (n=12) patients. Validation was conducted by Real Time quantitative PCR in two distinct well-differentiated GEP-NET validation cohorts, considering the primary site of origin (PanNETs n=38 and SINETs n=30). The Cox regression was applied to assess independent clinical parameters and imaging for progression-free survival (PFS) in PanNETs. In situ RNA hybridization combined with immunohistochemistry was performed to simultaneously detect miR and protein expression in the same tissue specimens. This novel semi-automated miR-protein protocol was applied in PanNET FFPE specimens (n=9). In vitro functional experiments were performed in PanNET models. While no miRNAs emerged to be deregulated in SINETs, hsa-miR-5096, hsa-let-7i-3p and hsa-miR-4311 were found to correlate with 18F-FDG-PET/CT in PanNETs (p-value:<0.005). Statistical analysis has shown that, hsa-miR-5096 can predict 6-month PFS (p-value:<0.001) and 12-month Overall Survival upon PRRT treatment (p-value:<0.05), as well as identify 18F-FDG-PET/CT positive PanNETs with worse prognosis after PRRT (p-value:<0.005). In addition, hsa-miR-5096 inversely correlated with both SSTR2 expression in PanNET tissue and with the 68Gallium-DOTATOC captation values (p-value:<0.05), and accordingly it was able to decrease SSTR2 when ectopically expressed in PanNET cells (p-value:<0.01). hsa-miR-5096 well performs as a biomarker for 18F-FDG-PET/CT and as independent predictor of PFS. Moreover, exosome-mediated delivery of hsa-miR-5096 may promote SSTR2 heterogeneity and thus resistance to PRRT.

A novel prognostic 7-methylguanosine signature reflects immune microenvironment and alternative splicing in glioma based on multi-omics analysis.

Glioma is the most common type of central nervous system tumor with increasing incidence. 7-methylguanosine (m7G) is one of the diverse RNA modifications that is known to regulate RNA metabolism and its dysregulation was associated with various cancers. However, the expression pattern of m7G regulators and their roles in regulating tumor immune microenvironments (TIMEs) as well as alternative splicing events (ASEs) in glioma has not been reported. In this study, we showed that m7G regulators displayed a close correlation with each other and most of them were differentially expressed between normal and glioma tissues. Two m7G signatures were then constructed to predict the overall survival of both GBM and LGG patients with moderate predictive performance. The risk score calculated from the regression coefficient and expression level of signature genes was proved to be an independent prognostic factor for patients with LGG, thus, a nomogram was established on the risk score and other independent clinical parameters to predict the survival probability of LGG patients. We also investigated the correlation of m7G signatures with TIMEs in terms of immune scores, expression levels of HLA and immune checkpoint genes, immune cell composition, and immune-related functions. While exploring the correlation between signature genes and the ASEs in glioma, we found that EIF4E1B was a key regulator and might play dual roles depending on glioma grade. By incorporating spatial transcriptomic data, we found a cluster of cells featured by high expression of PTN exhibited the highest m7G score and may communicate with adjacent cancer cells via SPP1 and PTN signaling pathways. In conclusion, our work brought novel insights into the roles of m7G modification in TIMEs and ASEs in glioma, suggesting that evaluation of m7G in glioma could predict prognosis. Moreover, our data suggested that blocking SPP1 and PTN pathways might be a strategy for combating glioma.

Impact of Dermal Matrix Brand in Implant-Based Breast Reconstruction Outcomes.

Implant-based reconstruction is the most common procedure for breast reconstruction after mastectomy. Acellular dermal matrix is used to provide additional coverage in subpectoral and prepectoral implant placement. In this study, the authors compared postoperative outcomes between AlloDerm (LifeCell, Branchburg, N.J.) and DermACELL (Stryker, Kalamazoo, Mich.), two acellular dermal matrix brands. A retrospective review of implant-based breast reconstruction from 2016 to 2020 was conducted. Patient demographics and comorbidities, implant size and location, acellular dermal matrix choice, and postoperative outcomes were recorded. Primary outcomes assessed were seroma and infection compared between two acellular dermal matrix brands. Independent clinical parameters were assessed with multiple logistic regression models for the primary outcomes. Reconstruction was performed in 150 patients (241 breasts). Eighty-eight patients underwent expander placement with AlloDerm and 62 patients with DermACELL. There were no significant differences in patient characteristics between the two groups. There was a significantly higher incidence of seroma in the AlloDerm group in univariate (AlloDerm 21.7 percent versus DermACELL 8.2 percent, p < 0.005) and multivariate analyses ( p = 0.04; 95 percent CI, 1.02 to 6.07). Acellular dermal matrix use (regardless of type) was not associated with higher rates of infection ( p = 0.99), but body mass index was ( p = 0.004). Both AlloDerm and DermACELL had similar infection rates regardless of contributing risk factors. AlloDerm was found to be a risk factor for seroma formation in the postoperative period. As such, it is important to be aware of this complication when performing implant-based reconstruction with this brand of acellular dermal matrix. Therapeutic, III.

Collagen signature as a novel biomarker to predict axillary lymph node metastasis in breast cancer using multiphoton microscopy.

Accurate identification of axillary lymph node (ALN) status is crucial for tumor staging procedure and decision making. This retrospective study of 898 participants from two institutions was conducted. The aim of this study is to evaluate the diagnostic performance of clinical parameters combined with collagen signatures (tumor-associated collagen signatures [TACS] and the TACS corresponding microscopic features [TCMF]) in predicting the probability of ALN metastasis in patients with breast cancer. These findings suggest that TACS and TCMF in the breast tumor microenvironment are both novel and independent biomarkers for the estimation of ALN metastasis. The nomogram based on independent clinical parameters combined with TACS and TCMF yields good diagnostic performance in predicting ALN status.

Collagen Signature as a Novel Biomarker to Predict Axillary Lymph Node Metastasis in Breast Cancer Using Multiphoton Microscopy

Background: Accurate identification of axillary lymph node (ALN) status is crucial for tumour staging procedure and decision making. The aim of this study is to evaluate the diagnostic performance of clinical parameters combined with collagen signatures (tumour-associated collagen signatures (TACS) and the TACS corresponding microscopic features (TCMF)) in predicting the probability of ALN metastasis in patients with breast cancer. Methods: This retrospective study of 898 participants from two institutions was conducted. Collagen signatures (TACS and TCMF) were generated by multiphoton microscopy (MPM) imaging and feature extraction. Logistic analysis was used to determine the association of clinical parameters, TACS and TCMF with ALN metastasis. Findings: TACS and TCMF were significant predictors of ALN status. A nomogram based on independent clinical parameters combined with TACS and TCMF was developed to predict the probability of ALN metastasis with an area under the receiver operating curve (AUC) of 0.783 in the training cohort, 0.747 in the internal validation cohort, and 0.746 in the external validation cohort. Interpretation: These findings suggest that TACS and TCMF in the breast tumour microenvironment are both novel and independent biomarkers for the estimation of ALN metastasis. The nomogram yields good diagnostic performance in predicting ALN status. Funding: Fujian Major Scientific and Technological Special Project for “Social Development” (No. 2020YZ016002), Special Funds of the Central Government Guiding Local Science and Technology Development (No. 2020L3008), Natural Science Foundation of China (Nos. 81901787, 81700576), Natural Science Foundation of Fujian Province (Nos. 2019J01269, 2020J011008, 2020J01154). Declaration of Interest: The authors declare no competing interests. Ethical Approval: This retrospective study used anonymous data which was approved by the Institutional Review Board of Fujian Medical University Union Hospital (Fuzhou, China) and Harbin Medical University Cancer Hospital (Harbin, China).

Immature platelet levels correlate with disease activity and predict treatment response of thrombocytopenia in lupus patients.

The immature platelet fraction (IPF) represents recently produced platelets in bone marrow and this parameter is increased in patient with primary immune thrombocytopenia (ITP). We investigated the associations between IPF and absolute immature platelet count (AIPC), and clinical parameters in systemic lupus erythematosus (SLE), which has more complex pathological mechanisms than in primary ITP. Patients with SLE were retrospectively reviewed at the University of Tokyo Hospital from May, 2012 to January, 2021. The correlations between clinical parameters and the number of immature platelets were assessed with Spearman's rank correlation coefficients. A multiple logistic regression model was used to identify the independent clinical parameters for IPF and AIPC. The difference in the distribution of time for a complete response (CR) after prednisolone (PSL) administration was also evaluated by log-rank test. A total of 282 SLE patients were enrolled, and 12.41% of those patients showed thrombocytopenia. IPF correlated with clinical parameters such as platelet count (r = -0.58), AIPC (r = 0.64) and systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) (r = 0.24). SLEDAI-2K [odds ratio (OR) (per unit increase), 1.07; 95% CI, 1.013 - 1.13] and thrombocytopenia (OR, 32.23; 95% CI, 11.072 - 93.80) were independent clinical parameters to account for IPF increase. IPF correlated with the number of bone marrow megakaryocytes (n = 19, r = 0.57). Notably, the probability of CR in response to PSL in AIPC-high patients was higher than in AIPC-low patients (hazard ratio, 4.62; 95% CI, 1.07 - 20.02). IPF correlated with disease activity of SLE and represented platelet production in the bone marrow, whereas AIPC predicted a rapid response to steroids in thrombocytopenic patients with SLE.

Altered Gray-White Matter Boundary Contrast in Toddlers at Risk for Autism Relates to Later Diagnosis of Autism Spectrum Disorder.

BackgroundRecent neuroimaging studies have highlighted differences in cerebral maturation in individuals with autism spectrum disorder (ASD) in comparison to typical development. For instance, the contrast of the gray-white matter boundary is decreased in adults with ASD. To determine how gray-white matter boundary integrity relates to early ASD phenotypes, we used a regional structural MRI index of gray-white matter contrast (GWC) on a sample of toddlers with a hereditary high risk for ASD.Materials and MethodsWe used a surface-based approach to compute vertex-wise GWC in a longitudinal cohort of toddlers at high-risk for ASD imaged twice between 12 and 24 months (n = 20). A full clinical assessment of ASD-related symptoms was performed in conjunction with imaging and again at 3 years of age for diagnostic outcome. Three outcome groups were defined (ASD, n = 9; typical development, n = 8; non-typical development, n = 3).ResultsASD diagnostic outcome at age 3 was associated with widespread increases in GWC between age 12 and 24 months. Many cortical regions were affected, including regions implicated in social processing and language acquisition. In parallel, we found that early onset of ASD symptoms (i.e., prior to 18-months) was specifically associated with slower GWC rates of change during the second year of life. These alterations were found in areas mainly belonging to the central executive network.LimitationsOur study is the first to measure maturational changes in GWC in toddlers who developed autism, but given the limited size of our sample results should be considered exploratory and warrant further replication in independent and larger samples.ConclusionThese preliminary results suggest that ASD is linked to early alterations of the gray-white matter boundary in widespread brain regions. Early onset of ASD diagnosis constitutes an independent clinical parameter associated with a specific corresponding neurobiological developmental trajectory. Altered neural migration and/or altered myelination processes potentially explain these findings.

Clinical Features and Molecular Markers on Diffuse Midline Gliomas With H3K27M Mutations: A 43 Cases Retrospective Cohort Study.

PurposeDiffuse midline gliomas (DMG) with H3K27M mutations have been identified as a rare distinctive entity with unique genetic features, varied molecular alterations, and poor prognosis. The current study aimed to evaluate the clinical characteristics and profile of molecular markers on patients with a DMG harboring H3K27M mutations, and explore the impact of this genetic makeup on overall survival.MethodsWe retrospectively analyzed 43 consecutive patients diagnosed with a DMG harboring H3K27M mutations (age range 3 to 75 years) and treated in a tertiary institution within China between January 2017 to December 2019. Various clinical and molecular factors were evaluated to assess their prognostic value in this unique patient cohort.ResultsThe median overall survival (OS) was 12.83 months. Preoperative Karnofsky Performance Score (KPS) and adjuvant radiotherapy were found to be independent clinical parameters influencing the OS by multivariate analysis (p = 0.027 and p < 0.001 respectively). Whereas extent of tumor resection failed to demonstrate statistical significance. For molecular markers, P53 overexpression was identified as a negative prognostic factor for overall survival by multivariate analysis (p = 0.030).ConclusionLow preoperative KPS, absence of radiotherapy and P53 overexpression were identified as predictors of a dismal overall survival in patients with DMG and H3K27M mutations.

Machining learning predicts the need for escalated care and mortality in COVID-19 patients from clinical variables

Objective: This study aimed to develop a machine learning algorithm to identify key clinical measures to triage patients more effectively to general admission versus intensive care unit (ICU) admission and to predict mortality in COVID-19 pandemic.Materials and methods: This retrospective study consisted of 1874 persons-under-investigation for COVID-19 between February 7, 2020, and May 27, 2020 at Stony Brook University Hospital, New York. Two primary outcomes were ICU admission and mortality compared to COVID-19 positive patients in general hospital admission. Demographic, vitals, symptoms, imaging findings, comorbidities, and laboratory tests at presentation were collected. Predictions of mortality and ICU admission were made using machine learning with 80% training and 20% testing. Performance was evaluated using receiver operating characteristic (ROC) area under the curve (AUC).Results: A total of 635 patients were included in the analysis (age 60±11, 40.2% female). The top 6 mortality predictors were age, procalcitonin, C-creative protein, lactate dehydrogenase, D-dimer and lymphocytes. The top 6 ICU admission predictors are procalcitonin, lactate dehydrogenase, C-creative protein, pulse oxygen saturation, temperature and ferritin. The best machine learning algorithms predicted mortality with 89% AUC and ICU admission with 79% AUC.Conclusion: This study identifies key independent clinical parameters that predict ICU admission and mortality associated with COVID-19 infection. The predictive model is practical, readily enhanced and retrained using additional data. This approach has immediate translation and may prove useful for frontline physicians in clinical decision making under time-sensitive and resource-constrained environment.

Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: Association With Exercise Capacity in Chronic Kidney Disease.

BackgroundLeft atrial (LA) function plays a pivotal role in modulating left ventricular performance. The aim of our study was to evaluate the relationship between resting LA function by strain analysis and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its utility compared with exercise E/e'.Methods and ResultsConsecutive patients with stage 3 and 4 CKD without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation and resting and exercise stress echocardiography. Resting echocardiographic parameters including E/e' and phasic LA strain (LA reservoir [LASr], conduit, and contractile strain) were measured and compared with exercise E/e'. A total of 218 (63.9±11.7 years, 64% men) patients with CKD were recruited. Independent clinical parameters associated with exercise capacity were age, estimated glomerular filtration rate, body mass index, and sex (P<0.01 for all), while independent resting echocardiographic parameters included E/e', LASr, and LA contractile strain (P<0.01 for all). Among resting echocardiographic parameters, LASr demonstrated the strongest positive correlation to metabolic equivalents achieved (r=0.70; P<0.01). Receiver operating characteristic curves demonstrated that LASr (area under the curve, 0.83) had similar diagnostic performance as exercise E/e' (area under the curve, 0.79; P=0.20 on DeLong test). A model combining LASr and clinical metrics showed robust association with metabolic equivalents achieved in patients with CKD.ConclusionsLASr, a marker of decreased LA compliance is an independent correlate of exercise capacity in patients with stage 3 and 4 CKD, with similar diagnostic value to exercise E/e'. Thus, LASr may serve as a resting biomarker of functional capacity in this population.

Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma of the Breast.

Invasive lobular carcinoma (ILC) of the breast makes up 5 to 15 percent of all invasive breast cancers. It has distinctive clinical and histopathological features when compared to invasive ductal carcinoma (IDC). This study intends to describe factors influencing sentinel lymph node (SLN) positivity in patients with "pure" ILC. Data of 105 patients, who were treated at a tertiary oncology center, with lobular carcinoma of the breast that were subjected to SLN biopsy was probed retrospectively. Patients were categorized as ≤60 and >60 years of age, positive or negative for estrogen receptor and progesterone, tumor grade I, II and III, Ki67≤15% and >30%, lymphovascular invasion presence and the presence of multicentricity and multifocality. Mean age at the time of diagnosis was 52 (38-81). Mean tumor size was 2.7 cm (0.7-13cm). Univariate analyses revealed a significant relationship between tumor size (≤2 cm vs >2cm) and metastasis in the SLN. This relation kept its significance in multivariate analyses. (p=0.013). With so many different characteristics from IDC, ILC is mostly a uniform tumor. In this study, tumor size was the only independent clinical parameter that was found related to SLN metastases.

Identification of relevant prognostic values of cytokeratin 20 and cytokeratin 7 expressions in lung cancer.

Lung cancer is one of the most common malignant tumors harmful to human health. Cytokeratin (CK) is highly conserved and differentiated related to the proliferation and differentiation of epithelial cells. The aim of the study was to explore expressions of CK20 and CK7 and corresponding prognostic values in patients with lung cancer. Our study included 258 cases of patients confirmed with lung cancer. Expressions of CK20 and CK7 mRNA and protein were detected using real-time quantitative PCR (qRT-PCR) and Western blot, respectively, followed by the performance of immunohistochemistry staining. Associations of CK20 and CK7 with the clinical parameters and prognosis of lung cancer patients were further analyzed. There were obvious differences regarding the positive expression of CK20 in different T stage, lymph node metastasis, invasion, size, and clinical stage subgroups; besides, significant differences in the positive expression of CK7 were also observed in subgroups of different sex, age, lymph node metastasis, invasion, and differentiation. Furthermore, effects of age, smoking, T stage, lymph node metastasis and invasion, size, and CK7 expressions were significant on the survival of patients (all P<0.05). Multivariate analysis revealed that lymph node metastasis, T stage, and CK7 expression were independent risk factors for poor prognosis of involved patients (all P<0.05), while age, smoking, and invasion had no marked relation to the survival time of patients with lung cancer (all P>0.05). Positive CK20 and CK7 expressions are detected in patients with lung cancer; positive expression of CK7 associated with pathological features of lymph node metastasis and T stage may be independent clinical parameters for poor prognosis of patients with lung cancer.

Clinical Usefulness of Measuring Red Blood Cell Distribution Width in Patients with Hepatitis B Virus-Related Acute-On-Chronic Liver Failure.

The red blood cell distribution width (RDW) is increased in chronic liver disease, but its clinical significance in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is still unclear. The aim of the present study was to investigate the clinical significance of RDW in HBV-ACLF patients. The medical records of HBV-ACLF patients who were admitted to The Second Affiliated Hospital of Anhui Medical University between April 2012 and December 2015 were retrospectively reviewed. Correlations between RDW, neutrophil lymphocyte ratio (NLR), and the model for end-stage liver disease (MELD) scores were analyzed using the Spearman's approach. Multivariable stepwise logistic regression test was used to evaluate independent clinical parameters predicting 3-month mortality of HBV-ACLF patients. The association between RDW and hospitalization outcome was estimated by receiver operating curve (ROC) analysis. Patient survival was estimated by Kaplan-Meier analysis and subsequently compared by log-rank test. Sixty-two HBV-ACLF patients and sixty CHB patients were enrolled. RDW were increased in HBVACLF patients and positively correlated with the NLR as well as MELD scores. Multivariate analysis demonstrated that RDW value was an independent predictor for mortality. RDW had an area under the ROC of 0.799 in predicting 3-month mortality of HBV-ACLF patients. Patients with HBV-ACLF who had RDW > 17% showed significantly poorer survival than those who had RDW ≤ 17%. RDW values are significantly increased in patients with HBV-ACLF. Moreover, RDW values are an independent predicting factor for an in-hospital mortality in patients with HBV-ACLF.

Clinical parameters related to metamorphopsia outcome in patients with resolved central serous chorioretinopathy using M-CHARTS: retrospective cohort study.

BackgroundThe purpose of this study was to determine the clinical parameters related to metamorphopsia outcome in patients with resolved central serous chorioretinopathy (CSCR).MethodsThe charts of 36 eyes with resolved CSCR were retrospectively reviewed. We measured metamorphopsia using M-CHARTS after resolution of serous retinal detachment. We analyzed the relationship between metamorphopsia outcome and clinical parameters including age, visual acuity, chronicity of CSCR, symptom duration and several spectral-domain optical coherence tomography findings using univariate and multivariate forward logistic regression analyses.ResultsThe M-CHARTS detected metamorphopsia in 19 eyes (52.8 %). In the univariate analysis, the eyes with metamorphopsia were, relative to those without metamorphopsia, significantly associated with a greater proportion of chronic-recurrent CSCR, initial and final irregularities of retinal pigment epithelium, longer symptom duration, thinner final thickness of central fovea and outer nuclear layer, and final disruption of external limiting membrane (ELM), photoreceptor inner and outer segment junction and cone outer segment tip line (P = 0.003, 0.037, 0.019, 0.003, 0.013, 0.015, <0.001, 0. 012 and 0.002, respectively). However, in the multivariate analysis, chronic-recurrent CSCR (OR 22.5, P = 0.019) and final disrupted ELM (OR 82.6, P = 0.004) were the independent clinical parameters related to poor metamorphopsia outcome.ConclusionsResidual metamorphopsia was detected using M-CHARTS in about half of patients (52.8 %) with resolved CSCR. Chronic-recurrent CSCR and final disrupted ELM were the independent clinical parameters related to poor metamorphopsia outcome in patients with resolved CSCR.

PO-0708 Identification Of High Risk Clinical Parameters For Predicting Outcome Of Hospitalised Neonates-a Prospective Observational Study: Abstract PO-0708 Table 1

<h3>Background and aims</h3> The early identification of severity of illness is important for prioritising treatment to reduce mortality and morbidity in neonates but it is sometimes difficult to assess. An overall subjective assessment of the severity of underlying illness is useful in final decision making. Most of the available neonatal scoring systems have certain limitations namely : i. These are not a one time asessment and data collection extends over a number of hours. ii. Are complex, labour intensive, expensive and include a large number of investigations. iii. Limited to certain category of neonates. None of the scoring systems can predict neonatal outcome by assessing only clinical parameters without including any laboratory investigations. Hence there is a need for a study to predict neonatal outcome at admission. involving only clinical parameters. This study aimed to identify high risk clincial parameters that will be helpful in Predicting outcome of hospitalised neonates. <h3>Material</h3> <h3>Design and Setting</h3> Prospective, Clinical, teaching hopital based observational study. <h3>Subjects</h3> A total of 344 neonates included, at admission. <h3>Methods</h3> All the neonates at admission were assessed on the basis of various clinical parameters and history. These included vital sign (HR, RR, CFT, Temp), activity, cry, pallor, icterus, cyanosis, bleeding, anterior fontanel, congenital malformations, respiratory distress, cardiac murmur, hepatomegaly, neonatal reflexes, weight, gestational age, seizures. <h3>Statistical analysis</h3> Mean and SD were computed; comparision between mean was done by ANOVA. Odds ratio with 95% CI were calculated for each parameter. Multiple logistic regression analysis was carried out Positive and negative predictive values, sensitivity, specificity of each significant clinical variable were calculated. The significance level was taken as p value ≤ 0.05. <h3>Results</h3> Variables which were significantly associated with outcome in terms of mortality on univariate analysis (Table) were: HR, RR, SPO₂, CFT, hypo/hyperthermia, low birth weight, abnormal conciousness level, reduced or no activity, moderate or severe pallor, cyanosis, bleeding, dehydration, respiratory distress, cardiac murmur, abdominal distension, hepatomegaly, hypo/hypertonia incomplee/absent Moro’s/DTRs and hospital stay of &lt;7 days. On multiple logistic regression the significant independent clinical parameters for mortality were : HR, RR, O₂ saturation, CFT, hypo/hypothermia, LBW, decreased sensorium level, reduced or no activity, moderate/severe pallor, cynosis, bleeding, dehydration, respiratory distress, cardiac murmur, abdominal distension. <h3>Conclusions</h3> Outcome of neonates can be predicted at the time of admission, using simple, easily assessed bedside clinical parameters.

Abstract T MP4: The Rapidity of Recanalization is an Independent Factor to Achieve Good Clinical Outcome After Intraarterial Thrombectomy

Background: The present study evaluated whether the time interval from symptom onset to recanalization (onset-to-recanalization time) was independently related with the clinical outcomes after intraarterial thrombectomy (IAT) in acute ischemic stroke patients. Methods: We analyzed clinical and radiological data of 140 consecutive patients who underwent IAT for terminal internal carotid and/or middle cerebral artery occlusions. The patients were classified into 4 groups by the onset-to-recanalization time; &lt;4.5, 4.5-6, &gt;6 hours, and no recanalization (NR). Subsequent changes of the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were compared between the four time interval groups. The independent relationship of the onset-to-recanalization time with the clinical outcomes was analyzed with other clinical and radiological parameters simultaneously checked before and after IAT using multivariate analyses. Results: Successful recanalization after IAT was performed in 47 (34%) &lt;4.5hours, 39 (28%) 4.5-6 hours, 31 (22%) patients &gt;6 hours groups, no recanalization in 23 patients (16%). Even though initial NIHSS score was not different between the four groups (&lt;4.5 hrs, 12.2±4.0; 4.5-6hrs, 12.2±4.2; &gt;6hrs, 12.1±3.3; NR, 12.8±3.3, p &gt;0.05), two first groups who recanalized within 6 hour showed more significant reductions of NIHSS at discharge (&lt;4.5 hrs, 5.4±5.8; 4.5-6hrs, 6.5±6.7; &gt;6hrs, 9.6±6.0; NR, 12.7±4.0, p &lt;0.001). The first two groups showed more favorable outcome (mRS 0-2) at discharge (&lt;4.5hrs, 51%; 4.5-6hrs, 51%; &gt;6hrs, 13%; NR, 0, p &lt;0.001) and 3 months later (&lt;4.5hrs, 62%; 4.5-6hrs, 63%; &gt;6hrs, 23%; NR, 0, p &lt;0.001) rather than other 2 groups. On the multiple regression analysis, recanalization within 6 hours was an independent parameter related with the favorable outcome at 3 months after IAT (OR 15.5, 95% CI 2.0-119.8, p =0.009) along with less extensive lesions on initial brain image (OR 13.2, 95% CI 1.7-103.3, p =0.014) and high recanalization grade (OR 13.0, 95% CI 1.5-115.6, p =0.022). Conclusions: The present study showed that the successful recanalization within 6 hours might be an independent clinical parameter to achieve favorable outcome after IAT for ischemic stroke patients.

Postinterventional Tumor Necrosis Predicts Recurrence-Free Long-Term Survival in Liver Transplant Patients with Advanced Hepatocellular Carcinoma on Clinical Staging

Background: There is some evidence that a subset of patients with advanced HCC on clinical staging may, nonetheless, benefit from liver transplantation. The role of pretransplant interventional bridging treatment (IBT) for identifying adequate liver transplant candidates with HCC beyond the Milan criteria is still undefined. The aim of this trial was, therefore, to evaluate the value of IBT induced tumor necrosis on recurrence-free long-term survival in liver transplant patients with advanced HCC. Furthermore, we aimed at identifying pretransplant available clinical parameters that may predict histopathological response to IBT, and thereby, be useful for selecting adequate liver transplant candidates. Patients and methods: A total of 93 patients with HCC were included in this trial. 18F-FDG positron emission tomography (PET) has been performed in all of them pre-LT, classifying patients in PET− (no increased FDG tumor uptake on PET) and PET + (increased FDG tumor uptake on PET). If being eligible, patients underwent pretransplant IBT by transarterial chemoembolization (TACE) or radiofrequency ablation (RFA). Clinical response to IBT was assessed by repeat CT scans (RECIST criteria). Macromorphologic tumor staging was based on CT/MRI. Explant livers were histopathologically examined to determine variables of macromorphology, vascular and lymphatic invasion invasion, grading and grade of post-IBT tumor necrosis. Patients with a 50%-100% tumor necrosis were defined to be histological responders, while tumor necrosis rate < 50% indicated histological non-response to IBT. The impact of clinical and histopathologic parameters on clinical outcome was evaluated in uni- and multivariate analysis. Results: Current overall follow-up is ranging between 5 and 162 months posttransplantation (mean: 64.3 ± 44.2 months). Finally, 59 liver transplant patients (63.4%) have received IBT, predominantly TACE. Overall, 21 patients developed tumor recurrence post-LT (22.6%), 11 patients in the IBT-group (18.6%) and 10 patients in the non-IBT-population (29.4%). Histologic responders had a significantly better recurrence-free survival rate after 5 years than histologic non-responders (96% versus 21%; P < 0,001). Histologic response to IBT resulted in a 5-year recurrence-free survival of 80% in Milan Out patients, which was comparable to Milan In recipients (87%), but significantly better than in histologically non-responding Milan Out recipients (0%; P < 0,001). In multivariate analysis, histologic response to IBT was identified as the only independent predictor of recurrence-free long-term survival (hazard ratio 53.3; P < 0.001). In multivariate logistic regression, pretransplant PET- status was assessed as the only independent clinical parameter predicting histologic response to IBT (odds ratio 12.4; P < 0.001). Conclusion: Data of our trial indicate that liver transplant patients with HCC should undergo pretransplant IBT, if being eligible, aiming at extended tumor necrosis. Patients with advanced HCC on clinical staging may, thereby, achieve excellent recurrence-free lomg-term survival. Pretransplant PET evaluation is useful for identifying those patients that may undergo successful IBT. This could be useful for a reasonable extension of liver transplant criteria.