Long-term Course Of Patients Research Articles

Long-term Outcomes Following Non-operative Management of Acute Appendicitis: A Population-based Analysis.

To describe long-term re-presentations and interventions following non-operative management (NOM) of acute appendicitis (AA). Trial data suggest NOM of AA carries a substantial risk of subsequent appendectomy, although NOM is increasingly offered to patients. Population-based data is required to understand the real-world long-term course of patients undergoing NOM of AA. This population-based cohort study included all adult patients in Ontario, Canada who presented to any emergency department (ED) with AA between 2004-2019. Patients who did not undergo a procedure on index ED presentation or hospital admission were defined as NOM and followed for five years. The cumulative incidence of composite re-presentation or intervention (ED re-presentation, re-admission, emergency, or scheduled appendicitis procedure) was calculated accounting for competing risk of death. Of 156,362 patients identified with AA, 13,200 underwent NOM. The cumulative incidence of composite re-presentation or intervention was 33% at 1-year (95%CI 32-33%) and 36% at 5-years (95%CI 36-37%). At 5-years, the incidence of appendicitis-specific ED re-presentation or hospital re-admission was 16% (95%CI 15-16%), the incidence of an emergency procedure for AA was 12% (95%CI 12-13%), and the incidence of scheduled surgery was 21% (95%CI 20-21%). In a subgroup of patients with uncomplicated AA, composite re-presentation or intervention was 28% at 1-year (95%CI 27-29%) and 32% at 5-years (95%CI 32-33%). Real-world estimates of emergency re-presentation with or without urgent surgery following NOM of AA were lower than previously described. Scheduled appendectomy made up an important proportion of long-term interventions following NOM.

Comparison of the effectiveness of open, laparoscopic, and robotic-assisted radical prostatectomies based on complication rates: a retrospective observational study with administrative data from Switzerland

BackgroundRadical prostatectomies can be performed using open retropubic, laparoscopic, or robot-assisted laparoscopic surgery. The literature shows that short-term outcomes (in particular, inpatient complications) differ depending on the type of procedure. To date, these differences have only been examined and confirmed in isolated cases based on national routine data.MethodsThe data was based on the Swiss Medical Statistics from 2016 to 2018 from a national survey of administrative data from all Swiss hospitals. Cases with the coded main diseases neoplasm of the prostate (ICD C61) and the main treatments of laparoscopic (CHOP 60.5X.20) or retropubic (CHOP 60.5X.30) radical prostatectomies were included, resulting in a total sample size of 8,593 cases.ResultsA procedure-related complication occurred in 998 cases (11.6%). By surgical procedure, complication rates were 10.1% for robotic-assisted laparoscopic radical prostatectomy 9.0% for conventional laparoscopic radical prostatectomy and 17.1% for open retropubic radical prostatectomy (p < 0.001). Conventional and robotic-assisted laparoscopic radical prostatectomies had a significantly lower risk of complications than retropubic procedures. Moreover, the risk of a procedure-related complication was almost twice as high in cases operated on retropubically; however, no significant difference was found between conventional and robotic-assisted laparoscopic cases.DiscussionThe use of a surgical robot showed no advantages in radical prostatectomies regarding procedure-related during the hospital stay. However, both conventional and robotic-assisted laparoscopically operated radical prostatectomies show better results than open retropubic procedures. Further studies on the long-term course of patients based on claims data are needed to confirm the inherent benefits of surgical robots in tandem with them being increasingly employed in hospitals.

A comprehensive correlation of the KI-67 proliferation index to patient´s, imaging and tumor features and its value in predicting long-term course of patients with newly diagnosed intracranial meningiomas.

To analyze the correlation of KI-67-Proliferation Index (KI-67-PI) with preoperative patients and MRI characteristics, WHO grading, histological subtype and long-term-course of patients with newly diagnosed intracranial meningiomas (IM). In this single-center retrospective study, all consecutive patients with IM were analyzed from January 2007 to August 2019. Patient´s demographics (age, sex), imaging parameters (location, volume, edema, necrosis), and tumor features (WHO grade, histology) were assessed and correlated with KI-67-PI. Long-term data were retrieved from patient's last follow-up visits. This study included 463 IM in 457 surgically treated patients. Males exhibited a higher KI-67-PI than females (7.31 ± 0.22 vs. 5.37 ± 0.53; p < 0.01, Mann-Whitney U Test). Age positively correlated with KI-67-PI in both sexes (p < 0.01, Spearman), with older patients having a higher KI-67-PI. KI-67-PI was significantly higher in convexity IM compared to frontobasal IM (7.15 ± 5.56 vs. 4.66 ± 2.94; p < 0.05, ANOVA, Tukey´s HSD), while no difference in KI-67-PI expression was found when other locations were compared to each other (Tukey´s HSD). Higher KI-67-PI was significantly correlated with larger tumor volume (p < 0.01, Spearman), larger tumor necrosis and larger peritumoral edema (p < 0.01, Kruskal-Wallis). Patients with recurrent IM had a significantly higher KI-67-PI than patients without recurrence (8.24 ± 5.88 vs. 5.14 ± 3.53; p < 0.01, ANOVA, Tukey´s HSD) during a mean follow-up period of 80.92 ± 38.1months. Atypical and anaplastic IM exhibited significantly higher KI-67-PI compared to all other WHO grade 1 histological subtypes (12.09 ± 0.73 vs. 4.51 ± 0.13; p < 0.01, Kruskal-Wallis test) and KI-67-PI was significantly higher in anaplastic IM compared to atypical meningioma (19.67 ± 1.41 vs. 11.01 ± 0.38; p < 0.01, ANOVA). Higher KI-67-PI is not only associated with atypical and anaplastic subtypes of IM, but is also significantly higher in males, positively correlates with patients age, larger tumor volume, lager peritumoral edema and necrosis on preoperative MRI and predicts tumor recurrence. Therefore, KI-67-PI may serve as a decision indicator for adjuvant treatment in patients with IM.

Factors affecting long-term changes of meibomian gland in MGD patients.

To explore the long-term course of patients with meibomian gland dysfunction (MGD), and to analyse potential factors affecting the recovery of meibomian gland (MG) dropout. Seventy-nine MGD patients (79 eyes) aged 36.03±15.78 years old who underwent more than one year of follow-up were enrolled in this retrospective study. Corneal fluorescein staining (CFS), tear meniscus height (TMH), noninvasive breakup time (NIBUT), and noncontact meibography at baseline and last visit were collected and analysed. Then an automatic MG analyzer was used to measure the morphological and functional parameters of MGs, including their area ratio (AR), tortuosity index (TI), and signal index (SI). The patients whose AR increased by more than 5% were defined as MG improvement, and AR decreased by more than 5% was MG worsening. A total of 79 patients (79 eyes) were assessed with at least 1-year of follow-up. More than 1/3 of MGD patients (27 eyes, 34.2%) underwent MG improvement, and 30.4% of MGs became worsened. Age (P=0.002), gender (P<0.001), IPL treatment (P=0.013), the change of CFS (P=0.0015), and the recovery of SI (P=0.035) showed significant differences among different recovery groups. Age(P<0.001), female sex (P=0.003), ΔCFS (P<0.001), AR at baseline (P<0.001) were negative correlation with AR recovery, and the change of SI (P=0.003) and IPL treatment (P=0.003) had a positive correlation with it. Among them, age (P=0.038), the change of CFS (P=0.004), and AR at baseline (P=0.007) were confirmed as negatively correlated factors predicting the long-term change of the MG. Although the MGD treatment has continued for more than 1 year, only 34.2% of MGD patients were observed to undergo MG improvement. Younger patients and patients with better CFS recovery seem to have more opportunities to improve their MGs.

Are serum levels of 25-hydroxy vitamin D reduced following orchiectomy in testicular cancer patients?

BackgroundThe testis represents one place where the progenitor of vitamin D is converted into its active form. Loss of one testis was suggested to result in reduced vitamin D serum levels. Vitamin D deficiency would represent a significant health problem in the long-term course of patients with testicular germ cell tumors (GCTs) since most of them survive. The purpose of this study was to look to the serum 25(OH)-Vitamin D (25OHD) levels in patients with GCTs before and after orchiectomy. A total of 177 GCT patients underwent measurements of serum 25OHD levels, thereof 83 with preoperative measurements and 94 with measurements at six particular time-points from immediate postoperatively to >24 months. Longitudinal assessments of 25OHD serum levels were performed in individual patients with repeated measurements. A second analysis involved patient cohorts with measurements at six postoperative time-points. Serum levels of patients were also compared with 2 control groups, one consisting of 84 patients with non-neoplastic testicular diseases and another with 237 patients with non-neoplastic urologic diseases. We also looked to associations of 25OHD levels with levels of testosterone, follicle stimulating hormone (FSH), age, histology of GCT and season. Descriptive statistical methods were employed to compare groups and to analyze changes over time.ResultsNormal serum levels of 25OHD were found in 21.7%, 23.1%, 20.2%, 21.9% in GCT patients preoperatively, after >2 years, in control group 1 and control group 2, respectively. Levels were significantly higher in spring and summer, but no association was found with other parameters. We found a significant transient decrease of 25OHD levels with a nadir at 6-12 months after orchiectomy and a recovery thereafter.ConclusionContrasting with previous studies we found no permanent reduction of serum 25OHD levels after orchiectomy but transient postoperative drop of 25OHD levels. There were no associations of 25OHD levels with age, and levels of testosterone or FSH. Our results may point to a particular role of the testis in vitamin D metabolism and may thus enhance the understanding of the diverse physiological roles of the testis.

Repeat Radiofrequency Catheter Ablation of Atrial Tachycardias in Patients with Congenital Heart Disease

Objectives. Aim of this study was to evaluate the long-term course of patients with congenital heart disease (CHD) requiring repeat ablation procedures (RAP) of atrial tachycardias (AT). Background. Reports on RAP of AT in patients with CHD are sparse.Patients and Methods. All 144 patients with CHD who had undergone ablation of AT at our center between January 2003 and October 2018 were enrolled. Patients were classified according to complexity of CHD: complex CHD (cCHD), moderate CHD (mCHD) and simple CHD (sCHD). Results. A total of 101 RAP were performed in 64 patients. One RAP was performed in n=40, two in n=13, three in n=10 and 5 in n=1. Acute success rate was 82% (83/101) and was not associated with complexity of CHD (p=1.0). Mean number of procedures was lower in patients with sCHD than in patients with mCHD and cCHD (sCHD 1.3{plus minus}0.6, mCHD 1.8{plus minus}1.0 and cCHD 1.8{plus minus}1.1, p=0.04). RAP were most frequent in patients after Fontan palliation or atrial switch procedure (2.0{plus minus}1.1 (n=41) vs. 1.6{plus minus}0.9 all others, p=0.016) and in patients with multiple unstable AT´s (2.5{plus minus}1.1 (n=11) vs. 1.7{plus minus}1.0, p=0.008). Major complications occurred in 4/101 procedures. Complete follow-up was available in 125 patients. Since last RAP 73% of the patients were in sinus/atrial rhythm and 34/125 patients (27%) with AT recurrence did not require re-ablation with mean follow-up of 52{plus minus}40 months. Conclusions. Recurrences after ablation of AT in CHD patients were frequent. After RAP promising long-term results could be achieved. Data encourage repetitive ablation procedures in this patient population.

Human leukocyte antigen (HLA)-Cw0303, HLA-Cw04, and HLA-Cw07 polymorphisms are associated with susceptibility of rheumatoid arthritis in Chinese Han patients from Southern China.

This study aimed to investigate the association between human leukocyte antigen Cw (HLA-Cw) polymorphisms and rheumatoid arthritis (RA) in Chinese Han patients in the Jiangsu area (Southern China). Polymerase chain reaction-sequence specific primers were used to detect HLA-Cw01-08 of 201 RA patients and 211 healthy individuals from Zhongda Hospital (China). The allele frequency distribution of HLA-Cw and genotypic differences between the two groups were analyzed. The frequency of HLA-Cw0303 in patients with RA was significantly higher than that in controls, while the frequency of HLA-Cw04 was lower than that in controls (P<0.05). The gene frequency of HLA-Cw07 in anti-cyclic citrullinated peptide (anti-CCP)-negative patients was higher than that in controls (P=0.044). The frequency of HLA-Cw04 was decreased in the short duration subgroup and increased in the long duration subgroup (P<0.05). Compared to controls, the frequency of HLA-Cw0303 in patients with RA and morning stiffness was increased (P=0.004), while the frequency of HLA-Cw04 was decreased ( 0.005). These results suggest that HLA-Cw0303 is a susceptibility gene for RA in Chinese Han patients in the Jiangsu area of southern China. The HLA-Cw04 gene may be a protective factor against RA, while HLA-Cw07 might play a protective role in the production of anti-CCP in the long-term course in patients with RA.

L’évolution à long terme du reflux vésico-rénal chez l’enfant

Le reflux vésico-rénal (RVR) est une pathologie assez fréquente chez l'enfant nécessitant un suivi long pour réduire l'évolution vers l'insuffisance rénale chronique. L'objectif de notre étude est d'analyser les aspects épidémiologiques, le diagnostic, la prise en charge du reflux vésico-rénal et l'évolution à long de terme de cette pathologie. Pour cela on a mené une étude rétrospective portant sur une série de 42 patients hospitalisés au Service de Chirurgie Pédiatrique Viscérale du CHU Hassan II de Fès suspectés porteurs d'un reflux vésico-rénal (RVR) sur une période de 6 ans allant de janvier 2010 à décembre 2015. On a trouvé que l'âge médian au moment du diagnostic était de 3 ans et 2 mois. Le sex ratio était de 1,8 garçon pour fille. Le RVR était retrouvé isolé chez 81%, et secondaire ou associé chez 19%. Le principal mode de révélation était l'infection urinaire (90,4%). La fonction rénale était altérée chez 54,8% des enfants. Le traitement a consisté en une antibiothérapie des IU documentées (90,4%) et une antibio-prophylaxie si récidive, une réimplantation de type COHEN dans 97,62%. L'indication chirurgicale a concerné d'emblée tous les grades IV et V (73,9%), ainsi que les reins altérés, et 26,1% après traitement médical. L'évolution postopératoire précoce et tardive était en général satisfaisante: on a noté 92,68% de disparition du RVR. L'UHN a régressé sauf chez 9,52% patients, 95,23% malades ont normalisé leur fonction rénale. La récurrence des IU a diminué (19,04 % après la chirurgie). La majorité des parents ont jugé positivement l'évolution de l'état général de leurs enfants (54,76 %) après la chirurgie.

Stability of the diagnosis of seasonal affective disorder in a long-term prospective study

BackgroundSeasonal affective disorder (SAD) is mainly characterized by a seasonal pattern of depressive recurrences over the years. However, few studies have been conducted on the long-term course of patients with SAD, whose findings raised questions about the diagnosis stability over time. This study aimed to better characterize the diagnosis evolution, and determine prognosis markers. MethodsAn initial cohort of 225 outpatients diagnosed as having a SAD, was assessed at baseline (T1) for clinical symptoms and response to bright light therapy. One hundred and nineteen patients (53%) were interviewed 2–12 years after (T2). ResultsOf 119 patients reached at follow-up (T2), only 32 patients (27%) still fulfilled the DSM-IV criteria for a stable SAD (S-SAD). A large proportion (59%) of the follow up cohort was in remission and 14% still suffered from a non-seasonal mood disorder. Family history of depression, previous suicide attempt, carbohydrate craving and HAD-depression score at baseline were associated with a stable SAD (S-SAD) diagnosis at T2, the HAD-depression score being the only one still significantly predictive (p=0.025) of a later stable SAD, with a multivariate approach. Carbohydrate craving, a core symptom of SAD, showed a trend (p=0.100) to predict diagnosis stability. LimitationsOnly 53% patients from the initial cohort were assessed at follow-up. ConclusionsPatients with eventual stable SAD show more subjective severity (higher HAD-Depression score) and carbohydrate craving at baseline. A low predictive validity of diagnosis criteria suggests that SAD is a temporary expression of a mood disorder rather than a specific disorder.

P372 The long term course of patients undergoing ileal pouch-anal anastomosis for ulcerative colitis

Background: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice for patients with ulcerative colitis who require colectomy for medically refractory disease or other complications such as dysplasia. The aim of this study was to evaluate the long term course of patients undergoing IPAA for ulcerative colitis, and to assess the occurrence of pouchitis and other complications. Methods: A retrospective analysis of all records of patients admitted at “Villa Sofia-Cervello” Hospital from 1988 to 2016 who underwent proctocolectomy with IPAA for ulcerative colitis was performed. At least one endoscopic evaluation during follow-up was available for all patients. Results: Among 1,490 patients with ulcerative colitis admitted at “Villa Sofia-Cervello” Hospital during the study period, the records of 71 patients (4.8%) undergoing IPAA were analyzed. The surgical procedure was performed in two stages in the majority of cases (76.0%), and the median time to recanalization was 6 months (I.Q.I. 6.5). The mean duration of follow-up after IPAA procedure was 110±77 months. The occurrence of pouchitis was reported in 48 (67.6%) patients. The time between IPAA and the diagnosis of pouchitis ranged from 1 to 120 months, with a median of 12 months. In addition, 33 out of 48 patients (68.8%) developed chronic pouchitis, while Crohn's disease of the pouch was diagnosed in four patients (8.3%). The stenosis of the anastomosis was reported in 18 patients (37.5%), and the presence of abscesses/fistula in 11 (22.9%). The occurrence of pouch failure was observed in 6 patients (12.5%), all of them suffering from chronic pouchitis complicated by fistulizing disease. No dysplasia nor Cytomegalovirus infection of the pouch were reported. Subgroup analysis of patients developing pouchitis revealed that only the chronic form of this condition was associated with the stenosis of the anastomosis, which conversely was rarely observed when the pouchitis was episodic and did not became chronic (88.9% vs. 11.1%, p=0.04). Conclusions: Our cohort with long term follow-up showed that pouchitis and chronic pouchitis are very frequent events. Conversely, Crohn's disease of the pouch is rare, and no cases of Cytomegalovirus infection of the pouch were reported.

Long-term course of patients with primary ocular adnexal MALT lymphoma: a large single-institution cohort study

AbstractWhile primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML) is the most common orbital tumor, there are large gaps in knowledge of its natural history. We conducted a retrospective analysis of the largest reported cohort, consisting of 182 patients with POAML, diagnosed or treated at our institution to analyze long-term outcome, response to treatment, and incidence and localization of relapse and transformation. The majority of patients (80%) presented with stage I disease. Overall, 84% of treated patients achieved a complete response after first-line therapy. In patients with stage I disease treated with radiation therapy (RT), doses ≥30.6 Gy were associated with a significantly better complete response rate (P = .04) and progression-free survival (PFS) at 5 and 10 years (P < .0001). Median overall survival and PFS for all patients were 250 months (95% confidence interval [CI], 222 [upper limit not reached]) and 134 months (95% CI, 87-198), respectively. Kaplan-Meier estimates for the PFS at 1, 5, and 10 years were 91.5% (95% CI, 86.1% to 94.9%), 68.5% (95% CI, 60.4% to 75.6%), and 50.9% (95% CI, 40.5% to 61.6%), respectively. In univariate analysis, age >60 years, radiation dose, bilateral ocular involvement at presentation, and advanced stage were significantly correlated with shorter PFS (P = .006, P = .0001, P = .002, and P = .0001, respectively). Multivariate analysis showed that age >60 years (hazard ratio [HR] 2.44) and RT<30.6Gy (HR=4.17) were the only factors correlated with shorter PFS (P = .01 and P = .0003, respectively). We demonstrate that POAMLs harbor a persistent and ongoing risk of relapse, including in the central nervous system, and transformation to aggressive lymphoma (4%), requiring long-term follow-up.

Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group.

The optimal treatment of stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is not well defined. Thus, we performed an analysis using the database of the German Hodgkin Study Group. The long-term outcome of 256 patients with stage IA NLPHL was evaluated. Patients had received combined-modality treatment (CMT; n = 72), extended-field radiotherapy (EF-RT; n = 49), involved-field radiotherapy (IF-RT; n = 108), or four weekly standard doses of rituximab (n = 27) within German Hodgkin Study Group clinical trial protocols between 1988 and 2009. The median age at NLPHL diagnosis was 39 years (range, 16 to 75 years). Most patients were male (76%). The whole patient group had a median follow-up of 91 months (CMT: 95 months; EF-RT: 110 months; IF-RT: 87 months; rituximab: 49 months). At 8 years, progression-free survival and overall survival rates were 88.5% and 98.6% for CMT, 84.3% and 95.7% for EF-RT, and 91.9% and 99.0% for IF-RT, respectively. Patients treated with rituximab had 4-year progression-free and overall survival rates of 81.0% and 100%, respectively. A second malignancy during the course of follow-up was diagnosed in 17 (6.6%) of 256 patients. A total of 12 deaths occurred. However, only one patient died from NLPHL. Tumor control in this analysis was equivalent with CMT, EF-RT, and IF-RT. Therefore, IF-RT, which is associated with the lowest risk for the development of toxic effects, should be considered as standard of care for patients with stage IA NLPHL. Rituximab alone is associated with an increased risk of relapse in this patient population.

Optimizing Cardio-Oncology Programs for Cancer Patients

10.2217/FON.15.128 © 2015 Future Medicine Ltd In the USA and in most industrialized nations the two leading causes of death are heart disease and cancer [1]. CardioOncology or Onco-Cardiology is a specialty that focuses on the intersection of cancer and cardiovascular disease. There are many points along the spectrum of cancer where cardiovascular risk factors or disease may influence the shortand longterm course of patients. From the interplay of shared risk factors between cancer and cardiovascular disease to the use of potentially cardiotoxic therapies that may cause acute or late toxicities; cardiovascular disease impacts overall morbidity and mortality in patients with cancer. Along this spectrum there are several potential points where interventions may lead to improved cardiovascular outcomes and overall health (Figure 1). Chemotherapy can cause direct effects on the heart leading to left ventricular dysfunction (cardiomyopathy). Anthracyclines are the prototypical cardiotoxic chemotherapy and have been used effectively in a variety of cancers for the past five decades. The incidence of cardiotoxicity varies among different studies in part related to different patient populations (survivors of childhood vs adult cancers), different methods of surveillance and different definitions of cardiotoxicity [2,3]. A contemporary prospective study reported an incidence of anthracycline associated cardiotoxicity of 9% [4]. Preventative strategies including prophylactic treatment with ACE inhibitors and β-blockers have shown some promise though further studies are necessary [5,6]. There has also been exciting research into the molecular mechanisms of anthracycline cardiotoxicity, which may allow for more sophisticated drug design or novel approaches to minimize the risk of cardiotoxicity [7,8]. The importance of prompt recognition and management of cardiotoxicity is supported by several studies. An important recent study by Cardinale et al. demonstrated in a large prospective cohort of patients being treated with anthracyclines that 9% of patients developed cardiac dysfunction (defined as a reduction in LVEF of >10% to a value less than 50%) and the overwhelming majority of these patients developed LV dysfunction within the first year after treatment [4]. The majority of these (82%) patients had a partial or full recovery of LV function. This finding challenges the previously held dogma that anthracycline associated LV dysfunction is irreversible. Importantly in this prospective study there was prompt institution of therapy with ACE inhibitors and β-blockers. Unraveling the molecular mechanisms of many cancer types has led to the rapid development of numerous targeted therapies. Many of these are tyrosine kinase inhibitors that have the potential for a OPINION Special Focus Issue: Cardio-oncology

Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders?

ObjectiveMentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses). MethodsSeventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years. ResultsRF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program. ConclusionThese findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.

Initial cognitive response to cholinesterase inhibitors and subsequent long-term course in patients with mild Alzheimer's disease.

Some guidelines recommend to discontinue treatment with cholinesterase inhibitors (ChEIs) in patients with Alzheimer's disease (AD) without an initial response to ChEI treatment. Evidence supporting this recommendation, however, is limited. This study aimed to investigate the relation between the initial cognitive response to ChEI treatment and the subsequent long-term course of cognition of AD patients. The Frisian Alzheimer's Disease Cohort study is a retrospective longitudinal study of 576 community-dwelling AD patients treated with ChEIs in a "real-life" setting at a large memory clinic. A repeated measures analysis using a marginal model (population based averaged model) was applied to investigate whether there is a difference in the subsequent long-term course of cognition (Mini-Mental State Examination (MMSE)) between initial non-responders and responders. Absence of an initial response was defined as a lower MMSE score after the first six months of treatment compared to baseline, a positive response as the same or a higher MMSE score. At baseline, median age was 80 years and the median MMSE score 23. Non-responders showed a slower rate of cognitive decline in the three subsequent years than responders, with a mean annual MMSE decline of 0.9 points versus 1.2 points, respectively (p < 0.0001). Our results suggest that it is not appropriate to discontinue ChEI treatment solely based on the absence of an initial cognitive response.

A 30-month follow-up of generalized anxiety disorder: Status after metacognitive therapy and intolerance of uncertainty-therapy

Objectives: Although metacognitive therapy and intolerance-of-uncertainty therapy are considered efficacious treatments for generalized anxiety disorder, little is known about the long-term course in patients who engaged in treatment studies. Method: We conducted a continuation study of patients with GAD who had participated in a randomized, delayed treatment controlled trial in which the relative efficacy of MCT and IUT were compared.Results: Of the original 85 patients who completed the study, 34 were available for assessment of worry severity at 30-month follow-up. Both treatment groups showed maintenance of treatment gains from 6-month to 30-month follow-up assesment. However, MCT produced better results at long-term follow-up, which was reflected in statistically and clinically significant differences, and in terms of sustained efficacy (i.e., the degree in which patients who improved with treatment remained improved).Conclusion: Both MCT and IUT may be associated with long-term benefits for patients diagnosed with GAD, with MCT performing significantly better than IUT, and showing greater sustained efficacy.

Broad Phenotypic Spectrum of A-Dystroglycanopathies due to POMT1 Mutations in 16 Families

Introduction: Congenital muscular dystrophies with defective O-glycosylation of α-dystroglycan (α-dystroglycanopathies) are a heterogeneous group of autosomal recessive inherited disorders explained by mutations in an increasing number of related genes. Among those, POMT1 was initially associated with Walker-Warburg syndrome (WWS) at the most severe end of the disease spectrum. Subsequently, milder POMT1-associated phenotypes such as congenital muscular dystrophy (CMD) or limb girdle muscular dystrophy (LGMD) have been described. In an ongoing study, we aim to further characterize the genotype-phenotype correlation and genotype-dependent long-term course of patients with genetically confirmed forms of those dystroglycanopathies and here present the wide clinical spectrum of POMT1-associated phenotypes.

The long-term course of patients undergoing alternative and integrative therapy for lumbar disc herniation: 3-year results of a prospective observational study

ObjectivesThis study aimed to assess the efficacy and safety of an integrative complementary and alternative medicine (CAM) approach in the management of lumbar herniated disc (LHD) with sciatic pain and...

Mulitmodality management of rare solitary fibrous tumor can be associated with extended survival.

Background:Little is known on the long-term course of patients treated for intracranial solitary fibrous tumors (iSFT). We therefore retrospectively reviewed the charts of our patients who underwent Gamma Knife radiosurgery (GKRS) for iSFT at Klinik Im Park in Zurich and who were treated by one of the authors. Between 1994 and 2009, two patients underwent GKRS for iSFT at Klinik Im Park.Case Description:One patient underwent altogether five radiosurgical treatments and two craniotomies for iSFT and its local recurrences. The other patient underwent two craniotomies and one radiosurgical treatment for iSFT. Both patients maintained a Karnofsky performance score 100 during follow-up and both were long-term survivors with a follow-up of 9 and 17 years, respectively.Conclusion:A close follow-up of patients with iSFT and repeat radiosurgery or surgery when indicated seems to lead to a favorable long-term outcome.

Purging Disorder: A Comparison to Established Eating Disorders with Purging Behaviour

This study is part of the larger Christina Barz Study, and it compared consecutively admitted patients with purging disorder (PurD; N = 225) with consecutively admitted patients with anorexia nervosa binge eating/purging subtype (AN-bp; N = 503) and bulimia nervosa purging subtype (BN-p; N = 756). Participants answered self-rating questionnaires on admission, at the end of inpatient treatment, and in a 5-year follow-up. Patients with PurD reported lower severity of general psychopathology than patients with AN-bp and lower severity of eating disorder symptoms than patients with AN-bp and BN-p on admission. Eating disorder symptoms of patients with PurD improved less during the course than of the comparison groups. Diagnostic perseverance was stronger in the PurD group than for patients with AN-bp; mortality was higher than for patients with BN-p. Predictors for better outcome differed for the groups. Our results provide new data about the long-term course of patients with PurD and indicate clinical relevance of the disorder.