Long-term Outcome Of Patients Research Articles

Impact of osteosarcopenia on short- and long-term outcomes in patients with gastric cancer

Abstract Backgrounds Osteopenia and sarcopenia are associated with adverse clinical outcomes. This study investigated the impact of osteosarcopenia on short- and long-term outcomes after gastrectomy for gastric cancer. Methods The present study included patients who underwent gastrectomy for gastric cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images. Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was defined as the coexistence of osteopenia and sarcopenia. We investigated the relationship of preoperative osteosarcopenia with short- and long-term outcomes after gastrectomy for gastric cancer. Results Of all 122 patients, 38 (31%) patients were diagnosed with osteosarcopenia. Multivariate logistic regression analysis revealed that osteosarcopenia (P = .008) was an independent risk factor for postoperative complications. Furthermore, multivariate Cox regression analysis revealed that male sex (P = .007), and osteosarcopenia (P = .038) were independent predictors of disease-free survival, while osteosarcopenia (P = .045) and pathological T stage ≥3 (P = .033) were independent predictors of overall survival. Conclusions Osteosarcopenia was a strong predictor of short- and long-term outcomes after gastrectomy for gastric cancer. Preoperative screening of osteosarcopenia may be helpful for better management of patients with gastric cancer.

Effects of respiratory sarcopenia on the postoperative course in elderly lung cancer patient: a retrospective study

ObjectivesRecently, sarcopenia has been linked to unfavorable outcomes in various surgical procedures, including lung cancer surgery. This study aimed to investigate the impact of respiratory sarcopenia (RS) on postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery.MethodsThis retrospective study included patients aged 70 years and older who underwent lobectomy with curative intent for lung cancer between 2017 and 2019. RS was defined as having values below the median for both the L3 skeletal muscle index, measured from preoperative PET-CT images, and peak expiratory flow (PEF). An inverse probability of treatment weighting (IPTW) approach was applied to balance covariates between the RS and non-RS groups. Baseline characteristics and postoperative outcomes were compared between groups using t-tests and chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall and recurrence-free survival. Multivariable logistic regression analysis incorporating IPTW weights was performed to assess the impact of RS on respiratory complications.ResultsA total of 509 patients were included, of whom 123 (24.2%) had RS. After IPTW adjustment, baseline characteristics, including pulmonary function, were similar between the RS and non-RS groups. All patients underwent lobectomy, with 78.8% of the RS group and 80.9% of the non-RS group undergoing minimally invasive surgery. The RS group had a significantly higher rate of respiratory complications compared to the non-RS group (14.5% vs. 7.7%, p = 0.041). Multivariable logistic regression analysis showed that male sex (odds ratio = 15.2, p < 0.01) and lower DLCO (odds ratio = 0.96, p < 0.01) were significantly associated with respiratory complications, whereas RS did not show a significant association (p = 0.05). No significant differences were found in overall survival (p = 0.11) or recurrence-free survival (p = 0.51) between the groups.ConclusionsIn this study, RS had a limited impact on both postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery. These findings suggest that other factors, such as DLCO and male sex, may play a more prominent role in predicting respiratory complications.

The BEnefit of LONGitudinal Micro-Incisions Prior to Paclitaxel-Coated Balloon Angioplasty (BELONG Study) in Patients With Lower Extremity Arterial Disease: Clinical Outcomes at 12 Months.

Angioplasty of lower extremity arteries with calcification may result in flow-limiting dissection requiring bail-out stenting with unfavorable long-term outcomes. Vessel preparation prior to angioplasty may improve immediate results of the angioplasty and long-term patency. This prospective study assessed the 12-month outcomes of patients who underwent novel vessel preparation catheter, the FLEX Vessel Prep™ System (FLEX VP), prior to drug-coated balloon angioplasty (DCB-PTA). This investigator-initiated single-arm prospective trial enrolled patients with symptomatic lower extremity peripheral artery disease with de novo, restenotic, or in-stent stenosis of the superficial femoral or popliteal arteries. Target lesions were prepared using FLEX VP that created 12 longitudinal micro-incisions before drug-coated balloon angioplasty. Forty-three lesions in 41 patients were treated in this study with an average lesion length of 118 mm (10-291 mm), average stenosis of 82% (40-100%), and an occlusion rate of 27.9% with an average occlusion length of 89 mm (10-272 mm). Calcification was observed in 85.7% of the lesions, with 66.7% of lesions demonstrating grade 3 or 4 of the Peripheral Arterial Calcification Scoring System. After FLEX VP and DCB-PTA, 92.7% of patients were absent of flow-limiting dissections. Stenting occurred in 39% (16/41) patients (median stent length 40 mm) for residual stenosis (15 patients) and flow-limiting dissection (1 patient). There was one death prior to the 12-month follow-up, not related to the index procedure. Freedom from clinically driven target lesion revascularization at 12 months was 97.5% (39/40). Rutherford classification shifted from 41.5% Class ≥3 at baseline to 95% Class ≤1 at 12 months. There were no amputations at 12 months. Vessel preparation with longitudinal micro-incisions of complex and calcified lesions prior to angioplasty was associated with few flow-limiting dissections. The majority of stents were placed to treat focal residual stenosis, using the shortest available stent length at the time of the study (40 mm) for the majority. Only one stent was needed to treat a flow-limiting dissection. The 97.5% freedom from clinically driven target lesion revascularization (CDTLR) and symptom relief at 12 months suggest that vessel preparation via FLEX VP provides value in maintaining long-term outcomes in patients with highly calcified superficial femoral artery (SFA) or popliteal lesions. Vessel preparation with longitudinal micro-incisions is a short and efficient intervention associated with promising clinical outcomes and patency rate 12 months after treatment of long and calcified occlusions or stenosis of the femoral and popliteal arteries. This innovative vessel preparation provides post-procedure less residual stenosis and more favorable dissection morphology, decreasing the placement of stent and especially their length. Vessel preparation by longitudinal incisions also favors optimal distribution of anti-restenotic drug in the lesion and thus prevents further intervention due to restenosis.

Association between weight-adjusted-waist index and long-term prognostic outcomes in cardiovascular disease patients: results from the NHANES 1999–2018 study

BackgroundAs cardiovascular disease (CVD) morbidity and mortality increase yearly, this study aimed to explore the potential of the weight-adjusted-waist index (WWI) and its relation to long-term mortality in patients with CVD.MethodsThe diagnosis of CVD was based on standardized medical condition questionnaires that incorporated participants’ self-reported physician diagnoses. WWI (cm/√kg) is a continuous variable and calculated as waist circumference (WC, cm) divided by square root of body weight (kg). For analysis purposes, the participants were divided into four groups based on the quartiles (Q1 – Q4) of the WWI. The study’s primary outcome was all-cause mortality in patients with CVD, with cardiovascular mortality as the secondary outcome, and sample weights and complex survey designs were used to ensure reliable, accurate results.ResultsThe final analysis included 4,445 study participants. In the fully adjusted model, the highest quartile (WWI > 12.05 cm/√ kg) showed a higher all-cause mortality rate compared with the lowest quartile (WWI < 11.03 cm/√ kg) (HR = 1.37, 95% CI: 1.03, 1.82, P < 0.05). The risk of all-cause mortality increased with WWI and showed a linear association in patients with congestive heart failure, heart attack (P-overall < 0.05, P − nonlinear > 0.05); WWI was nonlinearly associated with the risk of all-cause mortality in patients with coronary heart disease and angina (P-overall < 0.05, P − nonlinear < 0.05). Survival curve analysis further showed that all cause and cardiovascular mortality were higher in the high WWI group (Q4) (P < 0.001). The time-dependent receiver operating characteristic (ROC) curve showed that WWI’s area under the curves (AUC) for 5- and 10-year survival rates were 0.76 and 0.792 for all-cause mortality and 0.734 and 0.757 for CVD mortality. WWI’s AUC were higher than those of body mass index (BMI) and WC (all P < 0.01).ConclusionOur findings indicate that a high WWI is positively associated with an increased risk of all-cause mortality. Additionally, the high AUC values for WWI strengthen its potential as a meaningful prognostic marker, underscoring its utility in clinical practice for assessing long-term survival risk in patients with CVD.

Impact of pedicle screw accuracy on clinical outcomes after 1- or 2-level minimally invasive transforaminal lumbar interbody fusion.

When creating minimally invasive spine fusion constructs, accurate pedicle screw fixation is essential for biomechanical strength and avoiding complications arising from delicate surrounding structures. As research continues to analyze how to improve accuracy, long-term patient outcomes based on screw accuracy remain understudied. The objective of this study was to analyze long-term patient outcomes based on screw accuracy. This is a retrospective cohort study of patients who underwent 1- or 2-level minimally invasive transforaminal lumbar interbody fusion and were queried from a prospectively maintained multisurgeon registry. Pedicle screws were assessed for accuracy and graded as poor, acceptable, or good. Patient demographic characteristics and outcomes including complications, patient-reported outcome measures (PROMs), return to activities, and fusion rates were compared between the cohorts. A total of 665 pedicle screws in 153 patients were evaluated and included in the final analysis. Of these, 20 (13.1%) patients had poor screws, 63 (41.2%) had acceptable screws, and 70 (45.7%) had good screws. All groups showed similar and significant improvements in all PROMs, although the poor screw group experienced delayed improvement in physical function. A majority of patients in all groups returned to working and driving and discontinued narcotics at similar rates. However, the poor screw group displayed significantly slower return to activities. There were no significant differences in intraoperative or postoperative complications, although the poor screw group experienced significantly lower fusion rates. Patients with poorly accurate pedicle screws experienced delayed return to activities and decreased fusion rates with similar long-term PROMs. Surgeons should continue to focus on placing accurate pedicle screws, and research should continue to analyze ways to ensure accurate screw placement.

Lumbopelvic hyperlordosis is linked to higher femoral head coverage, lower femoral anteversion and younger age at periacetabular osteotomy.

The dynamic alignment of the lumbar spine, pelvis and femur is increasingly studied in hip preservation surgery. However, the interaction between lumbopelvic alignment, acetabular and femoral morphology and its influence on patients' preoperative symptom burden remains poorly understood. The aim of this study was to evaluate whether lumbopelvic malalignment affects osseous hip morphology and exacerbates preoperative patient-reported joint functionality in patients undergoing periacetabular osteotomy (PAO). One hundred thirteen patients were prospectively enroled in this single-centre study. Sagittal lumbopelvic radiographs were used to divide the patients in accordance with their lumbopelvic alignment (pelvic incidence [PI]-lumbar lordosis [LL] mismatch) into a balanced (PI-LL: 10° and 10°/n = 60) and unbalanced alignment (PI-LL: <10° and >10°/n = 53) group. Intergroup analyses were performed for acetabular and femoral morphology as well as various patient-reported outcome measures (PROMs) scores (modified Harris-Hip, Hip Osteoarthritis Outcome, International Hip Outcome tool-12 and University of California Los Angeles activity scale). Patients with concomitant unbalanced lumbopelvic alignment due to hyperlordosis showed higher femoral head coverage and lower femoral anteversion (lateral centre-edge angle 20.2° vs. 15.8°, p = 0.012/anterior wall index 0.47 vs. 0.36, p = 0.001/acetabular inclination 10.2° vs. 13.6°, p = 0.008/Femoral anteversion 21.3° vs. 28.2°, p = 0.041). Furthermore, these patients were significantly younger at the time of PAO (28.7 vs. 32.4 years, p = 0.020), even when there were no intergroup differences in all analyzed PROMs. Concomitant lumbopelvic deformity affecting the hip joint morphology could aggravate clinical symptoms leading to earlier presentation in patients undergoing PAO. Thus, the lumbopelvic balance needs to be carefully evaluated in clinical decision-making in PAO patients and future research should focus on long-term outcomes of patients with concomitant unbalanced lumbopelvic alignment. Level III, prognostic study.

Early and Long-Term Outcomes of Patients Undergoing Surgery for Native and Prosthetic Valve Endocarditis: The Role of Preoperative Neutrophil-to-Lymphocyte Ratio, Neutrophil-to-Platelet Ratio, and Monocyte-to Lymphocyte Ratio

Background/Objectives: Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to review our 20-year experience with the treatment of native (NVE) and prosthetic (PVE) valve endocarditis and to evaluate the role of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to monocyte ratio (NMR), and systemic inflammatory index (SII) on early and long-term outcomes of patients undergoing surgery for NVE and PVE. Methods: All adult patients undergoing surgery for NVE and PVE at our institution between January 2001 and December 2022 were included in the study. Preoperative NLR, NPR, PLR, MLR, NMR, and SII were calculated using hemograms with complete blood count. Results: During the study period, 503 patients, 371 (74%) males, median age 65 (52–73) years, underwent surgery for NVE (n = 337, 67%) or PVE (n = 166, 33%). Patients with PVE had significantly more aortic annulus abscess (95 (57%) vs. 51 (15%); p &lt; 0.001), longer CPB (180 (131–235) vs. 105 (84–145) min; p &lt; 0.001) and aortic cross-clamping times (129 (96–175) vs. 82 (64–114) min; p &lt; 0.001), and received more aortic homografts (47 (28%) vs. 28 (9%); p &lt; 0.001) and postoperative pacemaker implantation (25 (15%) vs. 20 (6%); p &lt; 0.001 compared to patients with NVE. Preoperative NLR was 3.7 (2.4–6.1), NPR was 23 (16–37), PLR was 159 (106–210), NMR was 8.4 (6.6–12), MRL was 0.41 (0.29–0.62], and SII was 790 (485–1396). NLR, NPR, and MLR were significantly lower in patients with NVE compared to patients with PVE and in survivors compared to non-survivors. Overall mean survival time was 12.2 ± 0.5 years, with patients with NVE having better early and late survival compared to patients with PVE. Patients with preoperative NLR &lt; 3.8, NPR &lt; 30.9, and MLR &lt; 0.4 had significantly better mean survival time compared to patients with preoperative NLR &gt; 3.8, NPR &gt; 30.9, and MLR &gt; 0.4, respectively. Conclusions: In patients undergoing surgery for IE, preoperative higher NLR, NPR, and MLR are associated with increased early and long-term mortality.

The Predictive Value of Heart Rate Variability for Long-Term Outcomes in Patients Undergoing Coronary Artery Bypass Grafting and ICU Referrals

Background: Heart rate variability (HRV) is known to play a significant role in predicting poor prognosis after acute myocardial infarction. Nonetheless, its potential for predicting long-term adverse outcomes following revascularization procedures remains unclear. This study aims to elucidate this relationship. Methods: This prospective cohort study included 258 consecutive patients undergoing elective isolated coronary artery bypass grafting (CABG). All patients required ICU referral before hospital discharge. A 3-week cardiac rehabilitation program with 24-hour ECG Holter monitoring was planned for all patients. HRV was analyzed by computer and manually over-read. During a follow-up period ranging from 1 to 3 years, patients were contacted via phone to assess long-term outcomes, including death and major adverse cardiovascular events (MACE), such as myocardial infarction, reoperation, or brain stroke. Results: Out of 258 patients (177 males and 81 females) with an average age of 58.80±9.60 years, 4.3% of patients died due to cardiovascular events, and 15.1% experienced long-term MACE. A comparison of HRV indicators between the non-surviving and surviving subgroups revealed significantly lower mean RR, mean standard deviation of normal-to-normal HRV interval (SDNN), and low and high-frequency values in the former group. However, when comparing HRV indicators between the subgroups with and without long-term MACE, no significant differences were observed. Cox proportional hazard analysis demonstrated that decreased HRV (SDNN) effectively predicted long-term mortality in patients who underwent CABG. Conclusion: Lower postoperative HRV serves as a valuable predictor of long-term mortality after CABG in ICU patients, with reduced SDNN values particularly relevant for anticipating long-term adverse events.

Exploring 3D Modeling for Enhanced Visualization and Analysis of Pediatric Pelvic Ring Fractures: A Pilot Study

Introduction Pediatric pelvic fractures are high energy injuries that present substantial treatment challenges due to their propensity for plastic deformation, complex fracture patterns, and lack of consensus on surgical indications. There is potential for negative long-term outcomes in patients with residual deformity, but our understanding of acceptable alignment is limited. Plain radiographs and computed tomography (CT) are frequently employed for pre- and post-operative assessment of injury patterns, but are limited to two-dimensional analysis. Three dimensional (3D) modeling offers an opportunity for improved assessment of pelvic anatomy. Methods Two pediatric patients who sustained unstable pelvic ring injuries requiring operative fixation, with both pre- and post-operative CT scans, were identified from an existing IRB-approved trauma database. Utilizing 3D Slicer, 3D segmentations were rendered from DICOM data and specific landmarks were identified to calculate deformity pre- and post-operatively including displacement at the sacroiliac (SI) joints, pubic symphysis, and iliac crest. A modified Keshishyan deformity index was also calculated. Mesh overlay was performed using Autodesk Maya in x, y and z planes to provide visual representation of post-operative changes. Results 3D renderings successfully illustrated complex pelvic fractures in a 9 year old female and 12 year old. Measurements made on 3D models showed similar improvements in diastasis and symmetry to measurements made in standard 2D imaging, but with generally smaller magnitudes. Graphic overlap allow for sophisticated representation of improvement in deformity. Measurements on plain radiographs and 2D CT differed from 3D measurements by anywhere from 0.1 mm to 6.7 mm. Conclusion This proof-of-concept pilot study demonstrates that 3D renderings enhance the ability to measure displacement and deformity in pediatric pelvic trauma for both pre-operative planning and post-operative evaluation. Future applications of this technology include evaluation of pelvic deformity remodeling after trauma in both operative and non-operatively treated pediatric patients.

The association of biological sex and long-term outcomes in older patients with physical restraint at the emergency department

BackgroundThe worldwide population is ageing and self-arm can be prevented with many techniques. Among them coercive measure consisting of physical restraint (PR) is one of the techniques. This study aims to assess the effects of the biological sex on the long-term survival after PR in geriatric patients during the initial emergency department (ED) visit.MethodsThis retrospective study included patients between November 2019 to March 2021. All consecutive hospitalized patients after emergency department visit older than 75 years with PR were included. The population was compared according to the biological sex. One-year all-cause mortality was plotted with the Kaplan-Meier curve. Hazard ratios (HRs) for 1-year mortality were calculated using a Cox proportional hazards regression model. Mortality was monitored over a 3-year period.ResultsPR was used in 149 patients representing 4.6% of 3210 hospitalized patients older than 75 years after ED visit. Women represented 52% of the study population. Compared to men, women were older [median (IQR) age 89 (85–93) vs. 85 (81–90) years, P = 0.002]. Women more often presented dementia (93 vs. 80%, P = 0.031). Both sexes presented the same limited independence. All-cause mortality was significantly lower for women than men after one year (25 vs. 51%, respectively, P = < 0.001). Likewise, adjusted HR of 1-year all-cause mortality was higher in men [a HR 3.4 (95% confidence interval 1.7–7.1), P < 0.001].ConclusionThis study suggested that the use of physical restraint in older adults was a more related factor of mortality in men than women. Women were older with lower expectancy life but PR use seemed to be a sign of global health decline in men. Further prospective studies are needed to assess if mortality after PR use is a cause or a consequence of a global health decline.

Age-associated differences in FIRES: Characterizing prodromal presentation and long-term outcomes via the web-based NORSE/FIRES Family Registry.

Febrile infection-related epilepsy syndrome (FIRES) is a rare clinical presentation of refractory status epilepticus following a febrile infection. This study analyzes data from the NORSE/FIRES Family Registry, an international web-based registry available in six languages with data entered by patients, families, and clinicians to explore clinical presentations, survivorship, and long-term outcomes in adult and pediatric FIRES patients. We characterize and examine differences in demographics, prodromal symptoms, seizure frequency, anti-seizure medications (ASMs), quality of life, cognition, mood, and anxiety in adults vs pediatric populations with FIRES. Eighty-six participants were included in the study. Pediatric patients (n = 54) were predominantly male (77.8%) and experienced a significantly higher post-FIRES seizure burden than adult survivors (67.7% ≥12 seizures/month in pediatrics vs 11.8% in adults, p <.001). Adults (n = 32) were more likely to be female (59.4%) and have flu-like prodromal symptoms (90.6%). At ≥6 months post-FIRES, both groups exhibited high ASM use, with the majority (87.5%) taking three or more medications. Pediatric patients reported worse mood and anxiety outcomes compared to adults (p <.005). Self-reported quality of life and cognition were rated as moderate across in adults (5.2/10) and pediatric(4.7/10) patients, although pediatric patients indicated poorer cognition. Our findings highlight the challenges in managing post-FIRES outcomes across different age groups, particularly in pediatric patients who face a higher seizure burden and report worse cognitive outcomes.

Association of Pre- and Postinjury Mental Health With Long-term Clinical and Financial Outcomes.

As increased attention is placed on optimizing long-term outcomes of trauma patients by addressing mental health, little is known regarding the interplay of pre- and postinjury mental health on long-term financial and functional outcomes. Patients from 19 Level 1 and 2 trauma centers took part in serial surveys 1 to 24 months postdischarge. Preinjury mental health diagnoses were identified using trauma registry data and postinjury mental health symptoms from survey data. Outcomes included (1) health-related quality of life from the EuroQol-5D-5L and (2) elements of financial toxicity (e.g. medical debt, job/income loss, nonmedical bills, unaffordable care). Multivariable models were created, adjusting for patient, injury, and treatment factors, to evaluate the association of preinjury mental health diagnoses and postinjury mental health symptoms on health-related quality of life and financial toxicity. A total of 1,017 patients completed 1,297 surveys from July 2021 to December 2023, at a median of 6 months postinjury. Forty-six percent were female, the median age was 67.5 years, and 89% had blunt injuries. Thirty-two percent of patients had a preinjury mental health diagnosis, and 49% had self-reported mental health symptoms postdischarge. Patients with preinjury mental health diagnoses had higher odds of postinjury mental health symptoms (adjusted odds ratio, 3.6 [2.6-4.9]; p < 0.001); however, 55% of those with postinjury symptoms had no preinjury diagnosis. Postinjury symptoms alone were associated with worse health-related quality of life or financial toxicity. Notably, patients with new postinjury mental health symptoms (no preinjury mental health diagnosis) had the highest rate of foregone postinjury care because of costs (26% vs. 14%, p < 0.01). More than one-in-two patients had peri-injury mental health conditions, and patients with postinjury mental health symptoms experienced worse financial and functional outcomes. Addressing postinjury mental health may potentially improve long-term health-related quality of life of trauma survivors; however, efforts are needed to ensure that patients can afford the care needed for optimal health. Prognostic and Epidemiological; Level IV.

Endoscopic butterfly cartilage myringoplasty: our long term results.

Myringoplasty is one of the treatments used for perforated tympanic membrane. We aimed to evaluate the long-term anatomical and functional outcomes of patients who underwent endoscopic inlay butterfly cartilage myringoplasty. We retrospectively analyzed 74 patients who had undergone endoscopic butterfly cartilage myringoplasty were followed for at least five years. The evaluation included age, sex, duration of follow-up, perforation location, size, preoperative and postoperative pure tone audiometry thresholds (years 2 and 5), air-bone gap, follow-up complications, and postoperative graft and tympanic membrane status. The study included 74 patients with a mean follow-up duration of 76.7 months (range: 60-125 months). The graft success rates were 89.1% at two years and 82.4% at five years postoperatively. There was a significant improvement in air conduction thresholds when comparing preoperative levels to those at two and five years postoperatively (p = 0.003). The air-bone gap showed a significant reduction from preoperative levels to those observed at two and five years postoperatively (p < 0.0001). Our study demonstrates that endoscopic butterfly cartilage myringoplasty is safe and effective for achieving long-term anatomical and functional success. We recommend extending the follow-up period to five years with additional annual assessments thereafter.

Experience in performing multivisceral resections for pelvic cancer

Background. Treatment of patients with locally advanced pelvic cancer remains challenging. The use of modern surgical techniques has expanded the feasibilities of performing multivisceral resections (MVR) in this category of patients. However, the postoperative period in patients who have undergone MVR is associated with a high risk of developing postoperative complications. The purpose of the study was to assess the short-term and long-term treatment outcomes in patients with locally advanced and multiple-primary pelvic cancer. Material and Methods. From 2009 to 2021, 114 patients treated in the clinics of Cancer Research Institute of Tomsk National Research Medical Center underwent MVR for primary or recurrent rectal cancer (n=40, 35.1 % and n=4, 3.5 %, respectively), female reproductive cancer (endometrial cancer: n=18, 17.1 % and recurrent ovarian cancer: n=18, 17.1 %), primary and recurrent bladder cancer (n=15, 13.2 % and n=2, 1.8 %, respectively), synchronous multiple primary pelvic tumors (n=8, 7.0 %) and extraorgan mesenchymal tumors of the pelvis (n=4, 3.5 %). Paraneoplastic complications were observed in 31 (27.2 %) patients. Invasion to more than 2 adjacent pelvic organs was diagnosed in 52 (45.4 %) cases. Total pelvic evisceration (TPE) was performed in 9 (7.9 %) patients, including 5 (4.4 %) patients who underwent TPE for primary rectal cancer with extensive local spread and 4 (3.5 %) patients who underwent TPE for multiple primary cancer: 2 (1.75 %) for synchronous primary rectal cancer and bladder cancer and 2 (1.75 %) for primary rectal cancer and recurrent bladder cancer. MVR for rectal cancer was the most common (n=101, 88.6 %). Resections with the formation of colorectal anastomosis were performed in 75 (65.8 %) cases and obstructive resections of the rectum were performed in 14 (12.5 %) cases. Urinary tract surgeries were performed in 66 (57.5 %) cases. One-stage plastic surgery of the resected segment as a transposition of one or both ureters into the bottom of the bladder was performed in 22 (19.3 %) cases. Heterotopic and orthotopic plastic surgery of the bladder was performed in 19 (16.6 %) and 5 (4.4 %) cases, respectively. Combined uterine extirpations, including vaginal resection, were performed in 52 (45.4 %) cases. Grade III postoperative complications according to the Clavien–Dindo classification occurred in 18.4 % of cases. Urological complications were the most common (8.7 %). Postoperative mortality rate was 0.8 %. The assessment of the long-term outcomes was carried out using the example of patients with rectal cancer (n=45), as the most homogeneous and largest subgroup. The overall 3-year survival rate was 71.1 % and the relapse-free 3-year survival rate was 60.0 %. Conclusion. Treatment of locally advanced pelvic cancer requires extensive surgeries performed by a multidisciplinary team of surgeons. The immediate results can be assessed as satisfactory. In case of resection of the urinary tract as a component of MVR, regardless of the primary localization of the tumor, primary plastic surgery of the bladder and/or ureters is preferable. Long-term outcomes allow us to consider MVR as a method of choice in the treatment of this group of patients.

The clinical characteristics and treatment outcomes of patients with systemic polyarteritis nodosa (PAN): a single centre study from India.

To describe the clinical profile and compare the long-term outcomes of patients with S-PAN treated with various treatment regimens at our centre in the last 2 decades. Data regarding clinical presentation, treatment allocation, relapses and outcomes of patients fulfilling American College of Rheumatology (ACR) 1990 criteria for PAN in the last 2 decades were recorded from electronic medical records. Relapse-free survival and predictors were analysed using KM survival statistics and regression analysis. Altogether, 53 patients including 2 with hepatitis B infection were included. Cutaneous lesions and peripheral neuropathy were the commonest manifestations. Most patients (64.2%) presented with a five-factor score (FFS) of 0. Disease-attributable hypertension and peripheral gangrene were the most common manifestations of severe disease. During a median follow-up period of 53.5 months in 49 patients, 43 (87.8%) attained complete response while 3(6.1%) had a partial response. Nineteen (40.4%) patients relapsed at a median duration of 82 (IQR 36.3-127.7) months. The relapse-free survival in patients who received induction with mycophenolate (n = 26), was comparable to that with cyclophosphamide (n = 21) [adjusted HR : 0.68]. Smoking history was an independent predictor of relapse (HR = 6.28, p= 0.013) while age was protective (HR = 0.94, p= 0.015). FFS and BVAS at 3 months were among the predictors of mortality (total deaths = 5). In our cohort of S-PAN, relapses were observed in 40.4% of patients. Mycophenolate was similar to cyclophosphamide in maintaining relapse-free survival. Only 10% fatality was recorded. FFS and BVAS at 3 months were predictors of mortality.

Occluded Fenestration is Associated with Improved Long-Term Outcomes in Patients Undergoing the Fenestrated Fontan Operation.

The modified Fontan operation, a palliative approach for single ventricular circulation patients, often incorporates a fenestration to facilitate postoperative management. Postoperative fenestration closure is sometimes performed to mitigate potential risks such as low oxygen saturation. However, the benefits and potential risks of this procedure remain under investigation. A retrospective propensity score matching study was conducted at the National Taiwan University Children's Hospital. It included all patients who underwent their first-ever fenestrated modified Fontan procedure between February 1998 and July 2020. The primary objective was to assess the incidence of death, Fontan takedown, and heart transplantation. Major adverse cardiovascular events (MACEs) were considered as a secondary outcome. The study comprised 173 patients (male/female 100/73), median operation age of 4.6 years, and a median follow-up of 10.4 years (interquartile range 6.2, 14.0 years) post-operation. At the latest follow-up, fenestration was occluded in 74 (42.8%) patients, with 29 undergoing transcatheter closure and 45 experiencing spontaneous occlusion. After propensity score matching, patients with occluded fenestration demonstrated significantly better event-free survival (15-year survival 95.3% vs. 78.6%, P = 0.047), although the intention-to-treat fenestration closure group showed similar outcomes compared to the natural course group. High recent NT-proBNP and Fontan pressure emerged as critical risk factors for worse event-free survival and MACEs. The cut-off points of NT-proBNP and Fontan pressure were 467.7 pg/mL and 18 mmHg, respectively. Patients with occluded fenestration exhibit superior event-free survival. Fenestration closure presents as a feasible strategy to enhance oxygen saturation without elevating Fontan pressure.

Long-term Outcomes of Definitive Chemoradiation with Proton Therapy for Treatment of Carcinoma of the Anal Canal: Combined Analysis of Two Prospective Trials.

While definitive chemoradiation (CRT) with 5-FU/MMC remains the standard of care for localized anal cancer, treatment is associated with significant acute and late toxicity. Proton radiation therapy (RT) may potentially reduce such toxicity. Here, we assess the long-term outcomes of anal cancer patients treated with CRT using proton RT in two prospective pilot studies. Patients with stage I-III anal cancer treated with proton RT (pencil beam scanning or intensity modulated proton therapy) per RTOG 0529 dose schema with concurrent 5-FU/MMC (2 cycles) in two prospective, single-arm trials were followed. Loco-regional failure (LRF), distant metastases (DM), colostomy-free survival (CFS), disease free survival (DFS), and overall survival (OS) were assessed. Physician-graded late toxicity (>90 days from CRT) was assessed per CTCAE v4.0. Late toxicities were compared with RTOG 0529 via Fisher's exact test. Patient-reported outcomes (PROs) were analyzed. Between 2013-2020, 39 patients were treated. 37 (95%) patients completed treatment per protocol. Median follow-up was 63 months. 5-year LRF, DM, CFS, DFS, and OS were 21%, 19%, 72%, 69%, and 75%, respectively. Worst late treatment toxicities were G1 in 38%, G2 in 24%, G3 in 19%, G4 in 3%, and no G5. Compared to RTOG 0529, rates of overall G2+ late toxicities were significantly lower (46% vs 75%, p=0.01), attributed to lower dermatologic toxicities (0% vs 25%, p<0.01), but there was no significant difference in overall G3+ toxicities (22% vs 20%, p=1.00). No statistically significant correlations between organ-at-risk dosimetry and late toxicities were noted. Available PROs demonstrated significant proportion of patients had persistent gastrointestinal symptoms at long-term. Definitive CRT with proton RT with concurrent 5-FU/MMC for the treatment of anal cancer resulted in comparable long-term disease control and grade 3+ late toxicities compared to RTOG 0529. Future studies should evaluate additional measures to minimizing treatment toxicity and subsets of patients who are most likely to benefit from proton RT.

KCNJ5 Somatic Mutations are Associated with Better Long-Term Outcomes in Patients with Unilateral Primary Aldosteronism.

The association between KCNJ5 somatic mutations and long-term outcomes in patients with operated unilateral primary aldosteronism (uPA) is unclear. To evaluate associations among KCNJ5 somatic mutations, clinical characteristics, incident long-term cardiovascular events, and all-cause mortality in uPA patients after adrenalectomy in a large longitudinal population study. We enrolled uPA patients from the Taiwan Primary Aldosteronism Investigation database who had undergone adrenalectomy between 2013 and 2017 and followed them until 2020. The outcomes were achieving complete clinical success at 1 year after adrenalectomy, long-term major adverse cardiac and cerebrovascular events (MACCEs), and mortality. Of the 358 enrolled patients (46.7% men; mean age, 51.3 years), 188 (52.5%) harbored KCNJ5 somatic mutations. The baseline characteristics of younger age [odds ratio (OR)=2.44; P=0.001], lower body mass index (OR=2.04; P=0.005), lower potassium (OR=6.55; P<0.001), and larger tumor size (OR=2.05; P=0.023) were potential predictors of KCNJ5 somatic mutations. The operated uPA patients harboring KCNJ5 somatic mutations were associated with a higher likelihood of complete clinical success at 1 year after adrenalectomy (OR=1.98; P=0.016). KCNJ5 somatic mutation carriers [hazard ratio (HR)=0.46; P=0.044), those with a shorter duration of hypertension (HR=1.05; P=0.008), and those who achieved complete clinical success (HR=0.49; P=0.036) had a lower risk of MACCEs and mortality. Operated uPA patients harboring KCNJ5 somatic mutations had a lower risk of long-term MACCEs and mortality after adrenalectomy. However, better long-term outcomes in the operated uPA patients harboring KCNJ5 somatic mutations were attenuated in those with baseline lower potassium levels, shorter duration of hypertension, obesity, higher estimated glomerular filtration rate, and residual hypertension after adrenalectomy.

Impact of the Inflammatory Burden Index on Prognosis After Hepatectomy for Colorectal Liver Metastasis.

The aim of this study was to investigate the prognostic impact of the inflammatory burden index (IBI), a novel inflammation-based biomarker, in patients with colorectal liver metastases (CRLM) after hepatic resection. One hundred fifty patients with CRLM who underwent hepatectomy were retrospectively analyzed. The IBI was defined as C-reactive protein × neutrophil count/lymphocyte count. The relationship of the IBI with overall survival was investigated by univariate and multivariate analyses. Seventy-three (49%) patients had a high IBI (>3.45). In univariate analysis, overall survival was significantly worse in patients with lymph node metastases (P = 0.048), high NLR (P = 0.03), and high IBI (P < 0.01). In multivariate analysis, high IBI (P = 0.048) was an independent and significant predictor of overall survival. Patients with a high IBI had more postoperative complications compared with those with a low IBI (P < 0.01). The IBI was a strong predictor for both short- and long-term outcomes in patients who underwent hepatic resection for CRLM.

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial.

Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial. Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. Images of 1769 patients were assessed (56​% male, 58​±​9 years). Diabetes mellitus was present in 196 (11​%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p​<​0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p​<​0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p​=​0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95​% confidence interval 1.09 to 3.17, p​=​0.024). Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.