non-PD Group Research Articles

Can 18F-fluorodeoxyglucose positron emission tomography predict the response to radioactive iodine therapy in metastatic differentiated thyroid carcinoma?

Background131I radioactive iodine therapy (RAI) has been commonly applied for metastatic differentiated thyroid cancer (DTC) and played an adjunctive role to total thyroidectomy. However, there is no reliable method to predict therapeutic response to RAI in metastatic DTC. Several studies showed potential use of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in lesion detection or therapeutic response prediction of DTC. Thus we aimed to evaluate the feasibility of 18F-FDG PET for the prediction of therapeutic response to RAI in patients with metastatic DTC. MethodsWe retrospectively evaluated 29 adult patients with metastatic DTC who underwent RAI after total thyroidectomy. 18F-FDG PET/CT was performed within three months before RAI, and the maximum, average and sum of each maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were assessed. Therapeutic response to RAI was categorized into the progressive disease (PD) or non-progressive disease (Non-PD), based on the Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 using pre- and post-therapeutic computed tomography (CT) or magnetic resonance imaging (MRI) images. The area under curve (ROC) analyses were performed to evaluate their predictive potentials of therapeutic response to RAI.ResultsAmong 29 patients (12 men; median age, 62.4 y.o.; range, 26–81), eight patients were classified into PD and 21 were into Non-PD. PD patients showed a significantly higher maximum, average and sum SUVmax, MTV and TLG before RAI, compared to the Non-PD group (p < 0.05). Among all the 18F-FDG PET/CT parameters, maximum SUVmax showed the highest sensitivity and positive predictive value (PPV) in predicting treatment response to RAI. With a cutoff value of 9.12, the highest area under curve (AUC) of 0.98 was obtained to differentiate between PD and Non-PD patients.Conclusions18F-FDG PET/CT before RAI was a useful predictor of therapeutic response to RAI, and maximum SUVmax was the most sensitive parameter.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P118. Outcomes of patients with Parkinson's disease undergoing cervical spine surgery for radiculopathy and myelopathy with minimum two-year follow-up

BACKGROUND CONTEXT Parkinson's disease (PD) is a neuromuscular disorder that affects both mobility and resting tone. This may make patients susceptible to spine malalignment and frequent candidates for surgical interventions. However, there is little evidence comparing the outcomes of PD patients in cervical spinal fusion (CF). PURPOSE This study evaluated the: (1) demographics; (2) complications (medical and surgical); (3) length of stay; (4) hospital charges; (5) reoperations; and (6) readmissions following cervical spine surgery. We hypothesized that patients who have Parkinson's Disease will experience similar postoperative outcomes to other CF patients. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients with cervical radiculopathy and myelopathy who underwent any cervical spinal fusion (anterior or posterior) between 2009 and 2011 and were eligible for at least 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). Patients with Parkinson's disease were identified and propensity score matched by age, sex, and DEYO index. A total of 134 propensity score matched patients with and without PD were included. OUTCOME MEASURES Demographic information, complications, length of stay, reoperations, and readmissions. METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify all patients with cervical radiculopathy and myelopathy who underwent any cervical spinal fusion (anterior and posterior) from 2009 to 2011 with 2-year follow-up surveillance. Patients with PD were then identified and propensity matched at a 1:1 ratio with patients without PD based on demographics and DEYO index. Demographics, insurance status, and hospital-related parameters were compared between the two groups. Logistic regression was performed to identify any predictive factors for postoperative outcomes. RESULTS There were a total of 134 CF patients included, with 67 patients in the PD group and 67 patients in the nonPD group. PD patients were less commonly white (74.6vs. 91.0%, p=.024) but all other demographics were comparable between the groups. PD patients had significantly longer length of stay (7.3vs. 3.6days, p=.004) and higher total hospital charges ($77,439.13vs. $45,761.24, p=.008) compared to nonPD patients. Overall (41.8vs. 40.3%, p=.861), medical (38.8vs. 31.3%, p=.365) and surgical (11.9vs. 11.9%, p=1) complication rates were comparable between PD and nonPD patients, respectively. However, PD patients did have higher rates of altered mental status (6.0vs. 0%, p=.042) than nonPD patients. PD patients also had comparable reoperation (14.9vs. 13.4, p=.804) and readmission (85.1vs. 74.6%, p=.132) rates as nonPD patients. Regression analysis revealed that Deyo index was the lone significant predictor of higher two-year complication (OR1.936, p .05). CONCLUSIONS This study compared 2-year outcomes between Parkinsonrs Disease and nonPD patients following cervical spinal fusion. PD patients and nonPD patients had comparable rates of complications, reoperations and readmissions at least two years after CF. PD was also not a significant predictor for any adverse outcomes. This study suggested that spine surgeons should not preclude PD patients from undergoing cervical spinal fusion because of a pre-existing PD diagnosis.

Parkinson's disease and the risk of osteoporotic vertebral compression fracture: a nationwide population-based study.

The purpose of this study was to evaluate the risk of OVCF in patients with PD. Data from patients over the age of 60years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease. OVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21-1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47-1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78-4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment. Patients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.

Effects of comorbid personality disorders in bipolar type I disorder patients to disease course

Objective: It was planned to compare bipolar I patients (BP-I) with personality disorder (PD) and without any personality disorder in terms of variables such as disease characteristics, disease course, suicide risk, alcohol and substance use. Methods: This cross-sectional study 99 patients with BP I according to DSM-IV TR and gave to informed consent were included. Sociodemographic Data Form, Hamilton Depression Scale, Young Mania Scale, and DSM-IV-TR-SCID-II were administered to participants. Results: At least one PD was detected in 38 (38.4%) patients with BP-I. Histrionic type (18%) PD was the most common in patients. Two types of PD were found in 21.2% and three types of PD were found in 6.1% of the participants. In patients without personality disorder, the mean number of hospitalizations and the total number of manic episodes were high while the total number of depressive episodes was low. The incidence of atypical depression, attempted suicide, and alcohol-substance abuse were statistically higher in patients with multiple PD than non-PD group. Conclusion: BP-I patients with multiple PD have more depressive episodes than non-PD patients; this group of patients should be considered as a special subgroup that should be followed carefully because of the atypical nature of these attacks, more suicide rates and the use of more alcohol and substance. In addition, these patients lower hospitalization times may need to be interpreted in favor of not being able to complete the treatment. For this reason, it may be important to monitor these patients out-patiently.

Impact of preoperative balloon dilatation on outcomes of laparoscopic surgery in young patients with esophageal achalasia.

Balloon dilatation is reportedly less effective for young patients with esophageal achalasia than for older patients. However, there is no consensus on the impact of prior balloon dilatation on outcomes of surgical treatment. This study investigated the significance of preoperative balloon dilatation on surgical outcomes in young patients with esophageal achalasia. Of patients aged less than 40years who had undergone a laparoscopic Heller-Dor operation for esophageal achalasia, 201 with a postoperative follow-up period of at least 1year were included. They were divided into two groups with and without a history of balloon dilatation, and compared preoperative pathological conditions and surgical outcomes. This study included 100 men and 101 women with a median age of 31years, of whom 158 patients without a history of pneumatic dilatation (79%, non-PD group) and 43 with a history of pneumatic dilatation (21%, PD group) The preoperative symptom scores for dysphagia and regurgitation were significantly higher in the non-PD group. Although no differences were observed in surgical outcomes or postoperative course, the esophageal clearance rates calculated on preoperative and postoperative timed barium esophagograms were lower in terms of both height and width of the barium column in the PD group than in the non-PD group. Subjectively, both groups expressed equally high satisfaction. In patients aged less than 40years with esophageal achalasia, although preoperative balloon dilatation did not affect subjective levels of satisfaction with surgery, postoperative improvement in esophageal clearance in the lower esophagus was inhibited.

Risk factors of periodontal disease in maintenance hemodialysis patients.

To explore the characteristics and relevant risk factors of periodontal disease (PD) among hemodialysis patients.Uremic patients on maintenance hemodialysis from November 2015 to March 2016 were retrospectively reviewed. Patients were divided into a PD group and a non-PD group. Demographic and laboratory data were collected and analyzed.In all, 136 uremic patients (79 males and 57 females, aged 50.8 ± 15.3 years) on maintenance hemodialysis were included in this study. The incidence of PD increased with age. Hemodialysis patients most likely developed PD if they were male, smokers, or diabetic (P = .009, <.001, and <.001, respectively). Patients brushing their teeth twice daily had significantly less chance of developing PD as compared with those only brushing once daily (P < .001). Hemodialysis patients in the PD group had significantly higher levels of total cholesterol, high-sensitivity C-reactive protein, fasting blood glucose, and peripheral white blood cell counts, compared with the non-PD group (all P < .001). Logistic regression analysis revealed that diabetes, total cholesterol, high-sensitivity C-reactive protein, and peripheral white blood cell count were independent risk factors for developing PD, whereas teeth brushing twice daily and serum calcium were favorable factors for maintenance hemodialysis patients against PD.Identification of risk factors provides a theoretical basis for prevention and improvement of PD among maintenance hemodialysis patients.

Bleeding out the quality-adjusted life years: evaluating the burden of primary dysmenorrhea using time trade-off and willingness-to-pay methods.

Primary dysmenorrhea (PD), or painful menstruation in the absence of identified uterine pathology, affects 5 to 9 in every 10 reproductive-aged women. Despite its high prevalence, just a few studies with very small patient numbers have focused on health-related quality of life impairment in PD. We aimed to assess health-related quality of life values for a severe and a mild hypothetical PD health state using 10-year time trade-off and willingness-to-pay methods. In 2015, a nationwide convenience sample of women, aged between 18 and 40 years, was recruited using an Internet-based cross-sectional survey in Hungary. Respondents with a known history of secondary dysmenorrhea were excluded. Data on 1836 and 160 women, with and without a history of PD, respectively, were analysed. Mean utility values for the severe and mild health states were 0.85 (median 0.95) and 0.94 (median 1), respectively. Participants were willing to pay a mean of &OV0556;1127 (median &OV0556;161) and &OV0556;142 (median &OV0556;16) for a complete cure from the severe and mild PD health states. Compared with the non-PD group, women with PD valued both health states worse according to willingness to pay (P < 0.05) but similar in the time trade-off. It seems that PD substantially contributes to the quality-adjusted life year loss in this age group, which is comparable with losses from chronic diseases such as type 1 diabetes, asthma, atopic eczema, or chronic migraine. Our findings provide a useful input to cost-effectiveness and cost-benefit analyses of PD treatments.

Pharmacological inhibition of heparin-binding EGF-like growth factor promotes peritoneal angiogenesis in a peritoneal dialysis rat model.

Molecular mechanisms of peritoneal dialysis (PD) ultrafiltration failure, peritoneal neo-angiogenesis, and fibrosis remain to be determined. We aimed to determine the role of heparin-binding EGF-like growth factor (HB-EGF) inhibition on angiogenesis of peritoneal membrane in a PD rat model. 32 male Wistar rats were assigned into (1) control group; (2) uremic non-PD group: subtotal nephrectomy-induced uremic rats without PD; (3) uremic rats subjected to PD: uremic rats that were dialyzed with Dianeal® for 4weeks; (4) CRM 197 group: dialyzed uremic rats were supplemented with CRM197, a specific HB-EGF inhibitor. Peritoneal transport function was examined by peritoneal equilibration test. Expression of HB-EGF and EGFR in peritoneal samples were examined by real-time PCR, immunohistochemical staining, and western blot. Progressive angiogenesis and fibrosis were observed in uremic PD rats, and there were associated with decreased net ultrafiltration (nUF), increased permeability of peritoneal membrane, and reduced expression of HB-EGF and EGFR protein and mRNA in uremic PD rats compared to uremic non-PD or control groups (both p<0.05). CRM197 significantly induced peritoneal membrane permeability, decreased nUF, increased higher vessel density, and reduced pericyte count compared to that of uremic PD rats. The levels of HB-EGF and EGFR expression negatively correlated with vessel density in peritoneal membrane (both p<0.001). PD therapy was associated with peritoneal angiogenesis, functional deterioration, and downregulation of HB-EGF/EGFR. Pharmacological inhibition of HB-EGF promoted PD-induced peritoneal angiogenesis and fibrosis and ultrafiltration decline, suggesting that HB-EGF downregulation contributes to peritoneal functional deterioration in the uremic PD rat model.

Delirium after fast-track hip and knee arthroplasty - a cohort study of 6331 elderly patients.

Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS >4days. Prospective risk assessment study with retrospective analysis of discharge notes or medical records of signs of PD in 6331 elective primary unilateral THA and TKA patients ≥70years, and LOS >4days. Preoperative patient characteristics collected from eight high volume centers with similar standardized fast-track protocols from January 2010 to November 2013. We identified 43 (0.7%) cases of PD symptoms mentioned as a reason for LOS >4days among the 789 patients with LOS >4days (12.5% of all THA and TKA). PD patients had a mean age of 80.7 [[95% CI] 79.3-82.1] years, being 4.0 [[95% CI] 2.5-5.5] years older compared to patients without PD (P<0.001). LOS was median 10 [[Q2-Q3] 7-14] days in the PD group vs. 3 [2-3] days in the non-PD group (P<0.001), without differences in gender or site of arthroplasty (P=0.139 and 0.499, respectively). Postoperative delirium symptoms contributing to LOS >4days in fast-track THA and TKA are rare in elderly patients.

Non-progression during avelumab treatment is associated with clinically relevant improvements in health-related quality of life in patients with Merkel cell carcinoma.

e21070 Background: There is little data on quality of life (QoL) for patients (pts) with Merkel cell carcinoma (MCC). To better understand how new treatments might impact QoL in MCC, pts with stage IV chemotherapy-treated MCC from a single-arm, open-label, multicenter, international phase 2 trial (NCT02155647) of a novel immunotherapy were followed for QoL and clinical outcomes. Methods: Because there is no MCC-specific QoL instrument, the FACT-Melanoma (FACT-M), a validated QoL questionnaire including multiple subscales and summary scores (Trial Outcome Index [TOI], FACT-G total and FACT-M total) was used. Pts completed the FACT-M at baseline (BL), week 7, every 6 weeks until disease progression (PD) and at end of treatment (EOT). Linear mixed models (LMM) were fitted for change from BL for each scale including the time-varying covariate PD vs non-PD. Established minimal important differences (MID) were used to interpret meaningfulness of changes. Sensitivity analyses explored the effects of missing data. Results: 70 pts were analyzed. Overall, no meaningful changes from BL were observed for each scale during treatment. Moderate correlations between reduction in tumor size and improvements in FACT-M were observed at week 7 for Functional Well-being (-0.47), TOI (-0.36), FACT-M total (-0.36), and FACT-G total (-0.34), suggesting improvements in QoL with tumor shrinkage. LMM showed differences between PD vs non-PD groups in the range of MIDs for Functional Well-being (2.23, p = 0.018), Melanoma (3.19, p = 0.012), Surgery (1.95, p = 0.109), TOI (6.36, p = 0.012) and FACT-G total (3.89, p = 0.105). These models showed improvement for the non-PD group in Emotional Well-being (1.55, p = 0.004) and worsening for the PD group in Physical Well-being (-1.63, p = 0.041), Surgery (-2.09, p = 0.044) and TOI (-4.56, p = 0.036). As expected, all scales worsened in the range of MIDs at EOT, mostly due to PD. Sensitivity analyses were consistent, with modest increases in estimated differences. Conclusions: In pts with metastatic MCC, non-progression during avelumab treatment contributed to statistically and clinically meaningful improvements in health-related QoL. Clinical trial information: NCT02155647.

MP56-10 NATIONAL TRENDS IN UTILIZATION OF PENILE PROSTHESIS SURGERY IN THE TREATMENT OF PEYRONIE′S DISEASE

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie’s Disease II1 Apr 2017MP56-10 NATIONAL TRENDS IN UTILIZATION OF PENILE PROSTHESIS SURGERY IN THE TREATMENT OF PEYRONIE′S DISEASE Michael Benson, David Shin, Fatima Elgammal, Dongfeng Qi, and Guanghui Liu Michael BensonMichael Benson More articles by this author , David ShinDavid Shin More articles by this author , Fatima ElgammalFatima Elgammal More articles by this author , Dongfeng QiDongfeng Qi More articles by this author , and Guanghui LiuGuanghui Liu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1763AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical management for the treatment of Peyronie′s disease (PD) is indicated when men fail medical therapy such as intralesional collagenase clostridium histolyticum (CCH) injections. For men with severe curvature and concomitant erectile dysfunction (ED) not responsive to CCH and phosphodiesterase 5 inhibitor (PDEi) therapy, penile prosthesis (PP) surgery is a treatment option. We sought to evaluate trends in PP surgery for the treatment of PD and examine the effect of medical therapy on practice patterns. METHODS Analysis of 21 years of a national prospectively maintained American Medical Systems database was performed (1995-2015). Utilization of PP was compared with ANOVA analysis between four distinct time periods: Pre-PDEi use for ED treatment (1995-1997); post-sildenafil (1998-2003); post-tadalafil and vardenafil (2004-2013); post-CCH approval (2014-2015). Comparison was made between patients who underwent PP surgery for PD as sole etiology versus all other patients (non-PD) using Chi-square or t-test. RESULTS 6701 PP surgeries for the treatment of PD were included in the study period. Number of PP cases decreased annually from 494 (7.4%) in 1995 to 203 (3.0%) in 2015 (Figure 1). Significant decrease in PP surgery occurred for PD patients between each of the time intervals (′95-′97, ′98-′03, ′04-′13, ′14-′15) [p<0.05] (Table 1). For non-PD patients, PP surgery decreased after the introduction of sildenafil only. PD patients were younger than those without PD (59.4 ±8.6 vs. 62.2 ±10.0 years, p<0.001). Proximal and distal measurements were lower in PD vs. non-PD group (Proximal 9.6 ±2.4 vs. 10.0 ±2.6 cm; Distal 9.0 ±2.4 vs. 9.5 ±2.7 cm, p<0.001). Penoscrotal is the most common surgical approach (p<0.05). CONCLUSIONS Decrease in PP surgery for the treatment of PD was observed between 1995-2015 notably due to the introduction of PDEi and CCH therapy. In contrast, PP surgery for men without PD has remained stable over the past decade. Further study is needed to determine if similar trends in utilization of PP surgery will continue for PD patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e758 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Michael Benson More articles by this author David Shin More articles by this author Fatima Elgammal More articles by this author Dongfeng Qi More articles by this author Guanghui Liu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A randomized phase 2 study of MK-2206 versus everolimus in refractory renal cell carcinoma

Activation of the phosphoinisitide-3 kinase (PI3K) pathway through mutation and constitutive upregulation has been described in renal cell carcinoma (RCC), making it an attractive target for therapeutic intervention. We performed a randomized phase II study in vascular endothelial growth factor (VEGF) therapy refractory patients to determine whether MK-2206, an allosteric inhibitor of AKT, was more efficacious than the mammalian target of rapamycin inhibitor everolimus. A total of 43 patients were randomized in a 2:1 distribution, with 29 patients assigned to the MK-2206 arm and 14 to the everolimus arm. Progression-free survival (PFS) was the primary endpoint. The trial was closed at the first futility analysis with an observed PFS of 3.68 months in the MK-2206 arm and 5.98 months in the everolimus arm. Dichotomous response rate profiles were seen in the MK-2206 arm with one complete response and three partial responses in the MK-2206 arm versus none in the everolimus arm. On the other hand, progressive disease was best response in 44.8% of MK2206 versus 14.3% of everolimus-treated patients. MK-2206 induced significantly more rash and pruritis than everolimus, and dose reduction occurred in 37.9% of MK-2206 versus 21.4% of everolimus-treated patients. Genomic analysis revealed that 57.1% of the patients in the PD group had either deleterious TP53 mutations or ATM mutations or deletions. In contrast, none of the patients in the non-PD group had TP53 or ATM defects. No predictive marker for response was observed in this small dataset. Dichotomous outcomes are observed when VEGF therapy refractory patients are treated with MK-2206, and MK-2206 does not demonstrate superiority to everolimus. Additionally, mutations in DNA repair genes are associated with early disease progression, indicating that dysregulation of DNA repair is associated with a more aggressive tumor phenotype in RCC.

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study.

ObjectiveTo investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.MethodsWe used the 1999–2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999–2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.ResultsWe enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06–1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25–1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.ConclusionThe present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.

Persistently active disease is common in patients with rheumatoid arthritis, particularly in women: a long-term inception cohort study

Objectives: Despite improved treatment strategies for rheumatoid arthritis (RA), some patients do not respond satisfactorily. The aim of this study was to investigate the course and outcome of early RA diagnosed during the 1990s and followed for 8 years with a focus on those who did not respond well to treatment.Method: This study included 640 patients (66% women) who were enrolled in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) RA inception cohort between the years 1993 and 1999. The 28-joint count Disease Activity Score (DAS28) < 2.6 criteria were used to assess remission. Persistent disease (PD) was defined as absence of remission at all predefined follow-up visits at 1, 2, 5, and 8 years. Function was assessed by Health Assessment Questionnaire (HAQ) and Signals of Functional Impairment (SOFI) scores and radiological joint damage by the Sharp/van der Heijde score (SHS).Results: Of the 640 patients, 214 (37%) had PD (43% of the women and 25% of the men). Over the 8 years of follow-up, patients with PD had significantly worse mean values for patient’s global health measured on a visual analogue scale (VAS patGH), VAS pain, HAQ, SOFI, and SHS compared with those in the non-PD group. Multivariate logistic regression analyses revealed that female gender, current smoking, disease activity at baseline, and absence of remission at 6 months independently predicted PD.Conclusions: Of the patients who entered the early RA inception cohort, 37% suffered a PD course over 8 years. The consequences of PD with regard to general health, pain, function, and joint damage were considerable. Of note, PD was more common in women than in men.

A Novel Scoring System Based on Fibrinogen and the Neutrophil-Lymphocyte Ratio as a Predictor of Chemotherapy Response and Prognosis in Patients with Advanced Gastric Cancer

Objective: We assessed the clinical applicability of the F-NLR score, which is based on fibrinogen (F) and the neutrophil-lymphocyte ratio (NLR), and the Glasgow Prognostic Score (GPS) to predict the therapeutic effects of chemotherapy or chemoradiotherapy on advanced gastric cancer and the prognoses of patients. Methods: Sixty-eight patients with advanced gastric cancer treated with first-line chemotherapy or chemoradiotherapy were classified into two groups based on tumor response. Furthermore, we categorized patients according to cutoff F-NLR scores of 2 [hyperfibrinogenemia (>400 mg/dl) and high NLR (>3.0)], 1 [one of these hematological abnormalities], and 0 [neither hyperfibrinogenemia nor high NLR]. Results: A total of 27 patients had progressive disease (PD) and 41 did not. The F-NLR scores were significantly higher in the PD than in the non-PD group (p = 0.003). Survival was significantly shorter for patients with high F-NLR scores and GPS (p = 0.0071 and p = 0.0065, respectively). Multivariate analysis selected the F-NLR score as an independent prognostic factor (p = 0.017). Conclusion: A novel grading system based on F-NLR scores, as well as the GPS, appears to have value as a clinical predictor of the therapeutic response of advanced gastric cancer to chemotherapy or chemoradiotherapy and the prognoses of patients.

Transforaminal Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation in Parkinson's Disease: A Case-Control Study.

Study DesignA case-control study.PurposeTo investigate the effectiveness of transforaminal percutaneous endoscopic discectomy (TPED) in Parkinson's disease (PD).Overview of LiteraturePatients with PD frequently suffer from radiculopathy and low back pain. Additionally, they demonstrate higher complication rates after open spine surgery. However, the clinical outcome of minimally invasive techniques for lumbar discectomy, such as TPED, have not been established for this population.MethodsPatients diagnosed with lumbar disc hernia were divided into Group A (11 patients diagnosed with PD), and Group B (10 patients as the control, non-PD group). All patients underwent TPED. Indexes of visual analogue scale (VAS) for leg pain and Oswestry disability index (ODI) were assessed right before surgery and at six weeks, three months, six months and one year post-surgery.ResultsAt the baseline visit, groups did not differ significantly with age (p=0.724), gender (p=0.835), level of operation (p=0.407), ODI (p=0.497) and VAS (p=0.772). Parkinson's patients had higher scores in ODI at every visit, but the outcome was statistically significant only at 3 months (p=0.004) and one year (p=0.007). Similarly, VAS measurements were higher at each time point, with the difference being significant at 3 (p<0.001), 6 (0.021), and 12 (p<0.001) months after surgery. At the end of a year of follow up, ODI was reduced by 49.6% (±16.7) in Group A and 59.2% (±8.0) in Group B (p=0.111), translating to a 79.5% (±13.0) and 91.5% (±4.1) average improvement in daily functionality (p=0.024). VAS was reduced by 59.1 mm (±11.8) in Group A and 62.2 mm (±7.4) in Group B (p=0.485), leading to an 85.3 % (±4.0) and 91.9% (±2.6) general improvement in leg pain (p<0.001).ConclusionsOur data indicate that TPED led to satisfactory improvement in leg pain and daily living in PD patients a year after surgery.

Abstract 16650: The Relationship Between Post Deployment Balloon Dilation and Cerebrovascular Events During Transcatheter Aortic Valve Replacement

Introduction: The risk of stroke or transient ischemic attack (TIA) remains increased after transcatheter aortic valve replacement (TAVR), especially in the first 30 days. Limited data is available regarding the impact of procedural characteristics on risk of stroke/TIA. Hypothesis: Post deployment balloon dilatation (PD) and total number of balloon dilatations (pre, valve and post insertion) may be associated with increased risk of stroke/TIA in patients undergoing TAVR. Methods: We included consecutive patients who underwent balloon-expandable TAVR until June 2014 at Mayo Clinic, Rochester. Patients who died in the operating room, converted to open surgery, or had valve-in-valve, or underwent self-expanding TAVR were excluded. Primary end-point was stroke or TIA at 30 days. Results: Mean age was 80.9±8 y, mean STS score was 8.3±5 and 50% underwent transfemoral access. The overall incidence of PD was 14% (n=53). Total number of dilations ranged from 2-7, with 5% (n=19) getting ≥ 4 total dilatations. Out of the 370 patients, 13 patients (3.5%) suffered stroke/TIA (9.4% in PD group vs. 2.2% in non-PD group) in the first 30 days after TAVR. Cox-proportional hazards regression analysis indicated that PD during TAVR was associated with a significantly increased risk of 30-day stroke/TIA (HR, 3.8; 95% CI, 1.2-11.6; p=0.02). There was a trend towards increased stroke/TIA with total number of dilations (HR, 1.5; 95% CI, 0.87-2.6; p=0.14), longer procedural time (HR per 30 minutes, 1.3; 95% CI, 0.96-1.7; p=0.09) and severity of atherosclerosis (moderate-severe - HR, 1.9; 95% CI 0.95- 3.8; p=0.07). PD was not significantly associated with the risk of 30 day death (HR, 1.1; 95% CI, 0.24-4.85; p=0.93). Conclusions: In patients undergoing PD after balloon-expandable TAVR, 9.4% suffered a stroke or TIA in the first 30 days. PD was associated with a four-fold increase in 30 day risk of stroke or TIA.

Is combined pancreatoduodenectomy for advanced gallbladder cancer justified?

The clinical impact of combined pancreatoduodenectomy (PD) for advanced gallbladder cancer remains unclear. A total of 96 patients who underwent resection for stage II, III, or IV gallbladder cancer were enrolled. Patients with lower bile duct involvement, pancreatic or duodenal infiltration, or peripancreatic lymph node metastasis were considered candidates for combined PD. The operative outcomes were compared between the patients treated with PD (PD group, n = 21) and those treated without PD (non-PD group, n = 75), and between those treated with major hepatopancreatoduodenectomy (major HPD group, n = 9) and those treated with major hepatectomy (major hepatectomy group, n = 20). Overall morbidity in the PD group was greater than that in the non-PD group (81% vs 23%, P < .001), whereas the overall survival (OS) was comparable between the groups (5-year OS; 39.8% vs 46.7%, P = .96). There was no in-hospital mortality in the PD group. A serum albumin <3.0 g/dL (P = .004) and tumor size ≥ 9.0 cm (P = .029) were associated independently with a poor prognosis in the PD group. Overall morbidity in the major HPD group was greater than that in the major hepatectomy group (89% vs 40%, P = .014), whereas the OS was comparable between the groups (5-year OS; 34.6% vs 21.1%, P = .57), and the OS of major HPD group was better than that of unresectable group (n = 18, P = .017). Combined PD, including major HPD, is beneficial for selected patients of advanced gallbladder cancer; however, the indications should be carefully evaluated because of greater morbidity rates.

Clinical analysis of 36 cases of duodenal gastrointestinal stromal tumors

To review the clinical features of duodenal gastrointestinal stromal tumors(GISTs), and to compare the clinical efficacy among different surgical treatments for duodenal GISTs. Clinicalpathological data of 36 cases of duodenal GISTs undergoing operation in The First Affiliated Hospital of Sun Yat-sen University from January 2000 to July 2013 were retrospectively analyzed. All the patients received surgical treatments, including 15 cases with regional resection, 8 cases with segmental resection, 12 cases with pancreaticoduodenectomy (PD), and 1 case with liver biopsy, respectively. Clinical efficacy between pancreaticoduodenectomy (PD) and non-PD (NPD) was compared. Nine of 36 cases (25%) developed postoperative complications who were all in the PD group. Eight patients recovered and healed finally after active treatment, and 1 case was complicated with acute pancreatitis, pancreatic fistula and intra-abdominal infection. The median follow-up time was 54 months and the 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate were 78.1% and 72.1%, respectively. The 5-year OS rate in the PD group and the NPD group was 61.1% and 61.1% respectively. The 5-year RFS rate in the PD group and the NPD group was 85.8% and 78.8% respectively. Statistical analysis showed no significant difference between the both groups (P=0.71 and P=0.89). For duodenal GISTs patients, regional resection and segmental resection have similar clinical outcomes to pancreaticoduodenectomy while the former two can obviously decrease the incidence of postoperative complications. Based on the premise of R0 resection guaranteed, regional sectional and segmental resection with less injury should be the surgical treatment of choice.

Prostate volume and prostate-specific antigen in men with Parkinson's disease are not different compared to age-matched control group: A prospective, case-controlled multicenter study.

PurposePatients with Parkinson's disease (PD) suffer from gait disturbance as well as lower urinary tract symptoms (LUTS). There have been no reports that evaluated the prostate volume (PV) and prostate-specific antigen (PSA) of patients with PD. In this study, we prospectively evaluated PV and PSA in men with PD.MethodsFrom May 2009 to January 2012, 60 PD patients and 60 age-matched non-PD patients with LUTS enrolled at three centers in Korea. All participants (PD as well as non-PD patients) had LUTS at presentation. We measured the PV using a transrectal ultrasonography and checked the serum PSA level in patients with PD and their non-PD counterparts, who served as the age-matched control group, and then compared the data of both groups. Patients with abnormal digital rectal examination results and/or serum PSA levels >4.0 ng/mL underwent prostate biopsy.ResultsThe mean patient age was 71.37 ± 7.36 years and 70.85 ± 6.31 years for PD and non-PD patients (P = 0.651), respectively. There were no significant statistical differences between the two groups in terms of total PV (28.56 ± 14.59 in PD vs. 29.21 ± 10.41 in non-PD, P = 0.727), transition zone PV (12.72 ± 8.76 vs. 12.73 ± 6.68, P = 0.993), and total serum PSA (1.88 ± 2.80 vs. 2.01 ± 2.02, P = 0.759). In the PD group, seven patients had PSA levels >4.0 ng/mL (range, 4.12–11.18 ng/mL). Among these patients, prostate cancer (PC) was detected in two patients. In the non-PD group, PSA levels >4.0 ng/mL were detected in nine patients (range, 4.16–8.28 ng/mL). Among these patients, PC was detected in three patients. The PC occurrence rate was similar in both groups.ConclusionsOur data show that a neurologic lesion causing PD does not affect PV and PSA. As both groups have a similar PC occurrence rate, it is clear that prostate evaluation is necessary for PD as well as non-PD patients.