Poor Prognostic Sign Research Articles

Immune Marker and C-Reactive Protein Dynamics and Their Prognostic Implications in Modulated Electro-Hyperthermia Treatment in Advanced Pancreatic Cancer: A Retrospective Analysis

Background: Previous research has suggested that modulated electro-hyperthermia (mEHT) can be used to induce anti-tumor immune effects and to extend patient survival. The use of mEHT in advanced pancreatic cancer is beneficial; however, its immune-mediating effects were never investigated. Methods: A retrospective observational study was conducted. Leukocyte counts, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and granulocyte-to-lymphocyte ratio (GLR) were measured at baseline, midpoint, and after mEHT treatment. Results: A total of 73 mEHT treated pancreatic cancer patients were included. The time elapsed between tumor diagnosis and the first mEHT treatment was 4.40 ± 5.70 months. While no change could be observed between the baseline and the first follow-up visits, the total white blood cell (WBC), neutrophil, and granulocyte count, CRP, NLR, and GLR were significantly higher at the second follow-up compared to both previous visits. Higher levels of the latter parameters following the last mEHT treatment were signaling significantly poor prognostic signs, and so were their longitudinal changes. Conclusions: After the initiation of mEHT, immune markers stabilize with the treatment, but this positive effect is eroded over time by progressive disease. Monitoring the changes in these markers and the occurrence of their increase is a prognostic marker of shorter survival.

MODERN MORPHOLOGICAL APPROACHES IN PROSTATE PATHOLOGY DETECTION

Prostate diseases are among the most common ones in men. Disease incidence is increasing both in the Russian Federation and all over the world. Objective. The purpose of the study is to examine the morphological aspects of benign hyperplasia and cancer using scanning electron microscopy. Materials and Methods. The authors analyzed morphological data of 30 patients with cancer (stage 1–3) and 10 patients with benign prostatic hyperplasia. The samples were examined using FE1 Quanta 200 3D and FE1 Quanta 600 FEG microscopes. Statistical processing was performed calculating intensive and extensive parameters of the mean values. Statistical significance of the mean and relative quantitative values was determined by Student's t-test. Results. Benign prostatic hyperplasia is characterized by stromal sclerosis, abnormal prostate glands with areas of glandular hyperplasia, including atypical conglomerates with loose cell-cell contacts. In addition, hemorrhages were observed in cancer. As the tumor progressed, cell polymorphism increased, and tumor emboli were formed. Conclusion. Scanning electron microscopy can detect atypical cells. The detection of atypical cells in patients with benign hyperplasia is a poor prognostic sign, as it indicates possible tumor progression. Tumor emboli formation in cancer indicates stage 3 and is associated with a high risk of metastasis.

Lactate as an early prognostic indicator in yellow phosphorus rodenticide-induced acute hepatic failure: a retrospective observational study in a tertiary care hospital

Introduction Acute hepatic failure due to yellow phosphorus rodenticide ingestion is often lethal. This study aimed to analyze demographic characteristics and prognostic indicators, focusing on hyperlactataemia as a potential early indicator of mortality in patients poisoned with yellow phosphorus rodenticide. Materials and methods This was a retrospective study of 96 patients poisoned with a yellow phosphorus-containing rodenticide (Ratol paste, which contains 3% yellow phosphorus). We examined demographic details, clinical symptoms, and biochemical markers to identify prognostic indicators. Results Demographics were similar among survivors and non-survivors. Mortality (36.5%) correlated with a higher ingested dose and treatment delays, with a mean (±SD) of 5.26 ± 2.2 survival days among those who died. Symptoms, including gastrointestinal and neurological features, typically appeared 48 h after ingestion. Non-survivors developed increased aminotransferase activities (74.3%), prolonged prothrombin time (65.7%), and hyperbilirubinaemia (65.7%) during hospitalization, significantly more commonly compared to survivors (P < 0.0001). Hyperlactataemia (lactate concentration >2 mmol/L) was present in 97.1% of non-survivors, with increased serial lactate concentrations observed in 88.6%. The median (interquartile range) admission lactate concentration among non-survivors was 4.6 mmol/L (3.36–7.53 mmol/L), and their peak median (interquartile range) lactate concentration was 6.1 mmol/L (8.74–10.6 mmol/L). In non-survivors, an increased lactate concentration preceded increased aminotransferase activities and prolonged prothrombin time. Logistic regression and receiver operating characteristic curve analysis confirmed that a 24 h lactate concentration ≥2.67 mmol/L predicted death with 94.3% sensitivity and 91.8% specificity. Discussion The majority of patients who ingest yellow phosphorus remain asymptomatic initially and typically present to hospital following the onset of gastrointestinal symptoms, usually a day later. As progression to death occurs within a week of yellow phosphorus ingestion in most cases, determining prognosis as early as possible enables swift referral to a liver transplant centre. Based on our study, a 24 h lactate concentration ≥2.67 mmol/L appears to be an early prognostic indicator of death. In another study, a lactate concentration >5.8 mmol/L was found to be a poor prognostic indicator. Conclusions Hyperlactataemia on admission and increased serial lactate concentrations appear to be early poor prognostic signs in patients with yellow phosphorus-induced liver failure.

Multi Organ Failure (MOF) and a Promising Novel Device

Acutely ill hospitalized patients are at risk of cascading failure of vital organs leading to prolonged stay in the hospital, persistent dysfunction of vital organs and higher probability of death. It is estimated that 50 to 75% of ICU patients have failure of one or more vital organs and as more organs are involved the risk of death increases [1, 2]. For example in Acute on Chronic Liver Failure (AOCLF) the 28 day probability of death increases from 20% with one vital organ failure to 90% or higher if 3 or more organs are involved. Dysfunction of brain, lungs, heart and kidneys are most commonly seen, kidney involvement is usually poor prognostic sign.

Heparin-induced thrombocytopenia after cardiac surgery. A single-center, retrospective cohort study

BackgroundCardiac surgery is a high-risk setting for heparin-induced thrombocytopenia (HIT). However, large differences in its incidence, rate of thrombotic complications, and mortality have been reported in this context. Few studies address the pharmacologic management of HIT specifically in this setting. ObjectivesTo describe the incidence, outcomes, and management of patients with HIT in our cohort and to compare them with patients presenting platelet factor 4/heparin antibodies but without platelet-activating capacity. MethodsA retrospective observational study was conducted over a period of 10 years and 6 months on 13,178 cardiac operations in a single high-volume cardiac surgery center. ResultsHIT was diagnosed in 0.22% of patients. HIT with associated thromboembolic complications occurred in 0.04% of cases. Two deaths at 30 days were registered, both in patients with associated thrombosis. The 4T score showed a 99.9% negative predictive value. The immunoglobulin G-specific chemiluminescence test positivity rate was highly predictive of HIT. Warfarin was often started early after surgery, and although it was rarely stopped when the diagnosis of HIT was made, no new thromboembolic complications subsequently occurred. Thrombocytopenia appeared to be a poor prognostic sign, whatever the cause. ConclusionAlthough rare, HIT is characterized by high mortality in this setting, especially if thrombotic complications occur. Large multicentric studies or an international registry should be created to enhance the scientific evidence on HIT diagnosis and management in this context.

SAT541 Pleural Effusion As First Manifestation Of Recurrent Follicular Thyroid Cancer

Abstract Disclosure: N.S. Kadakia: None. C.A. Poku: None. Pleural effusions are a rare presentation of Follicular Thyroid Cancer (FTC). We portray a case of a patient with a remote history of FTC who presented with pleural effusion 57 years later as the first sign of recurrence. A 80 year old male presented to the hospital 8/2021 with shortness of breath and was found to have a pleural effusion. He had a history of FTC diagnosed at age 23 status post total thyroidectomy, external beam radiation and radioactive iodine. He was started on thyroid hormone replacement and was subsequently lost to follow up. Chart review showed unremarkable neck ultrasounds completed in 2004 and 2006. During admission 8/2021, a malignant pleural effusion was diagnosed after the effusion tested positive for TTF-1 and thyroglobulin (Tg). He was diagnosed with recurrent metastatic thyroid cancer. A CT scan of the neck showed a small paratracheal nodule while a PET scan revealed hypermetabolic activity in the left pleura. A neck ultrasound reported a 2 cm cervical lymph node on the right with preserved fatty hilum and an ovoid 1 cm isoechoic solid nodule in the left surgical bed. There was evidence of bulky calcified lymph nodes on CT. The pleural lesion was not accessible however biopsy of a supraclavicular lymph node was consistent with metastatic follicular carcinoma. After a delay due to iodine contrast exposure, a whole body scan with radioactive iodine was completed in 1/2022 and showed multiple foci of uptake in the right neck, right thyroid, left clavicular region, and lung bases. He was treated with 250 mCi I-131 sodium iodide in 1/2022 and levothyroxine dose was increased with a target TSH of less than 0.1. His Tg level was mildly increased. Thyroglobulin antibodies (Tg ab) were positive but have continued to trend down after treatment. A follow up CT chest done 7/2022 had persistent pleural thickening but significant improvement in pleural effusion and thus thyroxine kinase inhibitors (TKI) chemotherapy has not been initiated. Malignant pleural effusion is a rare presentation of FTC metastasis with a reported median survival of 11 months (Kazushige). Pleural effusion is a poor prognostic sign in patients with FTC and distant metastases (Broome). This affirms that prompt recognition is of essence however it also raises the question of how effective current therapies are. A retrospective study evaluated 20 patients who received RAI for pulmonary metastasis from FTC, and found the efficacy rate was relatively low (40%). There is insufficient data to determine the effectiveness of RAI as treatment for metastatic FTC to the pleura. This case adds to the limited literature on recurrence of FTC with pleural effusion and highlights limitations of current management. If the response to RAI is deemed inadequate then consideration should be given to the use of TKI. Presentation Date: Saturday, June 17, 2023

The anti-inflammatory and autophagy-induced effects of baicalin in ankylosing spondylitis hip ligament fibroblasts

IntroductionAnkylosing spondylitis (AS) is characterised by chronic inflammation that affects the axial skeleton and peripheral joints. Hip involvement occurs in nearly one-third of patients with AS and is considered a poor prognostic sign. Inflammation is also associated with AS progression. Baicalin is a bioactive flavonoid possessing both anti-inflammatory and antioxidant properties, although its activity in AS has not been investigated. The aim of our study was to evaluate the effects of baicalin on AS pathogenesis-related cells and investigate the potential mechanisms. MethodsFibroblasts were isolated from AS patients who met the modified New York criteria and underwent total hip arthroplasty. Flow cytometry was used to identify the fibroblasts. Cytokine expression was evaluated by enzyme-linked immunosorbent assay and real-time polymerase chain reaction, and protein expression was detected using western blotting. Immunofluorescence and transmission electron microscopy were used to assess autophagy. ResultsBaicalin effectively inhibited the expression of inflammatory cytokines upregulated by lipopolysaccharides in AS hip ligament fibroblasts. Moreover, the lipopolysaccharide-triggered nuclear factor kappa-B (NF-κB) and Janus kinase/signal transducer and activator of transcription (JAK/STAT) signalling pathways were also suppressed by baicalin. Furthermore, baicalin markedly induced autophagy, which suppressed inflammation dose-dependently. ConclusionsThe anti-inflammatory activity of baicalin was mediated by the repression of NF-κB and JAK/STAT signalling pathways. Furthermore, the induction of autophagy may contribute to inhibiting inflammation.

177. BULKY LYMPHADENOPATHY IN ESOPHAGEAL CANCER: ASSESSING PATHOLOGICAL AND SURVIVAL OUTCOMES AFTER TREATMENT WITH CURATIVE INTENT

Abstract Aim Whilst pre-treatment bulky regional lymphadenopathy is associated with poor survival outcomes in gastric adenocarcinoma, the impact this may have on survival in the setting of esophageal adenocarcinoma has not been described. The aim of this study was to explore the relationship between bulky regional lymphadenopathy found at diagnosis and survival outcomes in patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy and en bloc esophagogastrectomy. Methods A single center, retrospective review of a prospectively maintained upper GI cancer surgical database was performed between 01/2012 and 12/2020. Patients with adenocarcinoma of the esophagus/esophagogastric junction (cT2–3, Nany, M0) treated with neoadjuvant docetaxel based chemotherapy and transthoracic en bloc esophagogastrectomy were identified. Pretreatment CT scans were reviewed and patients stratified according to whether bulky periesophageal or periceliac lymph nodes were present. This was defined as periceliac or periesophageal lymphadenopathy &amp;gt;2 cm in its long axis. Once stratified by the presence of bulky lymphadenopathy, overall survival (OS) was compared and a Cox multivariate regression model calculated. Results Of the 975 patients identified, 225 met the inclusion criteria. cT3/4 and cN+ was found in 169/225 (75%) and 154/225 (73%) respectively. Forty-eight patients (21%) were allocated to the bulky lymphadenopathy group. Among them, ypT status was similar, ypN3 disease more common (18/48,38% vs 39/177,20%, p = 0.025) with a trend towards pathological complete response (5/48,10% vs 7/177,4%, p = 0.086). OS was worse among patients with bulky regional lymphadenopathy (32.6 vs 50 months, p = 0.012). Along with poor differentiation (HR 1.8,95% CI 1.0–2.9, p = 0.034) and ypN+ (HR 1.9,95% CI 1.1–3.6, p = 0.032), bulky lymphadenopathy was independently associated with an increased risk of death (HR 1.7,1.0–2.9,p = 0.048). Conclusion Pre-treatment bulky regional lymphadenopathy is a poor prognostic sign despite multimodal treatment with docetaxel based systemic neoadjuvant therapy and en bloc resection. Identification of alternative treatment strategies may help improve survival outcomes among this specific group of patients.

Ectopic Cushing’s Syndrome as the First Presenting Sign of Small Cell Lung Carcinoma

A 67-year-old man with a history of hypertension, hyperlipidemia, coronary artery disease, and former smoking presented with fatigue, lower extremity edema, and a new tremor over the course of one month. Workup was notable for hypokalemia, metabolic alkalosis, and extremely elevated adrenocorticotropic hormone (ACTH) and cortisol levels. He was ultimately diagnosed with ectopic Cushing’s syndrome (CS) secondary to new metastatic small cell lung carcinoma. About 5-10% of CS cases are caused by ectopic ACTH production. The most commonly implicated malignancies are small cell lung cancer (SCLC) and neuroendocrine tumors, with SCLC accounting for up to three-fourths of cases. ACTH production is a poor prognostic sign in SCLC, associated with more extensive disease and decreased response to first-line treatment. Tumor-associated ACTH production is often so rapid that patients do not have time to develop classic Cushingoid physical exam findings, instead presenting with acute-onset hyperglycemia, pseudohyperaldosteronism, and generalized weakness. Prompt diagnosis and treatment are essential to improve outcomes.

In-Hospital Mortality in Hyponatremia Patients Hospitalized for Heart Failure at National Institute of Cardiovascular Disease (N.I.C.V.D) Karachi

Heart failure is a clinical syndrome that appears when the heart either is unable to sustain a sufficient cardiac output or can only do so at the cost of an increased filling pressure. Hyponatremia is poor prognostic sign. Objective: To determine the frequency of in-hospital mortality in hyponatremic patients hospitalized for heart failure at National Institute of Cardiovascular Disease (N.I.C.V.D) Karachi. Methods: This cross sectional study was conducted at Department of Cardiology, NICVD, Karachi, Pakistan from 1st March 2018 to 31st August 2018. All patient who fulfilled the inclusion criteria were enrolled and consent was taken. All the patients were managed according to guidelines and followed during hospital stay for in-hospital mortality. Data were collected in proforma. Results: The in-hospital mortality was 13(9.09%). Lower admission serum sodium was associated with high mortality. Conclusions: Patients hospitalized with heart failure frequently had hyponatremia, which was linked to greater in-hospital mortality. Severe hyponatremic patients have worse clinical outcomes

Influence of a colloidal silver dioxide solution on the edge adjustment of the mineral aggregate trioxide cement for closure of perforation communications &lt;i&gt;in vitro&lt;/i&gt;

BACKGROUND: According to Russian and foreign literature, the probability of iatrogenic perforation of the wall of the tooth root canal is high (9.712.5%) during endodontic dental treatment. This is a poor prognostic sign and may subsequently result in tooth extraction. Moreover, cases without curing of mineral trioxide aggregate (MTA) cement with pronounced exudation were reported. Сurrently, the modification of domestically produced MTA cement is relevant for closing teeth root canal perforation.&#x0D; AIM: This study aimed to conduct a comparative experimental microscopic study of the preservation of the marginal fit to the tooth tissues in perforation areas filled with MTA cement mixed conventionally with distilled water and a colloidal silver dioxide solution.&#x0D; MATERIALS AND METHODS: Sixty teeth previously removed for medical reasons were endodontically treated after iatrogenic perforation formation in the furcation area of the roots. Two groups were formed. In the first group, MTA cement mixed with distilled water was used to close dental perforations. In the second group, MTA cement mixed with a colloidal silver dioxide solution was utilized. The groups were divided into subgroups depending on the MTA cement brand used. The teeth were placed in an automatic incubator HHD 7 LED, in which an optimal mode was created, simulating the conditions of the oral cavity (t = 37 C, humidity 99%). The samples were placed in artificial saliva. After two months of exposing the teeth to a humid environment, the preservation and damage to the marginal fit in the perforation area of the fillings were determined under a Levenhuk 720B binocular microscope.&#x0D; RESULTS: In the perforations of the 30 teeth sealed with various MTA cement types mixed with distilled water, damage of the marginal fit was found in seven (23.3 7.9%) cases. Similar damage in 30 teeth with colloidal silver dioxide solution used to prepare MTA cements was detected in two (6.7 4.6%) cases (p 0.050, t = 1.82).&#x0D; CONCLUSION: The use of MTA cement mixed in a colloidal silver dioxide solution, in comparison with distilled water, contributes to a greater preservation of the marginal fit of the material to the walls of the root canal in an in vitro experiment.

Assessment of electronic health record (EHR) –based machine learning (ML) in predicting risk of brain metastasis among patients with early-stage non–small-cell lung cancer (eNSCLC).

2036 Background: Among patients (pts) with eNSCLC, development ofbrain metastasis (BM) is a poor prognostic sign, but routine surveillance for BM is not recommended post-therapy. EHR-based ML algorithms may identify pts who would benefit from active brain MRI surveillance and/or treatment intensification in the early-stage setting. Methods: ConcertAI Patient360 database, consisting of structured and curated EHR records from pts receiving care in ~900 US oncology clinics, was used to identify pts diagnosed with stage IB-IIIA NSCLC without prior evidence of BM between Jan 2010 – December 2021. Presence of BM was identified from human curation of patient documents. Gradient boosting (GB), random forest (RF), and logistic regression (LR) algorithms with 3-fold cross-validation were trained and compared to predict risk of BM at two landmarks: 18 and 24 months (mos) from initial diagnosis (index). Pts who did not develop BM and either died or were lost to follow-up prior to landmark times were removed. Feature importance was defined using Shapley Additive Explanation (SHAP)-derived marginal odds ratios (OR). Due to low prevalence of BM, AUPRC was used as performance metric. Pts in the 1st and 4th quartiles of predicted probabilities from GB model were flagged as low-risk vs. high-risk. Results: Among 7473 pts in 18 mos model, median age was 68.4 years (IQR 13.2), 50.5% were female, and 10.9% were black. Demographics were similar for 6863 pts in 24 mos model. 6.4% and 8.3% developed BM at 18 and 24 mos. Ability of GB, RF, and LR models to predict BM was similar with validation AUPRC of 0.109 at 18 mos and 0.137 at 24 mos. In the GB model, BM prevalence in high-risk vs. low-risk group was 10.3% vs. 3.1% at 18 mos and 13.4% vs. 4.4% at 24 mos. In both landmark models, N0 stage and surgery within 90 days after index diagnosis were protective against BM, while presence of EGFR targetable mutations, adenocarcinoma (AD) histology, higher platelets (PLT), and history of pneumonia were risk factors. A glucose-by-histology interaction was found: For pts with normal blood glucose (GLU), risk of BM was independent of histology, for pts with high GLU, AD conferred greater risk of BM. Conclusions: An EHR-based ML model identified risk factors for developing BM among pts with eNSCLC and may identify pts who would benefit from active brain MRI surveillance and treatment intensification. [Table: see text]

Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction.

The aim of this study was to develop and validate a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction. Children with intussusception who had treated with sonographically guided saline hydrostatic reduction as an initial treatment were enrolled in this study. The enrolled patients were randomly selected for training and validation sets, and the split ratio was 7:3. The medical records of enrolled patients were retrospectively reviewed. The patients were divided into a surgery and a non-surgery group according to the results of the nonsurgical reduction. A model for predicting the risk of surgical treatment was virtualized by the nomogram using logistic regression analysis. The training set consisted of 139 patients and the validation set included 74. After logistic regression analysis using training set, duration of symptoms, bloody stools, white blood cells (WBCs), creatine kinase isoenzyme (CK-MB), long-axis diameter, poor prognostic signs by ultrasound and mental state were identified as the independent predictors of surgical intervention for intussusception. A model that incorporated the above independent predictors was developed and presented as a nomogram. The C-index of the nomogram in the validation set was 0.948 (95% CI, 0.888-1.000). The calibration curve demonstrated a good agreement between prediction and observation. The decision curve analysis (DCA) curve showed that the model achieved a net benefit across all threshold probabilities. Based on the predictors of duration of symptoms, bloody stools, WBCs, CK-MB, long-axis diameter, poor prognostic signs by ultrasound and mental state, we developed a nomogram for predicting surgical intervention after hydrostatic reduction. This nomogram could be applied directly to facilitate pre-surgery decision for pediatric intussusception.

Cardiovascular Subphenotypes in ARDS: Diagnostic and Therapeutic Implications and Overlap with Other ARDS Subphenotypes.

Acute respiratory distress syndrome (ARDS) is a highly heterogeneous clinical condition. Shock is a poor prognostic sign in ARDS, and heterogeneity in its pathophysiology may be a barrier to its effective treatment. Although right ventricular dysfunction is commonly implicated, there is no consensus definition for its diagnosis, and left ventricular function is neglected. There is a need to identify the homogenous subgroups within ARDS, that have a similar pathobiology, which can then be treated with targeted therapies. Haemodynamic clustering analyses in patients with ARDS have identified two subphenotypes of increasingly severe right ventricular injury, and a further subphenotype of hyperdynamic left ventricular function. In this review, we discuss how phenotyping the cardiovascular system in ARDS may align with haemodynamic pathophysiology, can aid in optimally defining right ventricular dysfunction and can identify tailored therapeutic targets for shock in ARDS. Additionally, clustering analyses of inflammatory, clinical and radiographic data describe other subphenotypes in ARDS. We detail the potential overlap between these and the cardiovascular phenotypes.

Abstract #1406235: Silent Corticotroph Adenomas are More Aggressive than Other Nonfunctional Pituitary Adenomas

Silent corticotroph adenomas (SCAs) are immunopositive for adrenocorticotropic hormone (ACTH) but do not cause Cushing disease. They account for approximately 20% of all corticotroph adenomas and 5% of nonfunctioning pituitary adenomas (NFAs). We present a case of an SCA with extensive invasion outside the sella turcica and causing pathology through mass effect on adjacent structures. A 48-year-old male was found to have a 3.8 cm pituitary mass with invasion of the left cavernous sinus and compression of the optic chiasm during an evaluation of headaches and diplopia. No signs of Cushing syndrome or acromegaly were apparent on examination. Metabolic evaluation was notable for secondary hypothyroidism (TSH 0.7 mIU/L, 0.45-5.33; free T4 0.3 ng/dL, 0.5-1.3) and hypogonadism (LH 2.2 mIU/L, 1.2-8.8; total testosterone 105 ng/dL, 270-1070), though serum prolactin (17.3 ng/mL, 2.6-13.2) and IGF-1 levels (133 ng/mL, 71-224) were unremarkable. ACTH level was increased on multiple measurements (69.9-146.8 μg/dL, 7.2-63.3), but 8 AM cortisol level during an overnight dexamethasone suppression test was only modestly elevated (1.9 μg/dL, expected < 1.8). The patient underwent transsphenoidal surgery (TSS) to remove accessible tumor and relieve symptoms of mass effect. Histopathology was notable for a pituitary adenoma with low Ki-67 proliferation index (< 5%) and 70-80% staining for ACTH. Symptoms recurred approximately 1 y later, and imaging revealed a substantial increase in volume of residual tumor. Unfortunately, the patient died from arterial bleeding during a second attempt at TSS. SCAs are more aggressive than NFAs that fail to stain for an intact pituitary hormone. Patients with SCAs are younger, more likely female, and have a greater likelihood of symptoms at diagnosis than patients with NFAs, though the proportion of SCAs present with extrasellar extension is equivalent to NFAs. SCAs and NFAs progress or recur at the same rate, but time to recurrence for SCAs is more than two-fold faster than for NFAs. Recurrence rate and time to recurrence for SCAs are unaffected by adjuvant radiation. SCAs with extensive staining for ACTH as in this case are more likely to be aggressive than tumors with limited staining for ACTH. Reduced expression of the mismatch repair gene MSH 6/2 may be a driver for the behavior of SCAs. This case illustrates SCAs are a small but challenging subset of NFAs with greater propensity to cause symptoms of mass effect and recur quickly than the typical NFA. Extensive ACTH staining is a poor prognostic sign for tumor recurrence.

Large vessel occlusion stroke presenting with coma: Not uncommon and poor prognostic sign (P12-5.002)

Large vessel occlusion stroke presenting with coma: Not uncommon and poor prognostic sign (P12-5.002)

Prognostic Factors in Alcohol-associated Liver Disease Patients Presenting With First Evidence of Ascites.

To identify factors associated with transplantation and death in alcohol-associated liver disease (ALD) patients presenting with first evidence of ascites. Ascites development is a poor prognostic sign for patients with cirrhosis. Among ALD patients, the baseline factors at time of ascites development that are associated with eventual transplantation or death are currently unknown. Adult patients with ascites in the "Evaluating Alcohol Use in Alcohol-related Liver Disease Prospective Cohort Study" (NCT03267069 clinicaltrials.gov) were identified from 2016 to 2020. Demographic, clinical, and laboratory factors at initial ascites presentation were identified as potential predictors of transplant and death as competing risks. A total of 96 patients were identified. Median (interquartile range) follow-up time was 2.00 years (0.87 to 3.85). By last follow-up, 34/96 patients had been transplanted (35.4%) and 11/96 had died (11.4%). Prognostic factors for transplant included age per decade [hazard ratio (HR): 0.52 (95% CI, 0.33 to 0.83)], employed status [HR: 0.35 (95% CI, 0.14 to 0.90)], and sodium [HR: 0.94 (95% CI, 0.90 to 0.99)], whereas prognostic factors for death were body mass index [HR: 1.11 (95% CI, 1.00 to 1.22)], Charlson index [HR: 2.14 [95% CI, 1.13 to 4.08]), Maddrey Discriminant Function >32 (HR: 5.88 (95% CI, 1.18, 29.39)], aspartate aminotransferase [HR: 0.99 (95% CI, 0.98 to 0.997)], and a prior 12-month abstinence period [HR: 5.53 (95% CI, 1.10 to 27.83)], adjusted for age, sex, and ALD subcategory. Several factors at initial ascites presentation are associated with increased risk of transplantation or death and validation in larger cohorts will allow for improved risk stratification for ALD patients.

Results of surgical treatment of patients with malignant peripheral nerve sheath tumors: a retrospective and prospective study

Background. Peripheral nerve sheath malignancies (PNSM) are a rare and aggressive group of sarcomas that can occur sporadically, after radiation therapy, or related to neurofibromatosis type 1. Loss of function of NF1, TP53, and CDKN2A genes is thought to contribute to the progression of benign neurofibroma to PNSM and is a poor prognostic sign. The optimal management of patients with this disease is currently unresolved, and specific prognostic factors have not been established.&#x0D; Aim. To analyze the results of surgical treatment in patients with PNSM and establish prognostic factors of overall and recurrence-free survival rate.&#x0D; Materials and methods. The retrospective and prospective studies enrolled adult patients with histologically confirmed PNSM treated between 1998 and 2021 at the N.N. Blokhin National Medical Research Center for Oncology. Surgical intervention was performed on 61 patients, 38 (62%) females and 23 (38%) males. The most common PNSM localization was paravertebral (22 [36%] patients), followed by retroperitoneal (14 [23%] patients), and upper and lower extremities (13 [21%] and 12 [20%] patients, respectively).&#x0D; Results. For PNSM patients with a history of surgery, the median overall survival (OS) was 46 months (95% confidence interval 26.165.9). The 3-year and 5-year OS was 46% and 31%, respectively. The median recurrence-free survival (RFS) was 27 months (8.745.3), and 3-year and 5-year RFS was 26% and 13%, respectively. Median OS for grade 1 malignancies was not achieved, while grade 2 and grade 3 malignancy was 53 and 33 months, respectively (p=0.033). The median RFS for grade 1, 2, and 3 tumors was 119, 43, and 15 months, respectively (p=0.078). Patients who underwent radical (R0) surgery had higher RFS (p=0.006) and OS (p0.0001). After radical (R0) surgery, the median OS was not achieved; after nonradical (R1/R2) surgery, the median was 34 months. The median RFS was 124 months after R0-resection and 48 months after R1/R2.&#x0D; Conclusion. The most significant prognostic factors in PNSM patients are the radicality of the surgery performed and the malignancy grade. In our study, tumor size and localization did not affect the long-term treatment results.

Treatment of cicatricial tracheal stenosis and tracheoesophageal fistula in patients with COVID-19 pneumonia

To describe treatment of cicatricial tracheal stenosis and tracheoesophageal fistula in patients with COVID-19 pneumonia. There were 91 patients with cicatricial tracheal stenosis for the period from August 2020 to April 2022 (21 months). Of these, 32 (35.2%) patients had cicatricial tracheal stenosis, tracheoesophageal fistula and previous coronavirus infection with severe acute respiratory syndrome. Incidence of iatrogenic tracheal injury following ventilation for viral pneumonia in the pandemic increased by 5 times compared to pneumonia of other genesis. Majority of patients had pneumonia CT grade 4 (12 patients) and grade 3 (8 patients). Other ones had pulmonary parenchyma lesion grade 2-3 or mixed viral-bacterial pneumonia. Isolated tracheoesophageal fistula without severe cicatricial stenosis of trachea or esophagus was diagnosed in 4 patients. In other 2 patients, tracheal stenosis was combined with tracheoesophageal fistula. Eight (25%) patients had tracheostomy at the first admission. This rate was almost half that of patients treated for cicatricial tracheal stenosis in pre-pandemic period. Respiratory distress syndrome occurred in 1-7 months after discharge from COVID hospital. All patients underwent surgery. In 7 patients, we preferred palliative treatment with dilation and stenting until complete rehabilitation. In 5 patients, stent was removed after 6-9 months and these ones underwent surgery. There were 3 tracheal resections with anastomosis, and 2 patients underwent tracheoplasty. Resection was performed in 3 patients due to impossible stenting. Postoperative course in these patients was standard and did not differ from that in patients without viral pneumonia. In case of tracheoesophageal fistula, palliative interventions rarely allowed isolation of trachea. Four patients underwent surgery through cervical approach. There were difficult surgeries in 2 patients with tracheoesophageal fistula and cicatricial tracheal stenosis. One of them underwent separation of fistula and tracheal resection via cervical approach at primary admission. In another patient with thoracic fistula, we initially attempted to insert occluder. However, open surgery was required later due to dislocation of device. Absolute number of patients with tracheal stenosis, tracheoesophageal fistula and previous COVID-19 has increased by several times compared to pre-pandemic period. This is due to greater number of patients requiring ventilation with risk of tracheal injury, non-compliance with preventive protocol for tracheal injury including anti-ischemic measures during mechanical ventilation. The last fact was exacerbated by involvement of allied physicians with insufficient experience of safe ventilation in the «red zone», immunodeficiency in these patients aggravating purulent-inflammatory process in tracheal wall. The number of patients with tracheostomy was 2 times less that was associated with peculiarity of mechanical ventilation in SARS-CoV-2. Indeed, tracheostomy was a poor prognostic sign and physicians tried to avoid this procedure. Incidence of tracheoesophageal fistula in these patients increased by 2 times compared to pre-pandemic period. In subacute period of COVID-associated pneumonia, palliative measures for cicatricial tracheal stenosis and tracheoesophageal fistula should be preferred. Radical treatment should be performed after 3-6 months. Absolute indication for circular tracheal resection with anastomosis is impossible tracheal stenting and ensuring safe breathing by endoscopic methods, as well as combination of cicatricial tracheal stenosis with tracheoesophageal fistula and resistant aspiration syndrome. Incidence of postoperative complications in patients with cicatricial tracheal stenosis and previous mechanical ventilation for COVID-19 pneumonia and patients in pre-pandemic period is similar.

Implantation metastasis of colorectal cancer following percutaneous biliary drainage

Introduction. Malignant biliary obstruction represents a poor prognostic sign of metastatic colorectal carcinoma. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice for palliative biliary decompression, and this method has both diagnostic and therapeutic values. One of the wellknown complications following this procedure is the development of catheter tract metastases that occur in 0.6?6% of cases post-PTBD. In this case report, we present a patient with implantation metastases of colorectal cancer following PTBD. Case report. In the last six years, 89 patients underwent PTBD procedure at the Oncology Institute of Vojvodina. Among these patients, catheter tract implantation metastasis developed in one patient (1.1%). In this report, we present a patient who underwent right hemicolectomy in January 2015 at the Oncology Institute due to colon cancer located in the transverse colon. In January of 2018, a computed tomography scan of the abdomen showed metastatic disease and chemotherapy was initiated. However, 29 months following the start of chemotherapy, the patient developed jaundice, and as a result, PTBD procedure was performed. A control computed tomography scan of the abdomen in March of 2021 showed a de novo subcutaneous nodule 20 mm in diameter located at the level of ninth right rib. The nodule had been considered a part of the scar that formed at a place of catheter entry, and was still present eight months after PTBD procedure. Biopsy of the subcutaneous mass and pathohistological analysis confirmed well differentiated colon adenocarcinoma. Conclusion. Catheter tract implantation metastasis is not a rare complication following PTBD for malignant biliary obstruction. It generally has a poor prognosis. Nevertheless, literature review shows that radical surgical excision of the catheter tract tissue with hepatectomy can prolong survival in select group of patients.