Possible Predictors Of Prognosis Research Articles

The stratification and prognostic importance of molecular and immune landscapes in clear cell renal cell carcinoma.

The aim of our research is to explore the various characteristics and genetic profiles of clear cell renal cell carcinoma (ccRCC) in order to discover possible predictors of prognosis and targets for treatment. By utilizing ssGSEA scores, we categorized patients with ccRCC into groups based on their phenotype, distinguishing between low and high. This categorization revealed significant variations in the expression of crucial immune checkpoint genes and Human Leukocyte Antigen (HLA) genes, suggesting the presence of a potential immune evasion tactic in different subtypes of ccRCC. A predictive model was built using genes that are expressed differently and linked to cell death, showing strong effectiveness in categorizing patient risk. Furthermore, we discovered a noteworthy correlation among risk scores, infiltration of immune cells, the expression of genes related to immune checkpoint inhibitors, and diverse clinical features. This indicates that our scoring system for risk could function as a comprehensive gauge of the severity of the disease. The examination of the mutational terrain further highlighted the predominance of particular genetic changes, including VHL and PBRM1 missense mutations. Finally, we have discovered the function of DKK1 in facilitating cell death in ccRCC, presenting an additional possibility for therapeutic intervention. The results of our study suggest the possibility of incorporating molecular information into clinical prediction, which could lead to personalized treatment approaches in ccRCC.

Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up.

Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child's headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis. We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4-14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis. Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01-odds ratio 9.34 (2.53-41.64) and sleep disorders (p < 0.01-odds ratio 13.18 (2.25-252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis. To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes.

Neutrophil to-lymphocyte ratio as a possible predictor of prognosis in recently diagnosed multiple sclerosis patients

Neutrophil to-lymphocyte ratio as a possible predictor of prognosis in recently diagnosed multiple sclerosis patients

Indications of airway stenting for severe central airway obstruction due to advanced cancer.

BackgroundManagement of severe central airway obstruction due to advanced cancer is a medical and technical challenge. The impact of airway stenting on the clinical outcome of such patients is unclear.MethodThis single-center, retrospective study evaluated 21 patients who underwent airway stenting for advanced cancer. We examined predictors of the post-stenting mortality, including age, serum albumin, tracheal diameter, smoking, opioid use, respiratory failure, and performance status (PS). We also compared survival according to the PS.ResultsThe mean survival period after stenting was 85.2 days. On univariate analysis, age, albumin, PS before airway stenting, respiratory failure, admission route, and PS grade were the candidates as possible predictors of prognosis after the procedure. On multivariate analysis, PS before airway stenting was identified as possible predictor of prognosis after stenting (HR 1.6180, 95% CI 0.969 to 2.7015, p = 0.066). The mean survival period after stenting was significantly longer in the good PS group, compared to the poor PS group (147.8 days vs. 38.2 days,p = 0.0346).ConclusionAirway stenting for advanced cancer may be more effective for patients in good general condition than in those with poor performance status.

Clinical characteristics and outcome of clinically diagnosed viral encephalitis in southwest China.

Patients with viral encephalitis have a high incidence of morbidity and mortality. We analyze the clinical characteristics and outcome of patients with clinically diagnosed viral encephalitis to investigate possible predictors of prognosis. We retrospectively evaluated 1107 patients diagnosed with viral encephalitis in southwest China from 2009 to 2012 by evaluating their outcomes using the Glasgow Outcome Scale. We compared patient outcome at hospital discharge with long-term follow-up visits, and evaluated the prognostic indicators of the outcome. At hospital discharge, 375 (33.9 %) of the 1107 patients who survived made a full recovery, while 399 (36.0 %), 160 (14.5 %), and 145 (13.1 %) had mild, moderate or severe neurologic sequelae, respectively. Twenty-eight (2.5 %) of the patients died prior to discharge from the hospital. Of the 1027 patients who had follow-up assessments, 658 (64.1 %) made a full recovery, while 213 (20.7 %), 103 (10.0 %), and 19 (1.8 %) had mild, moderate or severe neurologic sequelae, respectively. Six (0.6 %) of the patients died after discharge from the hospital. Use of mechanical ventilation, lower Glasgow coma score, and concurrent seizures are predictors for a poor outcome in patients both at hospital discharge and at long-term follow-up visits.

Concussion Symptoms and Recovery in Football Players

Source: Lau BC, Kontos AP, Collins MW, et al. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011; 39(11): 2311– 2318; doi: 10.1177/0363546511410655Researchers from the University of Pittsburgh sought to determine which on-field signs and symptoms are predictive of protracted (>21 days) versus rapid (≤7 days) recovery after a sport-related concussion in high school football players. Participants included 176 male high school football players (mean age 16.02±1.22 years) from the state of Pennsylvania who were diagnosed with a sport-related concussion by a trained sports medicine professional (ie, certified athletic trainer, team physician) during the preseason or regular season between 2002 and 2006. On-field signs and symptoms were observed and documented by the trained professional at the time of injury and included confusion, headache, loss of consciousness, post-traumatic amnesia, retrograde amnesia, imbalance, dizziness, visual problems, personality changes, fatigue, sensitivity to light/noise, numbness, and vomiting. Participants completed computerized neurocognitive testing using the Immediate Post-concussion Assessment and Cognitive Test (ImPACT)1 within an average 2.4 days after injury, and were followed until cleared to return to play by one of the study’s team of neuropsychologists using international clinical concussion management guidelines.Sixty-nine participants (40%) were lost to follow-up or did not return to football. Of the 107 evaluable athletes, 62 experienced rapid and 36 experienced protracted recovery. There were no significant differences between protracted and rapid recovery groups with regard to pre-injury history of headache, migraine, ADD/ADHD, learning disability, or more than one previous concussion. Mean recovery time in days for the rapid and protracted groups was 4.31 and 29.61, respectively, after correction for outliers. Nine participants’ recovery time fell between 7 and 21 days. The most common measured sign/symptom at the time of injury was headache (94.9%) and the least common was loss of consciousness (13.3%). Dizziness at the time of injury was associated with a 6.34 odds ratio (95% CI, 1.3–29.9; P=.01) of a protracted recovery from concussion. No other on-field signs and symptoms were associated with an increased risk of protracted recovery.The authors conclude that assessment of on-field dizziness may help identify high school football players at risk for a protracted recovery from concussion, which may allow clinicians to manage and treat concussion more effectively in these at-risk athletes.Dr LaBella has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.This study is important because it is the first to evaluate on-field signs and symptoms at the time of injury as possible predictors of prognosis after a sport-related concussion in adolescent football players. Previous studies focused on signs and symptoms at the time of initial clinical evaluation in an emergency department and up to several months after injury in heterogeneous groups of adults with sport- and non-sport-related concussions, with results demonstrating that persistent dizziness was associated with prolonged recovery.2–4 Since many high school football teams have health care providers on site to evaluate injuries and render care, information about signs and symptoms at the time of injury is valuable.The strengths of the current study include a uniform evaluation of all athletes by a team of neuropsychologists who applied the same specific set of criteria to define recovery and determine return-to-play status. Possible confounders such as pre-injury history of headache, learning disability, and previous concussion were accounted for in the analyses. The study’s limitations include a sample comprised of only male high school football players, so results cannot be extrapolated to older or younger players, females, or other sports. Additionally, 40% of athletes were lost to follow-up. Finally, balance was assessed in the enrolled athletes with Romberg, tandem walking, and heel-to-toe walking tests. Postural/balance tests specific for sport-related concussion, such as the Balance Error Scoring System (BESS), may be more sensitive measures of postural stability in athletes.5Despite these limitations, health care providers who evaluate and manage concussions in this population of athletes, especially those providing sideline care, will find these results clinically useful. Identifying dizziness at the time of the injury may allow health care providers to better inform athletes of what to expect regarding the timeframe for recovery and return to school and sports. Furthermore, previous studies2–4 suggest that prompt implementation of modalities to treat dizziness (eg, vestibular rehabilitation) may expedite recovery.

A new comprehensive gene expression panel to study tumor micrometastasis in patients with high-risk breast cancer

The incidence and prognostic relevance of bone marrow (BM) and leukapheresis (PBPC) tumor cell contamination (TCC) in breast cancer patients is still to be circumstantiated. We developed a new comprehensive gene expression panel to study cytokeratins (CK), maspin (MAS) and mammaglobin (MAM) as possible predictors of prognosis. Forty-eight patients undergoing high dose chemotherapy (HDCT) and PBPC support were enrolled and analyzed for TCC on 116 PBPC apheresis and 96 BM obtained at basal conditions. All of the patients were evaluated by reverse transcriptase nested PCR (RT-PCR) for MAM and MAS gene expression and by immunocytochemistry (ICC) and nested RT-PCR to evaluate CK expression. PBPC and BM frequency of CK-positive (+) cells was 12-13% by ICC and 71-73% by RT-PCR respectively. Sixty-seven percent of CK ICC+ samples were MAM RT-PCR+ and 89% of them were MAS RT-PCR+. PBPC and BM frequency of MAM+ cells was 21% and 31% respectively, while for MAS+ cells it was 48% and 52% respectively by RT-PCR. After 71 mo median FU, 16 patients (33%) relapsed and 14 (88%) had BM/PBPC TCC. No marker had an impact on overall survival (OS) but MAS expression on BM and MAM expression on PBPC correlated with a statistically significant improved (p=0.05) and worsened RFS (p=0.06) respectively. These data confirm the activity of MAM as a negative prognostic factor and show for the first time that MAS could work as a tumor suppressor gene even in a clinical setting, since it protects from recurrence.

Prognosis of migraine headaches in adolescents

To determine the long-term outcome of migraine headaches in adolescents and to identify possible predictors of prognosis. Fifty-five of 80 subjects with migraine headaches (ages 11 to 14 years), who attended the baseline examination of a population-based study conducted in southern Italy in 1989, were eligible for follow-up in 1999. All interviews and examinations were conducted by neurologists, and migraine diagnoses were based on the International Headache Society (IHS) criteria. The association between possible prognostic factors and the long-term persistence of migraine headaches was explored using logistic regression analysis. Of 55 subjects with migraine headaches at baseline, 41.8% had persistent migraine, 38.2% had experienced remission, and 20.0% transformed to tension-type headache. Only migraine without aura persisted in the same IHS code after 10 years, whereas migrainous disorder and nonclassifiable headache did not. The family history of migraine significantly predicted the 10-year persistence of migraine headaches (odds ratio [OR] = 7.0; 95% CI: 1.7 to 26.8). The risk persisted when only subjects with migraine with or without aura were evaluated (OR = 5.0; 95% CI: 1.2 to 20.9). Migraine headaches in adolescents have a favorable long-term prognosis. Familial disposition for migraine predicted a poorer outcome, especially in subjects with migraine without aura.

Clinical Outcome and Reversibility of Systolic Dysfunction in Patients With Dilated Cardiomyopathy Due to Hypertension and Chronic Heart Failure

There is little information on the clinical and functional course of patients with heart failure secondary to dilated cardiomyopathy due to hypertension. The objectives of our study were to assess the clinical and functional course of these patients, and to identify possible predictors of prognosis. We evaluated a series of 49 patients with this condition diagnosed in our hospital from 1994 to 2003. Mean age was 63(11) years, and 40% were women. Left ventricular ejection fraction was 30.1(4.8)%. Follow-up was 45(23) months (median, 41 months). Four-year survival was 0.84, the 4-year rate of hospitalization due to heart failure was 0.12, and likelihood of readmission-free survival was 0.80 at 4 years. Left ventricular ejection fraction increased from 30.1(4.8)% to 57.6(13.5)% (P< .001). An unfavorable clinical and functional outcome at 4 years (death, readmission for heart failure or persistence of dilated cardiomyopathy) was recorded in only in 40% of the patients. Multivariate analysis with the Cox model showed appropriate control of blood pressure to be the only independent predictor of a favorable clinical outcome (absence of death or readmission for heart failure) (hazard ratio = 4.58; 95% CI, 1.32-9.83; P=.032). The course of patients with severe dilated cardiomyopathy due to hypertension was favorable in 60% of cases. Adequate control of blood pressure was the only independent predictor of a favorable clinical outcome.