Prognosis Of Different Groups Research Articles

Characteristics of type 2 inflammation in nocturnal asthma and evaluation of the effectiveness of inhaled corticosteroids combination therapy

Objective: To investigate the characteristics of type 2 inflammation in patients with nocturnal asthma, and analyze the improvement of asthma symptoms after the use of inhaled corticosteroids (ICS) combined with different long-acting bronchodilators. Methods: Data of 231 asthma patients who first visited the Respiratory and Critical Care Medical Clinic of Nanfang Hospital of Southern Medical University from January 2020 to June 2023 and had positive bronchodilator tests (BDT), were retrospectively analyzed. These patients were divided into nocturnal asthma group and non-nocturnal asthma group based on the presence or absence of nocturnal symptoms. According to fractional exhaled nitric oxide (FeNO) levels, patients were divided into type 2 inflammatory group [FeNO≥20 ppb (×10-12)] and non-type 2 inflammatory group (FeNO<20 ppb). Patients were further divided into ICS+long-actingβ2 agonist (LABA) group and ICS+LABA+long-acting anticholinergic agent (LAMA) group based on medication regimens. Patients were followed-up at the 3rd, 6th, and 12th months after enrollment to evaluate the patient's asthma control test (ACT) questionnaire, actual medication status and number of acute attacks. The clinical characteristics, treatment and prognosis of different groups were compared. Results: A total of 231 asthma patients were included, including 152 males and 79 females, with a age[M (Q1, Q3)] of 52 (42, 60) years. There were 144 cases (62.3%) in the nocturnal asthma group and 87 cases (37.7%) in the non-nocturnal asthma group. Among the 144 patients with nocturnal asthma, 133 patients completed FeNO testing, of which 95 were classified into the type 2 inflammation group and 38 to the non-type 2 inflammation group. The eosinophil (EOS) count and FeNO level in the nocturnal asthma group were both higher than those in the non-nocturnal asthma group [(0.45±0.40) ×109/L vs (0.25±0.20)×109/L, 38 (18, 82) vs 29 (15, 48) ppb, both P<0.05]. Baseline ACT score was lower in nocturnal asthma group than in non-nocturnal asthma group [16 (14, 18) vs 21 (19, 23) scores, P<0.001]. There was no significant difference in the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) in the two groups (both P>0.05). During the follow-up at the 3rd, 6th, and 12th months, the improvement values of ACT scores (ΔACT) in the nocturnal asthma group were higher than the non-nocturnal asthma group [5 (3, 7) vs 2 (1, 3), 7 (4, 9) vs 3 (1, 4) and 7 (6, 9) vs 3 (1, 5) scores, all P<0.05]. The EOS count [0.40 (0.29, 0.80)×109/L vs 0.20 (0.12, 0.29)×109/L] and percentage [5.10% (3.55%, 9.10%) vs 2.20% (1.65%, 3.85%)] of the type 2 inflammation group were both higher than the non-type 2 inflammation group (both P<0.05). In the nocturnal asthma group, there was no significant difference in ΔACT between ICS+LABA and ICS+LABA+LAMA groups (both P>0.05). Conclusions: Patients with nocturnal asthma have more pronounced type 2 inflammation and the symptoms are often not well controlled or even worse. After one year of combined therapy with ICS, significant improvements in asthma symptoms can be observed. But there is no significant difference in symptom improvement among different medication regimens in the nocturnal asthma group.

Clinical characteristics and prognosis analysis of pulmonary sarcomatoid carcinoma

Objective: To summarize the clinical characteristics, treatment, and outcomes of patients with pulmonary sarcomatoid carcinoma (PSC) in order to improve clinicians' understanding of this disease. Methods: The clinical data of patients diagnosed with PSC in our hospital from January 1, 2015 to November 30, 2023 were retrospectively analyzed. According to whether radical resection was performed, the patients were divided into resectable group and unresectable group. The characteristics and treatments of PSC in different groups were compared. The survival curves were drawn by Kaplan-Meier method to compare the prognosis of different groups of patients. Results: A total of 43 PSC patients were included, including 32 males, with an average age of (62.79±9.59) years, and 31 smokers. Peripheral-type tumors were more common, with imaging showing predominantly solid soft tissue masses, and the maximum diameter of the tumor was more than 5 cm in 14 patients. Among the 23 patients who underwent NGS gene testing, the KRAS mutation rate was 43.5%, the TP53 mutation rate was 30.4%, and the MET mutation rate was 8.7%, all of which were MET-14 exon skipping mutations. PD-L1 expression was detected in 13 patients, 10 of whom showed high expression. The median overall survival (mOS) of the 43 patients with PSC was 24.6 months (13.0-52.7 months). Among them, 22 patients underwent radical lobectomy plus mediastinal lymph node dissection, 13 patients had postoperative recurrence, and 7 patients died during follow-up. The median disease-free survival (mDFS) was 12.3 months, the mOS was not achieved and the 1-year OS rate was 77.3 %. Twenty-one patients had unresectable locally advanced or advanced stage, and 15 patients died. The mDFS was 2.5 months, the mOS was 6.2 months, and the 1-year OS rate was 42.9 %. Seventeen patients received immunotherapy, and 1 patient received targeted therapy with the MET inhibitor glumetinib. Conclusions: PSC has a higher incidence in the elderly, smokers, and males, is highly malignant and has a poor prognosis. Based on its molecular biological characteristics, PD-L1 expression and tumor molecular detection can be performed to guide treatment options.

Potential interplay between tumor size and vitamin D receptor (VDR) polymorphisms in breast cancer prognosis: a prospective cohort study.

Vitamin D has some anticancer properties that may decrease breast cancer risk and improve prognosis. The aim was to investigate associations between four previously studied VDR SNPs (Taq1, Tru91, Bsm1, and Fok1) and prognosis in different groups of breast cancer patients. VDR genotyping of 1,017 breast cancer patients included 2002-2012 in Lund, Sweden, was performed using Oncoarray. Follow-up was until June 30, 2019. Clinical data and patient information were collected from medical records and questionnaires. Cox regression was used for survival analyses. Genotype frequencies were as follows: Fok1 (AA 15.7%, AG 49.1%, GG 35.1%), Bsm1 (CC 37.2%, CT 46.1%, TT 16.7%), Tru91 (CC 77.8%, CT 20.7%, TT 1.5%), and Taq1 (AA 37.2%, AG 46.2%, GG 16.6%). During follow-up there were 195 breast cancer events. The homozygous variants of Taq1 and Bsm1 were associated with reduced risk of breast cancer events (adjusted HR = 0.59, 95% CI 0.38-0.92 for Taq1 and adjusted HR = 0.61, 95% CI 0.40-0.94 for Bsm1). The G allele of the Fok1 was associated with increased risk of breast cancer events in small tumors (pT1, adjusted HR = 1.83, 95% CI 1.04-3.23) but not in large tumors (pT2/3/4, adjusted HR = 0.80, 95% CI 0.41-1.59) with a borderline interaction (Pinteraction = 0.058). No interactions between VDR genotypes and adjuvant treatments regarding breast cancer prognosis were detected. VDR genotypes were associated with breast cancer prognosis and the association might be modified by tumor size. Further research is needed to confirm the findings and elucidate their potential clinical implications.

HER2-positive is an independent indicator for predicting pathological complete response to neoadjuvant therapy and Ki67-changed after neoadjuvant chemotherapy predicts favorable prognosis in Chinese women with locally advanced breast cancer.

The growing body of evidence suggests that breast cancer (BC) who achieve pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) may experience a more favorable prognosis. The objective of this study is to investigate the correlation between clinicopathologic parameters of locally advanced breast cancer (LABC) patients and the outcomes of NAC, with the aim of identifying predictive indicators for pCR. Additionally, we seek to examine the conversion of IHC markers in pCR patients following NAC and its impact on the prognosis of BC patients. We conducted a study involving 126 patients with LABC. Clinicopathological parameters associated with pCR were subjected to univariate and multivariate analysis. Kaplan-Meier (KM) curves and the log-rank test were used to compare the statistical difference in prognosis in different groups of patients. Additionally, we used difference and consistency tests to examine the conversion of immunohistochemistry (IHC) markers following NAC. The status of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and molecular subtypes of BC were associated with pCR in the univariate analysis (all P < .05), which may be potential markers to predict pCR. HER2 was identified as an independent factor for predicting pCR in the multivariate analysis. The pCR rate of HER2-positive patients who received NAC combined targeted therapy was higher than that of patients who only received NAC (P = .003). The disease-free survival (DFS) rate of TNBC patients who achieved pCR was significantly higher than that of non-pCR TNBC patients (P = .026). The IHC marker conversion after NAC mainly existed in PR (P = .041). Ki67 expression decreased in the luminal B subtype and increased in the HER2 enriched subtype after NAC (all P < .001). Patients with Ki67 expression change after NAC had longer overall survival (OS) and DFS than unchanged patients (all P < .05). HER2-positive is an independent indicator for predicting pCR, and HE2-positive patients who received NAC combined targeted therapy were favorable to achieving pCR. IHC markers of BC patients exhibit varying degrees of alterations after NAC, and changes in Ki67 expression after NAC could serve as a marker to predict a better prognosis.

Prognostic impact of PTK6 expression in triple negative breast cancer

BackgroundThe aim of this study was to investigate the expression of PTK6 in different groups of triple negative breast cancer and its impact on prognosis.MethodsRetrospective study of a total of 209 surgical specimens of breast cancer were identified by IHC or FISH methods as triple negative,and divided into a lymph node metastasis positive (LNM +)group (n = 102) and a lymph node metastasis negative(LNM-) group (n = 107) according to the lymph node status of the surgical specimen. PTK6 expression was detected by IHC technique in all surgical specimens. PTK6 expression and clinicopathological features was explored by Chi-square test. The prognosis of different groups of patients was analyzed by Kaplan–Meier survival analysis and COX analysis.ResultsThe incidence of PTK6 expression in the LNM + group (78.4%) was significantly higher than in the LNM- group (28%). Clinicopathological analysis showed that PTK6 expression in the LNM + group was negatively correlated with the 5-year survival of patients. Kaplan–Meier analysis showed that only PTK6 expression in the LNM + group was negatively correlated with OS and DFS. COX analysis also showed that PTK6 expression and N stage were independent prognostic factors for DFS in the LNM + group. No correlation was observed between HER2 and PTK6 expression in any of the groups.ConclusionsThis study suggests that PTK6 promotes tumor development and was associated with poor prognosis in the LNM + group of triple negative breast cancer. Inhibition of PTK6 may be a new approach for the treatment of triple negative breast cancer patients, especially those with metastasis.

Correlation of blood cell counts with mutant subtypes and impact prognosis in acute myeloid leukemia patients with FLT3 mutations

ABSTRACTObjectivesAcute myeloid leukemia (AML) often presents with abnormal blood cell counts and gene mutations at diagnosis. But, the correlation between blood cell counts and gene mutations and the clinical effects on AML is unclear.Methods279 AML patients with FMS-like tyrosine kinase 3(FLT3) mutations were selected. Patients with FLT3 mutations were counted by PCR amplification products direct sequencing and second-generation sequencing (NGS), and blood cell counts at the time of initial diagnosis. The relapse-free survival (RFS) and overall survival (OS) and the influence of the clinical characteristics of patients on the prognosis in different groups were analyzed.ResultsThe median of platelet (PLT) count was higher in the TET2 non-mutation group than mutation group and higher in the IDH1/2 mutation group than non-mutation group. The median of white blood cell (WBC) count was reduced in the poor prognosis group. The differences in levels of WBC and PLT count varied among the four groups binding sequence (JM-B), switching sequence (JM-S), zipper sequence (JM-Z), and high chain region (JM-H). The differences in PLT count varied between the insertion length ≥39 bp and <39 bp, and between ≥ 50 bp and <50 bp; The OS and RFS in 10 < WBC (×109/L) < 100 group and in the 30 ≤ PLT (×109/L)<80 group were better.ConclusionsIn AML patients with FLT3 mutations, the location of FLT3 mutations and the type of co-mutated genes may be correlated with blood cell counts, and different blood cell counts may have an impact on the prognosis.

Conversion therapy with the intent to perform radical local treatment may not be suitable for patients with 10 or more liver metastases from colorectal cancer.

The number of colorectal cancer liver metastases (CRLMs) is usually considered a contradictory indicator to surgical resection. However, some patients with initially unresectable CRLMs can receive radical local treatment after conversion therapy. This study aimed to evaluate the effect of radical local treatment after conversion therapy and the prognosis of patients with more than 10 initially unresectable CRLMs. Data for a total of 229 patients with initially unresectable CRLMs were retrospectively reviewed between December 2012 and January 2020. Among these patients, 107 had ≥10 CRLMs, and 122 had <10 CRLMs. Overall survival (OS) and progression-free survival (PFS) were used to reflect the prognosis of different groups of patients. Conversion therapy was defined as an initially unresectable liver metastasis converted into an R0 resectable lesion after systemic chemotherapy. Radical local treatment included hepatectomy and radiofrequency ablation (RFA). Patients with ≥10 CRLMs had a lower conversion rate (42.7% vs. 56.6%, p=0.001). Baseline clinical N stage 1-2, ≥8 first-line chemotherapy courses, and stable disease (SD) according to the Response Evaluation Criteria in Solid Tumours (RECIST) were independent factors predictive of conversion failure. Primary tumour location in the right colon, RECIST response of SD, and the absence of targeted therapy were independent factors predictive of unfavourable OS. The survival curves revealed that the OS of patients with or without conversion could be distinguished only among patients with <10 CRLMs (89.9% [95% CI, 82.5%-98.0%] vs. 58.9% [95% CI, 45.2%-76.7%], p < 0.001); this cut-off point could also distinguish patients with a successful conversion outcome according to OS (89.9% [95% CI, 82.5-98.0%] vs. 58.2% [95% CI, 42.2-80.4%], p=0.008). For CRLMs ≥ 10, patients with a successful conversion outcome cannot be distinguished from those without successful conversion outcome according to OS. Thus, conversion therapy with the intent to perform radical local treatment may not be suitable for patients with 10 or more liver metastases from colorectal cancer.

Types of obesity and their impact on long-term outcomes in patients with cardiovascular disease

Large prospective studies involving several hundred thousands to several million people from the general population have shown that people with obesity have a higher overall mortality rate than people with a normal BMI. The use of BMI in predicting the prognosis of people with cardiovascular disease has led to the inverse relationship between BMI and risk of death. Obesity, determined by BMI, is very heterogeneous in determining prognosis in different groups of patients. The use of imaging techniques during the examination revealed that poor health effects are associated with the accumulation of visceral adipose tissue. New evidence also suggests that ectopic deposition of fat (in the liver, in the epicardium) may increase the risk of developing atherosclerosis and cardiovascular disease and type 2 diabetes. The number of studies examining the direct effect of visceral adipose tissue on mortality is very limited. Their results are extremely contradictory, based not on prospective observations, but on the construction of statistical models. Adipose tissue is currently considered as an endocrine and paracrine organ. Deposition of adipose tissue in the internal organs, in addition to metabolic disorders), probably leads to the formation of local adverse effects. The above data lead us to the conclusion that it is necessary to create a new classification that would improve the stratification of the risk of developing cardiovascular disease and death in people with obesity.

Types of obesity and their prognostic value

Large prospective studies involving several hundred thousands to several million people from the general population have shown, that people with obesity have a higher overall mortality rate than people with a normal BMI. The use of BMI in predicting the prognosis of people with cardiovascular disease has led to the inverse relationship between BMI and risk of death. Obesity, determined by BMI, is very heterogeneous in determining prognosis in different groups of patients. The use of imaging techniques during the examination revealed that poor health effects are associated with the accumulation of visceral adipose tissue. New evidence also suggests that ectopic deposition of fat (in the liver, in the epicardium) may increase the risk of developing atherosclerosis and cardiovascular disease and type 2 diabetes. The number of studies examining the direct effect of visceral adipose tissue on mortality is very limited. Their results are extremely contradictory, based not on prospective observations, but on the construction of statistical models. The above data lead us to the conclusion that it is necessary to create a new classification that would improve the stratification of the risk of developing cardiovascular disease and death in people with obesity. • Despite the advantages of using CT and MRI, these methods are expensive, not available in general clinical practice, and, in particular, CT has a radiation load. In addition to CT and MRI, the method of bioimpedance analysis and determination of neck circumference showed good results in determining visceral obesity. • In contrast to visceral obesity, the accumulation of adipose tissue in the buttocks and thighs (gluteo-femoral obesity) is associated with a decrease in the risk of developing cardiovascular diseases, myocardial infarction , type 2 diabetes mellitus and cancer, as well as with the best indicators of lipid metabolism. • The results indicate the need to identify visceral obesity and to form a classification of obesity based on the presence of visceral obesity, and not just BMI.

Prognostic significance of clinical parameters in patients with cerebral low-grade glioma

Introduction/Objective. Low-grade gliomas affect younger adults and carry a favorable prognosis. We aim to describe clinical patterns of low-grade gliomas as well as prognosis in different groups of patients. Our intention was to determine clinical parameters that may affect prognosis, and whether a greater extent of resection would increase the long-term progression-free or overall survival of patients with low-grade gliomas. Methods. We analyzed data obtained from the files of the patients with a diagnosis of the World Health Organization classification grade II gliomas. The relationships among categorical variables were analyzed using standard statistical tools and a 95% confidence interval. Results. We analyzed 118 patients with median age of 34 years. Over 57% were male and the primary site location was the cerebrum. All these patients were operated on and some of them received radiation and/ or chemotherapy. Median overall survival was 9.6 years and better prognosis is associated with younger age, frontal and noneloquent zone location, seizures as the first symptom of the disease, and gross total resection of the tumor. Indications for early surgery are increased intracranial pressure, preoperative neurologic deficit, tumor size larger than 6 cm with contrast enhancement, and older age. Conclusion. Tumor location, 1p/19q co-deletion, and age were the main determinants of treatment received and overall survival, likely reflecting tumor biology differences. Any form of treatment was preferred over watchful waiting. This study found that a greater extent of resection could significantly increase the overall survival of patients with low-grade gliomas.

Clinical analysis of 16 children with traumatic basal ganglia stroke

Objective: To investigate the clinical characteristics and risk-factors of traumatic basal ganglia stroke (TBGS) in children. Methods: A retrospective case study was conducted to analyze the clinical and imaging data of 16 children with TBGS in the First Hospital of Jilin University from January 2014 to June 2017. A total of 16 TBGS cases (11 males, 5 females) were diagnosed and the age ranged from 0.5 to 13.0 years. The prognosis of children with TBGS at different ages (≥5 years and<5 years) and with different traumatic stroke (infarction and hemorrhage) were compared. Fisher 's test was used to compare the prognosis of different groups. Results: All cases had clear history of head trauma and varying degrees of limb paralysis after injury, including 4 cases of facial paralysis, 3 cases of consciousness disturbance and 1 case of seizures. Head CT scan of the 16 cases showed 11 cases of ischemic stroke and 5 cases of hemorrhagic stroke. Moreover, scattered calcification was observed in the bilateral basal ganglia point of 8 cases. Neurotrophic treatment, microcirculation improvement and nerve rehabilitations were given according to the clinical and imaging data. One patient was treated with craniotomy and hematoma clearance. Of the 16 cases, 11 cases were restored to normal, while 3 cases developed limb paralysis and 2 cases died. The prognosis of 11 cases of traumatic basal ganglia infarction (10 cases recovered and 1 case remained hemiplegic) was relatively better than that of 5 cases of hemorrhage (1 case recovered, 2 cases remained hemiplegic and 2 cases died) (χ(2)=8.045, P=0.013). In addition, the children younger than 5-year-old (all 8 cases recovered) had a better prognosis than the children older than 5-year-old (8 cases, 3 of whom recovered, 3 cases remained hemiplegia, 2 cases died)(χ(2)=12.121, P<0.01). Conclusions: The anatomical characteristics of basal ganglia and calcification of the lenticulostriate artery are risk-factors for TBGS in children. The prognosis of infarcted children and younger children is relatively better.

Prognosis of thymectomy in myasthenia gravis patients with thymus hyperplasia

Purpose: To compare the post-thymectomy prognosis in different conditions of myasthenia gravis (MG) patients with thymus hyperplasia. Materials and methods: Collecting medical record and carrying out the follow-up study of 123 myasthenia gravis patients with thymus hyperplasia who have underwent thymectomy during the period between 2003 and 2013. Dividing into different groups based on gender, age of onset, duration of disease and Myasthenia Gravis Association of America (MGFA) clinical classification to analyze different prognosis in different groups. Results: Complete stable remission (CSR) was achieved in 71 of 123 patients (59.5%). There is no gender-related difference in achieving CSR. Patients with early onset of MG (≤40 years old) or disease duration less than 12 months had significantly higher CSR rates than those with late onset of MG (>40 years old) or disease duration more than 12 months respectively, while no difference was found in remission rate between MGFA clinical classification I and MGFA II. Conclusion: Myasthenia gravis patients with thymus hyperplasia who had thymectomy are proved to possess greater chance of achieving CSR. The onset age of disease and duration are the prognostic factors.

Chronic Kidney Disease Progression and Outcome According to Serum Phosphorus in Mild-to-Moderate Kidney Dysfunction

Several factors might alter serum phosphate homeostasis and induce hyperhosphatemia in patients with chronic kidney disease (CKD) not requiring dialysis. However, whether and to what extent hyperphosphatemia is associated with a poor prognosis in different CKD patient groups remain to be elucidated. We utilized the "Prevenzione Insufficienza Renale Progressiva" (PIRP) database, a large project sponsored by the Emilia-Romagna Health Institute. PIRP is a collaborative network of nephrologists and general practitioners located in the Emilia-Romagna region, Italy, aimed at increasing awareness of CKD complications and optimizing CKD patient care. We identified 1716 patients who underwent a GFR and serum phosphorous assessment between 2004 and 2007. We tested whether phosphate levels ≥4.3 mg/dl are associated with the risk of CKD progression or all causes of death. Older age and male sex were associated with lower phosphate levels. Instead, higher phosphate levels were noted in patients with diabetes. Patients with phosphate levels ≥4.3 mg/dl were at an increased risk of starting dialysis or dying (hazard ratio 2.04; 95% confidence interval [1.44, 2.90]). Notably, subgroup analyses revealed that the magnitude of the risk associated with hyperphosphatemia varied depending on age, sex, diabetes, and different stages of CKD. These analyses lend support to the hypothesis that phosphorous abnormalities might have a negative effect on the residual renal function and prognosis in different groups of CKD patients. However, the risk associated with hyperphosphatemia might vary in specific CKD patient subgroups.

Molecular screening of interleukin-6 gene promoter and influence of −174G/C polymorphism on breast cancer

Interleukin-6 (IL-6) is a cytokine involved in different physiologic and pathophysiologic processes including carcinogenesis. In 2003, a single nucleotide polymorphism (−174G/C) of the IL-6 gene promoter has been linked to breast cancer prognosis in node-positive (N+) breast cancer patients. Since, different studies have led to conflicting conclusions about its role as a prognostic and/or diagnostic marker. The primary aim of our study was to investigate the link between −174G/C polymorphism and breast cancer risk on the one hand, and −174G/C polymorphism and prognosis in different groups of patients: sporadic N+ breast cancers ( n = 138), sporadic N− breast cancers ( n = 95) and familial breast cancer ( n = 60) on the other hand. The variables of interest were disease-free survival and overall survival. The secondary aim of the study was to screen IL-6 gene promoter using direct sequencing to identify new polymorphisms in our French Caucasian breast cancer population. No association or trend of association between −174G/C polymorphism of IL-6 gene promoter gene and breast cancer diagnosis or prognosis was shown, even in meta-analyses. Furthermore, we have identified four novel polymorphic sites in the IL-6 gene promoter region: −764G → A, −757C → T, −233T → A, 15C → A.