Prognosis Outcome Research Articles

A multiplex protein panel assay for severity prediction and outcome prognosis in patients with COVID-19: An observational multi-cohort study.

SummaryBackgroundGlobal healthcare systems continue to be challenged by the COVID-19 pandemic, and there is a need for clinical assays that can help optimise resource allocation, support treatment decisions, and accelerate the development and evaluation of new therapies.MethodsWe developed a multiplexed proteomics assay for determining disease severity and prognosis in COVID-19. The assay quantifies up to 50 peptides, derived from 30 known and newly introduced COVID-19-related protein markers, in a single measurement using routine-lab compatible analytical flow rate liquid chromatography and multiple reaction monitoring (LC-MRM). We conducted two observational studies in patients with COVID-19 hospitalised at Charité – Universitätsmedizin Berlin, Germany before (from March 1 to 26, 2020, n=30) and after (from April 4 to November 19, 2020, n=164) dexamethasone became standard of care. The study is registered in the German and the WHO International Clinical Trials Registry (DRKS00021688).FindingsThe assay produces reproducible (median inter-batch CV of 10.9%) absolute quantification of 47 peptides with high sensitivity (median LLOQ of 143 ng/ml) and accuracy (median 96.8%). In both studies, the assay reproducibly captured hallmarks of COVID-19 infection and severity, as it distinguished healthy individuals, mild, moderate, and severe COVID-19. In the post-dexamethasone cohort, the assay predicted survival with an accuracy of 0.83 (108/130), and death with an accuracy of 0.76 (26/34) in the median 2.5 weeks before the outcome, thereby outperforming compound clinical risk assessments such as SOFA, APACHE II, and ABCS scores.InterpretationDisease severity and clinical outcomes of patients with COVID-19 can be stratified and predicted by the routine-applicable panel assay that combines known and novel COVID-19 biomarkers. The prognostic value of this assay should be prospectively assessed in larger patient cohorts for future support of clinical decisions, including evaluation of sample flow in routine setting. The possibility to objectively classify COVID-19 severity can be helpful for monitoring of novel therapies, especially in early clinical trials.FundingThis research was funded in part by the European Research Council (ERC) under grant agreement ERC-SyG-2020 951475 (to M.R) and by the Wellcome Trust (IA 200829/Z/16/Z to M.R.). The work was further supported by the Ministry of Education and Research (BMBF) as part of the National Research Node ‘Mass Spectrometry in Systems Medicine (MSCoresys)', under grant agreements 031L0220 and 161L0221. J.H. was supported by a Swiss National Science Foundation (SNSF) Postdoc Mobility fellowship (project number 191052). This study was further supported by the BMBF grant NaFoUniMedCOVID-19 – NUM-NAPKON, FKZ: 01KX2021. The study was co-funded by the UK's innovation agency, Innovate UK, under project numbers 75594 and 56328.

Multivariable prediction models for long-term outcomes after hip fracture: A protocol for a systematic review

Background: Hip fracture results in high mortality and, for many survivors, long-term functional limitations. Multivariable prediction models for hip fracture outcomes have the potential to aid clinical-decision making as well as risk-adjustment in national audits of care. The aim of this study is to identify, critically appraise and synthesise published multivariable prediction models for long-term outcomes after hip fracture. Protocol: The systematic review will include a literature search of electronic databases (MEDLINE, Embase, Scopus, Web of Science and CINAHL) for journal articles. Search terms related to hip fracture, prognosis and outcomes will be included. Study selection criteria includes studies of people with hip fracture where the study aimed to predict one or more long-term outcomes through derivation or validation of a multivariable prediction model. Studies will be excluded if they focus only on the predictive value of individual factors, or only include patients with periprosthetic fractures, fractures managed non-surgically or younger patients. Covidence software will be used for data management. Two review authors will independently conduct study selection, data extraction and appraisal. Data will be extracted based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist. Risk of bias assessment will be conducted using the Prediction model Risk of Bias Assessment Tool (PROBAST). Characteristics and results of all studies will be narratively synthesised and presented in tables. Where the same model has been validated in multiple studies, a meta-analysis of discrimination and calibration will be conducted. Conclusions: This systematic review will aim to identify multivariable models for hip fracture outcome prognosis that have been derived using high quality methods. Results will highlight if current models have the potential for further assessment for use in both clinical decision making and improving methods of national hip fracture audits. PROSPERO registration: CRD42022330019 (25th May 2022).

Patients With Better Outcome Have Higher ERP Response to Emotional Auditory Stimuli.

Accuracy of outcome prognosis is one of the most important tasks of coma arousal therapy. Reactions toward sensory stimuli are the most significant predictor of conscience and cognitive functions restoration after a brain injury. A paradigm that includes ERP registration has the advantage of detailed stimuli processing visualization. The authors aimed to investigate perception and distinguishing of emotionally significant sounds (crying and laughter) in coma patients with different consciousness restoration prognosis. EEG was recorded in 24 comatose patients with different outcomes (scored with Glasgow Outcome Scale-Extended) and 32 healthy volunteers. The authors presented sounds of crying and laughter. ERPs for sound stimulation were calculated. An analysis of the correlation of ERP components and Glasgow Outcome Scale-Extended score was performed. P200 (r = 0.6, P = 0.0014) and N200 amplitudes (r = -0.56, P = 0.0037) for emotional sounds correlated with the Glasgow Outcome Scale-Extended score. The significant differences of P300 and N400 amplitudes corresponded to differences of response between sounds of crying and laughter in subjects of the control group. Unlike the control group, comatose participants with good outcome produced similar electrical activity toward pleasant and unpleasant emotional stimuli. Comatose patients with good outcome produced more prominent ERP for emotional sounds. Even the good outcome participants were unable to distinguish emotional sounds of different moods, which indicate the preservation of solely robust mechanisms of sound processing. N200 and P200 amplitudes for emotional stimuli correlated significantly with outcome prognosis in coma patients.

Endothelins and liver cirrhosis

AbstractEndothelins are a family of 21‐amino acid oligopeptides, called endothelin‐1 (ET‐1), endothelin‐2 (ET‐2), and endothelin 3 (ET‐3). Endothelins act on hepatocytes, liver endothelial cells, and Kupffer cells in a paracrine or autocrine manner through two G protein‐coated receptors, called endothelin A and B receptors, which are mainly located in interlobular veins, interlobular artery endothelial cells and hepatic stellate cells (HSCs). ET B receptor (ETBR)‐1 is responsible for the induction of endothelial nitric oxide synthase, resulting in nitric oxide release and vasodilatation, whereas ETBR‐2 is located on HSCs and is responsible for vasoconstriction. Endothelins are not stored in the organs. Approximately 20% of endothelins are secreted into the circulation system, and are rapidly cleared by the lungs, liver, heart, and kidneys. As a potent vasoconstrictor, endothelins may have a key role for the treatment of hypertensive vascular diseases, inflammation, fibrosis, and metabolic diseases. By clearing ET‐1 from the circulation, endothelin A receptor (ETAR) antagonists can reduce intraportal vascular resistance by dilatating the portal vein, reducing the contraction of HSCs, increasing the diameter of sinusoids, facilitating the regression of liver fibrosis, and restoring liver parenchyma. ET‐1 induces nitric oxide synthase and upregulates cyclooxygenase 2 mRNA levels, making it a key factor during the onset of fibrosis and in the prognosis of patient outcomes. Endothelins can be used to treat porto‐pulmonary hypertension, portal hypertension, angiogenesis, and liver fibrosis and have been approved for the treatment of porto‐pulmonary hypertension. Endothelins are produced on mesangial cells, podocytes, tubular epithelium, and renal collecting tubes in high amounts. Activation of ETAR supports the progression of kidney diseases, whereas activation of ETBR has protective effects on the kidneys. ET‐1 plays an important role in normal cardiovascular homeostasis. Endothelins are closely associated with severe systemic hypertension, congestive heart failure, atherosclerosis, and pulmonary hypertension. Dual ET receptor antagonists reduce blood pressure, but have several side effects, including liver toxicity, acute liver failure, accumulation of salt and water, testicular toxicity, headache, and teratogenicity. Liver enzymes should be checked in all patients who have received ET receptor antagonists, and women of childbearing years should use contraception.

MiR-6124: A potential new prognosis biomarker for lung squamous cell carcinoma through m5C regulating mechanism.

e20568 Background: RNA methylation is an important epigenetic modification that can act as tumor prognosis biomarkers, and which is regulated by methyltransferase, RNA binding protein, and demethylase. 5-Methylcytosine (m5C) is a well-known post-transcriptional modification that plays an important role in cell differentiation and apoptosis. Although gene mutations in those regulator genes are associated with various cancers, the m5C regulating mechanism and its roles in cancer prognosis largely remains unknown. This study aimed to find new microRNA biomarkers associated with prognosis of clinical outcomes through m5C regulating mechanism in lung squamous cell carcinoma (LUSC). Methods: The RNA-seq expression data of LUSC were collected from the The Cancer Genome Atlas (TCGA). In total, we obtained 501 LUSC tumor samples and 49 normal samples from 502 LUSC patients. We firstly identified differential expressed genes of the 13 previously reported m5C regulators between the tumor tissues and adjacent normal tissues. Then miRNAs were identified using Pearson correlation analysis between the microRNA expression and the differential expressed m5C regulator genes. Pathway enrichment analysis of the miRNAs was performed using clusterProfiler to examine their cancer development roles. Furthermore, cox regression analysis was used to evaluate the risk factor for overall survival. Targeted relationship between miRNA and genes were confirmed by miRTarBase. Results: Differential analysis revealed 4 significantly up-regulated (NOP2, NSUN2, DNMT3B and ALYREF) genes in tumor among 13 interested m5C regulators. Pearson correlation analysis identified 39 correlated miRNAs. After cox regression, we found out one micro-RNA miR-6124, which is highly correlated with DNMT3B gene and is significantly associated with worse overall survival (OS, p < 0.01). We then identified the regulatory targets of miR-6124 using miRTarBase database. In total we identified 181 target genes. Among them, H3F3A which encode histone H3 synergistically work with DNMT3B gene as showed in the previous studies and promote DNA methylation of the oncogenes. Such preliminary results showed miR-6124 may be involved in cancer pathway regulating and was a potential prognosis biomarker candidate in LUSC. Conclusions: We identified a potential new prognosis biomarker in lung squamous cell carcinoma. The identified miR-6124 is involved in DNMT3B and m5C regulating mechanism. Further evidences are needed to study its’ role in clinical applications.

131 Surgical features of adolescent girls with genital anomalies

The incidence of Müllerian anomalies is 0.2–0.4% in the general population and 3-13% among patients with infertility. Uterine malformations can interfere with implantation and placentation, resulting in infertility or complications during pregnancy. The prognosis of reproductive outcomes depends not only on the type of defect and the level of impairment, but also on the concomitant gynecological pathology and complications. Therefore, there is no doubt that a timely diagnosed pathology and performed surgical intervention can facilitate the solution of issues of future pregnancy and childbirth in such patients.

Additive Impact of Interleukin 6 and Neuron Specific Enolase for Prognosis in Patients With Out-of-Hospital Cardiac Arrest – Experience From the HAnnover COoling REgistry

BackgroundPatients after out-of-hospital cardiac arrest (OHCA) are at increased risk for mortality and poor neurological outcome. We assessed the additive impact of interleukin 6 (IL-6) at admission to neuron-specific enolase (NSE) at day 3 for prognosis of 30-day mortality and long-term neurological outcome in OHCA patients.MethodsA total of 217 patients from the HAnnover COoling REgistry with return of spontaneous circulation (ROSC) after OHCA and IL-6 measurement immediately after admission during 2017–2020 were included to investigate the prognostic value and importance of IL-6 in addition to NSE obtained on day 3. Poor neurological outcome was defined by cerebral performance category (CPC) ≥ 3 after 6 months.ResultsPatients with poor outcome showed higher IL-6 values (30-day mortality: 2,224 ± 524 ng/l vs 186 ± 15 ng/l, p < 0.001; CPC ≥ 3 at 6 months: 1,440 ± 331 ng/l vs 180 ± 24 ng/l, p < 0.001). IL-6 was an independent predictor of mortality (HR = 1.013/ng/l; 95% CI 1.007–1.019; p < 0.001) and poor neurological outcome (HR = 1.004/ng/l; 95% CI 1.001–1.007; p = 0.036). In ROC-analysis, AUC for IL-6 was 0.98 (95% CI 0.96–0.99) for mortality, but only 0.76 (95% CI 0.68–0.84) for poor neurological outcome. The determined cut-off value for IL-6 was 431 ng/l for mortality (NPV 89.2%). In patients with IL-6 > 431 ng/l, the combination with NSE < 46 μg/l optimally identified those individuals with potential for good neurological outcome (CPC ≤ 2).ConclusionElevated IL-6 levels at admission after ROSC were closely associated with 30-day mortality. The combination of IL-6 and NSE provided clinically important additive information for predict poor neurological outcome at 6 months.

22q11.2 Deletion Syndrome: Impact of Genetics in the Treatment of Conotruncal Heart Defects.

Congenital heart diseases represent one of the hallmarks of 22q11.2 deletion syndrome. In particular, conotruncal heart defects are the most frequent cardiac malformations and are often associated with other specific additional cardiovascular anomalies. These findings, together with extracardiac manifestations, may affect perioperative management and influence clinical and surgical outcome. Over the past decades, advances in genetic and clinical diagnosis and surgical treatment have led to increased survival of these patients and to progressive improvements in postoperative outcome. Several studies have investigated long-term follow-up and results of cardiac surgery in this syndrome. The aim of our review is to examine the current literature data regarding cardiac outcome and surgical prognosis of patients with 22q11.2 deletion syndrome. We thoroughly evaluate the most frequent conotruncal heart defects associated with this syndrome, such as tetralogy of Fallot, pulmonary atresia with major aortopulmonary collateral arteries, aortic arch interruption, and truncus arteriosus, highlighting the impact of genetic aspects, comorbidities, and anatomical features on cardiac surgical treatment.

Immunopsychiatry – Innovative Technology to Characterize Disease Activity in Autoantibody-Associated Psychiatric Diseases

Background Anti-neural autoantibody-associated psychiatric disease is a novel field in immunopsychiatry that has been attracting attention thanks to its potentially positive therapeutic outcome and distinct prognosis compared with non-organic psychiatric disease. This review aims to describe recent novel technological developments for improving diagnostics in the field of autoantibody-related psychiatric disease.MethodsWe screened for relevant articles in PubMed for this narrative article. We focused on research methods such as neuroimaging, immune cells and inflammation markers, and molecular biomarkers in human biofluids like serum and cerebrospinal fluid and plasma proteomics.ResultsWe introduce several novel methods for investigating autoinflammation with the aim of optimizing therapies for autoantibody-associated psychiatric disease. We describe measuring the translocator protein 18kDa in activated microglia via positron emission tomography imaging, brain volumetric assessment, flow cell cytometry of cerebrospinal fluid and blood, and blood biological probes as well as psychopathological cues to help us gain insights into diagnosing inflammation and brain damage better in psychiatric patients presenting a suspected autoimmune etiology.ConclusionOur short methodological review provides an overview of recent developments in the field of autoantibody-related immunopsychiatry. More research is needed to prove their usefulness in diagnosing and treating autoantibody-associated psychiatric disease and its subtypes.

The importance of the cerebroplacental ratio for the prognosis of neonatal outcome in AGA fetuses

PurposeAs a Doppler sonographic parameter, the cerebroplacental ratio (CPR) provides information about fetal hemodynamics and the redistribution of fetal blood volume in response to a metabolic change. The present study was undertaken to determine the extent to which CPR can be used as a valid parameter in routine obstetric assessment. We investigated whether CPR can be used to assess the neonatal outcome in appropriate for gestational age (AGA) fetuses and its association with secondary cesarean section due to fetal distress.MethodsIn this retrospective analysis 1739 pregnant women were admitted to the University Women‘s Clinic Magdeburg, Germany, between January 2016 and December 2017. Of them, 710 AGA fetuses were eligible for analysis. SGA fetuses with an estimated fetal weight < 10th percentile were excluded from the study. The AGA fetuses were divided in two groups based on the CPR: 669 fetuses showed a normal CPR ≥ 1.08; 41 fetuses showed a decreased CPR < 1.08.ResultsIn our study cohort decreased CPR in AGA fetuses was associated with threefold increased rate of cesarean sections due to fetal distress (p < 0.001). Our data suggested that low CPR is a reliable predictor of an impaired neonatal outcome in AGA fetuses in terms of a lower birth weight, transfer to neonatology, longer length of hospitalization, and the presence of severe morbidity.ConclusionDecreased CPR in AGA fetuses correlated with impaired neonatal outcome and secondary cesarean section due to fetal distress. The potential role of CPR for obstetric screening should be investigated in further studies.

Myeloperoxidase as prognostic factor for atrial fibrillation development in patients with ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmia is among the most common and severe myocardial infarction complications. Myeloperoxidase as an important immune factor can be linked to atrial fibrillation (AF) development. Previous studies indicated myeloperoxidase (MPO) as a significant mortality predictor in ST-segment elevation myocardial infarction (STEMI). The MPO role in prognosis for adverse clinical outcomes, as atrial fibrillations in STEMI patients remains not fully understood. The purpose of the investigation was to examine the MPO in prognosis of adverse outcomes presented by atrial fibrillations in patients with STEMI. Methods The study included 233 STEMI patients, 112 males, 121 females, and average age 67.87±7.11 years. Follow-up period was 14 days. Adverse outcome was observed and included atrial fibrillations. Plasma MPO levels were determined by ELISA, MPO was collected on admission. Results Patients with indicated adverse effects showed significantly increased MPO levels compared to those without ones, 169.91 IQR [89.45; 201.98] ng/ml vs 81.4 [33.91;181.29] ng/ml; p &amp;lt; 0.001. A ROC analysis determined a MPO cut-off value for arrhythmia (AF) development of 176.53 ng/ml with a sensitivity of 71.1% and specificity of 77.6%, AUC 0.732; 95 % CI 0.677-0.782; p &amp;lt;0.001. Elevated MPO concentration was a significant predictor for AF (OR 1.115; 95% CI: 1.007-1.841; p&amp;lt;0.001). Even adjusted for age and sex MPO remained significantly predictive for arrhythmia development. Conclusions The study suggests that increased levels of MPO are associated with the higher risk of atrial fibrillation. MPO could be a possible significant factor for therapy optimization in high-risk STEMI patients.

Cytokine markers of clinical variants of infective endocarditis

Introduction. Infective endocarditis is a bacterial disease. Pathogen is localized mainly on heart valves and endocardium. This condition is accompanied by immunopathological manifestations and potential generation of septic process being unfavorable prognosis for disease outcome. Currently, the causes of death of patients with endocarditis have been increasingly presented as thromboembolic complications, which severity depends on variant of the disease course. An important role in imbalanced immune system in the infectious process is assigned to altered intercellular interaction mediated via cytokine network. Activated immune cells produce cytokines, which investigating is important in terms of interpreting changes in immune system functionality, assessing the severity of diseases and controlling therapeutic effectiveness. Infective endocarditis remains a severe disease associated with high mortality despite current advances in diagnostics and treatment. A timely diagnostic process and early initiation of treatment are major factors for successful patient management necessitating to improve diagnostics of various clinical variants of endocarditis course, taking into account pathogenetically relevant cytokines. Objective was to comparatively evaluate the importance of serum cytokine concentrations in patients with uncomplicated course of infective endocarditis and its thromboembolic complications and determine cytokine markers of various variants of endocarditis course. Materials and methods. An immunological examination of 119 blood serum samples from patients with confirmed diagnosis of infectious endocarditis and 20 samples from apparently healthy persons was carried out. Depending on the clinical disease form, the patients were divided into 4 groups: group 1 primary infective endocarditis (PIE) with thromboembolic complications (n = 24), 2 PIE without thromboembolic complications (n = 34), 3 secondary IE with thromboembolic complications (n = 27), 4 secondary IE without thromboembolic complications (n = 34). The control group consisted of 20 apparently healthy subjects. Immunological studies of serum cytokine concentrations were conducted in all groups. Results. Statistically significant increase in serum concentration of IL-10, IL-6, VEGF-A, IL-18, IL-1Ra and IL-8 was revealed in all clinical groups of patients compared to those in control group (p 0,05). By correlation analysis, we found a significant positive relationship between IL-10 and IL-18 or IL-6. An increase in the concentration of IL-10 leads to increased level of pro-inflammatory IL-18 and IL-6. The marker of secondary endocarditis was observed as increased level of serum concentrations of IFN. A characteristic feature of primary infective endocarditis with thromboembolic complications was revealed as significantly increased serum concentration of IL-8, IL-1Ra and IL-6. Markers of secondary complicated endocarditis were identified as increased level of IL-6, VEGF-A and IL-18.

Association of Systolic Blood Pressure and Cerebral Collateral Flow in Acute Ischemic Stroke by Stroke Subtype.

Background and PurposeCollateral flow in acute ischemic stroke is known as a predictor of treatment outcome and long-term prognosis. However, factors determining the initial collateral flow remain unclear. We investigated factors related to collateral flow in patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO) and further analyzed the results according to stroke etiology.MethodsThis was a retrospective study using prospective stroke registry data from a single university hospital from October 2014 to May 2021. AIS-LVO with middle cerebral artery M1 occlusion identified by pre-treatment multiphasic computed tomography angiography was included. Collateral flow score was graded on a 6-point ordinal scale according to pial arterial filling.ResultsA total of 74 patients [cardioembolism (CE): 57; large artery atherosclerosis (LAA): 17] was included. The mean age of all patients was 72.2 ± 11.7 years, and 37.8 % (n = 28) were men. Multivariate regression analysis showed that initial SBP [odds ratio (OR): 0.994; 95% confidence interval (CI): 0.990–0.998; p = 0.002] and stroke etiology (OR: 0.718; 95% CI: 0.548–0.940; p = 0.019) were independent factors of the collateral flow grade. Collateral flow grade was independently associated with initial SBP in the CE group (OR: 0.993; 95% CI: 0.989–0.998; p = 0.004) but not in the LAA group (OR: 0.992; 95% CI: 0.980–1.004; p = 0.218). Initial SBP was significantly correlated with NIHSS score in the CE group but not in the LAA group (r2= 0.091, p = 0.023; r2 = 0.043, p = 0.426, respectively).ConclusionsElevated initial SBP was associated with poor cerebral collateral flow and more severe symptoms in the CE group, but not in the LAA group in patients with AIS-LVO. These findings suggest differential effects of initial SBP elevation on collateral flow by stroke subtypes.

Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry.

In patients with large vessel occlusion stroke of the anterior circulation, underlying cause is a determinant of outcome. Whether this is the case for posterior circulation large vessel occlusion stroke has yet to be determined. We aimed to report on cause in patients with posterior circulation stroke treated with endovascular thrombectomy and to analyze the association with functional outcome. We used data of patients with posterior circulation stroke included in the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, a prospective multicenter observational study, between 2014 and 2018. Stroke cause was categorized into large artery atherosclerosis (LAA), cardioembolism, arterial dissection, embolic stroke of undetermined source (ESUS), other determined cause, or undetermined cause. For primary analysis on the association between cause and outcome, we used multivariable ordinal logistic regression analysis to estimate the adjusted common odds ratio for a shift towards a better functional outcome on the modified Rankin Scale at 90 days with LAA as a reference group. Secondary outcomes included favorable functional outcome (modified Rankin Scale score 0-3), National Institutes of Health Stroke Scale score at 24 to 48 hours, reperfusion on digital subtraction angiography, and stroke progression. Of 264 patients with posterior circulation stroke, 84 (32%) had LAA, 48 (18%) cardioembolism, 31 (12%) dissection, and 14 (5%) ESUS. Patients with a dissection were younger (48 [interquartile range, 43-60] years) and had a lower National Institutes of Health Stroke Scale at baseline (12 [interquartile range, 6-31]) than patients with other cause. Functional outcome was better for patients with cardioembolism and ESUS compared to LAA (modified Rankin Scale adjusted common odds ratio, 2.4 [95% CI, 1.1-5.2], respectively adjusted common odds ratio, 3.1 [95% CI, 1.0-9.3]). Patients with a dissection had a lower chance of successful reperfusion compared with LAA (adjusted odds ratio, 0.20 [95% CI, 0.06-0.70]). Unlike the anterior circulation, most frequent cause in our posterior large vessel occlusion stroke cohort is LAA followed by cardioembolism, dissection, and ESUS. Patients with cardioembolism and ESUS have a better prognosis for functional outcome after endovascular thrombectomy than patients with LAA.

Barbed suture pharyngoplasty in velopharyngeal complete concentric collapse: a multicentric study

BackgroundStudies have shown that complete concentric circular collapse (CCC) at the velum is a frequent finding in drug-induced sleep endoscopy, implying a worse prognosis for surgical outcomes in the treatment of obstructive sleep apnea syndrome (OSAS). Our group evaluated the results of pharyngoplasties with barbed sutures for this indication. We selected 48 patients with OSAS and CCC who underwent pharyngoplasty with barbed sutures in 8 tertiary centers. The outcome results were measured by polygraphy or polysomnography and Epworth Symptoms Scale (ESS) at least 6 months after surgery.ResultsApnea Hypopnea Index (AHI) improved from 34.9/h [21.2] to 12.7/h [10.6]. The success rate according to Sher’s criteria was 86.7%, the cure rate was 23.9%, and an AHI < 10 occurred in 42.2% of the cases. The oxygen desaturation index improved from 32.5/h [29.9] to 12.5/h SD [11.6], and the ESS improved from 10.2 [5.2] to 6 [3.5].ConclusionsPharyngoplasty with barbed sutures seems to be a good alternative for patients with OSAS and CCC findings in drug-induced sleep endoscopy.

MP008 - Value of RENAL nephrometry index in prognosis of perioperative outcome of laparoscopic partial nephrectomy

MP008 - Value of RENAL nephrometry index in prognosis of perioperative outcome of laparoscopic partial nephrectomy

Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States

Sexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes. The purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners. The analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age=23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007. Age-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers. Around half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR]=1.30, 95% confidence interval [CI]: 1.22-1.38), bisexual (RR=1.30, 95% CI: 1.10-1.52), and lesbian (RR=1.23, 95% CI: 1.00-1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b=0.63, 95% CI: 0.25-1.02), work/school (b=0.55, 95% CI: 0.17-0.93), and sex (b=0.53, 95% CI: 0.05-1.00). Healthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women). Our study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women. Our key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities. Tabaac AR, Chwa C, Sutter ME, etal. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States. J Sex Med 2022;19:1012-1023.

Comparison of follow-up treatment regimens for colorectal cancer liver metastases without objective response to neoadjuvant chemotherapy: direct surgery or surgery after second-line chemotherapy

Objective: To compare the effect of direct surgery or surgery after second-line chemotherapy for colorectal cancer patients with liver metastases who did not achieve objective remission after neoadjuvant chemotherapy. Methods: A retrospective case cohort study was used. The clinical and pathological data of 107 patients with colorectal cancer liver metastases who did not achieve objective response to neoadjuvant chemotherapy at Department of Hepatobiliary Surgery,Cancer Hospital,Chinese Academy of Medical Sciences from December 2008 to December 2016 were retrospectively collected. There were 71 males and 36 females, median age was 57 years (range: 28 to 79 years). According to the different treatment regimens after neoadjuvant chemotherapy,107 cases were divided into a direct surgery group (direct group,n=65) and an operation after receiving second-line chemotherapy group (second-line group,n=42). The propensity score matching(PSM) of the Logistic regression model was used to match the bilobar distribution of liver metastases and the number of first-line chemotherapy cycles in the two groups of patients. The caliper value was set to 0.10 and the matching ratio was 1∶2. T test, Mann-Whitney U test, χ2 test or Fisher's exat test was used to analyzed the data between the tuo groups, respectively. Survival analysis design was used to investigate the difference in prognosis between the two groups of patients. Results: The follow-up time(M(IQR)) was 56.3(34.3) months (range: 2.1 to 95.0 months),and all patients were followed up. After PSM,there were 28 cases in the direct group and 42 cases in the second-line group, there were no significant differences in whether R0 resection was feasible,blood loss,blood transfusion,postoperative complications and postoperative hospital stay between the two groups (all P>0.05). The 1,3,and 5-year progression-free survival(PFS) rates of the direct group were 40.0%,16.5%,and 11.0%,and the 1,3,and 5-year overall survival(OS) rates were 98.5%,61.2%,and 41.4%,respectively, the second-line group 1,3,5 years PFS rates were 35.7%,14.3%,14.3%,1,3,5-year OS rate were 95.2%,55.1%,44.4%,respectively. The median PFS time of the direct group and the second-line group was 8.5 months and 7.5 months,respectively,and the difference was not statistically significant (P=0.826). The median OS time of the direct group and the second-line group were 33.8 months and 46.9 months,respectively. The difference was not statistically significant(P=0.646).The median PFS time of the direct group and second-line chemotherapy complete remission and partial remission group(CR/PR group) was 10.2 months and 9.1 months,respectively,and the difference was not statistically significant(P=0.669). The median OS time of the direct group and the second-line CR/PR group was 51.0 months and 46.9 months,respectively,and the difference was not statistically significant(P=0.427). The results of survival analysis suggested that major liver resection was an independent prognosis factor for PFS (HR=1.809,95%CI: 1.067 to 3.067,P=0.028) and OS(HR=2.751,95%CI: 1.317 to 5.747,P=0.007). Second-line chemotherapy was not an independent prognostic factor for PFS (HR=0.945, 95%CI:0.570 to 1.567,P=0.828) and OS (HR=0.866,95%CI: 0.468 to 1.602,P=0.646). Conclusions: There is no significant difference in the short-term outcome and long-term prognosis between direct surgery patients and second-line chemotherapy followed by surgery. Second-line chemotherapy is not an independent prognostic factor for colorectal cancer liver metastases patients who fail to achieve objective response after neoadjuvant chemotherapy.

A tri-modal tissue-equivalent anthropomorphic phantom for PET, CT and multi-parametric MRI radiomics

PurposeRadiomics has emerged as an advanced image processing methodology to define quantitative imaging biomarkers for prognosis and prediction of treatment response and outcome. The development of quantitative imaging biomarkers requires careful analysis to define their accuracy, stability and reproducibility through phantom measurements. Few efforts were devoted to develop realistic anthropomorphic phantoms. In this work, we developed a multimodality image phantom suitable for PET, CT and multiparametric MRI imaging. MethodsA tissue-equivalent gel-based mixture was designed and tested for compatibility with different imaging modalities. Calibration measurements allowed to assess gel composition to simulate PET, CT and MRI contrasts of oncological lesions. The characterized gel mixture was used to create realistic synthetic lesions (e.g. lesions with irregular shape and non-uniform image contrast), to be inserted in a standard anthropomorphic phantom. In order to show phantom usefulness, issues related to accuracy, stability and reproducibility of radiomic biomarkers were addressed as proofs-of-concept. ResultsThe procedure for gel preparation was straightforward and the characterized gel mixture allowed to mime simultaneously oncological lesion contrast in CT, PET and MRI imaging. Proofs-of-concept studies suggested that phantom measurements can be customized for specific clinical situations and radiomic protocols. ConclusionsWe developed a strategy to manufacture an anthropomorphic, tissue-equivalent, multimodal phantom to be customized on specific radiomics protocols, for addressing specific methodological issues both in mono and multicentric studies.

Classifying Pituitary Adenoma Invasiveness Based on Radiological, Surgical and Histological Features: A Retrospective Assessment of 903 Cases.

Invasiveness is a major predictor of surgical outcome and long-term prognosis in patients with pituitary adenomas (PAs). We assessed PA invasiveness via radiological, surgical and histological perspectives to establish a classification scheme for predicting invasive behavior and poor prognosis. We retrospectively analyzed 903 patients who underwent transnasal-transsphenoidal surgery between January 2013 and December 2019. Radiological (hazard ratio (HR) 5.11, 95% confidence interval (CI): 3.98–6.57, p < 0.001) and surgical (HR 6.40, 95% CI: 5.09–8.06, p < 0.001) invasiveness better predicted gross-total resection (GTR) and recurrence/progression-free survival (RPFS) rates than did histological invasiveness (HR 1.44, 95% CI: 1.14–1.81, p = 0.003). Knosp grades 2 (HR 4.63, 95% CI: 2.13–10.06, p < 0.001) and 3 (HR 2.23, 95% CI: 1.39–3.59, p = 0.011) with surgical invasiveness were better predictors of prognosis than corresponding Knosp grades without surgical invasiveness. Classifications 1 and 2 were established based on radiological, surgical and histological invasiveness, and Knosp classification and surgical invasiveness, respectively. Classification 2 predicted RPFS better than Knosp classification and Classification 1. Overall, radiological and surgical invasiveness were clinically valuable as prognostic predictors. The convenience and good accuracy of Invasiveness in Classification 2 is useful for identifying invasive PAs and facilitating the development of treatment plans.