Recurrence Time Research Articles

Epidemiology of odontogenic tumours and selected cysts diagnosed at a single New Zealand oral pathology centre- A 15-year retrospective study.

This research aimed to investigate the relative frequency of odontogenic tumours (OT) and selected odontogenic cysts in a single oral pathology center in New Zealand from 2008 to 2023. Histopathological records from the Oral Pathology Centre, University of Otago (2008-2023) were examined to identify OT. Odontogenic keratocyst (OKC) and calcifying odontogenic cyst (COC), previously classified as OT were also included. Patient demographics, clinical details and histopathologic diagnoses were recorded. Data were analyzed using SPSS. Of the 34,225 biopsies over the 15-year period, 1.8% were identified as OTs, COC and OKCs and accounted for 47%, 1.5% and 51.5% respectively. The most prevalent OT types were odontoma (43.7%), ameloblastoma (27%) and cemento-ossifying fibroma (7.5%). Malignant OT, ameloblastic carcinoma, constituted 1.4% of OT. The average age at diagnosis for OKC, COC and OT patients were 48.2 ± 20.9, 33.7 ± 23.3 and 28.9 ± 19.3 years. Overall, male and mandibular site predilections were observed. Recurrence of OKC and ameloblastoma occurred in 15.2% and 13.7% of patients. The time for recurrence for OKC and Ameloblastoma were 61.7 ± 56.5 months and 122 ± 152 months respectively. The demographic features and range of OT, COC and OKC in New Zealand align with those of other western countries. The study also confirms need for long term follow up for patient with OKC and ameloblastoma.

THE IMPACT OF VASCULAR RISK FACTORS ON CEREBRAL AMYLOID ANGIOPATHY: A COHORT STUDY IN HEREDITARY CAA AND A SYSTEMATIC REVIEW IN SPORADIC CAA

Background: Cerebral amyloid angiopathy (CAA) has a remarkably variable disease course, even in monogenetic hereditary forms. Our aim was to investigate the prevalence of vascular risk factors and their effect on disease onset and course in Dutch-type hereditary (D-)CAA and sporadic CAA. Methods: We performed a cohort study in D-CAA to investigate the association between vascular risk factors (hypertension, hypercholesterolemia, smoking and alcohol use) and age of intracerebral hemorrhage (ICH) onset and time of ICH recurrence with survival analyses. In addition, we performed a systematic review to assess the prevalence of vascular risk factors and their effect on clinical outcome in sporadic CAA. We searched PubMed, Embase, Web of Science and COCHRANE Library, from 1987-2022 and included cohorts with ≥10 patients. We created forest plots, calculated pooled estimates and reported variability (heterogeneity plus sampling variability) and risk of bias. Results: We included 70 participants with D-CAA (47% women, mean age 53y). Sixteen (23%) had hypertension, 15 (21%) hypercholesterolemia, 45 (64%) were smokers and 61 (87%) used alcohol. We found no clear effect of vascular risk factors on age of first ICH (log-rank test hypertension: p=0.35, hypercholesterolemia: p=0.41, smoking: p=0.61 and alcohol use: p=0.55) or time until ICH recurrence (log-rank test hypertension: p=0.71, hypercholesterolemia: p=0.20 and smoking: p=0.71). We identified 25 out of 1234 screened papers that assessed the prevalence of risk factors in CAA and 6 that reported clinical outcomes. The pooled prevalence estimates of hypertension was 62% (95%CI:55%-69%), diabetes 17% (95%CI:14%-20%), dyslipidemia 32% (95%CI:23%-41%), and tobacco use 27% (95%CI:18%-36%). One study reported study diabetes and hypertension to be associated with a lower risk of recurrent ICH, whereas another study reported hypertension to be associated with an increased risk. All other studies showed no association between vascular risk factors and clinical outcome. High quality studies focusing on vascular risk factors were lacking. Conclusions: In patients with D-CAA and sporadic CAA the prevalence of vascular risk factors is high. Although this suggests an opportunity for prevention, there is no clear association between these risk factors and CAA-related ICH onset and recurrence.

Survival outcomes for HER2-low breast cancer: Danish national data.

We investigated the prognosis of breast cancer (BC) with low expression of human epidermal growth factor receptor 2 (HER2), as previous studies have found varying impacts on survival of HER2-low BC compared with HER2 0 BC (HER2 IHC score of 0). HER2-low is defined as a score of 1+ or 2+ in an immunohistochemical (IHC) assay without HER2 gene amplification. Patients with HER2 0 or HER2-low BC from the national Danish Breast Cancer Group database were examined by multivariable survival analysis in a retrospective noninterventional investigation. Patients were grouped as either HER2 0 or HER2-low. The primary endpoint was time to recurrence (TR), and the secondary endpoints were overall survival (OS) and distant recurrence-free interval (DRFI). 41,610 patients were included (12,981 with HER2 0 BC and 28,629 with HER2-low BC). HER2-low BC was associated with a lower risk of recurrence (hazard ratio [HR]: 0.92, p = 0.03). Regarding secondary endpoints, HER2-low disease was linked to improved overall OS (HR: 0.94, p = 0.02). No statistically significant effect of HER2-low was found for DRFI, along with no differential effect of HER2-low according to estrogen receptor (ER) status. HER2-low BC was found to show an improved HR for OS and DRFI compared with HER2 0 BC; however, further studies are need to establish whether it represents a separate biological entity.

PATH-30. CLINICAL OUTCOMES AND PREDICTIVE BIOMARKERS FOR IDH-WILDTYPE GLIOBLASTOMAS DEVELOPING HYPERMUTATION FOLLOWING TEMOZOLOMIDE TREATMENT

Abstract Current standard of care for IDH-wildtype glioblastoma (GBM) includes maximal safe resection, adjuvant radiation, and chemotherapy with the alkylating agent temozolomide. A subset of gliomas treated with temozolomide develop somatic hypermutation with a predominance of C>T transitions due to the alkylation effects on DNA. However, the frequency of occurrence, clinical ramifications, and predictive biomarkers for developing temozolomide-induced hypermutation (TMZ-HM) in GBM are unknown. Here we performed comprehensive histopathologic, genomic, and epigenomic evaluation of paired initial and recurrent GBM from 106 patients. Seven patients (7%) developed hypermutation at time of first recurrence, while an additional five patients (5%) developed hypermutation at a subsequent recurrence. Patients who developed TMZ-HM had a significantly longer interval between initial surgery and first recurrence (27.8 vs. 9.9 months, p<0.001). In contrast to IDH-mutant gliomas where TMZ-HM is associated with poor prognosis, those patients with IDH-wildtype GBM who developed TMZ-HM had significantly longer overall survival from both initial surgery (67.9 vs. 20.3 months, p<0.001) and from time of recurrence after development of hypermutation (30.9 vs. 9.5 months, p=0.001). There was no difference in oncogenic alteration frequency in initial GBM that subsequently developed TMZ-HM. However, 4 specific CpG sites out of 12 total interrogated sites in the promoter region of MGMT (a DNA repair enzyme) and 5 specific CpG sites in the promoter region of KCNQ1DN (a negative regulator of c-Myc) were significantly more hypermethylated in those GBM that developed TMZ-HM. We then generated a weighted risk score across these CpG sites that can be used to prospectively identify GBM likely to develop TMZ-HM associated with favorable survival. In summary, patients with GBM that develop TMZ-HM follow a more favorable clinical course, and specific MGMT and KCNQ1DN promoter hypermethylation patterns could serve as a biomarker to identify these patients who may potentially benefit from extended alkylating chemotherapy treatment.

RADT-37. PROTON THERAPY REIRRADIATION FOR RECURRENT MALIGNANT GLIOMA: PROSPECTIVE ANALYSIS FROM THE PROTON COLLABORATIVE GROUP

Abstract BACKGROUND Standard of care treatment for recurrent malignant glioma after prior radiotherapy (RT) is not well established. Proton therapy (PT) is increasingly used for reirradiation (ReRT) at the time of recurrence; however, treatment outcomes, toxicity, and prognostic factors for patients treated with PT-ReRT remain poorly defined. METHODS The prospective, multi-institutional Proton Collaborative Group (PCG) registry was queried for patients with malignant glioma who previously received RT and underwent PT-ReRT between 7/2011-12/2023. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method, and Cox proportional hazards regression was used for uni- and multivariate analysis (UVA and MVA). Dose was calculated using equivalent dose in 2-Gy fractions (EQD2). RESULTS 143 consecutive patients were identified. Median follow-up was 11.2 months and median time interval (TI) from prior RT (median 58.5 Gy) to PT-ReRT (median 44.6 Gy) was 42.4 months. Primary histology was glioblastoma (n=74), astrocytoma (n=35), and oligodendroglioma (n=34). Median PFS and OS were 8.1 and 11.2 months, respectively. On UVA, improved OS was associated with oligodendroglioma (HR 0.37) and astrocytoma histology (HR 0.53) compared to glioblastoma, TI >60 months (HR 0.2), CNS WHO Grade 2 compared to 4 (HR 0.42), and ECOG performance status 0 (HR 0.47). On MVA, improved OS remained associated only with oligodendroglioma (HR 0.42) and TI >60 months (HR 0.49). Acute and Late Grade 3 toxicity occurred in 7% and 4% of patients. Acute Grade 3 toxicity was associated with poor performance status (HR 16.15). CONCLUSIONS In the largest series of glioma PT-ReRT reported to date, retreatment appears well tolerated with variable outcomes based on clinical prognostic factors. Toxicity rates were acceptable compared to historical photon-based literature despite a high median prescription dose.

SURG-13. PATHOLOGICAL EXAMINATION OF MENINGIOMA RECURRENCE AFTER ABSORBABLE ARTIFICIAL DURA MATER RECONSTRUCTION

Abstract INTRODUCTION In meningioma surgery, the removal of the tumor and tumor-attached dura mater is essential. Due to its high affinity, absorbable artificial dura mater is used for the reconstruction of dural defects. In this study, we report a pathological examination of dural-like tissue in a case of meningioma that recurred at the same site after the use of absorbable artificial dura mater during initial surgery. METHOD We investigated two cases in which absorbable artificial dura mater was used for dural reconstruction during meningioma resection, and subsequently, a recurrent lesion was identified at the site of the dural reconstruction. We examined MRI images and surgical and pathological findings at the time of recurrence in these cases. RESULT All patients underwent total resection, and the pathological diagnosis was atypical meningioma. MRI images at the time of recurrence revealed multiple meningiomas along the artificial dura site. Gross findings during recurrent surgery indicated that the absorbable dura had been replaced by dura-like tissue, with the tumor also attached to the same site. Pathological findings showed bundles of fibrous tissue within the dura-like tissue, albeit with a sparser density compared to autologous dura mater. Meningioma cell invasion and angiogenesis were also observed in the dural-like tissue. DISCUSSION In all cases, multiple meningiomas were found along the dural-like tissue. This suggests that meningioma cells invading the dural-like tissue may have used it as a scaffold for meningioma recurrence. Future studies are necessary to determine the appropriateness of absorbable artificial dura mater for dural defect sites during malignant meningioma surgery.

PATH-29. LONGITUDINAL EPIGENOMIC EVOLUTION OF IDH-WILDTYPE GLIOBLASTOMA

Abstract Glioblastoma, IDH-wildtype remains a molecularly heterogeneous disease that is refractory to current therapies. To investigate how longitudinal epigenomic evolution of glioblastoma drives tumor progression and treatment resistance, we performed comprehensive histopathologic assessment, targeted genomic sequencing, and genome-wide DNA methylation profiling of paired initial and recurrent IDH-wildtype glioblastoma samples from 98 patients, as well as a separate longitudinal cohort of IDH-mutant astrocytomas for comparison. Primary treatment-naïve IDH-wildtype glioblastomas had more globally hypomethylated genomes compared to primary IDH-mutant astrocytomas. At time of recurrence, IDH-mutant astrocytomas uniformly became more hypomethylated similar to the global methylation levels in IDH-wildtype glioblastomas. In contrast, recurrent IDH-wildtype glioblastomas were heterogeneous with subsets becoming more globally hypermethylated (27%), hypomethylated (22%), or remaining stable (51%). Accordingly, a substantial proportion (52%) of recurrent glioblastomas underwent methylation class switching compared to their matched primary tumor, with a predominance of the RTK2 epigenetic subtype at initial surgery and the Mesenchymal epigenetic subtype at recurrence. Among approximately 850,000 interrogated CpG sites, we identified only 110 and 153 sites that consistently became more hypermethylated or hypomethylated between initial and recurrent IDH-wildtype glioblastomas, which regulate genes involved in neuronal morphogenesis, oligodendrocyte differentiation, and myelination. In contrast, we identified 260 and 18,527 CpG sites that consistently became more hypermethylated or hypomethylated between initial and recurrent IDH-mutant astrocytomas, which regulate genes involved in neuronal stem-like differentiation, cell cycle control, and other biologic processes. Finally, we developed a DNA methylation evolution signature incorporating change in mean beta-methylation values from initial to recurrent tumor specimens across 347 critical CpG sites that significantly correlated with clinical outcomes for patients with IDH-wildtype glioblastoma. In summary, IDH-wildtype glioblastomas demonstrate heterogeneous epigenomic evolution patterns distinct from IDH-mutant astrocytomas. These changes in epigenetic patterns may identify unique subgroups of glioblastoma with differential treatment response and inform future therapeutic studies targeting differentially methylated gene programs.

Ideal cystoscopic interval after nephroureterectomy in patients with upper tract urothelial carcinoma.

The purpose of this study was to clarify the appropriate cystoscopic interval after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) using a hypothetical model. A total of 155 patients who underwent NU in 15 years were retrospectively evaluated. Three hypothetical models for surveillance intervals were created: 3 (model 1), 6 (model 2) and 12 months (model 3). We superimposed these models on the actual surveillance of each patient and analyzed the observed timing of recurrence. The time from recurrence to scheduled cystoscopy (timeRCS) was defined as the time from recurrence to estimated cystoscopy. The gap risk ratio was calculated based on the average of timeRCS for model 1 at 0-1 year after surgery. The median follow-up was 20.5 months. Intravesical recurrence was observed in 63 patients (40.6%). The 3-year intravesical recurrence-free survival rate in patients without a history of bladder cancer before NU was significantly higher than in those with a history of bladder cancer (61% vs. 42%, P = 0.034). The medians of timeRCS for models 1, 2, and 3 were 1.9, 2.9, and 8.4 months, respectively. The gap risk ratios for model 1 at 1-3 years, model 2 at 2-3 years for patients with a history of bladder cancer, and model 2 at 1-3 years for patients without a history of bladder cancer were less than 1.0. Model analysis shows that the cystoscopic follow-up interval can be extended depending on the presence or absence of a history of bladder cancer and the time after NU.

Predictors of recurrent ischemic stroke: A retrospective cohort study

Introduction: Cerebrovascular events are one of the most common causes of disability and the third leading cause of death in developed countries. Herein, we aimed to investigate the potential underlying causes of recurrent ischemic stroke. Methods: This study was a retrospective cohort study conducted in Razi Hospital, Tabriz, Iran between March 2018 and September 2020. Patients with the diagnosis of recurrent ischemic stroke during the study period were eligible to be included. Baseline characteristics and data on the recurrence were collected using chart reviews. Also, binary logistic regression was used to examine the factors related to recurrence. Results: Among one hundred participants with a mean age of 68.88 years, 59% were male. Hypertension, diabetes, heart disease, smoking, and hyperlipidemia were identified in 79%, 42%, 24%, 15%, and 15%, respectively. The average recurrence time of stroke was about 2.52 years. According to our findings, a significant relationship between the history of heart diseases and ischemic stroke recurrence was observed (risk ratio: 0.10: 95% confidence interval: 0.03-0.33). Conclusion: We found no significant association between ischemic stroke recurrence and underlying diseases except for heart diseases. Further large-scale observational studies and meta-analyses are recommended to evaluate the possible association.

Prediction of recurrence-free survival and risk factors of sinonasal inverted papilloma after surgery by machine learning models

ObjectivesOur research aims to construct machine learning prediction models to identify patients proned to recurrence after inverted papilloma (IP) surgery and guide their follow-up treatment.MethodsThis study collected 210 patients underwent IP resection surgery at a university hospital from January 2010 to December 2023. Six machine learning algorithms including ExtraSurvivalTrees (EST), GradientBoostingSurvivalAnalysis (GBSA), RandomSurvivalForest (RSF), SurvivalSVM, Coxnet and Coxph, were used to construct the prediction models. Shapley Additive Explanations (SHAP) values were used to explain the importance of various features in predicting IP recurrence.ResultsWe found that the recurrence rate of IP patients is 20.00%, with a median recurrence time of 35.5 months. Multivariate Cox regression analysis identified mild or moderate dysplasia as an independent risk factor for recurrence. The EST model performs the best in predicting postoperative recurrence of IP, with C-index of 0.968 and 0.878 in the training and testing sets. SHAP emphasizes five important predictive factors for recurrence, including bone defects, orbital involvement, smoking, no processing of tumor attachment sites and drinking.ConclusionsTo our knowledge, this is the first study to use multiple ML models to predict postoperative recurrence of IP. The EST model has the best predictive performance, with SHAP emphasizing several key predictive factors for IP recurrence. This study emphasizes the practicality of machine learning algorithms in predicting IP clinical outcomes, providing valuable insights into the potential for improving clinical decision-making.

Risk factors for and timing of presumptive recurrent TB.

<sec><title>INTRODUCTION</title>Understanding factors associated with increased risk for tuberculosis (TB) recurrence is essential in lowering the TB burden. We aimed to quantify the burden, risk factors, and timing of TB presumptive recurrence.</sec><sec><title>METHODS</title>We analyzed test results from 2013 to 2017 in the South African National Health Laboratory Service's database. We defined a person's TB episode to start with their first positive TB test. In the absence of treatment outcome data, we assumed the episode concluded 6 months later for rifampicin-susceptible TB (RS-TB) and 18 months later for rifampicin-resistant TB (RR-TB), provided that at least one negative smear or culture test was recorded within this period. We defined a presumptive recurrent TB episode to start with a positive TB test after the completion of a prior episode. We calculated recurrence measures stratified by various demographics and RR-TB status.</sec><sec><title>RESULTS</title>Of 574,316 people with RS-TB, 4.7% experienced at least one presumptive recurrent TB episode. Higher local TB notification rates, HIV coinfection, and males experienced higher recurrence rates. Most (89.4%) of the first RS-TB recurrences occurred within a year of the initial episode.</sec><sec><title>CONCLUSION</title>Our findings of when and among whom recurrent TB is more likely to occur can be used to assist early interventions and inform impact on patient care.</sec>.

Pediatric nasolacrimal duct intubation using deep sedation outside the operating room- comparison of three types of stents

BackgroundCongenital nasolacrimal duct obstructions that persist after 9 months of age often require surgical intervention through probing and stenting of the tear duct. These procedures typically occur under general anesthesia in an operating room setting. We propose a novel approach using intravenous sedation outside the operating room. MethodsWe reviewed the medical records of patients at a tertiary pediatric hospital treated for nasolacrimal duct obstruction from 2018 to 2023 using monocanalicular Monoka, Masterka, and LacriJet nasolacrimal stents. All procedures were performed outside of the operating room under intravenous sedation provided by a specialized sedation team. Symptom resolution, sedation duration and complications were reviewed for each type of stent. ResultsA total of 64 patients (81 stents) were included in our analysis. Of the 81 stents used, 32 were Monoka, 15 Masterka, and 34 LacriJet. Symptoms resolved in 86% of the eyes. Sedation side effects were minor and infrequent. Occasionally brief apnea, hypoxia, hypotension or laryngospasm occurred, but in no cases were patients harmed or was hospitalization required. A single factor analysis of variance showed no statistically significant difference between the stents for recurrence or sedation time. The Fisher exact test suggested a higher risk of side effects in the Monoka group. ConclusionsIn our pediatric patient cohort, nasolacrimal duct stenting procedures have a high success rate and safety profile when performed under deep sedation outside of the operating room.

Significance of anatomical resection and wide surgical margin for HCC patients with MVI undergoing laparoscopic hepatectomy: A multicenter study

ObjectiveTo investigate the impact of surgical resection margin and hepatic resection type on prognosis and compare their prognostic significance on patients with hepatocellular carcinoma (HCC) with or without microvascular invasion (MVI) who underwent laparoscopic liver resection (LLR). MethodsA retrospective analysis was conducted on 320 patients with HCC who underwent LLR. According to the grading of MVI, patients were classified as M0, M1 and M2. Patients were divided into the anatomical resection (AR) and nonanatomical resection (NAR) groups according to the hepatic resection type. Survival and Cox regression analyses were performed to explore the effects of AR and NAR, wide and narrow resection margin on overall survival (OS) and time to recurrence (TTR). ResultsIn the whole cohort, narrow resection margin was an independent risk factor for OS and TTR, whereas NAR was not. Subgroup analysis showed that narrow resection margin and NAR were both independent risk factors for OS and TTR in HCC patients with MVI. The 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M1 were 85.3 % versus 62 % and 34.4 % versus 60.2 %. Similarly, the 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M2 were 80.2 % versus 47.9 % and 30.8 % versus 64.8 %. ConclusionsAnatomical hepatectomy and wide resection margin were independent protective factors for HCC patients with MVI receiving LLR. Nonetheless, wide resection margin had a greater impact on prognosis than anatomical hepatectomy.

Hereditary vitreoretinal amyloidosis with transthyretin Gly83Arg variant, a long-term study.

This study evaluated the clinical data on ophthalmic follow-up and treatment efficacy of hereditary vitreoretinal amyloidosis kindred due to transthyretin Gly83Arg variant over a 15-year follow-up period. The clinical data of patients with hereditary ATTRG83R amyloidosis from 2006 to 2021 were analysed retrospectively. Sanger sequencing of the transthyretin gene, detailed medical history, pedigree charting, and systemic and ophthalmic examinations were carried out in all patients. The changes of best-corrected visual acuity (BCVA) after vitrectomy and the associations of amyloidosis recurrence and post-vitrectomy glaucoma were analysed. Fourteen patients with ATTRG83R were included, all experiencing vision loss due to vitreous opacities. The average age of onset was 40.93 ± 6.96 (29 to 52) years. The preoperative BCVA was 2.20 ± 0.69 logMAR, whereas the postoperative BCVA improved to 0.13 ± 0.35 logMAR (P < 0.05). The recurrence time was 58.83 ± 20.85 months after vitrectomy. At 90 months after vitrectomy, the cumulative recurrence rate was 94.7%. Eight eyes developed glaucoma after vitrectomy. None of the 5 eyes without vitrectomy developed glaucoma. Paired chi-square test showed a significant difference in the incidence rate of glaucoma between eyes with or without vitrectomy (P < 0.05). However, retinal amyloid angiopathy and cataract surgery were not associated with glaucoma (P > 0.05). Poor intraocular pressure control in 7 eyes resulted in severe visual impairment. Hereditary ATTRG83R amyloidosis predominantly manifests as vitreous opacity, and vitrectomy can improve the visual acuity in affected patients. However, the recurrence of amyloidosis and related complications significantly impact long-term visual outcomes. Thus, delaying vitrectomy appropriately and maintaining regular follow-up visits is advisable.

Broadband X-ray spectral and timing properties of the accreting millisecond X-ray pulsar IGR J17498−2921 during the 2023 outburst

We report on the broadband spectral and timing properties of the accreting millisecond X-ray pulsar IGR J17498−2921 during its April 2023 outburst. We used data from NICER (1–10 keV), NuSTAR (3–79 keV), Insight-HXMT (2–150 keV), and INTEGRAL (30–150 keV). We detected significant 401 Hz pulsations across the 0.5–150 keV band. The pulse fraction increases from ∼2% at 1 keV to ∼13% at 66 keV. We detected five type-I X-ray bursts, including three photospheric radius expansion bursts, with a rise time of ∼2 s and an exponential decay time of ∼5 s. The recurrence time is ∼9.1 h, which can be explained by unstable thermonuclear burning of hydrogen-deficient material on the neutron star surface. The quasi-simultaneous 1–150 keV broadband spectra from NICER, NuSTAR and INTEGRAL can be aptly fitted by an absorbed reflection model, relxillCp, and a Gaussian line of instrumental origin. The Comptonized emission from the hot corona is characterized by a photon index Γ of ∼1.8 and an electron temperature kTe of ∼40 keV. We obtained a low inclination angle i ∼ 34°. The accretion disk shows properties of strong ionization, log(ξ/erg cm s−1)∼4.5, over-solar abundance, AFe ∼ 7.7, and high density, log(ne/cm−3)∼19.5. However, a lower disk density with normal abundance and ionization could also be possible. Based on the inner disk radius of Rin = 1.67RISCO and the long-term spin-down rate of −3.1(2)×10−15 Hz s−1, we were able to constrain the magnetic field of IGR J17498−2921 to the range of (0.9 − 2.4)×108 G.

Factors Affecting Biochemical Recurrence After Radical Prostatectomy and Validity of CAPRA Score in Predicting Biochemical Recurrence

Objective: Biochemical recurrence (BCR) after prostate cancer (PCa) treatment is undesirable. It is important to inform a patient about BCR in preoperative evaluation. We aimed to demonstrate the effectiveness of the (The Prostate Cancer Risk Assessment) CAPRA score used to predict this situation in our study. Material and Methods: The study included 348 patients who underwent Radical Prostatectony (RP) for localized PCa. Demographic, preoperative and postoperative data were collected. CAPRA score based on preoperative total PSA value, Gleason Score, clinical T stage, percentage of positive biopsy cores and age was calculated using these data. BCR was defined as a total PSA value &gt;0.2 ng/dL for two consecutive times after RP. Follow-up periods, recurrence status and time of recurrence were recorded. Results: BCR positivity was detected in 60 (17.2%) of 348 patients. In univariate analyses, PSA level, lesion volume on MRI, ISUP grade, D’Amico risk classification, Seminal vesicule invasion (SVI) and CAPRA score were statistically significant in the groups. In multivariate analyses, PSA level, Neutrophile Lymphocyte Ratio, lesion dimension, intermediate risk according to D’amico classification, Extraprostatic extension (EPE) showed differences between both groups. The probability of biochemical progression-free in CAPRA risk groups shows a significant decrease in the probability of biochemical progression-free in the long term as risk increases in CAPRA risk groups: 91.4% in the low-risk group, 77.8% in the intermediate-risk group and only 61.7% in the high-risk group at 80-month follow-up. Conclusion: CAPRA scoring system should be supported by MpMRI findings and a new nomogram should be developed with these findings.

Discrete Joint Random Variables in Fréchet-Weibull Distribution: A Comprehensive Mathematical Framework with Simulations, Goodness-of-Fit Analysis, and Informed Decision-Making

This paper introduces a novel four-parameter discrete bivariate distribution, termed the bivariate discretized Fréchet–Weibull distribution (BDFWD), with marginals derived from the discretized Fréchet–Weibull distribution. Several statistical and reliability properties are thoroughly examined, including the joint cumulative distribution function, joint probability mass function, joint survival function, bivariate hazard rate function, and bivariate reversed hazard rate function, all presented in straightforward forms. Additionally, properties such as moments and their related concepts, the stress–strength model, total positivity of order 2, positive quadrant dependence, and the median are examined. The BDFWD is capable of modeling asymmetric dispersion data across various forms of hazard rate shapes and kurtosis. Following the introduction of the mathematical and statistical frameworks of the BDFWD, the maximum likelihood estimation approach is employed to estimate the model parameters. A simulation study is also conducted to investigate the behavior of the generated estimators. To demonstrate the capability and flexibility of the BDFWD, three distinct datasets are analyzed from various fields, including football score records, recurrence times to infection for kidney dialysis patients, and student marks from two internal examination statistical papers. The study confirms that the BDFWD outperforms competitive distributions in terms of efficiency across various discrete data applications.

Recurrence patterns in differentiated thyroid cancer (DTC) following adjuvant radioiodine therapy.

With an increasing incidence of differentiated thyroid cancer (DTC) diagnosis, questions emerge about the optimal duration of follow-up for detecting recurrent disease and its outcomes. The objective of this retrospective research was to assess the clinical course of differentiated thyroid cancer after radioiodine adjuvant treatment in patients monitored over an extended period. Special attention was paid to the analysis of the time from treatment to recurrence. We also assessed patient outcomes after recurrence. A total of 650 patients with DTC after total/near-total thyroidectomy and adjuvant radioiodine post-recombinant human thyrotropin (post-rhTSH) stimulation were evaluated. All patients were followed up with neck ultrasound, serum thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and antithyroglobulin antibody (anti-Tg) measurements at intervals of 6 to 18 months. Only structural recurrences were considered. They were defined as locoregional recurrence confirmed by biopsy or distant metastases [confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), or abnormal foci on radioiodine scintigraphy or 18F-gluorodeoxyglucose positron emission tomography [18 F] FDG-PET scan], regardless of thyroglobulin (Tg) or anti-Tg levels. The median follow-up was 12 years (5-15.5). Structural recurrence was observed in 47 out of 650 patients (7%). All but 3 locoregional recurrences were suitable for surgery. The median time to structural recurrence was 16 months, with only 9 (1.4%) patients presenting with recurrence after more than 60 months. At the time of the database closure, 601 patients (92%) had an excellent response, including 20 out of 47 (42%) patients with structural recurrence. Eighty-one out of 650 patients had died (12.5%) before the database closure. The median age at the last follow-up of the patients who died was 72 years (range 20-88). A second recurrence was diagnosed in 10 out of 650 patients (1.5%), corresponding to 21% (10 out of 47) of patients who had already experienced a recurrence. The median time from radioiodine (RAI) therapy to the second structural recurrence was 108 months. Structural recurrences in DTC are uncommon, with most patients showing a favourable response to treatment. Improved understanding of recurrence timing may define the duration of patient surveillance at reference centres that can be safely discontinued after 5 years in low- and intermediate-risk groups, as indicated in our study.

Timing of early recurrence of atrial fibrillation during the blanking period after catheter ablation for persistent atrial fibrillation and implications for long-term success: a multicentre study

Abstract Background After catheter ablation (CA) for atrial fibrillation (AF), early recurrences of AF (ERAF) that occur within a 90-day post-ablation "blanking period" are considered to represent transient post-ablation pro-arrhythmia. Purpose To determine if the timing of early recurrence of AF during the traditional 90-day post-CA blanking period is associated with long-term AF recurrence after CA for persistent AF (PsAF). Methods We performed a multicentre retrospective study of patients undergoing first-time CA for PsAF between 2015-2018. All patients had undergone pre-CA DCCV. Incidences of ERAF during the post-CA blanking period were reviewed, and patients were categorised into three groups based on the timing of last episode of ERAF during the blanking period: (1) no ERAF (reference population); (2) last ERAF &amp;lt;30 days post-CA; (3) last ERAF 31-90 days post-CA. The primary outcome was long-term recurrence of atrial arrhythmia, i.e. time to first recurrence of atrial arrhythmia occurring beyond the first 90 days after CA. Patients who had ERAF and exited the blanking period in AF (i.e. those with immediate recurrence at 90 days) were excluded from this analysis. Results 331 patients were identified from five centres. 206 patients had no ERAF during follow-up, 124 patients had ERAF during the blanking period, and in one patient the presence of ERAF was not documented. Of the 124 patients experiencing ERAF during the 90-day post-CA blanking period, the timing of the last episode was known in 122 patients (Table 1). Of these, 58 patients exited the 90-day blanking period in AF and were excluded. Over median post-CA follow-up of 590 days, 147 patients (54%) experienced the primary outcome. Compared with Group 1 (no ERAF), ERAF within each of the time periods was associated with a statistically significant progressively increased risk of long-term recurrence (Group 2, last ERAF &amp;lt;30 days post-CA: hazard ratio [HR] 1.95 [95% CI 1.15-3.31]; Group 3, last ERAF 31-90 days post-CA: HR 4.86 [95% CI 2.13-11.08]; Figure 1). Conclusion ERAF during the traditional 90-day post-CA blanking period is associated with long-term AF recurrence, with later recurrence within the 90-day period conferring greater risk. Patients with ERAF during the blanking period may need to be considered for earlier repeat intervention where clinically appropriate.

Advanced mapping and ablation technologies to target pulmonary veins gaps and residual antral potentials during repeat paroxysmal AF ablation: acute and long-term follow-up

Abstract Background A comprehensive understanding of pulmonary vein (PV) reconnection and residual potentials (RAP) within the antral scar during repeat atrial fibrillation (AF) ablation, facilitated by advanced mapping and ablation technologies, is currently lacking. Optimizing radiofrequency (RF) deliveries after failed PV isolation (PVI) may enhance ablation efficiency. Purpose This study aims to assess both the acute and long-term outcomes focusing on PV gaps (PVGs) and RAPs, utilizing advanced mapping and ablation technologies during repeat PV ablation in patients (pts) with paroxysmal AF. Methods Repeat AF-CHARISMA study, a prospective, single-arm cohort study, included consecutive pts from 13 centers undergoing repeat ablation of paroxysmal AF. The Lumipoint (Boston Scientific) map-analysis tool was used sequentially on each PV component. All patients were followed-up for at least 12 months after the procedure. The ablation endpoint was PVI and electrical quiescence in the antral region. Long-term outcome was the recurrence of AT/AF over follow-up. Results One-hundred pts were included (69% after failed RF procedure, 31% after failed cryoablation procedure). A total of 276 PVGs (192 after RF ablation, 2.8±1.8/pt; 84 after cryoablation, 2.7±1.9/pt, p=0.665 vs RF) and 44 RAPs (43 after RF ablation, 0.6±1.1/pt; 1 after cryoablation, 0.03±0.2/pt, p=0.002 vs RF) were detected. In the majority of cases (75%), only PVGs were present whereas, in 21%, both PVGs and RAPs were detected (2 pts had only RAPs). In 2 pts no PVG nor RAP were identified. PVGs were most common at anterior sites (103, 37.3%), followed by posterior sites (75, 27.2%) and carina sites (49, 17.8%). PVG location sites did not differ between prior ablation approach. Only 1 pt after cryoablation showed a RAP (at carina site), whereas the 44 RAPs after RF were fairly distributed across different sites. Acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study pts. After the blanking period, over a follow-up of 480±211 days, 18 pts (18%) suffered an AT/AF recurrence (time to recurrence: 245±80 days). Previous ablation approach (HR=0.66, 95%CI: 0.2 to 2.0 for previous cryoablation, p=0.46), number of PVGs (1.05, 0.8 to 1.3, p=0.67) or number of RAPs (0.41, 0.1 to 1.2, p=0.12) were not associated to AT/AF recurrence. No major complications or adverse events occurred. Conclusion A structured ablation workflow for repeat catheter ablation, incorporating consistent high-density mapping and improved diagnostic tools to guide the procedure, demonstrated safety and efficacy in treating paroxysmal AF irrespectively of previous ablation approach. Residual potentials within the antral scar were more frequently detected after RF ablation compared to cryoablation.