Risk Factors For Early Death Research Articles

Baseline laboratory tests as predictors of early death risk in 746 elderly oncologic patients: A prospective cohort study.

e23039 Background: The elderly population is the thoroughly affected by new cases of cancer, as well as by its complications. The occurrence of early death (in the first six months after diagnosis) is one of the most important outcomes to be studied in this population. This study aims to identify if simple baseline laboratory tests can be used as predictive factors for early death in older cancer patients. Methods: Prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015 -2017. Sociodemographic, tumor-related and laboratorial (leukocytes, creatinine, platelets and hemoglobin) variables were collected at admission and analyzed. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. The outcome was a six-month death. Descriptive, univariate and multivariate analysis of Cox proportional hazards and Kaplan-Meier global survival were performed. Results: A total of 746 patients with an average of 71 (± 7.4) years were eligible. 16.5% died in the first six months after diagnosis. Risk factors for early death were controlled by age. Leukocytes < 4,000 / mm3 or > 12,000 / mm3 (HR 2.51 IC95% 1.68-3.75), Creatinine > 1.7mg / dL (HR 2.14 95% CI 1.37-3.36), Platelets < 150,000 / mm3 or > 300,000 / mm3 (HR 1.92 CI 95% 1.31-2.80) and Hemoglobin < 12 g / dL if female, or < 13 g / dL, if male (HR 1.89 95% CI 1.27-2.83) were all associated with greater risk of dying in the first six months after diagnosis (log rank < 0.001). Conclusions: Baseline laboratory tests performed at the hospital admission of the elderly cancer patient may be a simple way to help the clinician to identify patients at higher risk of early death.

Triple treatment of high-risk prostate cancer. A matched cohort study with up to 19 years follow-up comparing survival outcomes after triple treatment and treatment with hormones and radiotherapy

Purpose: To evaluate the efficacy of a triple treatment strategy, including surgery, on high risk prostate cancer comparing long-term survival outcome with a cohort receiving standard radiotherapy with endocrine therapy.Materials and methods: This study compared two cohorts in survival outcomes, matched on the year of diagnosis and age. In both groups there was a curative intention to treat localized high-risk prostate cancer (one or more of Gleason score 8–10, PSA 20–50 or stage T3), diagnosed between 1995–2010, follow-up at the end of 2014. Triple treatment group: 153 patients treated primarily with radical prostatectomy with neoadjuvant endocrine treatment, and a majority with adjuvant radiotherapy. Standard radiotherapy group: 702 patients with a treatment of either external radiotherapy or high dose brachytherapy combined with external beam therapy, both modalities in combination with neoadjuvant endocrine therapy.Results: The prostate-cancer-specific mortality was 10% for the triple treatment group and 15% for the standard radiotherapy group during the period, HR = 2.01 (1.17–3.43), p = 0.011. The corresponding overall mortality was 26% vs 29%, HR = 1.54 (1.09–2.17), p = 0.015. High Gleason score was the dominating risk factor for early death due to the disease. Clinical T-stage was not an independent risk factor for death in this population.Conclusion: Adding surgery in a multimodal treatment model in high-risk prostate cancer showed significantly better survival outcome compared with the current standard of radiotherapy. Surgery in this group is, therefore, compelling and that also includes a clinical T3-stage of the disease. The study is limited by possible selection bias for the two treatment models.

Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain

Suboptimal diet is a leading risk factor for early death and disability globally. Changing food prices via tax or subsidy policies is often recommended to improve diets, particularly increasing the relative price of sugar-sweetened beverages to reduce sugar consumption. Less evidence exists on how such policies, if applied across a wide range of foods and beverages, could affect purchases and diet quality. Using home-scan data from a sample of 26,799 households in Great Britain (2012-2013) we estimate separate demand elasticities for price increases and decreases using a reference-price dependent demand model, to simulate the impact of a 20% price change on purchases of energy and nutrients from 26 healthier and less healthy food groups that make up the full basket of purchases. Where asymmetry exists between elasticity of price increase and decrease, household response to price increases is stronger. Households with low socio-economic status (SES) respond to price changes in either direction more strongly than high-SES, especially for less healthy foods. On average, energy and nutrient content of take-home purchases were near or above reference daily intake levels. The combined effect of increasing the price of all less healthy foods, and decreasing the price of all healthier foods, led to an overall improvement with a net reduction in energy (by 67.6kcal per capita/day), sugar (6.3g), salt (0.21g) and saturated fat (2.3g) content, and a net increase in protein (3.4g) and fibre (0.9g) content of purchases. From individual food groups, the greatest reduction in energy, sugar and saturated fat content was observed for price increases in sweet snacks, desserts and puddings, and fats and oils. Dietary quality of the purchases of low-SES households generally improved most. Our findings support the view that price change policies can lead to dietary improvements, if they are based on the healthiness of food and beverages.

How Much Malperfusion Is Too Much in Acute Type A Aortic Dissections?

(1) Background: Malperfusion is a central limiting factor in the setting of acute Type A aortic dissections (AAAD). We sought to find preoperative metabolic acidosis thresholds that might influence decision-making in this setting. (2) Methods: We retrospectively reviewed consecutive patients operated on with AAAD between January 2002 and December 2017. We analyzed preoperative variables that might influence early and long-term outcomes, with particular emphasis on malperfusion markers. (3) Results: Our sample consisted of 153 patients, most of them male (69.2%), with a mean age of 55.89 ± 12.8 years. Malperfusion was present in 20.9% of cases: peripheric 25, renal 7, cerebral 4, and mesenteric 3. Cardiogenic shock was present in 18.9% of patients. Logistic regression revealed entry site (odds ratio (OR) = 2.83, p = 0.03), cardiogenic shock (OR = 3.30, p = 0.03), prebypass pH (OR = 0.93, p = 0.02) as independent risk factors for early death (<30 days). Receiver operating characteristic (ROC) analysis identified a prebypass pH of 7.25 as a cutpoint for an unfavourable early outcome. Patients whose prebypass pH was ≤7.25 had a 2.98 higher relative risk (65.7% vs. 22%, p < 0.001). Prebypass pH 7.25 (hazard ratio (HR) = 4.00, p < 0.01) and entry site (HR = 2.10, p = 0.04) were independent predictors of early phase survival (<30 days), while long-term survival (>30 days) was determined by age >65 years (HR = 3.12, p = 0.02). (4) Conclusions: Patients with a prebypass pH ≤ 7.25 have an unacceptably high early mortality after AAAD repair. Those patients might benefit from a two-stage approach.

Risk factors of early death in adult patients with secondary hemophagocytic lymphohistiocytosis: a single-institution study of 171 Chinese patients

ABSTRACTBackground: Adult secondary hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome characterized by excessive activation of mononuclear-phagocytic system resulting in hyperinflammatory response. To date, the factors influencing early death of HLH are still not fully elucidated.Patients and Methods: We did a retrospective study of 171 adult patients with newly diagnosed HLH at our institution from January 2012 to April 2018. All patients’ clinical features, laboratory findings, treatments and prognosis were reviewed.Results: The median age was 49 years (range, 18–88 years), and 110 (64.3%) were male. The major underlying trigger of HLH was malignancy (88/171, 51.5%), especially non-Hodgkin lymphoma. In a multivariate analysis, age ≥54 years (P = 0.002), platelet ≤39.5 × 109/L (P = 0.028), activated partial thromboplastin time (APTT) ≥54 sec (P = 0.048), triglyceride ≥3.23 mmol/L (P < 0.001), lactate dehydrogenase (LDH) ≥1300 U/L (P = 0.012) and malignancy (P = 0.001) were significantly associated with early death in HLH. Then, patients were classified into four groups according to the number of risk factors at the time of diagnosis: low risk (zero, one or two risk factors), low intermediate risk (three risk factors), high intermediate risk (four risk factors) and high risk (at least five risk factors), with the 30-day overall survival (OS) of 92.4%, 58.8%, 30.0% and 4.8%, respectively (P < 0.001).Conclusions: Patients with old age, thrombocytopenia, prolonged APTT, hypertriglyceridemia, elevated LDH and malignancy had inferior survival. It is important to identify those patients at risk of early death, which may guide treatment and reduce mortality.

Risk factors for early death in acute myocardial infarction patients complicating with ventricular septal rupture

Objective: To assess the clinical characteristics and identify the risk factors in the acute myocardial infarction (AMI) patients complicating with ventricular septal rupture (VSR). Methods: A retrospective study was performed on 96 AMI patients complicating with VSR, who were hospitalized in the Second Xiangya Hospital of Central South University, Hunan Provincial Peoples' Hospital, the First Affiliated Hospital of University of South China, the Second Affiliated hospital of University of south China, Xiangtan Central Hospital from December 2007 to May 2017. There were 46 females and the age was (66.2±10.7) years (from 43 to 90 years). Patients were divided into in-hospital survival group (n=64) and in-hospital death group (n=32). The 96 patients were also divided into the early death group (survived ≤2 weeks after admission, n=50) and non-early death group (survived>2 weeks after admission, n=46). Multivariate logistic regression was used to analyze the independent risk factors of the early death. Results: Location of VSR was available in 71 patients, VSR was located at the apical or anterior septum near the apical region in 64.0% (32/50) patients with the anterior AMI, VSR was located at the posterior wall and basal inferior segment in 57.1% (12/21) patients with non-anterior AMI. Compared to the in-hospital survival group, patients in the in-hospital death group were older ((69.6±11.3) years vs. (64.6±10.1) years, P=0.031), incidence of non-ventricular aneurysm (71.9% (23/32) vs. 37.5% (24/64), P=0.001) and anterior AMI (84.4%(27/32) vs. 62.5%(40/64), P=0.028) was significantly higher in the in-hospital death group than in the in-hospital survival group. The comparison between the early death group and non-early death group showed that older age, female, no history of angina or myocardial infarction, Killip grade>Ⅲ, and non-ventricular aneurysm were related to increased risk of the early mortality in this patient cohort. Logistic regression analysis revealed that female (OR=5.109,95%CI 1.19-22.00, P=0.012), no history of angina or myocardial infarction (OR=23.34, 95%CI 3.44-158.37, P=0.001), Killip grade>Ⅲ(OR=5.35, 95%CI 1.26-22.66, P=0.019) and non-ventricular aneurysm (OR=6.30,95%CI 1.67-23.73, P=0.005) were independent risk factors for early death in this patient cohort. Conclusion: The risk factors of in-hospital death include older age, non-ventricular aneurysm and anterior AMI. Female, no history of angina or myocardial infarction, Killip grade>Ⅲ and non-ventricular aneurysm are independent risk factors for the early death of AMI patients complicating VSR.

Are death and loss to follow-up still high in people living with HIV on ART after national scale-up and earlier treatment initiation? A large cohort study in government hospital-based setting, Myanmar: 2013-2016.

SettingMyanmar National AIDS Program has had significant scale-up of services and changes in CD4 eligibility criterion for ART initiation from 2013 to 2016. This study assessed early death within 6 months and attrition (death and loss to follow-up, LTFU) after ART initiation and their associated factors.DesignA retrospective cohort study on people living with HIV (PLHIV >15 year of age) enrolled at three specialist hospitals in Yangon from 1st June 2013 to 30th June 2016. Cox regression was used to calculate hazard ratios (HRs) of early death and attrition.ResultsOf 11,727 adults enrolled, 11,186 (95%) were initiated on ART, providing 15,964 person-years of follow-up. At baseline, median age was 36 years [IQR: 30–43], 58% were men and median CD4 count was 151 cells/mm3 (IQR: 54–310). There were 733(6%) early deaths, 961(9%) total deaths and 1371 (12%) LTFU during the study period. Independent risk factors for early death were older age (41–50 and ≥51 years) [aHR 1.38, 1.07–1.78 and 1.68, 1.21–2.34], male (1.84, 1.44–2.35), low weight (2.06, 1.64–2.59), bedridden, (3.81, 2.57–5.66) and CD4 count ≤ 50 cells/mm3 (6.83, 2.52–18.57). In addition to above factors, high attrition was associated with an abacavir-based regimen.ConclusionAlthough there was a low rate of early deaths, patients were being diagnosed late and there was a high attrition rate from specialist hospitals. Concerted effort is required to increase early diagnosis and ART initiation, and strengthen community systems for HIV care to achieve ambitious goal of ending AIDS epidemic by 2030.

Factors Affecting Early Death and Survival of Patients With Acute Promyelocytic Leukemia Treated With ATRA-Based Therapy Regimens

PurposeTo perform a retrospective analysis of the prognostic relevance of clinicopathologic parameters in a well-documented cohort of patients treated with all-trans-retinoic acid (ATRA)-based induction regimens in order to discover which indicators can predict a high risk of early death (ED) and patient survival. Patients and MethodsWe analyzed data of 288 newly diagnosed adult acute promyelocytic leukemia patients in Hangzhou, China. The median follow-up time was 32 months (range, 6-78 months). ResultsThe 3-year disease-free and overall survival rates were 90.83% and 91.69%, respectively. In the multivariable analysis, older age (≥ 60 years) was the only independent risk factor for ED (hazard ratio [HR] = 15.057; P = .004). High white blood cell count was not a risk factor for ED (P = .055), but it was for relapse (HR = 2.7; P = .009). FLT3 mutation (HR = 3.9; 95% confidence interval, 1.4 to 10; P = .007) and older age (≥ 60 years) (HR = 5.3; 95% confidence interval, 2.4 to 11; P < .001) were prognostic factors for poorer disease-free and overall survival. Interestingly, CD15 negativity (HR = 0.23; P = .049) was a prognostic factor for relapse. The ED rate was 5.9% (17/288 patients). ConclusionThe perceived impact of the identification of these high-risk factors should be described in order to decide whether any modifications to treatment strategy should be entertained.

Risk factors for early death in primary malignant cardiac tumors: An analysis of over 40 years and 500 patients

ObjectivesTo investigate risk factors contributing to early death in patients diagnosed with primary malignant cardiac tumors (PMCTs) and derive better understanding of these poorly characterized individuals. MethodData from the Surveillance, Epidemiology and End-Results (SEER) registries on 564 patients diagnosed with PMCTs between 1973 and 2014 were analyzed. Early death was defined as survival of ≤3 months from the time of diagnosis. Two-tailed χ2 or fisher's exact test were used for association between categorical variables and occurrence of early death. Logistic regression analysis was used to assess independent risk factors of early death. Time trends in early death rates of PMCTs were described using scatter plot. ResultsOf the 564 patients with PMCTs, early death was identified in 214 individuals (37.9%). Patients with unspecified soft tissue sarcomas and blood vessel tumors had the highest risk of early death. Age > 80 years and non-consent for surgery were strong predictors of early death in all PMCT subtypes. In sarcomas, disadvantaged income was associated with an increase in early mortality, while black race was associated with a reduction in early mortality. In mesotheliomas and others, male sex was a risk factor for early mortality, while Hispanic ethnicity was associated with a reduction in early mortality. Percentages of early death slightly decreased over the past 40 years. ConclusionsPredictors of early death are primarily related to age older than 80 years, no surgery and specific histopathology types but also include disadvantaged socioeconomic status and male sex. Initiatives to identify those at risk and develop preventive interventions should be prioritized.

Sa1259 HIGH BLOOD UREA NITROGEN LEVEL CAN BE A PREDICTIVE CLINICAL FACTOR FOR EARLY DEATH AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY.

Percutaneous endoscopic gastrostomy (PEG) is accepted as a method for administering enteral feeding to patients with swallowing difficulties. However, the prevalence of complications and early death after PEG is considerably high. To decrease the incidence of early mortality after PEG, it is very important to identify risk factors for early death after PEG. The aim of our study was to determine factors that could predict early death within 30 days following PEG. We retrospectively analyzed the records of all patients who underwent PEG at Kure Medical Center and Chugoku Cancer Center from April 2008 to July 2017. We examined clinical and preoperative laboratory data and extracted data of predictive factors for early death after PEG by using univariate and multivariate analyses. A total of 993 patients—459 female (46.2%) and 534 male (53.8%) patients with a mean age of 78 years—were assessed. Predictors of poor survival after PEG included age ≥81 years (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.1–3.2; P<0.01), white blood cell count ≥9000/μL (OR, 1.91; 95% CI, 1.2–3.1; P<0.005), L-lactate dehydrogenase level ≥300 U/L (OR, 2.51; 95% CI, 1.5–4.3; P<0.005), blood urea nitrogen level ≥34 mg/dL (OR, 2.75; 95% CI, 1.6–4.8; P<0.001), C-reactive protein level ≥2.6 mg/dL (OR 2.72; 95% CI, 1.6–4.4; P<0.001), total protein level ≤5.8 mg/dL (OR, 2.4; 95% CI, 1.3–4.4; P<0.05), albumin level ≤2.7 mg/dL (OR, 3.2; 95% CI, 1.7–6.1; P<0.005), hemoglobin level ≤9.4 g/dL (OR, 2.6; 95% CI, 1.5–4.2; P<0.001), and cholinesterase level ≤172 IU/L (OR, 7.2; 95% CI, 1.6–32; P<0.05). Multivariate analysis on predictive factors for early death revealed high blood urea nitrogen level (OR, 5.45; 95% CI, 1.7–16.9; P<0.05) as an independent risk factor. High blood urea nitrogen level may be a useful predictive clinical factor for early death after PEG. If patients have a history of high blood urea nitrogen levels, PEG should be considered carefully.

Overview of Intracerebral Hemorrhage

Stroke is categorized into two major subtypes i.e., ischemic and hemorrhagic and is one of the major causes of morbidity and mortality worldwide. Primary intracerebral hemorrhage (ICH), i.e. spontaneous extravasation of blood into the brain parenchyma, begins very suddenly and is a medical catastrophe. The well-known risk factors for ICH are hypertension, heavy drinking of alcohol, and anticoagulant medication. Risk factors for early death include clinical and radiological severity of the bleeding. Moreover, intraventricular bleeding, use of anticoagulants, and high blood pressure on admission also predict early death after ICH. CT brain imaging is the immediate modality for establishing diagnosis and supplemented with MR imaging depending upon aetiology. Treatment of patients with ICH includes standard supportive care, medical management and surgical intervention.

Long-Term Outcomes of Total Anomalous Pulmonary Venous Drainage Repair in Neonates and Infants

Outcomes of operations for total anomalous pulmonary venous drainage (TAPVD) have improved. However, operations in the neonatal period and the development of postoperative pulmonary venous obstruction are associated with a high mortality rate. A retrospective review was conducted for all neonates and infants (n= 214) who underwent operations for isolated TAPVD (1973 to 2014). Median age was 18 days (1 day to 1 year). There were 17 (7.9%) early deaths. Risk factors for early death were prolonged cardiopulmonary bypass time (p= 0.005) and neonatal age at the operation (p= 0.048). Early mortality was 2.5% for infants (n= 81) and 11% for neonates (n= 133; p= 0.021) during the entire study period. Hospital deaths for neonates remained unchanged during the four eras of 1973 to 1988, 1989 to 1998, 1999 to 2008, and 2009 to 2014. Survival at 10 and 20 years was 88% ± 2.2% (95% confidence interval, 82% to 91%). Reoperation for postoperative pulmonary venous obstruction was required in 22 patients (10%). Risk factors for reoperation were prolonged cardiopulmonary bypass time (p= 0.015), lower operative weight (p= 0.003), and an episode of postoperative pulmonary hypertensive crisis (p= 0.005). Freedom from reoperation at 20 years was 86% ± 3.2% (95% confidence interval, 78% to 91%). All survivors were asymptomatic at a mean of 13 ± 9 years (range, 1 month to 42 years) after the operation. Although isolated TAPVD repair in infants can be performed without death, the operation is associated with a high mortality rate in neonates that remained unchanged during the long study period. Survival beyond 1 year after the operation is associated with excellent long-term outcomes.

Clinical differences between men and women undergoing surgery for acute Type A aortic dissection.

The differences in clinical features, surgical outcome and long-term prognosis between men and women who undergo surgery for Type A aortic dissection are not well known. From January 2004 to December 2016, 303 patients, consisting of 147 women and 156 men, underwent surgery for acute Type A aortic dissection at our institution. We compared clinical outcomes between the 2 cohorts. Women were older than men (72.6 vs 63.0; P < 0.001). Operative mortality was similar between the groups (8.2% vs 8.9%; P = 0.80). The duration of intensive care unit stay (54 vs 64 h median; P = 0.03) and mechanical ventilator support (34 vs 43 h; P = 0.02) was significantly shorter in women. Multivariate logistic regression analysis revealed that preoperative cardiopulmonary resuscitation, cardiac tamponade, chronic obstructive pulmonary disease, haemodialysis and longer cardiopulmonary bypass time were independent risk factors for early death. Among the hospital survivors, the actuarial survival rate was 59.0% in women and 65.7% in men at 10 years (P = 0.81). During the follow-up period, there were 9 female and 27 male patients who underwent reoperation related to the aortic dissection. The rate of 10-year actuarial freedom from reoperation was 80.7% in women and 53.1% in men (log-rank P = 0.018). No differences were observed in both early and long-term mortality between women and men. Male patients had a significantly higher rate of reoperation. UMIN000029179.

Analysis of Early-Death and Factors Affecting Prognosis of Patients with Acute Promyelocytic Leukemia

To investigate the factors affecting the early-death, overall survival (OS) and relapse-free survival (RFS) of acute promyelocytic leukemia (APL) patients. The clinical and laboratorial charachteristics of 176 APL patients in our center were analyzed retrospectively during January 2002 to Mar 2016. The risk factors of early death and factors affecting OS and RFS of patients were analyzed. Among total of 176 patients, early death occured in 10 patients. Multivariate analysis showed both age ≥60 years and fibrinogen<1.5 g/L (HR=6.4, 95%CI 1.4-28.2) (P=0.015), (HR=12.2, 95%CI 1.5-102.8) (P=0.021), respectively were the independent risk factors for the early death during the induction therapy. Among 154 patients with full follow-up data (median follow-up time was 101(2-262) months), the estimated 5-year OS and RFS rate were (98± 1)% and (77± 4)%, respectively. Cox regression analysis showed relapse during treatment as well as initial WBC count≥30× 109/L were independent prognostic indicators for OS. Accompanied psoriasis indicated higher relapse rate of APL(HR=4.8, 95%CI 1.8-12.5)(P=0.002), while the low-risk APL indicated lower relapse rate (HR=0.4, 95%CI 0.2-0.99)(P=0.048). Importance should be attached to the early-death events in elder and low-fibrinogen APL patients. As for patients with psoriasis or non low-risk group, emphasizing the intensified dynamic supervision during the treatment helps to detect the early-relapse events. For relapsed patients and patients with ≥30× 109/L WBC count, seeking more optimized therapy strategy seems allow this cohorts to get better prognosis.

The predictive prognostic factors for polymyositis/dermatomyositis-associated interstitial lung disease

BackgroundInterstitial lung disease (ILD) is the principal cause of death in polymyositis/dermatomyositis (PM/DM). Here we investigated prognostic factors for death and serious infection in PM/DM-ILD using the multicenter database.MethodsWe retrospectively reviewed baseline demographic, clinical and laboratory findings, treatment regimens and outcomes in patients with PM/DM-ILD. The distribution of ILD lesions was evaluated in four divided lung zones of high-resolution computed tomography images.ResultsOf 116 patients with PM/DM-ILD, 14 died within 6 months from the diagnosis. As independent risk factors for early death, extended ILD lesions in upper lung fields (odds ratio (OR) 8.01, p = 0.016) and hypocapnia (OR 6.85, p = 0.038) were identified. Serious infection was found in 38 patients, including 11 patients who died of respiratory or multiple infections. The independent risk factors were high serum KL-6 (OR 3.68, p = 0.027), high initial dose of prednisolone (PSL) (OR 4.18, p = 0.013), and combination immunosuppressive therapies (OR 5.51, p < 0.001).ConclusionThe present study shows the progression of ILD at baseline is the most critical for survival and that infection, especially respiratory infection, is an additive prognostic factor under the potent immunosuppressive treatment.

Intracerebroventricular administration of cigarette smoke condensate induced generalized seizures reduced by muscarinic receptor antagonist in rats

Tobacco smoking is considered the greatest risk factor for early death caused by noncommunicable diseases. Currently, there are more than one billion tobacco smokers in the world predisposed to many diseases including heart attack, stroke, cancer, and premature birth or birth defects related to the consumption of cigarettes. However, studies on the association between tobacco smoking and seizures or epilepsy are insufficient and not well documented. In the present study, the authors examined the convulsive effects of the intracerebroventricular administration of cigarette smoke condensate (CSC, 2μl/Rat) in rats and compared it with the intensity of seizures in the kainic acid (KA)-induced seizure model of epilepsy. The role of the cholinergic system was also investigated by testing the effect of the muscarinic acetylcholine receptors (mAChRs) antagonist atropine (2ml/kg) on CSC-induced seizures.The results indicate that a central injection of CSC produces an epileptic behavior similar to that induced by KA, the similarities include the following parameters: time latency of seizures, latency and duration of tonic–clonic seizures, duration of seizures, survival, and tonic–clonic rate. However, a pretreatment with atropine reduced seizures and all their parameters.

Transient Myeloproliferative Disorder in Neonates with Down syndrome: Case Report and Review

Down syndrome (DS) or trisomy 21 is the most prevalent chromosomopathy. Interesting associations have been documented between DS and various hematopoietic and non-hematopoietic malignancies. Transient myeloproliferative disorder (TMD) is a clonal proliferation of megakaryoblasts, typically occurring in newborns with DS. It is believed that TMD occurs in the presence of GATA-1 mutation together with trisomy 21. The disorder resolved in the majority of patients during the first six months of life, however, 30% of patients can develop acute leukemia or a myelodysplastic syndrome in the first five years of life. In most instances, this unique disorder has the ability to spontaneously “turn off” the overproliferation and enter a state of remission. Only supportive care is recommended for TMD during the first months of life unless the clinical condition requires intervention. This is the report of a preterm newborn with Down syndrome diagnosed with TMD that required chemotherapy on the first days of life due to a poor clinical course and other risk factors for early death. As more cases of this disorder are presented, it is important to share our experience to aid in management and diagnosis.

Difference in causes and prognostic factors of early death between cohorts with de novo and relapsed acute promyelocytic leukemia.

Early death (ED) remains the most critical issue in the current care of patients with acute promyelocytic leukemia (APL). Very limited data are available regarding ED in patients with relapsed APL. In this retrospective study, 285 de novo and 79 relapsed patients were included. All patients received single-agent arsenic trioxide as induction therapy. The differences in baseline clinical features, incidence, causes, and prognostic factors of ED were compared between the two patient cohorts. The relapse cohort exhibited a better overall condition than the de novo cohort upon hospital admission. The ED rate in the relapsed patients (24.1%) was somewhat higher than that in the de novo patients (17.9%), although the difference was not significant (P = 0.219). For both cohorts, hemorrhage was the main cause of ED, followed by differentiation syndrome, infection, and other causes. Increased serum creatinine level, older age, male sex, white blood cell (WBC) count > 10 × 109/L, and fibrinogen < 1g/L were independently risk factors for ED in the de novo patients, whereas WBC count > 10 × 109/L, elevated serum uric acid level, and D-dimer > 4mg/L were independent risk factors for ED in the relapsed patients. These data furnish clinically relevant information that might be useful for designing more appropriate risk-adapted treatment protocols aimed at reducing ED rate in patients with relapsed APL.

Analysis of risk factors related to the prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation

Objective: To investigate the prognostic factors of late-onset severe pneumonia (LOSP) in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: From January 2009 to December 2015, 68 patients with LOSP after allo-HSCT at Peking University Institute of Hematology were enrolled. In this retrospective study, univariate and multivariate analysis were used to evaluate the prognostic factors for LOSP after allo-HSCT. Results: The median time from allo-HSCT to the development of LOSP was 213 (90-2 330) days. The overall survival rate was 42.6% (29/68). The median survival time from LOSP to death was 21 days. Early mortality was defined as death within 21 days after LOSP, as late death more than or equal to 21 days. The median oxygenation index was 199.15 (92.21-290.48) mmHg. LOSPs in thirty-two patients (36.8%) were caused by virus, bacteria, fungi or mixed pathogens. The median C-reactive protein (CRP) was 75.65 (0.94-451.00) mg/L. The median procalcitonin (PCT) was 0.66 (0.00-249.00) μg/L. The higher PCT value indicated an early higher mortality rate by the ROC curve (PCT: cut-off ≥0.94 μg/L). Furthermore, multivariate analysis suggested that PCT more than or equal to 0.94 μg/L was a risk factor for early death of LOSP (OR=5.77, 95%CI 1.66-20.11, P=0.006). LOSP occurred later or equal to 213 days after allo-HSCT was also a risk factor of early death in LOSP (OR=4.74, 95%CI 1.33-16.89, P=0.017). No previous history of chronic graft versus host disease (GVHD) (OR=4.50, 95%CI 1.58-12.83, P=0.005) and LOSP later or equal to 213 days (OR=4.40, 95%CI 1.61-11.99, P=0.004) were the risk factors of late death in LOSP. Conclusions: PCT more than or equal to 0.94 μg/L and LOSP later or equal to 213 days are the risk factors of early death in LOSP. No previous chronic GVHD and LOSP later or equal to 213 days are the risk factors of late death in LOSP.

Analysis of Early Death in Japanese Patients With Advanced Non–small-cell Lung Cancer Treated With Nivolumab

BackgroundThe increased risk for early death owing to anti-programmed cell death 1 inhibitors is a major disadvantage that requires special management. We evaluated the frequency, causes, and risk factors of early death during nivolumab treatment for non-small cell lung cancer (NSCLC) in a Japanese clinical setting. Patients and MethodsThe medical records of patients with NSCLC who started receiving nivolumab between December 17, 2015 and July 31, 2016 in 3 Japanese institutes were collected. Early death was defined as any death within 3 months from the start of nivolumab treatment, irrespective of its cause. Treatment response was evaluated using the Response Evaluation Criteria In Solid Tumors criteria, version 1.1. ResultsA total of 201 patients with NSCLC were enrolled, and 38 (18.9%) died within the first 3 months. Thirty-one (81.6%) patients who experienced early death developed progressive disease, whereas 14 (36.8%) patients who experienced early death demonstrated nivolumab-induced immune-related adverse events, which required corticosteroid intervention, including interstitial lung disease in 7 (18.4%) patients. Multivariate logistic regression demonstrated that an Eastern Cooperative Oncology Group performance status score ≥ 2 (odds ratio [OR], 5.66; 95% confidence interval [CI], 2.01-15.61; P < .001), C-reactive protein-to-albumin ratio > 0.3 (OR, 10.56; 95% CI, 3.61-30.86; P < .001), and the response to prior treatment (OR, 2.07; 95% CI, 1.03-4.14; P = .041) were independent predictors for early death. ConclusionDisease progression and immune-related adverse events are 2 major causes of early death with nivolumab in patients with NSCLC. An Eastern Cooperative Oncology Group performance status score ≥ 2, pretreatment C-reactive protein-to-albumin ratio > 0.3, and poor response to prior treatment were associated with early death.