Significant Difference In Patient Survival Research Articles

CT Findings of Benign Omental Lesions Following Abdominal Cancer Surgery

The greater omentum is frequently involved in the intra-abdominal dissemination of gastrointestinal and ovarian malignancies, either during primary seeding or as a site of recurrent cancer after surgical treatment (1-4). Therefore, the greater omentum, historically, was totally resected during surgery for abdominal cancer. However, several studies of omentum-preserving operations show a lower rate of postoperative complications and no statistically significant difference in patient survival, as compared with total omentectomy (5-7). Therefore, the use of omentum-preserving operations has recently been increasing, especially for gastric cancer surgery. However, a variety of benign lesions of traumatic, inflammatory, vascular, or systemic origin can occur in the remnant omentum. Various findings are visible on computed tomography (CT), including hazy stranding, nodules, mass formation, and diffuse infiltration. In this article, we review the CT findings of a variety of benign omental lesions after abdominal cancer surgery. The appearances of benign omental lesions on CT are classified into four categories, according to the etiopathogenic mechanism: 1) traumatic omental lesions; 2) inflammatory omental lesions; 3) vascular omental lesions; and 4) omental lesion from systemic causes.

Validation of T Stage According to Depth of Invasion and N Stage Subclassification Based on Number of Metastatic Lymph Nodes for Distal Extrahepatic Bile Duct (EBD) Carcinoma.

According to the current AJCC staging system, the T stage of distal extrahepatic bile duct carcinoma (EBD) is classified according to the extent of the tumor within or beyond the bile duct wall. However many invasive carcinoma accompany stromal desmoplasia that obscure lower boundary of bile duct wall; it is frequently difficult to clearly define the extent of tumors using the current T classification system. In this study, we validated an alternative T classification system by depth of invasion (DoI; T1: < 5 mm, T2: 5 to 12 mm, and T3: ≥ 12 mm). Specifically, we evaluated DoI in 114 cases of distal EBD carcinoma using digital scan images to achieve more objective measurements of tumor DoI. In addition, we evaluated the effect of the number of metastatic lymph nodes (LNs) as well as the number of total examined LNs on the survival rate in the same patient group, and performed a comparative analysis of these data to assess patient survival. We also analyzed 114 cases of distal EBD carcinoma using the current T and N classification of the AJCC staging system (7th edition). The T stage of the current AJCC staging system was not associated with significant differences in patient survival, especially between T2 and T3. However, T staging by DoI was associated with statistically significant differences in patient survival (P < 0.001 in DoI-1, P = 0.002 in DoI-2). With respect to N stage, we divided patients into 3 tiers comprising class 1 (no nodal metastasis), class 2 (1–3 nodal metastases), and class 3 (4 or more nodal metastases). In 3-tier classification analysis, the median survival times for classes 1, 2, and 3 were 79.2, 28.8, and 10.9 months, respectively. The difference in survival among the 3 classes was statistically significant (P < 0.001). We found the cut-off value of 11 LNs (1 to 10 vs ≥ 11) for N0 stage showed most significant difference (P = 0.007). We think at least 11 LNs should be examined for more accurate evaluation of N stage in distal EBD carcinoma. We propose an alternative T classification using DoI and 3-tier sub-classification of N stage for distal EBD carcinoma.

Cordyceps sinensis (a traditional Chinese medicine) for kidney transplant recipients.

Kidney transplantation is the treatment of choice for patients with end-stage kidney disease (ESKD). Rising ESKD prevalence has substantially increased numbers of kidney transplants performed. Maintenance immunosuppression is long-term treatment to prevent acute rejection and deterioration of graft function. Although immunosuppressive treatment using drugs such as calcineurin inhibitors (CNIs, such as cyclosporin A (CsA) or tacrolimus) reduce acute rejection rates, long-term allograft survival rates are not significantly enhanced. CNI-related adverse effects contribute to reduced quality of life among kidney transplant recipients. Adjuvant immunosuppressive therapies that could offer a synergetic immunosuppressive effect, while minimising toxicity and reducing side effects, have been explored recently. Cordyceps sinensis, (Cordyceps) a traditional Chinese medicine, is used as an adjuvant immunosuppressive agent in maintenance treatment for kidney transplantation recipients in China, but there is no consensus about its use as an adjuvant immunosuppressive treatment for kidney transplantation recipients. This review aimed to evaluate the benefits and potential adverse effects of Cordyceps as an adjuvant immunosuppressive treatment for kidney transplant recipients. We searched the Cochrane Kidney and Transplant Specialised Register through contact with the Trials Search Co-ordinator to 7 September 2015 using search terms relevant to this review. We also searched Chinese language databases and other resources. We included all randomised controlled trials (RCTs) and quasi-RCTs evaluating the benefits and potential side effects of Cordyceps sinensis for kidney transplant recipients, irrespective of blinding or publication language. An inclusion criterion was that baseline immunosuppressive therapy must be the same in all study arms. Two authors extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Our review included five studies (six reports; 447 participants) that assessed Cordyceps. Limited reporting of study methods and data meant that all included studies were assessed as having unclear risks of bias. The studies investigated Cordyceps compared with azathioprine (AZA) (4 studies, 265 participants) and Cordyceps plus low dose CsA versus standard dose CsA (1 study, 182 participants).Compared with AZA, Cordyceps showed no significant difference in graft or patient survival, but improved graft function and may reduce acute rejection episodes. Anaemia, leucopenia, and liver function improved, and incidence of infection may also be reduced.Compared with low dose CsA versus standard dose CsA, Cordyceps did not demonstrate any statistically significant differences in patient survival, graft loss, acute rejection or allograft function. There was limited low quality evidence to suggest benefits in pulmonary infection, serum albumin, serum uric acid levels, CNI nephrotoxicity and hepatotoxicity.None of the included studies reported on quality of life, and follow-up was short-term (three months to one year). Given the limited number of small studies, and high risk of bias, results should be interpreted with caution. Although there were some favourable aspects associated with Cordyceps, longer-term studies are needed to clarify any benefit-harm trade-off. Future studies should investigate the use of Cordyceps in combination with other immunosuppressive agents such as tacrolimus, mycophenolate mofetil or induction therapy. Such studies also need to be appropriately sized and powered.

The Efficacy of Intraluminal Brachytherapy as Palliative Therapy of Hilar Cholangiocarcinoma

Background/Aims: The aim of this study is to assess the therapeutic benefits of a combination of external beam radiation therapy (EBRT) and intraluminal brachytherapy (ILBT) in hilar cholangiocarcinoma as palliative therapy. Methods: A total of 21 patients with hilar cholangiocarcinoma were included. Only 12 patients were treated with EBRT (group 1), and only nine patients were treated with EBRT and ILBT (group 2). The survival data and stent patency period were measured in both groups and the results were compared. Results: No statistically significant difference in patient survival was observed between the two groups. The median survival period of group 1 was 353 days and that of group 2 was 224 days. Also, stent patency did not differ significantly between groups. The period for group 1 was 250 days, and that of group 2 was 133 days. In addition, there were no other factors influencing patient survival and stent patency period. However, patient survival tended to increase with increase in the amount of irradiation dose (Spearman’s correlation coefficient=0.65, p =0.065). Conclusions: EBRT with ILBT did not have a benefit when compared with the treatment effect of EBRT alone as palliative therapy for hilar cholangiocarcinoma. Korean J Pancreatobiliary 2015;20(2):71-77

Influence of Different Payment Schemes on the Clinical Outcome in Peritoneal Dialysis Patients.

♦ Cost is always a big issue for dialysis patients. In the present study, we analyzed the effect of different payment schemes on dialysis adequacy and clinical outcome in our peritoneal dialysis program. ♦ This is a single-center cohort study. A total of 175 patients who began dialysis from January 2006 to December 2007 were included. Baseline data, including volume status, dietary intake and nutrition status, dialysis adequacy, and sodium removal were collected at 6 months after peritoneal dialysis. Based on the different payment schemes, the patients were divided into 2 groups, higher payment group (GHP, 130 cases, with more than 85% reimbursement), and lower payment group (GLP, 45 cases, with less than 50% payment or totally self-paid). Patients were followed up until dropout or until December 31, 2013. ♦ At baseline, patients in the 2 groups had nearly the same residual renal function. But the GLP group patients dialyzed at a lower dose (4,516.91 ± 1,768.20 mL vs 6,058.17 ± 2,013.43 mL, p < 0.001). They had lower creatinine clearance (51.64 ± 24.23 L/w vs 70.54 ± 30.27 L/w, p < 0.001), sodium removal (2.23 ± 1.29 g vs 2.77 ± 1.29 g, p = 0.027), and fluid removal (970.33 ± 545.97 mL vs 1,146.66 ± 460.93 mL, p = 0.038). Normalized by height (in meters), the GLP group patients still had a lower normalized dialysis dose (2,890.61 ± 1084.44 mL/m vs 3,761.34 ± 1,237.10 mL/m, p < 0.001). Baseline nutritional and dietary parameters were comparable except that a lower daily protein intake (42.73 ± 10.99 g vs 47.26 ± 14.30 g, p = 0.032) and higher serum urea level (23.43 ± 6.88 mmol/L vs 19.84 ± 5.92 mmol/L, p < 0.001) were presented in the GLP group. There was no difference in volume status. During the follow-up, Kaplan-Meier analysis showed that there was no significant difference in patient survival and technique survival. In multivariate Cox regression analysis, after adjusting for related factors, payment was again not a strong predictor of survival in the study population. ♦ Our study found that GLP group patients were adherent to lifestyle modification with lower dialysis doses, and they also had nearly the same long-term clinical outcome as the GHP group patients. Thus, lower dialysis doses combined with controlled dietary intake may be an effective approach to solve the dialysis problem for the low socio-economic status (SES) population.

Circulating Aldosterone Levels and Disease Severity in Pulmonary Arterial Hypertension.

It is not known whether aldosterone levels are associated with increased mortality in patients with pulmonary arterial hypertension (PAH). The primary goal of this study was to determine whether circulating aldosterone levels predict severity of PAH in terms of hemodynamic characteristics and mortality. Patients with stable PAH were enrolled at the Baylor PH program. The plasma levels of aldosterone and BNP were measured. Clinical, hemodynamic, and outcome data was collected by chart review. Mean follow up time from study enrollment was 39 ± 102 months. Cox proportional hazards model was used to assess time to death. There were 125 PAH patients with plasma aldosterone levels. Median aldosterone level was 9.9 pg/ml (25th-75th percentile: 4.1 pg/ml, 27.1 pg/ml) and median brain natriuretic peptide (BNP) level was 67.5 pg/ml (25th-75th percentile: 31 pg/ml, 225 pg/ml). Aldosterone levels were not significantly associated with BNP levels, six-minute walk distance, Borg dyspnea score, right ventricular systolic pressure, cardiac output and cardiac index. However, the association between aldosterone and right atrial pressure was dependent on mineralocorticoid receptor blocker treatment (Coef. =2.88, 95CI: 1.19, 4.56, p=0.001). By log-rank statistic there was no statistical difference between the survival of patients divided by median aldosterone level (p=0.914). However, there was a significant difference in patient survival between the BNP categories (p<0.001) such that those with high BNP level (>180 pg/mL) had a shorter survival time. The aldosterone level was not associated with increased mortality in PAH but was a marker of disease severity.

Paired kidney exchange transplantation: Maximizing the donor pool.

In the last decade, paired kidney exchange (PKE) transplantation has gained popularity worldwide as a viable alternative for end stage renal disease (ESRD) patients who have incompatible or sensitized donors. This study presents our experience with PKE transplantation and compares outcome between PKE and non-PKE renal transplant recipients. Between February 2010 and November 2013, 742 transplants were performed, of which 26 (3.5%) were PKE transplantations. All were two-way exchanges. PKE recipients were significantly older than non-PKE (46.73 ± 9.71 vs. 40.08 ± 13.36 years; P = 0.012) while donor ages were comparable. PKE patients had significantly higher number of HLA mismatches (5.03 ± 1.14 vs. 3.49 ± 1.57; P < 0.0001). After a median follow-up of 20 months (range: 3–47 months), there was no significant difference in patient survival (PKE 96.16% vs. non-PKE 96.65%; P = 0.596) and death censored graft survival (PKE 96.16% vs. non-PKE 96.37%; P = 1). Mean serum creatinine at 1 month and at last follow-up was lower in PKE versus non-PKE group (0.98 ± 0.33 vs. 1.3 ± 0.61 mg/dl; P = 0.008 and 0.96 ± 0.30 vs. 1.27 ± 0.57 mg/dl, P = 0.006, respectively). Biopsy proven acute rejection rate was 11.5% in PKE group and 16.89% in non-PKE patients (P = 0.6). To conclude, paired kidney donation is an excellent way of increasing the donor pool and needs to be promoted to overcome the shortage of suitable kidney in our country.

Reply

Dr Khauli has correctly interpreted and eloquently summarized our findings. Our results demonstrate that African American (AA) recipients of deceased donor allografts, although having no significant differences in patient survival, do experience significantly inferior outcomes with respect to the level of graft function and graft survival compared with Caucasian Americans (CAs). In contrast, AA recipients of living donor allografts enjoy parity in outcomes of both level of graft function and short- and long-term allograft survival compared with CAs.

Registry of the Japanese Society of Lung and Heart-Lung Transplantation: official Japanese lung transplantation report, 2014.

The number of organ donations after brain death has significantly increased since the revised Japanese Organ Transplant Law took effect in July 2010. Sixty-one lung transplantations were conducted throughout Japan in 2013, including 20 living-donor lung transplantations and 41 brain-dead-donor lung transplantations (23 bilateral lungs, 17 single lungs, and 1 heart-lung transplantation). The number of lung transplant candidates newly registered at the Japan Organ Transplantation Network also increased to 126 in 2013, suggesting a severe donor shortage in Japan. More than 60 % of offered brain-dead-donor, lungs were used for transplantation, indicating the effort of Japanese lung transplant centers to overcome the challenge of donor shortage. After lung transplantation, patients generally enjoyed a good quality of life with excellent survival of 86.2 % at 1 year, 79.6 % at 3 years, and 73.7 % at 5 years post-transplantation. There was no significant difference in patient survival between living-donor and brain-dead-donor lung transplantation. Early mortality of lung transplant recipients within 90 days was attributable to graft failure followed by infection, while long-term mortality was mostly explained by chronic lung allograft dysfunction (chronic rejection), infection, and malignancy. Eight lung transplant centers are currently approved to conduct lung transplantation in Japan (Tohoku, Dokkyo, Chiba, Kyoto, Osaka, Okayama, Fukuoka, and Nagasaki Universities). These centers are expected to continue to make a special effort to save critically ill patients waiting for lung transplantation.

A Comparison of Outcomes Between OKT3 and Antithymocyte Globulin for Treatment of Steroid-Resistant Rejection in Hepatitis C Liver Transplant Recipients

The treatment of steroid-resistant rejection (SRR) is associated with severe recurrent hepatitis C virus (HCV) infection after liver transplantation (LTx). After OKT3 was recently withdrawn from the market, thymoglobulin (TG) became the principal treatment for SRR. A retrospective analysis of 32 HCV patients who were treated for SRR with OKT3 (n=15) or TG (n=17) using yearly protocol liver biopsies. Mean follow-up was 4.3 years (OKT3) and 3.2 years (TG). We compared both groups for patient survival, graft loss, and severity of HCV recurrence, manifested as the mean stage of fibrosis (MSF). Patient survival at 1, 2, and 5 years after LTx was 80%, 73%, and 67% in the OKT3 group and 82%, 77%, and 64% in the TG group, respectively. At 2 years after LTx, the graft losses were 3 versus 4 in the OKT3 and TG groups, respectively. At years 1 and 2, the MSF in the OKT3 group was 1.9 and 2.3 versus 2.4 and 2.8 in the TG group, respectively. None of the differences between both groups was statistically significant. There was no significant difference in patient survival, graft loss, or severity of recurrent HCV, measured as MSF, between both groups.

Elevated Expression of Maspin mRNA as a Predictor of Survival in Stage II and III Gallbladder Cancer Cases

Maspin expression is a potential prognostic factor for various malignancies but its relation with gallbladder cancer is unknown and needs to be investigated needs to be investigated. We therefore here focused on maspin mRNA expression in normal, gall stone disease and gallbladder cancer subjects, with particular attention to prognostic importance in individuals with malignancies. This study was carried out at the Department of Surgical Gastroenterology, King George's Medical University, Lucknow, India. Gallbladder samples from normal (n=25), gall stone disease (n=25) and cancer patients (n=38) were analysed for maspin mRNA expression by semi-quantitative reverse transcriptase PCR and quantitative real time PCR. Statistical analysis was carried out using the Students t test or ANOVA. Survival analysis was conducted according to the Kaplan-Meier method and correlations were assessed using the Pearson correlation method. p<0.05 was considered statistically significant. Significant increase (p=0.028) in expression of maspin mRNA was observed in gallbladder cancer as compared to gall stone disease, whereas no expression was found in normal tissues. Significant correlation (Pearson's coefficient(r)=-0.798, p<0.0001) was observed between relative quantification of maspin mRNA and survival of cancer patients after surgery, with significantly shorter (p=0.002) survival in patients having relative quantification >1.5 as compared to those having relative quantification <1.5. Similarly, significant differences in patient survival for maspin mRNA expression was observed for stage II (p=0.025) and III (p=0.011) cancer. Higher expression of maspin mRNA in gallbladder cancer has prognostic significance for stage II and III cancer, which needs to be investigated further.

Calcineurin inhibitors in HLA-identical living related donor kidney transplantation

Given the nephrotoxicity of calcineurin inhibitors (CNIs), we asked whether their addition improved living related donor (LRD) human leukocyte antigen (HLA) identical kidney transplant recipient outcomes. We performed a comprehensive literature review and a single-center study comparing patient survival (PS) and graft survival (GS) of LRD HLA-identical kidney transplants for three different immunosuppression eras: Era 1 (up to 1984): anti-lymphocyte globulin (ALG) induction and maintenance immunosuppression with prednisone and azathioprine (AZA) (n = 114); Era 2a (1984-99): CNI added; evolution from ALG to thymoglobulin; AZA to mycophenolate (n = 262). Era 2b (1999-2011): rapid discontinuation of prednisone (thymoglobulin induction, CNI and mycophenolate) in recipients having first or second transplant and not previously on prednisone (n = 77). Demographics differed by era: recipient (P < 0.0001) and donor age (P < 0.0001) increased and the proportion of Caucasian donors (P = 0.02) and recipients (P = 0.003) decreased with each advancing era. There was no significant difference in PS (P = 0.6); cause of death (P = 0.5); death-censored GS (P = 0.8) or graft loss from acute rejection by era. Graft loss from chronic allograft nephropathy (P = 0.02) and hypertension (P = 0.005) were greater in the CNI eras. There were no significant differences in the 1/creatinine slopes between eras for the first (P = 0.6), second (P = 0.9) or >2 years post-transplant (P = 0.4). Literature review revealed no clear benefits for CNI in these human leukocyte antigen (HLA) identical LRD graft recipients. This study confirmed that there are no benefits of CNIs for HLA-identical LRD recipients. Moreover, we did find evidence of potential harm. Thus, monotherapy or early discontinuation of CNI should be given consideration in these patients.

Attainment of Complete Hematological Remission is Crucial for Extended Survival of AL Amyloidosis Patients with Cardiac Involvement

Symptomatic cardiac involvement is the most important prognostic factor in AL amyloidosis patients. Longterm survival is limited not only by cardiac involvement condition, but also by limited choice of treatment with unsatisfactory results. The aim of the present report is to assess the effect of achieved treatment response on survival of AL amyloidosis patients with symptomatic cardiac involvement under conventional treatment. The monitored patient set consisted of 19 patients with systemic AL amyloidosis and symptomatic cardiac involvement, treated and monitored at the III. Clinic of Internal Medicine between 2004 and 2012. The male : female ratio was 17 : 2, and the age median was 64 (range 48 to 78 years). Thirteen patients died within the monitored period. Functional status was defined according to the NYHA classification, where five patients had class II involvement, 10 patients had class III involvement, and four patients had class IV involvement. Treatment response was assessed by the application of modified IMWG and ISA criteria; all patients were undergoing conventional treatment. Nine patients were treated by a combination of alkylating agents (alkeran, cyclophosphamide), six were treated by a combination treatment with thalidomide, and four were treated by a combination of bortezomib and dexamethasone. Data were analyzed with software SPSS v. 15 (SPSS, Inc., Chicago, USA). Log Rank Test was applied to survival evaluation. The statistical analysis included only 13 patients who underwent at least three months of treatment, where six patients attained complete remission (CR), four patients attained partial remission (PR), and three patients attained only stabilization of disease (SD). Significant difference in patient survival was found to be correlated with attained hematological response, where the patients who attained CR had median survival of 39 months vs 10 months in patients who attained PR or SD (p = 0.005). The results indicate that attainment of complete hematological remission is associated with significantly longer survival of AL amyloidosis patients with symptomatic cardiac involvement.

Outcomes following renal transplantation in older people: a retrospective cohort study

BackgroundThe mean age of renal transplant recipients is rising, with age no longer considered a contraindication. Outcomes in older patients have not, however, been fully defined. The aim of our study is to evaluate outcomes in older people following renal transplantation at a Scottish regional transplant unit.MethodsAll renal transplants from January 2001 to December 2010 were analysed (n = 762). Outcomes following renal transplantation in people over 65 years old were compared to those in younger patients. Outcome measures were: delayed graft function (DGF), primary non-function (PNF), biopsy proven acute rejection (BPAR), serum creatinine at 1 year and graft and recipient survival. Lengths of initial hospital stay and re-admission rates were also assessed. Student’s T-Test was used to analyse continuous variables, Pearson’s Chi-Squared test for categorical variables and the Kaplan-Meier estimator for survival analysis.ResultsOlder recipients received proportionately more kidneys from older donors (27.1% vs. 6.3%; p < 0.001). Such kidneys were more likely to have DGF (40.7% vs. 16.9%; p < 0.001). Graft loss at 1 year was higher in kidneys from older donors (15.3% vs. 7.6%; p = 0.04). There was no significant difference in patient survival at 1 year based on the age of the donor kidney. Recipient age did not affect DGF (16.9% vs. 18.5%; p = 0.77) or graft loss at 1 year (11.9% vs. 7.8%; p = 0.28). Older recipients were, however, more likely to die in the first year post transplant (6.8% vs. 2.1%; p = 0.03). BPAR was less common in older patients (6.8% vs. 22%; p < 0.01). Older recipients were more likely to be readmitted to hospital (31.8% vs. 10.9%; p < 0.001).ConclusionsOlder patients experience good outcomes following renal transplantation and donor or recipient age alone should not preclude this treatment. An awareness of this in clinicians managing older patients is important since the prevalence of End Stage Renal Disease is increasing in this age group.

Abstract B82: Immune signatures of glioblastoma subtypes: Extrapolation from the Cancer Genome Atlas.

Abstract A major obstacle to the treatment of gliomas is the subversion of the immune system by the tumor to facilitate proliferation and malignant degeneration of tumor cells. Immune suppression is thought to play a major role in the aggressive nature of gliomas and their resistance to current therapies. Genomic profiling of glioblastomas (GBMs) has shown that at least four genotypic subtypes exist, with two being dominant (proneural and mesenchymal), each correlating with significant differences in patient survival. Despite a marked immunosuppressive microenvironment, a retrospective analysis of a dendritic cell immunotherapy clinical trial demonstrated that patients with the mesenchymal subtype were more likely to be clinical responders to immunomodulatory treatments. Although this finding tends to contradict what is thought about the immune suppressive nature of mesenchymal gliomas with respect to aggressiveness and poor patient survival, it suggests that mesenchymal gliomas may be more immunogenic and more responsive to immunotherapy. We analyzed mRNA expression levels of immune system genes relative to the other genes among the various glioblastoma subtypes using the Cancer Genome Atlas (TCGA) database to ascertain if there are alterations in antigen expression, the pattern of immune suppression, and effector response genes within glioblastoma subtypes that accounts for this apparent paradox. The glioblastoma cancer study set from the TCGA database of defined glioblastoma subtypes of proneural (n=56), mesenchymal (n=56), classical (n=54) and neural (n=29) was used as the source data available through the open access cBio Cancer Genomics Portal at www.cbioportal.org. To analyze mRNA expression of a comprehensive list of immune-associated genes in the four subtypes of glioma, the z-score for all genes (the number of standard deviations above the mean expression level of the selected gene) was set to &amp;gt; 1 for each of the subtypes (e.g.: IL10: EXP&amp;gt;1). Our results demonstrate a marked and preferential enrichment of genes associated with antitumor proinflammatory responses, including both adaptive and innate immunity as determined by mRNA overexpression of immune effector-associated genes in the mesenchymal subtype of glioma. This analysis also demonstrated an association of mRNA expression of immune suppression-associated genes such as PD-L1, CTLA-4, IL-10, and TGF-β, within the mesenchymal subtype. Furthermore, distinct glioma antigens demonstrated preferential expression within distinct subtypes. Cumulatively, our data suggest that analysis of these selected immune effector and suppressor genes may provide a way to programmatically prioritize different types of potentially competing immune therapeutic strategies and rapidly assess the prognostic impact of select genes on patient outcome. Additionally, these results may help to identify subsets of patients that may be particularly responsive to a particular strategy and thus selectively enrich for potential responders during early or small-scale clinical trials. Citation Format: Tiffany Doucette, Ganesh Rao, Kenneth Aldape, Jun Wei, Kristine Dziurzynski, Arvind Rao, Li Shen, Mark R. Gilbert, Amy B. Heimberger. Immune signatures of glioblastoma subtypes: Extrapolation from the Cancer Genome Atlas. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr B82.

Clinical Significance of Serum Autoantibodies in Idiopathic Interstitial Pneumonia

Although autoantibodies are routinely screened in patients with idiopathic interstitial pneumonia, there are no reliable data on their clinical usefulness. The aim of this study was to investigate the prognostic value of autoantibodies for predicting the development of new connective tissue disease in these patients and also mortality. We conducted retrospective analysis of the baseline, and follow-up data for 688 patients with idiopathic interstitial pneumonia (526 with idiopathic pulmonary fibrosis, 85 with nonspecific interstitial pneumonia, and 77 with cryptogenic organizing pneumonia) at one single tertiary referral center. The median follow-up period was 33.6 months. Antinuclear antibody was positive in 34.5% of all subjects, rheumatoid factor in 13.2%, and other specific autoantibodies were positive between 0.7%-6.8% of the cases. No significant difference in patient survival was found between the autoantibody-positive and -negative groups. However, the presence of autoantibodies, especially antinuclear antibody with a titer higher than 1:320, was a significant predictor for the future development of new connective tissue diseases (relative risk, 6.4), although the incidence was low (3.8% of all subjects during follow-up). In conclusion, autoantibodies are significant predictors for new connective tissue disease development, although they have no prognostic value.

Trends in Kaposi's Sarcoma in Miami Beach from 1987 to 2007.

Purpose. Kaposi's sarcoma (KS) is a rare low-grade vascular tumor associated with the human herpes virus 8. By analyzing the epidemiology, staging, and treatment of KS, we hoped to improve the quality of care at our institution. Methods. Review of the Mount Sinai Medical Center tumor registry database in Miami Beach, FL, USA, identified 143 cases of KS between January 1, 1987 and December 31, 2007. Results. The majority of patients were non-Hispanic whites, non smoking males diagnosed between 1987 and 1996. Most of the patients were HIV positive, with an equal percentage diagnosed with local or distant disease. Most patients received no chemotherapy or radiation. There were no significant differences in patient survival based on sex, HIV status, or radiation received. There was a trend toward improved survival among older patients who smoked, received no chemotherapy, and had localized stage at diagnosis. Multivariate analysis revealed that non-Hispanic whites had a significant worse survival than Hispanic whites (HR = 0.55, 95% CI (0.33, 0.90), P = 0.02). Patients diagnosed between 1987 and 1996 had a worse survival than those between 1997 and 2007 (HR = 0.33 (95% CI 0.19, 0.55), P < 0.0001). Conclusion. This large retrospective study provides further insight into KS. Ethnicity and date of diagnosis are important predictors of long-term survival.

Mycobacterium tuberculous peritonitis in CAPD patients: a report of 11 patients and review of literature

The aims of the present report were to document our experience of the prevalence of tuberculous peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, mode of presentation, diagnosis and outcome and to discuss the current published data about catheter removal. A retrospective study of CAPD patients with tuberculous peritonitis was done. A minimum of three specimens of peritoneal fluid were examined for acid-fast bacilli smears. The BACTEC 9000 Blood Culture Series of instruments were used for the culture of Mycobacterium tuberculosis. After 2005, patients were treated with anti-tuberculous treatment, and catheter retention was started in our patients. There were eleven patients (2.6 %) with tuberculous peritonitis among 414 CAPD patients. M. tuberculosis accounted for 4.47 % of all peritonitis episodes. The incidence of tuberculous peritonitis was 1/794 months. There were eight males and three females. The mean age was 49 years. Intestinal obstruction was reported in two patients, and two patients were treated for antecedent peritonitis. One of them had a simultaneous fungal peritonitis. One patient each developed a peritoneo-cutaneous fistula and ultrafiltration failure. Three were successfully treated without the removal of catheter. Based on the analysis of all published reports of tuberculous peritonitis, there was no significant difference in patient survival between patients in whom CAPD catheter was removed or retained. Tuberculous peritonitis should be considered in patients with neutrophilic 'sterile' peritonitis with no response to antibacterial medications, predominance of lymphocytic peritonitis and in bacterial peritonitis not responding to antibiotics. After an early diagnosis, with close monitoring, an effort to retain the catheter after 5 days of anti-tuberculous therapy may be attempted.

Influence of the First Graft Nephrectomy in the Evolution of Second Kidney Transplant

Introduction: Nephrectomy is usually specified after the loss of a graft when there are signs of intolerance or resistance to erythropoietin. However, the influence of the first graft nephrectomy in the evolution of the second graft is less known. Materials and methods: We conducted a multicenter study of all second transplants performed between January 2001 and December 2005 in 15 centers in our country. Were analyzed: Data from the first graft (donor and recipient age, pretransplant antibody(Ac) titres, rejection acute rate, acute tubular necrosis(ATN), immunosupression, causes of graft loss) Indication of nephrectomy, second transplant data (pretransplant Ac title, acute rejection rate, inmunospresión, ATN, yearly development of proteinuria and renal function and patient and graft survival. The minimum follow-up period is 5 years Results: The sample consists of 525 patients who received a second kidney transplant, 243 had been nephrectomized, in 25 had been performed an embolization and 258 continued with the first graft. The indication for nephrectomy / embolization was 31.5% for graft intolerance in 38.16% by early nephrectomy and required rest from other causes.No nephrectomy for resistance to erythropoietin were made. In the first graft did not find significant differences in donor age, the title of Ac at transplantation, acute rejection rate or frequency of ATN among patients with or without nephrectomy. The duration of first graft was 31.8 months in patients nephrectomized and 94.9 in which nephrectomy was not required. The waiting time for the second transplant was higher in patients nephrectomized (33 vs 23 months, p< 0,01) In the second graft did not find significant differences in donor age, cause of donor death, recipient age or number of HLA incompatibilities in patients with or without prior nephrectomy. The nephrectomized patients had a significantly higher second pretransplant Ac (15.7 vs. 11.8%, p < 0.001), increased frequency of NTA (54% vs. 39%, p < 0.001) and higher rate of acute rejection (24, 7 vs. 17.1%, p < 0.001), as well as more frequently required the use of induction therapy (55 vs 41%, p < 0.01). There were no significant differences in patient survival or graft survival after 5 years of follow-up Conclusions: Nephrectomy was performed in 50.9% of grafts lost. It is indicated by early nephrectomy and graft intolerance syndrome. It is associated with: Increased waiting on dialysis, increased pre-second transplant antibodies, more NTA, more acute rejection, further immunosuppression. No impact on graft and patient survival was observed at 5 years of follow-up.

Influence of the First Graft Nephrectomy in the Evolution of Second Kidney Transplant

Introduction: Nephrectomy is usually specified after the loss of a graft when there are signs of intolerance or resistance to erythropoietin. However, the influence of the first graft nephrectomy in the evolution of the second graft is less known. Materials and methods: We conducted a multicenter study of all second transplants performed between January 2001 and December 2005 in 15 centers in our country. Were analyzed: Data from the first graft (donor and recipient age, pretransplant antibody(Ac) titres, rejection acute rate, acute tubular necrosis(ATN), immunosupression, causes of graft loss) Indication of nephrectomy, second transplant data (pretransplant Ac title, acute rejection rate, inmunospresión, ATN, yearly development of proteinuria and renal function and patient and graft survival. The minimum follow-up period is 5 years Results: The sample consists of 525 patients who received a second kidney transplant, 243 had been nephrectomized, in 25 had been performed an embolization and 258 continued with the first graft. The indication for nephrectomy/embolization was 31.5% for graft intolerance in 38.16% by early nephrectomy and required rest from other causes.No nephrectomy for resistance to erythropoietin were made. In the first graft did not find significant differences in donor age, the title of Ac at transplantation, acute rejection rate or frequency of ATN among patients with or without nephrectomy. The duration of first graft was 31.8 months in patients nephrectomized and 94.9 in which nephrectomy was not required. The waiting time for the second transplant was higher in patients nephrectomized (33 vs 23 months, p< 0,01) In the second graft did not find significant differences in donor age, cause of donor death, recipient age or number of HLA incompatibilities in patients with or without prior nephrectomy. The nephrectomized patients had a significantly higher second pretransplant Ac (15.7 vs. 11.8%, p < 0.001), increased frequency of NTA (54% vs. 39%, p < 0.001) and higher rate of acute rejection (24, 7 vs. 17.1%, p < 0.001), as well as more frequently required the use of induction therapy (55 vs 41%, p < 0.01). There were no significant differences in patient survival or graft survival after 5 years of follow-up Conclusions: Nephrectomy was performed in 50.9% of grafts lost. It is indicated by early nephrectomy and graft intolerance syndrome. It is associated with: Increased waiting on dialysis, increased pre-second transplant antibodies, more NTA, more acute rejection, further immunosuppression. No impact on graft and patient survival was observed at 5 years of follow-up.