Strong Predictor Of Poor Outcome Research Articles

The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke

Background: CT angiography (CTA) and CT perfusion (CTP) are important diagnostic tools in acute ischemic stroke. We investigated the prognostic value of CTA and CTP for clinical outcome and determined whether they have additional prognostic value over patient characteristics and non-contrast CT (NCCT). Methods: We included 1,374 patients with suspected acute ischemic stroke in the prospective multicenter Dutch acute stroke study. Sixty percent of the cohort was used for deriving the predictors and the remaining 40% for validating them. We calculated the predictive values of CTA and CTP predictors for poor clinical outcome (modified Rankin Scale score 3-6). Associations between CTA and CTP predictors and poor clinical outcome were assessed with odds ratios (OR). Multivariable logistic regression models were developed based on patient characteristics and NCCT predictors, and subsequently CTA and CTP predictors were added. The increase in area under the curve (AUC) value was determined to assess the additional prognostic value of CTA and CTP. Model validation was performed by assessing discrimination and calibration. Results: Poor outcome occurred in 501 patients (36.5%). Each of the evaluated CTA measures strongly predicted outcome in univariable analyses: the positive predictive value (PPV) was 59% for Alberta Stroke Program Early CT Score (ASPECTS) ≤7 on CTA source images (OR 3.3; 95% CI 2.3-4.8), 63% for presence of a proximal intracranial occlusion (OR 5.1; 95% CI 3.7-7.1), 66% for poor leptomeningeal collaterals (OR 4.3; 95% CI 2.8-6.6), and 58% for a >70% carotid or vertebrobasilar stenosis/occlusion (OR 3.2; 95% CI 2.2-4.6). The same applied to the CTP measures, as the PPVs were 65% for ASPECTS ≤7 on cerebral blood volume maps (OR 5.1; 95% CI 3.7-7.2) and 53% for ASPECTS ≤7 on mean transit time maps (OR 3.9; 95% CI 2.9-5.3). The prognostic model based on patient characteristics and NCCT measures was highly predictive for poor clinical outcome (AUC 0.84; 95% CI 0.81-0.86). Adding CTA and CTP predictors to this model did not improve the predictive value (AUC 0.85; 95% CI 0.83-0.88). In the validation cohort, the AUC values were 0.78 (95% CI 0.73-0.82) and 0.79 (95% CI 0.75-0.83), respectively. Calibration of the models was satisfactory. Conclusions: In patients with suspected acute ischemic stroke, admission CTA and CTP parameters are strong predictors of poor outcome and can be used to predict long-term clinical outcome. In multivariable prediction models, however, their additional prognostic value over patient characteristics and NCCT is limited in an unselected stroke population.

Abstract 4005: microRNA profiles in metastatic versus non-metastatic salivary mucoepidermoid carcinoma

Abstract Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands, especially affecting the parotids. MEC derives from the main duct segment and is composed of mucous, intermediate, and epidermoid cells in varying combinations. Histological grading (low, intermediate, and high) is of recognized prognostic importance. This is based on the architectural formation, cytological features, perineural invasion, and the presence of necrosis. Metastatic spread occurs in up to 80% of high-grade tumors and it is a strong predictor of poor outcome, however, the mechanisms underlying this process are largely unknown. Large-scale microRNA expression profiling studies of human cancers have demonstrated that dysregulation of miRNA is frequently associated with many cancer types. MicroRNAs (miRNAs) are approximately 22 nucleotide non-coding RNA molecules that regulate gene expression post-transcriptionally and are involved in various biological processes. The aim of this study was to investigate the microRNA profile in metastatic versus non-metastatic MECs. Using Real Time RT-PCR we have analyzed the expression of 762 miRNAs and controls using the TaqMan Array Human MicroRNA A+B Cards in FFPE samples from 2 metastatic MEC, 2 non-metastatic MEC and 2 non-neoplastic human salivary gland. For the identification of differentially expressed microRNAs between tumor samples versus normal samples and between metastatic versus non-metastatic samples, bioinformatics analysis was performed using hierarchical cluster analysis and the t test with Bonferroni correction was applied. Among the 762 microRNAs and controls contained in the array panel, 353 showed an expression level below the detection limit (Ct >38) and were excluded from downstream analyses. The microRNA profile was able to discriminate between normal and tumor samples and between metastatic and non-metastatic tumors. Considering tumor and normal samples, 29 microRNAs were differentially expressed. The metastatic versus non-metastatic analysis demonstrated that 62 microRNAs were differentially expressed. Among the differentially expressed microRNAs, some have already been described as associated with the metastatic process (hsa-miR-9, hsa-miR-125, hsa-miR-145, hsa-miR-494, hsa-miR-140, hsa-miR-212, hsa-miR-146, hsa-miR-183, hsa-miR-21, hsa-miR-200, hsa-miR-638, and hsa-miR-141). Our results suggest that microRNA profiles could discriminate the metastatic potential of salivary MECs and might be helpful in diagnostic and prognostic evaluation of patients. Financial Support: FAPESP 11/02051-6 Citation Format: Cláudia M. Coutinho-Camillo, Renato D. Puga, Cibele P. Nagano, Yukie Sato-Kuwabara, Felipe D'Almeida Costa, Clóvis A. Lopes Pinto, Luiz P. Kowalski, Fernando A. Soares, Silvia V. Lourenço. microRNA profiles in metastatic versus non-metastatic salivary mucoepidermoid carcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4005. doi:10.1158/1538-7445.AM2015-4005

The Oncogenic Properties Of The Redox Inflammatory Protein Inducible Nitric Oxide Synthase In ER(-) Breast Cancer

Inflammation generates reactive chemical species that induce conditions of oxidative nitrosative stress as emerged as factor in poor outcome of many cancers. Our recent findings show that in the inflammatory protein inducible nitric oxide synthase (iNOS) is a strong predictor of poor outcome in ER(-) patients (Glynn et al. JCI 2010). Furthermore 46 genes, of which 23 were associated with basal like breast cancer, were elevated when iNOS high. In vitro studies using ER(-) cell lines showed that fluxes of nitric oxide (NO) delivered by NO donors surprising mimic this relationship in the patient cohort. Using this model, we show that NO at different specific concentrations stimulate pro-oncogenic mechanisms such as AKT, ERK, NFkB, AP-1, and HIF-1α that lead to increase of metastatic and cancer stem cells proteins. In addition, we show that tumor suppressor gene BRCA1 and PP2A are inhibited by these NO levels. Similarly other studies show that these concentrations of NO increase immunosuppressive proteins TGF-β and IL-10 in leukocytes to decrease efficacy of some anticancer therapies further contributing to pro-tumorigenic environment. Using this model we have identified several new compounds that have efficacy in xenographic models. These finding have provided a model that shows how NO can affect numerous mechanism that leads to a more aggressive phenotype.

Neuron-Specific Enolase as a Predictor of Death or Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest and Targeted Temperature Management at 33°C and 36°C

BackgroundNeuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management. ObjectivesThis study investigated the role of NSE as a prognostic marker of outcome after out-of-hospital cardiac arrest (OHCA) in a contemporary setting. MethodsA total of 686 patients hospitalized after OHCA were randomized to targeted temperature management at either 33°C or 36°C. NSE levels were assessed in blood samples obtained 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was neurological outcome at 6 months using the cerebral performance category score. ResultsNSE was a robust predictor of neurological outcome in a baseline variable-adjusted model, and target temperature did not significantly affect NSE values. Median NSE values were 18 ng/ml versus 35 ng/ml, 15 ng/ml versus 61 ng/ml, and 12 ng/ml versus 54 ng/ml for good versus poor outcome at 24, 48, and 72 h, respectively (p < 0.001). At 48 and 72 h, NSE predicted neurological outcome with areas under the receiver-operating curve of 0.85 and 0.86, respectively. High NSE cutoff values with false positive rates ≤5% and tight 95% confidence intervals were able to reliably predict outcome. ConclusionsHigh, serial NSE values are strong predictors of poor outcome after OHCA. Targeted temperature management at 33°C or 36°C does not significantly affect NSE levels. (Target Temperature Management After Cardiac Arrest [TTM]; NCT01020916)

TCTAP A-006 Clinical Significance of ST-Segment Changes in Lead aVR for Patients with Acute Coronary Syndrome

Acute occlusion or critical stenosis in the coronary artery leads to acute coronary syndrome (ACS). Many studies have shown that ST-segment depression on the admission electrocardiogram (ECG) is a strong predictor of poor outcomes in patients with ACS. ECG changes in the aVR lead may play an

Infective Etiology Affects Outcomes of Late Open Conversion After Failed Endovascular Aneurysm Repair

Purpose: To retrospectively review all patients undergoing late open conversion (LOC) after endovascular aneurysm repair (EVAR) in order to identify any clinical or technical predictors of poor outcome. Methods: Twenty-six consecutive patients (24 men; mean age 74.7±8.3 years) underwent LOC between June 2006 and April 2013 at our institution. The mean interval from index EVAR to LOC was 40.4±29.2 months (range 5–93 months). The indication for LOC was endoleak in 14 (54%) patients and infection in 12 (46%): 2 (8%) patients with endoleak had a ruptured aneurysm and 6 (23%) patients with infection had a recurrent secondary aortoesophageal fistula (sAEF). Results: In all 12 cases of infection and in 12 of 14 endoleaks, the entire endograft was explanted. A rifampin-soaked Dacron silver graft was implanted in all patients with infection. Patients with any infection and with recurrent AEF required more blood units than patients with endoleak (6.40 vs. 1.86, p=0.045; 6.76 vs. 1.86, p=0.0036, respectively). Compared with endoleak, the duration of conversions in the setting of infection (274 vs. 316 minutes, p=0.42) and recurrent sAEF (274 vs. 396 minutes, p=0.021) was longer. All patients with recurrent sAEF died at a mean 3.0±2.5 days after LOC from proximal anastomosis disruption and hemorrhagic shock (n=2), myocardial infarction (n=2), acute stroke (n=1), or persistent sepsis (n=1). Perioperative mortality was significantly higher in patients with endograft infection (6/12, p=0.002) and in cases of supraceliac cross-clamping (4/6, p=0.003). The association of infection with supraceliac cross-clamping was a strong predictor for perioperative mortality (p<0.001). Conclusion: In our experience, endograft infection led to greater perioperative mortality after LOC. Recurrent aortoenteric fistula in association with supraceliac cross-clamping is a strong predictor of poor outcome. Patients surviving the perioperative period may have good chances of long-term survival.

Short term outcomes following clipping and coiling of ruptured intracranial aneurysms: does some of the benefit of coiling stem from less procedural impact on deranged physiology at presentation?

BackgroundEndovascular coiling (EVC) has been shown to yield superior clinical outcomes to surgical clipping (SC) in the treatment of ruptured cerebral aneurysms. The reasons for these differences remain obscure. We...

Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study.

Global ageing contributes greatly to the burden of stroke. We investigated the influence of age on the baseline profile and on outcomes in acute intracerebral haemorrhage (ICH) among participants of the INTERACT2 study. INTERACT2 was an international, randomised controlled trial in 2839 patients with spontaneous ICH within 6 h of onset and elevated systolic blood pressure (SBP; 150-220 mmHg) who were allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) blood pressure lowering treatment. Stroke severity was assessed with the National Institutes of Health Stroke Scale. Poor outcome was defined as death or major disability ('dependency', modified Rankin Scale scores 3-6) at 90 days. Health-related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Associations between age and outcomes were analysed in multivariable logistic regression models. Stroke severity increased in categories of older age (P-trend 0.002). Stroke patients over 75 years old were four times more likely to die or be disabled at 90 days than those <52 years when other confounders were accounted for (odds ratio 4.36, 95% confidence interval 3.12-6.08). Older age was also associated with decreasing HRQoL, across mobility, self-care, usual activities and depression (all P-trend <0.001), and pain or discomfort (P-trend 0.022). In the INTERACT2 cohort, older people had more severe ICH and worse outcomes (death, major disability and HRQoL). These data will help guide clinicians manage older people with haemorrhagic stroke. http://www.clinicaltrials.gov (NCT00716079).

The susceptibility vessel sign at the proximal M1: A strong predictor for poor outcome after intravenous thrombolysis

BackgroundHalf of acute stroke patients have poor outcomes at 3months even when treated with intravenous thrombolysis using tissue-plasminogen activator (t-PA) therapy. The aim of the present study was to evaluate the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) T2* at the proximal portion of the middle cerebral artery (M1 proximal SVS) on clinical outcome in anterior circulation stroke patients treated with t-PA. MethodsThe presence of the M1 proximal SVS was assessed before t-PA therapy. Good outcome and poor outcome at 3months were defined as a modified Rankin Scale score of 0 to 2 and 4 to 6, respectively. The predictive values of the M1 proximal SVS for a good and poor outcome were calculated. Results161 patients (median age [interquartile], 76 [67–83] years; male, 91 [57%]) were enrolled. At 3months after stroke, 68 (42%) patients achieved a good outcome, and 75 (47%) had a poor outcome. The M1 proximal SVS was found in 17 (11%) patients, of whom none (0%) achieved a good outcome, and 16 (94%) had a poor outcome. The sensitivity and positive predictive value of the M1 proximal SVS for good outcome were very low (0.000 and 0.000, respectively). Furthermore, the specificity and positive predictive value of the M1 proximal SVS for poor outcome were very high (0.988 and 0.941, respectively). ConclusionThe M1 proximal SVS appears to be a strong predictor for poor outcome after t-PA therapy.

Efficacy and safety of transarterial chemoembolization combined to conformal radiotherapy for uninodular hepatocellular carcinoma

Purpose: A proportion of patients with uninodular hepatocellular carcinoma (HCC) cannot benefit from potential curative therapies such as liver transplantation, surgical resection or radiofrequency ablation. Thus, they are prone to receive transarterial chemoembolization (TACE) that is a palliative option with low probability of both complete response and prolonged local control. Herein, we assessed the combination of TACE and 3D-high dose conformal radiotherapy (3D-HDCRT) for efficacy and safety in HCC. Methods: We retrospectively analyzed the outcome of 35 consecutive patients with uninodular HCC ≤ 100 mm, treated by one course of TACE combined to 3D-HDCRT. The follow-up consisted on clinics, biology, hepatic CT-scan or MRI at month-1 and -3, and thereafter every 3 months. Results: Complete response was obtained in 80% of patients following mRECIST criteria (95% in HCC ≤ 50 mm, and 60% in HCC > 50 mm) with uncommon local recurrence (11%), overall survival rates of 79%, 59% and 44% at respectively 1, 2 and 3 years (median, 37.3 months), and 11.4% grade-3/4 toxicities. Pre-therapeutic α-fetoprotein level ≥ 200 ng/mL was found as a strong predictor of poorer outcome. Conclusion: We showed that TACE combined to 3D-HDCRT can be highly efficient to reach local control and interesting overall survival rates for uninodular HCC, with limited severe toxicities for Child-Pugh A patients. Subsequent prospective controlled trials are warranted for comparison with therapeutic standards.

198: Inflammation and nitric oxide synthase 2 in driving poor prognosis in era(-) breast cancer

Inflammation generates reactive chemical species that induce conditions of oxidative nitrosative stress as emerged as factor in poor outcome of many cancers. Our recent finding show that in the inflammatory protein inducible nitric oxide synthase (iNOS) is a strong predictor of poor outcome in ER(-) patients (Glynn et al. JCI 2010). Furthermore 46 genes, of which 23 were associated with basal like breast cancer, were elevated when iNOS high. In vitro studies using ER(-) cell lines showed that fluxes of nitric oxide (NO) delivered by NO donors surprising mimic this relationship in the patient cohort. Using this model, we show that NO through nitrosation of key thiols and non heme metals at different specific concentration stimulate pro-oncogenic mechanisms such as AKT, ERK, NFkB, AP-1, and HIF-1a that lead to increase of metastatic and cancer stem cells proteins as well as pro-angiogenic and immunosuppressive factors. In addition, we show that tumor suppressor gene BRCA1 and PP2A are inhibited by these NO levels. In the induction of NOS2 was found to dependent inflammatory mediators IFNg, IL6, PGE2, TNFa, and TLR4 agonist (Heinecke et al., PNAS 2014). Since NOS2 and NO also induce these factors, a critical feed-forward autocrine loop is formed that drives poor outcome. These finding provide a novel model that shows how NO can drive numerous inflammatory mechanism that leads to a more aggressive landscape.

Nonalcoholic fatty liver disease (NAFLD) - a new factor that interplays between inflammation, malnutrition, and atherosclerosis in elderly hemodialysis patients.

Background/aimIn the past decade, in most regions of the world, an increasing number of adults aged 65 years and older were started on renal replacement therapy each year. In contrast to the general population for whom overnutrition or obesity is associated with increased cardiovascular risk, for patients who are maintained on hemodialysis (HD), malnutrition and malnutrition-inflammation complex syndrome are associated with poor outcome. In recent years, nonalcoholic fatty liver disease (NAFLD) has been considered to be the liver manifestation of metabolic syndrome, and the development of NAFLD is strongly associated with all components of metabolic syndrome (arterial hypertension, dyslipidemia, obesity, and diabetes mellitus type 2) in the general population. The primary end point of this study was to determine the patient’s survival in relation to nutritional and inflammatory state and the presence or absence of NAFLD. The secondary end point of this analysis was the association among NAFLD and various clinical and laboratory data, with the nutritional and inflammatory state of our elderly HD patients.MethodsUsing a single-center, prospective, cohort study design, we followed the progress of 76 patients who were ≥65 years and treated with chronic HD for at least 6 months, at the Department of Nephrology, Dialysis and Transplantation. All patients were followed for a minimum of 18 months or until death. Survival was defined as the time from study initiation to death (or end of study, if still alive).ResultsThe main findings of our study were a remarkable positive correlation between NAFLD and high-sensitivity C-reactive protein (hs-CRP) (r=0.659; P<0.0001) and consequent negative correlation with the nutritional parameter, serum albumin (r=−0.321; P=0.004). Interestingly, we showed that in contrast to the general population, where NAFLD is associated with obesity, in the present study, there was no statistically significant association between NAFLD and overnutrition in elderly HD patients. Furthermore, the presence of NAFLD, low serum albumin levels, and high hs-CRP were strong predictors of poor outcome in our elderly HD patients.ConclusionOur results indicated that NAFLD probably interplays between inflammation, malnutrition, and atherosclerosis in elderly HD patients. NAFLD could be a new factor that contributes to type 2 malnutrition in elderly HD patients, who may be amenable to adequate nutritional and HD support.

Positive prognostication from median-nerve somatosensory evoked cortical potentials.

The bilateral absence of the cortical N20 median-nerve somatosensory evoked potential (SSEP) is a strong predictor of poor outcome from coma. However, when N20s are present, accurate prognostication is challenging. Here, we investigated the potential for later SSEP components to help disambiguate outcome in these cases. In a retrospective review of data from two intensive care units, the amplitudes and latencies of the N20, P25, and N35 components of 28 patients in coma were quantified and related to outcome at discharge from primary care (average 1-month post-injury). Only patients who had survived primary care were included in order to avoid self-fulfilling prophecies, and to focus outcome prediction on those patients with relatively present SSEPs. The amplitudes of the N20 and N35 components (averaged across hemispheres) significantly predicted the range of outcomes beyond death. Abnormal amplitudes of the N20 and N35--as derived from a healthy control group--were significantly associated with poor outcome. The relative latencies of the cortical components were not related to outcome. While it is well documented that absent SSEPs are highly predictive of poor outcome, the current data indicate that the relative preservation (absolute amplitude) of "present" N20 and N35 SSEP components can also provide predictive value and thereby inform clinicians and families with decision-making in coma. Further prospective study will elucidate the relative contributions of etiology to the predictive power of these SSEP measures.

Evaluation of Clinical and Biochemical Variables in Acute Methanol Poisoning: Is blood pH a Good Prognostic Factor for Prediction of Outcome?

Background: Acute methanol poisoning is one of the most important chemical poisoning due to drinking of illegal and handmade alcoholic beverages in Iran. The aim of this study was to evaluate clinical and biochemical parameters as prognostic factor in acute methanol poisoning. Methods: A retrospective study was performed on acute methanol poisoning cases admitted to the Loghman Hakim Hospital Poison Center (Tehran, Iran) over a two-year period. The demographic data, clinical presentations, paraclinical findings and patients’ outcome were extracted from medical records. Results: During this period, thirty patients with acute methanol poisoning have been enrolled in the study. All of the patients were men, with the median age of 25.5 years. Visual disturbances, respiratory manifestations, and loss of consciousness were the most common clinical manifestations on admission. The median of blood methanol level was 20 mg/dL. The median of pH, PaCO2 and HCO3 was 7.15, 22.35 mmHg and 7.2 mEq/L, respectively. Fatality rate was 30%. There was a significant difference between survivors and non-survivors with regards to coma, blood methanol level, and PaCO2 and blood glucose. Also, we did not observe a significant difference between these two groups regarding pH and HCO3 level. Conclusion: It can be suggested that coma, PaCO2 and hyperglycemia on admission time could be used as strong predictors of poor outcome and blood pH and HCO3 is not a good prognostic factor for assessment of methanol poisoning outcome.

Showing No Spot Sign Is a Strong Predictor of Independent Living after Intracerebral Haemorrhage

Background: A spot sign on computed tomography angiography (CTA) is a potentially strong predictor of poor outcome on ultra-early radiological imaging. The aim of this study was to assess the spot sign as a predictor of functional outcome at 3 months as well as long-term mortality, with a focus on the ability to identify patients with a spontaneous, acceptable outcome. Methods: In a prospective, consecutive single-centre registry of acute stroke patients, we investigated patients with spontaneous intracerebral haemorrhage (ICH) admitted within 4.5 h after symptom onset from April 2009 to January 2013. The standard work-up in our centre included CTA for spot sign status, unless a contraindication was present. Modified Rankin Scale (mRS) scores were assessed at 3 months in the outpatient clinic or by telephone interviews. Long-term mortality was assessed by electronic chart follow-up for up to 1,500 days. Results: Of the 128 patients, 37 (28.9%) had a spot sign on admission CTA. The presence of a spot sign was associated with larger median admission haematoma volume [38.0 ml (IQR 18.0-78.0) vs. 12.0 ml (5.0-24.0); p < 0.0001] and higher median National Institutes of Health Stroke Scale score [19 (IQR 12-23) vs. 12 (6-16); p < 0.0001]. Three months after stroke, the median functional outcome was considerably better in patients without spot sign [mRS score 3 (IQR 2-4) vs. 6 (4-6); p < 0.0001]. The absence of a spot sign showed a sensitivity and specificity for good outcome (mRS scores 0-2) of 0.91 and 0.36, respectively. The presence of a spot sign was, in multivariate models, an independent inverse predictor of good 3-month outcome (OR 0.17; 95% CI: 0.03-0.88) as well as a prominent independent predictor of poor 3-month outcome (mRS scores 5-6; OR 3.40; 95% CI: 1.10-10.5) and death during follow-up (HR 3.04; 95% CI: 1.45-6.34). Patients with a spot sign surviving the acute phase had long-term survival comparable to patients with no spot sign. Conclusion: The absence or presence of a spot sign is a reliable ultra-early predictor of long-term mortality and functional outcome in patients with spontaneous ICH.

Abstract T P56: M1 Proximal SVS Should Be a Strong Predictor for Poor Outcome after tPA Therapy

BACKGROUND AND PURPOSE: Although intravenous thrombolysis using tPA can improve the clinical outcome in patients with acute ischemic stroke, a half of the patients complains of poor outcomes at 3 months. We previously reported that the susceptibility vessel sign (SVS) shown on MRI T2* at the proximal portion of the middle cerebral artery is a strong predictor for no early recanalization. The aim of the present study is to evaluate the impact of the M1 proximal SVS on poor outcome in acute patients with anterior-circulation stroke. METHODS:Consecutive patients treated with tPA were enrolled. Patients treated with intra-arterial intervention were excluded. Initial neurological deficit was assessed using the NIHSS score. The extent of the early ischemic change was evaluated using the DWI-ASPECTS. The presence of M1 proximal SVS was assessed before tPA therapy. Poor outcome at 3 months was defined as a mRS of 4 to 6. Results: One-hundred and sixty patients (median age, 76 years [67-83], male; 91 [57%]) were enrolled. Seventy-four (46%) patients had poor outcome (P group), and 86 (54%) had a non-poor outcome (NP group). Patients in the P group were older than those in the NP group (77 [69-84] versus 74 [64-81], p=0.010). NIHSS score was higher in the P group than the NP group (17 [13-20] vs. 8 [5-13], p&lt;0.001). Regarding the imaging parameter, 16 (22%) patients in the P group and only 1 (1%) in the NP group had M1 proximal SVS (p&lt;0.002). Patients in the P group had lower initial DWI-ASPECTS compared to those in the NP group (7 [5-9] versus 9 [7-10], p&lt;0.001). Internal carotid artery occlusion was seen in 19 (26%) patients in the P group and 6 (7%) in the NP group (p=0.002). The glucose level was slightly higher in the P group compared to the NP group (140 mg/dl [120-182] vs. 130 mg/dl [116-164], p=0.076). Multivariate regression analysis revealed that proximal M1-SVS (OR:14.17, 95%CI:1.47-136.42, p=0.022) was the strong predictor for poor outcome, followed by NIHSS score ≥14 (OR:7.95, 95%CI:3.26-19.37, p&lt;0.001), and glucose ≥125 mg/dl (OR:2.83, 95%CI:1.22-6.57, p=0.016) after adjusting age, onset treatment time, DWI-ASPECTS, cardioembolic stroke, and internal carotid artery occlusion. Conclusions: M1 proximal SVS should be a strong predictor for poor outcome after tPA therapy.

Correction: Prognostic Value of Cancer Stem Cell Marker CD133 Expression in Gastric Cancer: A Systematic Review

In the list of references, 29 is incorrect. Reference 29 should read, Coco C, Zannoni GF, Caredda E, Sioletic S, Boninsegna A, et al. (2012) Increased expression of CD133 and reduced dystroglycan expression are strong predictors of poor outcome in colon cancer patients. J Exp Clin Cancer Res. 31: 71. Additionally, the affiliation for Dr. Xian-Ming Mo should be Laboratory of Stem Cell Biology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Temperamental factors predict long-term modifications of eating disorders after treatment

BackgroundEating Disorders (EDs) are complex psychiatric pathologies characterized by moderate to poor response to treatment. Criteria of remission and recovery are not yet well defined. Simultaneously, personality plays a key role among the factors that determine treatment outcome. The aim of the present research is to evaluate the possibility of temperamental and character traits to predict the long-term outcome of ED.MethodA sample of 25 AN and 28 BN female patients were re-assessed face-to-face after a minimum 5-years-follow-up through SCID-I, EDI-2 and TCI-R. Regression Analyses were performed to ascertain the possibility of TCI-R dimensions at the first visit to predict the long-term outcome.ResultsClinical and psychopathological symptoms significantly decreased over the time and 23% of participants no longer received a categorical ED diagnosis after at least 5 years of follow-up. TCI-R dimensions failed to predict the absence of a DSM-IV-TR diagnosis in the long term, but Novelty Seeking, Harm Avoidance and Reward Dependence demonstrated to predict the clinical improvement of several EDI-2 scales.ConclusionsOur results support the idea that temperamental dimensions are relevant to the long-term improvement of clinical variables of ED. Low Novelty Seeking is the strongest predictor of poor outcome.

Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results

hip fracture is expensive in terms of mortality, hospital length of stay (LOS) and consequences for independence. Poor outcome reflects the vulnerability of patients who typically sustain this injury, but the impact of different comorbidities and impairments is complex to understand. We consider this in a prospective cohort study designed to examine how a patients' frailty index (FI) predicts outcome. consecutive patients with low trauma hip fracture were assessed, excluding only those unfit for surgery. Comprehensive Geriatric Assessment (CGA) findings were used to derive a FI for each patient, which was examined alongside other assessment and outcome data from our National Hip Fracture Database (NHFD) submission for these individuals. we describe 178 patients; mean age 81 years, 73.5% female. The mean FI was 0.34 (SD = 0.16), and logistic regression identified abbreviated mental test score and FI as the strongest predictors of poor outcome. When patients were stratified by FI, 56 (31.5%) were in the low-frailty group (FI ≤0.25), 58 (32.5%) in intermediate (FI >0.25-0.4), and 64 (36%) in the high-FI group (FI >0.4). All the patients in the low-FI group returned to their original residence within a mean of 21.6 days. The mean LOS for the intermediate group was 36.3 days compared with 67.8 days in the high-FI group (P < 0.01) while 30-day mortality was 3.4% for the intermediate group compared with 17.2% for the high-FI group (P < 0.001). individual CGA findings proved disappointing as outcome predictors, while FI turned out to be a better predictor of mortality, 30-day residence and length of inpatient stay.

Elevated CSF-1 serum concentrations to predict lymph node metastasis and overall survival in women with early breast cancer.

11032 Background: Colony-stimulating factor-1 (CSF1) is a key modulator of tissue macrophages and contributes to the physiological function of the mammary gland. It has, however, also been associated with breast cancer since expression of its receptor CSF-1R is a strong predictor of poor outcome in early breast cancer and results in tumor cell invasiveness and pro-metastatic behavior in vitro. Methods: We have prospectively measured circulating CSF-1 with ELISA in 572 women with early breast cancer and in 688 women with benign breast lesions; and correlated these values with overall survival, nodal status and other clinical and histological parameters. Results: Serum CSF-1 concentrations were significantly elevated in patients with early breast cancer when compared to those with benign tumors (p&lt;0.0001). Within breast cancer patients, CSF-1 was higher in women with involved axillary lymph nodes (p=0.04). CSF-1 concentrations were correlated with tumor size (p=0.002), age (p&lt;0.001), and Ki67 expression (p=0.006). Log CSF-1 serum concentrations were predictive of poor survival in both univariate (HR: 3.77, CI: 1.65-8.65, p=0.002) and multivariate analyses (HR: 3.1, CI: 1.03-9.33, p=0.04). Post- but not premenopausal women with CSF-1 serum concentrations &gt;873 pg/ml experienced a significantly poorer outcome (p=0.004 log rank test). Conclusions: CSF1 serum concentrations are elevated in women with malignant breast tumors. In early breast cancer, elevated serum CSF-1 is associated with nodal involvement, and in postmenopausal women also with poor overall survival.