True Prognosis Research Articles

A Retrospective Analysis of Self-Limiting Fever following Percutaneous Patent Foramen Ovale and Atrial Septal Defect Closure.

While percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) are generally well-tolerated procedures, the development of postprocedure fever has been observed at a higher frequency than reported in the initial device trials. We performed a retrospective analysis of 62 patients who underwent PFO or ASD closure from January 1, 2020, to December 31, 2022, at Mayo Clinic, Arizona. Eight patients out of 62 (12.9%) developed fever following PFO or ASD closure. In each of the fever cases, the Gore Cardioform devices (W.L. Gore and Associates, Flagstaff, AZ) were used. No association was found between clinical characteristics or procedural details and the development of fever. The reactions occurred 24 to 48 hours following device implantation and resolved spontaneously. No evidence of infection was found upon diagnostic evaluation. There was a higher incidence of self-limited atrial fibrillation (AF) in the fever patients (37.5% vs. 18.5%) which was not statistically significant. All patients who developed fever had successful closure with no other subsequent clinical events. We have found a high incidence of fever following PFO or ASD closure using the Gore family of devices that has not been observed in prior years. A unifying etiology or risk factor, such as infection or medication, for the fever could not be identified. Long-term device success was achieved in all fever patients. This small retrospective study suggests that the observed fever is benign and self-limiting but further investigation is warranted to determine its true incidence, mechanism, and prognosis.

Molecular sensitization patterns to cat and dog allergens in Lithuanian children population

BackgroundOver the last few decades, there was observed an increase of asthma and allergic rhinitis cases caused by allergy to pets. ObjectiveThis study aimed to analyze molecular sensitization patterns to dog and cat allergens in Lithuanian children who were experiencing allergy-like symptoms. Materials and methodsA total of 574 children (0–18 years) were tested for allergen-specific immunoglobulin E (sIgE) levels with ALEX2 (ALEX2®, Allergy Explorer Test System). Positive sera were further analyzed for sensitization to cat (Fel d 1, Fel d 2, Fel d 4, and Fel d 7) and dog (Can f 1, Can f 2, Can f 3, Can f 4, Can f 5, and Can f 6) allergen components. ResultsTwo hundred forty-seven children tested positive (sIgE ≥0.3 kUA/L) to at least 1 dog or cat allergen component. There were 61.1% children sensitized to components from both sources, 29.2% – exclusively to cat, and 9.7% – to dog components. The major sensitizers were Fel d 1 (84.8%) and Can f 1 (59.4%). There were 42.9% patients sensitized to 3 or more different mammalian protein families and 40.4% – to 3 or more lipocalins. There were 5.7% of children sensitized both to Fel d 1 + Fel d 4 and Can f 1/2 + Can f 5, indicating the high risk of severe asthma. Monosensitization to Fel d 1 was the dominant pattern among Lithuanian children (26.3%). ConclusionThe majority of children were cat/dog-polysensitized, although sensitization only to cat allergens was most observed. Extensive molecular profiling can be an useful tool for accurate true sensitization diagnosis and prognosis of disease severity.

Deep Inception-ResNet: A Novel Approach for Personalized Prediction of Cumulative Pregnancy Outcomes in Vitro Fertilization Treatment (IVF).

Infertility is one of the major causes of socioeconomic stress worldwide due to social stigma and stressful lifestyles. Despite technological advances, couples still undergo several IVF cycles for conceiving without knowing their true prognosis which is causing a huge social and medical impact, and the live birth rate continues to be relatively low (~ 25%). A prediction model that predicts IVF prognosis accurately considering the pre-treatment parameters before starting the IVF cycle will help clinicians and patients to make better-informed choices. In this study, clinical details of 2268 patients with 79 features who underwent IVF/ICSI procedure from January 2018 to December 2020, at the Center of IVF and Human Reproduction, Sir Ganga Ram Hospital were retrospectively collected. The machine learning model was developed considering features such as maternal age, number of IVF cycle, type of infertility, duration of infertility, AMH, indication for IVF, sperm type, BMI, embryo transfer, and β-hCG value at the end of a fresh cycle and/or one subsequent frozen embryo transfer cycle was selected as the measure of outcome. Compared to other classifiers, for an 80:20 train-test split with feature selection, the proposed Deep Inception-Residual Network architecture-based neural network gave the best accuracy (76%) and ROC-AUC score of 0.80. For tabular datasets, the applied approach has remained unexplored in previously made studies for reproductive health. This model is the starting point for providing a personalized prediction of a successful outcome for an infertile couple before they enter the IVF procedure. The online version contains supplementary material available at 10.1007/s13224-023-01773-9.

The many faces of hypertension in individuals with type 1 diabetes

Several disturbed blood pressure (BP) patterns, including disparities between office and out-of-office BP measurements (such as white-coat and masked hypertension), disturbed circadian BP variability (such as abnormal dipping patterns and nocturnal hypertension) and treatment-resistant hypertension, are common in individuals with type 1 diabetes. Consequently, office or home BP measurements alone may not reflect real BP variation and may lead to inadequate diagnosis and treatment of hypertension. The early detection of these disturbed BP patterns is especially crucial in individuals with type 1 diabetes, as these patterns may indicate future development of adverse cardiovascular and renal outcomes. In this review we will describe these disturbed BP patterns and discuss recent findings on their prevalence and outcomes. We will also address critical areas for future research to determine the true prevalence and prognosis of disturbed BP patterns, and to optimize and improve the knowledge and management of high-risk individuals with type 1 diabetes and disturbed BP patterns.

Slow Development of Day 5 Embryo Leads to Compromised Live Birth But Not Birthweight Outcomes

Background: There is currently no consensus regarding developmental cutoff for fresh transfer of slow developing day 5 embryos on. Literature is sparse regarding true prognosis of such embryos. Aim: To investigate live birth and birthweight outcomes of slow developing day 5 transferred embryos. Method: This retrospective multi-center study included 1213 consecutive autologous-oocyte single fresh day 5 transfers performed at 4 Monash IVF clinics during 2016-2019. Repeat cycles by same patients were excluded to avoid clustering effects. Live birth and birthweight were followed up in all pregnancies. Multiple regression was performed to investigate associations between slow day 5 development (defined as ≤ early blastocyst) and (a) live birth, (b) birthweight, and (c) gestation-adjusted birthweight (Z score) to account for gestational age and gender. Results were expressed as adjusted odds ratio (aOR) with 95% confidence interval (CI). Results: No implantation was achieved when day 5 embryo failed to reach early blastocyst stage (i.e. ≤morula, n=76). Live birth rate was significantly lower following transfer of early blastocysts (n=237, 16%), in comparison to expanding (n=329, 27%, P=0.001), expanded (n=392, 41%, P=0.000), and ≥hatching blastocysts (n=169, 44%, P=0.000). After adjusting for maternal age, hours post insemination at day 5 assessment, number of oocytes collected, number of 2PNs, and number of embryos frozen; multiple logistic regression showed a significantly reduced likelihood of live birth resulting from early blastocysts in reference to expanding (aOR=0.584, 0.371-0.917, P=0.020), expanded (aOR=0.322, 0.208-0.501, P=0.000), or ≥hatching stages (aOR=0.255, 0.147-0.443, P=0.000). However, early blastocysts resulting in live birth (n=39) did not alter birthweight or Z score in reference to expanding (n=90, P>0.05 respectively), expanded (n=160, P>0.05 respectively), or ≥hatching (n=75, P>0.05 respectively). Conclusion: There is no clinical value of fresh transferring day 5 embryos at ≤morula stage. Fresh early blastocysts lead to a reduced live birth rate but not birthweight outcomes.

O-213 Slow day 5 development affects implantation potential of fresh transferred embryos but not birthweight once pregnancy occurs: A multi-center retrospective cohort study

Abstract Study question Does slow development of fresh transferred day 5 embryos lead to decreased implantation potential and birthweight? Summary answer Slow day 5 development was associated with reduced implantation potential when transferred fresh but the subsequent birthweight of the resulting baby was not impacted. What is known already Slow development of in vitro cultured cleavage stage embryos is associated with reduced blastocyst development and implantation rates. There is no current consensus regarding whether to transfer fresh slow developing day 5 embryos or to extend culture for a subsequent day with potential for cryopreservation. It is therefore important to understand the true prognosis of fresh transferred day 5 embryos at less advanced developmental stages. This would provide evidence based guidelines for the decision making process in regard to embryo transfer. Study design, size, duration This is a retrospective multi-center cohort study, including 1213 consecutive patients undergoing autologous oocyte in vitro fertilization (IVF) treatment during 2016-2019,with fresh transfer of a single day 5 embryo (selection based on developmental stage and inner cell mass and trophectoderm morphology if blastocyst was at the ≥expanding stage). Cycle data were collected from 4 associated private clinics, with repeat cycles of same patients excluded to avoid clustering effect at statistical analysis. Participants/materials, setting, methods Live birth and birthweight were followed up in all 1213 fresh day 5 SETs. Multiple regression (logistic or linear) was performed to investigate association between slow day 5 development (defined as ≤ early blastocyst) and (a)live birth, (b) birthweight, and (c) gestation-adjusted birthweight (Z score) to account for gestational age, gender and compared to embryos at ≥ expanded stage. Results were expressed as adjusted odds ratio (aOR) with 95% confidence interval (CI)or coefficients (β). Main results and the role of chance No implantation was achieved following single fresh transfer of day 5 embryos that failed to reach early blastocyst stage (n = 76) and were transferred as ≤ morula stage. Live birth rate was significantly lower following single day 5 fresh transfer of an early blastocyst (n = 237, 16%), in comparison to expanding (n = 329, 27%, P = 0.001), expanded(n = 392, 41%, P = 0.000), and hatching/hatched blastocysts (n = 169, 44%, P = 0.000). After adjusting for potential confounding factors including; maternal age, hours post insemination at day 5 assessment, number of oocytes collected, number of 2PN embryos, and number of embryos frozen; multiple logistic regression showed significantly reduced likelihood of live birth resulting from early blastocysts in reference to those at the expanding (aOR=0.584, 0.371-0.917, P = 0.020), expanded (aOR=0.322, 0.208-0.501, P = 0.000), or hatching/hatched stages (aOR=0.255, 0.147-0.443, P = 0.000). However, multivariate linear regression indicated that early blastocysts resulting in a live birth (n = 39) did not lead to altered birthweight (β=-9.091, P = 0.904; β=-34.960, P = 0.343; β=-26.074, P = 0.414; respectively) or Z score (β = 0.045, P = 0.706; β=-0.051, P = 0.426; β=-0.028, P = 0.506; respectively) in reference to the expanding (n = 90), expanded (n = 160), or hatching/hatched stages (n = 75). Limitations, reasons for caution The retrospective nature of this study does not allow controlling of unknown confounders. The 4 participating clinics are associated within the same network with shared protocols, therefore, results may not be generalized to other clinics with different settings. Wider implications of the findings The findings suggest no clinical value of fresh day 5 transfer of embryos ≤morula stage. Although early blastocysts implant at reduced rate, assuring birthweight outcomes suggest clinical value. Future studies intend to investigate slow growing day 5 fresh transfers versus embryos that were slow growing but transferred after day 6. Trial registration number NA

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

BackgroundPneumocystis jirovecii (P. jirovecii) is increasingly identified on lower respiratory tract specimens of COVID-19 patients. Our narrative review aims to determine whether the diagnosis of pneumocystis jirovecii pneumonia (PJP) in COVID-19 patients represents coinfection or colonization based on the evidence available in the literature. We also discuss the decision to treat COVID-19 patients with coinfection by PJP. MethodsA literature search was performed through the Pubmed and Web of Science databases from inception to March 10, 2021.ResultsWe identified 12 COVID-19 patients suspected to have PJP coinfection. All patients were critically ill and required mechanical ventilation. Many were immunosuppressed from HIV or long-term corticosteroids and other immunosuppressive agents. In both the HIV and non-HIV groups, severe lymphocytopenia was encountered with absolute lymphocyte and CD4+T cell count less than 900 and 200 cells/mm, respectively. The time to PJP diagnosis from the initial presentation was 7.8 (range 2–21) days. Serum lactate dehydrogenase and beta-D-glucan were elevated in those coinfected with PJP. All patients were treated with anti-PJP therapy, predominantly sulfamethoxazole-trimethoprim with corticosteroids. The overall mortality rate was 41.6%, and comparable for both HIV and non-HIV groups. ConclusionAs the current evidence is restricted to case reports, the true incidence, risk factors, and prognosis of COVID-19 patients with PJP coinfections cannot be accurately determined. Comorbidities of poorly controlled HIV with lymphocytopenia and multiple immunosuppressive therapies are likely predisposing factors for PJP coinfection.

Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2.

Although data on the incidence and severity of new coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed more significant disease among adults and the elderly, a clinical manifestation characterized by a multisystem inflammatory syndrome was described in children (MIS-C). It was initially thought to be specific to children, but recent reports have shown that it can also occur in adults. MIS-C is characterized by a number of multisystemic manifestations resembling other known previously described illnesses, mainly Kawasaki disease, especially in cases with shock, toxic shock syndrome, and macrophage activation syndrome. Available literature shows that our knowledge of MIS-C is largely incomplete. Its development in strict relation with SARS-CoV-2 infection seems documented and, in most cases, can be considered a post-infectious manifestation secondary to an abnormal immune response for some aspects, similar to that seen in adults several days after SARS-CoV-2 infection. However, in a minority of cases, a clinical picture with symptoms fulfilling criteria for MIS-C diagnosis develops during the acute phase of SARS-CoV-2 infection. It is highly likely that the criteria currently used to diagnose MIS-C are too broad, meaning that children with different diseases are included. As clarity on the pathogenesis of MIS-C is lacking, different therapeutic approaches have been used, but no specific therapy is currently available. Further studies are urgently needed to improve our definition of MIS-C, to define the real impact on child health, and to elucidate the best clinical and therapeutic approach and true prognosis.

Population-based Screening for BRAF V600E in Metastatic Colorectal Cancer Reveals Increased Prevalence and Poor Prognosis.

BRAF V600E mutations portend poor prognosis in metastatic colorectal cancer (mCRC); however, the true prevalence and prognosis are unknown, as unwell patients may not undergo BRAF sequencing. We reviewed a population-based cohort of 1,898 patients with colorectal cancer that underwent reflexive IHC mismatch repair (MMR) and BRAF V600E testing. Outcomes among IHC-detected BRAF V600E mCRC (BRAF IHC) were compared with patients with next-generation sequencing (NGS)-identified BRAF V600E-mutated mCRC from two institutions (BRAF NGS) with patients spanning from 2004 to 2018. All-stage population prevalence of BRAF V600E was 12.5% (238/1,898) and did not differ between early and metastatic stages (P = 0.094). Prevalence among mCRC was 10.6% (61/575), of whom 51 (83.6%) were referred to oncology and 26 (42.6%) had NGS testing. BRAF IHC had worse median overall survival (mOS) than BRAF NGS [5.5 vs. 20.4 months; HR, 2.90; 95% confidence interval (CI), 1.89-4.45; P < 0.0001], which persisted in multivariate analysis (P < 0.0001). Across a combined NGS and IHC cohort, BRAF V600E tumors with deficient MMR showed worse mOS compared with MMR proficient tumors (8.9 vs. 17.2 months; HR, 1.46; 95% CI, 0.96-2.27; P = 0.043). In this combined cohort, first-line progression-free survival was 5.9 months, with minimal differences between regimens. Within the population-based cohort, attrition between treatment lines was high with only 60.7% receiving first-line chemotherapy and 26.2% receiving second line. Patients with BRAF V600E-mutated mCRC have a worse prognosis than previously suggested, potentially arising from referral bias for testing. High attrition between lines of therapy suggests efficacious therapies need to be prioritized early for patients to benefit.

Clinical features and surgical outcomes of high-grade spinal meningiomas: Report of 19 cases and literature review

High-grade spinal meningiomas (SMs) are extremely rare lesions. The true incidence, clinical features and prognosis of SMs are still unclear. To elucidate this information by using institutional data and to provide an updated review of the literature. Nineteen consecutive patients harboring 20 high-grade SMs were identified, including 15 (78.9%) female patients, with a mean age of 37.8 ± 14.9 years. The 20 tumors were most frequently located in the lumbar and lumbosacral segment (n = 6, 30.0%), followed by the cervical segment (n = 5, 25.0%), thoracolumbar junction (n = 4, 20.0%), thoracic (n = 3, 15.0%) and cervicothoracic junction (n = 2, 10.0%). The mean number of affected spinal levels was 2 ± 1. Simpson grade II and III resection were achieved for sixteen (80.0%) and four (20.0%) tumors, respectively. During a mean follow-up of 79.6 ± 39.9 months, three tumors (15.0%) recurred. Fourteen patients (73.7%) achieved excellent outcomes, three (15.7%) remained stable, one (5.3%) deteriorated, and one (5.3%) died. High-grade SMs are rare entities which consist of 5.7% SM. These lesions tend to affect young patients, with atypical meningioma being the most common pathological subtype. In our study, surgery was an effective means of treatment. Close observation is warranted after surgery because of the high recurrence rate. Recurrent patients can still benefit from a second surgery.

Intestinal Thromboangiitis Obliterans (Buerger’s Disease): a Case Report

Buerger’s disease is an unknown etiology, inflammatory vaso-occlusive, and non-arteriosclerotic vascular disease. It affects medium- or small-sized arteries and veins; uncommonly it involves in vesical vessels. A 43-year-old man, previously diagnosed with Buerger’s disease for 25 years, presented with acute abdomen. Urgent laparotomy was done, and a perforated jejunal ulcer and peritonitis were detected. The patient had to undergo recurrent laparotomy for mesenteric ischemia. A case of intestinal manifestation of the disease with superior mesenteric vessels occlusion represents unexpected manifestation of the disease. Early diagnosis is the key for true clinical management and good willing prognosis.

Population-based screening for BRAF V600E in metastatic colorectal cancer (mCRC) to reveal true prognosis.

3579 Background: BRAFV600E ( BRAF) mutations (mts) portend poor prognosis in mCRC and patients (pts) may die before ascertainment. Since 2014, Vancouver Coastal Health (VCH) has performed reflex hereditary screening of CRCs with BRAF and mismatch repair (MMR) immunohistochemistry (IHC). We evaluated this BRAF mt population-based cohort ( BRAFPOP) to establish the true prognosis of BRAF mts in mCRC. Methods: We reviewed all mCRCs from VCH between 4/2014 and 5/2018 for BRAF by IHC (VE1 antibody). Overall survival (OS) from stage IV diagnosis was compared to mCRCs with next generation sequencing (NGS) determined BRAF mts ( BRAFNGS) from BC Cancer &amp; MD Anderson. BRAFNGS OS did not differ by center (p = 0.77). Results: See table for BRAF cohort baseline characteristic comparison. BRAFPOP pts had worse OS than BRAFNGS pts (HR 2.5, 95% CI 1.6 – 3.9, P &lt; 0.0001). Median OS for all BRAF mt pts was 17.9 mos. Both groups had worse OS than wild type pts (P &lt; 0.0001). 52 (81%) of BRAFPOP pts were referred to oncology, 40 (63%) received chemotherapy, and 12 (19%) had NGS BRAF testing. BRAFPOP pts who had NGS testing with BRAF mts had OS comparable to other BRAFNGS pts (P = 0.89) and better OS than BRAFPOP pts that never had NGS testing (HR 0.37, 95% CI 0.18-0.76, P = 0.030). Pts with BRAF mts and MMR deficiency (dMMR) (n = 40) had worse OS than MMR proficiency (pMMR, n = 202) (1.6, 95% CI 1.0-2.5, P = 0.011). This was driven by BRAFPOP dMMR pts (HR 1.9, 95% CI 0.9-4.0, P = 0.036) as no difference was seen by MMR in BRAFNGS pts (HR 1.3, 95% CI 0.8-2.2, P = 0.30). Conclusions: Current estimates of prognosis for mCRC with BRAF mts likely underestimate its impact due to referral bias for NGS testing. BRAF mts with dMMR are associated with worse prognosis than pMMR. This appears driven by BRAFPOP pts. [Table: see text]

Characteristics and outcomes of patients with essential thrombocythemia or polycythemia vera diagnosed before 20 years of age: a systematic review.

Although it is well known that myeloproliferative neoplasms occur in younger patients, few large cohorts of such patients have been reported. Thus, our knowledge about circumstances of diagnosis, outcome and treatment is limited, especially for children and young adults. We therefore performed a systematic review of cases, published since 2005, concerning patients aged below 20 years at the time of diagnosis of essential thrombocythemia or polycythemia vera. We identified 396 cases of essential thrombocythemia and 75 of polycythemia vera. The median age at diagnosis was 9.3 and 12 years, respectively, and females constituted 57.6% and 45% of the groups, respectively. Half of the patients were asymptomatic at diagnosis. The proportion of so-called triple negativity was high: 57% in essential thrombocythemia and 73% in polycythemia vera. The incidence of thrombosis during the follow-up was 9.3% in patients with polycythemia vera and less, 3.8%, in those with essential thrombocythemia. Venous events were predominant (84.2%), with hemorrhagic episodes being rarer (<5%). The risk of evolution also seemed low (2% to myelofibrosis and no reports of acute leukemia), but the median follow-up was only 50 months. Survival curves were not available. Half of the patients received an antithrombotic drug and 40.5% received a cytoreductive drug. All data should be analyzed with care because of the proportion of missing data (10.7% to 74.7%). This review highlights interesting points concerning this population of young patients with myeloproliferative neoplasms, including that such patients were identified as negative for all common driver mutations, but also shows the need for larger contemporary cohorts with longer follow-up to assess the true prognosis of these patients.

The PRIMA-Prognostic Index (PI) Is Valid in Follicular Lymphoma (FL) Patients with Rituximab Chemo-Free First-Line Treatment

Background: Follicular lymphoma (FL) is a heterogenous disease. The optimal timing, sequence and choice of therapy remain matters of debate and there is no optimal prognostic tool. The FLIPI (Follicular Lymphoma International Prognostic Index) is based on five bio-clinical parameters and is widely used, but not as guide for choice of treatment. Recently a new prognostic score (PRIMA-PI), based solely on two parameters, bone marrow involvement and serum beta2 microglobulin (ß2m) was proposed for patients treated with immunochemotherapy (Bachy E., Blood 2018).The Nordic Lymphoma Group (NLG) performed two randomized trials including patients with symptomatic/progressive indolent CD20+ lymphoma, with rituximab monotherapy or rituximab in combination with interferon (IFN)-α2a as primary treatment, without maintenance (Kimby E., 2008, 2015). The 10 years follow-up of these patients showed a good survival with no major safety issues and no need for later chemotherapy in 38% of FL patients (Lockmer S, JCO 2018).Aim/Purpose: To evaluate two different prognostic systems (the new PRIMA-PI and the FLIPI), for overall survival (OS) and time to treatment failure (TTF) in a cohort of symptomatic/progressive FL patients treated with a rituximab-containing first-line regimen without chemotherapy.Methods: Previously untreated patients with a confirmed FL diagnosis (n=269) or indolent lymphoma not otherwise specified (n=22, most FLs with insufficient material for grading), treated in the NLG randomized trials with two cycles rituximab (375 mg/m2 x 4 weeks), with or without IFN-α2a, were classified into the three PRIMA-PI categories: high-risk: ß2m> 3mg / L, intermediate-risk: ß2m ≤ 3 mg / L with bone marrow involvement and low-risk: ß2m ≤ 3 mg / without bone marrow involvement. The FLIPI scores were also assessed. TTF, defined as the interval between randomization and either initiation of new lymphoma therapy due to relapse or intolerance, or death from any cause, as well as OS were estimated using the Kaplan Meier method. The log-rank test was used for comparison between risk groups.Results: Out of 291 patients, 252 had complete data on PRIMA-PI and FLIPI (at the time of randomization in the original trials) and were available for analyses of TTF and OS. Patient characteristics are shown in Table 1. PRIMA-PI seemed to identify a true high-risk group of 47 patients, 32 of them being high risk also according to FLIPI, while a larger patient group (n=117) was classified as FLIPI high-risk.After a long follow-up time, median 9.9 years (0.4 -18.8) from randomization, median 10.6 years for the 214 patients (74%) still alive, 76 patients (26%) were failure-free and 108 (37%) without need of any chemotherapy, Patients with PRIMA-PI high showed a shorter TTF compared to PRIMA-PI intermediate and low (Fig 1a), whereas the FLIPI risk-groups were not significantly separated (Fig 1b). Evidence of transformation to aggressive disease was seen in 55 patients, with no significant difference in frequency between the PRIMA-PI groups, nor between FLIPI groups.Both PRIMA-PI and FLIPI were of significant value for predicting OS, most evident after a long follow-up time (Fig 1c and d). In 41 patients the cause of death was progressive disease or therapy complications, regarded as lymphoma-related death, whereas 21 died of other causes. The lymphoma-specific survival was related to the PRIMA-PI (log-rank p=0.03), but not to the FLIPI (n.s). Prognosis was worse for the PRIMA-PI high-risk group than the for the low-risk, also when adjusted for sex, high age (>60 years), diagnosis, stage, ECOG and FLIPI risk-group; TTF HR 1.82 (95% CI 1.16-2.85, p=0.01) and OS HR 2.3 (95% CI 1.00-5.38, p=0.05).Conclusion: FL patients included in two NLG trials with complete clinical data and a median follow-up of >10 years after randomization have been assessed for validation of different prognostic indices. In these patients, all with chemo-free first-line therapy, the PRIMA-PI was shown a valid predictor of both TTF and OS and seemed more useful than the FLIPI. The PRIMA-PI high risk identified a group of patients (19% of all) with true poor prognosis. [Display omitted] DisclosuresKimby:Roche: Honoraria; Roche: Honoraria; Janssen: Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; AbbVie: Membership on an entity's Board of Directors or advisory committees. Holte:Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees; Roche, Norway: Research Funding. Wahlin:Roche: Research Funding; Gilead: Consultancy, Honoraria, Research Funding. Hagberg:Roche: Honoraria.

Prognosis of Functional Results of Arising or Immature Cataract Phacoemulsification High Myopia

Actuality. Complicated cataract surgery in high myopia is accompanied by the high risk of intra- and postoperative complications caused by this background disease. The presence of lens opalescence influences the results of many functional diagnostic tests. Diagnostic and prognostic research of the modern methods of investigation such as spectral optical coherence tomography, ultrasound biomicroscopy and B-scanning is urgent in patients with high myopia and cataract. The true prognosis of visual functions in these patients will allow solving the problem of cataract phacoemulsification expediency, decreasing the risks of complications.Purpose. To determine prognostic criteria of complicated cataract phacoemulsification outcome in high myopia.Patients and methods. 62 patients (101 eyes) with arising or immature cataract and high myopia were examined. All patients underwent ultrasound biomicroscopy of retinal periphery, ultrasound B-scanning of vitreous body and spectral optical coherence tomography of macular zone preoperatively, in the first postoperative days, in a month, in 6–8 months. We performed the correlation analysis of the initial morphological parameters and postoperative visual acuity. To solve the problem of the favorable outcome prognostication (achieving a certain level of visual acuity by the definite term after surgery) the method of binary logistic regression was used.Results and conclusion. The performed mathematical analysis showed the correlation between the postoperative visual acuity and the initial morphological parameters in a myopic eye: the value of ocular anterior posterior axis, the height of the posterior vitreous detachment, posterior staphyloma, the retinoschisis length in the superior outer segment, epiretinal membrane height, pigmented epithelium destruction and discharge, increased choroidal reflectivity, subfoveal choroidal thickness. We built the mathematical models that allowed predicting with high accuracy the probability of achieving a certain level of postoperative visual acuity following cataract phacoemulsification in high myopia.

T4N0 colon cancers should be treated like T3N1 disease.

Patients with positive lymph nodal involvement in colon cancer have always been deemed to fare worse than those without. However, questions have been increasingly raised on the true prognosis of T4N0 disease. We conducted this study to investigate how T4N0 disease would compare with T3N1 disease. All patients with colon cancer treated from 2008 to 2014 was collected. Preoperative, intraoperative and histological information was compared between patients with T4N0 and T3N1 disease. Variables which significantly differed were included in multivariate analysis for recurrence and survival. Kaplan-Meier curves and cox regression analysis for time to recurrence and survival were evaluated. Seventy-eight patients had T4N0 colon cancer, while 160 had T3N1 disease. Vascular invasion, lymphatic invasion, total lymph node yield, and the administration of adjuvant chemotherapy were identified as variables for evaluation. Over a median follow-up of 41.4 (range, 21.6-65.0) months for T4N0 patients and 42.4 (range, 21.1-63.8) months for T3N1 patients, there was no statistically significant difference in the association of stage of cancer with survival [overall survival (OS): 0.97 (95% CI, 0.38-2.45), P=0.94]. Kaplan-Meier curves also showed no difference in time to death (P=0.867). There was no statistically significant difference in the time to death [hazard ratio (HR): 0.56 (95% CI, 0.20-1.55), P=0.26]. T4N0 colon cancers have similar outcomes to T3N1 disease and should be considered as stage III disease in future classification. Patients diagnosed with T4N0 disease should receive similar treatment as those with T3N1 disease and counselled accordingly.

Paradoxical Low Flow/Low Gradient Severe Aortic Stenosis: an Emerging Phenotype in Older Adults with Valve Disease

Aortic stenosis is a common disorder in older adults and is the second most common reason for open heart surgery. Paradoxical low flow/low gradient severe aortic stenosis, defined by a stroke volume index ≤35 mL/m2 with an left ventricular ejection fraction (EF) (LVEF) ≥50 %, is a recently recognized subset of aortic stenosis. It presents a unique challenge in diagnosis and management particularly in the elderly population. Physiologic changes of aging contribute to the development of this phenotype and its prevalence and true prognosis remains in dispute. Management options have expanded from surgical to minimally invasive transcatheter methods. Future investigations will improve our understanding of the physiologic basis of this condition and hold great promise to improve outcomes amongst older adults with paradoxically low flow aortic stenosis.

Blurring of boundaries in the doctor–patient relationship

Oncology is a specialty that can be enormously rewarding but is fraught with many challenges. Young oncologists have to master dealing with anxious patients who are facing a life-threatening disease; conveying the true prognosis; discussing the complexity of modern treatments; and explaining the unavailability of some drugs, the side-effects of treatment, and likely therapeutic aims. Evidence-based courses have been shown to help oncologists to communicate all these issues in a clear, honest, and empathic manner while maintaining realistic hopes about probable clinical outcomes. 1 Fallowfield L Jenkins V Farewell V Saul J Duffy A Eves R Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet. 2002; 359: 650-656 Summary Full Text Full Text PDF PubMed Scopus (689) Google Scholar However, getting closer to the emotional needs of patients and their families can put doctors at psychological risks unless they have skills to navigate the boundaries between personal and professional involvement.

Epidemiology and survivorship of soft tissue sarcomas in adults: a national cancer database report

The National Cancer Data Base (NCDB) of the American College of Surgeons gather demographic and survival data on ∼70% of cancers in the USA. We wanted to investigate the demographic and survivorship data on this potentially more representative cohort of patients with soft tissue sarcomas. We selected 34 of the most commonly encountered soft tissue sarcomas reported to the NCDB, provided that each entity contained a minimum of 50 cases. This report summarizes the demographic and survivorship data on 63,714 patients with these 34 histologically distinct soft tissue sarcomas reported to the NCDB from 1998 to 2010. The overall survivorships of these sarcomas were near the lower limits of many prior reports due to the all-inclusive, minimally biased inclusion criteria. The overall best prognosis was Dermatofibrosarcoma NOS (not otherwise specified). (5-year survivorship 92%). The worst prognosis was Dedifferentiated Chondrosarcoma (5-year survivorship 19%). New observations included Biphasic Synovial Sarcoma demonstrating a better 5-year survivorship (65%) compared to spindle-cell synovial sarcoma (56%, P < 0.031) and Synovial Sarcoma, NOS (52%, P < 0.001). The demographic and 2- and 5-year survivorship data for all 34 soft tissue sarcomas are presented herein. This extent of demographic and survival data in soft tissue sarcomas is unprecedented. Because of the large number of cases and the inclusive nature of the NCDB, without restriction to certain stages, categories, or treatments, it is less subject to selection bias. Therefore, these data are thought to be more reflective of the true overall prognosis given the current management of sarcoma across the NCDB contributing sites.

Association between Visceral Fat and Body Mass Index in Patients with Cirrhosis

Obesity has recently become a critical problem in patients with cirrhosis in Japan; however, its true prevalence and prognosis remain poorly understood. In this study, we investigated abdominal fat areas, including subcutaneous and visceral fat areas (VFA), in 49 cirrhotic patients and analyzed the association between VFA and body mass index (BMI). Fat areas were examined by computed tomography. Patients were classified as somatometric obesity and visceral obesity based on their BMI (cut-off value: 25 kg/m2) and VFA (cut-off value: 100 cm2), respectively. The mean BMI was 23.5±3.3 kg/m2 (&lt;25 kg/m2, 35 cases; 25 kg/m2, 14 cases) and mean VFA was 108.5±118.8 cm2 (&lt;100 cm2, 25 cases; 100 cm2, 24 cases). Thirteen out of 14 patients with BMI 25 kg/m2 had a VFA 100 cm2, and 11 of 35 patients with BMI &lt;25 kg/m2 had a VFA 100 cm2. Thus, almost half of the cirrhotic patients in this study had visceral obesity, including a high proportion of patients with BMI &lt;25 kg/m2. These results suggest that visceral obesity, as well as BMI, should be considered in patients with cirrhosis, and individual nutritive management regimes should be designed according to the results.