Unfavorable Group Research Articles

Correlation of Peripheral Blood Inflammatory Indicators to Prognosis After Intravenous Thrombolysis in Acute Ischemic Stroke: A Retrospective Study.

According to many previous studies, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and hypersensitive C-reactive protein (CRP) are commonly used as important indicators to assess the prognosis of intravenous thrombolysis in AIS patients. Based on this, we used two novel biomarkers C-NLR (CRP/neutrophil-to-lymphocyte ratio) and C-LMR (CRP×lymphocyte-to-monocyte ratio) to investigate their correlation with 90-day outcomes in AIS patients after intravenous thrombolysis. A total of 204 AIS patients who received intravenous thrombolysis at the Stroke Center of Jiangsu Province Hospital of Chinese Medicine from January 2021 to December 2022 were retrospectively included. All patients were followed up 90 days after thrombolysis to assess their prognosis. Patients with a modified Rankin scale score (mRS) of 3-6 were included in the unfavorable outcome group, and those with a score of 0-2 were included in the favorable outcome group. Logistic regression analysis, receiver operating characteristic (ROC) curve, and Kaplan-Meier survival curve were used to investigate the association between C-NLR, C-LMR, and 90-day prognosis in AIS patients treated with early intravenous thrombolysis. C-NLR (OR=1.586, 95% CI=1.098~2.291, P=0.014) and C-LMR (OR=1.099, 95% CI=1.025~1.179, P=0.008) were independent risk factors for 90-day prognosis of AIS patients treated with early intravenous thrombolysis. The higher C-NLR and C-LMR were associated with unfavorable prognosis. C-NLR and C-LMR can be used as biomarkers to predict prognosis of AIS patients treated with early intravenous thrombolysis.

Atypical meningioma: Histopathological, genetic, and epigenetic features to predict recurrence risk.

Grading assessed according to World Health Organization (WHO) criteria is a major prognostic factor for determining the risk of recurrence in patients with meningiomas and establishing the most appropriate therapeutic strategy after surgery. However, the main issue is to predict the recurrence risk of WHO grade 2 meningioma and, more specifically, of the atypical subtype. Indeed, owing to a reported recurrence rate of 50%, either radiotherapy or observation is currently considered an option after gross total surgical resection of atypical meningiomas. These heterogeneous clinical outcomes are likely related to the broad histopathological diagnostic criteria for this subtype, and whether meningiomas only present as brain invasion should be classified as atypical remains controversial. Over the last few years, several studies have shown that DNA methylation profiling, next-generation sequencing, and transcriptomics can better stratify meningiomas for their recurrence risk than histology. The main limitations to the widespread use of these approaches to classify meningiomas are their high cost and the need for sophisticated technologies. However, all studies concurred that atypical meningiomas without chromosome 1p deletion display a low recurrence risk, suggesting that the assessment of this cytogenetic alteration could represent an easy and quick method to determine which patients could benefit from adjuvant treatment after surgery. In addition, prognostically unfavorable molecular groups can be distinguished using specific immunostainings, although further validation is required.

Method of Selecting Surgical Treatment for Children with Congenital Deformity of the Spine and Thorax

Introduction. Spinal anomalies are considered to be the most severe pathology of the axial skeleton. Intrauterine formation of deformity with its subsequent progression during growth is the reason for the need for surgical intervention. The prevalence of patients with congenital scoliosis in the total structure of spinal deformities is up to 2%. In terms of the malignancy of the course of the disease, children with unsegmented rod and rib synostosis represent one of the most unfavorable groups of patients. Aim. To perform a comparative analysis of the results of surgical treatment of children with congenital scoliosis with unilateral lateral vertebral segmentation disorder and rib synostosis using different techniques. Methods. The work is a monocenter cohort study of “case-control” type (III level of evidence). The design of the work is a monocenter cohort retro and prospective study. The results of surgical treatment of patients between 2010 and 2020 were analyzed. The study included 45 patients aged 3 to 7 years with the diagnosis of congenital scoliosis with unilateral lateral segmentation disorder of vertebral bodies and rib synostosis. The patients were divided into 2 groups depending on the surgical treatment method applied. In the first group (n = 24), patients underwent thoracoplasty with implantation of an individual rib/rib/vertebral distractor; in the second group (n = 21), patients underwent spinal surgery in the scope of vertebrotomy at the apex of the curvature and correction of the deformity with a multifocal spinal system. The data of medical records, as well as MSCT, radiographs, and pulse oscillometry were included in the analysis of the results. Results. Me (median) of scoliosis before treatment in group 1 patients 58.5, IQR = 19.75; after treatment — Me = 40.0, IQR = 20.0. Me of kyphosis before surgery 22, IQR = 4.5; after surgery Me = 26.0, IQR = 4.0. In the second group, Me of scoliosis before treatment 58.0, IQR = 3.0; after treatment, Me = 20.0, IQR = 6.0. Me of kyphosis before surgery 22, IQR = 2.0; after surgery Me 28.0, IQR = 4.0. When comparing MSCT data, group 1 patients showed an increase in lung tissue volume by 21% of the initial lung volume, in group 2 the increase amounted to 27%. The analysis of external respiratory function indices demonstrates improvement of reactive component indices by 21.1%, frequency dependence of resistive component by 46.4%, resistive component by 50% in group 1 patients, in group 2 there is an improvement of reactive component indices by 21.1%, resistive component by 50.9% and frequency dependence of reactive component by 46.7%. Conclusion. Corrective intervention on the spine at an early age makes it possible to achieve effective correction of the deformity; similar changes are observed both in lung volume and functional state of the respiratory system due to the mediated correction of the thorax shape.

A Day 14 Endpoint for Acute GVHD Clinical Trials

The overall response rate (ORR) 28 days after treatment has been adopted as the primary endpoint for clinical trials of acute graft versus host disease (GVHD). However, physicians often need to modify immunosuppression earlier than day (D) 28, and non-relapse mortality (NRM) does not always correlate with ORR at D28. We studied 1144 patients that received systemic treatment for GVHD in the Mount Sinai Acute GVHD International Consortium (MAGIC) and divided them into a training set (n=764) and a validation set (n=380). We used a recursive partitioning algorithm to create a Mount Sinai model that classifies patients into favorable or unfavorable groups that predicted 12 month NRM according to overall GVHD grade at both onset and D14. In the Mount Sinai model grade II GVHD at D14 was unfavorable for grade III/IV GVHD at onset and predicted NRM as well as the D28 standard response model. The MAGIC algorithm probability (MAP) is a validated score that combines the serum concentrations of suppression of tumorigenicity 2 (ST2) and regenerating islet-derived 3-alpha (REG3α) to predict NRM. Inclusion of the D14 MAP biomarker score with the D14 Mount Sinai model created three distinct groups (good, intermediate, poor) with strikingly different NRM (8%, 35%, 76% respectively). This D14 MAGIC model displayed better AUC, sensitivity, positive and negative predictive value, and net benefit in decision curve analysis compared to the D28 standard response model. We conclude that this D14 MAGIC model could be useful in therapeutic decisions and may offer an improved endpoint for clinical trials of acute GVHD treatment.

The dilution effect of healthy lifestyles on the risk of cognitive function attributed to socioeconomic status among Chinese older adults: A national wide prospective cohort study.

Lower socioeconomic status (SES) is a risk factor for poor cognitive function, while a healthy lifestyle is associated with better cognitive function. We examined the complex relationship between SES and a healthy lifestyle and cognitive function among older Chinese adults. We used a national prospective cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008-18, aged 65 years and older with normal cognition at baseline. Participants were categorised into the favourable group if they had four to six healthy lifestyle factors and the unfavourable group for zero to three factors. SES was classified as higher and lower by assessing the socioeconomic vulnerability index (SEVI) with six components. Cognitive function was measured using the Mini-Mental State Examination (MMSE) scores and the standardised Z-scores. We applied the linear mixed effects and time-dependent Cox regression models to explore associations and further stratified the analysis by healthy lifestyles. A total of 6851 participants were included (the mean age was 80.87, 43.44% had a favourable lifestyle, and 49.29% had higher SES). Over the 10-year follow-up period, SES status and lifestyle profiles significantly affected the decline in the standardised Z-scores (P < 0.05). The higher SES group with favourable lifestyles exhibited a slower cognitive decline than those with lower SES (by 0.031 points per year, P < 0.05). The association was not observed in those in the unfavourable group (0.010 points per year, P > 0.05). During a follow-up, 25.06% of participants developed cognitive impairment (MMSE<18). We also observed a significant interaction between SES and healthy lifestyles (P < 0.05), with the corresponding associations of SES being more pronounced among participants with unfavourable lifestyles (hazard ratio (HR) = 0.821; 95% confidence interval (CI) = 0.701-0.960) than those with favourable lifestyles (HR = 1.006; 95% CI = 0.844-1.200). A healthy lifestyle may attenuate the adverse impacts of lower SES on cognitive function among older adults. This study might provide important information for protecting cognitive function, especially in low- and middle-income countries.

Low-intensity inflammation as a manifestation of comorbidity and a factor in the unfavorable clinical course of heart failure with preserved ejection fraction

Aim. To analyze the prognostic significance of clinical, anamnestic and paraclinical parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease.Material and methods. The study included 54 patients. Cardiac and lung ultrasound was performed. In addition, the level of N-terminal pro-brain natriuretic peptide (NT-proBNP), interleukin-1β, interleukin-18, growth differentiation factor 15 (GDF-15), and cryopyrin was determined. The level of quality of life, anxiety and depression, and adherence to treatment were analyzed.Results. The patients were divided into 2 following groups: group 1 (n=22) with an unfavorable course and group 2 (n=32) with a favorable disease course. Basic echocardiographic parameters, as well as the number of B-lines in lungs, were comparable in both groups. An unfavorable HFpEF course was associated with a longer history of hypertension — 17,5 [10;20] and 7 [5;15] years (p=0,03), smoking — 36,4 and 9,4% (p=0,035), impaired carbohydrate metabolism — 54,5 and 15,6% (p=0,003) and lower adherence to treatment (p=0,02). In group 1, GDF-15 levels were higher than in group 2 — 1841 [1237;3552] vs 1709,5 [1158;2492] pg/ml (p=0,026).Conclusion. Low-intensity subclinical inflammation, the predisposing factors of which are smoking, impaired carbohydrate metabolism, and a long history of hypertension, is associated with higher GDF-15 values in patients with HFpEF and, along with low patient adherence to treatment, has an adverse effect on the clinical course of heart failure.

Brain Plasticity Modulator p75 Neurotrophin Receptor in Human Urine after Different Acute Brain Injuries-A Prospective Cohort Study.

Acute brain injuries (ABIs) pose a substantial global burden, demanding effective prognostic indicators for outcomes. This study explores the potential of urinary p75 neurotrophin receptor (p75NTR) concentration as a prognostic biomarker, particularly in relation to unfavorable outcomes. The study involved 46 ABI patients, comprising sub-cohorts of aneurysmal subarachnoid hemorrhage, ischemic stroke, and traumatic brain injury. Furthermore, we had four healthy controls. Samples were systematically collected from patients treated at the University Hospital of Turku between 2017 and 2019, at early (1.50 ± 0.70 days) and late (9.17 ± 3.40 days) post-admission time points. Urinary p75NTR levels, measured by ELISA and normalized to creatinine, were compared against patients' outcomes using the modified Rankin Scale (mRS). Early urine samples showed no significant p75NTR concentration difference between favorable and unfavorable mRS groups. In contrast, late samples exhibited a statistically significant increase in p75NTR concentrations in the unfavorable group (p = 0.033), demonstrating good prognostic accuracy (AUC = 70.9%, 95% CI = 53-89%, p = 0.03). Assessment of p75NTR concentration changes over time revealed no significant variation in the favorable group (p = 0.992) but a significant increase in the unfavorable group (p = 0.009). Moreover, p75NTR concentration was significantly higher in ABI patients (mean ± SD 40.49 ± 28.83-65.85 ± 35.04 ng/mg) compared to healthy controls (mean ± SD 0.54 ± 0.44 ng/mg), irrespective of sampling time or outcome (p < 0.0001). In conclusion, late urinary p75NTR concentrations emerged as a potential prognostic biomarker for ABIs, showing increased levels associated with unfavorable outcomes regardless of the specific type of brain injury. While early samples exhibited no significant differences, the observed late increases emphasize the time-dependent nature of this potential biomarker. Further validation in larger patient cohorts is crucial, highlighting the need for additional research to establish p75NTR as a reliable prognostic biomarker across various ABIs. Additionally, its potential role as a diagnostic biomarker warrants exploration.

Compromised dynamic cerebral autoregulation is a hemodynamic marker for predicting poor prognosis even with good recanalization after endovascular thrombectomy.

In patients undergoing endovascular thrombectomy (EVT) with acute ischemic stroke (AIS), dynamic cerebral autoregulation (dCA) may minimize neurological injury from blood pressure fluctuations. This study set out to investigate the function of dCA in predicting clinical outcomes following EVT. 43 AIS of the middle cerebral or internal carotid artery patients underwent with EVT, and 43 healthy individuals (controls) were enrolled in this case control research. The dCA was evaluated using transcranial Doppler 12 h and five days after EVT. The transfer function analysis was used to derive the dCA parameters, such as phase, gain, and coherence. The modified Rankin scale (mRS) at 3 months after EVT was used to assess the clinical outcomes. Thefavorable outcome group was defined with mRS ≤2 and the unfavorable outcome group was defined with mRS score of 3-6. Logistic regression analysis was performed to determine the risk factors of clinical outcomes. A significant impairment in dCA was observed on the ipsilateral side after EVT, particularly in patients with unfavorable outcomes. After 5 days, the ipsilateral phase was associated with poor functional outcomes (adjusted odds ratio [OR] = 0.911, 95% confidence interval [CI]: 0.854-0.972; P = 0.005) and the area under the curve (AUC) (AUC, 0.878, [95% CI: 0.756-1.000] P < 0.001) (optimal cutoff, 35.0°). Phase change was an independent predictor of clinical outcomes from 12 h to 5 days after EVT (adjusted OR = 1.061, 95% CI: 1.016-1.109, P = 0.008). dCA is impaired in patients with AIS after EVT. Change in dCA could be an independent factor related to the clinical outcomes.

Later-Life Cognitive Trajectories and Risk of Death: Results from a 6-Year Longitudinal Study of 7082 Chinese.

To identify cognitive decline trajectories in a Chinese elderly population, explore the associations between these trajectories and mortality, and further identify risk factors related to certain trajectories of cognitive decline. Prospective cohort study. The group-based trajectory modeling and Cox proportional hazards models were conducted to explore the association between cognitive trajectory groups and mortality, while multinomial logistic regression models were constructed to estimate potential risk factors. We included 7082 participants aged 65 years or above in three consecutive but non-overlapping cohorts of the Chinese Longitudinal Healthy Longevity Survey with the Chinese version of the Mini-Mental State Examination up to 6 years. Participants were subsequently followed for a median (IQR) of 2.89 (1.38-3.12) years to obtain their survival status and date of death. Chinese version of the Mini-Mental State Examination was used to measure participants' cognitive function. Through use of group-based trajectory modeling, we determined three cognitive trajectory groups. Then, after adjusting for confounding factors, we found a monotonic and positive association between cognitive decline and mortality risk. Meanwhile, the association varied among elderly populations in different age groups and BMI categories, but did not differ by sex, smoking, drinking and exercising. Older seniors, females and those with poorer baseline cognitive function and less social participation tended to be more likely to be in the unfavorable trajectory groups. We found that the faster the cognitive decline, the higher the mortality, especially among those aged 65-79 years and those overweight. Our findings suggested the importance of implement better monitoring of the cognitive function of the elderly population.

"Climate-friendly" diets from an allergy point of view.

Since the EAT-Lancet Commission's call for a change in diet towards more plant-based foods, especially protein sources, this so called "Planetary Health Diet (PHD)" has been widely discussed. While for some the reduction in animal foods is not enough and vegan diets are advocated to save the climate, others are sounding the alarm that the reduction is too drastic and that the PHD makes it impossible to provide a diet that meets our needs (of essential nutrients). In addition to climate aspects, health benefits often cited to justify the PHD do not take into account that vegetarians/vegans differ from the general population by far more factors than the reduction or elimination of animal foods. Also not sufficiently discussed is the fact that a diet which excludes or severely restricts animal foods is also associated with health risks if critical nutrients are not adequately covered. Moreover, the challenge of meeting protein requirements is underestimated by many. The food industry has responded to the trend towards more plant-based foods by massively expanding the range of highly processed or ultra-processed vegan foods. These - vegan or not vegan - are suspected of being partly responsible for the development of non-communicable diseases. In addition to general criticism regarding the usefulness of advertising the PHD, the replacement of animal protein sources with plant-based sources notably harbors a number of additional relevant risks for allergy sufferers so that the latter should be classified as an unfavorable target group for the implementation of the PHD recommendations.

The expression of peripheral blood inflammatory factors in patients with acute ischemic stroke and its correlation with patients' prognosis.

This study aimed to determine the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in patients with acute ischemic stroke (AIS) and their correlation with the patients' prognosis. For this purpose, a total of 100 patients with AIS admitted to the neurology department of our hospital between March 2019 and February 2022 were selected as the AIS group, and all patients were treated with recombinant tissue plasminogen activator (rtPA) intravenous thrombolysis. According to the Modified Rankin Scale (mRS) scores three months after thrombolysis, patients in the AIS group were grouped into a favourable group (mRS score: 0-2 points) and an unfavourable group (mRS score: 3-6 points). Additionally, 100 healthy individuals who received physical examination over the same time span were enrolled into a health group. The NLR and PLR of each group were compared, and receiver operating characteristic (ROC) curves were drawn to analyze the predictive value of separate tests of NLR and PLR and joint tests of them for unfavourable prognosis of AIS patients who received thrombolytic therapy. Logistic regression analysis was conducted to understand the influencing factors of unfavourable prognosis of the AIS patients who received thrombolytic therapy. The results indicated that the AIS group exhibited significantly higher NLR and PLR levels compared to the health group. The unfavourable group showed notably higher NLR and PLR than the favourable group. Lymphocytes, NLR and PLR were independent risk factors for predicting the prognosis of AIS patients who received thrombolytic therapy. Additionally, NLR and PLR had high diagnostic efficiency in predicting patients' adverse prognoses, and the diagnostic efficiency of their combination is higher than that of single detection. In conclusion, NLR and PLR have certain predictive values for the prognosis of AIS patients who received thrombolytic therapy, and they can serve as indicators for disease monitoring and prognosis evaluation of AIS patients.

Diagnostic Utility of a Modified Reticulin Algorithm in Pediatric Adrenocortical Neoplasms.

Pediatric adrenocortical neoplasms (ACNs) are extremely rare tumors in contrast to their adult counterparts. Distinguishing benign from malignant is challenging based on pure morphologic grounds. Previously, 2 scoring systems were proposed in pediatric ACN, including the Wieneke criteria (WC) and its modified version (modified WC [mWC]). In adults, the reticulin algorithm (RA) has proven inexpensive, reliable, predictive, and reproducible; however, it has been validated only recently in children in a limited number of cases. This study aims to assess the RA utility compared with other scoring systems in a series of 92 pediatric ACNs. All cases were individually scored, and mitotic rate cutoffs were recorded. Reticulin alterations were classified as quantitative and qualitative. Outcome data were available in 59/92. The median age was 5 years (0.1 to 18 y) with an M:F of 0.6. Clinical presentation included virilization (39%), Cushing syndrome (21%), other symptoms (4%), and asymptomatic (36%). The reticulin framework was intact in 27% and altered in 73% of cases, showing qualitative (22%), quantitative (73%), and both (5%) alterations. In patients with favorable outcomes, 59% showed either intact reticulin or qualitative alteration compared with the unfavorable outcome group, where 90% showed quantitative alterations. All scoring systems WC ( P < 0.0001), mWC ( P = 0.0003), and the adult/pediatric RA ( P < 0.0001) had predictive value. The RA is comparable to WC and mWC, easier to apply, and is the most sensitive histopathological approach to identifying aggressive behavior in pediatric ACN. Its integration into the WC might be helpful in ACN of uncertain malignant potential and deserves further investigation.

The significance of admission blood lactate and fibrinogen in pediatric traumatic brain injury: a single-center clinical study

BackgroundTraumatic brain injury (TBI) is a significant cause of morbidity and mortality in pediatric patients, leading to long-term physical, cognitive, and psychological impairments. Blood lactate and fibrinogen levels have emerged as potential biomarkers associated with tissue hypoperfusion and coagulation dysfunction, respectively. However, limited research has specifically focused on the significance of these biomarkers in pediatric TBI. This study aimed to investigate the clinical significance of blood lactate and fibrinogen levels upon admission in pediatric patients with traumatic brain injury.MethodsThe medical records of 80 children with a traumatic brain injury who were admitted from January 2017 to January 2021 were retrospectively analyzed. The two groups were compared according to whether the blood lactate in the admission arterial blood gas increased and the fibrinogen content in the coagulation function decreased. The clinical data of the children in the two groups were different, and then they were divided into a good prognosis group and a poor prognosis group according to the GOS prognostic score, and the differences in the clinical indicators of the two groups were compared.ResultsAmong the 80 patients, 33 had elevated blood lactate levels, 34 had decreased fibrinogen levels, and 29 had an unfavorable outcome (GOS < 4). Compared to the normal blood lactate group, there were no statistically significant differences in age, sex ratio, or platelet count in the elevated blood lactate group (P > 0.05). However, the elevated blood lactate group had lower Glasgow Coma Scale (GCS) scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stay, lower GOS scores, and a higher proportion of GOS < 4 (P < 0.05). Compared to the normal fibrinogen group, there were no statistically significant differences in age, sex ratio, or platelet count in the decreased fibrinogen group (P > 0.05). However, the decreased fibrinogen group had lower GCS scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stays, lower GOS scores, and a higher proportion of GOS < 4 (P < 0.05). Compared to the favorable outcome group, there were no statistically significant differences in age, sex ratio, or platelet count in the unfavorable outcome group (P > 0.05). However, the unfavorable outcome group had lower GCS scores upon admission, higher blood lactate levels, lower fibrinogen levels, longer hospital stays, a higher incidence of pulmonary infection, a higher incidence of stress ulcers, and lower GOS scores (P < 0.05).ConclusionThe levels of blood lactate and fibrinogen may represent the severity of children with traumatic brain injury and may be risk factors for poor prognosis of children with traumatic brain injury.

Prognostic possibilities of CT in the diagnosis of chronic inflammatory complications of diverticular disease

Objective: to determine the diagnostic effectiveness of computed tomography (CT) in predicting the course of the disease in patients with chronic inflammatory complications of diverticular disease (DD).Material and methods. The study included 70 patients with a complicated course of colon diverticular disease in the phase of exacerbation of the chronic inflammatory process. All patients underwent CT of the abdominal cavity with intravenous contrast to assess the type and severity of inflammatory changes in the colon and surrounding tissues in the area of localization of diverticula. All patients received conservative treatment and were monitored as part of the ongoing study for 12 months from the moment of initial treatment at the Center. Surgical intervention due to the ineffectiveness of conservative therapy or the recurrence of the inflammatory process during the established follow-up period was considered as an unfavorable outcome of the disease (42/60%). The positive effect of drug therapy without signs of a return of the clinical picture of inflammation within 12 months was considered as a favorable outcome (28/40%). A statistical analysis of CT signs of inflammatory changes in various DD outcomes was performed to identify prognostic CT parameters.Results. Statistically significant differences were revealed between the severity of inflammatory changes according to CT data for different outcomes of the disease. In the favorable outcome group, the main part (23/28.82%) were patients with diverticulitis, in the unfavorable outcome group, 2/3 of patients (29/42.64%) were diagnosed with pericolic infiltrates, including abscesses/cavities, and colon fistulas. It was found that the thickness of the intestinal wall, the extent of inflammatory changes in the intestinal wall, the extent of inflammatory infiltration of pericolic fiber, the symptom of “centipede”, the accumulation of fluid in the pericolic region statistically significantly differed with different outcomes of chronic inflammatory complications of diverticular disease. Мultivariate Cox proportional hazard model revealed two main predictors of the onset of an unfavorable outcome – thickening of the intestinal wall and the presence of fluid in the pericolic region. Thickening of the intestinal wall at values equal to or greater than 0,6 cm increased the risk of an unfavorable outcome by 4.69 times, and the presence of fluid by 4.52 times.Conclusion. The use in clinical practice of the revealed CT predictors of the onset of an unfavorable outcome in chronic inflammatory complications of DB can serve as one of the factors for deciding on elective surgery in this category of patients.

The prognostic value of the phosphate-to-albumin ratio in patients with OHCA: A multicenter observational study

PurposeIn patients with out-of-hospital cardiac arrest (OHCA), early and accurate outcome prediction is crucial for making treatment decisions and informing their relatives. A previous study reported an association between high phosphate levels and unfavorable neurological outcomes after return of spontaneous circulation (ROSC); however, its prognostic value was insufficient when used independently. Therefore, this study aimed to validate the usefulness of the phosphate-to-albumin ratio (PAR) in predicting neurological outcomes and in-hospital mortality by incorporating albumin, another known prognostic indicator. Materials and methodsThis multicenter observational study included adult OHCA survivors from October 2015 to June 2021. The primary endpoint was an unfavorable neurological outcome at hospital discharge, defined as a cerebral performance category score of 3–5. The in-hospital mortality rates were also evaluated. ResultsOf the 2397 adult OHCA survivors, PAR differed significantly between the unfavorable and favorable neurological outcome groups, as well as between the non-survival and survival to hospital discharge groups (2.4 vs 1.4, 2.5 vs 1.6, respectively). The area under the receiver operating characteristic curve (AUROC) value of the PAR for predicting unfavorable neurological outcome was 0.81 (95% confidence interval [CI], 0.79–0.83), and the AUROC value for predicting in-hospital mortality was 0.76 (95% CI, 0.74–0.78). In multivariable analysis, the PAR was independently associated with unfavorable neurological outcome (odds ratio [OR] 1.30, 95% CI 1.15–1.37; p < 0.001) and in-hospital mortality (OR 1.24, 95% CI 1.12–1.38; p < 0.001). ConclusionThe PAR is a readily obtainable and independent prognostic indicator for patients with ROSC after OHCA, helping healthcare providers in predicting outcomes.

Prognosis of comatose patients with reduced EEG montage by combining quantitative EEG features in various domains.

As the frontoparietal network underlies recovery from coma, a limited frontoparietal montage was used, and the prognostic values of EEG features for comatose patients were assessed. Collected with a limited frontoparietal EEG montage, continuous EEG recordings of 81 comatose patients in ICU were used retrospectively. By the 60-day Glasgow outcome scale (GOS), the patients were dichotomized into favorable and unfavorable outcome groups. Temporal-, frequency-, and spatial-domain features were automatically extracted for comparison. Partial correlation analysis was applied to eliminate redundant factors, and multiple correspondence analysis was used to explore discrimination between groups. Prognostic characteristics were calculated to assess the performance of EEG feature-based predictors established by logistic regression. Analyses were performed on all-patients group, strokes subgroup, and traumatic brain injury (TBI) subgroup. By analysis of all patients, raised burst suppression ratio (BSR), suppressed root mean square (RMS), raised power ratio of β to α rhythm (β/α), and suppressed phase-lag index between F3 and P4 (PLI [F3, P4]) were associated with unfavorable outcome, and yielded AUC of 0.790, 0.811, 0.722, and 0.844, respectively. For the strokes subgroup, the significant variables were BSR, RMS, θ/total, θ/δ, and PLI (F3, P4), while for the TBI subgroup, only PLI (F3, P4) was significant. BSR combined with PLI (F3, P4) gave the best predictor by cross-validation analysis in the all-patients group (AUC = 0.889, 95% CI: 0.819-0.960). Features extracted from limited frontoparietal montage EEG served as valuable coma prognostic tools, where PLI (F3, P4) was always significant. Combining PLI (F3, P4) with features in other domains may achieve better performance. A limited-montage EEG coupled with an automated algorithm is valuable for coma prognosis.

Determining the Association Between Insurance Type and Myofascial Release in Large Ventral Hernias

IntroductionAbdominal wall reconstruction (AWR) utilizes advanced myofascial releases to perform complex ventral hernia repair (VHR). The relationship between the performance of AWR and disparities in insurance type is unknown. MethodsThe Abdominal Core Health Quality Collaborative was queried for adults who had undergone an elective VHR between 2013 and 2020 with a hernia size ≥10 cm. Patients with missing insurance data were excluded. Comparison groups were divided by insurance type: favorable (private, Medicare, Veteran's Administration, Tricare) or unfavorable (Medicaid and self-pay). Propensity score matching compared the cumulative incidence of AWR between the favorable and unfavorable insurance comparison groups. ResultsIn total, 26,447 subjects met inclusion criteria. The majority (89%, n = 23,617) had favorable insurance, while (11%, n = 2830) had unfavorable insurance. After propensity score matching, 2821 patients with unfavorable insurance were matched to 7875 patients with favorable insurance. The rate of AWR with external oblique release or transversus abdominis release was significantly higher (23%, n = 655) among the unfavorable insurance group compared to those with favorable insurance (21%, n = 1651; P = 0.013). ConclusionsThis study provides evidence that patients with unfavorable insurance may undergo AWR with external oblique or transversus abdominis release at a greater rate than similar patients with favorable insurance. Understanding the mechanisms contributing to this difference and evaluating the financial implications of these trends represent important directions for future research in elective VHR.

Association of blood pressure with neurologic outcome at hospital discharge after pediatric cardiac arrest resuscitation

BackgroundPoor outcomes are associated with post cardiac arrest blood pressures <5th percentile for age. We aimed to study the relationship of mean arterial pressure (MAP) with favorable neurologic outcome following cardiac arrest and return of spontaneous circulation (ROSC). MethodsThis retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC following index in-hospital or out-of-hospital cardiac arrest and survived ≥6 hours were included. Lowest documented MAP within the first 6 hours of ROSC was percentile adjusted for age and categorized into six groups – Group I: <5th, II: 5–24th, III: 25–49th, IV: 50–74th, V: 75–94th; and VI: 95–100th percentile. Primary outcome was favorable neurologic status at hospital discharge, defined as PCPC score 1, 2, or no change from pre-arrest baseline. Multivariable logistic regression was performed to analyze the association of MAP group with favorable outcome, controlling for illness category (surgical-cardiac), initial rhythm (shockable), arrest time (weekend or overnight), age, CPR duration, and clustering by site. Results787 patients were included: median [Q1,Q3] age 17.9 [4.8,90.6] months; male 58%; OHCA 21%; shockable rhythm 13%; CPR duration 7 [3,16] min; favorable neurologic outcome 54%. Median lowest documented MAP percentile for the favorable outcome group was 13 [3,43] versus 8 [1,37] for the unfavorable group. The distribution of blood pressures by MAP group was I: 37%, II: 28%, III: 13%, IV: 11%, V: 7%, and VI: 4%. Compared with patients in Group I (<5%ile), Groups II, III, and IV had higher odds of favorable outcome (aOR, 1.84 [95% CI, 1.24, 2.73]; 2.20 [95% CI, 1.32, 3.68]; 1.90 [95% CI, 1.12, 3.25]). There was no association between Groups V or VI and favorable outcome (aOR, 1.44 [95% CI, 0.75, 2.80]; 1.11 [95% CI, 0.47, 2.59]). ConclusionIn the first 6-hours post-ROSC, a lowest documented MAP between the 5th−74th percentile for age was associated with favorable neurologic outcome compared to MAP <5th percentile for age.

Real World Use of Azacitidine and Venetoclax in Acute Myeloid Leukemia in Frontline and Relapse/Refractory Settings: A Multicentric Study from French Auraml Group

Azacytidine and venetoclax combination regimen (AZA/VEN) is the standard of care in frontline acute myeloid leukemia (AML) settings for unfit to intensive chemotherapy patients. However, AZA/VEN is also associated with an increased hematological toxicity compared to azacytidine alone. In this context, alternative AZA/VEN regimens emerged progressively based on each physician experience and local procedures. Moreover, AZA/VEN is also recognized as a valuable therapeutic option in relapse/refractory settings. In this multicentric study, we aimed to evaluate the efficacy and safety of various AZA/VEN regimen in frontline and relapse/refractory (R/R) patients diagnosed with AML in real life setting. We retrospectively analyzed 331 patients from 11 different French centers (Saint-Etienne, Clermont-Ferrand, Lyon (Hopital Lyon Sud, Centre Léon Bérard), Vichy, Annecy, Chambery, Valence, Bourgoin-Jallieu, Grenoble, Roanne) in Auvergne Rhône Alpes (AURA) region, between January 2019 and February 2023. Composite complete remission was defined as in VIALE-A trial. Measurable residual disease (MRD) negativity was defined as ≤ 10 -3 by flow cytometry (on bone marrow) and/or ≤ 10 -4 for NPM1 by RT-qPCR. Overall, the entire cohort was composed of 186 and 146 patients in frontline and R/R settings respectively. In frontline setting, median age was 74.5 (19.1-86.1) and ELN 2022 risk groups were favorable, intermediate and unfavorable in 14.5, 16.7 and 68.8% respectively. De novo AML, MRC-AML, post-MPN/MDS AML and t-AML were 32.4%, 29.7%, 23.2% and 14.5% respectively. After 6 cycles, median CRc, morphologic leukemia free state (MLFS) and refractory rate were 66.4%, 5.4% and 28.2% respectively. Regarding probability of CRc, there was no significant difference between favorable and intermediate ELN 2022 risk group. Within unfavorable risk group, only complex karyotype was associated with lower CRc rate ( figure 1). Venetoclax dosage (400mg vs 100mg/d) and duration per cycle (28 days vs 21 days vs others) did not influence significantly CRc rate probability and OS. With a median follow-up of 7.3 months, median overall survival (OS) was 12.4 months (IC95%: 3.4-18.5). There was no significant difference in terms of OS according to ELN 2022 risk group classification ( figure 2). Among unfavorable risk group, only patients with unfavorable karyotype had a worst OS (median OS: 4.9 months), while patients with secondary AML mutations had similar OS than favorable/intermediate risk group (19.5 vs 20.2 vs 18.2 months, p=0.32). Reaching MRD negativity at any time during the first 6 cycles was associated with a better OS (26.1 vs 10.3 months, p&amp;lt;0.001). In responding patients, 22/122 withdrew VEN after a median of 5 cycles (range:1-17), while continuing AZA, mainly due to excessive hematological toxicity. Relapse free survival was similar between patients who stopped compared to those who continued up to progression. In multivariate analysis, only ECOG (continuous, HR= 1.52, p=0.04), IDH status (WT vs MUT: HR = 3.13, p=0.04, normal karyotype (yes vs no, HR=0.25, p=0.04) and CR type (CRMRD- vs other, HR= 0.21, p=0.001) significantly influence OS, whereas ELN 2022 did not In R/R settings, CRc rate was 43.8% and OS was 7.9 months. As in frontline setting, venetoclax dosage and duration per cycle did not influence CRs rate and OS. Febrile neutropenia (FN) occurred in 52.9%, 35.1% and 27.1% in cycle 1,2 and 3, respectively. Toxic death rates (TDR) range from 16.6% prior 2020 to 8.6% in 2021 and 6.25% from 2022 to 2023 (p=0.01). In or outpatient management for cycle 1 did not influence FN incidence. Azole prophylaxis did not significantly influence FN incidence. During cycle 1, shorter venetoclax duration regimens (&amp;lt;21 days/cycle) was associated with lower FN (41.5 vs 54.8%, p=0.042) compared to ≥21 days VEN cycle. In this real life settings study, our results suggest that outcome in frontline AZA/VEN treated patients is mainly driven by deep responses. Alternative AZA/VEN regimens were not associated with lower response rate and overall survival, while reducing venetoclax exposure during cycle 1 may reduce FN incidence without significant consequences on CR rate. TDR reduction through time suggest a learning curve and might be related to physician's skills improvement regarding AZA/VEN dosage schedules and supportive care management. An update with additional patients and longer follow-up will be presented at the meeting.

Risk Factors for Severe Infection and Unfavorable Outcomes in Hematologic Malignancy Patients with COVID-19 Inflection during the Omicron Era: A Chinese Single-Center Retrospective Study

Purpose: The objective of this study was to evaluate the potential risk factors associated with severe infection and unfavorable outcomes among individuals with hematologic malignancies who contracted the coronavirus infectious disease (COVID-19) during the Omicron era. Methods: This retrospective analysis included adult patients with hematologic malignancies who were diagnosed with COVID-19 during the period from November 2022 to February 2023. A comparison was made between the clinical characteristics of patients who experienced persistent COVID-19 infection or succumbed to death within 30 days and those of the remaining patients. Results: A total of 134 patients were included in the analysis, with 23.9% (n=32) presenting as asymptomatic/mild and 29.1% (n=39) classified as severe cases. Among the patients, 54.4% (n=73) had received at least two doses of vaccines. In the subgroup of asymptomatic/mild patients, 50% had received at least three doses of vaccines, while among the severe patients, 56.4% remained unvaccinated. The multivariate analysis examining risk factors for severe infection in COVID-19 and hematologic malignancy patients identified the number of vaccine doses as an independent prognostic factor. Less than two doses of vaccines were found to be associated with severe COVID-19 infection (odds ratio [OR]: 4.213, 95% confidence interval [CI] 1.433-12.392; p=0.009). In this study, patients with persistent COVID-19 infection or succumbed to death within 30 days were categorized as the unfavorable group (n=57), while the remaining patients were classified as the favorable group (n=77). A significant difference was observed between the two groups in terms of median age (p=0.015), malignancy status (p=0.001), number of vaccine doses received (p=0.001), neutrophil count (p=0.011), immunoglobulin G levels (p=0.038), and interleukin-6 levels (p=0.025). In the multivariable analysis of risk factors for unfavorable outcomes in patients with both COVID-19 and hematologic malignancies, it was found that the number of vaccine doses and the level of immunoglobulin G were independent prognostic factors. Specifically, receiving less than two doses of vaccines (OR: 233, 95%CI 0.068-0.798; p=0.020) and having an immunoglobulin G level below 1000 (OR: 220, 95%CI 0.066-0.753; p=0.014) were associated with unfavorable outcomes. Conclusions: Receiving multiple doses of vaccines and having higher levels of immunoglobulin G were found to improve the clinical outcome of COVID-19 in patients with hematologic malignancies.