Years Of Follow-up Information Research Articles

Prognostic impact of fibrinogen in patients with resistant hypertension.

In this study, we investigated the long-term prognostic effects of fibrinogen levels in patients with resistant hypertension. A total of 266 patients with resistant hypertension who had serum fibrinogen measurements and 5 years of follow-up information were retrospectively included in the study. The patients were stratified according to their fibrinogen levels, which were then divided into tertiles. Clinical outcomes for major adverse cardiovascular events (MACE) were assessed at 5 years. MACE was defined as all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction (MI), non-fatal stroke, a new diagnosis of heart failure, or hospitalization for heart failure and peripheral arterial disease. The incidence of MACE at 5 years in patients with resistant hypertension was higher in the highest tertile of fibrinogen. Multivariate analysis identified fibrinogen as an independent predictor of MACE in patients with resistant hypertension (odds ratio = 1.002; 95% CI: 1.001-1.004; p = 0.009). Compared to the lowest tertile, MACE was approximately 2.5 times higher in tertile 2 and approximately 6.9 times higher in the highest tertile. Fibrinogen was able to predict MACE in patients with resistant hypertension (AUC for MACE 0.662 (95% CI 0.596-0.727; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan-Meier curve showing follow-up without MACE (MACE-free) according to the fibrinogen cut-off value, the 5-year incidence of MACE was significantly higher in the high fibrinogen group (p < 0.001). Fibrinogen is a risk marker for MACE in patients with resistant hypertension. Antihypertensive therapy aimed at lowering fibrinogen levels may improve prognosis.

A National Longitudinal Study of Same-Sex Partnership and Self-Rated Health Trajectories

We know little about population-based patterns on same-sex partnership and health from a longitudinal perspective, largely due to data limitations. In this study, we analyzed nationally representative longitudinal data to compare changes in self-rated health trajectories for individuals in same-sex cohabitation, different-sex marriage, and different-sex cohabitation. Data were drawn from the 1996, 2001, 2004, and 2008 panels of the Survey of Income and Program Participation, with each panel including 2–4 years of follow-up information on self-rated health. The analytic sample included 103,995 respondents who contributed 294,944 person-period records. Results from growth curve models suggest that same-sex cohabitors experienced a slower rate of decline in self-rated health over time than both different-sex married and different-sex cohabiting respondents. Further analyses show that same-sex cohabitation is associated with a slower rate of health decline only for women but not for men. We discuss the implications of these findings in relation to the minority stress theory and the gender-as-relational perspective.

Rates of Fellow Eye Macular Hole Development During Long Term Follow-Up

Identify the long-term rate of fellow eye full-thickness macular hole (FTMH) development. In this single site, single provider retrospective consecutive case series, idiopathic FTMH patients who underwent surgery from 2003 to 2014 who also had at least 5 years of follow-up information within our electronic medical record (EMR) which was started in 2014 were identified. Cases with secondary causes (ie, trauma), high myopia, bilateral FTMH on presentation, previous retinal surgery, retinal breaks, or intraocular inflammation were excluded. Demographics, medical and ocular history, refractive error, phakic status, best corrected visual acuity, follow-up duration, surgical technique, single operation anatomic success, and reoperations were recorded. The rate of fellow eye FTMH was 2.6% (2/77) at 1 year, 5.2% (4/77) at 3 years, 9.1% (6/66) at 6 years, and 9.1% (7/77) as of final follow up. There were 2 cases by year 1, 2 additional cases by year 3, 2 additional cases by year 6, and 1 additional case reported thereafter. The average follow up was 11.1 ± 4.5 years. There was no significant difference in visual outcomes between primary eyes and fellow eyes. There was no significant difference in gender, age, ocular comorbidities, refractive error, phakic status, and visual acuity between the unilateral and bilateral groups. The rate of FTMH in the fellow eye was low but significant, increased during long-term follow up, and may stabilize after 6 years.

Prognostic significance of sodium iodide symporter and deiodinase enzymes mRNA expression in gastric cancer

Context:Thyroid hormones (THs) are critically important for development, homeostasis, and metabolic regulation in mammals. Iodine, one of the constituents of TH, is actively supplied by sodium iodide symporter (NIS) into the thyroid gland. TH is subsequently transported to distant organs where its activation and deactivation is catalyzed by isoforms of deiodinases (DIOs). NIS protein has been known to overexpress in cancer cases of the breast and gastrointestinal organs. Recent studies show a possible role of DIOs in various cancers.Aims:In the present investigation, the prognostic significance of NIS and DIO-1, 2 and 3 was studied in gastric cancer using a data mining bioinformatic approach.Methods:“The Kaplan–Meier plotter” database was used for direct in silico validation in clinically relevant 876 gastric cancer patients with >15 years of follow-up information. After obtaining KM survival plots, hazard ratio and log-rank P value were calculated.Results:Increased expression of NIS and DIO 1-3 is significantly associated with worsen overall survival of gastric cancer patients followed for 20 years. Prognostic roles of NIS and individual DIOs were assessed in different types of gastric cancer classified based on morphologies, human epidermal growth factor receptor-2 receptor status, treatment choices, and different clinicopathological features.Conclusions:Based on these analyses, the present study found the indication of prognostic values of these genes. This information will contribute to better understanding of managing complex and heterogeneous gastric cancer. Further, these findings may be beneficial as a companion diagnostic tool predicting more accurate gastric cancer prognosis.

Long-Term Outcomes after Macular Hole Surgery

To evaluate the structural and visual outcomes after pars plana vitrectomy (PPV) for idiopathic full-thickness macular hole (MH) with at least 5 years of follow-up information. Retrospective case series. Patients with idiopathic MH who had at least 5 years of follow-up information after PPV. Best-corrected visual acuity (BCVA) was recorded preoperatively and, when available, at 1, 2, 3, 5, 8, and 10 years after surgery. Reestablishment of the postoperative integrity of the ellipsoid zone (EZ) and the external limiting membrane (ELM) and presence of cystoid spaces were evaluated using spectral-domain (SD) OCT. Postoperative BCVA and its correlation with different SD OCT parameters. Eighty-seven eyes of 80 patients with a mean age at surgery of 68.9±7.03 years were included. The mean postoperative follow-up was 9.6±4.3 years (median, 9 years; range, 5-22 years). The mean preoperative BCVA was 0.20±0.14 (range, 0.03-0.66). Postoperative BCVA was improved at all time points compared with preoperative BCVA (P < 0.05). Improvement in the postoperative BCVA remained stable 10 years after surgery. Initial successful closure of MH was achieved in 82 eyes (94%). Macular hole reopening occurred in 7 eyes (8.0%). Eleven eyes (13%) were reoperated: 4 eyes (4.5%) for persistence and 7 eyes (8.0%) for reopening of MH. Indocyanine green (ICG) stain was used in 22 eyes (25.2%). Among 57 patients (66%) who were phakic before surgery, 52 eyes (91.2%) underwent cataract extraction after PPV at a mean duration of 32.7±38.5 months (range, 2-187 months). Postoperative EZ integrity was restored in 52 eyes (60%), ELM integrity was restored in 54 eyes (62%), and cystoid spaces of variable severity were observed in 28 eyes (32%). Preoperative BCVA of 20/60 or better and postoperative reestablished ELM and EZ integrity were associated significantly with better postoperative BCVA at different postoperative follow-up visits (P < 0.05). Visual acuity improvement after MH surgery continued during the first 3 years after PPV and was maintained thereafter in a substantial fraction of patients, and final BCVA correlated with better preoperative BCVA and better postoperative OCT parameters.

Outline of the Latest Analysis of Radiation Epidemiological Study among UK National Registry for Radiation Workers (NRRW)

In August 2018, the latest analysis of the UK National Registry for Radiation Workers (NRRW 3rd update) has been published. The NRRW studies have been published almost every ten years since the first analysis (1992). The series of NRRW aimed to analyse cancer risk from low dose occupational radiation exposure. This latest analysis is the study using third analysis data and an additional ten years of follow-up information, but did not include additionally dosimetry information. As the set of ten years lag period, only the risks of cancer were analysed, but excluding leukaemia risks owing to its lag period as two years. The same statistical methods were used in the series of NRRW study. This review provides an outline and summary of the key points of NRRW 3rd update. We denote introduction in chapter 1, summary in chapter 2, comparison with previous studies and other studies in chapter 3, discussion about results in chapter 4, meaning and limitation in chapter 5 and conclusion in chapter 6.

Cancer mortality and incidence following external occupational radiation exposure: an update of the 3rd analysis of the UK national registry for radiation workers

BackgroundThis study provides direct evidence of cancer risk from low dose and dose rate occupational external radiation exposures.MethodsCancer mortality and incidence were studied in relation to external radiation exposure in the National Registry for Radiation Workers. A cohort of 167,003 workers followed for an average of 32 years was analysed using Poisson regression methods.ResultsMortality and incidence risks were significantly raised for the group of all malignant neoplasms excluding leukaemia (ERR/Sv mortality = 0.28; 90%CI: 0.06, 0.53, ERR/Sv incidence = 0.28; 90%CI: 0.10, 0.48) but with narrower confidence bounds compared with the previous analysis of this cohort reflecting the increased statistical power from the additional 10 years of follow-up information. The linear trends in relative risk for both mortality and incidence of these cancers remained statistically significantly raised when information relating to cumulative doses above 100 mSv was excluded (ERR/Sv mortality = 1.42; 90%CI: 0.51, 2.38 and ERR/Sv incidence = 1.18; 90%CI: 0.47, 1.92).ConclusionsThis study improved the precision of the cancer risk estimates seen in the third analysis of the NRRW cohort. The overall results remain consistent with the risk estimates from the Life Span Study and those adopted in the current ICRP recommendations.

Recurrence of disk herniation following percutaneous laser disk ablation in dogs with a history of thoracolumbar intervertebral disk herniation: 303 cases (1994-2011).

OBJECTIVE To determine rate of recurrence of disk herniation in dogs that underwent percutaneous laser disk ablation (PLDA) because of a previous episode of suspected or confirmed thoracolumbar intervertebral disk herniation (IVDH). DESIGN Retrospective case series. ANIMALS 303 dogs that underwent PLDA and for which a minimum of 3 years of follow-up information was available (n = 294) or for which recurrence was documented within 3 years after the procedure (9). PROCEDURES Information on signalment, previous episodes of IVDH, specifics of the PLDA procedure, and recurrence was obtained from the medical records. Owners were contacted to complete a questionnaire regarding outcome and recurrence. RESULTS 60 of the 303 (19.8%) dogs had an episode of suspected or confirmed IVDH after undergoing PLDA, but only 11 of the 303 (3.6%) dogs had a recurrence of IVDH confirmed by means of CT or MRI and hemilaminectomy. Recurrence rate following PLDA was not significantly different between dogs that had been treated medically for previous episodes of IVDH and dogs that had been treated surgically. Overall, 270 of 286 (94.4%) owners reported that their dog was the same (109 [38.1%]) or improved (161 [56.3%]) immediately after PLDA, and 265 (92.7%) owners rated their satisfaction with the procedure as ≥ 9 on a scale from 1 (completely dissatisfied) to 10 (completely satisfied). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that PLDA was a relatively safe, minimally invasive procedure associated with a low rate of recurrence of disk herniation when performed in dogs with a history of previous episodes of suspected or confirmed IVDH.

Anti-epileptic drug utilization and treatment outcome among epileptic patients on follow-up in a resource poor setting

Introduction: Anti-epileptic drugs (AEDs) are the primary therapeutic modes for epileptic patients and have been demonstrated to control seizure, which decreases morbidity and mortality associated with epilepsy. There is a paucity of data on treatment outcome among epileptic patients in resource poor settings. The aim of this study was to assess AED utilization pattern and treatment outcome among epileptic patients on follow-up. Materials and Methods: A retrospective cross-sectional study was conducted among epileptic patients on follow-up at Epilepsy clinic of Jimma University specialized hospital. A total of 290 patient record cards which had 3 years of follow-up information was used to evaluate AED utilization pattern and treatment outcome through medical records review. Results: From a total 290 cards of epileptic patients on follow-up, 170 (58.6%) were males. The common type of seizure diagnosed was generalized tonic clonic seizure, 232 (80%). Monotherapy was commonly used in the management of seizure, 54.5%, among which phenobarbitone was the most commonly utilized single anticonvulsant drug. One hundred and sixty-five (56.7%) patients were seizure free during follow-up periods and 125 (43.3%) patients were not, of which 121 (73.3%) of patients had 1 up to 5 seizure attacks per 3 months during the 3 years follow-up period. Conclusion: All studied epileptic patients were put on traditional AEDs; phenobarbitone being the most frequently prescribed single drug. About one in every two epileptic patients evaluated were seizure free during the 3 years follow-up period. Key words: Anti-epileptic drugs utilization, epilepsy, ethiopia, seizure outcome.

Correlation between Early Subjective Response to Antipsychotics and the Number of Hospitalizations and Hospitalization Days in a Period of 10–11 Years in Schizophrenia Patients

Introduction: Research into the significance of early subjective response to antipsychotic medication has so far only involved observation periods of up to 1 year. Method: The Drug Attitude Inventory (DAI-10) questionnaires, completed by patients with the diagnosis of schizophrenia in 1997–1998, were the bases for this study. In 2009, data on 36 patients (18 women and 18 men) with 10–11 years of follow-up information were found whose completed DAI questionnaires were on record in the hospital register. The data included the number of hospitalizations, which enabled to calculate the total number of days spent in hospital for each patient. Statistical analysis examined possible correlations between the DAI scale results and the number of hospitalizations in 1997/1998–2009 and the number of days spent in the hospital during that period of time. Results: The total number of hospitalizations in the period of 11–12 years has shown no correlations with the results of the DAI-10 scale (p = 0.23). However, the number of days spent in hospital in the period of observation has shown a reverse correlation between the results of the DAI-10 scale in 1997–1998 and the number of days spent in hospital (p = 0.037). The higher the result of the DAI-10 scale was in 1997–1998 (indicating the absence of a dysphoric response to antipsychotic medications), the fewer days of hospitalization were found in the researched period. Conclusions: Early subjective response to antipsychotic drugs shows a relation to the number of days spent in hospital in the period of observation over 10 years. The data suggest that an early dysphoric response to antipsychotic medications is associated with more days spent in the hospital during subsequent years.

The Significance of Tumor Involved Adenomyosis in Otherwise Low-stage Endometrioid Adenocarcinoma

Depth of myometrial invasion by endometrioid adenocarcinoma (EMAC) is one of the most important predictive factors of disease recurrence. It is unclear whether myoinvasion arising in carcinomatous involvement of adenomyosis (AM) changes prognosis. The purpose of this study was to evaluate the significance and frequency of the tumor involved AM in otherwise low-stage cancers. Eighty-two hysterectomies with EMAC with less than 50% myoinvasion (T1a, FIGO IA), AM, and at least 2 years of follow-up information were reviewed. The tumors were divided into 4 histologic groups: group 1, no involvement of AM by EMAC (n=38); group 2, tumor involved AM surrounded by endometrial stroma (n=31); group 3, tumor involved AM with incomplete peripheral endometrial stroma (n=10); and group 4, tumor involved AM with invasion into adjacent smooth muscle (n=3). Tumor involved AM was in the inner half of the myometrium in 35 cases and in the outer half of the myometrium in 9 cases. The only adverse outcome was vaginal recurrence, which was noted in 2 of 82 patients; both the patients were from the control group. None of the patients with deep-seated tumor involved AM had tumor recurrence. In otherwise low-stage tumors, our data support the concept that tumor involvement of the deeply located AM does not affect prognosis. Myometrial-based foci of well-differentiated EMAC, completely or partially surrounded by endometrial stroma, most likely represents tumor colonized AM. Determining invasion out of these foci is subjective, and although limited by rarity in this study, carries no adverse outcome. Therefore, staging should be based on the myoinvasion noted at the native endomyometrial junction.

Chronic Enteropathies in Dogs: Evaluation of Risk Factors for Negative Outcome

Hypothesis: Certain variables that are routinely measured during the diagnostic evaluation of dogs with chronic enteropathies will be predictive for outcome and a new clinical disease activity index incorporating these variables can be applied to predict outcome of disease.Animals: Seventy dogs were entered into a sequential treatment trial with elimination diet (FR, food‐responsive group) followed by immunosuppressive treatment with steroids if no response was seen with the dietary trial alone (ST, steroidtreatment group). A 3rd group consisted of dogs with panhypoproteinemia and ascites (PLE, protein‐losing enteropathy) that were treated with immunosuppressive doses of steroids.Methods: Three years of follow‐up information was available for all dogs. Clinicopathologic variables were tested for their ability to predict negative outcome, defined as euthanasia due to refractoriness to treatment. Different scoring systems including different combinations of these variables were evaluated using receiver operating characteristic (ROC) curves.Results: Thirteen of 70 (18%) dogs were euthanized because of intractable disease. Univariate analysis identified a high clinical activity index, high endoscopic score in the duodenum, hypocobalaminemia (&lt;200 ng/L) and hypoalbuminemia (&lt;20 g/L) as risk factors for negative outcome.Conclusions and Clinical Importance: Based on the factors identified by logistic regression and ROC curve analysis, a new clinical scoring index (CCECAI) was defined that predicts negative outcome in dogs suffering from chronic enteropathies.

Chronic Enteropathies in Dogs: Evaluation of Risk Factors for Negative Outcome

Certain variables that are routinely measured during the diagnostic evaluation of dogs with chronic enteropathies will be predictive for outcome and a new clinical disease activity index incorporating these variables can be applied to predict outcome of disease. Seventy dogs were entered into a sequential treatment trial with elimination diet (FR, food-responsive group) followed by immunosuppressive treatment with steroids if no response was seen with the dietary trial alone (ST, steroid-treatment group). A 3rd group consisted of dogs with panhypoproteinemia and ascites (PLE, protein-losing enteropathy) that were treated with immunosuppressive doses of steroids. Three years of follow-up information was available for all dogs. Clinicopathologic variables were tested for their ability to predict negative outcome, defined as euthanasia due to refractoriness to treatment. Different scoring systems including different combinations of these variables were evaluated using receiver operating characteristic (ROC) curves. Thirteen of 70 (18%) dogs were euthanized because of intractable disease. Univariate analysis identified a high clinical activity index, high endoscopic score in the duodenum, hypocobalaminemia (<200 ng/L) and hypoalbuminemia (<20 g/L) as risk factors for negative outcome. Based on the factors identified by logistic regression and ROC curve analysis, a new clinical scoring index (CCECAI) was defined that predicts negative outcome in dogs suffering from chronic enteropathies.

Treating Veterans for Helicobacter Pylori Infection: Retrospective Evaluation of Long-term Outcomes

Purpose This study documented the long-term outcomes of patients treated in a pharmacist-managed Helicobacter pylori (HP) clinic. Background An HP clinic was created in 1996 at a Veterans Affairs (VA) hospital. Patients received clarithromycin/amoxicillin-based therapy according to the clinic protocol. Clarithromycin use was restricted to treatment of HP infection. Metronidazole was used instead of amoxicillin in penicillin allergic patients. Results at 1 year showed that 53% of the patients were able to discontinue chronic heartburn therapy. Outcomes beyond 1 year were not established. Methods The electronic records of patients treated at the HP clinic from June 1996 to March 2001 were evaluated. Patients with at least 2 years of follow-up information were included. Baseline demographic and long-term outcome data were collected. Discontinuation rate, failure rate, and need for retreatment were evaluated. Results Of 229 patients treated during the period studied, at least 2 years of data was available for 198 individuals. Of these, 177 were men and 21 were women. Three of the 198 patients (1.5%) were unable to complete antibiotic therapy. Five patients (2.5%), two of them women, failed an initial course to eradicate HP. After treatment with bismuth-based therapy, four of these five patients showed documented eradication of infection. Forty-four percent of patients were off chronic therapy at the time of last review. Conclusions A pharmacist-managed HP treatment clinic can facilitate discontinuation of chronic acid suppressive therapy in more than a third of patients. A low treatment failure rate — below the national average for clarithromycin-based regimens — was found in our population.

Leukemia risk associated with benzene exposure in the Pliofilm cohort.

A reanalysis of the Pliofilm cohort was conducted incorporating six additional years of follow-up information gathered by the National Institute of Occupational Safety and Health (NIOSH) and a new set of exposure estimates developed recently. The distribution of individual worker exposures calculated with the Paustenbach exposure estimates was compared to those derived using two earlier sets of job-, plant-, and year-specific exposure estimates. A traditional standardized mortality ratio analysis and the Cox proportional hazards model were used to investigate the impact of these exposure estimates and the NIOSH updated information on evaluation of benzene's leukemogenicity. There were no additional cases of multiple myeloma or any indication of increased incidences of solid tumors. The data added in the update did not greatly modify the estimated relative risk of all leukemias associated with benzene exposure but confirmed previous findings that occupational exposure only to very high concentrations had leukemogenic potential. Leukemia has not been observed in anyone who began employment in Pliofilm production after 1950. Neither the Paustenbach nor the Crump exposures gave dose-response estimates as steep as that resulting from the Rinsky exposures.

Base of skull chordoma. A correlative study of histologic and clinical features of 62 cases.

Chordomas are uncommon primary malignant tumors of bone that typically occur in the axial skeleton including the sacrum, vertebrae, and skull base. The base of skull tumors usually are not amenable to complete surgical resection, and most require postoperative radiotherapy. The natural history of skull base chordoma is typified by slow locally invasive tumor progression and eventual death, although few parameters are known that allow stratification of patients into prognostic groups. Sixty-two patients with skull base chordomas treated at the Massachusetts General Hospital by proton beam irradiation therapy with at least 2 years of follow-up information were reviewed in an attempt to identify clinical and pathologic parameters that predicted outcome. Female sex, tumor necrosis in preradiation treatment biopsy, and tumor volume in excess of 70 ml were each independent predictors of shortened overall survival after radiation therapy for skull base chordoma. Stratification of patients with skull base chordoma into poor and good outcome groups can be performed using the three parameters identified in our study. In addition, the striking difference in survival between the sexes suggests that further investigations of these tumors should include determination of their hormonal receptors status and consideration of hormonal manipulation in their management.

Survival discriminants for differentiated thyroid cancer

Since 1975, the American Cancer Society, Illinois Division, has published end results of major cancer sites drawn from patient data contributed voluntarily by hospital cancer registries throughout the state. The current study was undertaken, in part, to apprehend information regarding contested areas in the management of patients having differentiated (papillary/follicular) thyroid cancer. A total of 2,282 patients with either papillary or follicular carcinoma of the thyroid from 76 different Illinois hospitals and providing 10 years of follow-up information (life-table analysis) were retrospectively analyzed for demographic, disease, and treatment-related predictors of survival. Multivariate analysis using the Cox proportional hazards method was made for stage, age, race, sex, morphology, history of radiation exposure, presence of positive lymph nodes, initial surgical treatment, postoperative iodine 131 therapy, and replacement/suppressive thyroid hormone treatment. Statistically significant (p less than or equal to 0.05) predictors of favorable survival after thyroid cancer were low stage (I and II), young age (less than 50 years), white race, female sex, and the administration, postoperatively, of either thyroid hormone or radioactive iodine. Factors that had no influence on survival were lymph node status, choice of initial surgical treatment, and a history of prior irradiation. We suggest that where a prospective clinical trial is impracticable, a retrospective analysis of a large and detailed database, such as that available from cooperating hospital-based tumor registries, may yet provide useful insights to solutions of cancer management problems.

Efficacy of repeat percutaneous transluminal coronary angioplasty for coronary restenosis

The short- and long-term outcome of patients within the NHLBI PTCA Registry who underwent repeat PTCA for coronary restenosis were analyzed. Of 1,880 patients in whom an initial PTCA was successful, 203 had a repeat PTCA attempted after restenosis developed. Repeat PTCA was usually performed within 6 months of the first procedure. The success rate of repeat PTCA was 85.2%. As a direct result of repeat PTCA, 1.5% of patients had an MI and 2% required emergency CABG. No patien died as a result of the attempted second procedure. One to 3 years of follow-up information was available in 94% of eligible patients. Most patients (75,9%) did not have a subsequent (third) PTCA, CABG or an MI. The late mortality rate was 0.8%. Angiographic follow-up information was available in 62 patients. Sustained enhancement of the diameter of the redilated lesion was observed in 66%. Thus, repeat PTCA has a high success and a low complication rate. Most patients did not have subsequent restenosis and are free of angina. Hence, repeat PTCA should be recommended for patients who have restenosis and should be considered as an integral component of PTCA therapy.