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Sample records for kaplan-meier product-limit method

  1. A comparison between Kaplan-Meier and weighted Kaplan-Meier methods of five-year survival estimation of patients with gastric cancer.

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    Zare, Ali; Mahmoodi, Mahmood; Mohammad, Kazem; Zeraati, Hojjat; Hosseini, Mostafa; Holakouie Naieni, Kourosh

    2014-01-01

    The 5-year survival rate is a good prognostic indicator for patients with Gastric cancer that is usually estimated based on Kaplan-Meier. In situations where censored observations are too many, this method produces biased estimations. This study aimed to compare estimations of Kaplan-Meier and Weighted Kaplan-Meier as an alternative method to deal with the problem of heavy-censoring. Data from 330 patients with Gastric cancer who had undergone surgery at Iran Cancer Institute from 1995- 1999 were analyzed. The Survival Time of these patients was determined after surgery, and the 5-year survival rate for these patients was evaluated based on Kaplan-Meier and Weighted Kaplan-Meier methods. A total of 239 (72.4%) patients passed away by the end of the study and 91(27.6%) patients were censored. The mean and median of survival time for these patients were 24.86±23.73 and 16.33 months, respectively. The one-year, two-year, three-year, four-year, and five-year survival rates of these patients with standard error estimation based on Kaplan-Meier were 0.66 (0.0264), 0.42 (0.0284), 0.31 (0.0274), 0.26 (0.0264) and 0.21 (0.0256) months, respectively. The estimations of Weighted Kaplan-Meier for these patients were 0.62 (0.0251), 0.35 (0.0237), 0.24 (0.0211), 0.17 (0.0172), and 0.10 (0.0125) months, consecutively. In cases where censoring assumption is not made, and the study has many censored observations, estimations obtained from the Kaplan-Meier are biased and are estimated higher than its real amount. But Weighted Kaplan-Meier decreases bias of survival probabilities by providing appropriate weights and presents more accurate understanding.

  2. A comparison between Kaplan-Meier and weighted Kaplan-Meier methods of five-year survival estimation of patients with gastric cancer.

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    Ali Zare

    2014-10-01

    Full Text Available The 5-year survival rate is a good prognostic indicator for patients with Gastric cancer that is usually estimated based on Kaplan-Meier. In situations where censored observations are too many, this method produces biased estimations. This study aimed to compare estimations of Kaplan-Meier and Weighted Kaplan-Meier as an alternative method to deal with the problem of heavy-censoring. Data from 330 patients with Gastric cancer who had undergone surgery at Iran Cancer Institute from 1995- 1999 were analyzed. The Survival Time of these patients was determined after surgery, and the 5-year survival rate for these patients was evaluated based on Kaplan-Meier and Weighted Kaplan-Meier methods. A total of 239 (72.4% patients passed away by the end of the study and 91(27.6% patients were censored. The mean and median of survival time for these patients were 24.86±23.73 and 16.33 months, respectively. The one-year, two-year, three-year, four-year, and five-year survival rates of these patients with standard error estimation based on Kaplan-Meier were 0.66 (0.0264, 0.42 (0.0284, 0.31 (0.0274, 0.26 (0.0264 and 0.21 (0.0256 months, respectively. The estimations of Weighted Kaplan-Meier for these patients were 0.62 (0.0251, 0.35 (0.0237, 0.24 (0.0211, 0.17 (0.0172, and 0.10 (0.0125 months, consecutively. In cases where censoring assumption is not made, and the study has many censored observations, estimations obtained from the Kaplan-Meier are biased and are estimated higher than its real amount. But Weighted Kaplan-Meier decreases bias of survival probabilities by providing appropriate weights and presents more accurate understanding.

  3. On an exponential bound for the Kaplan-Meier estimator.

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    Wellner, Jon A

    2007-12-01

    We review limit theory and inequalities for the Kaplan-Meier Kaplan and Meier (J Am Stat Assoc 53:457-481, 1958) product limit estimator of a survival function on the whole line [Formula: see text] . Along the way we provide bounds for the constant in an interesting inequality due to Biotouzé et al. (Ann Inst H Poincaré Probab Stat 35:735-763, 1999), and provide some numerical evidence in support of one of their conjectures.

  4. Understanding survival analysis: Kaplan-Meier estimate

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    Goel, Manish Kumar; Khanna, Pardeep; Kishore, Jugal

    2010-01-01

    Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate. This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects. PMID:21455458

  5. A review and comparison of methods for recreating individual patient data from published Kaplan-Meier survival curves for economic evaluations: a simulation study.

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    Xiaomin Wan

    Full Text Available In general, the individual patient-level data (IPD collected in clinical trials are not available to independent researchers to conduct economic evaluations; researchers only have access to published survival curves and summary statistics. Thus, methods that use published survival curves and summary statistics to reproduce statistics for economic evaluations are essential. Four methods have been identified: two traditional methods 1 least squares method, 2 graphical method; and two recently proposed methods by 3 Hoyle and Henley, 4 Guyot et al. The four methods were first individually reviewed and subsequently assessed regarding their abilities to estimate mean survival through a simulation study.A number of different scenarios were developed that comprised combinations of various sample sizes, censoring rates and parametric survival distributions. One thousand simulated survival datasets were generated for each scenario, and all methods were applied to actual IPD. The uncertainty in the estimate of mean survival time was also captured.All methods provided accurate estimates of the mean survival time when the sample size was 500 and a Weibull distribution was used. When the sample size was 100 and the Weibull distribution was used, the Guyot et al. method was almost as accurate as the Hoyle and Henley method; however, more biases were identified in the traditional methods. When a lognormal distribution was used, the Guyot et al. method generated noticeably less bias and a more accurate uncertainty compared with the Hoyle and Henley method.The traditional methods should not be preferred because of their remarkable overestimation. When the Weibull distribution was used for a fitted model, the Guyot et al. method was almost as accurate as the Hoyle and Henley method. However, if the lognormal distribution was used, the Guyot et al. method was less biased compared with the Hoyle and Henley method.

  6. A Berry-Essen Inequality for the Kaplan-Meier L-Estimator

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    Qi Hua WANG; Li Xing ZHU

    2001-01-01

    LetFn be the Kaplan-Meier estimator of distribution function F. Let J(.) be a measureablereal-valued function. In this paper, a U-statistic representation for the Kaplan-Meier L-estimator,T(Fn) = xJ(Fn(x))dFn(x), is derived. Furthermore, the representation is also used to establish aBerry-Essen inequality for T(Fn).

  7. Application of Kaplan-Meier analysis in reliability evaluation of products cast from aluminium alloys

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    J. Szymszal

    2010-04-01

    Full Text Available The article evaluates the reliability of AlSi17CuNiMg alloys using Kaplan-Meier-based technique, very popular as a survival estimation tool in medical science. The main object of survival analysis is a group (or groups of units for which the time of occurrence of an event (failure taking place after some time of waiting is estimated. For example, in medicine, the failure can be patient’s death. In this study, the failure was the specimen fracture during a periodical fatigue test, while the survival time was either the test duration to specimen failure (complete observations, or the test end time (censored observations. The parameters of theoretical survival function were estimated with procedures based on the method of least squares, while typical survival time distribution followed either an exponential or two-parameter Weibull distribution. The goodness of fit of a model survival function was estimated with an incremental chi-square test, based on the values of the log likelihood ratio. The effect of alloy processing history on the run of a survival function was examined. The factors shaping the alloy processing history included: mould type (sand or metal mould, alloy modification process, and heat treatment type (solution heat treatment and ageing.

  8. THE LAW OF THE ITERATED LOGARITHM OF THE KAPLAN-MEIER INTEGRAL AND ITS APPLICATION

    Institute of Scientific and Technical Information of China (English)

    HE SHUYUAN; WANG YANHUA

    2004-01-01

    For right censored data, the law of the iterated logarithm of the Kaplan-Meier integral is established. As an application, the authors prove the law of the iterated logarithm for weighted least square estimates of randomly censored linear regression model.

  9. Gastric emptying of solids in humans: improved evaluation by Kaplan-Meier plots, with special reference to obesity and gender

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    Grybaeck, P. [Department of Diagnostic Radiology, Karolinska Hospital, Stockholm (Sweden); Naeslund, E. [Department of Surgery, Karolinska Institute at Danderyd Hospital, Stockholm (Sweden); Hellstroem, P.M. [Department of Internal Medicine, Karolinska Hospital, Stockholm (Sweden); Jacobsson, H. [Department of Diagnostic Radiology, Karolinska Hospital, Stockholm (Sweden)]|[Department of Nuclear Medicine, Karolinska Hospital, Stockholm (Sweden); Backman, L. [Department of Surgery, Karolinska Institute at Danderyd Hospital, Stockholm (Sweden)

    1996-12-01

    It has been suggested that obesity is associated with an altered rate of gastric emptying, and that there are also sex differences in gastric emptying. The results of earlier studies examining gastric emptying rates in obesity and in males and females have proved inconsistent. The aim of this study was to investigate the influence of obesity and gender on gastric emptying, by extending conventional evaluation methods with Kaplan-Meier plots, in order to assess whether these factors have to be accounted for when interpreting results of scintigraphic gastric emptying tests. Twenty-one normal-weight volunteers and nine obese subjects were fed a standardised technetium-99m labelled albumin omelette. Imaging data were acquired at 5- and 10-min intervals in both posterior and anterior projections with the subjects in the sitting position. The half-emptying time, analysed by Kaplan-Meier plot (log-rank test), were shorter in obese subjects compared to normal-weight subjects and later in females compared to males. Also, the lag-phase and half-emptying time were shorter in obese females than in normal females. This study shows an association between different gastric emptying rates and obesity and gender. Therefore, body mass index and gender have to be accounted for when interpreting results of scintigraphic gastric emptying studies. (orig.). With 6 figs., 4 tabs.

  10. A practical divergence measure for survival distributions that can be estimated from Kaplan-Meier curves.

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    Cox, Trevor F; Czanner, Gabriela

    2016-06-30

    This paper introduces a new simple divergence measure between two survival distributions. For two groups of patients, the divergence measure between their associated survival distributions is based on the integral of the absolute difference in probabilities that a patient from one group dies at time t and a patient from the other group survives beyond time t and vice versa. In the case of non-crossing hazard functions, the divergence measure is closely linked to the Harrell concordance index, C, the Mann-Whitney test statistic and the area under a receiver operating characteristic curve. The measure can be used in a dynamic way where the divergence between two survival distributions from time zero up to time t is calculated enabling real-time monitoring of treatment differences. The divergence can be found for theoretical survival distributions or can be estimated non-parametrically from survival data using Kaplan-Meier estimates of the survivor functions. The estimator of the divergence is shown to be generally unbiased and approximately normally distributed. For the case of proportional hazards, the constituent parts of the divergence measure can be used to assess the proportional hazards assumption. The use of the divergence measure is illustrated on the survival of pancreatic cancer patients. Copyright © 2016 John Wiley & Sons, Ltd.

  11. Kaplan-Meier analysis on seizure outcome after epilepsy surgery: do gender and race influence it?

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    Burneo, Jorge G; Villanueva, Vicente; Knowlton, Robert C; Faught, R Edward; Kuzniecky, Ruben I

    2008-06-01

    To evaluate seizure outcome following epilepsy surgery for patients with temporal lobe epilepsy and evaluate is gender and race/ethnicity influence it. Data were obtained from the discharge database of the University of Alabama at Birmingham, Epilepsy Center, between 1985 and 2001. The sample consisted of all patients with a primary diagnosis of medically intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy. Seizure recurrence was tabulated at 7 days, 2 months, 6 months, 1, 2, 3, 4, 5, and 6 years following surgery. Logistic regression analysis was used to model the presence of seizure recurrence after anterior temporal lobectomy for all patients. Kaplan-Meier analysis was done to obtain estimates and 95% CIs of seizure freedom from baseline. Baseline variables--age at surgery, age at seizure onset, sex, side of resection, immediate postoperative seizures, and pathology results--were assessed as potential predictors of each outcome by comparing the survival curves within each variable with a log rank test. Three hundred sixty-eight patients underwent surgical treatment for TLE, mean age of 30.2 years. Thirty-five patients were African American, 43% were men. Immediate postoperative seizures were seen in 23 patients, while seizure recurrence occurred in 27.3% patients within a year after surgery, and in 33.6% within 6 years. Logistic regression results showed no differences between African Americans and whites, between males and females. The occurrence of immediate postoperative seizures was a strong predictor of late seizure recurrence only at 1 year after surgery. The occurrence of seizures in the immediate postoperative period is a strong predictor of later seizure recurrence. Sex and race/ethnicity do not appear to be predictors of long-term outcome following surgery for temporal lobe epilepsy.

  12. Total Ankle Replacement Survival Rates Based on Kaplan-Meier Survival Analysis of National Joint Registry Data.

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    Bartel, Annette F P; Roukis, Thomas S

    2015-10-01

    National joint registry data provides unique information about primary total ankle replacement (TAR) survival. We sought to recreate survival curves among published national joint registry data sets using the Kaplan-Meier estimator. Overall, 5152 primary and 591 TAR revisions were included over a 2- to 13-year period with prosthesis survival for all national joint registries of 0.94 at 2-years, 0.87 at 5-years and 0.81 at 10-years. National joint registry datasets should strive for completion of data presentation including revision definitions, modes and time of failure, and patients lost to follow-up or death for complete accuracy of the Kaplan-Meier estimator.

  13. KMWin--a convenient tool for graphical presentation of results from Kaplan-Meier survival time analysis.

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    Arnd Gross

    Full Text Available BACKGROUND: Analysis of clinical studies often necessitates multiple graphical representations of the results. Many professional software packages are available for this purpose. Most packages are either only commercially available or hard to use especially if one aims to generate or customize a huge number of similar graphical outputs. We developed a new, freely available software tool called KMWin (Kaplan-Meier for Windows facilitating Kaplan-Meier survival time analysis. KMWin is based on the statistical software environment R and provides an easy to use graphical interface. Survival time data can be supplied as SPSS (sav, SAS export (xpt or text file (dat, which is also a common export format of other applications such as Excel. Figures can directly be exported in any graphical file format supported by R. RESULTS: On the basis of a working example, we demonstrate how to use KMWin and present its main functions. We show how to control the interface, customize the graphical output, and analyse survival time data. A number of comparisons are performed between KMWin and SPSS regarding graphical output, statistical output, data management and development. Although the general functionality of SPSS is larger, KMWin comprises a number of features useful for survival time analysis in clinical trials and other applications. These are for example number of cases and number of cases under risk within the figure or provision of a queue system for repetitive analyses of updated data sets. Moreover, major adjustments of graphical settings can be performed easily on a single window. CONCLUSIONS: We conclude that our tool is well suited and convenient for repetitive analyses of survival time data. It can be used by non-statisticians and provides often used functions as well as functions which are not supplied by standard software packages. The software is routinely applied in several clinical study groups.

  14. Quantitative estimation of the stability of methicillin-resistant Staphylococcus aureus strain-typing systems by use of Kaplan-Meier survival analysis.

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    O'Sullivan, Matthew V N; Sintchenko, Vitali; Gilbert, Gwendolyn L

    2013-01-01

    Knowledge concerning stability is important in the development and assessment of microbial molecular typing systems and is critical for the interpretation of their results. Typing system stability is usually measured as the fraction of isolates that change type after several in vivo passages, but this does not necessarily reflect in vivo stability. The aim of this study was to utilize survival analysis to provide an informative quantitative measure of in vivo stability and to compare the stabilities of various techniques employed in typing methicillin-resistant Staphylococcus aureus (MRSA). We identified 100 MRSA pairs (isolated from the same patient ≥ 1 month apart) and typed them using multilocus sequence typing (MLST), phage-derived open reading frame (PDORF) typing, toxin gene profiling (TGP), staphylococcal cassette chromosome mec (SCCmec) subtyping, pulsed-field gel electrophoresis (PFGE), and spa sequence typing. Discordant isolate pairs, belonging to different MLST clonal complexes, were excluded, leaving 81 pairs for analysis. The stabilities of these methods were examined using Kaplan-Meier survival analysis, and discriminatory power was measured by Simpson's index of diversity. The probability percentages that the type remained unchanged at 6 months for spa sequence typing, TGP, multilocus variable number of tandem repeats analysis (MLVA), SCCmec subtyping, PDORF typing, and PFGE were 95, 95, 88, 82, 71, and 58, respectively, while the Simpson's indices of diversity were 0.48, 0.47, 0.70, 0.72, 0.89, and 0.88, respectively. Survival analysis using sequential clinical isolates adds an important quantitative dimension to the measurement of stability of a microbial typing system. Of the methods compared here, PDORF typing provides high discriminatory power, comparable with that of PFGE, and a level of stability suitable for MRSA surveillance and outbreak investigations.

  15. Factors Determining Disease Duration in Alzheimer’s Disease: A Postmortem Study of 103 Cases Using the Kaplan-Meier Estimator and Cox Regression

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    R. A. Armstrong

    2014-01-01

    Full Text Available Factors associated with duration of dementia in a consecutive series of 103 Alzheimer’s disease (AD cases were studied using the Kaplan-Meier estimator and Cox regression analysis (proportional hazard model. Mean disease duration was 7.1 years (range: 6 weeks–30 years, standard deviation = 5.18; 25% of cases died within four years, 50% within 6.9 years, and 75% within 10 years. Familial AD cases (FAD had a longer duration than sporadic cases (SAD, especially cases linked to presenilin (PSEN genes. No significant differences in duration were associated with age, sex, or apolipoprotein E (Apo E genotype. Duration was reduced in cases with arterial hypertension. Cox regression analysis suggested longer duration was associated with an earlier disease onset and increased senile plaque (SP and neurofibrillary tangle (NFT pathology in the orbital gyrus (OrG, CA1 sector of the hippocampus, and nucleus basalis of Meynert (NBM. The data suggest shorter disease duration in SAD and in cases with hypertensive comorbidity. In addition, degree of neuropathology did not influence survival, but spread of SP/NFT pathology into the frontal lobe, hippocampus, and basal forebrain was associated with longer disease duration.

  16. Days of Shanghai Stock Index Successive Rises and Fall Based on Kaplan-Meier Algorithms%基于Kaplan-Meier算法的上证指数涨跌天数研究

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    毕建欣

    2011-01-01

    运用Kaplan-Meier算法对上证指数连续上涨和下跌天数进行研究,研究了在不同的市场交易制度(即T+0,T+1和涨停板制度)对上证指数涨跌天数的影响,其结果表明Kaplan-Meier算法对于分析股市的变动是有效的.%In this paper, Days of Shanghai Stock Index Successive rises and fall are analyzed by Kaplan-Meier Algorithms. It demonstrates the policy effect on days of Shanghai Stock Index successive rises and fall , such as" T + 0","T + 1"and"soaring deadline system". It also reveals that Kaplan-Meier Algorithms is valid for analyzing the changes of the stock market.

  17. Hazard Rate Estimation for Censored Data via Strong Representation of the Kaplan-Meier Estimator.

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    1985-08-01

    of bounded variation (condition (k4).) The process( /n 1 has mean zero and covariance SA t (26) r(s,t) E E[C(s) C(t)] - F(s) F(t) f [(u)]- 2 d Lj(u...continuous with density f(x) > 0 at x. Suppose k is of bounded variation and is continuous. Then fn(x) admits the strong approximation on the interval [0,T

  18. Bias and precision of methods for estimating the difference in restricted mean survival time from an individual patient data meta-analysis

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    Béranger Lueza

    2016-03-01

    Full Text Available Abstract Background The difference in restricted mean survival time ( rmstD t ∗ $$ rmstD\\left({t}^{\\ast}\\right $$ , the area between two survival curves up to time horizon t ∗ $$ {t}^{\\ast } $$ , is often used in cost-effectiveness analyses to estimate the treatment effect in randomized controlled trials. A challenge in individual patient data (IPD meta-analyses is to account for the trial effect. We aimed at comparing different methods to estimate the rmstD t ∗ $$ rmstD\\left({t}^{\\ast}\\right $$ from an IPD meta-analysis. Methods We compared four methods: the area between Kaplan-Meier curves (experimental vs. control arm ignoring the trial effect (Naïve Kaplan-Meier; the area between Peto curves computed at quintiles of event times (Peto-quintile; the weighted average of the areas between either trial-specific Kaplan-Meier curves (Pooled Kaplan-Meier or trial-specific exponential curves (Pooled Exponential. In a simulation study, we varied the between-trial heterogeneity for the baseline hazard and for the treatment effect (possibly correlated, the overall treatment effect, the time horizon t ∗ $$ {t}^{\\ast } $$ , the number of trials and of patients, the use of fixed or DerSimonian-Laird random effects model, and the proportionality of hazards. We compared the methods in terms of bias, empirical and average standard errors. We used IPD from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC and its updated version MAC-NPC2 for illustration that included respectively 1,975 and 5,028 patients in 11 and 23 comparisons. Results The Naïve Kaplan-Meier method was unbiased, whereas the Pooled Exponential and, to a much lesser extent, the Pooled Kaplan-Meier methods showed a bias with non-proportional hazards. The Peto-quintile method underestimated the rmstD t ∗ $$ rmstD\\left({t}^{\\ast}\\right $$ , except with non-proportional hazards at t ∗ $$ {t}^{\\ast } $$ = 5 years. In the presence of treatment effect

  19. Toward improved statistical methods for analyzing Cotinine-Biomarker health association data

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    Clark John D

    2011-10-01

    Full Text Available Abstract Background Serum cotinine, a metabolite of nicotine, is frequently used in research as a biomarker of recent tobacco smoke exposure. Historically, secondhand smoke (SHS research uses suboptimal statistical methods due to censored serum cotinine values, meaning a measurement below the limit of detection (LOD. Methods We compared commonly used methods for analyzing censored serum cotinine data using parametric and non-parametric techniques employing data from the 1999-2004 National Health and Nutrition Examination Surveys (NHANES. To illustrate the differences in associations obtained by various analytic methods, we compared parameter estimates for the association between cotinine and the inflammatory marker homocysteine using complete case analysis, single and multiple imputation, "reverse" Kaplan-Meier, and logistic regression models. Results Parameter estimates and statistical significance varied according to the statistical method used with censored serum cotinine values. Single imputation of censored values with either 0, LOD or LOD/√2 yielded similar estimates and significance; multiple imputation method yielded smaller estimates than the other methods and without statistical significance. Multiple regression modelling using the "reverse" Kaplan-Meier method yielded statistically significant estimates that were larger than those from parametric methods. Conclusions Analyses of serum cotinine data with values below the LOD require special attention. "Reverse" Kaplan-Meier was the only method inherently able to deal with censored data with multiple LODs, and may be the most accurate since it avoids data manipulation needed for use with other commonly used statistical methods. Additional research is needed into the identification of optimal statistical methods for analysis of SHS biomarkers subject to a LOD.

  20. Survival analysis in total joint replacement: an alternative method of accounting for the presence of competing risk.

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    Fennema, P; Lubsen, J

    2010-05-01

    Survival analysis is an important tool for assessing the outcome of total joint replacement. The Kaplan-Meier method is used to estimate the incidence of revision of a prosthesis over time, but does not account appropriately for competing events which preclude revision. In the presence of competing death, this method will lead to statistical bias and the curve will lose its interpretability. A valid comparison of survival results between studies using the method is impossible without accounting for different rates of competing events. An alternative and easily applicable approach, the cumulative incidence of competing risk, is proposed. Using three simulated data sets and realistic data from a cohort of 406 consecutive cementless total hip prostheses, followed up for a minimum of ten years, both approaches were compared and the magnitude of potential bias was highlighted. The Kaplan-Meier method overestimated the incidence of revision by almost 4% (60% relative difference) in the simulations and more than 1% (31.3% relative difference) in the realistic data set. The cumulative incidence of competing risk approach allows for appropriate accounting of competing risk and, as such, offers an improved ability to compare survival results across studies.

  1. The 434(G>C) polymorphism in the eosinophil cationic protein gene and its association with tissue eosinophilia in oral squamous cell carcinomas

    DEFF Research Database (Denmark)

    Pereira, Michele C; Oliveira, Denise T; Olivieri, Eloísa H R

    2010-01-01

    variables. METHODS: The ECP genotypes of 165 healthy individuals and 157 OSCC patients were detected by PCR-RFLP analysis after cleavage of the amplified DNA sequence with enzyme PstI. TATE was obtained by morphometric analysis. Chi-square test or Fisher's exact test was used to analyze the association...... of ECP-gene polymorphism 434(G>C) with TATE, demographic, clinical, and microscopic variables in OSCC patients. Disease-free survival and overall survival were calculated by the Kaplan-Meier product-limit actuarial method and the comparison of the survival curves were performed using log rank test...

  2. Edgeworth expansion of the Studentized product-limit estimator for truncated and censored data

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Based on random left truncated and right censored data we investigate the one-term Edgeworth expansion for the Studentized product-limit estimator, and show that the Edgeworth expansion is close to the exact distribution of the Studentized product-limit estimator with a remainder of o(n-1/2).

  3. Edgeworth expansion of the Studentized product-limit estimator for truncated and censored data

    Institute of Scientific and Technical Information of China (English)

    孙六全

    2000-01-01

    Based on random left truncated and right censored data we investigate the one-term Edgeworth expansion for the Studentized product-limit estimator, and show that the Edgeworth expan-sion is close to the exact distribution of the Studentized product-limit estimator with a remainder of

  4. Disease-specific survival for limited-stage small-cell lung cancer affected by statistical method of assessment

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    Yuan Fei

    2007-02-01

    Full Text Available Abstract Background In general, prognosis and impact of prognostic/predictive factors are assessed with Kaplan-Meier plots and/or the Cox proportional hazard model. There might be substantive differences from the results using these models for the same patients, if different statistical methods were used, for example, Boag log-normal (cure-rate model, or log-normal survival analysis. Methods Cohort of 244 limited-stage small-cell lung cancer patients, were accrued between 1981 and 1998, and followed to the end of 2005. The endpoint was death with or from lung cancer, for disease-specific survival (DSS. DSS at 1-, 3- and 5-years, with 95% confidence limits, are reported for all patients using the Boag, Kaplan-Meier, Cox, and log-normal survival analysis methods. Factors with significant effects on DSS were identified with step-wise forward multivariate Cox and log-normal survival analyses. Then, DSS was ascertained for patients with specific characteristics defined by these factors. Results The median follow-up of those alive was 9.5 years. The lack of events after 1966 days precluded comparison after 5 years. DSS assessed by the four methods in the full cohort differed by 0–2% at 1 year, 0–12% at 3 years, and 0–1% at 5 years. Log-normal survival analysis indicated DSS of 38% at 3 years, 10–12% higher than with other methods; univariate 95% confidence limits were non-overlapping. Surgical resection, hemoglobin level, lymph node involvement, and superior vena cava (SVC obstruction significantly impacted DSS. DSS assessed by the Cox and log-normal survival analysis methods for four clinical risk groups differed by 1–6% at 1 year, 15–26% at 3 years, and 0–12% at 5 years; multivariate 95% confidence limits were overlapping in all instances. Conclusion Surgical resection, hemoglobin level, lymph node involvement, and superior vena cava (SVC obstruction all significantly impacted DSS. Apparent DSS for patients was influenced by the

  5. Timing, method and discontinuation of hydrocortisone administration for septic shock patients

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    Ibarra-Estrada, Miguel A; Chávez-Peña, Quetzalcóatl; Reynoso-Estrella, Claudia I; Rios-Zermeño, Jorge; Aguilera-González, Pável E; García-Soto, Miguel A; Aguirre-Avalos, Guadalupe

    2017-01-01

    AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes. METHODS This prospective cohort study included 59 patients with septic shock who received stress-dose hydrocortisone. It was performed at 2 critical care units in academic hospitals from June 1st, 2015, to July 31st, 2016. Demographic data, comorbidities, medical management details, adverse effects related to corticosteroids, and outcomes were collected after the critical care physician indicated initiation of hydrocortisone. Univariate comparison between continuous and bolus administration of hydrocortisone was performed, including multivariate analysis, as well as Kaplan-Meier analysis to compare the proportion of shock reversal at 7 d after presentation. Receiver operating characteristic (ROC) curves determined the best cut-off criteria for initiation of hydrocortisone associated with the highest probability of shock reversal. We addressed the effects of the taper strategy for discontinuation of hydrocortisone, noting risk of shock relapse and adverse effects. RESULTS All-cause 30-d mortality was 42%. Hydrocortisone was administered as a continuous infusion in 54.2% of patients; time to reversal of shock was 49 h longer in patients who were given a bolus administration [59 h (range, 47.5-90.5) vs 108 h (range, 63.2-189); P = 0.001]. The maximal dose of norepinephrine after initiation of hydrocortisone was lower in patients on continuous infusion [0.19 μg/kg per minute (range, 0.11-0.28 μg)] compared with patients who were given bolus [0.34 μg/kg per minute (range, 0.16-0.49); P = 0.004]. Kaplan-Meier analysis revealed a higher proportion of shock reversal at 7 d in patients with continuous infusion compared to those given bolus (83% vs 63%; P = 0.004). There was a good correlation between time to initiation of hydrocortisone and time to reversal of shock (r = 0

  6. Actuarial and actual analysis of surgical results: empirical validation.

    Science.gov (United States)

    Grunkemeier, G L; Anderson, R P; Starr, A

    2001-06-01

    This report validates the use of the Kaplan-Meier (actuarial) method of computing survival curves by comparing 12-year estimates published in 1978 with current assessments. It also contrasts cumulative incidence curves, referred to as "actual" analysis in the cardiac-related literature with Kaplan-Meier curves for thromboembolism and demonstrates that with the former estimate the percentage of events that will actually occur.

  7. Comparison of Parameter Estimation Methods for Transformer Weibull Lifetime Modelling

    Institute of Scientific and Technical Information of China (English)

    ZHOU Dan; LI Chengrong; WANG Zhongdong

    2013-01-01

    Two-parameter Weibull distribution is the most widely adopted lifetime model for power transformers.An appropriate parameter estimation method is essential to guarantee the accuracy of a derived Weibull lifetime model.Six popular parameter estimation methods (i.e.the maximum likelihood estimation method,two median rank regression methods including the one regressing X on Y and the other one regressing Y on X,the Kaplan-Meier method,the method based on cumulative hazard plot,and the Li's method) are reviewed and compared in order to find the optimal one that suits transformer's Weibull lifetime modelling.The comparison took several different scenarios into consideration:10 000 sets of lifetime data,each of which had a sampling size of 40 ~ 1 000 and a censoring rate of 90%,were obtained by Monte-Carlo simulations for each scienario.Scale and shape parameters of Weibull distribution estimated by the six methods,as well as their mean value,median value and 90% confidence band are obtained.The cross comparison of these results reveals that,among the six methods,the maximum likelihood method is the best one,since it could provide the most accurate Weibull parameters,i.e.parameters having the smallest bias in both mean and median values,as well as the shortest length of the 90% confidence band.The maximum likelihood method is therefore recommended to be used over the other methods in transformer Weibull lifetime modelling.

  8. Side effects unrelated to disease activity and acceptability of highly effective contraceptive methods in women with systemic lupus erythematosus: a randomized, clinical trial.

    Science.gov (United States)

    Cravioto, María-del-Carmen; Jiménez-Santana, Luisa; Mayorga, Julio; Seuc, Armando H

    2014-08-01

    To assess the side effects unrelated to disease activity and the acceptability of combined oral contraceptives (COCs), progestin-only pills (POPs) and copper-releasing intrauterine devices (IUDs) in women with systemic lupus erythematosus (SLE). A randomized clinical trial including 162 women with SLE, assigned to COC (n=54), POP (n=54) or IUD (n=54). Follow-up visits were conducted after 1, 2, 3, 6, 9 and 12 months of treatment to monitor the presence of symptoms, changes in body weight and blood pressure as well as the development of health problems other than those relating to lupus. Reasons for discontinuation and satisfaction with the use of the assigned method were recorded at the end of treatment. Statistical analysis included descriptive statistics, repeated measure analyses and Kaplan-Meier curves. Significantly different discontinuation rates due to any reason [35%, 55%, 29% (plupus, when counseling and specialized health attention are provided; however, the acceptability of POP appears to be inferior. Side effects unrelated to lupus disease activity are not frequent reasons to discontinue the contraceptive methods. This study delves into an area that has not been explored among patients with lupus. Our findings on the associated side effects and reasons for discontinuing COCs, POPs or copper-bearing IUDs may be useful in improving contraceptive counseling for women with lupus. Furthermore, they also heighten our knowledge on the reasons that may preclude the widespread use of effective contraceptives among lupus patients. Copyright © 2014. Published by Elsevier Inc.

  9. Assessing the effect of quantitative and qualitative predictors on gastric cancer individuals survival using hierarchical artificial neural network models.

    Science.gov (United States)

    Amiri, Zohreh; Mohammad, Kazem; Mahmoudi, Mahmood; Parsaeian, Mahbubeh; Zeraati, Hojjat

    2013-01-01

    There are numerous unanswered questions in the application of artificial neural network models for analysis of survival data. In most studies, independent variables have been studied as qualitative dichotomous variables, and results of using discrete and continuous quantitative, ordinal, or multinomial categorical predictive variables in these models are not well understood in comparison to conventional models. This study was designed and conducted to examine the application of these models in order to determine the survival of gastric cancer patients, in comparison to the Cox proportional hazards model. We studied the postoperative survival of 330 gastric cancer patients who suffered surgery at a surgical unit of the Iran Cancer Institute over a five-year period. Covariates of age, gender, history of substance abuse, cancer site, type of pathology, presence of metastasis, stage, and number of complementary treatments were entered in the models, and survival probabilities were calculated at 6, 12, 18, 24, 36, 48, and 60 months using the Cox proportional hazards and neural network models. We estimated coefficients of the Cox model and the weights in the neural network (with 3, 5, and 7 nodes in the hidden layer) in the training group, and used them to derive predictions in the study group. Predictions with these two methods were compared with those of the Kaplan-Meier product limit estimator as the gold standard. Comparisons were performed with the Friedman and Kruskal-Wallis tests. Survival probabilities at different times were determined using the Cox proportional hazards and a neural network with three nodes in the hidden layer; the ratios of standard errors with these two methods to the Kaplan-Meier method were 1.1593 and 1.0071, respectively, revealed a significant difference between Cox and Kaplan-Meier (P neural network, and the neural network and the standard (Kaplan-Meier), as well as better accuracy for the neural network (with 3 nodes in the hidden layer

  10. High speed InAs electron avalanche photodiodes overcome the conventional gain-bandwidth product limit.

    Science.gov (United States)

    Marshall, Andrew R J; Ker, Pin Jern; Krysa, Andrey; David, John P R; Tan, Chee Hing

    2011-11-07

    High bandwidth, uncooled, Indium Arsenide (InAs) electron avalanche photodiodes (e-APDs) with unique and highly desirable characteristics are reported. The e-APDs exhibit a 3dB bandwidth of 3.5 GHz which, unlike that of conventional APDs, is shown not to reduce with increasing avalanche gain. Hence these InAs e-APDs demonstrate a characteristic of theoretically ideal electron only APDs, the absence of a gain-bandwidth product limit. This is important because gain-bandwidth products restrict the maximum exploitable gain in all conventional high bandwidth APDs. Non-limiting gain-bandwidth products up to 580 GHz have been measured on these first high bandwidth e-APDs.

  11. Trends in study design and the statistical methods employed in a leading general medicine journal.

    Science.gov (United States)

    Gosho, M; Sato, Y; Nagashima, K; Takahashi, S

    2017-07-27

    Study design and statistical methods have become core components of medical research, and the methodology has become more multifaceted and complicated over time. The study of the comprehensive details and current trends of study design and statistical methods is required to support the future implementation of well-planned clinical studies providing information about evidence-based medicine. Our purpose was to illustrate study design and statistical methods employed in recent medical literature. This was an extension study of Sato et al. (N Engl J Med 2017; 376: 1086-1087), which reviewed 238 articles published in 2015 in the New England Journal of Medicine (NEJM) and briefly summarized the statistical methods employed in NEJM. Using the same database, we performed a new investigation of the detailed trends in study design and individual statistical methods that were not reported in the Sato study. Due to the CONSORT statement, prespecification and justification of sample size are obligatory in planning intervention studies. Although standard survival methods (eg Kaplan-Meier estimator and Cox regression model) were most frequently applied, the Gray test and Fine-Gray proportional hazard model for considering competing risks were sometimes used for a more valid statistical inference. With respect to handling missing data, model-based methods, which are valid for missing-at-random data, were more frequently used than single imputation methods. These methods are not recommended as a primary analysis, but they have been applied in many clinical trials. Group sequential design with interim analyses was one of the standard designs, and novel design, such as adaptive dose selection and sample size re-estimation, was sometimes employed in NEJM. Model-based approaches for handling missing data should replace single imputation methods for primary analysis in the light of the information found in some publications. Use of adaptive design with interim analyses is increasing

  12. [Statistical and epidemiological methods used in biomedical research: implications for initial medical education].

    Science.gov (United States)

    Picat, M-Q; Savès, M; Asselineau, J; Dumoulin, M; Coureau, G; Salmi, L-R; Perez, P; Chêne, G

    2013-06-01

    The main source of key medical information consists in original articles published in peer-reviewed biomedical journals. Reported studies use increasingly sophisticated statistical and epidemiological approaches that first require a solid understanding of core methods. However, such understanding is not widely shared among physicians. Our aim was to assess whether the basic statistical and epidemiological methods used in original articles published in general biomedical journals are taught during the first years of the medical curriculum in France. We selected original articles published in The New England Journal of Medicine, The Lancet, and The Journal of the American Medical Association, over a period of six months in 2007 and in 2008. A standardized statistical content checklist was used to extract the necessary information in the "Abstract", "Methods", "Results", footnotes of tables, and legends of figures. The methods used in the selected articles were compared to the national program and the public health program of biostatistics and epidemiology taught during the first six years of medical school. The 237 analyzed original articles all used at least one statistical or epidemiological method. Descriptive statistics, confidence interval and Chi(2) or Fisher tests, methods used in more than 50% of articles, were repeatedly taught throughout the medicine curriculum. Measures of association, sample size, fit and Kaplan-Meier method, used in 40 to 50% of articles, were specifically taught during training sessions on critical reading methods. Cox model (41% of articles) and logistic regression (24% of articles) were never taught. The most widely used illustrations, contingency tables (92%) and flowcharts (48%), were not included in the national program. More teaching of the core methods underlying the understanding of sophisticated methods and illustrations should be included in the early medical curriculum so that physicians can read the scientific literature

  13. Diabetes and Body Mass Index Are Associated with Neuropathy and Prognosis in Colon Cancer Patients Treated with Capecitabine and Oxaliplatin Adjuvant Chemotherapy.

    Science.gov (United States)

    Ottaiano, Alessandro; Nappi, Anna; Tafuto, Salvatore; Nasti, Guglielmo; De Divitiis, Chiara; Romano, Carmela; Cassata, Antonino; Casaretti, Rossana; Silvestro, Lucrezia; Avallone, Antonio; Capuozzo, Maurizio; Capozzi, Monica; Maiolino, Piera; Quagliariello, Vincenzo; Scala, Stefania; Iaffaioli, Vincenzo Rosario

    2016-01-01

    There are few background data on the impact of clinical factors on neurotoxicity and prognosis in patients treated with adjuvant capecitabine and oxaliplatin (CAPOX) chemotherapy. 102 stage II high-risk and stage III colorectal cancer patients were treated for 6 months with adjuvant CAPOX, then they were followed up. Associations between clinical variables, metabolic syndrome components, smoking and neurotoxicity were evaluated by the x03C7;2 test. The Kaplan-Meier product limit method was applied to graph disease-free survival (DFS). Univariate analysis was done with the log-rank test. Cox's proportional hazards regression was used to analyze the effect of several risk factors on DFS. Significant associations were found between diabetes (p obesity could be involved in peripheral neuropathy and in stimulating micro-metastases. Further studies are necessary to explain this interesting connection between diabetes, obesity and colon cancer. © 2016 S. Karger AG, Basel.

  14. High income, employment, postgraduate education, and marriage. A suicidal cocktail among psychiatric patients

    DEFF Research Database (Denmark)

    Agerbo, Esben

    2007-01-01

    .48-0.70); and for disability or age pensioners, 0.63 (95% CI, 0.55-0.71). Compared with postgraduate education, HRs (95% CIs) associated with a bachelor's degree, vocational school, or primary school education were 0.82 (0.67-1.02), 0.66 (0.55-0.80), and 0.54 (0.44-0.65), respectively. The HRs (95% CIs) for widowed, divorced......CONTEXT: Studies dating back over 100 years have shown that the risk of suicide in the general population is associated with low income, unemployment, educational underachievement, and singleness. However, little is known about the association between suicide risk and these factors in psychiatric...... longitudinal data on income, labor market affiliation, educational attainment, and marital and cohabitational status (96,369 patients, 256,619 admissions, and 2727 suicides). MAIN OUTCOME MEASURES: Suicide risks after hospital discharge were depicted using Kaplan-Meier product-limit methods. Hazard ratios (HRs...

  15. Peritonitis-free survival in peritoneal dialysis: an update taking competing risks into account.

    Science.gov (United States)

    Evans, David W; Ryckelynck, Jean-Philippe; Fabre, Emmanuel; Verger, Christian

    2010-07-01

    Peritonitis-free survival is commonly reported in the peritoneal dialysis (PD) literature. The Kaplan-Meier method appears to be the only technique used to date, although it has known limitations for cohorts with multiple outcomes, as in PD. In the presence of these 'competing risks' outcomes, the Kaplan-Meier estimate is interpretable only under restrictive assumptions. In contrast, methods which take competing risks into account provide unbiased estimates of probabilities of outcomes as actually experienced by patients. We analysed peritonitis-free survival in a cohort of 8711 incident patients from the 'Registre de Dialyse Péritonéale de Langue Française' between 1 January 2000 and 31 December 2007 by calculating the cumulative incidence (CI) of the first episode of peritonitis using the Kaplan-Meier method and a method accounting for competing risks. We compared the CI in different patient groups by the log-rank test and a test developed for competing risk data, Gray's test. After 5 years of PD, the CI of at least one peritonitis episode was 0.4, and the probability of any outcome was 0.96. The Kaplan-Meier method overestimated the CI by a large amount. Compared with the log-rank test, Gray's test led to different conclusions in three out of seven comparisons. The competing risk approach shows that the CI of at least one peritonitis episode was lower than reported by the Kaplan-Meier method but that survival peritonitis-free and still on PD was overall low. The competing risk approach provides estimates which have a clearer interpretation than Kaplan-Meier methods and could be more widely used in PD research.

  16. The Impact of Balanced Counseling on Contraceptive Method Choice and Determinants of Long Acting and Reversible Contraceptive Continuation in Nepal.

    Science.gov (United States)

    Sapkota, Sabitri; Rajbhandary, Ruchita; Lohani, Shilpa

    2016-03-08

    Introduction Long-acting reversible contraceptives (LARCs) reduce rates of unintended pregnancies and repeat abortion. Uptake and continuation rates of LARCs are very low in Nepal, despite free provision from most health facilities. We sought to establish the effectiveness of a new approach to LARC promotion in Nepal. Methods We examined change in contraceptive method mix in Nepal using service data resulting from introduction of a balanced counseling (BC) approach to family planning (FP). All staff located at nine randomly selected FP sites were trained and began applying BC in April and May 2014. Women who accepted LARCs from a participating facility were re-contacted at 1, 3, 6 and 12 months. We estimated the LARC continuation rate and assessed determinants of continuation using descriptive analysis, Kaplan-Meier survival curves and univariate and multivariate Cox proportional hazard analysis. Results A total of 5744 women received BC between April and July 2014. 1580 women (27.5 %) took up LARCs, raising its contribution to contraceptive method mix at [organization] to 40 %, significantly higher than the 15 % recorded in 2013. 913 women were followed-up, and the LARC continuation rate at 12 months was 82 %. Women's reported satisfaction with LARC [AHR 0.23; 95 % CI 0.14-0.39, p = 0.000] was the single strongest determinant of LARC continuation after adjusting for all background characteristics. Discussion The findings suggest BC is an effective approach for increasing LARC uptake in Nepal. The rate of LARC continuation and its determinants are important inputs to strategies for improved delivery of FP services.

  17. INTRAPERITONEAL AEROSOL CHEMOTHERAPY UNDER PRESSURE (IACUP – AN INNOVATIVE METHOD OF TREATMENT OF PATIENTS WITH PERITONEAL CARCINOMATOSIS

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2016-01-01

    Full Text Available Widespread peritoneal carcinomatosis in gastric cancer, in fact, is the end-stage of the disease. The survival median of patients is no more than 3–6 months. Development of various methods of intraperitoneal chemotherapy can improve the prognosis of this category of patients.Objective. To evaluate the efficacy and safety of intraperitoneal aerosol chemotherapy under pressure (IACUP in patients with gastric cancer with peritoneal carcinomatosis.Materials and methods. The treatment Protocol consisted of a laparotomy or laparoscopy for the staging of the tumor process, 3–4 courses of systemic chemotherapy scheme XELOX followed by conducting at least 3 sessions of intraperitoneal aerosol chemotherapy under pressure (IACUP with an interval of 6 weeks on the background of chemotherapy. In the case of progression the patient was excluded from the study. Currently, the study included 27 patients with disseminated gastric cancer who underwent 46 procedures of IACUP. There were 8 men and 19 women. The average age of patients was 50.6 years.Results. In the framework of the safety assessment of IACUP there were 3 cases of adverse effects. Two patients (7,4% noted nausea for the first 2 days after running the session of IACUP. In one patient the iatrogenic perforation of the diaphragm during biopsy of the peritoneum with the development of carbonetworks occurred. The survival median was 11 months. One-year survival rate (by KaplanMeier was 50.7%. 14 patients are alive and continue to participate in the study during the first year of observation.Conclusion. Intraperitoneal aerosol chemotherapy under pressure (IACUP is a simple, minimally invasive and safe method for the palliative treatment of patients with disseminated carcinomatosis of gastric cancer. We developed the treatment Protocol that allows us to achieve one-year survival of more than half of patients.

  18. Does index tumor predominant location influence prognostic factors in radical prostatectomies?

    Science.gov (United States)

    Billis, Athanase; Freitas, Leandro L. L.; Costa, Larissa B. E.; de Angelis, Camila M.; Carvalho, Kelson R.; Magna, Luis A.; Ferreira, Ubirajara

    2017-01-01

    ABSTRACT Purpose To find any influence on prognostic factors of index tumor according to predominant location. Materials and Methods Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model. Results Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis. Conclusions The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors. PMID:28379672

  19. Characterizing Ipomopsis rubra (Polemoniaceae) germination under various thermal scenarios with non-parametric and semi-parametric statistical methods.

    Science.gov (United States)

    Pérez, Hector E; Kettner, Keith

    2013-10-01

    Time-to-event analysis represents a collection of relatively new, flexible, and robust statistical techniques for investigating the incidence and timing of transitions from one discrete condition to another. Plant biology is replete with examples of such transitions occurring from the cellular to population levels. However, application of these statistical methods has been rare in botanical research. Here, we demonstrate the use of non- and semi-parametric time-to-event and categorical data analyses to address questions regarding seed to seedling transitions of Ipomopsis rubra propagules exposed to various doses of constant or simulated seasonal diel temperatures. Seeds were capable of germinating rapidly to >90 % at 15-25 or 22/11-29/19 °C. Optimum temperatures for germination occurred at 25 or 29/19 °C. Germination was inhibited and seed viability decreased at temperatures ≥30 or 33/24 °C. Kaplan-Meier estimates of survivor functions indicated highly significant differences in temporal germination patterns for seeds exposed to fluctuating or constant temperatures. Extended Cox regression models specified an inverse relationship between temperature and the hazard of germination. Moreover, temperature and the temperature × day interaction had significant effects on germination response. Comparisons to reference temperatures and linear contrasts suggest that summer temperatures (33/24 °C) play a significant role in differential germination responses. Similarly, simple and complex comparisons revealed that the effects of elevated temperatures predominate in terms of components of seed viability. In summary, the application of non- and semi-parametric analyses provides appropriate, powerful data analysis procedures to address various topics in seed biology and more widespread use is encouraged.

  20. Application of field methods to assess isometamidium resistance of trypanosomes in cattle in western Ethiopia

    DEFF Research Database (Denmark)

    Tewelde, N.; Abebe, G.; Eisler, M.;

    2004-01-01

    the proportion of infections during an 8-week follow-up period and the ratio of mean hazards in an isometamidium treated versus untreated group, provided consistent results across the three villages. In Burka village, both indices demonstrated the presence of isometamidium resistance trypanosome infections while......, in Cheleleki and Kolu villages, both indices did not indicate significant levels of resistance. There were significant differences between the Kaplan-Meier survival estimates of the control and treatment groups in Cheleleki (P 0.05)....

  1. A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a "Sandwich" method for stage III, IV, and recurrent endometrial cancer.

    Science.gov (United States)

    Geller, Melissa A; Ivy, Joseph J; Ghebre, Rahel; Downs, Levi S; Judson, Patricia L; Carson, Linda F; Jonson, Amy L; Dusenbery, Kathryn; Vogel, Rachel Isaksson; Boente, Matthew P; Argenta, Peter A

    2011-04-01

    To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer. Patients with surgically staged III-IV (excluding IIIA from positive cytology alone) endometrial cancer or biopsy confirmed recurrent disease were eligible. Treatment consisted of 3 cycles of docetaxel (75 mg/m²) and carboplatin (AUC 6) on a q21 day schedule followed by involved field irradiation (45 Gy)± brachytherapy and three additional cycles of docetaxel and carboplatin. Kaplan-Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS). Forty-two patients enrolled, 7 did not complete therapy. 95% (39/41) had primary disease. Median age=58 years (range: 21-81 years). 78% (32/41)=endometrioid histology. Stages=10 IIIA, 21 IIIC, 1 IVA, 7 IVB, (recurrent=1 IC, 1 IIA). There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities. Seven patients died following treatment with a median follow-up of 28 months (range: 7-70 months). KM estimates and 95% confidence intervals for OS at 1 year were 95% (82-99%), at 3 years 90% (75-96%), and at 5 years 71% (45-86%). Of the 39 with primary disease, 11 progressed or died within 5 years of study enrollment. KM estimates and 95% confidence intervals for PFS at 1 year were 87% (72-94%), at 3 years 71% (51-83%), and at 5 years 64% (42-80%). "Sandwiching" radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS. Copyright © 2010 Elsevier Inc. All rights reserved.

  2. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle

    2012-01-01

    of cancer development. Method:  Follow-up of patients in a previous study with gastroduodenoscopy in 1990-2010. Statistical analysis included chi(2) test, actuarial method and Kaplan-Meier analysis. Results:  Among 304 patients, 261 (86%) had more than one endoscopy. The median follow-up was 14 years...

  3. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle

    2012-01-01

    of cancer development. Method: Follow-up of patients in a previous study with gastroduodenoscopy in 1990-2010. Statistical analysis included chi(2) test, actuarial method and Kaplan-Meier analysis. Results: Among 304 patients, 261 (86%) had more than one endoscopy. The median follow-up was 14 years...

  4. Cigarette smoking and progression in multiple sclerosis

    NARCIS (Netherlands)

    Koch, Marcus; van Harten, Annemarie; Uyttenboogaart, Maarten; De Keyser, Jacques

    2007-01-01

    Objective: To investigate the influence of cigarette smoking on progression and disability accumulation in multiple sclerosis ( MS). Methods: Information on past and present smoking of 364 patients with MS was obtained through a structured questionnaire survey. We used Kaplan-Meier analyses and Cox

  5. Factors associated with the risk of secondary progression in multiple sclerosis

    NARCIS (Netherlands)

    Koch, M; Uyttenboogaart, M; van Harten, A; De Keyser, J

    2008-01-01

    Objective To investigate factors associated with the risk of secondary progression in relapsing-remitting onset multiple sclerosis (MS). Methods We used Kaplan-Meier survival analyses and a multivariable Cox regression model to estimate the influence of the factors: gender, age at disease onset, use

  6. Cigarette smoking and progression in multiple sclerosis

    NARCIS (Netherlands)

    Koch, Marcus; van Harten, Annemarie; Uyttenboogaart, Maarten; De Keyser, Jacques

    2007-01-01

    OBJECTIVE: To investigate the influence of cigarette smoking on progression and disability accumulation in multiple sclerosis (MS). METHODS: Information on past and present smoking of 364 patients with MS was obtained through a structured questionnaire survey. We used Kaplan-Meier analyses and Cox r

  7. The prognostic value of lymph node metastases and tumour regression grade in rectal cancer patients treated with long-course preoperative chemoradiotherapy

    DEFF Research Database (Denmark)

    Lindebjerg, J; Spindler, Karen-Lise Garm; Ploen, J;

    2009-01-01

    to the tumour regression grade system and lymph node status in the surgical specimen was assessed. The prognostic value of clinico-pathological parameters was analysed using univariate analysis and Kaplan-Meier methods for comparison of groups. RESULTS: All patients responded to treatment and 47% had a major...

  8. EGF61A>G polymorphism as predictive marker of clinical outcome to first-line capecitabine and oxaliplatin in metastatic colorectal cancer

    DEFF Research Database (Denmark)

    Spindler, Karen-Lise Garm; Andersen, R F; Jensen, Lars Henrik;

    2010-01-01

    samples. Response was evaluated according to the RECIST. Survival analysis was described by the Kaplan-Meier method and log-rank testing. RESULTS: The overall response rate was 38% and the median overall survival 19.4 months. A favorable outcome was seen in patients with the EGF61A/G genotype compared...

  9. Comparison of methods for analyzing left-censored occupational exposure data.

    Science.gov (United States)

    Huynh, Tran; Ramachandran, Gurumurthy; Banerjee, Sudipto; Monteiro, Joao; Stenzel, Mark; Sandler, Dale P; Engel, Lawrence S; Kwok, Richard K; Blair, Aaron; Stewart, Patricia A

    2014-11-01

    The National Institute for Environmental Health Sciences (NIEHS) is conducting an epidemiologic study (GuLF STUDY) to investigate the health of the workers and volunteers who participated from April to December of 2010 in the response and cleanup of the oil release after the Deepwater Horizon explosion in the Gulf of Mexico. The exposure assessment component of the study involves analyzing thousands of personal monitoring measurements that were collected during this effort. A substantial portion of these data has values reported by the analytic laboratories to be below the limits of detection (LOD). A simulation study was conducted to evaluate three established methods for analyzing data with censored observations to estimate the arithmetic mean (AM), geometric mean (GM), geometric standard deviation (GSD), and the 95th percentile (X0.95) of the exposure distribution: the maximum likelihood (ML) estimation, the β-substitution, and the Kaplan-Meier (K-M) methods. Each method was challenged with computer-generated exposure datasets drawn from lognormal and mixed lognormal distributions with sample sizes (N) varying from 5 to 100, GSDs ranging from 2 to 5, and censoring levels ranging from 10 to 90%, with single and multiple LODs. Using relative bias and relative root mean squared error (rMSE) as the evaluation metrics, the β-substitution method generally performed as well or better than the ML and K-M methods in most simulated lognormal and mixed lognormal distribution conditions. The ML method was suitable for large sample sizes (N ≥ 30) up to 80% censoring for lognormal distributions with small variability (GSD = 2-3). The K-M method generally provided accurate estimates of the AM when the censoring was <50% for lognormal and mixed distributions. The accuracy and precision of all methods decreased under high variability (GSD = 4 and 5) and small to moderate sample sizes (N < 20) but the β-substitution was still the best of the three methods. When using the ML

  10. Identificação de um método estatístico como instrumento da qualidade: tempo da presença do doente na sala de operação Identification of a statistical method as a quality tool: patient's length of stay in the operating room

    Directory of Open Access Journals (Sweden)

    Guiomar Terezinha Carvalho Aranha

    2009-09-01

    Full Text Available OBJETIVO: Identificar um método estatístico que expresse o tempo da presença do doente na sala de operação e construir a "matriz de relação" de otimização deste tempo, o tempo exato e real da operação. MÉTODOS: A análise de sobrevivência e o estimador de Kaplan-Meier permitiram calcular as curvas de sobrevivência para os diferentes tempos e a "matriz de relação" com 10 hipóteses para auxiliar na escolha da nova operação. A amostra aleatória simples de 71 indivíduos, das operações eletivas de adultos da Cirurgia Cardíaca/Hospital de Clínicas/UNICAMP, no ano 2008, no nível de confiança de 95%. RESULTADOS: Os tempos das operações em média sobram em um intervalo de 140 a 200 minutos e excedem de 5 a 90 minutos. No geral, realizou-se em média diariamente uma operação dentro de 520 minutos, para um tempo disponível de 720 minutos. CONCLUSÃO: 1 Com o tempo máximo disponível de 720 minutos não é possível realizar operação, a não ser utilizando da "matriz de relação", sendo que o tempo máximo disponível varia entre 660 e 690 minutos, considerando-se intervalo de limpeza da sala. 2 O tempo do doente na sala de operação tem nele incluso o tempo de aprendizado pelo aluno, em um hospital escola, universitário. 3 Ao otimizar o tempo, mais doentes serão beneficiados, acarretando diminuição da fila de espera para novas operações. 4 A "matriz" de relação permite visualizar, opinar e decidir mediante várias hipóteses, resultando em melhor tomada de decisãoOBJECTIVE: To identify a statistical method that may express the patient length of stay in the operating room and build a "matrix of relationship" for optimizing this time, the real and exact time of the operation. METHODS: The analysis of survival and the Kaplan-Meier estimator allowed to calculate the survival curves for different times and the "matrix of relationship" with 10 hypothesis to help in choosing the new operation. The study consisted of a

  11. Reporting of loss to follow-up information in randomised controlled trials with time-to-event outcomes: a literature survey

    Directory of Open Access Journals (Sweden)

    Bender Ralf

    2011-09-01

    Full Text Available Abstract Background To assess the reporting of loss to follow-up (LTFU information in articles on randomised controlled trials (RCTs with time-to-event outcomes, and to assess whether discrepancies affect the validity of study results. Methods Literature survey of all issues of the BMJ, Lancet, JAMA, and New England Journal of Medicine published between 2003 and 2005. Eligible articles were reports of RCTs including at least one Kaplan-Meier plot. Articles were classified as "assessable" if sufficient information was available to assess LTFU. In these articles, LTFU information was derived from Kaplan-Meier plots, extracted from the text, and compared. Articles were then classified as "consistent" or "not consistent". Sensitivity analyses were performed to assess the validity of study results. Results 319 eligible articles were identified. 187 (59% were classified as "assessable", as they included sufficient information for evaluation; 140 of 319 (44% presented consistent LTFU information between the Kaplan-Meier plot and text. 47 of 319 (15% were classified as "not consistent". These 47 articles were included in sensitivity analyses. When various imputation methods were used, the results of a chi2-test applied to the corresponding 2 × 2 table changed and hence were not robust in about half of the studies. Conclusions Less than half of the articles on RCTs using Kaplan-Meier plots provide assessable and consistent LTFU information, thus questioning the validity of the results and conclusions of many studies presenting survival analyses. Authors should improve the presentation of both Kaplan-Meier plots and LTFU information, and reviewers of study publications and journal editors should critically appraise the validity of the information provided.

  12. Impact of reconstruction methods and pathological factors on survival after pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Salah Binziad

    2013-01-01

    Full Text Available Background: Surgery remains the mainstay of therapy for pancreatic head (PH and periampullary carcinoma (PC and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life. Materials and Methods: This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test. Results: Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1% and 18 women (43.9%, with a median age of 56 years (16 to 70 years. There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ, 17 patients underwent telescoping pancreatico jejunostomy (PJ and 15 patients pancreaticogastrostomy (PG. The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors

  13. Retention in Care among HIV-Infected Adults in Ethiopia, 2005- 2011: A Mixed-Methods Study.

    Directory of Open Access Journals (Sweden)

    Yordanos M Tiruneh

    Full Text Available Poor retention in HIV care challenges the success of antiretroviral therapy (ART. This study assessed how well patients stay in care and explored factors associated with retention in the context of an initial ART rollout in Sub-Saharan Africa.We conducted a mixed-methods study at a teaching hospital in Addis Ababa, Ethiopia. A cohort of 385 patients was followed for a median of 4.6 years from ART initiation to lost-to-follow-up (LTFU-missing appointments for more than three months after last scheduled visit or administrative censoring. We used Kaplan-Meier plots to describe LTFU over time and Cox-regression models to identify factors associated with being LTFU. We held six focus group discussions, each with 6-11 patients enrolled in care; we analyzed data inductively informed by grounded theory.Patients in the cohort were predominantly female (64% and the median age was 34 years. Thirty percent were LTFU by study's end; the median time to LTFU was 1,675 days. Higher risk of LTFU was associated with baseline CD4 counts 200 cells/μL (HR = 1.62; 95% CI:1.03-2.55; and HR = 2.06; 95% CI:1.15-3.70, respectively, compared with patients with baseline CD4 counts of 100-200 cells/μL. Bedridden participants at ART initiation (HR = 2.05; 95% CIs [1.11-3.80] and those with no or only primary education (HR = 1.50; 95% CIs [1.00-2.24] were more likely to be LTFU. Our qualitative data revealed that fear of stigma, care dissatisfaction, use of holy water, and economic constraints discouraged retention in care. Social support and restored health and functional ability motivated retention.Complex socio-cultural, economic, and health-system factors inhibit optimum patient retention. Better tracking, enhanced social support, and regular adherence counseling addressing stigma and alternative healing options are needed. Intervention strategies aimed at changing clinic routines and improving patient-provider communication could address many of the identified barriers.

  14. Impact of housing on the survival of persons with AIDS

    Directory of Open Access Journals (Sweden)

    Vittinghoff Eric

    2009-07-01

    Full Text Available Abstract Background Homeless persons with HIV/AIDS have greater morbidity and mortality, more hospitalizations, less use of antiretroviral therapy, and worse medication adherence than HIV-infected persons who are stably housed. We examined the effect of homelessness on the mortality of persons with AIDS and measured the effect of supportive housing on AIDS survival. Methods The San Francisco AIDS registry was used to identify homeless and housed persons who were diagnosed with AIDS between 1996 and 2006. The registry was computer-matched with a housing database of homeless persons who received housing after their AIDS diagnosis. The Kaplan-Meier product limit method was used to compare survival between persons who were homeless at AIDS diagnosis and those who were housed. Proportional hazards models were used to estimate the independent effects of homelessness and supportive housing on survival after AIDS diagnosis. Results Of the 6,558 AIDS cases, 9.8% were homeless at diagnosis. Sixty-seven percent of the persons who were homeless survived five years compared with 81% of those who were housed (p Conclusion Supportive housing ameliorates the negative effect of homelessness on survival with AIDS.

  15. Developing and comparing two different prognostic indexes for predicting disease-free survival of nonmetastatic breast cancer patients

    OpenAIRE

    TOKATLI, Zehra Füsun; Türe, Mevlüt; Ömürlü, İmran Kurt; ALAS, Ruşen Çoşar; Uzal, Mustafa Cem

    2011-01-01

    To determine 2 different prognostic indexes (PI) for the differentiation of subgroups of nonmetastatic breast cancer patients with the Cox regression analysis and survival tree (ST) methods and the additional usage of the Kaplan-Meier estimates to investigate the predictive power of these methods. Materials and methods: Prognostic factors data were collected for 410 patients. The Cox regression analysis examines the relationship of the survival distribution and covariates. The ST method is ...

  16. An omnibus CUSUM chart for monitoring time to event data.

    Science.gov (United States)

    Phinikettos, Ioannis; Gandy, Axel

    2014-07-01

    A non-parametric method is proposed for monitoring time-to-event data. A cumulative sum chart is constructed that is able to detect an unknown out-of-control state. This method exploits the absolute differences between the Kaplan-Meier estimator and the in-control distribution over specific time intervals. The efficiency of the algorithm is studied via a simulation and a real data study. The new method is also tested via the simulation study against existing methods.

  17. Difference in Survival between Housed and Homeless individuals with HIV, San Francisco, 2002-2011.

    Science.gov (United States)

    Khanijow, Keshav; Hirozawa, Anne; Ancock, Benedict; Hsu, Ling Chin; Bamberger, Joshua; Schwarcz, Sandra K

    2015-08-01

    San Francisco (SF), a city with large HIV-infected and homeless populations, expanded supportive housing for HIV-infected people in 2007. We used the SF HIV/AIDS registry to compare survival between people who were homeless and who were housed at time of HIV diagnosis from 2002 through 2011. Housing status was obtained from medical records and deaths from local, state, and national vital registration. Survival was estimated using the Kaplan-Meier product-limit method. Ten percent of the 5,474 cases were homeless. Among people diagnosed between 2002 and 2006, the five-year survival was worse for people who were homeless at HIV diagnosis than for housed individuals (79% vs. 92%, p<.0001), but not for those diagnosed between 2007 and 2011 (92% vs. 93%, p=.3938). The improved survival among HIV-infected homeless people occurred during the time of increased supportive housing for this population. Our findings support including housing as an essential component of HIV care.

  18. Comparison of Maxillary Implant-Supported Prosthesis in Irradiated and Non-Irradiated Patients

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Summary: In order to investigate the influence of radiation therapy after the treatment of maxillaryimplant-supported prostheses, 27 patients received a total of 131 implants in maxilla after oral cancertreatment and/or reconstructive surgery. Among them, 25 received maxillary implant-supportedprostheses. The cumulative survival rates of implants and prostheses were evaluated by the product-limit-estimates method according to Kaplan-Meier. The cumulative survival rate of implants andprostheses in irradiated patients was compared with that in non-irradiated patients by statistical Log-rank test. The results showed that 112 implants were observed after implant loading. The implantscumulative survival rate was approximately 65 % for overall patients. The cumulative prosthesis suc-cessful rate was approximately 88 % for all 25 patients. Log-rank test analysis revealed that therewas a significant difference in cumulative implants survival rates between non-irradiated and irradiat-ed maxillary bone (P<0. 01). It was concluded that the implants and prostheses in irradiated pa-tients have significantly lower survival rates than in non-irradiated patients.

  19. Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents

    Directory of Open Access Journals (Sweden)

    Jimmy T. Efird

    2015-07-01

    Full Text Available The aim of this study was to examine racial differences in long-term mortality after coronary artery bypass grafting (CABG, stratified by preoperative use of inotropic agents. Black and white patients who required preoperative inotropic support prior to undergoing CABG procedures between 1992 and 2011 were compared. Mortality probabilities were computed using the Kaplan-Meier product-limit method. Hazard ratios (HR and 95% confidence intervals (CI were computed using a Cox regression model. A total of 15,765 patients underwent CABG, of whom 211 received preoperative inotropic agents within 48 hours of surgery. Long-term mortality differed by race (black versus white among preoperative inotropic category (inotropes: adjusted HR = 1.6, 95% CI = 1.009–2.4; no inotropes: adjusted HR = 1.15, 95% CI = 1.08–1.2; Pinteraction < 0.0001. Our study identified an independent preoperative risk-factor for long-term mortality among blacks receiving CABG. This outcome provides information that may be useful for surgeons, primary care providers, and their patients.

  20. Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Duong, Cuong P.; Demitriou, Helen; Thompson, Anne; Williams, David; Thomas, Robert J.S. [Peter MacCallum Cancer Centre, Division of Surgical Oncology, Melbourne (Australia); Weih, LeAnn [Peter MacCallum Cancer Centre, Statistical Center, Melbourne (Australia); Hicks, Rodney J. [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia)

    2006-07-15

    To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p<0.001). Conventional stage was not able to clearly stratify this population. The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations. (orig.)

  1. Combination total lymphoid irradiation and low-dose corticosteroid therapy for progressive multiple sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Cook, S.D.; Zito, G.; Dowling, P.C. [University of Medicine and Dentistry of New Jersey, Department of Neurosciences, Newark, and Neurology Service, Department of Veterans Affairs Medical Center, NJ (United States); Devereux, C. [Univrsity of Medicine and Dentistry of New Jersey, Department of Neurosciences, Newark, and Radiation Oncology, Clara Maass Medical Center, Belleville, NU (United States); Troiano, R.; Jotkowitz, A.; Rohowsky-Kochan, C. [University of Medicine and Dentistry of New Jersey, Department of Neurosciences, Newark (United States); Sheffet, A. [University of Medicine and Dentistry of New Jersey, Department of Preventive Medicine and Community Health, Newark (United States)

    1995-01-01

    Total lymphoid irradiation (TLI) has been reported to delay deterioration in patients with progressive multiple sclerosis and other autoimmune disorders. Methods - In an open trial, the effect of TLI combined with a one year course of low dose prednisone was compared to the effect of sham TLI and TLI only in a prior double-blind study of patients with progressive multiple sclerosis. Results - Twenty-seven patients receiving TLI combined with corticosteroids had significantly greater lymphocytopenia in the year post-therapy than those receiving TLI only or sham TLI and Kaplan Meier product-limit survival analysis showed significantly less progression in the TLI plus steroid group over 4 years of follow-up. No difference in lymphocytopenia or progression was found with TLI plus corticosteroid therapy when the spleen was removed from the field of irradiation. Conclusion - These results lend further support to the hypothesis that TLI may be effective in progressive MS, and indicates that adding low-dose prednisone may enhance this effect. The study also suggests that TLI may be equally effective whether or not the spleen is irradiated. (au) (14 refs.).

  2. Efficacy and safety of the HAA regimen as induction chemotherapy in 236 de novo acute myeloid leukemia

    Institute of Scientific and Technical Information of China (English)

    叶佩佩

    2013-01-01

    Objective To evaluate the efficacy and safety of the HAA regimen (homoharringtonine,cytarabine and aclarubicin) as induction chemotherapy in de novo acute myeloid leukemia (AML) .Methods The efficacy and safety of 236 de novo AML patients who received the HAA regimen as induction chemotherapy were retrospectively analyzed.The complete remission (CR) rate was assayed.Kaplan-Meier method was used to estimate overall survival (OS) and relapse free survival (RFS) ,and the differ-

  3. Lifetime Risk of Cardiovascular Disease Among Individuals With and Without Diabetes Stratified by Obesity Status in the Framingham Heart Study

    OpenAIRE

    Pencina, Michael J.; Wilson, Peter W. F.; Vasan, Ramachandran S; D’Agostino, Ralph B.; Fox, Caroline; Paynter, Nina Palanza

    2008-01-01

    Objective: We assessed the lifetime risk of cardiovascular disease (CVD) among individuals with and without obesity and diabetes. Research Design and Methods: Participants were drawn from the original and offspring cohorts of the Framingham Heart Study. Lifetime (30-year) risk of CVD was assessed using a modified Kaplan-Meier approach adjusting for the competing risk of death, beginning from age 50 years. Results: Over 30 years, the lifetime risk of CVD among women with diabetes was 54.8% amo...

  4. Syncytin immunoreactivity in colorectal cancer

    DEFF Research Database (Denmark)

    Larsen, Julie Mou; Christensen, Ib Jarle; Nielsen, Hans Jørgen

    2009-01-01

    monoclonal syncytin antibody we have assessed syncytin expression in a retrospective series of 140 colorectal cancer patients. Variable degrees of syncytin expression were detected in both colonic and rectal tumors and the prognostic impact of such expression was analysed with the Kaplan-Meier method...... and the Cox proportional hazard model. Interestingly, increased syncytin expression was associated with decreased overall survival in rectal but not in colonic cancer patients. Thus, the prognostic impact of syncytin expression appears to vary with the tumor type....

  5. Effects of Smoking on Menopausal Age: Results From the Korea National Health and Nutrition Examination Survey, 2007 to 2012

    OpenAIRE

    Yang, Hee Jung; Suh, Pae Sun; Kim, Soo Jeong; Lee, Soon Young

    2015-01-01

    Objectives: Decreased fertility and impaired health owing to early menopause are significant health issues. Smoking is a modifiable health-related behavior that influences menopausal age. We investigated the effects of smoking-associated characteristics on menopausal age in Korean women. Methods: This study used data from the Korea National Health and Nutrition Examination Survey from 2007 to 2012. Menopausal age in relation to smoking was analyzed as a Kaplan-Meier survival curve for 11 510 ...

  6. Duración del tratamiento con etanercept y razones de discontinuación en una cohorte de pacientes con patología reumática

    OpenAIRE

    2011-01-01

    [EN]: [Objective]: To evaluate the duration of etanercept (ETN) treatment and motives for discontinuation in our local cohort of patients with rheumatic pathology and compare them to the group with other biological treatments. [Patients and methods]: Prospective observational cohort study. Disease diagnosis, start and end date and motive for discontinuation were recorded. Survival estimation was explored using Kaplan-Meier analysis with remaining patients censored at 1-year, 2-years and 5-yea...

  7. A capture-recapture survival analysis model for radio-tagged animals

    Science.gov (United States)

    Pollock, K.H.; Bunck, C.M.; Winterstein, S.R.; Chen, C.-L.; North, P.M.; Nichols, J.D.

    1995-01-01

    In recent years, survival analysis of radio-tagged animals has developed using methods based on the Kaplan-Meier method used in medical and engineering applications (Pollock et al., 1989a,b). An important assumption of this approach is that all tagged animals with a functioning radio can be relocated at each sampling time with probability 1. This assumption may not always be reasonable in practice. In this paper, we show how a general capture-recapture model can be derived which allows for some probability (less than one) for animals to be relocated. This model is not simply a Jolly-Seber model because it is possible to relocate both dead and live animals, unlike when traditional tagging is used. The model can also be viewed as a generalization of the Kaplan-Meier procedure, thus linking the Jolly-Seber and Kaplan-Meier approaches to survival estimation. We present maximum likelihood estimators and discuss testing between submodels. We also discuss model assumptions and their validity in practice. An example is presented based on canvasback data collected by G. M. Haramis of Patuxent Wildlife Research Center, Laurel, Maryland, USA.

  8. Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial.

    Science.gov (United States)

    Hubacher, David; Spector, Hannah; Monteith, Charles; Chen, Pai-Lien; Hart, Catherine

    2017-02-01

    Measures of contraceptive effectiveness combine technology and user-related factors. Observational studies show higher effectiveness of long-acting reversible contraception compared with short-acting reversible contraception. Women who choose long-acting reversible contraception may differ in key ways from women who choose short-acting reversible contraception, and it may be these differences that are responsible for the high effectiveness of long-acting reversible contraception. Wider use of long-acting reversible contraception is recommended, but scientific evidence of acceptability and successful use is lacking in a population that typically opts for short-acting methods. The objective of the study was to reduce bias in measuring contraceptive effectiveness and better isolate the independent role that long-acting reversible contraception has in preventing unintended pregnancy relative to short-acting reversible contraception. We conducted a partially randomized patient preference trial and recruited women aged 18-29 years who were seeking a short-acting method (pills or injectable). Participants who agreed to randomization were assigned to 1 of 2 categories: long-acting reversible contraception or short-acting reversible contraception. Women who declined randomization but agreed to follow-up in the observational cohort chose their preferred method. Under randomization, participants chose a specific method in the category and received it for free, whereas participants in the preference cohort paid for the contraception in their usual fashion. Participants were followed up prospectively to measure primary outcomes of method continuation and unintended pregnancy at 12 months. Kaplan-Meier techniques were used to estimate method continuation probabilities. Intent-to-treat principles were applied after method initiation for comparing incidence of unintended pregnancy. We also measured acceptability in terms of level of happiness with the products. Of the 916

  9. Primary early-stage intestinal and colonic non-Hodgkin's lymphoma: Clinical features, management, and outcome of 37 patients

    Institute of Scientific and Technical Information of China (English)

    Shu-Lian Wang; Ye-Xiong Li; Zhong-Xing Liao; Xin-Fan Liu; Zi-Hao Yu; Da-Zhong Gu; Tu-Nan Qian; Yong-Wen Song; Jing Jin; Wei-Hu Wang

    2005-01-01

    AIM: To analyze the clinical features, management, and outcome of treatment of patients with primary intestinal and colonic non-Hodgkin's lymphoma (PICL).METHODS: A retrospective study was performed in 37 patients with early-stage PICL who were treated in our hospital from 1958 to 1998. Their clinical features,management, and outcome were assessed. Prognostic factors for survival were analyzed by univariate analysis using the Kaplan-Meier product-limit method and log-rank test.RESULTS: Twenty-five patients presented with Ann Arbor stage I PICL and 12 with Ann Arbor stage Ⅱ PICL. Thirty-five patients underwent surgery (including 31 with complete resection), 22 received postoperative chemotherapy or radiotherapy or both. Two patients with rectal tumors underwent biopsy and chemotherapy with or without radiotherapy. The 5- and 10-year overall survival (OS) rates were 51.9% and 44.5%. The corresponding diseasefree survival (DFS) rates were 42.4% and 37.7%. In univariate analysis, multiple-modality treatment was associated with a better DFS rate compared to single treatment (P = 0.001).While age, tumor size, tumor site, stage, histology, or extent of surgery were not associated with OS and DFS,use of adjuvant chemotherapy significantly improved DFS (P = 0.031) for the 31 patients who underwent complete resection. Additional radiotherapy combined with chemotherapy led to a longer survival than chemotherapy alone in six patients with gross residual disease after surgery or biopsy.CONCLUSION: Combined surgery and chemotherapy is recommended for treatment of patients with PICL.Additional radiotherapy is needed to improve the outcome of patients who have gross residual disease after surgery.

  10. Non-ocular melanomas in cats: a retrospective study of 30 cases.

    Science.gov (United States)

    Chamel, Gabriel; Abadie, Jérôme; Albaric, Olivier; Labrut, Sophie; Ponce, Frédérique; Ibisch, Catherine

    2017-04-01

    Objectives The aim of the study was to describe the clinical outcome of 30 cats with non-ocular melanomas and to evaluate the association between clinical or pathological parameters and overall survival time. Methods The database of the animal histopathological laboratory of the National Veterinary School of Nantes (Oniris, Nantes, France) was retrospectively searched to identify cases of feline non-ocular melanomas between December 2009 and April 2014. For each case, clinical data, including signalment, location of the primary tumour, staging, treatment and outcome, were collected from the medical records or via interviews with referring veterinarians. Histological and immunohistochemical evaluation included mitotic index, cytonuclear atypias, junctional activity, Melan A and S100 immunostaining, and surgical margins. Univariate analysis to test the prognostic value of the different variables was performed by the Kaplan-Meier product limit method using the log-rank test of significance. Results Thirty cats were included in the study. Eleven had a cutaneous non-auricular melanoma, six had a tumour located on the pinna and 13 had a tumour in the oral cavity. Cats with auricular melanomas were significantly younger than cats with tumours in other locations. Location and presence of clinical signs were not of prognostic significance, but the achromic phenotype was significantly associated with a poorer prognosis. Twenty cats were treated with surgery and survived significantly longer than cats that received only medical treatment or that did not receive any treatment. According to our data, mitotic index, cytonuclear atypias, junctional activity, Melan A or S100 expression, and surgical margins were not associated with survival. Conclusions and relevance We show for the first time, in a large series, that the auricular form of melanoma affected significantly younger cats than other extraocular forms. Most feline non-ocular melanomas are malignant and achromic tumours

  11. The value of the 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system as a predictor of biochemical recurrence after radical prostatectomy.

    Science.gov (United States)

    Billis, Athanase; Quintal, Maisa M Q; Meirelles, Luciana; Freitas, Leandro L L; Costa, Larissa B E; Bonfitto, João F L; Diniz, Betina L; Poletto, Paola H; Magna, Luís A; Ferreira, Ubirajara

    2014-05-01

    To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS). Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model. Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor. The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.

  12. Assessing receipt of medical care and disparity among persons with HIV/AIDS in San Francisco, 2006-2007.

    Science.gov (United States)

    Hsu, Ling C; Chen, Mi; Kali, Jessica; Pipkin, Sharon; Scheer, Susan; Schwarcz, Sandy

    2011-03-01

    We used data from HIV/AIDS surveillance case registry to assess the timing of entry into medical care, level of care received after HIV diagnosis, and to identify characteristics associated with delayed and insufficient care among persons diagnosed with HIV/AIDS between 2006 and 2007 in San Francisco. Laboratory reports of HIV viral load and CD4 test results were used as a marker for receipt of medical care. The time from HIV diagnosis to entry into care was estimated using Kaplan-Meier product limit method and independent predictors of delayed entry into care were determined using the proportional hazards model. Insufficient care was defined as less than an average of two viral load/CD4 tests per person-year of follow-up. Predictors of insufficient care were evaluated using a logistic regression model. An estimated 85% of persons diagnosed with HIV/AIDS entered care within three months after HIV diagnosis; the proportion increased to 95% within 12 months after diagnosis. Persons who were born outside of the USA and those tested at the public counseling and testing sites were more likely to delay care. Nineteen percent of persons were determined to have received insufficient care. Younger persons and those diagnosed at a hospital were more likely to receive insufficient care. A high proportion of persons diagnosed with HIV/AIDS in San Francisco established timely and adequate care after HIV diagnosis. However, delays for some individuals in entry into care and markers of insufficient care suggest that there remains a need to improve access to and sustainability of HIV-specific medical care.

  13. Long-term graft survival after conversion from cyclosporin to azathioprine 1 year after renal transplantation. A prospective, randomized study from 1 to 6 years after transplantation.

    Science.gov (United States)

    Pedersen, E B; Hansen, H E; Kornerup, H J; Madsen, S; Sørensen, A W

    1993-01-01

    Cyclosporin has improved graft survival after renal transplantation, but cyclosporin nephrotoxicity is a severe clinical problem. Conversion from cyclosporin to azathioprine 1 year after transplantation might improve long-term graft survival by avoidance of cyclosporin nephrotoxicity. After treatment with cyclosporin and prednisolone during the first year after renal transplantation, 106 patients were consecutively randomized to treatment with either azathioprine and prednisolone or cyclosporin and prednisolone in a prospective, controlled study during the following 5 years, i.e. 6 years after transplantation. Actuarial estimates of graft survival rates after inclusion in the study were obtained by the product-limit method of Kaplan-Meier, and the Mantel-Cox log rank test was used to compare the two treatment regimens. When the end-points in the analyses were cessation of graft function or withdrawal of immunosuppressive treatment due to side-effects, and when patients alive with graft function or who had died with a functioning graft were treated as censored observations, graft survival 5 years after inclusion in the study was 57.7 +/- 5.2% in the total material and was the same in both the azathioprine group (52.4 +/- 7.7%) and the cyclosporin group (63.3 +/- 6.7%) (log rank = 0.40, P = 0.53). When cessation of graft function was the only end-point, graft survival 5 years after inclusion in the study was 73.7 +/- 5.2% for the total material with no significant differences between the two groups (log rank = 0.58, P = 0.45).(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy.

    Science.gov (United States)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent; Gimbel, Helga

    2015-04-01

    The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to estimate the risk of undergoing POP surgery after hysterectomy. The study was a population-based registry study. Patient data from 154,882 women hysterectomized for benign conditions in the period from 1977 to 2009 were extracted from the Danish National Patient Registry. Patients were followed up from hysterectomy to POP surgery, death/emigration, or end of study period. An estimate of the hazard of undergoing POP surgery following hysterectomy was calculated. Survival analysis was performed using the Kaplan-Meier product limit method. The frequency of POP surgery on hysterectomized women was high the first 2 years of the follow-up period with almost 800 women operated yearly. More than one third (n = 2,872) of all women operated for POP were operated less than 5 years after the hysterectomy with a median of 8.6 years. The cumulated incidence of POP surgery after hysterectomy with follow-up of up to 32 years was 12 %; 50 % (n = 5,451) of all POP surgeries were in the posterior compartment. The mean age of women undergoing a first POP surgery after hysterectomy was 60 years. POP after hysterectomy occurs as a long-term complication of hysterectomy; 12 % of hysterectomized women were operated for POP. They were operated at younger age than non-hysterectomized women and half the POP operations were performed in the posterior compartment.

  15. Canine digital tumors: a veterinary cooperative oncology group retrospective study of 64 dogs.

    Science.gov (United States)

    Henry, Carolyn J; Brewer, William G; Whitley, Elizabeth M; Tyler, Jeff W; Ogilvie, Gregory K; Norris, Alan; Fox, Leslie E; Morrison, Wallace B; Hammer, Alan; Vail, David M; Berg, John

    2005-01-01

    We compared clinical characteristics and outcomes for dogs with various digital tumors. Medical records and histology specimens of affected dogs from 9 veterinary institutions were reviewed. Risk factors examined included age, weight, sex, tumor site (hindlimb or forelimb), local tumor (T) stage, metastases, tumor type, and treatment modality. The Kaplan-Meier product limit method was used to determine the effect of postulated risk factors on local disease-free interval (LDFI), metastasis-free interval (MFI), and survival time (ST). Outcomes were thought to differ significantly between groups when P dogs were included. Squamous cell carcinoma (SCC) accounted for 33 (51.6%) of the tumors. Three dogs presented with or developed multiple digital SCC. Other diagnoses included malignant melanoma (MM) (n = 10; 15.6%), osteosarcoma (OSA) (n = 4; 6.3%), hemangiopericytoma (n = 3; 4.7%), benign soft tissue tumors (n = 5; 7.8%), and malignant soft tissue tumors (n = 9; 14%). Fourteen dogs with malignancies had black hair coats, including 5 of the 10 dogs with MM. Surgery was the most common treatment and, regardless of the procedure, had a positive impact on survival. None of the patient variables assessed, including age, sex, tumor type, site, and stage, had a significant impact on ST. Both LDFI and MFI were negatively affected by higher T stage, but not by type of malignancy. Although metastasis at diagnosis correlated with a shorter LDFI, it did not have a significant impact on ST. On the basis of these findings, early surgical intervention is advised for the treatment of dogs with digital tumors, regardless of tumor type or the presence of metastatic disease.

  16. Early experiences on living donor liver transplantation in China: multicenter report

    Institute of Scientific and Technical Information of China (English)

    WANG Xue-hao; SUN Bei-cheng; GE Wen-gang; YAN Lü-nan; ZHANG Feng; LI Xiang-cheng; ZHU Ji-ye; PENG Zhi-hai; LIU Jin-hui; LI Guo-qiang; CHENG Feng

    2006-01-01

    Background Because of the lack of brain death laws in China, the proportion of cadaveric organ donation is low. Many patients with end-stage liver disease die waiting for a suitable donor. Living donor liver transplantation (LDLT) would reduce the current discrepancy between the number of patients on the transplant waiting list and the number of available organ donors. We describe the early experience of LDLT in the mainland of China based on data from five liver transplant centers.Methods Between January 2001 and October 2003, 45 patients with end-stage liver disease received LDLT at five centers in China. The indication and timing, surgical techniques and complications, nonsurgical issues including rejection, infection, and advantages of LDLT in the series were reviewed. Actuarial patient and graft survival rates were calculated by using the Kaplan-Meier product-limit estimate. Statistical analysis was completed by using SPSS 10.0.Results All LDLT recipients were cirrhotic patients, except for one man with fulminant hepatic failure. Among the 45 cases of LDLT, 35 (77.8%) were performed in one center (the First Affiliated Hospital of Nanjing Medical University). The overall 1 and 3 year survival rate of the recipients was 93.1% and 92.0%, respectively. Of the 45 LDLT donors, there were 3 cases of biliary leakage, 2 subphrenic collections, 1 fat liquefaction around the incision and 1 biliary peritonitis after T tube removal. All donors recovered completely.Conclusions LDLT provides an excellent approach to addressing the problem of donor shortage in China even though the operation is complicated, uncompromising and difficult with respect to the safety of the donors and receptors. Despite early technical hurdles having been overcome, perfection of technique is still necessarily. At present, LDLT is a good choice for the patients with irreversible liver disease.

  17. Timing of HIV Seroreversion Among HIV-Exposed, Breastfed Infants in Malawi: Type of HIV Rapid Test Matters.

    Science.gov (United States)

    Smith, Emily R; Hudgens, Michael; Sheahan, Anna D; Miller, William C; Wheeler, Stephanie; Nelson, Julie A E; Dube, Queen; Van Rie, Annelies

    2017-02-01

    Introduction Rapid HIV serological tests are a cost-effective, point-of-care test among HIV exposed infants but cannot distinguish between maternal and infant antibodies. The lack of data on the timing of decay of maternal antibodies in young infants hinders the potential use of rapid tests in exposed infants. We aimed to determine the time to seroreversion for two commonly used rapid tests in a prospective cohort of HIV-exposed breastfeeding infants ages 3-18 months of life. Methods We collected data on the performance of two commonly used rapid tests (Determine and Unigold) in Malawi between 2008 and 2012 or at the University of North Carolina between 2014 and 2015. Time to seroreversion was estimated for both rapid tests using the Kaplan-Meier product limit estimator which allows for interval censored data. Results At 3 months of age, 3 % of infants had seroreverted according to Determine and 7 % had seroreverted according to Unigold. About one in four infants had achieved seroreversion by 4 months using Unigold, but only about one in twelve infants by 4 months when using Determine. More than 95 % of all infants had seroverted by 7 months according to Unigold and by 12 months according to the Determine assay. Discussion We show that the time of seroreversion depends greatly on the type of test used. Our results highlight the need for recommendations to specify the timing and type of test used in the context of infant HIV detection in resource-poor settings, and base the interpretation of test result on knowledge of time to seroreversion of the selected test.

  18. Continuation versus discontinuation of lithium in recurrent bipolar illness: a naturalistic study.

    Science.gov (United States)

    Biel, Matthew G; Peselow, Eric; Mulcare, Loretta; Case, Brady G; Fieve, Ron

    2007-08-01

    Lithium's efficacy in prophylaxis of mood episodes in bipolar disorder (BD) is well established in the clinical trial setting, but may be less robust in routine clinical practice. We compared illness recurrence in bipolar patients naturalistically continued on or discontinued from lithium after an extended period of clinical stability on lithium monotherapy, and evaluated other potential risk factors for relapse. We followed 213 patients who were stable for 2 years on lithium monotherapy following resolution of acute symptoms marking their last manic episode. Based upon patient preference and clinical judgment, 159 patients were continued on lithium monotherapy and 54 patients were slowly discontinued. Survival differences between the continued and discontinued groups were assessed using the Kaplan-Meier product limit method, and risk factors for relapse were evaluated in Cox proportional hazards regression. Patients continued on lithium prophylaxis experienced risk of recurrence equivalent to a third of that suffered by discontinued patients during the first year of treatment (0.15 versus 0.45), and significant survival differences persisted throughout follow-up. Median survival time to illness recurrence for patients continued on lithium was 7.33 years [95% confidence interval (CI) 5.67-9.67]; that for patients discontinued from lithium was 1.33 years (95% CI 0.33-2.33). After controlling for all significant covariates, lithium discontinuation was associated with a hazard ratio of 4.85. Inter-episode manic and depressive symptoms conferred increased risk for subsequent recurrence of illness in both groups, while lower lithium levels recorded during the two years of clinical stability preceding study onset were protective. Despite considerable rates of illness recurrence in both groups, those who continued on lithium sustained markedly lower rates of recurrence over a lengthy follow-up period. Lithium discontinuation in BD after successful maintenance monotherapy

  19. Location of Receipt of Initial Treatment and Outcomes in Long-Term Breast Cancer Survivors.

    Science.gov (United States)

    Sinha, Arup K; Patel, Jenil R; Shen, Yu; Ueno, Naoto T; Giordano, Sharon H; Tripathy, Debu; Lopez, David S; Barcenas, Carlos H

    2017-01-01

    Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment. We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9-6.0; RFS: HR = 5.8, 95% CI = 4.8-7.0; DRFS: HR = 5.4, 95% CI = 4.5-6.6). Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.

  20. Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head.

    Science.gov (United States)

    Lee, Young-Kyun; Park, Chan Ho; Ha, Yong-Chan; Kim, Do-Yeon; Lyu, Sung-Hwa; Koo, Kyung-Hoi

    2017-06-01

    Various osteotomies have been introduced to treat osteonecrosis of the femoral head. The purpose of this study was to compare surgical parameters, postoperative limb length discrepancy, and minimum 5-year clinical and radiological results between transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head. From 2004 to 2009, 103 consecutive TROs (97 patients) followed by 72 consecutive TCVOs (64 patients) were performed for the treatment of osteonecrosis of the femoral head. Of these, 85 patients (91 hips) in the TRO group and 58 patients (65 hips) in the TCVO group completed minimum 5-year clinical and radiological follow-up. The Kaplan-Meier product-limit method was used to estimate survival. The TCVO group had shorter operation time (p TRO group and 7 hips (10.8%) in the TCVO group (p = 0.007). Osteophyte formation was observed in 34 hips (37.4%) in the TRO group and 13 hips (20%) in the TCVO group (p = 0.020). Fifteen hips (16.5%) in the TRO group and 7 hips (10.8%) in the TCVO group underwent conversion total hip arthroplasty (THA). The survival rate at 9 years with radiographic collapse as the endpoint was 68.7% (95% confidence interval [CI], 58.1% to 79.3%) in the TRO group, and 84.7% (95% CI, 71.5% to 97.9%) in the TCVO group. With conversion to THA as the endpoint, the survival rate was 82.2% (95% CI, 73.1% to 91.3%) in the TRO group and 89.2% (95% CI, 81.7% to 96.7%) in the TCVO group. The comparison indicates that TCVO was better than TRO in terms of surgical parameters including operation time and estimated blood loss while the 9-year survival rates were similar.

  1. The prognostic significance of lymphovascular space invasion in laparoscopic versus abdominal hysterectomy for endometrioid endometrial cancer.

    Science.gov (United States)

    Dewdney, S B; Jiao, Z; Roma, A A; Gao, F; Rimel, B J; Thaker, P H; Powell, M A; Massad, L S; Mutch, D G; Zighelboim, I

    2014-01-01

    Recent reports have suggested that uterine manipulators can induce lymphovascular space involvement (LVSI) by endometrial cancer in laparoscopic hysterectomy specimens. The prognostic significance of this phenomenon known as "vascular pseudo invasion" remains elusive. The authors conducted a retrospective, single institution study of patients who underwent initial surgery for grade 1 and grade 2 endometrioid endometrial cancers with LVSI. Cases were stratified by surgical approach (laparoscopy vs laparotomy). Clinicopathologic and procedure characteristics as well as outcome data were analyzed. Univariate and multivariate analyses were performed. Disease-free survival (DFS) was analyzed using the Kaplan-Meier product limit method. A total of 104 cases (20 laparoscopic, 84 laparotomy) were analyzed. Mean age (65 vs 64 years, respectively), stage distribution, mean number of lymph nodes sampled (18 vs 21, respectively) and use of adjuvant therapy was similar for both groups (p > 0.05). Mean body mass index (BMI) was 30 vs 35 kg/m2, respectively (p = 0.002). Mean follow up was 24 months (range 0.1-102). Univariate analysis demonstrated that LVSI in the laparoscopic setting was associated with worse DFS (p = 0.002). After adjusting for grade the risk of recurrence remained higher for laparoscopic cases (HR: 15.7, 95% CI 1.7-140.0, p = 0.014). Adjusted risk of recurrence associated with LVSI is higher in cases approached laparoscopically arguing against the concept of "vascular pseudo invasion" associated with the use of uterine manipulators and balloons. LVSI should be regarded as a serious risk factor and taken into account for triage to adjuvant therapies, even in laparoscopically treated early-stage endometrial cancer.

  2. method

    Directory of Open Access Journals (Sweden)

    L. M. Kimball

    2002-01-01

    Full Text Available This paper presents an interior point algorithm to solve the multiperiod hydrothermal economic dispatch (HTED. The multiperiod HTED is a large scale nonlinear programming problem. Various optimization methods have been applied to the multiperiod HTED, but most neglect important network characteristics or require decomposition into thermal and hydro subproblems. The algorithm described here exploits the special bordered block diagonal structure and sparsity of the Newton system for the first order necessary conditions to result in a fast efficient algorithm that can account for all network aspects. Applying this new algorithm challenges a conventional method for the use of available hydro resources known as the peak shaving heuristic.

  3. Effectiveness of the Dader Method for Pharmaceutical Care on Patients with Bipolar I Disorder: Results from the EMDADER-TAB Study.

    Science.gov (United States)

    Salazar-Ospina, Andrea; Amariles, Pedro; Hincapié-García, Jaime A; González-Avendaño, Sebastián; Benjumea, Dora M; Faus, Maria José; Rodriguez, Luis F

    2017-01-01

    Bipolar I disorder (BD-I) is a chronic illness characterized by relapses alternating with periods of remission. Pharmacists can contribute to improved health outcomes in these patients through pharmaceutical care in association with a multidisciplinary health team; however, more evidence derived from randomized controlled trials (RCTs) is needed to demonstrate the effect of pharmaceutical care on patients with BD-I. To assess the effectiveness of a pharmaceutical intervention using the Dader Method on patients with BD-I, measured by the decrease in the number of hospitalizations, emergency service consultations, and unscheduled outpatient visits from baseline through 1 year of follow-up. This study is based on the EMDADER-TAB trial, which was an RCT designed to compare pharmaceutical care with the usual care given to outpatients with BD-I in a psychiatric clinic. The main outcome was the use of health care services, using Kaplan-Meier methods and Cox regression. The trial protocol was registered in ClinicalTrials.gov (Identifier NCT01750255). 92 patients were included in the EMDADER-TAB study: 43 pharmaceutical care patients (intervention group) and 49 usual care patients (control group). At baseline, no significant differences in demographic and clinical characteristics were found across the 2 groups. After 1 year of follow-up, the risk of hospitalizations and emergencies was higher for the control group than for the intervention group (HR = 9.03, P = 0.042; HR = 3.38, P = 0.034, respectively); however, the risk of unscheduled outpatient visits was higher for the intervention group (HR = 4.18, P = 0.028). There was no "placebo" treatment, and patients in the control group might have produced positive outcomes and reduced the magnitude of differences compared with the intervention group. Compared with usual care, pharmaceutical care significantly reduced hospitalizations and emergency service consultations by outpatients with BD-I. This study received funding from

  4. Method

    Directory of Open Access Journals (Sweden)

    Xixin Wang

    2012-01-01

    Full Text Available ZrO2 nanotube arrays were prepared by anodization method in aqueous electrolyte containing (NH42SO4 and NH4F. The morphology and structure of nanotube arrays were characterized through scanning electron microscope, X-ray diffraction, and infrared spectra analysis. The zirconia nanotube arrays were used as catalyst in esterification reaction. The effects of calcination temperature and electrolyte concentration on catalytic esterification activity have been investigated in detail. Experiments indicate that nanotube arrays have highest catalytic activity when the concentration of (NH42SO4 is 1 mol/L, the concentration of NH4F is 1 wt%, and the calcination temperature is 400°C. Esterification reaction yield of as much as 97% could be obtained under optimal conditions.

  5. Method

    Directory of Open Access Journals (Sweden)

    Andrey Gnatov

    2015-01-01

    Full Text Available Recently repair and recovery vehicle body operations become more and more popular. A special place here is taken by equipment that provides performance of given repair operations. The most interesting things are methods for recovery of car body panels that allow the straightening without disassembling of car body panels and damaging of existing protective coating. Now, there are several technologies for repair and recovery of car body panels without their disassembly and dismantling. The most perspective is magnetic-pulse technology of external noncontact straightening. Basics of magnetic-pulse attraction, both ferromagnetic and nonferromagnetic thin-walled sheet metal, are explored. Inductor system calculation models of magnetic-pulse straightening tools are presented. Final analytical expressions for excited efforts calculation in the tools under consideration are introduced. According to the obtained analytical expressions, numerical evaluations of excited forces were executed. The volumetric epures of the attractive force radial distributions for different types of inductors were built. The practical testing of magnetic-pulse straightening with research tools is given. Using the results of the calculations we can create effective tools for an external magnetic-pulse straightening of car body panels.

  6. Incidence and Outcome of BRCA Mutations in Unselected Patients with Triple Receptor-Negative Breast Cancer.

    LENUS (Irish Health Repository)

    Gonzalez-Angulo, Ana M

    2011-03-01

    To investigate the incidence of germline and somatic BRCA1\\/2 mutations in unselected patients with triple-negative breast cancer (TNBC) and determine the prognostic significance of carrying a mutation. Methods: DNA was obtained from 77 TNBC and normal tissues. BRCA1\\/2 exons\\/flanking regions were sequenced from tumor and patients classified as mutant or wild type (WT). Sequencing was repeated from normal tissue to identify germline and somatic mutations. Patient characteristics were compared with chi-square. Survival was estimated by Kaplan-Meier method and compared with log-rank. Cox proportional hazards models were fit to determine the independent association of mutation status with outcome.

  7. Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

    Science.gov (United States)

    Albu, Silviu; Nagy, Alina; Doros, Caius; Marceanu, Luigi; Cozma, Sebastian; Musat, Gabriela; Trabalzini, Franco

    2016-01-01

    The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD). Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method. Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups. Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Rehospitalization rates of patients with schizophrenia discharged on haloperidol, risperidone or clozapine Taxas de re-hospitalização de pacientes após alta hospitalar em uso de haloperidol, risperidona ou clozapina

    Directory of Open Access Journals (Sweden)

    Ana Paula Werneck de Castro

    2007-09-01

    Full Text Available OBJECTIVE:The purpose of this study was to evaluate the rehospitalization rates of patients discharged from the Institute of Psychiatry of the Hospital das Clínicas of the Universidade de São Paulo Medical School while being treated with haloperidol, risperidone or clozapine. METHOD: This is a naturalistic study designed to monitor rehospitalization rates for patients discharged on haloperidol (n = 43, risperidone (n = 22 or clozapine (n = 31. Time to readmission over the course of three years was measured by the product-limit (Kaplan-Meier method. Risk factors associated with rehospitalizations were examined. RESULTS: At 36 months, remained in the community 74% of the haloperidol-treated patients, 59% of the risperidone-treated patients and 84% of the clozapine-treated patients. The haloperidol group showed a higher proportion of women, a late age of onset and shorter length of illness than the other groups, whereas the opposite was observed in the clozapine group. CONCLUSIONS: This study suggests that the rehospitalization rates of patients taking clozapine are lower than the rate for patients treated with haloperidol and risperidone. However confounding variables such as gender distribution and age of onset represent limitations that should be taken into account for the interpretation of the results.OBJETIVO: O propósito desse estudo foi observar as taxas de re-hospitalização de pacientes com esquizofrenia que receberam alta do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo em uso de haloperidol, risperidona ou clozapina. MÉTODO: Este foi um estudo naturalístico conduzido de forma a observar as taxas de re-hospitalizações dos pacientes que receberam alta em uso de haloperidol (n = 43, risperidona (n = 22 ou clozapina (n = 31. O tempo de re-hospitalização foi analisado de acordo com a fórmula produto-limite (Kaplan-Meier por três anos. Fatores de risco associados

  9. Incidences and Risk Factors of Organ Manifestations in the Early Course of Systemic Sclerosis

    DEFF Research Database (Denmark)

    Jaeger, Veronika K; Wirz, Elina G; Allanore, Yannick

    2016-01-01

    OBJECTIVE: Systemic sclerosis (SSc) is a rare and clinically heterogeneous autoimmune disorder characterised by fibrosis and microvascular obliteration of the skin and internal organs. Organ involvement mostly manifests after a variable period of the onset of Raynaud's phenomenon (RP). We aimed...... and their risk factors were assessed using Kaplan-Meier methods and Cox regression analysis. RESULTS: Of the 695 SSc patients who had a baseline visit within 1 year after RP onset, the incident non-RP manifestations (in order of frequency) were: skin sclerosis (75%) GI symptoms (71%), impaired diffusing capacity...

  10. Brain metastases: epidemiological profile and therapeutic results, about a cohort of patients treated in a radiotherapy department in Algiers; Les metastases cerebrales: profil epidemiologique et resultats therapeutiques, a propos d'une serie de patients traites dans un service de radiotherapie a Alger

    Energy Technology Data Exchange (ETDEWEB)

    Chami, S.; Mekki, F. [Service de radiotherapie, hopital d' Alger, Alger (Algeria)

    2010-10-15

    The authors report a retrospective study of the epidemiological profile, clinic characteristics, and mainly palliative therapeutic treatments, more particularly in terms of life quality, and improvement of clinic symptomatology and performance index. This study is based on 38 patients (17 women and 21 men), with a median age of 58.6, and a Karnofsky index greater than 70 per cent. Various data have been collected: brain metastasis number and topography, time interval between cancer diagnosis and metastasis diagnosis, impact on neuro-cognitive function. Survival has been analysed with the Kaplan-Meier method. Short communication

  11. Running Related injury, mileage and Q-angle: A prospective follow-up study

    DEFF Research Database (Denmark)

    Ramskov, Daniel; Nielsen, R.O.; Rasmussen, Sten

    intensity, time or distance. The Kaplan-Meier method was used to estimate survival mileage until RRI in each group. If a participant reported an injury, their survival mileage was eliminated, they underwent examination and the RRI was diagnosed. To evaluate the outcome, cox-regression model was used......The Quadriceps angle (Q-angle) may be associated with the development of Running Related Injuries (RRI). Only a few studies have investigated the association between Q-angle, and the likelihood of RRI. These studies have not led to any firm conclusions, on the link between Q-angle and development...

  12. Clinical and evolving features of women diagnosed with precancerous cervical lesions, screened and treated in the Amazon region of Brazil.

    Science.gov (United States)

    Prado, Patricia Rezende do; Koifman, Rosalina Jorge; Silva, Ilce Ferreira da

    2014-09-01

    The objective of the study was to determine the dynamics of precancerous lesions in women of a cohort treated for cervical intraepithelial neoplasia (CIN) and followed up over the next two years. The conditional probability of failure was calculated using the Kaplan-Meier method, and the raw and adjusted hazard ratios (HR) were determined using Cox regression with a p-value entry of history of more frequent pregnancies and a histological diagnosis of CIN II/III are directly correlated with risk of CIN treatment failure, whereas being in a stable relationship is inversely correlated with this risk.

  13. Long-term survival and radiological results of the Duracon™ total knee arthroplasty

    OpenAIRE

    Bachmann, Matthias; Bolliger, Lilianna; Ilchmann, Thomas; Clauss, Martin

    2013-01-01

    Purpose The aim of this study was to analyse the long-term (>ten years) survival rate and radiological results of the Duracon TKA. Methods Between 1992 and 1999 159 Duracon TKA were implanted at our institution. A Kaplan-Meier survival analysis for the endpoints exchange, addition or removal of any component for any reason, revision due to aseptic loosening and mechanical failure was performed. Radiological long-term (>ten years) follow-up (FU) analysis was performed according to the Knee Soc...

  14. Infants with prenatally diagnosed kidney anomalies have an increased risk of urinary tract infections

    DEFF Research Database (Denmark)

    Rasmussen, Maria; Sunde, Lone; Andersen, René F

    2017-01-01

    computed. Mortality was estimated using the Kaplan-Meier method. RESULTS: We identified 412 foetuses with parenchymal kidney anomalies out of 362 069 who underwent ultrasound scans and 277 were born alive. The overall risk of a UTI before the age of two years was 19%, and it was 14% among infants without...... between 2007 and 2012 had previously been identified. These were compared with foetuses without kidney anomalies who were prenatally scanned the same year. Live born infants were followed from birth until the diagnosis of UTI, emigration, death or two years of age. Cumulative incidences of UTIs were...

  15. Implant survival of the most common cemented total hip devices from the Nordic Arthroplasty Register Association database

    DEFF Research Database (Denmark)

    Junnila, Mika; Laaksonen, Inari; Eskelinen, Antti

    2016-01-01

    Background and purpose - According to previous Nordic Arthroplasty Register Association (NARA) data, the 10-year implant survival of cemented total hip arthroplasties (THAs) is 94% in patients aged 65-74 and 96% in patients aged 75 or more. Here we report a brand-level comparison of cemented THA...... based on the NARA database, which has not been done previously. Patients and methods - We determined the rate of implant survival of the 9 most common cemented THAs in the NARA database. We used Kaplan-Meier analysis with 95% CI to study implant survival at 10 and 15 years, and Cox multiple regression...

  16. Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database

    DEFF Research Database (Denmark)

    Mäkelä, Keijo T; Matilainen, Markus; Pulkkinen, Pekka

    2014-01-01

    Background and purpose An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA...... database with the Finnish data included. Material and methods 438,733 THRs performed during the period 1995-2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression...

  17. Experience of the Casablanca radiotherapy-oncology centre on radiotherapy in the treatment of the adult Hodgkin lymphoma; Experience du centre de radiotherapie-oncologie de Casablanca sur la radiotherapie dans le traitement du lymphome de Hodgkin de l'adulte

    Energy Technology Data Exchange (ETDEWEB)

    Bouchbika, Z.; Benchakroun, N.; Sellai, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Benider, A. [Service radiotherapie-oncologie, CHU Ibn-Rochd, Casablanca (Morocco)

    2011-10-15

    The authors report the assessment of the local control, global survival and survival without recurrence, and also late complications, based on retrospective study over 8 years of 169 cases Hodgkin lymphoma in patients older than 18 (average age of 34) and who had been submitted to radiotherapy. Survival has been computed according to the Kaplan-Meier method. The authors notice that the recurrence rate is slightly higher than in the literature. During the considered period, radiotherapy was two-dimensional with higher doses than those corresponding to current standards. The improvement of radiotherapy techniques and the decrease of doses within the standards should improve the therapeutic results. Short communication

  18. Markov chains and semi-Markov models in time-to-event analysis.

    Science.gov (United States)

    Abner, Erin L; Charnigo, Richard J; Kryscio, Richard J

    2013-10-25

    A variety of statistical methods are available to investigators for analysis of time-to-event data, often referred to as survival analysis. Kaplan-Meier estimation and Cox proportional hazards regression are commonly employed tools but are not appropriate for all studies, particularly in the presence of competing risks and when multiple or recurrent outcomes are of interest. Markov chain models can accommodate censored data, competing risks (informative censoring), multiple outcomes, recurrent outcomes, frailty, and non-constant survival probabilities. Markov chain models, though often overlooked by investigators in time-to-event analysis, have long been used in clinical studies and have widespread application in other fields.

  19. Characterization of annual disease progression of multiple sclerosis patients: A population-based study

    DEFF Research Database (Denmark)

    Freilich, Jonatan; Manouchehrinia, Ali; Trusheim, Mark

    2017-01-01

    the milestone. To characterize clinical factors influencing MS disease progression as annual transitions from each Expanded Disability Status Scale (EDSS). The annual progression of 11,964 patients from the Swedish MS Registry was analysed with 10 multinomial logistic regressions, that is, one for transition......Previous research characterizing factors influencing multiple sclerosis (MS) disease progression has typically been based on time to disease milestones (Kaplan-Meier, Cox hazard regression, etc.). A limitation of these methods is the handling of the often large groups of patients not reaching...

  20. Rotational Acetabular Osteotomy for Pre- and Early Osteoarthritis Secondary to Dysplasia Provides Durable Results at 20 Years.

    Science.gov (United States)

    Yasunaga, Yuji; Ochi, Mitsuo; Yamasaki, Takuma; Shoji, Takeshi; Izumi, Sotaro

    2016-10-01

    Kaplan-Meier product-limited method and parametric survivorship analysis using the Cox proportional-hazards model was used to determine risk factors for radiographic OA progression. The mean clinical score improved very slightly, from 15 (SD, 0.8) to 18 (SD, 1.1) (95% confidence interval [CI], -2.9 to -2.0; p osteotomy of 20 (SD, 2.5) years. Radiographic indices were improved after surgery in both groups. Radiographic progression of OA occurred in 24 patients (25 hips). Kaplan-Meier survivorship analysis, with radiographic signs of progression of OA as the endpoint, predicted survival of 96% (95% CI, 89%-100%) at 10 years and 20 years in the pre-OA group. For the early-stage group, we found survivorship of 89% (95% CI, 83%-95%) at 10 years and 78% (95% CI, 69%-87%) at 20 years. We identified two factors associated with poor outcome: fair (rather than excellent and good) postoperative joint congruency (hazard ratio, 12.1; 95% CI, 3.8-39; p osteotomy is an effective surgical procedure for symptomatic dysplastic hips in pre- and early-stage OA, and it prevented radiographic OA progression and maintained hip function at a mean 20 years after surgery. Level IV, therapeutic study.

  1. Mortality impact of positive blood cultures in patients with suspected community-acquired bacteraemia. A Danish population-based cohort study

    DEFF Research Database (Denmark)

    Søgaard, Mette; Nørgaard, Mette; Sørensen, Henrik Toft

    2009-01-01

    from medical databases. Positive cultures were defined as those with growth of one or more pathogen given an aetiological role based on joint clinical and microbiological assessment. Mortality within 180 days following the date of first blood culture was determined through the Danish Civil Registration......,210) with a first-time registered blood culture during 1995 through 2006 in Northern Denmark. We obtained information on blood cultures, coexisting chronic diseases (for this study identified as the 19 chronic diseases included in the Charlson Comorbidity Index), laboratory findings, and immunosuppressive therapy...... System. We computed Kaplan-Meier curves and product limit estimates for the main study variables. Next, time-dependent Cox regression analyses was used to compare the risk of death in patients with positive blood cultures and patients with negative cultures at days 0-7, 8-30, and 31-180, controlling...

  2. Factors Affecting the Recurrence of Giant Cell Tumor of Bone After Surgery: A Clinicopathological Study of 80 Cases from a Single Center

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    Dong-dong Cheng

    2015-07-01

    Full Text Available Background/Aims: This aim of the present study was to identify specific markers determining the recurrence of the giant cell tumor of bone (GCTB. Methods: This study involved the clinicopathological analysis of 80 cases. All of the clinical features, pathological fracture, Campanacci grade, histological features and surgical methods were reviewed. Immunohistochemistry was used to detect the expression of Ki-67, CD147, mutant p53 and p63 in GCTB. Comparisons between different groups were performed using the Chi-square test. The risk factors affecting recurrence were analyzed using a binary logistic model. Kaplan-Meier analysis was employed for the survival analysis between the groups. Cell proliferation assays, migration and invasion assays were used to detect the function of CD147 on GCTB in vitro. Results: The univariate analysis showed that Ki-67 and CD147 expression, pathological fracture, Campanacci grade and surgical method were associated with recurrence. The multivariate analysis revealed that CD147 expression, Campanacci grade and surgical method were the factors affecting GCTB recurrence. In addition, the Kaplan-Meier analysis revealed that these factors affected tumor-free survival time. In vitro study revealed that the CD147 knockdown by small interfering RNA (siRNA technique dramatically reduced the proliferation, migration and invasion of GCTB. Conclusion: Our results suggest that CD147 may serve as an adequate marker for GCTB recurrence. Campanacci grade is a risk factor for GCTB recurrence, which is also affected by the surgical method used.

  3. Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children

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    Zongo Issaka

    2008-08-01

    Full Text Available Abstract Background Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs will result in different estimates being reported, with implications for changes in treatment policy. Methods Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a reinfections excluded from the analysis (standard WHO per-protocol analysis or (1b reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a WHO (2001 definitions of failure, or (2b failure defined using parasitological criteria only. Results Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702, artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706 and artemether-lumefantrine (AL, N = 518. Using method (1a, the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference and the others were: (i method 1b = 1.3% [0 to24.8], (ii method 2a = 1.1% [0 to21.5], and (iii method 2b = 0% [-38 to19.3]. The standard per-protocol method (1a tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a. It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size

  4. Analysis of Survival Predictors in Patients with Lung Cancer and Brain Metastases

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    Shaohua CUI

    2015-07-01

    Full Text Available Background and objective The prognosis for patients with lung cancer and brain metastases remains poor, with approximately 6 months of survival, despite active measures after treatment. In this study, we determined and analyzed clinical parameters that affect the survival of patients with lung cancer and brain metastases to provide clinical guidance. Methods Lung cancer cases with brain metastases were retrospectively collected during 2002 and 2008 from Shanghai Chest Hospital, Shanghai Jiao Tong University. Kaplan-Meier method and Cox regression were performed for univariate and multivariate analyses, respectively, to explore independent predictors influencing the survival of patients with lung cancer and brain metastases. Results Age, Eastern Cooperative Oncology Group performance status (ECOG PS, metastasis interval, number of metastasis, treatment method, treatment period, symptoms of brain metastases, extracranial metastasis, and brain metastasis order were factors that affect the survival of patients with brain metastases as confirmed through the Kaplan-Meier method. Treatment periods and extracranial metastasis were independent survival predictors in patients with lung cancer and brain metastasis as indicated by Cox proportional hazard model. Conclusion Treatment periods and extracranial metastasis were independent predictors of survival of patients with lung cancer and brain metastasis. Treatment periods and extracranial metastasis were independent predictors of survival of patients with lung cancer and brain metastasis.

  5. Probability Prediction in Multistate Survival Models for Patients with Chronic Myeloid Leukaemia

    Institute of Scientific and Technical Information of China (English)

    FANG Ya; Hein Putter

    2005-01-01

    In order to find an appropriate model suitable for a multistate survival experiment, 634 patients with chronic myeloid leukaemia (CML) were selected to illustrate the method of analysis.After transplantation, there were 4 possible situations for a patient: disease free, relapse but still alive, death before relapse, and death after relapse. The last 3 events were considered as treatment failure. The results showed that the risk of death before relapse was higher than that of the relapse,especially in the first year after transplantation with competing-risk method. The result of patients with relapse time less than 12 months was much poor by the Kaplan-Meier method. And the multistate survival models were developed, which were detailed and informative based on the analysis of competing risks and Kaplan-Meier analysis. With the multistate survival models, a further analysis on conditional probability was made for patients who were disease free and still alive at month 12 after transplantation. It was concluded that it was possible for an individual patient to predict the 4 possible probabilities at any time. Also the prognoses for relapse either death or not and death either before or afterrelapse may be given. Furthermore, the conditional probabilities for patients who were disease free and still alive in a given time after transplantation can be predicted.

  6. On the importance of accounting for competing risks in pediatric cancer trials designed to delay or avoid radiotherapy: I. Basic concepts and first analyses.

    Science.gov (United States)

    Tai, Bee-Choo; Grundy, Richard G; Machin, David

    2010-04-01

    In trials designed to delay or avoid irradiation among children with malignant brain tumor, although irradiation after disease progression is an important event, patients who have disease progression may decline radiotherapy (RT), or those without disease progression may opt for elective RT. To accurately describe the cumulative need for RT in such instances, it is crucial to account for these distinct events and to evaluate how each contributes to the delay or advancement of irradiation via a competing risks analysis. We describe the summary of competing events in such trials using competing risks methods based on cumulative incidence functions and Gray's test. The results obtained are contrasted with standard survival methods based on Kaplan-Meier curves, cause-specific hazard functions and log-rank test. The Kaplan-Meier method overestimates all event-specific rates. The cause-specific hazard analysis showed reduction in hazards for all events (A: RT after progression; B: no RT after progression; C: elective RT) among children with ependymoma. For event A, a higher cumulative incidence was reported for ependymoma. Although Gray's test failed to detect any difference (p = 0.331) between histologic subtypes, the log-rank test suggested marginal evidence (p = 0.057). Similarly, for event C, the log-rank test found stronger evidence of reduction in hazard among those with ependymoma (p = 0.005) as compared with Gray's test (p = 0.086). To evaluate treatment differences, failing to account for competing risks using appropriate methodology may lead to incorrect interpretations.

  7. Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study

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    Køber Lars

    2010-01-01

    Full Text Available Abstract Background The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI is unclear. We studied the risk of death or recurrent myocardial infarction (MI in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI. Methods Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens. Results The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference for the composite endpoint of 1.01 (confidence intervals 0.81-1.26 and 1.24 (confidence intervals 0.95-1.62 for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06. Conclusions We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

  8. Elevation of serum GGT and LDH levels, together with higher BCLC staging are associated with poor overall survival from hepatocellular carcinoma: a retrospective analysis.

    Science.gov (United States)

    Yang, Zongguo; Ye, Peiyan; Xu, Qingnian; Lu, Yunfei; Tang, Bozong; Wang, Qiang; Chen, Shishi; Chen, Xiaorong

    2015-06-01

    Serum biomarkers predicting prognosis have not been adequately explored in HCC patients. The aim of this study was to investigate prognostic significance of parameters of liver function, tumor markers, and other clinicopathological features in HCC patients. Medical records of HCC patients were retrospectively extracted and overall survival was evaluated with the Kaplan-Meier method. Significant difference was estimated with the Log rank method. Univariate and multivariate analyses were used for the study of significance of prognostic factor. A total of 273 HCC patients were included in this analysis. According to the Cox regression analysis and Kaplan-Meier event analysis, GGT and LDH levels of liver function tests were significantly associated with HCC overall survival. Elevated serum CEA level was a risk factor related to poor HCC overall survival. And advanced BCLC staging contributed to a lower overall survival in HCC patients. HCC could benefit from surgical resection, TACE, and radiotherapy. ROC curves demonstrated that different from CEA, elevated GGT and LDH could accurately predict HCC overall survival. In conclusion, serum GGT and LDH together with higher BCLC staging should be potential predictive factors for HCC overall survival.

  9. Identification of C16orf74 as a marker of progression in primary non-muscle invasive bladder cancer.

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    Won Tae Kim

    Full Text Available PURPOSE: Methylation-induced silencing of PRSS3 has been shown to be significantly associated with invasive bladder cancer, and expression of the C16orf74 gene locus has been shown to correlate positively with PRSS3. The aim of the current study was to evaluate the relationship between C16orf74 expression level and progression in non-muscle invasive bladder cancer (NMIBC. MATERIALS AND METHODS: C16orf74 mRNA levels were examined by real-time reverse transcriptase polymerase chain reaction (RT-PCR analysis of 193 tumor specimens from patients with primary NMIBC. Expression data were analyzed in terms of clinical and experimental parameters. Kaplan-Meier curves and multivariate Cox regression models, respectively, were used to determine progression-free survival and to identify independent predictive parameters of progression. RESULTS: Analysis using Kaplan-Meier curves revealed prolonged progression-free survival of high-C16orf74-expressors as compared to low-expressors (p<0.001. Multivariate Cox regression analysis revealed that low C16orf74 mRNA expression levels are a significant risk factor for disease progression in patients with primary NMIBC (HR: 10.042, CI:2.699-37.360, p = 0.001. CONCLUSIONS: Decreased expression of C16orf74 correlates significantly with progression in primary NMIBC. C16orf74 expression level represents a potentially useful marker for predicting progression in primary NMIBC patients.

  10. Factors affecting commencement and cessation of smoking behaviour in Malaysian adults

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    Ghani Wan

    2012-03-01

    Full Text Available Abstract Background Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as bidi and rokok daun are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs. Methods Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios. Results Males had a much higher prevalence of the habit (61.7% as compared to females (5.8%. Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p Conclusions Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.

  11. Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

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    Kim, Eun Ji; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jeong, Woo Kyoung; Lee, Yong Ho [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    We evaluated the technical success and complication rates associated with the radiological placement of tunneled central venous catheters in pediatric patients. Between May 1, 2005 and March 31, 2008, a total of 46 tunneled central venous catheters were placed in 34 children (M:F = 22:12; mean age, 9.9 years [9 months to 16.8 years]). All procedures were performed under ultrasonographic and fluoroscopic guidance. Follow-up data were obtained through the retrospective review of the medical records. We used the Kaplan-Meier survival method for the evaluation of survival rate of the catheters. All procedures were technically successful. The observed periprocedural complications included hematoma formation in three patients. The mean catheter life was 189.3 days (total, 8710 days; range, 7-810). Catheters were removed due to death (n=9), the end of treatment (n=8), catheter sepsis (n=4), malfunction (n=8), and accidental removal (n=4). The rate of catheter sepsis and malfunction was 0.459 and 0.919 for every 1000 catheter days, respectively. The expected mean catheter life was 479.6 days as per the Kaplan- Meier analysis. The results suggest that the radiologic placement of a tunneled central venous catheter is an effective technique with a high technical success rate and low complication rate.

  12. High serum uric acid concentration predicts poor survival in patients with breast cancer.

    Science.gov (United States)

    Yue, Cai-Feng; Feng, Pin-Ning; Yao, Zhen-Rong; Yu, Xue-Gao; Lin, Wen-Bin; Qian, Yuan-Min; Guo, Yun-Miao; Li, Lai-Sheng; Liu, Min

    2017-08-26

    Uric acid is a product of purine metabolism. Recently, uric acid has gained much attraction in cancer. In this study, we aim to investigate the clinicopathological and prognostic significance of serum uric acid concentration in breast cancer patients. A total of 443 female patients with histopathologically diagnosed breast cancer were included. After a mean follow-up time of 56months, survival was analysed using the Kaplan-Meier method. To further evaluate the prognostic significance of uric acid concentrations, univariate and multivariate Cox regression analyses were applied. Of the clinicopathological parameters, uric acid concentration was associated with age, body mass index, ER status and PR status. Univariate analysis identified that patients with increased uric acid concentration had a significantly inferior overall survival (HR 2.13, 95% CI 1.15-3.94, p=0.016). In multivariate analysis, we found that high uric acid concentration is an independent prognostic factor predicting death, but insufficient to predict local relapse or distant metastasis. Kaplan-Meier analysis indicated that high uric acid concentration is related to the poor overall survival (p=0.013). High uric acid concentration predicts poor survival in patients with breast cancer, and might serve as a potential marker for appropriate management of breast cancer patients. Copyright © 2017. Published by Elsevier B.V.

  13. G388R mutation of the FGFR4 gene is not relevant to breast cancer prognosis.

    Science.gov (United States)

    Jézéquel, P; Campion, L; Joalland, M-P; Millour, M; Dravet, F; Classe, J-M; Delecroix, V; Deporte, R; Fumoleau, P; Ricolleau, G

    2004-01-12

    This study screened large cohorts of node-positive and node-negative breast cancer patients to determine whether the G388R mutation of the FGFR4 gene is a useful prognostic marker for breast cancer as reported by Bange et al in 2002. Node-positive (n=139) and node-negative (n=95) breast cancer cohorts selected for mutation screening were followed up for median periods of 89 and 87 months, respectively. PCR - RFLP analysis was modified to facilitate molecular screening. Curves for disease-free survival were plotted according to the Kaplan - Meier method, and a log-rank test was used for comparisons between groups. Three other nonparametric linear rank-tests particularly suitable for investigating possible relations between G388R mutation and early cancer progression were also used. Kaplan - Meier analysis based on any of the four nonparametric linear rank tests performed for node-positive and node-negative patients was not indicative of disease-free survival time. G388R mutation of the FGFR4 gene is not relevant for breast cancer prognosis.

  14. [Incidence of congenital heart disease and factors associated with mortality in children born in two Hospitals in the State of Mexico].

    Science.gov (United States)

    Mendieta-Alcántara, Gustavo Gabriel; Santiago-Alcántara, Elia; Mendieta-Zerón, Hugo; Dorantes-Piña, Ramsés; Ortiz de Zárate-Alarcón, Gabriela; Otero-Ojeda, Gloria A

    2013-01-01

    We studied the incidence, survival, and risk factors for mortality in a cohort of infants for a period of five years, born in two hospitals, one a second-level General Hospital, the second a tertiary perinatal hospital, both in the City of Toluca. The analysis of survival was performed with the Kaplan-Meier method, and Cox regression was used to estimate the risk of death according to different factors. We found an overall incidence of 7.4 per 1,000 live births; in preterm infants, the rate was 35.6 per 1,000, and in term newborns it was 3.68 per 1,000. The most common heart disease was the ductus arteriosus in the overall group and in preterm infants; in term newborns the most common was the atrial septal defect. The specific mortality was 18.64%, follow-up was 579 days, where we found, according to Kaplan-Meier, survival of an average of 437.92 days, with 95% confidence intervals of 393.25 to 482.6 days, with a standard error of 22.79 days; the cumulative probability of survival was 0.741, with a standard error of 0.44. In Cox regression, two variables had a high hazard ratio (HR): these were the presence or absence of cyanosis and the hospital where they were treated as newborns.

  15. Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy

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    Keck Bastian

    2013-02-01

    Full Text Available Abstract Background Since the definition of different histologic subtypes of urothelial carcinomas by the World Health Organization (WHO 2004 classification, description of molecular features and clinical behavior of these variants has gained more attention. Methods We reviewed 205 tumor samples of patients with locally advanced bladder cancer mainly treated within the randomized AUO-AB05/95 trial with radical cystectomy and adjuvant cisplatin-based chemotherapy for histologic subtypes. 178 UC, 18 plasmacytoid (PUC and 9 micropapillary (MPC carcinomas of the bladder were identified. Kaplan Meier analysis and backward multivariate Cox’s proportional hazards regression analysis were performed to compare overall survival between the three histologic subtypes. Results Patients suffering from PUC have the worst clinical outcome regarding overall survival compared to conventional UC and MPC of the bladder that in turn seem have to best clinical outcome (27.4 months, 62.6 months, and 64.2 months, respectively; p=0.013 by Kaplan Meier analysis. Backward multivariate Cox´s proportional hazards regression analysis (adjusted to relevant clinicopathological parameters showed a hazard ratio of 3.2 (p=0.045 for PUC in contrast to patients suffering from MPC. Conclusions Histopathological diagnosis of rare variants of urothelial carcinoma can identify patients with poor prognosis.

  16. The effect of preoperative serum triglycerides and high-density lipoprotein-cholesterol levels on the prognosis of breast cancer.

    Science.gov (United States)

    Li, Xing; Tang, Hailin; Wang, Jin; Xie, Xinhua; Liu, Peng; Kong, Yanan; Ye, Feng; Shuang, Zeyu; Xie, Zeming; Xie, Xiaoming

    2017-04-01

    Although dyslipidemia has been documented to be associated with several types of cancer including breast cancer, it remains uncertainty the prognostic value of serum lipid in breast cancer. The purpose of this study is to evaluate the association between the preoperative plasma lipid profile and the prognostic of breast cancer patients. The levels of preoperative serum lipid profile (including cholesterol [CHO], Triglycerides [TG], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C], apolipoprotein A-I [ApoAI], and apolipoprotein B [ApoB]) and the clinical data were retrospectively collected and reviewed in 1044 breast cancer patients undergoing operation. Kaplan-Meier method and the Cox proportional hazards regression model were used in analyzing the overall survival [OS] and disease-free survival [DFS]. Combining the receiver-operating characteristic and Kaplan-Meier analysis, we found that preoperative lower TG and HDL-C level were risk factors of breast cancer patients. In multivariate analyses, a decreased HDL-C level showed significant association with worse OS (HR: 0.528; 95% CI: 0.302-0.923; P = 0.025), whereas a decreased TG level showed significant association with worse DFS (HR: 0.569; 95% CI: 0.370-0.873; P = 0.010). Preoperative serum levels of TG and HDL-C may be independent factor to predict outcome in breast cancer patient. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. An electronic health record-enabled obesity database

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    Wood G

    2012-05-01

    Full Text Available Abstract Background The effectiveness of weight loss therapies is commonly measured using body mass index and other obesity-related variables. Although these data are often stored in electronic health records (EHRs and potentially very accessible, few studies on obesity and weight loss have used data derived from EHRs. We developed processes for obtaining data from the EHR in order to construct a database on patients undergoing Roux-en-Y gastric bypass (RYGB surgery. Methods Clinical data obtained as part of standard of care in a bariatric surgery program at an integrated health delivery system were extracted from the EHR and deposited into a data warehouse. Data files were extracted, cleaned, and stored in research datasets. To illustrate the utility of the data, Kaplan-Meier analysis was used to estimate length of post-operative follow-up. Results Demographic, laboratory, medication, co-morbidity, and survey data were obtained from 2028 patients who had undergone RYGB at the same institution since 2004. Pre-and post-operative diagnostic and prescribing information were available on all patients, while survey laboratory data were available on a majority of patients. The number of patients with post-operative laboratory test results varied by test. Based on Kaplan-Meier estimates, over 74% of patients had post-operative weight data available at 4 years. Conclusion A variety of EHR-derived data related to obesity can be efficiently obtained and used to study important outcomes following RYGB.

  18. Long-Term Visual Outcome in Wet Age-Related Macular Degeneration Patients Depending on the Number of Ranibizumab Injections

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    Pilar Calvo

    2015-01-01

    Full Text Available Purpose. To analyse the visual outcome in wet age-related macular degeneration (AMD patients depending on the number of ranibizumab injections. Methods. 51 naïve wet AMD patients were retrospectively recorded. Visual acuity (VA, central retinal thickness (CRT measured with spectral domain (SD optical coherence tomography (OCT, and number of intravitreal injections were compared at 6, 12, 18, 24, 30, and 36 months of follow-up. Kaplan-Meier survival rates (SRs based on VA outcomes were calculated depending on the number of ranibizumab injections performed. Results. VA improved compared with baseline at 6 and 12 months (P0.05. CRT measured with Cirrus OCT decreased (P<0.001 at all time points analysed. The mean number of injections received was 6.98±3.69. At 36 months, Kaplan-Meier SR was 76.5% (the proportion of patients without a decrease in vision of more than 0.3 logMAR units. VA remained stable (≤0.01 logMAR units or improved in 62.7%. Within this group, SR was 92.9% in those who received 7 or more injections versus 51.4% receiving <7 treatments (P=0.008; log-rank test. Conclusion. Better VA outcomes were found in stable wet AMD patients after 3 years of follow-up if they received ≥7 ranibizumab injections.

  19. Intraoperative Radiotherapy in the Management of Locally Recurrent Extremity Soft Tissue Sarcoma

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    Christopher L. Tinkle

    2015-01-01

    Full Text Available Purpose. To investigate the efficacy and morbidity of limb-sparing surgery with intraoperative radiotherapy (IORT for patients with locally recurrent extremity soft tissue sarcoma (ESTS. Methods and Materials. Twenty-six consecutively treated patients were identified in a single institution retrospective analysis of patients with locally recurrent ESTS treated with IORT following salvage limb-sparing resection from May 2000 to July 2011. Fifteen (58% patients received external beam radiotherapy (EBRT prior to recurrence (median dose 63 Gy, while 11 (42% patients received EBRT following IORT (median dose 52 Gy. The Kaplan-Meier product limit method was used to estimate disease control and survival and subsets were compared using a log rank statistic, Cox’s regression model was used to determine independent predictors of disease outcome, and toxicity was reported according to CTCAE v4.0 guidelines. Results. With a median duration of follow-up from surgery and IORT of 34.9 months (range: 4 to 139 mos., 10 patients developed a local recurrence with 4 subsequently undergoing amputation. The 5-year estimate for local control (LC was 58% (95% CI: 36–75%, for amputation-free was 81% (95% CI: 57–93%, for metastasis-free control (MFC was 56% (95% CI: 31–75%, for disease-free survival (DFS was 35% (95% CI: 17–54%, and for overall survival (OS was 50% (95% CI: 24–71%. Prior EBRT did not appear to influence disease control (LC, p=0.74; MFC, p=0.66 or survival (DFS, p=0.16; OS, p=0.58. Grade 3 or higher acute and late toxicities were reported for 6 (23% and 8 (31% patients, respectively. The frequency of both acute and late grade 3 or higher toxicities occurred equally between patients who received EBRT prior to or after IORT. Conclusions. IORT in combination with oncologic resection of recurrent ESTS yields good rates of local control and limb-salvage with acceptable morbidity. Within the limitations of small subsets, these data suggest

  20. Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy

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    Athanase Billis

    2012-04-01

    Full Text Available PURPOSE: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal and in more than 1 quadrant or section (Group 2, diffuse; and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal and in more than 2 quadrants or sections (Group 2, diffuse. The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS: Extraprostatic extension was found in 129/360 (35.8% patients, 39/129 (30.2% in Group 1 and 90/129 (69.8% in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2 had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4% patients, 81/160 (50.6% patients in Group 1 and 79/160 (49.4% patients in Group 2. Patients with diffuse positive surgical margins (Group 2 had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant

  1. Geographic differences in time to culture conversion in liquid media: Tuberculosis Trials Consortium study 28. Culture conversion is delayed in Africa.

    Directory of Open Access Journals (Sweden)

    William R Mac Kenzie

    Full Text Available BACKGROUND: Tuberculosis Trials Consortium Study 28, was a double blind, randomized, placebo-controlled, phase 2 clinical trial examining smear positive pulmonary Mycobacterium tuberculosis. Over the course of intensive phase therapy, patients from African sites had substantially delayed and lower rates of culture conversion to negative in liquid media compared to non-African patients. We explored potential explanations of this finding. METHODS: In TBTC Study 28, protocol-correct patients (n = 328 provided spot sputum specimens for M. tuberculosis culture in liquid media, at baseline and weeks 2, 4, 6 and 8 of study therapy. We compared sputum culture conversion for African and non-African patients stratified by four baseline measures of disease severity: AFB smear quantification, extent of disease on chest radiograph, cavity size and the number of days to detection of M. tuberculosis in liquid media using the Kaplan-Meier product-limit method. We evaluated specimen processing and culture procedures used at 29 study laboratories serving 27 sites. RESULTS: African TB patients had more extensive disease at enrollment than non-African patients. However, African patients with the least disease by the 4 measures of disease severity had conversion rates on liquid media that were substantially lower than conversion rates in non-African patients with the greatest extent of disease. HIV infection, smoking and diabetes did not explain delayed conversion in Africa. Some inter-site variation in laboratory processing and culture procedures within accepted practice for clinical diagnostic laboratories was found. CONCLUSIONS: Compared with patients from non-African sites, African patients being treated for TB had delayed sputum culture conversion and lower sputum conversion rates in liquid media that were not explained by baseline severity of disease, HIV status, age, smoking, diabetes or race. Further investigation is warranted into whether modest

  2. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience.

    Science.gov (United States)

    Patel, Uday B; Taylor, Fiona; Blomqvist, Lennart; George, Christopher; Evans, Hywel; Tekkis, Paris; Quirke, Philip; Sebag-Montefiore, David; Moran, Brendan; Heald, Richard; Guthrie, Ashley; Bees, Nicola; Swift, Ian; Pennert, Kjell; Brown, Gina

    2011-10-01

    To assess magnetic resonance imaging (MRI) and pathologic staging after neoadjuvant therapy for rectal cancer in a prospectively enrolled, multicenter study. In a prospective cohort study, 111 patients who had rectal cancer treated by neoadjuvant therapy were assessed for response by MRI and pathology staging by T, N and circumferential resection margin (CRM) status. Tumor regression grade (TRG) was also assessed by MRI. Overall survival (OS) was estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging of good and poor responders on MRI or pathology and survival outcomes after controlling for patient characteristics. On multivariate analysis, the MRI-assessed TRG (mrTRG) hazard ratios (HRs) were independently significant for survival (HR, 4.40; 95% CI, 1.65 to 11.7) and disease-free survival (DFS; HR, 3.28; 95% CI, 1.22 to 8.80). Five-year survival for poor mrTRG was 27% versus 72% (P = .001), and DFS for poor mrTRG was 31% versus 64% (P = .007). Preoperative MRI-predicted CRM independently predicted local recurrence (LR; HR, 4.25; 95% CI, 1.45 to 12.51). Five-year survival for poor post-treatment pathologic T stage (ypT) was 39% versus 76% (P = .001); DFS for the same was 38% versus 84% (P = .001); and LR for the same was 27% versus 6% (P = .018). The 5-year survival for involved pCRM was 30% versus 59% (P = .001); DFS, 28 versus 62% (P = .02); and LR, 56% versus 10% (P = .001). Pathology node status did not predict outcomes. MRI assessment of TRG and CRM are imaging markers that predict survival outcomes for good and poor responders and provide an opportunity for the multidisciplinary team to offer additional treatment options before planning definitive surgery. Postoperative histopathology assessment of ypT and CRM but not post-treatment N status were important postsurgical predictors of outcome.

  3. Cancer of Unknown Primary in Adolescents and Young Adults: Clinicopathological Features, Prognostic Factors and Survival Outcomes.

    Directory of Open Access Journals (Sweden)

    Kanwal Raghav

    Full Text Available Cancer in adolescents and young adults (AYAs (15-39 years is increasingly recognized as a distinct clinical and biological entity. Cancer of unknown primary (CUP, a disease traditionally presenting in older adults with a median age of 65 years, poses several challenges when diagnosed in AYA patients. This study describes clinicopathological features, outcomes and challenges in caring for AYA-CUP patients.A retrospective review of 47 AYAs diagnosed with CUP at MD Anderson Cancer Center (6/2006-6/2013 was performed. Patients with favorable CUP subsets treated as per site-specific recommendations were excluded. Demographics, imaging, pathology and treatment data was collected using a prospectively maintained CUP database. Kaplan-Meier product limit method and log-rank test were used to estimate and compare overall survival. The cox-proportional model was used for multivariate analyses.Median age was 35 years (range 19-39. All patients underwent comprehensive workup. Adenocarcinoma was the predominant histology (70%. A median of 9 immunostains (range 2-29 were performed. The most common putative primary was biliary tract based on clinicopathological parameters as well as gene profiling. Patients presented with a median of 2 metastatic sites [lymph node (60%, lung (47%, liver (38% and bone (34%]. Most commonly used systemic chemotherapies included gemcitabine, fluorouracil, taxanes and platinum agents. Median overall survival for the entire cohort was 10.0 (95% confidence interval (CI: 6.7-15.4 months. On multivariate analyses, elevated lactate dehydrogenase (Hazard ratio (HR 3.66; 95%CI 1.52-8.82; P = 0.004, ≥3 metastatic sites (HR 5.34; 95%CI 1.19-23.9; P = 0.029, and tissue of origin not tested (HR 3.4; 95%CI 1.44-8.06; P = 0.005 were associated with poor overall survival. Culine's CUP prognostic model (lactate dehydrogenase, performance status, liver metastases was validated in this cohort (median overall survival: good-risk 25.2 months vs

  4. The pattern of attrition from an antiretroviral treatment program in Nigeria.

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    Solomon Odafe

    Full Text Available OBJECTIVE: To evaluate the rate and factors associated with attrition of patients receiving ART in tertiary and secondary hospitals in Nigeria. METHODS AND FINDINGS: We reviewed patient level data collected between 2007 and 2010 from 11 hospitals across Nigeria. Kaplan-Meier product-limit and Cox regression were used to determine probability of retention in care and risk factors for attrition respectively. Of 6,408 patients in the cohort, 3,839 (59.9% were females, median age of study population was 33years (IQR: 27-40 and 4,415 (69% were from secondary health facilities. The NRTI backbone was Stavudine (D4T in 3708 (57.9% and Zidovudine (ZDV in 2613 (40.8% of patients. Patients lost to follow up accounted for 62.7% of all attrition followed by treatment stops (25.3% and deaths (12.0%. Attrition was 14.1 (N = 624 and 15.1% (N = 300 in secondary and tertiary hospitals respectively (p = 0.169 in the first 12 months on follow up. During the 13 to 24 months follow up period, attrition was 10.7% (N = 407 and 19.6% (N = 332 in secondary and tertiary facilities respectively (p<0.001. Median time to lost to follow up was 11.1 (IQR: 6.1 to 18.5 months in secondary compared with 13.6 (IQR: 9.9 to 17.0 months in tertiary sites (p = 0.002. At 24 months follow up, male gender [AHR 1.18, 95% CI: 1.01-1.37, P = 0.038]; WHO clinical stage III [AHR 1.30, 95%CI: 1.03-1.66, P = 0.03] and clinical stage IV [AHR 1.90, 95%CI: 1.20-3.02, p = 0.007] and care in a tertiary hospital [AHR 2.21, 95% CI: 1.83-2.67, p<0.001], were associated with attrition. CONCLUSION: Attrition could potentially be reduced by decentralizing patients on ART after the first 12 months on therapy to lower level facilities, earlier initiation on treatment and strengthening adherence counseling amongst males.

  5. Inferior vena cava filter placement in the gynecologic oncology patient: A 15-year institutional experience.

    Science.gov (United States)

    Dewdney, Summer B; Benn, Teri; Rimel, B J; Gao, Feng; Saad, Nael; Vedantham, Suresh; Mutch, David G; Zighelboim, Israel

    2011-05-01

    Venous thrombosis is a frequent complication of gynecologic cancer. Data regarding the use of inferior vena cava (IVC) filters in this population is limited. The aim of this study was to review our experience with gynecologic oncology patients who received an IVC filter, specifically to evaluate indications for filter placement and survival outcomes. This was a retrospective, single-institution study of patients who had an IVC filter placed after a histologically confirmed gynecologic malignancy. Patients were identified from a prospectively collected interventional radiology (IR) database. Clinicopathologic characteristics, procedure details, and outcome data were obtained from outpatient and inpatient medical records. Survival after IVC filter placement was analyzed using the Kaplan-Meier product limit method and compared by log-rank test. A total of 128 patients were identified and 103 were found to be eligible for analysis. Most patients had ovarian cancer (52%), followed by cervical cancer (25%) and endometrial cancer (21%). Two-thirds had advanced stage disease (III/IV). The procedure complication rate was 2%. Median survival after IVC filter placement was 7.8months (95% CI, 4.1-13.6). The most common indication for IVC filter placement was contraindication to anticoagulation secondary to hemorrhage (44%), followed by perioperative indications (30%) and failed anticoagulation (14%). There was no difference in survival by IVC filter placement indication (p=0.18). The majority of the IVC filters placed were permanent (90.5%) and in an infrarenal position (95.8%). There was no difference in survival according to specific thromboembolic event (DVT vs. PE vs. both). Patients able to receive anticoagulation after IVC filter placement had improved survival (HR 0.45, 95%CI 0.45-0.27, p=0.003). We present the largest series of gynecologic oncology patients treated with IVC filters. Long-term survival after IVC filter placement is uncommon. Patients who receive

  6. Successful Restoration of Severely Mutilated Primary Incisors Using a Novel Method to Retain Zirconia Crowns - Two Year Results.

    Science.gov (United States)

    El Shahawy, Osama Ibrahim; O'Connell, Anne C

    This manuscript describes a simple reliable technique for restoring severely mutilated primary anterior teeth. A rigid glass ionomer post is created over which zirconia crowns can be fitted to achieve a long-term stable esthetic restoration for primary anterior teeth. Children aged 2-5 years with two up to six extensively decayed upper primary incisors were included. Fuji IX was condensed into an intracanal space created to a depth of 3mm, to provide a core which also extended 3mm supragingivally. Crown preparations were completed upon these cores. Zirconia crowns (Nusmile, Houston Texas USA) were fitted and cemented over the prepared cores. All patients were recalled at regular intervals. Twenty-three healthy children with 86 restorations participated in the study. The overall survival of the restorations was 95.3% after 12 months and 80.2% after 24 months. According to Kaplan-Meier survival analysis, the median survival time was not reached while the estimated mean survival time was 22.9 months. This newly described clinical technique is simple and reliable to use for restoration of extensively decayed primary incisors. Use of zirconia crowns retained using this technique offers superior esthetic, durable restorations with remarkable gingival response up to 24 months.

  7. Kernelized partial least squares for feature reduction and classification of gene microarray data

    Directory of Open Access Journals (Sweden)

    Land Walker H

    2011-12-01

    Full Text Available Abstract Background The primary objectives of this paper are: 1. to apply Statistical Learning Theory (SLT, specifically Partial Least Squares (PLS and Kernelized PLS (K-PLS, to the universal "feature-rich/case-poor" (also known as "large p small n", or "high-dimension, low-sample size" microarray problem by eliminating those features (or probes that do not contribute to the "best" chromosome bio-markers for lung cancer, and 2. quantitatively measure and verify (by an independent means the efficacy of this PLS process. A secondary objective is to integrate these significant improvements in diagnostic and prognostic biomedical applications into the clinical research arena. That is, to devise a framework for converting SLT results into direct, useful clinical information for patient care or pharmaceutical research. We, therefore, propose and preliminarily evaluate, a process whereby PLS, K-PLS, and Support Vector Machines (SVM may be integrated with the accepted and well understood traditional biostatistical "gold standard", Cox Proportional Hazard model and Kaplan-Meier survival analysis methods. Specifically, this new combination will be illustrated with both PLS and Kaplan-Meier followed by PLS and Cox Hazard Ratios (CHR and can be easily extended for both the K-PLS and SVM paradigms. Finally, these previously described processes are contained in the Fine Feature Selection (FFS component of our overall feature reduction/evaluation process, which consists of the following components: 1. coarse feature reduction, 2. fine feature selection and 3. classification (as described in this paper and prediction. Results Our results for PLS and K-PLS showed that these techniques, as part of our overall feature reduction process, performed well on noisy microarray data. The best performance was a good 0.794 Area Under a Receiver Operating Characteristic (ROC Curve (AUC for classification of recurrence prior to or after 36 months and a strong 0.869 AUC for

  8. Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years.

    Science.gov (United States)

    Anselmi, Amedeo; Flecher, Erwan; Chabanne, Celine; Ruggieri, Vito Giovanni; Langanay, Thierry; Corbineau, Hervé; Leguerrier, Alain; Verhoye, Jean-Philippe

    2017-06-12

    To address the long-term durability of bioprostheses used for aortic valve replacement (AVR) in adult patients aged ≤60 years at the time of surgery. Through a retrospective review of a prospectively collected database, we identified 416 bioprosthetic AVRs performed between 1977 and 2013. A prospective follow-up of valve-related and non-valve-related events was performed. Follow-up was 98.5% complete (2423.1 patient-years; average, 6 ± 5.5 years). At 15 years, overall survival was 62.1 ± 4.4%; freedom from valve-related death was 97.1 ± 1.6%. There were 68 SVD events (11.9 ± 28.8 years after surgery). Freedom from SVD at 15 years was 48.7 ± 5.5% for Kaplan-Meier analysis and 61.4 ± 4.3% for competing-risks analysis. After stratification into age subgroups (SVD (P = .50). The average delay to SVD was not statistically different among subgroups (P = .30). There were 57 reoperations for SVD (11.8 ± 5.2 years after implantation). The 15 year freedom from reoperation for SVD was 55.4 ± 5.6% by Kaplan-Meier analysis and 67.1 ± 4.2% by competing-risks analysis. After stratification by age, freedom from reoperation for SVD was comparable (P = .13). Freedom from any valve-related complication or death was 42 ± 5% by Kaplan-Meier analysis and 54.4 ± 4.1% by competing-risks analysis. The lifetime risk of SVD is considerable in patients aged ≤60 years at the time of bioprosthesis implantation. Nonetheless, durability remains consistent during the first decade; additional data are required for the second decade. Patients' information is pivotal for valve choice (competing-risks method). Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  9. Periodontal healing after intentional auto-alloplastic reimplantation of injured immature upper front teeth.

    Science.gov (United States)

    Pohl, Y; Filippi, A; Tekin, U; Kirschner, H

    2000-03-01

    Conventional endodontic treatment results in high complication quota when performed in immature teeth. Intentional reimplantation with extraoral insertion of an endodontic implant (auto-alloplastic reimplantation) is an alternative. In a retrospective study, the healing of 40 teeth reimplanted intentionally according to this method in patients aged 7 to 15 years was evaluated. Clinical tests (palpation, percussion sound, periotest values) and radiographical examinations were used to determine the type of periodontal healing (inflammatory resorption/periodontitis apicalis; replacement resorption/ankylosis; normal healing). Mean lifetime of the replanted teeth was 59.2+/-42.5 months, estimated survival time on the basis of the Kaplan-Meier analysis was 99.5 months. 17 teeth (42.5%) were classified as failures, mostly due to inflammatory resorption or periodontitis apicalis. Further investigations demonstrated that success rate and retention period of intentionally replanted teeth depend on the preoperative condition of the pulp. Teeth with preoperative infection suffered frequently from inflammatory resorption or periodontitis apicalis after being replanted (14 of 28 teeth). Estimated survival time according to Kaplan-Meier was 75.5 months. In contrast, inflammations or progressive resorptions were not observed in teeth without preoperative infection of the pulp. All these 12 teeth showed normal periodontal healing and regular tooth mobility. In the absence of any pathology in clinical or radiological findings after an average functional period of 72.3 months, the prognosis can be presumed excellent. Estimated survival time of 148.3 months according to Kaplan-Meier differs significantly from survival time of teeth infected preoperatively. From the results of this investigation, it may be concluded that an infection of the pulp - due to delay of treatment or attempts at endodontic therapy - should be avoided before intentional replantation of immature front teeth with

  10. Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares Sobrevida después de accidentes de tránsito: impacto de las variables clínicas y pre hospitalarias Survival after motor vehicle crash: impact of clinical and prehospital variables

    Directory of Open Access Journals (Sweden)

    Marisa Aparecida Amaro Malvestio

    2008-08-01

    Full Text Available OBJETIVO: Analisar as variáveis clínicas e pré-hospitalares associadas à sobrevivência de vítimas de acidente de trânsito. MÉTODOS: Estudo realizado no município de São Paulo, SP, de 1999 a 2003. Foram analisados dados de 175 pacientes, entre 12 e 65 anos, vitimados por acidente de trânsito. A Análise de Sobrevivência de Kaplan-Meier foi utilizada na abordagem dos resultados na cena do acidente com as vítimas de escore OBJETIVO: Analizar las variables clínicas y pre hospitalarias asociadas a la sobrevida de víctimas de accidentes del tránsito. MÉTODOS: Estudio realizado en el municipio de São Paulo (Sudeste de Brasil, de 1999 a 2003. Fueron analizados datos de 175 pacientes, entre 12 y 65 años, victimas de accidentes de tránsito. El análisis de Sobrevida de Kaplan-Meier fue utilizado en el abordaje de los resultados en la escena del accidente con las víctimas de score OBJECTIVE: To assess clinical and prehospital variables associated with survival of motor vehicle crash victims. METHODS: Study carried out in the city of São Paulo (Southeastern Brazil, from 1999 to 2003. Data from 175 patients, who were aged between 12 and 65 years and had been motor vehicle crash victims, were analyzed. Kaplan-Meier Survival Analysis was used to approach the results at the accident scene with victims scoring <11, according to the Revised Trauma Score. Variables analyzed were: sex, age, injury mechanisms, basic and advanced support procedures, Revised Trauma Score parameters and fluctuations, time elapsed in the prehospital phase and trauma severity according to the Injury Severity Score and Maximum Abbreviated Injury Scale. RESULTS: Analysis revealed that victims who were less likely to survive during the hospitalization period showed serious lesions in the abdomen, thorax, or lower limbs, with negative fluctuation of respiratory frequency and Revised Trauma Score in the prehospital phase. In addition, they needed specialized

  11. Overexpression of Pofut1 and activated Notch1 may be associated with poor prognosis in breast cancer.

    Science.gov (United States)

    Wan, Guoxing; Tian, Lin; Yu, Yuandong; Li, Fang; Wang, Xuanbin; Li, Chen; Deng, Shouheng; Yu, Xiongjie; Cai, Xiaojun; Zuo, Zhigang; Cao, Fengjun

    2017-09-09

    The present study was to evaluate the prognostic value of protein expression of Pofut1 and Notch1 signaling in breast cancer. Formalin-fixed paraffin-embedded 314 breast specimens including 174 infiltrating ductal carcinoma(IDC), 50 ductal carcinoma in situ(DCIS) and 90 adjacent normal tissue(ANT) were immunohistochemically examined to evaluate the protein expression of Pofut1, activated Notch1(N1IC) and Slug on specimens. Survival analysis was performed by Kaplan-Meier method and Cox's proportional-hazards model. A online database was computationally used to further explore the prognostic role of Pofut1 and Notch1 mRNA expression by Kaplan-Meier Plotter. Pofut1, Slug and N1IC expression were significantly increased in IDC compared to ANT(all p < 0.05). High expression of Pofut1, Slug and N1IC were associated with tumor aggressiveness including lymph node metastasis (LNM: p = 0.005 for Pofut1, p < 0.001 for N1IC, p = 0.017 for Slug), advanced stage(p = 0.039 for Pofut1, p = 0.025 for N1IC) and higher histological grade(p = 0.001 for N1IC). Additionally, high expression of Pofut1 was found to be significantly associated with high expressions of N1IC and Slug in IDC(r = 0.244, p = 0.001; r = 0.374, p < 0.001, respectively), similar correlation was also observed between high N1IC and Slug expression(r = 0.496, p < 0.001). Moreover, Kaplan-Meier and Cox's regression analysis indicated the significant prognostic value of elevated Pofut1, N1IC, Slug expressions, positive LNM and advanced tumor stage for the prediction of a shorter disease-free survival (DFS) and overall survival(OS). The web-based analysis also suggested a significant association of high Pofut1 and Notch1 mRNA expression with worse survival outcome. Our findings suggested that overexpression of Pofut1 and activated Notch1 signaling may be associated with a poor prognosis in breast cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Glomalin: characteristics, production, limitations and contribution to soilsGlomalina: características, produção, limitações e contribuição nos solos

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    Carla Silva Sousa

    2012-12-01

    Full Text Available Glomalin is a hydrophobic, heat-stable, and recalcitrant glycoprotein produced by arbuscular mycorrhizal fungi. The glomalin is extracted from the hyphae or from the soil through the use of sodium citrate (20-50 mM; pH 7.0 or 8.0 at high temperature (121 °C and is quantified by ELISA or Bradford methods. Soil characteristics, climatic conditions, land use systems, agricultural practices, presence and type of vegetation, among other factors, influence the amount of glomalin produced by AMF. The ‘glue’ property of glomalin helps to fixate soil particles, favoring the formation of stable aggregates. Glomalin sequesters heavy metals, reducing the availability and the risk of toxicity of these elements for organisms and plants grown in polluted soils. Depending on the extraction procedure and the origin of the soil, between 28 to 45% dry weight of the glomalin molecule is carbon and 0.9 to 7.3% is nitrogen, representing up to 4 to 5% of total C and N of the soil. Despite the important contribution of glomalin, studies are needed to reformulate the extraction protocol and to identify its physiological function for the AMF, their stocks in different ecosystems, the organisms responsible for its decomposition and consumption, and the AMF species producing more of this protein in the soil. A glomalina é uma glicoproteína hidrofóbica, termoestável e recalcitrante produzida pelos fungos micorrízicos arbusculares. A glomalina é extraída das hifas ou do solo através do uso de citrato de sódio (20-50 mM; pH 7,0 ou 8,0 a elevada temperatura (121ºC, e quantificada pelos métodos Elisa ou Bradford. Acredita-se que características do solo, condições climáticas, sistema de uso do solo, práticas de manejo agrícola, presença e tipo de vegetação, dentre outros fatores, influenciam na quantidade de glomalina produzida pelos FMA. A propriedade de “cola” da glomalina auxilia a fixação das partículas do solo, favorecendo a formação de

  13. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis

    DEFF Research Database (Denmark)

    Reginster, Jean-Yves; Felsenberg, Dieter; Boonen, Steven;

    2008-01-01

    to receive either strontium ranelate at 2 gm/day or placebo for 5 years. The main efficacy criterion was the incidence of nonvertebral fractures. In addition, incidence of hip fractures was assessed, by post hoc analysis, in the subset of 1,128 patients who were at high risk of fractures (age 74 years...... or older with lumbar spine and femoral neck bone mineral density T scores -2.4 or less). The incidence of new vertebral fractures was assessed, using the semiquantitative method described by Genant, in the 3,646 patients in whom spinal radiography (a nonmandatory procedure) was performed during the course...... of the study. Fracture data were analyzed using the Kaplan-Meier survival method. RESULTS: Of the 5,091 patients, 2,714 (53%) completed the study up to 5 years. The risk of nonvertebral fracture was reduced by 15% in the strontium ranelate group compared with the placebo group (relative risk 0.85 [95...

  14. Long-term mortality in HIV-infected individuals 50 years or older

    DEFF Research Database (Denmark)

    Legarth, Rebecca; Ahlström, Magnus G; Kronborg, Gitte;

    2016-01-01

    , when compared to an individually-matched cohort from the background population. METHODS: Population-based cohort-study including HIV-infected individuals ≥ 50 years, who were alive one year after HIV-diagnosis (n=2,440) and a comparison cohort individually-matched by age and gender extracted from......BACKGROUND: Although the prevalence of HIV-infection among individuals ≥ 50 years of age has increased, the impact of HIV-infection on risk of death in this population remains to be established. Our aim was to estimate long-term mortality among HIV-infected individuals who were 50 years or older...... the background population (n=14,588). Cumulative survival was evaluated using Kaplan-Meier method and Mortality Rate Ratios (MRRs) were estimated using Cox Regression Models. Study period 1996-2014. RESULTS: Estimated median survival time from age 50 years for HIV-infected individuals increased from 11.8 years...

  15. Prognostic Factors in Patients with Pancreatic Carcinoma

    Institute of Scientific and Technical Information of China (English)

    HANYue; SUICheng-guang1; RUANZhi-ping

    2004-01-01

    To evaluate the major prognostic factors in patients with pancreatic carcinoma.Methods : 113 cases of a particular disease were retrospectively analysed and 9 factors for prognosis were studied by muitivaritate analysis with Cox proportional hazards survival model. Survival rate was calculated by Kaplan-Meier estimation. Results:In this group,survival time was 0.1 to 82 months,and the median survival time was 3 months.Overall survival rates at month 6,12,18,36 were 35.6%, 20.3%, 15.9% and 6.2%, respectively.Multivariate analyses revealed significant prognostic factors as follows:jaundice, metastasis, therapy method and synthetic therapy. Conchusion: The prognosis of pancreatic carcinoma is determined by various factors. Jaundice and metastasis are independent predictors of poor survival.Radical operation and synthetic therapy will improve the prognosis.

  16. EphA2/CD10/Bcl-6/MUM1 contributes to sub-classiifcation of diffuse large B cell lymphoma

    Institute of Scientific and Technical Information of China (English)

    Huang Xiaoyin; Wang Jiandong; Sun Qian; Fu Haijin; Guan Xiaoxiang; Wang Jinghua

    2013-01-01

    Objective:To investigate the clinical and prognostic signiifcance of EphA2 expression in diffuse large B-cell lymphoma (DLBCL). Methods:Immunohistochemistry for EphA2/CD10/Bcl-6/MUM-1 was performed on tissue sections from 51 patients diagnosed with DLBCL, and its correlation with clinicopathologic variables of patients was assessed using Pearson’s χ2 test or Fisher’s exact test when necessary. The survival was analyzed by Kaplan-Meier method. Results:High expression of EphA2 was detected in patients of lower clinical stage (P=0.001), better international prognostic index (IPI) score (P = 0.020) and germinal center B-cell (GCB) phenotype (P = 0.000). It was also correlated with the expression of CD10 (P = 0.001) and MUM-1 (P=0.001). Conclusion:EphA2/CD10/MUM1 might contribute to sub-classiifcation of DLBCL.

  17. Novel nomograms for survival and progression in HPV+ and HPV- oropharyngeal cancer

    DEFF Research Database (Denmark)

    Grønhøj Larsen, Christian; Jensen, David H; Carlander, Amanda-Louise Fenger

    2016-01-01

    on the largest-to-date, unselected, population-based cohort of patients diagnosed with OPSCC, we performed a comprehensive analysis of long-term OS, TTP, and SAP and constructed novel nomograms to evaluate patients' prognoses. RESULTS: At a median follow-up of 4.0 years (range: 0.8-15.8 yrs.), 690 deaths were......BACKGROUND: No study has combined tumour and clinical covariates for survival to construct an individual risk-profile for overall survival (OS), time to progression (TTP), and survival after progression (SAP) in patients with HPV+ and HPV- oropharyngeal squamous cell carcinoma (OPSCC). Based...... combined with p16 status remained one of the most informative covariates in the final Cox regression model for OS, TTP, and SAP. METHODS: We included all patients diagnosed with OPSCC (n = 1,542) between 2000-2014 in Eastern Denmark. Survival rates were estimated by the Kaplan-Meier method. A multivariate...

  18. Conditional survival of patients with diffuse large B-cell lymphoma

    DEFF Research Database (Denmark)

    Møller, Michael Boe; Pedersen, Niels Tinggaard; Christensen, Bjarne E

    2006-01-01

    a period of time after treatment. Conditional survival data have not been reported for lymphoma patients. METHODS: Conditional survival was estimated for 1209 patients with diffuse large B-cell lymphoma (DLBCL) from the population-based LYFO registry of the Danish Lymphoma Group. The Kaplan-Meier method...... was also significant at diagnosis, but 2 years after diagnosis only age had prognostic impact. Multivariate analysis of patients who survived > or = 3 years identified only age as a prognostic factor. CONCLUSION: For patients with DLBCL who have survived more than 1 year after diagnosis, the conditional......BACKGROUND: Prognosis of lymphoma patients is usually estimated at the time of diagnosis and the estimates are guided by the International Prognostic Index (IPI). However, conditional survival estimates are more informative clinically, as they consider those patients only who have already survived...

  19. Prognostic value of plasma C-reactive protein in the evaluation of paraquat poisoning patients

    Institute of Scientific and Technical Information of China (English)

    Zong NingΔ; Yu-Long BaiΔ; Hua Lu; Kang-Lin Mo

    2015-01-01

    Objective:To investigate the prognostic value of plasma C-reactive protein (CRP) level in patients with paraquat poisoning. Methods: This study included 162 patients with paraquat poisoning. The data of plasma paraquat,CRP level and arterial blood gas were analyzed. Cox regression analysis was applied to evaluate the risk factors of prognosis. Receiver operating characteristics curve analysis and area under curve were used to calculate the predictive power of significant variable. Differences in patient survival were determined using the Kaplan-Meier method and a log-rank test. Results:PlasmaCRP level was significantly increased in non-survival patients compared with survival patients (P Conclusions: These results suggest that plasmaCRP level is distinct increased in patients with paraquat poisoning, and the plasmaCRP level may be useful for the prediction of prognosis in paraquat poisoning.

  20. Expression of E-Cadherin in Oral Squamous Cell Carcinoma is Associated with Clinical Prognosis

    Institute of Scientific and Technical Information of China (English)

    Jianming Zhang; Wei Zhang; Ping Gao; Yanqiu Li; Changyi Li; Sakan Maeda

    2006-01-01

    OBJECTIVE To investigate the correlation of E-cadherin expression with clinicopathological parameters and prognosis of patients with oral squamous cell carcinoma.METHODS We examined the expression of the protein E-cadherin in 43 oral squamous cell carcinoma (SCC) surgical speciments by SABC immunohistochemistry.RESULTS There was a significant correlation between the level of Ecadherin expression and tumor stage (P=0.024), invasive pattern (P=0.009) and lymph node metastasis (P=0.023). No relation was found with age (P=0.084), sex (P=1.356) and differentiation (P=0.877). Using the Kaplan-Meier method we demonstrated that those cases which showed E-cadherin expression (-) or (+) had a significantly poorer prognosis compared those cases which showed expression (++) or (+++) (P= 0.0146).CONCLUSION E-cadherin, is an important indicator of clinical diagnoses and prognositic marker for oral SCC patients.

  1. Significance of age and comorbidity on treatment modality, treatment adherence, and prognosis in elderly ovarian cancer patients

    DEFF Research Database (Denmark)

    Jørgensen, Trine Lembrecht; Teiblum, Sandra; Paludan, Merete

    2012-01-01

    and comorbidity (ASA score) on receiving cytoreductive surgery and TC, and on adhering to TC. Kaplan-Meier method and Cox proportional hazards analysis were employed for survival analyses. RESULTS: Of 961 patients, 348 (36.2%) were elderly. Age ≥70years was independently predictive of not receiving surgery, OR 0......BACKGROUND: Age is associated with poor prognosis in ovarian cancer patients. Reasons could be increased comorbidity, more advanced stage, or nonoptimal surgery or chemotherapy. Objectives of this study were to evaluate the significance of comorbidity and age ≥70years on receiving cytoreductive...... surgery, standard combination chemotherapy (TC), adherence to TC treatment, and prognosis. METHODS: A retrospective cohort study of all women registered in a nation-wide database with ovarian or peritoneal cancer in 2005-2006. Logistic regression was employed for determining the predictive value of age...

  2. Breast conserving treatment of breast carcinoma T2 ({<=} 4 cm) and T3 by neoadjuvant chemotherapy, quadrantectomy, high dose rate brachytherapy as a boost, external beam radiotherapy and adjuvant chemotherapy: local control and overall survival analysis; Tratamento conservador do cancer de mama T2 ({<=} 4 cm) e T3 por quimioterapia neoadjuvante, quadrantectomia, braquiterapia com alta taxa de dose como reforco de dose, teleterapia complementar e quimioterapia adjuvante: analise de controle local e sobrevida global

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Celia Regina; Miziara Filho, Miguel Abrao; Fogaroli, Ricardo Cesar; Baraldi, Helena Espindola; Pellizzon, Antonio Cassio Assis; Pelosi, Edilson Lopes [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Radioterapia], e-mail: celiarsoares@terra.com.br; Fristachi, Carlos Elias [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Onco-Ginecologia e Mastologia; Paes, Roberto Pinto [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil)

    2008-12-15

    Objective: to assess the treatment of breast cancer T2 ({<=} 4 cm) and T3 through neoadjuvant chemotherapy, quadrantectomy and high dose rate brachytherapy as a boost, complementary radiotherapy and adjuvant chemotherapy, considering local control and overall survival. Material and method: this clinical prospective descriptive study was based on the evaluation of 88 patients ranging from 30 to 70 years old, with infiltrating ductal carcinoma, clinical stage IIb and IIIa, responsive to the neoadjuvant chemotherapy, treated from June/1995 to December/2006. Median follow-up was 58 months. Using clinical methods the tumor was evaluated before and after three or four cycles of chemotherapy based on anthracyclines. Overall survival and local control were assessed according to Kaplan-Meier methodology. Results: Local control and overall survival in five years were 90% and 73.5%, respectively. Conclusion: local control and overall survival were comparable to other forms of treatment. (author)

  3. First Danish single-institution experience with radical prostatectomy

    DEFF Research Database (Denmark)

    Vrang, Marie-Louise; Røder, Martin Andreas; Vainer, Ben

    2012-01-01

    OBJECTIVE: This study aimed to investigate the impact of positive surgical margins (PSMs), stratified by location and extension, on biochemical outcome after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: The study included data from 605 consecutive patients treated with RRP...... for localized prostate cancer. Patients with node-positive disease were excluded. Biochemical recurrence-free survival was calculated using the Kaplan-Meier method. Univariate and multivariate analysis was used to assess risk factors. RESULTS: The overall PSM rate was 35.4%. Eighty-three per cent (82.......7%) of these had a single PSM, whereas 17.3% of patients had two or more PSMs. Apical PSMs were present in 42.5% and non-apical in 57.5%. The presence of any PSM had a significant impact on the risk of biochemical recurrence (BR) [hazard ratio (HR) = 3.3, p

  4. Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia

    DEFF Research Database (Denmark)

    Ware, P; Bay-Nielsen, M; Juul, P

    2005-01-01

    BACKGROUND: According to a Cochrane review, laparoscopic inguinal hernia repair compares favourably with open mesh repair, but few data exist from surgical practice outside departments with a special interest in hernia surgery. This study compared nationwide reoperation rates after laparoscopic...... and Lichtenstein repair, adjusting for factors predisposing to recurrence. METHODS: Some 3606 consecutive laparoscopic repairs were compared with 39 537 Lichtenstein repairs that were prospectively recorded in a nationwide registry between 1998 and 2003. Patients were subgrouped according to type of hernia......: primary or recurrent and unilateral or bilateral. Overall reoperation rates and 95 per cent confidence intervals were calculated. Long-term reoperation rates were estimated using the Kaplan-Meier method. RESULTS: The overall reoperation rates after laparoscopic and Lichtenstein repair of unilateral...

  5. Urinary incontinence in the prediction of falls in hospitalized elderly

    Directory of Open Access Journals (Sweden)

    Hellen Cristina de Almeida Abreu

    2014-10-01

    Full Text Available Objective Analyzing the effect of urinary incontinence as a predictor of the incidence of falls among hospitalized elderly. Method Concurrent cohort study where 221 elderly inpatients were followed from the date of admission until discharge, death or fall. The Kaplan-Meier methods, the incidence density and the Cox regression model were used for the survival analysis and the assessment of the association between the exposure variable and the other variables. Results Urinary incontinence was a strong predictor of falls in the surveyed elderly, and was associated with shorter time until the occurrence of event. Urinary incontinence, concomitant with gait and balance dysfunction and use of antipsychotics was associated with falls. Conclusion Measures to prevent the risk of falls specific to hospitalized elderly patients who have urinary incontinence are necessary.

  6. Urinary incontinence in the prediction of falls in hospitalized elderly

    Directory of Open Access Journals (Sweden)

    Hellen Cristina de Almeida Abreu

    Full Text Available Objective Analyzing the effect of urinary incontinence as a predictor of the incidence of falls among hospitalized elderly. Method Concurrent cohort study where 221 elderly inpatients were followed from the date of admission until discharge, death or fall. The Kaplan-Meier methods, the incidence density and the Cox regression model were used for the survival analysis and the assessment of the association between the exposure variable and the other variables. Results Urinary incontinence was a strong predictor of falls in the surveyed elderly, and was associated with shorter time until the occurrence of event. Urinary incontinence, concomitant with gait and balance dysfunction and use of antipsychotics was associated with falls. Conclusion Measures to prevent the risk of falls specific to hospitalized elderly patients who have urinary incontinence are necessary.

  7. LINEAR REGRESSION MODEL ESTİMATİON FOR RIGHT CENSORED DATA

    Directory of Open Access Journals (Sweden)

    Ersin Yılmaz

    2016-05-01

    Full Text Available In this study, firstly we will define a right censored data. If we say shortly right-censored data is censoring values that above the exact line. This may be related with scaling device. And then  we will use response variable acquainted from right-censored explanatory variables. Then the linear regression model will be estimated. For censored data’s existence, Kaplan-Meier weights will be used for  the estimation of the model. With the weights regression model  will be consistent and unbiased with that.   And also there is a method for the censored data that is a semi parametric regression and this method also give  useful results  for censored data too. This study also might be useful for the health studies because of the censored data used in medical issues generally.

  8. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Bonde, Lisbeth; Sorensen, Rikke; Fosbøl, Emil Loldrup

    2010-01-01

    OBJECTIVES: We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). BACKGROUND: Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel...... is associated with absolute mortality reduction in AMI patients. METHODS: All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score...... with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan-Meier method and Cox regression analyses. RESULTS: We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n = 5,050) and a mean follow...

  9. Tumor Mutation Burden Forecasts Outcome in Ovarian Cancer with BRCA1 or BRCA2 Mutations

    DEFF Research Database (Denmark)

    Birkbak, Nicolai Juul; Kochupurakkal, Bose; Gonzalez-Izarzugaza, Jose Maria;

    2013-01-01

    Background: Increased number of single nucleotide substitutions is seen in breast and ovarian cancer genomes carrying disease-associated mutations in BRCA1 or BRCA2. The significance of these genome-wide mutations is unknown. We hypothesize genome-wide mutation burden mirrors deficiencies in DNA...... repair and is associated with treatment outcome in ovarian cancer. Methods and Results: The total number of synonymous and non-synonymous exome mutations (Nmut), and the presence of germline or somatic mutation in BRCA1 or BRCA2 (mBRCA) were extracted from whole-exome sequences of high-grade serous...... ovarian cancers from The Cancer Genome Atlas (TCGA). Cox regression and Kaplan-Meier methods were used to correlate Nmut with chemotherapy response and outcome. Higher Nmut correlated with a better response to chemotherapy after surgery. In patients with mBRCA-associated cancer, low Nmut was associated...

  10. Productivity limits and potentials of the principles of conservation agriculture.

    Science.gov (United States)

    Pittelkow, Cameron M; Liang, Xinqiang; Linquist, Bruce A; van Groenigen, Kees Jan; Lee, Juhwan; Lundy, Mark E; van Gestel, Natasja; Six, Johan; Venterea, Rodney T; van Kessel, Chris

    2015-01-15

    One of the primary challenges of our time is to feed a growing and more demanding world population with reduced external inputs and minimal environmental impacts, all under more variable and extreme climate conditions in the future. Conservation agriculture represents a set of three crop management principles that has received strong international support to help address this challenge, with recent conservation agriculture efforts focusing on smallholder farming systems in sub-Saharan Africa and South Asia. However, conservation agriculture is highly debated, with respect to both its effects on crop yields and its applicability in different farming contexts. Here we conduct a global meta-analysis using 5,463 paired yield observations from 610 studies to compare no-till, the original and central concept of conservation agriculture, with conventional tillage practices across 48 crops and 63 countries. Overall, our results show that no-till reduces yields, yet this response is variable and under certain conditions no-till can produce equivalent or greater yields than conventional tillage. Importantly, when no-till is combined with the other two conservation agriculture principles of residue retention and crop rotation, its negative impacts are minimized. Moreover, no-till in combination with the other two principles significantly increases rainfed crop productivity in dry climates, suggesting that it may become an important climate-change adaptation strategy for ever-drier regions of the world. However, any expansion of conservation agriculture should be done with caution in these areas, as implementation of the other two principles is often challenging in resource-poor and vulnerable smallholder farming systems, thereby increasing the likelihood of yield losses rather than gains. Although farming systems are multifunctional, and environmental and socio-economic factors need to be considered, our analysis indicates that the potential contribution of no-till to the sustainable intensification of agriculture is more limited than often assumed.

  11. Influence of Body Mass Index on Tumor Pathology and Survival in Uterine Cancer

    DEFF Research Database (Denmark)

    Kristensen, Anne Bjerrum; Hare-Bruun, Helle; Høgdall, Claus Kim;

    2016-01-01

    for uterine cancer or atypical endometrial hyperplasia (International Classification of Diseases-10 codes D070, DC549) 2005 to 2012 (n = 6003). MAIN OUTCOME MEASURES: Impact of BMI on type I and II endometrial cancer survival. MATERIALS AND METHODS: Danish Gynecological Cancer Database data on women with type......OBJECTIVE: To evaluate the influence of body mass index (BMI) on endometrial tumor pathology, stage and complication rate and to identify individual prognostic factors, such as BMI, in types I and II endometrial cancer. DESIGN: Register study included all Danish women who underwent surgery...... I and II endometrial cancer were retrieved. Kaplan-Meier plot was used to illustrate differences in survival in relation to BMI. Log-rank test was used to demonstrate difference between the curves. Cox regression hazard model was used to estimate hazard ratios (HR) of the effect of BMI on overall...

  12. Epidemiology of cryptosporidiosis among European AIDS patients

    DEFF Research Database (Denmark)

    Pedersen, C; Danner, S; Lazzarin, A;

    1996-01-01

    OBJECTIVE: To study epidemiology and possible risk factors associated with the development of cryptosporidiosis among European patients with AIDS. METHODS: An inception cohort of 6548 patients with AIDS, consecutively diagnosed from 1979 to 1989, from 52 centres in 17 European countries was studied....... Data on all AIDS defining events were collected retrospectively from patients' clinical records. Kaplan-Meier estimates, log rank tests and Cox proportional hazard models were used to examine for possible risk factors associated with cryptosporidiosis. RESULTS: Cryptosporidiosis was diagnosed in 432 (6.......6%) patients, 216 at time of the AIDS diagnosis and 216 during follow-up. The probability of being diagnosed with cryptosporidiosis at AIDS diagnosis was significantly lower for intravenous drug users (1.3%) than for homosexual men (4.1%) and for patients belonging to other transmission categories (4.0%) (p...

  13. Registry of Hospital das Clínicas of the University of São Paulo Medical School: first official solid organ and tissue transplantation report - 2008

    Directory of Open Access Journals (Sweden)

    Estela Azeka

    2009-02-01

    Full Text Available OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.

  14. Erythropoietin and erythropoietin receptor in hepatocellular carcinoma: correlation with vasculogenic mimicry and poor prognosis.

    Science.gov (United States)

    Yang, Zhihong; Sun, Baocun; Zhao, Xiulan; Shao, Bing; An, Jindan; Gu, Qiang; Wang, Yong; Dong, Xueyi; Zhang, Yanhui; Qiu, Zhiqiang

    2015-01-01

    To evaluate erythropoietin (Epo) and erythropoietin receptor (EpoR) expression, its relationship with vasculogenic mimicry (VM) and its prognostic value in human hepatocellular carcinoma (HCC), we examined Epo/EpoR expression and VM formation using immunohistochemistry and CD31/PAS (periodic acid-Schiff) double staining on 92 HCC specimens. The correlation between Epo/EpoR expression and VM formation was analyzed using two-tailed Chi-square test and Spearman correlation analysis. Survival curves were generated using Kaplan-Meier method. Multivariate analysis was performed using Cox regression model to assess the prognostic values. Results showed positive correlation between Epo/EpoR expression and VM formation (P age, Epo and EpoR were independent prognostic factors related to OS. These results will provide evidence for further research on HCC microcirculation patterns and also will provide new possible targets for HCC diagnosis and treatment.

  15. Smooth conditional distribution function and quantiles under random censorship.

    Science.gov (United States)

    Leconte, Eve; Poiraud-Casanova, Sandrine; Thomas-Agnan, Christine

    2002-09-01

    We consider a nonparametric random design regression model in which the response variable is possibly right censored. The aim of this paper is to estimate the conditional distribution function and the conditional alpha-quantile of the response variable. We restrict attention to the case where the response variable as well as the explanatory variable are unidimensional and continuous. We propose and discuss two classes of estimators which are smooth with respect to the response variable as well as to the covariate. Some simulations demonstrate that the new methods have better mean square error performances than the generalized Kaplan-Meier estimator introduced by Beran (1981) and considered in the literature by Dabrowska (1989, 1992) and Gonzalez-Manteiga and Cadarso-Suarez (1994).

  16. PAM50 breast cancer intrinsic subtypes and effect of gemcitabine in advanced breast cancer patients

    DEFF Research Database (Denmark)

    Jørgensen, Charlotte Levin Tykjær; Nielsen, Torsten O; Bjerre, Karsten D

    2014-01-01

    chemotherapy were analyzed by the Kaplan-Meier method, and Cox proportional hazards regression models. Data analysis was performed independently by the Danish Breast Cancer Cooperative Group (DBCG) statistical core and all statistical tests were two-sided. RESULTS: RNA from 270 patients was evaluable; 84...... by NanoString nCounter. Statistical analyses were prespecified as a formal prospective-retrospective clinical trial correlative study. Using time to progression (TTP) as primary endpoint, overall survival (OS) and response rate as secondary endpoints, relationships between subtypes and outcome after......: A significantly improved and clinically important prolongation of survival was seen from the addition of gemcitabine to docetaxel in advanced basal-like breast cancer patients....

  17. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery

    DEFF Research Database (Denmark)

    Platon, Anna Maria; Erichsen, Rune; Christiansen, Christian Fynbo;

    2014-01-01

    all patients undergoing CRC surgery in the period 2005-2011, identified through medical databases. We categorised the patients according to the history of COPD. We assessed the rate of complications within 30 days. We computed 30-day mortality among patients with/without COPD using the Kaplan......-Meier method. We used Cox regression to compute HRs for death, controlling for age, gender, type of admission, cancer stage, hospital volume, alcohol-related diseases, obesity and Charlson comorbidity score. RESULTS: We identified 18 302 CRC surgery patients. Of these, 7.9% had a prior diagnosis of COPD. Among...... patients with COPD, 16.1% were admitted postoperatively to the intensive care unit, 1.9% were treated with mechanical ventilation, and 3.6% were treated with non-invasive ventilation. In patients without COPD, the corresponding proportions were 9.7%, 1.1% and 1.1%. The reoperation rate was 10.6% among...

  18. Clinical correlation between myeloperoxidase and acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Jie Wang; Yanwei Xing; Changsheng Ma; Shihong Li; Zhizhong Li; Yonghong Gao; Yibing Nong

    2007-01-01

    Objective To study whether myeloperoxidase (MPO) can provide prognostic information in patients with acute coronary syndromes (ACS). Methods The study population consisted of 274 consecutive patients with ACS. All patients underwent coronary angiography which showed significant coronary artery disease and blood samples were collected at admission. Follow-ups were scheduled at 1, 3, and 6 months.The end point included cardiac death, acute myocardial infarction (MI), percutaneous or surgical revascularization. Results Patients with elevated MPO serum levels (MPO ≥ 72.2 AUU/L) were more likely to have diabetics and had a history of coronary events. Kaplan-Meier event rate curves with accumulative incidence of end point at 6-month follow-up in the MPO ≥ 72.2 AUU/L group was significantly higher than in MPO<72.2 AUU/L group. Conclusions MPO may be a powerful predictor of adverse outcome in patients with ACS.

  19. The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis

    DEFF Research Database (Denmark)

    Højgaard, Pil; Glintborg, Bente; Kristensen, Lars Erik

    2016-01-01

    (95% CI 1.7, 3.2) in obese vs 5.9 (4.1, 7.7) in non-obese patients (P obese vs 65% of non-obese patients after 6 months (P = 0.02). In multivariable analyses, obesity increased the risk of TNFI withdrawal [hazard ratio 1.6 (95......OBJECTIVES: To investigate the impact of obesity on response to the first TNF-α inhibitor (TNFI) treatment course in patients with PsA followed in routine care. METHODS: We performed an observational cohort study based on the Danish and Icelandic biologics registries. Kaplan-Meier plots, Cox...... and logistic regression analyses were performed to study the impact of obesity (BMI ⩾30 kg/m(2)) on TNFI adherence and response after 6 months (according to 20/50/70% improvement in ACR criteria and EULAR criteria). Subanalyses studied the impact of obesity according to gender, TNFI type and nationality...

  20. Cardiovascular risk factors and 5-year mortality in the Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Olsen, Tom Skyhøj

    2005-01-01

    analyses, adjustment for other factors and especially age revealed the lethal effect of smoking, while the positive effect of alcohol disappeared. More focus on secondary preventive measures, such as anticoagulation for AF, smoking cessation, and proper treatment of diabetes may significantly improve long...... population. METHODS: We studied 905 ischemic stroke patients from the community-based Copenhagen Stroke Study. Patients had a CT scan and stroke severity was measured by the Scandinavian Stroke Scale on admission. A comprehensive evaluation was performed by a standardized medical examination...... by Cox proportional hazards analyses adjusted for age, gender, stroke severity, and risk factor profile. RESULTS: In Kaplan-Meier analyses atrial fibrillation (AF), ischemic heart disease, diabetes, and previous stroke were associated with increased mortality, while smoking and alcohol intake were...

  1. Design and analysis of clinical trials in the presence of delayed treatment effect.

    Science.gov (United States)

    Sit, Tony; Liu, Mengling; Shnaidman, Michael; Ying, Zhiliang

    2016-05-20

    In clinical trials with survival endpoint, it is common to observe an overlap between two Kaplan-Meier curves of treatment and control groups during the early stage of the trials, indicating a potential delayed treatment effect. Formulas have been derived for the asymptotic power of the log-rank test in the presence of delayed treatment effect and its accompanying sample size calculation. In this paper, we first reformulate the alternative hypothesis with the delayed treatment effect in a rescaled time domain, which can yield a simplified sample size formula for the log-rank test in this context. We further propose an intersection-union test to examine the efficacy of treatment with delayed effect and show it to be more powerful than the log-rank test. Simulation studies are conducted to demonstrate the proposed methods. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Colorectal cancers detected through screening are associated with lower stages and improved survival

    DEFF Research Database (Denmark)

    Lindebjerg, Jan; Osler, Merete; Bisgaard, Claus Hedebo

    2014-01-01

    in the distribution of colon cancer stages and rectal cancer groups between the various screening categories were analysed through χ(2)-tests. Survival analysis with respect to screening groups was done by Kaplan-Meier and Cox-Mantel hazard ratios, and survival was corrected for lead time. RESULTS: Colon cancers......INTRODUCTION: Population screening for colorectal cancer (CRC) using faecal occult blood test (FOBT) will be introduced in Denmark in 2014. Prior to the implementation of the screening programme, a feasibility study was performed in 2005-2006. In this paper, occurrences of colorectal cancer...... in the feasibility study cohort were reviewed with respect to the effect of screening participation on stages and survival. MATERIAL AND METHODS: All cases of CRC in a feasibility study cohort diagnosed from the beginning of the study until two years after the study ended were identified. Differences...

  3. Survival benefit of early androgen receptor inhibitor therapy in locally advanced prostate cancer

    DEFF Research Database (Denmark)

    Thomsen, Frederik B; Brasso, Klaus; Christensen, Ib J

    2015-01-01

    -metastatic PCa. Kaplan-Meier analysis was used to estimate overall survival (OS) and multivariate Cox proportional hazard model was performed to analyse time-to-event (death). FINDINGS: A total of 1218 patients were included into the Scandinavian Prostate Cancer Group (SPCG)-6 study of which 607 were randomised......BACKGROUND: The optimal timing of endocrine therapy in non-metastatic prostate cancer (PCa) is still an issue of debate. METHODS: A randomised, double-blind, parallel-group trial comparing bicalutamide 150mg once daily with placebo in addition to standard care in patients with hormone-naïve, non...... disease (HR=1.19 (95% CI: 1.00-1.43), p=0.056). However, a survival gain from bicalutamide therapy was present in patients with localised disease and a baseline PSA greater than 28ng/mL at randomisation. In multivariate Cox proportional hazard model, only including patients managed on watchful waiting...

  4. Moderate precision of prognostic scoring systems in a consecutive, prospective cohort of 544 patients with metastatic spinal cord compression

    DEFF Research Database (Denmark)

    Morgen, Søren Schmidt; Nielsen, Dennis Hallager; Larsen, Claus Falck

    2014-01-01

    PURPOSE: Improved survival among cancer patients and diverse conclusions from recent studies make it relevant to reassess the performance of the Tokuhashi Revised score and the Tomita score. The aim of this study was to validate and compare these two scoring systems in a recent and unselected...... and compared to the observed survival. We assessed how precise the scoring systems predicted survival with McNemar's test. The prognostic value was illustrated with Kaplan-Meier curves, and the individual prognostic components were analyzed with Cox regression analysis. RESULTS: The mean age was 65 years...... cohort of patients with metastatic spinal cord compression (MSCC). METHODS: In 2011, we conducted a prospective cohort study of 544 patients who were consecutively admitted with MSCC to one treatment facility. Patients estimated survival were assessed with the Tokuhashi Revised score and the Tomita score...

  5. Association of versican turnover with all-cause mortality in patients on haemodialysis

    DEFF Research Database (Denmark)

    Genovese, Federica; Karsdal, Morten A; Leeming, Diana J

    2014-01-01

    patients with a 5-years follow-up, using a robust competitive enzyme-linked immunosorbent assays. Association between VCANM plasma concentration and survival was assessed by Kaplan-Meier analysis and adjusted Cox model. RESULTS: Haemodialysis patients with plasma VCANM concentrations in the lowest quartile...... had increased risk of death (odds ratio, as compared to the highest quartile: 7.1, psurvival of 152 days compared to 1295 days for patients with plasma VCANM in the highest quartile. Multivariate analysis showed that low VCANM (p... with cardiovascular diseases. The objective of the study was to investigate the association of versican turnover assessed in plasma with survival in haemodialysis patients. METHODS: A specific matrix metalloproteinase-generated neo-epitope fragment of versican (VCANM) was measured in plasma of 364 haemodialysis...

  6. Treatment of opioid overdose in a physician-based prehospital EMS: Frequency and long-term prognosis

    DEFF Research Database (Denmark)

    Nielsen, K.; Nielsen, S.L.; Siersma, Volkert Dirk

    2011-01-01

    BACKGROUND: Prehospital treatment of opioid overdose accounts for a significant proportion of the workload of the emergency system in most major cities. Treatment consists of basic life support and administering naloxone. In our physician-manned mobile emergency care unit (MECU), most patients...... are released and not admitted to hospital. In this study, we aimed to assess the pattern in the number of episodes with opioid overdose treated by MECU in Copenhagen during a 10-year period and to investigate risk factors for mortality of these patients beyond the initial contact. METHODS: Data were collected...... prospectively in the MECU database covering all cases of opioid overdose in a 10-year period between 1994 and 2003. The pattern in the number of opioid overdose was analysed in Poisson regression models, and mortality was analysed in Kaplan-Meier plots and in Cox regression models. RESULTS: A total of 4762...

  7. Stavudine- and nevirapine-related drug toxicity while on generic fixed-dose antiretroviral treatment: incidence, timing and risk factors in a three-year cohort in Kigali, Rwanda.

    Science.gov (United States)

    van Griensven, Johan; Zachariah, Rony; Rasschaert, Freya; Mugabo, Jules; Atté, Edi F; Reid, Tony

    2010-02-01

    This cohort study was conducted to report on the incidence, timing and risk factors for stavudine (d4T)- and nevirapine (NVP)-related severe drug toxicity (requiring substitution) with a generic fixed-dose combination under program conditions in Kigali, Rwanda. Probability of 'time to first toxicity-related drug substitution' was estimated using the Kaplan-Meier method and Cox-proportional hazards modeling was used to identify risk factors. Out of 2190 adults (median follow-up: 1.5 years), d4T was replaced in 175 patients (8.0%) for neuropathy, 69 (3.1%) for lactic acidosis and 157 (7.2%) for lipoatrophy, which was the most frequent toxicity by 3 years of antiretroviral treatment (ART). NVP was substituted in 4.9 and 1.3% of patients for skin rash and hepatotoxicity, respectively. Use of d4T 40 mg was associated with increased risk of lipoatrophy and early (strategies.

  8. Soluble urokinase plasminogen activator receptor as a prognostic marker in men participating in prostate cancer screening

    DEFF Research Database (Denmark)

    Kjellman, A; Akre, O; Gustafsson, O;

    2011-01-01

    with prostate cancer and cardiovascular disease mortality. METHODS: Using time-resolved fluorescence immunoassays, we measured intact suPAR [suPAR(I-III)] and intact plus cleaved suPAR [suPAR(I-III) + suPAR(II-III)] and thus calculated the amount of suPAR(II-III) in serum samples from 375 men participating...... cardiovascular disease. No similar association was found for prostate cancer after adjustment for other prognostic factors....... in a prostate cancer screening trial. A total of 312 men were free of prostate cancer and 63 men had prostate cancer diagnosed at the time of screening. The cohort was followed for 15 years. We assessed survival using Kaplan-Meier estimation and Cox proportional hazards regression. RESULTS: The mean age...

  9. Association between poor clinical prognosis and sleep duration among breast cancer patients

    Directory of Open Access Journals (Sweden)

    Thalyta Cristina Mansano-Schlosser

    Full Text Available ABSTRACT Objective: to investigate the association between clinical progression and the quality and duration of sleep in women with breast cancer. Method: longitudinal study, with 114 participants, conducted in a hospital in Brazil. The instruments used were: questionnaire for sociodemographic and clinical characterization, Pittsburgh Sleep Quality Index; Beck Depression Inventory and Herth Hope Scale. Data were analyzed through descriptive statistics and survival analyses (outcome: poor clinical progression, using the Kaplan-Meier curve, Log-rank test and Cox proportional model. Results: a higher probability of poor clinical progression was verified in women with sleep durations of less than six hours or nine hours and over (p=.0173. Conclusion: the results suggest the importance of further studies that seek to verify whether the quantitative management of sleep disorders would have an impact on the progression of breast cancer. Women should be encouraged to report sleep problems to nurses.

  10. A population-based, incidence cohort study of mid-back pain after traffic collisions

    DEFF Research Database (Denmark)

    Johansson, M S; Boyle, E; Hartvigsen, Jan

    2015-01-01

    data from a population-based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2-year period were used. Annual overall and age-sex-specific incidence rates were calculated, the course of recovery was described using the Kaplan-Meier technique, and associations between......, depression or others) has been investigated previously; however, knowledge about traffic collision-related MBP is lacking. The study objectives were to describe the incidence, course of recovery and prognosis of MBP after traffic collisions, in terms of global self-reported recovery. METHODS: Longitudinal...... participant characteristics and time-to-self-reported recovery were explored in 3496 MBP cases using Cox proportional hazards models. RESULTS: The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time-to-first reported...

  11. Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children

    DEFF Research Database (Denmark)

    Desmonde, Sophie; Dicko, Fatoumata; Koueta, Fla

    2014-01-01

    OBJECTIVE: We describe the association between age at antiretroviral therapy (ART) initiation and 24-month CD4 cell response in West African HIV-infected children. METHODS: All HIV-infected children from the IeDEA paediatric West African cohort, initiating ART, with at least two CD4 cell count...... measurements, including one at ART initiation (baseline) were included. CD4 cell gain on ART was estimated using a multivariable linear mixed model adjusted for baseline variables: age, CD4 cell count, sex, first-line ART regimen. Kaplan-Meier survival curves and a Cox proportional hazards regression model...... compared immune recovery for age within 24 months post-ART. RESULTS: Of the 4808 children initiated on ART, 3014 were enrolled at a median age of 5.6 years; 61.2% were immunodeficient. After 12 months, children at least 4 years at baseline had significantly lower CD4 cell gains compared with children less...

  12. Implications of a positive sentinel node in oral squamous cell carcinoma

    DEFF Research Database (Denmark)

    Gurney, Benjamin A S; Schilling, Clare; Putcha, Venkata;

    2012-01-01

    BACKGROUND: The role of sentinel node biopsy in head and neck cancer is currently being explored. Patients with positive sentinel nodes were investigated to establish if additional metastases were present in the neck, their distribution, and their impact on outcome. METHODS: In all, 109 patients (n...... = 109) from 15 European centers, with cT1/2,N0 tumors, and a positive sentinel lymph node were identified. Kaplan-Meier and univariate and multivariate logistic regression analysis were used to identify variables that predicted for additional positive nodes and their position within the neck. RESULTS......: A total of 122 neck dissections were performed in 109 patients. Additional positive nodes were found in 34.4% of cases (42/122: 18 same, 21 adjacent, and 3 nonadjacent neck level). Additional nodes, especially if outside the sentinel node basin, had an impact on outcome. CONCLUSIONS: The results...

  13. Epilepsy in Rett syndrome--lessons from the Rett networked database

    DEFF Research Database (Denmark)

    Nissenkorn, Andreea; Levy-Drummer, Rachel S; Bondi, Ori

    2015-01-01

    OBJECTIVE: Rett syndrome is an X-linked dominant neurodevelopmental disorder caused by mutations in the MECP2 gene, and characterized by cognitive and communicative regression, loss of hand use, and midline hand stereotypies. Epilepsy is a core symptom, but literature is controversial regarding...... genotype-phenotype correlation. Analysis of data from a large cohort should overcome this shortcoming. METHODS: Data from the Rett Syndrome Networked Database on 1,248 female patients were included. Data on phenotypic and genotypic parameters, age of onset, severity of epilepsy, and type of seizures were...... collected. Statistical analysis was done using the IBM SPSS Version 21 software, logistic regression, and Kaplan-Meier survival curves. RESULTS: Epilepsy was present in 68.1% of the patients, with uncontrolled seizures in 32.6% of the patients with epilepsy. Mean age of onset of epilepsy was 4...

  14. Usage of Calendula officinalis in the prevention and treatment of radiodermatitis: a randomized double-blind controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Franciane Schneider

    2015-04-01

    Full Text Available OBJECTIVE To evaluate the efficacy of Calendula officinalis in relation to Essential Fatty Acids for the prevention and treatment of radiodermatitis. METHOD This is a randomized double-blind controlled clinical trial with 51 patients with head and neck cancer in radiotherapy treatment divided into two groups: control (27 and experimental (24. RESULTS There is statistically significant evidence (p-value = 0.0120 that the proportion of radiodermatitis grade 2 in Essential Fatty Acids group is higher than Calendula group. Through the Kaplan-Meier survival curve we observed that Essential Fatty Acids group has always remained below the Calendula group survival curve, due to the lower risk of developing radiodermatitis grade 1, which makes the usage of Calendula more effective, with statistical significance (p-value = 0.00402. CONCLUSION Calendula showed better therapeutic response than the Essential Fatty Acids in the prevention and treatment of radiodermatitis. Brazilian Registry of Clinical Trials: RBR-237v4b.

  15. Treatment-dependent and treatment-independent risk factors associated with the risk of diabetes-related events

    DEFF Research Database (Denmark)

    Wilke, Thomas; Mueller, Sabrina; Groth, Antje

    2015-01-01

    BACKGROUND: The aim of this study was to analyse which factors predict the real-world macro-/microvascular event, hospitalisation and death risk in patients with type 2 diabetes mellitus. Furthermore, we aimed to investigate whether there exists both an under- and over-treatment risk...... of these patients. METHODS: We used a German claims/clinical data set covering the years 2010-12. Diabetes-related events were defined as (1) macro-, (2) microvascular events leading to inpatient hospitalisation, (3) other hospitalisations with type 2 diabetes mellitus as main diagnosis, (4) all-cause death and (5......) a composite outcome including all event categories 1-4. Factors associated with event risk were analysed by a Kaplan-Meier curve analysis and by multivariable Cox regression models. RESULTS: 229,042 patients with type 2 diabetes mellitus (mean age 70.2 years; mean CCI 6.03) were included. Among factors...

  16. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer.

    Science.gov (United States)

    Honda, Keigo; Asato, Ryo; Tsuji, Jun; Miyazaki, Masakazu; Kada, Shinpei; Tsujimura, Takashi; Kataoka, Michiko

    2017-09-01

    Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. Preserving cervical nerves in neck dissection is oncologically safe in selected cases. © 2017 Wiley Periodicals, Inc.

  17. Effects of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated P. carinii pneumonia

    DEFF Research Database (Denmark)

    Helweg-Larsen, J; Benfield, Thomas; Eugen-Olsen, Jesper

    1999-01-01

    BACKGROUND: Sulpha drugs are widely used for the treatment and long-term prophylaxis of Pneumocystis carinii pneumonia (PCP) in HIV-1-infected individuals. Sulpha resistance in many microorganisms is caused by point mutations in dihydropteroate synthase (DHPS), an enzyme that is essential...... for folate biosynthesis. We assessed whether mutations in the DHPS gene of P. carinii were associated with exposure to sulpha drugs and influenced outcome from PCP. METHODS: We studied bronchoalveolar samples collected in 1989-99 from a prospective cohort of HIV-1-infected patients who had PCP. In 144...... patients with 152 episodes of PCP, we analysed portions of DHPS using PCR and direct sequencing. The relation between survival, P. carinii DHPS mutations, and other predictors of treatment failure was assessed by Kaplan-Meier and multivariate Cox regression analysis. FINDINGS: P. carinii DHPS mutations...

  18. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent;

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...... of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders. MAIN OUTCOME MEASURES: Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy. RESULTS: The cumulative...

  19. Survival after radical prostatectomy for clinically localised prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Brasso, Klaus; Christensen, Ib Jarle

    2013-01-01

    hazard of all-cause and prostate cancer-specific mortality after 10 years was 15.4% (95% confide3nce interval [CI] 13.2-17.7) and 6.6% (95% CI 4.9-8.2) respectively. CONCLUSIONS: We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer......OBJECTIVES: To describe survival and cause of death in a nationwide cohort of Danish patients with prostate cancer undergoing radical prostatectomy (RP). To describe risk factors associated with prostate cancer mortality. PATIENTS AND METHODS: Observational study of 6489 men with localised prostate...... cancer treated with RP at six different hospitals in Denmark between 1995 and 2011. Survival was described using Kaplan-Meier estimates. Causes of death were obtained from the national registry and cross-checked with patient files. Cumulative incidence of death, any cause and prostate cancer...

  20. MRI and SPECT findings as a predictive factor for postencephalitic epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Mizobuchi, Masahiro; Tanaka, Chiharu; Sako, Kazuya; Murakami, Nobuto; Nihira, Atsuko [Nakamura Memorial Hospital, Sapporo (Japan)

    2000-04-01

    Relationship between postencephalitic epilepsy and acute phase symptoms, CSF, EEG and MRI findings was assessed by Kaplan-Meier method. Thirteen of 34 patients manifestated epilepsy including four intractable cases. Women (7/11), herpes simplex virus (6/7), seizures in acute phase (12/18), abnormal findings or MRI (6/7) were statistically significant. Four of nine patients with hyperperfusion area by HMPAO-SPECT in acute phase and two of three patients with hypoperfusion area by IMP-SPECT in recovery phase had epilepsy. Hyperperfusion in acute phase reflected acute seizures and inflammations, whereas hypoperfusion in the recovery phase reflected hypometabolism caused by brain damage. These findings suggest epileptogenicity, MRI and SPECT findings may predict prognosis of postencephalitic epilepsy. (author)

  1. Incidence of and survival from oligodendroglioma in Denmark, 1943-2002

    DEFF Research Database (Denmark)

    Nielsen, Malene Schjønning; Christensen, Helle Collatz; Kosteljanetz, Michael;

    2008-01-01

    case per 100,000 person-years, but varied somewhat when viewed across isolated periods. Comparison of the incidence rate before and after the introduction of CT scanning did not reveal a significant difference in the incidence rate. The median survival increased from 1.4 years (95% confidence interval......,304 cases of oligodendroglioma were included in the study. We calculated sex- and age-specific incidence rates in 5-year age intervals and for 5-year calendar periods. Overall survival was estimated by the Kaplan-Meier method. In the period 1943-2002, the incidence rate of oligodendroglioma was less than 1......We established the nationwide, population-based incidence of oligodendroglioma in Denmark during 59 years of monitoring and compared the overall survival of patients with oligodendroglial tumors during the periods 1943-1977 and 1978-2002. On the basis of reports in the Danish Cancer Registry, 1...

  2. Fatigue, General Health, and Ischemic Heart Disease in Older Adults

    DEFF Research Database (Denmark)

    Ekmann, Anette; Petersen, Inge; Mänty, Minna Regina

    2013-01-01

    Backgrounds.Fatigue has been shown to predict ischemic heart disease (IHD) and mortality in nonsmoking middle-aged men free of cardiovascular disease. The aim of this study was to investigate the predictive value of fatigue for IHD and general health in nondisabled individuals free...... of cardiovascular disease and older than 70 years. METHODS: The study population was drawn from The Longitudinal Study of Aging Danish Twins. In total, 1,696 participants were followed up for 2-10 years by questionnaires and 10-16 years through registries. Kaplan Meier, Cox Proportional Hazard and logistic......-related diagnoses, no use of heart medication, sustained good mobility, and participation at follow-up. IHD was defined as first hospitalization due to IHD (ICD10: I20-I25) or death due to IHD as primary cause. RESULTS: Participants without fatigue had higher chances of a sustained good general health at 2 (odds...

  3. Epidemiology of cryptosporidiosis among European AIDS patients

    DEFF Research Database (Denmark)

    Pedersen, C; Danner, S; Lazzarin, A

    1996-01-01

    OBJECTIVE: To study epidemiology and possible risk factors associated with the development of cryptosporidiosis among European patients with AIDS. METHODS: An inception cohort of 6548 patients with AIDS, consecutively diagnosed from 1979 to 1989, from 52 centres in 17 European countries was studied....... Data on all AIDS defining events were collected retrospectively from patients' clinical records. Kaplan-Meier estimates, log rank tests and Cox proportional hazard models were used to examine for possible risk factors associated with cryptosporidiosis. RESULTS: Cryptosporidiosis was diagnosed in 432 (6.......6%) patients, 216 at time of the AIDS diagnosis and 216 during follow-up. The probability of being diagnosed with cryptosporidiosis at AIDS diagnosis was significantly lower for intravenous drug users (1.3%) than for homosexual men (4.1%) and for patients belonging to other transmission categories (4.0%) (p...

  4. Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir

    DEFF Research Database (Denmark)

    Kirk, O; Mocroft, A; Pradier, C

    2001-01-01

    -up within the EuroSIDA study. METHODS: Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical...... progression (new AIDS/death). Adjustment was made for differences in baseline parameters, in particular pVL, CD4 cell count, and region of Europe. RESULTS: A total of 2708 patients (median follow-up: 30 months) were included, of which 556 started ritonavir (21%), 1342 indinavir (50%), and 810 saquinavir hgc......OBJECTIVE: To compare the clinical response among patients who initiate protease inhibitor therapies with different virological potency. DESIGN: We analysed patients who started indinavir, ritonavir or saquinavir hard gel capsule (hgc) as part of at least triple therapy during prospective follow...

  5. CCL7 and CCL21 overexpression in gastric cancer is associated with lymph node metastasis and poor prognosis

    Institute of Scientific and Technical Information of China (English)

    Tsann-Long Hwang; Li-Yu Lee; Chee-Chan Wang; Ying Liang; Shu-Fang Huang; Chi-Ming Wu

    2012-01-01

    AIM:TO investigate how a complex network of CC chemokine ligands (CCLs) and their receptors influence the progression of tumor and metastasis.METHODS:In the present study,we used immunohistochemistry to examine the expression of CCL7,CCL8 and CCL21 in 194 gastric cancer samples and adjacent normal tissues.We analyzed their correlation with tumor metastasis,clinicopathologic parameters and clinical outcome.RESULTS:We found that the higher expression of CCL7 and CCL21 in cancer tissues than in normal tissues was significantly correlated with advanced depth of wall invasion,lymph node metastasis and higher tumor node metastasis stage.Moreover,Kaplan-Meier survival analysis revealed that CCL7 and CCL21 overexpression in cancer tissues was correlated with poor prognosis.CONCLUSION:These results suggest that overexpression of these two CC chemokine ligands is associated with tumor metastasis and serves as a prognostic factor in patients with gastric cancer.

  6. Long-term clinical outcomes following the use of synthetic hydroxyapatite and bone graft in impaction in revision hip arthroplasty.

    Science.gov (United States)

    Aulakh, Tajeshwar S; Jayasekera, Narlaka; Kuiper, Jan-Herman; Richardson, James B

    2009-03-01

    Impaction grafting using morsellised allograft bone restores bone stock, but carries the potential for transmission of infection. Synthetic bone graft substitutes can eliminate this risk but may, however, influence outcome. In this study we tested the hypothesis that a 50/50 mix of hydroxyapatite and allograft does not affect long-term function, survival or radiological outcome. Sixty-five patients had revision hip arthroplasty using impaction grafting with either pure allograft (42 patients) or a 50/50 mixture of allograft and solid particulate hydroxyapatite. Harris hip scores were assessed pre-operatively and annual intervals thereafter. Function was analyzed using multilevel modeling, the Kaplan-Meier method used for survival analysis and graft incorporation was assessed radiologically. The hip score improved in both groups but showed a small annual decline (average 1.2/year, plong-term prosthesis survival and function following revision arthroplasty with a 50/50 mixture of allograft and hydroxyapatite are comparable to allograft alone.

  7. The cachexia clinic: from staging to managing nutritional and functional problems in advanced cancer patients.

    Science.gov (United States)

    Vigano, Antonio; Del Fabbro, Egidio; Bruera, Eduardo; Borod, Manuel

    2012-01-01

    Panels of experts have agreed on the definition of cancer cachexia stages (CCS). We evaluated the clinical relevance of these stages and proposed ways to apply the CCSs to the clinical practice via standardized methods. The CCS were applied to 207 patients with advanced non-small-cell lung or gastrointestinal cancers from the Human Cancer Cachexia Database via consensus among the coauthors. Patients were categorized as noncachectic, precachectic, cachectic, and in refractory cachexia. Through analysis of variance, χ2, and Kaplan-Meier analyses, we tested the relationships between CCSs and selected outcomes. The CCS were significantly correlated (P model for diagnosing more precisely the pathophysiology and severity of precachectic and cachectic conditions. The cachexia clinic, by working closely with palliative care programs, may offer the best environment for a comprehensive and personalized approach to the nutritional and functional problems in advanced cancer patients.

  8. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities...... of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders. MAIN OUTCOME MEASURES: Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy. RESULTS: The cumulative...

  9. Right-Censored Nonparametric Regression: A Comparative Simulation Study

    Directory of Open Access Journals (Sweden)

    Dursun Aydın

    2016-11-01

    Full Text Available This paper introduces the operating of the selection criteria for right-censored nonparametric regression using smoothing spline. In order to transform the response variable into a variable that contains the right-censorship, we used the KaplanMeier weights proposed by [1], and [2]. The major problem in smoothing spline method is to determine a smoothing parameter to obtain nonparametric estimates of the regression function. In this study, the mentioned parameter is chosen based on censored data by means of the criteria such as improved Akaike information criterion (AICc, Bayesian (or Schwarz information criterion (BIC and generalized crossvalidation (GCV. For this purpose, a Monte-Carlo simulation study is carried out to illustrate which selection criterion gives the best estimation for censored data.

  10. Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir

    DEFF Research Database (Denmark)

    Kirk, O; Mocroft, A; Pradier, C;

    2001-01-01

    OBJECTIVE: To compare the clinical response among patients who initiate protease inhibitor therapies with different virological potency. DESIGN: We analysed patients who started indinavir, ritonavir or saquinavir hard gel capsule (hgc) as part of at least triple therapy during prospective follow.......62--1.11); P = 0.20. CONCLUSIONS: Saquinavir hgc was associated with an inferior long-term clinical response relative to indinavir, which was consistent with the observed differences in virological and immunological responses.......-up within the EuroSIDA study. METHODS: Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical...

  11. The mortality after surgery in primary lung cancer

    DEFF Research Database (Denmark)

    Green, Anders; Hauge, Jacob; Iachina, Maria

    2015-01-01

    OBJECTIVES: The study has been performed to investigate the mortality within the first year after resection in patients with primary lung cancer, together with associated prognostic factors including gender, age, tumour stage, comorbidity, alcohol abuse, type of surgery and post......-surgical complications. METHODS: All patients (n = 3363) from the nationwide Danish Lung Cancer Registry with first resection performed between 1 January 2007 and 31 December 2011 were analysed by Kaplan-Meier techniques and Cox-regression analysis concerning death within the first year after resection. Covariates....... Low stage, female gender, young age, no comorbidity, no postoperative complications, no alcohol abuse and lobectomy as type of resection were favourable for survival. CONCLUSIONS: Our results demonstrate that resection in primary lung cancer impacts mortality far beyond the initial 30 days after...

  12. Durability of initial antiretroviral therapy in a resource-constrained setting and the potential need for zidovudine weight-based dosing.

    Science.gov (United States)

    Willig, James H; Echevarria, Juan; Westfall, Andrew O; Iglesias, David; Henostroza, German; Seas, Carlos; Mugavero, Michael J; Allison, Jeroan; Paz, Jorge; Hernandez, Fiorella; Tomatis, Cristina; Saag, Michael S; Gotuzzo, Eduardo

    2010-02-01

    Whereas access to antiretroviral therapy (ART) for HIV-infected individuals in the developing world is increasing, data on factors impacting initial regimen durability are lacking. Retrospective review patients starting initial ART at Instituto de Medicine Tropical (Lima, Peru) April 1, 2004 to December 30, 2007. Survival methods (Kaplan-Meier, Cox proportional hazard) assessed factors associated with regimen durability including an interaction term between nucleoside reverse transcriptase inhibitor backbone and time. Decreased initial regimen durability was observed with weight 70 kg. An increased risk of early toxicity-related discontinuation of AZT-containing regimens was observed for baseline weight 120 days) lowered hazards for regimen discontinuation. Weight <60 kg was associated with an increased risk of toxicity-related AZT discontinuation. As ART use expands globally, further study into maximally durable, least toxic regimens, and the role of weight-based AZT dosing is imperative.

  13. CNS infections in Greenland

    DEFF Research Database (Denmark)

    Nordholm, Anne Christine; Søborg, Bolette; Andersson, Mikael

    2017-01-01

    BACKGROUND: Indigenous Arctic people suffer from high rates of infectious diseases. However, the burden of central nervous system (CNS) infections is poorly documented. This study aimed to estimate incidence rates and mortality of CNS infections among Inuits and non-Inuits in Greenland...... and in Denmark. METHODS: We conducted a nationwide cohort study using the populations of Greenland and Denmark 1990-2012. Information on CNS infection hospitalizations and pathogens was retrieved from national registries and laboratories. Incidence rates were estimated as cases per 100,000 person......-years. Incidence rate ratios were calculated using log-linear Poisson-regression. Mortality was estimated using Kaplan-Meier curves and Log Rank test. RESULTS: The incidence rate of CNS infections was twice as high in Greenland (35.6 per 100,000 person years) as in Denmark (17.7 per 100,000 person years...

  14. A population-based study of survival and discharge status for survivors after head injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Teasdale, T W

    2004-01-01

    OBJECTIVES: Creation of a basis for the planning of rehabilitation after head injury in Denmark. MATERIALS AND METHODS: Patients with cranial fractures or traumatic cerebral lesions occurring in Denmark in 1979-93 were identified by computerized searches in the national hospital register. Kaplan......-Meier survival functions were calculated for these two categories. Hospital records for a random sample of 389 survivors in 1997 after cranial fracture, acute brain lesion or chronical subdural haematoma, which occurred in 1982, 1987 and 1992 in patients aged 15 years or more at injury, were reviewed. Survivors...... were characterized by age, gender, place and severity of injury, as well as neurophysical, speech and mental deficits at discharge from hospital. RESULTS: Acute/subacute mortality of hospitalized patients was 27% for cerebral lesions and 4% after cranial fracture. As attrition by death outweighed...

  15. Surgical Revision after Sacroiliac Joint Fixation or Fusion

    Science.gov (United States)

    Holt, Timothy

    2017-01-01

    Background Minimally invasive sacroiliac joint (SIJ) fusion has been shown to be safe and effective for the treatment of SIJ dysfunction. Multiple devices are available to perform SIJ fixation or fusion. Surgical revision rates after these procedures have not been directly compared. Methods We retrospectively identified all patients in our practice who underwent SIJ fixation or fusion between 2003 and 2015. Using both chart review and focused contact with individual patients, we determined the likelihood of surgical revision. Revision rates were compared using Kaplan-Meier survival analysis. Results Thirty-eight patients underwent SIJ fixation with screws and 274 patients underwent SIJ fusion using triangular titanium implants. Four-year cumulative revision rates were 30.8% for fixation and 5.7% for fusion. Conclusions In our study, SIJ fixation with screws had a much higher revision rate compared to SIJ fusion with triangular titanium implants designed for bone adherence.

  16. Systemic inflammation worsens outcomes in emergency surgical patients.

    Science.gov (United States)

    Becher, Robert D; Hoth, J Jason; Miller, Preston R; Meredith, J Wayne; Chang, Michael C

    2012-05-01

    Acute care surgeons are uniquely aware of the importance of systemic inflammatory response and its influence on postoperative outcomes; concepts like damage control have evolved from this experience. For surgeons whose practice is mostly elective, the significance of such systemic inflammation may be underappreciated. This study sought to determine the influence of preoperative systemic inflammation on postoperative outcome in patients requiring emergent colon surgery. Emergent colorectal operations were identified in the American College of Surgeons National Surgical Quality Improvement Program 2008 dataset. Four groups were defined by the presence and magnitude of the inflammatory response before operation: no inflammation, systemic inflammatory response syndrome (SIRS), sepsis, or severe sepsis/septic shock. Thirty-day survival was analyzed by Kaplan-Meier method. A total of 3,305 patients were identified. Thirty-day survival was significantly different (p SIRS was 1.9 (p SIRS or sepsis patients, operations surgery. II, prognostic study.

  17. Fitness for Entering a Simple Exercise Program and Mortality: A Study Corollary to the Exercise Introduction to Enhance Performance in Dialysis (Excite Trial

    Directory of Open Access Journals (Sweden)

    Rossella Baggetta

    2014-07-01

    Full Text Available Background/Aims: In this corollary analysis of the EXCITE study, we looked at possible differences in baseline risk factors and mortality between subjects excluded from the trial because non-eligible (n=216 or because eligible but refusing to participate (n=116. Methods: Baseline characteristics and mortality data were recorded. Survival and independent predictors of mortality were assessed by Kaplan-Meier and Cox regression analyses. Results: The incidence rate of mortality was higher in non-eligible vs. eligible non-randomized patients (21.0 vs. 10.9 deaths/100 persons-year; PConclusions: Deambulation ability mostly explains the difference in survival rate in non-eligible and eligible non-randomized patients in the EXCITE trial. Extending data analyses and outcome reporting also to subjects not taking part in a trial may be helpful to assess the representability of the study population.

  18. Post-operative breast cancer patients diagnosed with skeletal metastasis without bone pain had fewer skeletal-related events and deaths than those with bone pain

    Directory of Open Access Journals (Sweden)

    Koizumi Mitsuru

    2010-08-01

    Full Text Available Abstract Background Skeletal metastases are often accompanied by bone pain. To investigate the clinical meaning of bone pain associated with skeletal metastasis in breast cancer patients after surgery, we explored whether the presence of bone pain was due to skeletal-related events (SREs or survival (cause specific death, CSD, retrospectively. Methods Consecutive breast cancer patients undergoing surgery between 1988 and 1998 were examined for signs of skeletal metastasis until December 2006. Patients who were diagnosed as having skeletal metastasis were the subjects of this study. Bone scans were performed annually for 5, 7 or 10 years; they were also conducted if skeletal metastasis was suspected. Data concerning bone pain and tumor markers at the time of skeletal metastasis diagnosis, and data relating to various factors including tumors, lymph nodes and hormone receptors at the time of surgery, were investigated. The relationships between factors such as bone pain, SRE and CSD were analyzed using the Kaplan-Meier method and Cox's analysis. Results Skeletal metastasis occurred in 668 patients but the pain status of two patients was unknown, therefore 666 patients were included in the study. At the time of skeletal metastasis diagnosis 270 patients complained of pain; however, 396 patients did not. Analysis of data using Cox's and Kaplan-Meier methods demonstrated that patients without pain had fewer SREs and better survival rates than those with pain. Hazard ratios regarding SRE (base = patients without pain were 2.331 in univariate analysis and 2.243 in multivariate analysis. Hazard ratios regarding CSD (base = patients without pain were 1.441 in univariate analysis and 1.535 in multivariate analysis. Similar results were obtained when analyses were carried out using the date of surgery as the starting point. Conclusion Bone pain at diagnosis of skeletal metastasis was an indicator of increased SRE and CSD. However, these data did not

  19. High volume practice proved the safety of off-pump coronary artery bypass surgery in left main coronary artery lesions:a two-year single center experience

    Institute of Scientific and Technical Information of China (English)

    LIU Tong; LU Chun-shan; LU Jia-kai; GAN Hui-li; ZHANG Jian-qun; HUANG Fang-jong; GU Cheng-xiong; KONG Qing-yu; CAO Xiang-rong; BO Ping

    2012-01-01

    Background Left main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG).This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG),compared with non-left main coronary artery stenosis (non-mainstem disease).Methods From January 1,2009 to December 31,2010,4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital.According to the pathology of LMCA lesions,they were retrospectively classified as a non-mainstem disease group (n=3933) or a LMCA group (n=936).Propensity scores were used to match the two groups,patients from the non-mainstem disease group (n=831) were also randomly selected to match patients from the LMCA group (n=831).Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.Results The difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P=0.429,P=0.127 respectively).With a mean follow-up of (12.8±7.5) months and a cumulative follow-up of 1769.6 patient-years,the difference in the freedom from MACCEs between the two groups,calculated through Kaplan-Meier method,did not reach statistical significance (P=0.831).Conclusion Analysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG.Therefore,a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.

  20. Interim analysis for binary outcome trials with a long fixed follow-up time and repeated outcome assessments at pre-specified times.

    Science.gov (United States)

    Parpia, Sameer; Julian, Jim A; Gu, Chushu; Thabane, Lehana; Levine, Mark N

    2014-01-01

    In trials with binary outcomes, assessed repeatedly at pre-specified times and where the subject is considered to have experienced a failure at the first occurrence of the outcome, interim analyses are performed, generally, after half or more of the subjects have completed follow-up. Depending on the duration of accrual relative to the length of follow-up, this may be inefficient, since there is a possibility that the trial will have completed accrual prior to the interim analysis. An alternative is to plan the interim analysis after subjects have completed follow-up to a time that is less than the fixed full follow-up duration. Using simulations, we evaluated three methods to estimate the event proportion for the interim analysis in terms of type I and II errors and the probability of early stopping. We considered: 1) estimation of the event proportion based on subjects who have been followed for a pre-specified time (less than the full follow-up duration) or who experienced the outcome; 2) estimation of the event proportion based on data from all subjects that have been randomized by the time of the interim analysis; and 3) the Kaplan-Meier approach to estimate the event proportion at the time of the interim analysis. Our results show that all methods preserve and have comparable type I and II errors in certain scenarios. In these cases, we recommend using the Kaplan-Meier method because it incorporates all the available data and has greater probability of early stopping when the treatment effect exists.

  1. Prognostic significance of preoperative fibrinogen in patients with colon cancer.

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    Sun, Zhen-Qiang; Han, Xiao-Na; Wang, Hai-Jiang; Tang, Yong; Zhao, Ze-Liang; Qu, Yan-Li; Xu, Rui-Wei; Liu, Yan-Yan; Yu, Xian-Bo

    2014-07-14

    To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients. A total of 255 colon cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University from June 1(st) 2005 to June 1(st) 2008 were enrolled in the study. All patients received radical surgery as their primary treatment method. Preoperative fibrinogen was detected by the Clauss method, and all patients were followed up after surgery. Preoperative fibrinogen measurements were correlated with a number of clinicopathological parameters using the Student t test and analysis of variance. Survival analyses were performed by the Kaplan-Meier method and Cox regression modeling to measure 5-year disease-free survival (DFS) and overall survival (OS). The mean preoperative fibrinogen concentration of all colon cancer patients was 3.17 ± 0.88 g/L. Statistically significant differences were found between preoperative fibrinogen levels and the clinicopathological parameters of age, smoking status, tumor size, tumor location, tumor-node-metastasis (TNM) stage, modified Glasgow prognostic scores (mGPS), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) levels. Univariate survival analysis showed that TNM stage, tumor cell differentiation grade, vascular invasion, mGPS score, preoperative fibrinogen, WBC, NLR, PLR and CEA all correlated with both OS and DFS. Alpha-fetoprotein (AFP) and body mass index correlated only with OS. Kaplan-Meier analysis revealed that both OS and DFS of the total cohort, as well as of the stage II and III patients, were higher in the hypofibrinogen group compared to the hyperfibrinogen group (all P TNM stage, mGPS score, CEA, and AFP levels correlated with both OS and DFS. Preoperative fibrinogen levels can serve as an independent prognostic marker to evaluate patient response to colon cancer treatment.

  2. Prognostic value of tumor volume for patients with advanced lung cancer treated with chemotherapy.

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    Kuo, Chung-Feng Jeffrey; Ke, Bo-Han; Wu, Nain-Ying; Kuo, Joseph; Hsu, Hsian-He

    2017-06-01

    We aim to develop a reference system utilizing computed tomography to calculate changes in tumor volume of lung cancer patients after chemotherapy to assist physicians in clinical treatment and evaluation. Image processing techniques were used to analyze the computed tomography of lung cancer, locate the tumor, and calculate the tumor volume. The medical indicator was then evaluated and analyzed. We examined the correlation between reduced tumor volume and survival duration of 88 patients after chemotherapy at Tri-Service General Hospital, Taiwan. The innovative survival prediction index was obtained by four statistical methods: receiver operating characteristic curve, Youden index, Kaplan-Meier method, and log rank test. From the image processing techniques, tumor volume from each patient were obtained within an average of 7.25 seconds. The proposed method was shown to achieve rapid positioning of lung tumors and volume reconstruction with an estimation error of 1.92% when calibrated with an irregularly shaped stone. In medical indicator evaluation and analysis, the area below the receiver operating characteristic curve is greater than 0.8, indicating good predictability of the medical index used herein. The Youden index spotted the best cut-off point of volume, and the correlation between the volume's cut-off point and survival time was confirmed again by Kaplan-Meier and log rank test. The p-values were all less than 0.05, presenting a high degree of correlation between the two, indicating that this medical indicator is highly reliable. The proposed techniques can automatically find the location of tumors in the lung, reconstruct the volume, and calculate changes in volume before and after treatment, thus obtaining an innovative survival prediction index. This will help facilitate early and accurate predictions of disease outcomes during the course of therapy, and categorize patient stratification into risk groups for more efficient therapies. Copyright © 2017

  3. Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer

    Science.gov (United States)

    2013-01-01

    Background The TNM staging criteria for gastric carcinoma have seen numerous revisions, the most recent of which are reflected in the seventh edition AJCC TNM cancer staging manual. Methods A retrospective evaluation of the sixth and seventh TNM classification of gastric cancer on a prospective database, regarding patients operated on for primary gastric cancer, was conducted. The end point of the study was prognosis evaluation in terms of overall survival. Patients operated on for primary gastric cancer between September 2003 and March 2012 at our Department of Emergency and General Surgery, were consecutively retrieved in this study; a total of 114 patients were considered. Cardia gastric cancers, gastric lymphomas and gastrointestinal stromal tumors (GIST) were excluded. Median and mean follow-up periods were 22.5 and 27.7 months (range 15 days to 5 years). Both TNM6 and TNM7 were used to evaluate our patients. Overall survival and survival rates at different stages were analyzed using the Kaplan-Meier method and differences were determined using a log-rank test. Cox’s proportional hazard model was used to identify significant factors related to prognosis in a multivariate analysis. Results Overall survival between the sixth and seventh TNM classification was not significantly different. Both the Kaplan-Meier analysis and the multivariate analysis showed that the major negative prognostic factor was lymphovascular invasion (P TNM. Conclusions Even though further studies are needed in order to increase the number of patients studied, the seventh edition seems to provide a more accurate prognosis, especially regarding N1 and N2 tumors, showing that the most important prognostic factor is lymphovascular invasion. PMID:23687939

  4. Cardiovascular Magnetic Resonance and prognosis in cardiac amyloidosis

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    Roughton Michael

    2008-11-01

    Full Text Available Abstract Background Cardiac involvement is common in amyloidosis and associated with a variably adverse outcome. We have previously shown that cardiovascular magnetic resonance (CMR can assess deposition of amyloid protein in the myocardial interstitium. In this study we assessed the prognostic value of late gadolinium enhancement (LGE and gadolinium kinetics in cardiac amyloidosis in a prospective longitudinal study. Materials and methods The pre-defined study end point was all-cause mortality. We prospectively followed a cohort of 29 patients with proven cardiac amyloidosis. All patients underwent biopsy, 2D-echocardiography and Doppler studies, 123I-SAP scintigraphy, serum NT pro BNP assay, and CMR with a T1 mapping method and late gadolinium enhancement (LGE. Results Patients with were followed for a median of 623 days (IQ range 221, 1436, during which 17 (58% patients died. The presence of myocardial LGE by itself was not a significant predictor of mortality. However, death was predicted by gadolinium kinetics, with the 2 minute post-gadolinium intramyocardial T1 difference between subepicardium and subendocardium predicting mortality with 85% accuracy at a threshold value of 23 ms (the lower the difference the worse the prognosis. Intramyocardial T1 gradient was a better predictor of survival than FLC response to chemotherapy (Kaplan Meier analysis P = 0.049 or diastolic function (Kaplan-Meier analysis P = 0.205. Conclusion In cardiac amyloidosis, CMR provides unique information relating to risk of mortality based on gadolinium kinetics which reflects the severity of the cardiac amyloid burden.

  5. Oral cancer development in patients with leukoplakia--clinicopathological factors affecting outcome.

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    Wei Liu

    Full Text Available BACKGROUND: Oral leukoplakia (OL is the best-known potentially malignant disorder. The objective of the current study was to evaluate the clinicopathological factors predictive of outcome in a large cohort of patients with OL, and report our experience in the early detection of malignant events. METHODS: A total of 320 patients with biopsy-proven OL were retrospectively reviewed from the study institution who had a mean follow-up of 5.1 years. Data on patient and lesion at initial diagnosis and patient underwent sequential biopsies were reviewed. Multiple biopsies indicates > = 3 times sequential biopsies. Oral cancer-free survival rate (OCFS was determined by the Kaplan-Meier method and significant factors were identified by Cox regression analysis. RESULTS: The 3-year and 5-year OCFS was 86.6% and 82.0%, respectively. A new binary system of grading oral dysplasia was performed and Kaplan-Meier analysis indicated that high-grade dysplasia had significantly higher malignant incidence than low-grade dysplasia (5-year OCFS, 90.5% vs 59.0%; P60 years, lesion located at lateral/ventral tongue, non-homogenous lesion, high-grade dysplasia were independent significant indicators for OL malignant transformation. In addition, significant positive correlation between the multiple biopsies and these 4 factors and malignant outcome was established. CONCLUSIONS: Elderly patients with OL located at lateral/ventral tongue and who had non-homogenous lesion with high-grade dysplasia correlated much higher risk of transformation. This high-risk subpopulation was suggested to undergo sequential biopsies and histologic examination contributing to early detection of malignant event.

  6. Risk of cardiovascular thrombotic events after surgical castration versus gonadotropin-releasing hormone agonists in Chinese men with prostate cancer

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    Jeremy YC Teoh

    2015-06-01

    Full Text Available We investigated the cardiovascular thrombotic risk after surgical castration (SC versus gonadotropin-releasing hormone agonists (GnRHa in Chinese men with prostate cancer. All Chinese prostate cancer patients who were treated with SC or GnRHa from year 2000 to 2009 were reviewed and compared. The primary outcome was any new-onset of cardiovascular thrombotic events after SC or GnRHa, which was defined as any event of acute myocardial infarction or ischemic stroke. The risk of new-onset cardiovascular thrombotic event was compared between the SC group and the GnRHa group using Kaplan-Meier method. Multivariate Cox regression analysis was performed to adjust for other potential confounding factors. A total of 684 Chinese patients was included in our study, including 387 patients in the SC group and 297 patients in the GnRHa group. The mean age in the SC group (75.3 ± 7.5 years was significantly higher than the GnRHa group (71.8 ± 8.3 years (P < 0.001. There was increased risk of new cardiovascular thrombotic events in the SC group when compared to the GnRHa group upon Kaplan-Meier analysis (P = 0.014. Upon multivariate Cox regression analysis, age (hazard ratio [HR] 1.072, 95% confidence interval [CI] 1.04-1.11, P< 0.001, hyperlipidemia (HR 2.455, 95% CI 1.53-3.93, P< 0.001, and SC (HR 1.648, 95% CI 1.05-2.59, P= 0.031 were significant risk factors of cardiovascular thrombotic events. In conclusion, SC was associated with increased risk of cardiovascular thrombotic events when compared to GnRHa. This is an important aspect to consider while deciding on the method of androgen deprivation therapy, especially in elderly men with known history of hyperlipidemia.

  7. Marital status and survival in pancreatic cancer patients: a SEER based analysis.

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    Michael Baine

    Full Text Available BACKGROUND: Recent findings suggest that marital status affects survival in patients with different types of cancer. However, its role in the survival of patients with pancreatic ductal adenocarcinoma is unknown. In this study, we investigated whether there was an association between marital status and overall survival (OS in patients with pancreatic ductal adenocarcinoma (PDAC. METHODS: Adult patients diagnosed with PDAC between 1998 and 2003 with known marital statuses were identified from the Surveillance, Epidemiology, and End Results registry of the National Cancer Institute. OS for these patients was plotted using the Kaplan-Meier method. Comparative risks of mortality were evaluated by using univariate and multivariate-adjusted Cox regression models. RESULTS: Using Kaplan-Meier analysis, we found that the median overall survival of patients was 4 months and 3 months (p<0.001 for married and unmarried patients, respectively. Subgroup analysis on patients with cancer-directed surgery showed that the median survival was 16 months and 13 months (P<0.0005 for married and unmarried groups, respectively. Multivariate analysis adjusting for age, race, sex, stage, year of diagnosis, radiation therapy and cancer-directed surgery showed that patients who were married at the time of diagnosis had a significantly decreased risk of death at both 2 months (15% risk reduction and 3 years (13% risk reduction post diagnosis. CONCLUSIONS: Marital status is an independent prognostic factor of both perioperative and long-term survival in patients with PDAC. This observation may suggest a suboptimally met psychosocial need among PDAC patients that is partially fulfilled by the support system provided by marriage.

  8. Does urothelial cancer of bladder behave differently in young patients?

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-hua; LI You-yuan; HU Zhi-quan; ZHU Hui; ZHUANG Qian-yuan; QI Yong; YE Zhang-qun

    2012-01-01

    Background Bladder urothelial cancer has been diagnosed at an increasing rate among young adults in China while the clinical outcomes remain highly controversial.To optimize the management of young patients with bladder cancer,we examined whether bladder urothelial cancer in young patients behaved differently from that in the elder patients.Methods From 1994 to 2008,a database of bladder urothelial cancer patients at a major tertiary medical center was retrospectively reviewed.The clinical and pathological parameters of patients who were less than 40 years of age and a series of patients older than 40 years of age as the control group during the same period were compared.A survival analysis was performed using the Kaplan-Meier method and log-rank test,and Cox regression was performed to identify clinical parameters that affected the clinic outcomes.Results Young bladder cancer patients had a lower male-to-female ratio and were less likely to have advanced stages and high-grade cancers at the initial diagnosis.Tumors in young bladder cancer patients tended to be less multifocal at diagnosis.In addition,young patients had a lower recurrence rate and longer recurrence interval than older patients.The Kaplan-Meier curve and Log-rank test showed that young patients had significantly better cancer specific survival than old patients.The univariats and multivariate Cox regression analysis revealed that tumor grade is the sole predictor for tumor recurrence in young patients.Conclusions Young patients with bladder cancer have favorable pathological features and clinical outcomes than older patients.These findings argue for more conservative management approaches for young patients with bladder cancer.

  9. Prognostic value of DNA alterations on chromosome 17p13.2 for intrahepatic cholangiocarcinoma

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    Ubol Chuensumran; Sopit Wongkham; Chawalit Pairojkul; Siri Chauin; Songsak Petmitr

    2007-01-01

    AIM: To characterize and evaluate DNA alterations among intrahepatic cholangiocarcinoma (ICC) patients.METHODS: DNA from tumor and corresponding normal tissues of 52 patients was amplified with 33 arbitrary primers. The DNA fragment that alters most frequently in ICC was cloned, sequenced, and identified by comparison with known nucleotide sequences in the genome database (www.ncbi.nlm.nih.gov). The DNA copy numbers of the allelic alterations in cholangiocarcinoma were determined by quantitative real-time PCR and interpreted as allelic loss or DNA amplification by comparison with the reference gene. Associations between allelic imbalance and clinicopathological parameters of ICC patients were evaluated by x2-test.The Kaplan-Meier method was used to analyze survival rates.RESULTS: From 33 primers, an altered DNA fragment (518 bp) amplified from BC17 random primer was found frequently in the tumors analyzed and mapped to chromosome 17p13.2. Sixteen of 52 (31%) cases showed DNA amplification, while 7 (13%) showed allelic loss. Interestingly, DNA amplification on chromosome 17p13.2 was associated with a good prognosis, median survival time (wk) of amp vs no amp was 44.14 vs 24.14,P = 0.002; whereas allelic loss of this DNA sequence corresponded with a poor prognosis, median survival time (wk) of loss vs no loss was 18.00 vs 28.71, P =0.019). Moreover, Kaplan-Meier curves comparing the DNA alterations with survival depicted highly significant separation that the median survival time equal to DNA amplification, allelic loss, and normal was 44.14 wk,18.00 wk, and 24.29 wk, respectively (P = 0.005).CONCLUSION: Alterations in the DNA sequence on chromosome 17p13.2 may be involved in cholangiocarcinogenesis, and could be used as a prognostic marker in the treatment of ICC patients.

  10. Long-Term Outcomes and Complications in Patients With Craniopharyngioma: The British Columbia Cancer Agency Experience

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Andrea C., E-mail: andrealo@gmail.com [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Howard, A. Fuchsia [School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (Canada); Nichol, Alan; Sidhu, Keerat; Abdulsatar, Farah [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Hasan, Haroon [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Goddard, Karen [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada)

    2014-04-01

    Purpose: We report long-term outcomes and complications of craniopharyngioma patients referred to our institution. Methods and Materials: Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy. Results: Median follow-up was 8.9 years, and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07). Conclusions: We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.

  11. Long-term results of pneumatic dilation for achalasia: A 15 years' experience

    Institute of Scientific and Technical Information of China (English)

    Panagiotis Katsinelos; Jannis Kountouras; George Paroutoglou; Athanasios Beltsis; Christos Zavos; Basilios Papaziogas; Kostas Mlimidis

    2005-01-01

    AIM: Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years' experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation.METHODS: Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia (diagnosed by clinical presentation, esophagoscopy,barium esophagogram, and manometry) who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score.The median dysphagia-free duration was calculated by Kaplan-Meier analysis.RESULTS: Symptoms were dysphagia (n = 39, 100%),regurgitation (n =23, 58.7%), chest pain (n = 4, 10.2%),and weight loss (n = 26, 66.6%). A total of 74 dilations were performed in 39 patients; 13 patients (28%) underwent a single dilation, 17 patients (48.7%) required a second procedure within a median of 26.7 mo (range 5-97 mo), and 9 patients (23.3%) underwent a third procedure within a median of 47.8 mo (range 37-120 mo). Post-dilation lower esophageal sphincter (LES) pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4-10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years (range 0.5-15 years). The dysphagiafree duration by Kaplan-Meier analysis was 78%, 61%and 58.3% after 5, 10 and 15 years respectively.CONCLUSION: Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response.

  12. Adherence to drug-refill is a useful early warning indicator of virologic and immunologic failure among HIV patients on first-line ART in South Africa.

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    Ziad El-Khatib

    Full Text Available BACKGROUND: Affordable strategies to prevent treatment failure on first-line regimens among HIV patients are essential for the long-term success of antiretroviral therapy (ART in sub-Saharan Africa. WHO recommends using routinely collected data such as adherence to drug-refill visits as early warning indicators. We examined the association between adherence to drug-refill visits and long-term virologic and immunologic failure among non-nucleoside reverse transcriptase inhibitor (NNRTI recipients in South Africa. METHODS: In 2008, 456 patients on NNRTI-based ART for a median of 44 months (range 12-99 months; 1,510 person-years were enrolled in a retrospective cohort study in Soweto. Charts were reviewed for clinical characteristics before and during ART. Multivariable logistic regression and Kaplan-Meier survival analysis assessed associations with virologic (two repeated VL>50 copies/ml and immunologic failure (as defined by WHO. RESULTS: After a median of 15 months on ART, 19% (n = 88 and 19% (n = 87 had failed virologically and immunologically respectively. A cumulative adherence of <95% to drug-refill visits was significantly associated with both virologic and immunologic failure (p<0.01. In the final multivariable model, risk factors for virologic failure were incomplete adherence (OR 2.8, 95%CI 1.2-6.7, and previous exposure to single-dose nevirapine or any other antiretrovirals (adj. OR 2.1, 95%CI 1.2-3.9, adjusted for age and sex. In Kaplan-Meier analysis, the virologic failure rate by month 48 was 19% vs. 37% among adherent and non-adherent patients respectively (logrank p value = 0.02. CONCLUSION: One in five failed virologically after a median of 15 months on ART. Adherence to drug-refill visits works as an early warning indicator for both virologic and immunologic failure.

  13. Multiple factor analysis of metachronous upper urinary tract transitional cell carcinoma after radical cystectomy

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    P. Wang

    2007-07-01

    Full Text Available Transitional cell carcinoma (TCC of the urothelium is often multifocal and subsequent tumors may occur anywhere in the urinary tract after the treatment of a primary carcinoma. Patients initially presenting a bladder cancer are at significant risk of developing metachronous tumors in the upper urinary tract (UUT. We evaluated the prognostic factors of primary invasive bladder cancer that may predict a metachronous UUT TCC after radical cystectomy. The records of 476 patients who underwent radical cystectomy for primary invasive bladder TCC from 1989 to 2001 were reviewed retrospectively. The prognostic factors of UUT TCC were determined by multivariate analysis using the COX proportional hazards regression model. Kaplan-Meier analysis was also used to assess the variable incidence of UUT TCC according to different risk factors. Twenty-two patients (4.6%. developed metachronous UUT TCC. Multiplicity, prostatic urethral involvement by the bladder cancer and the associated carcinoma in situ (CIS were significant and independent factors affecting the occurrence of metachronous UUT TCC (P = 0.0425, 0.0082, and 0.0006, respectively. These results were supported, to some extent, by analysis of the UUT TCC disease-free rate by the Kaplan-Meier method, whereby patients with prostatic urethral involvement or with associated CIS demonstrated a significantly lower metachronous UUT TCC disease-free rate than patients without prostatic urethral involvement or without associated CIS (log-rank test, P = 0.0116 and 0.0075, respectively. Multiple tumors, prostatic urethral involvement and associated CIS were risk factors for metachronous UUT TCC, a conclusion that may be useful for designing follow-up strategies for primary invasive bladder cancer after radical cystectomy.

  14. Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus Ⅱ D Aortoiliac Occlusive Lesions: What Determines the Rate of Restenosis?

    Institute of Scientific and Technical Information of China (English)

    Chen-Yang Shen; Yun-Feng Liu; Qing-Le Li; Yong-Bao Zhang; Yang Jiao; Miltiadis E Krokidis; Xiao-Ming Zhang

    2015-01-01

    Background: Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients.The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions (AIOLs).Methods: Fifty-six patients (82 limbs) who underwent open repair and endovascular treatment (ET) for symptomatic TASC ⅡD AIOLs between March 2005 and December 2012 were retrospectively reviewed.Baseline characteristics, preoperative and postoperative imaging,and operation procedure reports were reviewed and analyzed.Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram.Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency.Results: The mean duration of follow-up was 42.8 ± 23.5 months (ranging from 3 to 90 months).Primary patency rates at 1-, 3-, 5-,and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively.Restenosis after revascularization occurred in 11 limbs.Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency.According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization.Conclusion: This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AIOLs.

  15. Exclusive breastfeeding duration and determinants among Brazilian children under two years of age

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    Sarah Warkentin

    2013-06-01

    Full Text Available OBJECTIVE: The present study described the duration and identified the determinants of exclusive breastfeeding. METHODS: The study used data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher 2006 (National Demographic and Health Survey on Women and Children 2006. Data were collected using questionnaires administered by trained professionals and refer to a subsample of 1,704 children aged less than 24 months. The estimated durations of exclusive breastfeeding are presented according to socioeconomic, demographic and epidemiological variables. Kaplan Meier estimator curves were used to produce valid estimates of breastfeeding duration and the Cox's proportional hazards model was fitted to identify risks. RESULTS: The median estimated duration of exclusive breastfeeding was 60 days. The final Cox model consisted of mother's age <20 years (hazard ratio=1.53, 95% confidence interval=1.11-1.48, use of pacifier (hazard ratio=1.53, 95% confidence interval=1.37-1.71, not residing in the country's southeast region (hazard ratio=1.22, 95% confidence interval=1.07-1.40 and socioeconomic status (hazard ratio=1.28, 95% confidence interval=1.06-1.55. CONCLUSION: The Kaplan Meier estimator corrected the underestimated duration of breastfeeding in the country when calculated by the current status methodology. Despite the national efforts done in the last decades to promote breastfeeding, the results indicate that the duration of exclusive breastfeeding is still half of that recommended for this dietary practice to promote health. Ways to revert this situation would be ongoing educational activities involving the educational and health systems, associated with advertising campaigns on television and radio mainly targeting young mothers with low education level and low income, identified as those at high risk of weaning their children early.

  16. Pre-operative perfusion skewness and kurtosis are potential predictors of progression-free survival after partial resection of newly diagnosed glioblastoma

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    Paik, Wo Yul [Dept. of Radiology, Dankook University Hospital, Cheonan (Korea, Republic of); Kim, Ho Sung; Choi, Choong Gon; Kim, Sang Joon [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2016-02-15

    To determine whether pre-operative perfusion skewness and kurtosis derived from normalized cerebral blood volume (nCBV) histograms are associated with progression-free survival (PFS) of patients after partial resection of newly diagnosed glioblastoma. A total of 135 glioblastoma patients who had undergone partial resection of tumor (resection of < 50% of pre-operative tumor volume or surgical biopsy) confirmed with immediate postsurgical MRI and examined with both conventional MRI and dynamic susceptibility contrast (DSC) perfusion MRI before the surgery were retrospectively reviewed in this study. They had been followed up post-surgical chemoradiotherapy for tumor progression. Using histogram analyses of nCBV derived from pre-operative DSC perfusion MRI, patients were sub-classified into the following four groups: positive skewness and leptokurtosis (group 1); positive skewness and platykurtosis (group 2); negative skewness and leptokurtosis (group 3); negative skewness and platykurtosis (group 4). Kaplan-Meier analysis and multivariable Cox proportional hazards regression analysis were performed to determine whether clinical and imaging covariates were associated with PFS or overall survival (OS) of these patients. According to the Kaplan-Meier method, median PFS of group 1, 2, 3, and 4 was 62, 51, 39, and 41 weeks, respectively, with median OS of 82, 77, 77, and 72 weeks, respectively. In multivariable analyses with Cox proportional hazards regression, pre-operative skewness/kurtosis pattern (hazard ratio: 2.98 to 4.64; p < 0.001), Karnofsky performance scale score (hazard ratio: 1.04; p = 0.003), and post-operative tumor volume (hazard ratio: 1.04; p = 0.02) were independently associated with PFS but not with OS. Higher skewness and kurtosis of nCBV histogram before surgery were associated with longer PFS in patients with newly diagnosed glioblastoma after partial tumor resection.

  17. Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus.

    Science.gov (United States)

    Gebert, Anna-Felicitas; Schulz, Matthias; Schwarz, Karin; Thomale, Ulrich-Wilhelm

    2016-05-01

    OBJECTIVE The use of adjustable differential pressure valves with gravity-assisted units in shunt therapy of children with hydrocephalus was reported to be feasible and promising as a way to avoid chronic overdrainage. In this single-center study, the authors' experiences in infants, who have higher rates of shunt complications, are presented. METHODS All data were collected from a cohort of infants (93 patients [37 girls and 56 boys], less than 1 year of age [mean age 4.1 ± 3.1 months]) who received their first adjustable pressure hydrocephalus shunt as either a primary or secondary implant between May 2007 and April 2012. Rates of valve and shunt failure were recorded for a total of 85 months until the end of the observation period in May 2014. RESULTS During a follow-up of 54.2 ± 15.9 months (range 26-85 months), the Kaplan-Meier rate of shunt survival was 69.2% at 1 year and 34.1% at 85 months; the Kaplan-Meier rate of valve survival was 77.8% at 1 year and 56% at 85 months. Survival rates of the shunt were significantly inferior if the patients had previous shunt surgery. During follow-up, 44 valves were exchanged in cases of infection (n = 19), occlusion (n = 14), dysfunction of the adjustment unit (n = 10), or to change the gravitational unit (n = 1). CONCLUSIONS Although a higher shunt complication rate is observed in infant populations compared with older children, reasonable survival rates demonstrate the feasibility of using this sophisticated valve technology. The gravitational unit of this valve is well tolerated and its adjustability offers the flexible application of opening pressure in an unpredictable cohort of patients. This may adequately address overdrainage-related complications from early in treatment.

  18. Geometrical Measures Obtained from Pretreatment Postcontrast T1 Weighted MRIs Predict Survival Benefits from Bevacizumab in Glioblastoma Patients

    Science.gov (United States)

    Sepúlveda, Juan M.; Peralta, Sergi; Gil-Gil, Miguel J.; Reynes, Gaspar; Herrero, Ana; De Las Peñas, Ramón; Luque, Raquel; Capellades, Jaume

    2016-01-01

    Background Antiangiogenic therapies for glioblastoma (GBM) such as bevacizumab (BVZ), have been unable to extend survival in large patient cohorts. However, a subset of patients having angiogenesis-dependent tumors might benefit from these therapies. Currently, there are no biomarkers allowing to discriminate responders from non-responders before the start of the therapy. Methods 40 patients from the randomized GENOM009 study complied the inclusion criteria (quality of images, clinical data available). Of those, 23 patients received first line temozolomide (TMZ) for eight weeks and then concomitant radiotherapy and TMZ. 17 patients received BVZ+TMZ for seven weeks and then added radiotherapy to the treatment. Clinical variables were collected, tumors segmented and several geometrical measures computed including: Contrast enhancing (CE), necrotic, and total volumes; equivalent spherical CE width; several geometric measures of the CE ‘rim’ geometry and a set of image texture measures. The significance of the results was studied using Kaplan-Meier and Cox proportional hazards analysis. Correlations were assessed using Spearman correlation coefficients. Results Kaplan-Meier and Cox proportional hazards analysis showed that total, CE and inner volume (p = 0.019, HR = 4.258) and geometric heterogeneity of the CE areas (p = 0.011, HR = 3.931) were significant parameters identifying response to BVZ. The group of patients with either regular CE areas (small geometric heterogeneity, median difference survival 15.88 months, p = 0.011) or those with small necrotic volume (median survival difference 14.50 months, p = 0.047) benefited substantially from BVZ. Conclusion Imaging biomarkers related to the irregularity of contrast enhancing areas and the necrotic volume were able to discriminate GBM patients with a substantial survival benefit from BVZ. A prospective study is needed to validate our results. PMID:27557121

  19. Good outcome of total hip replacement in patients with cerebral palsy

    Science.gov (United States)

    King, Garry; Hunt, Linda P; Wilkinson, J Mark; Blom, Ashley W

    2016-01-01

    Background and purpose — People with cerebral palsy (CP) often have painful deformed hips, but they are seldom treated with hip replacement as the surgery is considered to be high risk. However, few data are available on the outcome of hip replacement in these patients. Patients and methods — We linked Hospital Episode Statistics (HES) records to the National Joint Registry for England and Wales to identify 389 patients with CP who had undergone hip replacement. Their treatment and outcomes were compared with those of 425,813 patients who did not have CP. Kaplan-Meier estimates were calculated to describe implant survivorship and the curves were compared using log-rank tests, with further stratification for age and implant type. Reasons for revision were quantified as patient-time incidence rates (PTIRs). Nationally collected patient-reported outcomes (PROMS) before and 6 months after operation were compared if available. Cumulative mortality (Kaplan-Meier) was estimated at 90 days and at 1, 3, and 5 years. Results — The cumulative probability of revision at 5 years post-surgery was 6.4% (95% CI: 3.8–11) in the CP cohort as opposed to 2.9% (CI 2.9–3%) in the non-CP cohort (p < 0.001). Patient-reported outcomes showed that CP patients had worse pain and function preoperatively, but had equivalent postoperative improvement. The median improvement in Oxford hip score at 6 months was 23 (IQR: 14–28) in CP and it was 21 (14–28) in non-CP patients. 91% of CP patients reported good or excellent satisfaction with their outcome. The cumulative probability of mortality for CP up to 7 years was similar to that in the controls after stratification for age and sex. Interpretation — Hip replacement for cerebral palsy appears to be safe and effective, although implant revision rates are higher than those in patients without cerebral palsy. PMID:26863583

  20. Pulmonary function tests in patients with amyotrophic lateral sclerosis and the association between these tests and survival.

    Directory of Open Access Journals (Sweden)

    Seyed-Ali Javad Mousavi

    2014-09-01

    Full Text Available The rapidity of progression of amyotrophic lateral sclerosis (ALS to death or respiratory failure impacts patients, clinicians, and clinical investigators. The aim of this study is to evaluate of the pulmonary function tests (PFTs in patients with ALS and the association between these PFTs and survival Methods: A total of 36 ALS patients who PFTs, including vital capacity (VC, maximum mid-expiratory flow rate (MMEFR, forced vital capacity (FVC, and forced expiratory volume in 1 s (FEV1, were available from the time of diagnosis were included in this study. Non-pulmonary characteristics assessed at the time of PFTs. Data were analyzed using chi-square, Student's independent t-test, Kaplan-Meier, correlation, and receiver operating characteristic (ROC curve.The mean age of subjects was 55.36 (SD = 12.24 year, and the male to female ratio was 2.6. Twenty-five (69.4% were died in 5 years period of our study. The mean and median survival time (In months was calculated as 42.51 (95% confidence interval [CI] 33.64-51.39 and 38 (95% CI 27.23-48.77 months, respectively. The rate of ALS survival was 74% at 1(st year, 41% at 3(rd year and 10% at 5(th year of starting symptoms. The results of Kaplan-Meier test showed survival was significantly longer in the group with PFTs closer to normal. In addition, ROC analysis showed that FVC < 50% could potentially be a predictor of death in ALS patients(P = 0.003, area under curve = 0.649.We found single measures of upright FVC, FEV1 to be significantly associated with survival, even after controlling for relevant non-pulmonary patient characteristics. Our study demonstrated that upright FVC, FEV1, VC, and MMEFR are useful non-invasive measures in the prediction of survival in ALS.

  1. Impact of estimated HDL particle size via the ratio of HDL-C and apoprotein A-I on short-term prognosis of diabetic patients with stable coronary artery disease.

    Science.gov (United States)

    Hong, Li-Feng; Yang, Bo; Luo, Song-Hui; Li, Jian-Jun

    2014-09-01

    Revascularization and statin therapy are routinely used in the management of stable coronary artery disease. However, it is unclear whether the estimated high-density lipoprotein (HDL) particle size (eHDL-S), the ratio of HDL cholesterol (HDL-C) to apoprotein A-I (apoA-I), is associated with the clinical outcomes of diabetic patients with stable coronary artery disease (CAD). We performed a prospective cohort study of 328 patients diagnosed with stable CAD by coronary angiography. Patients were followed up for a mean duration of 12 months. The patients were divided into three groups by the tertiles of eHDL-S: low eHDL-S ( 0.79, n = 99). The associations between the baseline eHDL-S and short-term outcomes were evaluated using the Kaplan-Meier method and Cox proportional regression. The low eHDL-S group had higher triglyceride, hemoglobin A1c, uric acid, and leukocyte count than the other groups. During the follow-up period, 47/328 patients experienced a pre-specified outcome. According to the Kaplan-Meier analysis, the incidence of pre-specified outcomes was lower in the high eHDL-S group (P = 0.04). However, eHDL-S was not independently associated with adverse outcomes in Cox proportional hazards regression (hazard ratio (HR): 0.23, 95% confidence interval (95% CI): 0.01-11.24, P = 0.493). Although the eHDL-S was associated with inflammatory biomarkers, it was not independently associated with the short-term prognosis of diabetic patients with stable CAD in the era of revascularization and potent statin therapy.

  2. Two-year survival analysis of twisted wire fixed retainer versus spiral wire and fiber-reinforced composite retainers: a preliminary explorative single-blind randomized clinical trial

    Science.gov (United States)

    Sobouti, Farhad; Rakhshan, Vahid; Saravi, Mahdi Gholamrezaei; Zamanian, Ali

    2016-01-01

    Objective Traditional retainers (both metal and fiber-reinforced composite [FRC]) have limitations, and a retainer made from more flexible ligature wires might be advantageous. We aimed to compare an experimental design with two traditional retainers. Methods In this prospective preliminary clinical trial, 150 post-treatment patients were enrolled and randomly divided into three groups of 50 patients each to receive mandibular canine-to-canine retainers made of FRC, flexible spiral wire (FSW), and twisted wire (TW). The patients were monitored monthly. The time at which the first signs of breakage/debonding were detected was recorded. The success rates of the retainers were compared using chi-squared, Kaplan-Meier, and Cox proportional-hazard regression analyses (α = 0.05). Results In total, 42 patients in the FRC group, 41 in the FSW group, and 45 in the TW group completed the study. The 2-year failure rates were 35.7% in the FRC group, 26.8% in the FSW group, and 17.8% in the TW group. These rates differed insignificantly (chi-squared p = 0.167). According to the Kaplan-Meier analysis, failure occurred at 19.95 months in the FRC group, 21.37 months in the FSW group, and 22.36 months in the TW group. The differences between the survival rates in the three groups were not significant (Cox regression p = 0.146). Conclusions Although the failure rate of the experimental retainer was two times lower than that of the FRC retainer, the difference was not statistically significant. The experimental TW retainer was successful, and larger studies are warranted to verify these results. PMID:27019825

  3. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

    Science.gov (United States)

    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.

    2012-01-01

    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  4. Prognostic value of the lymph node ratio in stage Ⅲcolorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Jing-Qing Ren; Jian-Wei Liu; Zhi-Tang Chen; Shao-Jie Liu; Shi-Jie Huang; Yong Huang; Jing-Song Hong

    2012-01-01

    The nodal stage of colorectal cancer is based on the number of positive nodes.It is inevitably affected by the number of removed lymph nodes,but lymph node ratio can be unaffected.We investigated the value of lymph node ratio in stage Ⅲ colorectal cancer in this study.The clinicopathologic factors and follow-up data of 145 cases of stage Ⅲ colorectal cancer between January 1998 and December 2008 were analyzed retrospectively.The Pearson and Spearman correlation analyses were used to determine the correlation coefficient,the Kaplan-Meier method was used to analyze survival,and the Cox proportional hazard regression model was used for multivariate analysis in forward stepwise regression.We found that lymph node ratio was not correlated with the number of removed lymph nodes (r =-0.154,P =0.065),but it was positively correlated with the number of positive lymph nodes (r =0.739,P <0.001) and N stage (r =0.695,P < 0.001),Kaplan-Meier survival analysis revealed that tumor configuration,intestinal obstruction,serum carcinoembryonic antigen (CEA) concentration,T stage,N stage,and lymph node ratio were associated with disease-free survival of patients with stage Ⅲ colorectal cancer (P < 0.05).Multivariate analysis showed that serum CEA concentration,T stage,and lymph node ratio were prognostic factors for disease-free survival (P < 0.05),whereas N stage failed to achieve significance (P =0.664).We confirmed that lymph node ratio was a prognostic factor in stage Ⅲ colorectal cancer and had a better prognostic value than did N stage.

  5. Miners’ return to work following injuries in coal mines

    Directory of Open Access Journals (Sweden)

    Ashis Bhattacherjee

    2016-12-01

    Full Text Available Background: The occupational injuries in mines are common and result in severe socio-economical consequences. Earlier studies have revealed the role of multiple factors such as demographic factors, behavioral factors, health-related factors, working environment, and working conditions for mine injuries. However, there is a dearth of information about the role of some of these factors in delayed return to work (RTW following a miner’s injury. These factors may likely include personal characteristics of injured persons and his or her family, the injured person’s social and economic status, and job characteristics. This study was conducted to assess the role of some of these factors for the return to work following coal miners’ injuries. Material and Methods: A study was conducted for 109 injured workers from an underground coal mine in the years 2000–2009. A questionnaire, which was completed by the personnel interviews, included among others age, height, weight, seniority, alcohol consumption, sleeping duration, presence of diseases, job stress, job satisfaction, and injury type. The data was analyzed using the Kaplan-Meier estimates and the Cox proportional hazard model. Results: According to Kaplan-Meier estimate it was revealed that a lower number of dependents, longer sleep duration, no job stress, no disease, no alcohol addiction, and higher monthly income have a great impact on early return to work after injury. The Cox regression analysis revealed that the significant risk factors which influenced miners’ return to work included presence of disease, job satisfaction and injury type. Conclusions: The mine management should pay attention to significant risk factors for injuries in order to develop effective preventive measures. Med Pr 2016;67(6:729–742

  6. Prognosis of patients with coronary artery disease treated in different therapy units at department of cardiology: a retrospective cohort study

    Science.gov (United States)

    Fu, Cong; Yao, Yuyu; Wang, Xin; Yu, Chaojun; Ma, Genshan

    2015-01-01

    Background: Coronary artery disease (CAD) is a major health problem in global. Benefit from different care unit for various type of CAD is remaining unknown. We investigate if coronary care unit (CCU) reduces the incidence of major adverse cardiovascular events (MACEs). Method: 806 CAD patients including stable angina (SA) and acute coronary syndrome (ACS) who treated in department of cardiology were involved in the study as two groups. Each group involved two subgroups according to the therapy unit including CCU and normal unit. 12-48 months follow-up was carried out. The primary end point was all cause mortality. Results: For SA, death from any cause occurred in 1.0% of the patients in the normal group (1 of 108), as compared with 5.1% in the CCU group (3 of 59) (hazard ratio [HR], 0.164; 95% confidence interval [CI], 0.017 to 1.580; P=0.118). Kaplan-Meier survival analysis showed that there were no significant differences between the two subgroups with respect to the risk of death (P=0.074), revascularization (P=0.660), stroke (P=0.497), heart failure (P=0.658) and hemorrhage (P=0.096). For ACS, death occurred in 1.9% of the patients in the normal subgroup (5 of 267), as compared with 1.3% in the CCU subgroup (5 of 372) (HR, 1.403; 95% CI, 0.406-4.846; P=0.593). Kaplan-Meier survival analysis showed that there were no significant differences between the two subgroups with respect to the risk of death (P=0.591), revascularization (P=0.996), stroke (P=0.425), heart failure (P=0.625). Conclusion: CAD patients treated in CCU obtain little benefits compared with normal. PMID:26629060

  7. The Role of Vaginal Brachytherapy in the Treatment of Surgical Stage I Papillary Serous or Clear Cell Endometrial Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Barney, Brandon M., E-mail: barney.brandon@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Mariani, Andrea; Dowdy, Sean C.; Bakkum-Gamez, Jamie N. [Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota (United States); Haddock, Michael G. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2013-01-01

    Objectives: The optimal adjuvant therapy for International Federation of Gynecology and Obstetrics (FIGO) stage I papillary serous (UPSC) or clear cell (CC) endometrial cancer is unknown. We report on the largest single-institution experience using adjuvant high-dose-rate vaginal brachytherapy (VBT) for surgically staged women with FIGO stage I UPSC or CC endometrial cancer. Methods and Materials: From 1998-2011, 103 women with FIGO 2009 stage I UPSC (n=74), CC (n=21), or mixed UPSC/CC (n=8) endometrial cancer underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjuvant high-dose-rate VBT. Nearly all patients (n=98, 95%) also underwent extended lymph node dissection of pelvic and paraortic lymph nodes. All VBT was performed with a vaginal cylinder, treating to a dose of 2100 cGy in 3 fractions. Thirty-five patients (34%) also received adjuvant chemotherapy. Results: At a median follow-up time of 36 months (range, 1-146 months), 2 patients had experienced vaginal recurrence, and the 5-year Kaplan Meier estimate of vaginal recurrence was 3%. The rates of isolated pelvic recurrence, locoregional recurrence (vaginal + pelvic), and extrapelvic recurrence (including intraabdominal) were similarly low, with 5-year Kaplan-Meier estimates of 4%, 7%, and 10%, respectively. The estimated 5-year overall survival was 84%. On univariate analysis, delivery of chemotherapy did not affect recurrence or survival. Conclusions: VBT is effective at preventing vaginal relapse in women with surgical stage I UPSC or CC endometrial cancer. In this cohort of patients who underwent comprehensive surgical staging, the risk of isolated pelvic or extrapelvic relapse was low, implying that more extensive adjuvant radiation therapy is likely unnecessary.

  8. Diagnostic and prognostic value of serum nitric oxide, tumor necrosis factor-alpha, basic fibroblast growth factor and copper as angiogenic markers in premenopausal breast cancer patients: a case-control study.

    Science.gov (United States)

    Hewala, T I; Abd El-Moneim, N A; Ebied, S Abd El-Moneim; Sheta, M I; Soliman, K; Abu-Elenean, A

    2010-01-01

    Many studies demonstrate that increased microvessel density (MVD) surrounding primary tumour is associated with decreased overall survival in patients with breast cancer. This study compares the diagnostic and prognostic values of the angiogenic serum factors nitric oxide (NO), tumour necrosis factor-alpha (TNFalpha), basic fibroblast growth factor (bFGF) and copper with those of serum CA15-3 as the standard tumour marker in breast cancer patients. Microvessel density was estimated in CD31-immunostained sections from breast cancer patients. Before surgery, NO, TNFalpha, bFGF, copper and CA 15-3 were measured in serum samples from 30 premenopausal breast cancer patients in comparison with 15 healthy controls. The diagnostic values of the assayed parameters were compared using receiver operating characteristic (ROC) curve analysis. Univariate survival analysis of patients was assessed using the Kaplan-Meier method. Breast cancer tissues showed higher MVD than did normal breast tissues adjacent to the tumour (P = 0.008). Before surgery, tumour MVD correlated significantly with serum NO, TNFalpha, bFGF and copper (r = 0.458, P = .011; r = 0.379, P = .039; r = 0.513, P = .004 and r = 0.613, P = 0.000, respectively). Serum NO, TNFalpha, bFGF, copper and CA 15-3 levels in patients were significantly elevated compared with controls (P = 0.011, P = 0.004, P = 0.039, P = 0.000 and P = 0.001, respectively). Kaplan-Meier analysis revealed that patients with elevated serum TNFalpha, CA 15-3 and copper (P = 0.035, P = 0.040, P = 0.0339, respectively) had an overall survival significantly shorter than those who had lower levels of these parameters. These data suggest that serum TNFalpha, CA 15-3 and copper are useful predictive markers for overall survival in premenopausal breast cancer patients.

  9. Durability and Predictors of Successful Radiofrequency Ablation for Barrett’s Esophagus

    Science.gov (United States)

    Pasricha, Sarina; Bulsiewicz, William J.; Hathorn, Kelly E.; Komanduri, Srinadh; Muthusamy, V. Raman; Rothstein, Richard I.; Wolfsen, Herbert C.; Lightdale, Charles J.; Overholt, Bergein F.; Camara, Daniel S.; Dellon, Evan S.; Lyday, William D.; Ertan, Atilla; Chmielewski, Gary W.; Shaheen, Nicholas J.

    2014-01-01

    Background & Aims Following radiofrequency ablation (RFA), patients may experience recurrence of Barrett’s esophagus (BE) after complete eradication of intestinal metaplasia (CEIM). Rates and predictors of recurrence after successful eradication are poorly described. Methods We used the U.S. RFA Registry, a nationwide registry of BE patients receiving RFA, to determine rates and factors that predicted recurrence of IM. We assessed recurrence by Kaplan-Meier analysis for the overall cohort and by worst pretreatment histology. Characteristics associated with recurrence were included in a logistic regression model to identify independent predictors. Results Among 5521 patients, 3728 had biopsies ≥12 months after initiation of RFA. Of these, 3169 (85%) achieved CEIM, and 1634 (30%) met inclusion criteria. Average follow-up was 2.4 years after CEIM. IM recurred in 334 (20%), and was non-dysplastic or indefinite for dysplasia in 86% (287/334); the average length of recurrent BE was 0.6 cm. In Kaplan-Meier analysis, more advanced pretreatment histology was associated with an increased yearly recurrence rate. Compared to patients without recurrence, patients with recurrence were more likely, based on bi-variate analysis, to be older, have longer BE segments, be non-Caucasian, have dysplastic BE before treatment, and require more treatment sessions. In multivariate analysis, likelihood for recurrence was associated with increasing age and BE length, and non-Caucasian race. Conclusion BE recurred in 20% of patients followed for an average of 2.4 years after CEIM. Most recurrences were short segments and were non-dysplastic or indefinite for dysplasia. Older age, non-Caucasian race, and increasing length of BE length were all risk factors. These risk factors should be considered when planning post-RFA surveillance intervals. PMID:24815329

  10. Chemokine-like factor-like MARVEL transmembrane domain-containing 3 expression is associated with a favorable prognosis in esophageal squamous cell carcinoma.

    Science.gov (United States)

    Han, Tianci; Shu, Tianci; Dong, Siyuan; Li, Peiwen; Li, Weinan; Liu, Dali; Qi, Ruiqun; Zhang, Shuguang; Zhang, Lin

    2017-05-01

    Decreased expression of human chemokine-like factor-like MARVEL transmembrane domain-containing 3 (CMTM3) has been identified in a number of human tumors and tumor cell lines, including gastric and testicular cancer, and PC3, CAL27 and Tca-83 cell lines. However, the association between CMTM3 expression and the clinicopathological features and prognosis of esophageal squamous cell carcinoma (ESCC) patients remains unclear. The aim of the present study was to investigate the correlation between CMTM3 expression and clinicopathological parameters and prognosis in ESCC. CMTM3 mRNA and protein expression was analyzed in ESCC and paired non-tumor tissues by quantitative real-time polymerase chain reaction, western blotting and immunohistochemical analysis. The Kaplan-Meier method was used to plot survival curves and the Cox proportional hazards regression model was also used for univariate and multivariate survival analysis. The results revealed that CMTM3 mRNA and protein expression levels were lower in 82.5% (30/40) and 75% (30/40) of ESCC tissues, respectively, when compared with matched non-tumor tissues. Statistical analysis demonstrated that CMTM3 expression was significantly correlated with lymph node metastasis (P=0.002) and clinical stage (P<0.001) in ESCC tissues. Furthermore, the survival time of ESCC patients exhibiting low CMTM3 expression was significantly shorter than that of ESCC patients exhibiting high CMTM3 expression (P=0.01). In addition, Kaplan-Meier survival analysis revealed that the overall survival time of patients exhibiting low CMTM3 expression was significantly decreased compared with patients exhibiting high CMTM3 expression (P=0.010). Cox multivariate analysis indicated that CMTM3 protein expression was an independent prognostic predictor for ESCC after resection. This study indicated that CMTM3 expression is significantly decreased in ESCC tissues and CMTM3 protein expression in resected tumors may present an effective prognostic

  11. SAMSN1 is highly expressed and associated with a poor survival in glioblastoma multiforme.

    Directory of Open Access Journals (Sweden)

    Yong Yan

    Full Text Available OBJECTIVES: To study the expression pattern and prognostic significance of SAMSN1 in glioma. METHODS: Affymetrix and Arrystar gene microarray data in the setting of glioma was analyzed to preliminarily study the expression pattern of SAMSN1 in glioma tissues, and Hieratical clustering of gene microarray data was performed to filter out genes that have prognostic value in malignant glioma. Survival analysis by Kaplan-Meier estimates stratified by SAMSN1 expression was then made based on the data of more than 500 GBM cases provided by The Cancer Genome Atlas (TCGA project. At last, we detected the expression of SAMSN1 in large numbers of glioma and normal brain tissue samples using Tissue Microarray (TMA. Survival analysis by Kaplan-Meier estimates in each grade of glioma was stratified by SAMSN1 expression. Multivariate survival analysis was made by Cox proportional hazards regression models in corresponding groups of glioma. RESULTS: With the expression data of SAMSN1 and 68 other genes, high-grade glioma could be classified into two groups with clearly different prognoses. Gene and large sample tissue microarrays showed high expression of SAMSN1 in glioma particularly in GBM. Survival analysis based on the TCGA GBM data matrix and TMA multi-grade glioma dataset found that SAMSN1 expression was closely related to the prognosis of GBM, either PFS or OS (P<0.05. Multivariate survival analysis with Cox proportional hazards regression models confirmed that high expression of SAMSN1 was a strong risk factor for PFS and OS of GBM patients. CONCLUSION: SAMSN1 is over-expressed in glioma as compared with that found in normal brains, especially in GBM. High expression of SAMSN1 is a significant risk factor for the progression free and overall survival of GBM.

  12. Basal {sup 18}F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Soriano Castrejon, Angel [University General Hospital, Nuclear Medicine Department, Ciudad Real (Spain); Lopez-Fidalgo, Jesus Fernando; Amo-Salas, Mariano [University of Castilla-La Mancha, Department of Mathematics, Ciudad Real (Spain); Mar Munoz Sanchez, Maria del [Virgen de la Luz Hospital, Oncology Department, Cuenca (Spain); Alvarez Cabellos, Ruth [Virgen de la Salud Hospital, Oncology Department, Toledo (Spain); Espinosa Aunion, Ruth [La Mancha Centro Hospital, Oncology Department, Ciudad Real (Spain)

    2015-11-15

    To explore the relationship between basal {sup 18}F-FDG PET/CT information in breast tumours and survival in locally advanced breast cancer (LABC). This prospective, multicentre study included 198 women diagnosed with LABC. All patients underwent {sup 18}F-FDG PET/CT prior to treatment. The maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N) and the N/T ratio was obtained in all cases. Stage according to PET/CT imaging (metabolic stage) and conventional imaging techniques (clinical stage) was established. During follow-up, patient status was established (disease free status or not). The relationship between all the variables and overall survival (OS) and disease-free survival (DFS) was analysed using the Kaplan-Meier and Cox regression methods. A ROC analysis was performed to obtain a cut-off value of SUVmax that was useful in the prediction of outcome. The mean SUVmax ± SD values in the primary tumour, lymph nodes and the SUVmax N/T index were 7.40 ± 5.57, 4.17 ± 4.74 and 0.73 ± 1.20, respectively. Higher semiquantitative metabolic values were found in more advanced metabolic and clinical stages. During follow-up, 78.4 % of patients were free of disease. Significant relationships were observed between SUVT and SUVN and patient status. With respect to OS and DFS, significant differences were detected for the metabolic stage. Kaplan-Meier analysis revealed that using the cut-off values, a primary-tumour SUVmax ≥ 6.05 or a nodal SUVmax ≥2.25 were significantly correlated with DFS and OS. PET imaging with {sup 18}F-FDG offers prognostic information for LABC that can be obtained preoperatively and noninvasively. (orig.)

  13. Influence to the curative effect of THA with different methods to reconstruct limb length for Crowe Ⅳ type developmental dysplasia of the hip%下肢重建方式对Crowe Ⅳ型髋关节发育不良全髋关节置换术后疗效的影响

    Institute of Scientific and Technical Information of China (English)

    丛锐军; 符培亮; 吴宇黎; 陈松; 王波; 李晓华; 付奇伟; 祝云利

    2013-01-01

    目的 探讨不同重建方式恢复单侧CroweⅣ型髋关节发育不良(developmental dysplasia of the hip,DDH)的患肢长度后关节功能与患者满意度的差异.方法 将21例拟行全髋关节置换术的单侧CroweⅣ型DDH患者随机分为代偿长度组11例(转子下截骨后按照代偿法测得的双下肢长度差重建患肢长度)和绝对长度组10例(按照双下肢绝对长度差重建患肢长度).平均随访10年,比较两组患者Harris髋关节评分和健康调查简表SF-36(the MOS item short form health survey,SF-36)评分;以翻修作为终点,采用Kaplan-Meier生存分析法评估假体生存率;根据症状及X线表现评价关节功能和假体松动情况.结果 17例获得随访,随访时间8~10年.两组患者Harris髋关节评分、主要的SF-36评分和假体生存率的差异无统计学意义,代偿长度组患者SF-36评分的“心理健康”项优于绝对长度组.10例出现聚乙烯磨损,6例出现大转子区严重骨质疏松,3例骨溶解.5例翻修:1例感染、1例假体周围骨折、3例无菌性松动.结论 两种不同重建方式的全髋关节置换术后髋关节功能和假体生存率无差异.绝对长度组患者手术满意度低于代偿长度组,术后持续感觉双下肢不等长.%Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier

  14. Non-Invasive Ventilation in HIV Positive patients with Sepsis and ...

    African Journals Online (AJOL)

    46987.2

    review of 385 folders, every 5thfile was selected as comparator group. .... Depending on patient responses, the oxygen flow rates were adjusted from between ... Kaplan-Meier plots using log rank test for between-group comparison. RESULTS.

  15. Sobrevida de mulheres tratadas por câncer de mama no estado do Rio de Janeiro Sobrevida de mujeres tratadas por câncer de mama en el estado de Rio de Janeiro, Sureste de Brasil Survival of breast cancer women in the state of Rio de Janeiro, Southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Claudia Brito

    2009-06-01

    establecimientos de asistencia oncológica. MÉTODOS: Estudio longitudinal retrospectivo, basado en informaciones del Sistema de Autorización de Procedimientos de Alta Complejidad del Sistema Único de Salud y en muestra aleatoria de 310 prontuarios de mujeres prevalentes atendidas en 15 unidades hospitalarias y ambulatorias oncológicas con quimioterapia entre 1999 y 2002, en el estado de Río de Janeiro, Sureste de Brasil. Fueron consideradas como variables independientes características de la estructura de las unidades oncológicas y sus intervenciones practicadas, controlando el efecto con variables sociodemográficas y clínicas de las pacientes. Para análisis de los datos, fueron utilizados la técnica de Kaplan-Meier y el modelo de riesgo de Cox (pseudos-verosimilitud. RESULTADOS: Los análisis de Kaplan-Meier señalaron asociaciones significativas entre sobrevida y tiempo entre diagnóstico e inicio del tratamiento, realización de cirugía, utilización de hormonoterapia, tipo de hormonoterapia, combinaciones terapéuticas, tipo de unidad y seguro de salud, volumen de atención en cáncer de mama del establecimiento y naturaleza jurídica de la unidad. Estimaciones obtenidas por el modelo Cox indicaron asociaciones positivas entre el hazard de muerte y tiempo entre diagnóstico e inicio del tratamiento, volumen de atención de cáncer de mama del establecimiento y tipo de unidad combinado con el uso del seguro de salud; y negativas entre sobrevida y cirugía de mama y tipo de hormonoterapia. CONCLUSIONES: Los resultados muestran asociación entre sobrevida de cáncer de mama y el cuidado de salud prestado por los servicios acreditados, con implicaciones prácticas para pautar nuevas propuestas para el control del cáncer en Brasil.OBJECTIVE: To assess the association between breast cancer survival and infrastructure and practices of cancer care units. METHODS: Retrospective longitudinal study based on data from the Brazilian information system of authorizations for

  16. 血清神经元特异性烯醇化酶和胆红素与大动脉粥样硬化性卒中后脑功能损伤及预后的关系%Relationship between serum neuron-specific enolase,bilirubin and cerebral dysfunction,prognosis after large-artery atherosclerotic stroke

    Institute of Scientific and Technical Information of China (English)

    王岩; 欧阳和中; 刘凤国; 刘淑艳; 谢莉

    2015-01-01

    Objective Toinvestigatetherelationbetweenserumneuron-specificenolase(NSE), bilirubinandcerebraldysfunction,prognosisafterlarge-arteryatheroscleroticstroke.Methods According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST)criteria,all the 73 patients with large artery atherosclerotic stroke were divided into the test group (41 cases ) and control group (32 cases ) according to the elevated or normal levels of serum NSE and total bilirubin. At the first day of their hospitalization,the National Institutes of Health Stroke Scale (NIHSS)score was conducted,their serum NSE,bilirubin (total bilirubin,direct bilirubin,indirect bilirubin)levels were detected,and were compared with the reevaluation of 7 and 14 days of their hospitalization and reexamination results. The modified Rankin Scale (mRS)was use to assess the recovery of their neurological function at day 30 after onset/admission. The prognosis of the patients was followed up at 1 year after onset/admission. The Kaplan-Meier product-limit method was used to conduct the analysis of the good outcome rate,and the good outcomes of both groups/interlayers (different bilirubin and NSE levels)were tested with Log-rank test. Results (1)The NIHSS scores,the levels of serum bilirubin and NSE at day 1,7,and 14 in the test group were significantly higher than those of a control group (all P<0. 01). The levels of serum bilirubin and NSE at day 7 and 14 were lower than those at day 1. (2)The mRS score at day 30 between the test group and the control group was singnificantly different (Z =3. 286,P =0. 001). (3)At day 1,the CT detection rate of large area cerebral infarction of the test group was significantly higher than that of the control group (56. 1%[n=23]vs. 28. 1%[n=9]). There was significant difference (χ2 =5. 712,P=0. 017). (4)The analysis result of Kaplan-Meier showed that there was no significant difference in its good outcome no matter grouped by the test or by serum NSE level stratification of the

  17. The Epidemiology of Bartonellosis in Peru

    Science.gov (United States)

    2000-12-19

    CHAPTER 3. Figure 1. Kaplan-Meier Survival Plot of hematic-phase bartonellosis 102 patients developing verrucous lesions Figure 2. TIme-line showing...onset of verrucous lesions in patients with 103 Hematic bartonellosis following treatment Figure 3. Kaplan-Meier Survival Pfot of ~nset of verrucous ...of bartonellosis in endemic areas, reports of aggressive verrucous bartonellosis from the western coastal desert region of Ecuador, emergence of the

  18. Delayed-type hypersensitivity responses to HIV Gag p24 relate to clinical outcome after peptide-based therapeutic immunization for chronic HIV infection.

    Science.gov (United States)

    Kran, Anne-Marte B; Sommerfelt, Maja A; Baksaas, Ingebjørg; Sørensen, Birger; Kvale, Dag

    2012-03-01

    Therapeutic immunization in chronic HIV infection aims to induce durable, HIV-specific immune responses capable of controlling disease progression, but immunological correlates of clinical efficacy are poorly defined. We have previously immunized 38 patients with a mixture of four short Gag p24-like conserved peptides (Vacc-4x) targeting skin dendritic cells. Antiretroviral treatment (ART) was initially stopped after completed immunizations and resumed post-protocol during regular clinical follow-up according to current guidelines. Four years after enrolment, Vacc-4x-specific cellular responses were evaluated in vivo by delayed-type hypersensitivity (DTH) skin test, and in vitro by a T-cell proliferation assay. Kaplan-Meier product-limit estimates were used to analyse time until ART was resumed. Peptide-specific cellular immune responses induced by Vacc-4x had persisted 4 years after the last immunization in terms of unchanged DTH independent of ART and detectable proliferative T-cell responses which correlated to the native peptides (R = 0.73, p = 0.01). Circulating bifunctional (IFN-γ and IL-10) Vacc-4x-specific T-cell clones were detected in 43% of patients. Subjects with the strongest post-immunization DTH responses appeared to start ART later compared with DTH low responders (p = 0.07). These data suggest that DTH responses should be further evaluated as a new and convenient tool for predicting clinical efficacy in trials testing therapeutic immunizations.

  19. Relationships between subjective or objective symptoms and mortality in schizophrenia: a prospective study on 310 schizophrenic patients with a median follow-up of 8.4 years.

    Science.gov (United States)

    Loas, Gwenolé; Yon, Valérie; Maréchal, Virginie; Dècle, Pénélope

    2011-01-30

    The aim of the study was to explore the relationships between subjective or objective symptoms and mortality in schizophrenia. 310 subjects meeting the ICD-10 criteria for schizophrenia were included in the study between 1998 and 2000. At the initial assessment the following variables were respectively assessed to evaluate subjective and objective symptoms: the Frankfurt Complaints Questionnaire (FCQ) and the Positive and Negative Syndrome Scale (PANSS). In May 2008, information about the subjects were collected in order to know if they are alive or not and if they are deceased to know the date and the causes of their death. Survival analysis was conducted using the Kaplan-Meier product-limit estimator and standardized mortality ratio (SMR) was calculated. A multivariate Cox regression was done to detect predictive factors associated with mortality. Absolute mortality rates were 10.01%, 4.46% and 5.42% for overall mortality, unnatural causes and natural causes, respectively. SMR for overall mortality was 4.73. Cox regression analyses showed that elevated scores of FCQ was significant predictor of deaths from unnatural causes. High levels of subjective symptoms, as rated by the FCQ were independent predictor of mortality by unnatural causes in schizophrenic subjects. There were several limitations: The causes of death were not determined by autopsy and secondly, the duration of the study could be insufficient to detect significant associations between clinical variables and mortality.

  20. 不同感染途径、CD4+绝对值计数对1189例无症状期HIV感染者潜伏期影响的横断面研究%Research on Contribution to the Incubation Period of 1189 Cases of Asymptomatic HIV Infection on the Different Routes of Infection and Different CD4+ Counts by Cross-Sectional Study

    Institute of Scientific and Technical Information of China (English)

    郭建中; 杨小平; 徐立然

    2012-01-01

    Objective: To study the impact of different routes of infection and CD4+ absolute value on incubation period of a-symptomatic HIV infection. Methods: 1189 asymptomatic HIV infected persons in 10 research centers were investigated with cross-sectional studies, and the average incubation period of asymptomatic HIV infection with different routes of infection and CD4+ value were calculated by Kaplan meier product-limited method. Results : The incubation period of HIV infection adults by blood was 8. 99 years;by drug taking was 7. 42 years;by heterosex was 7. 70 years ; by gay sex was 7. 70 years. The incubation period of HIV infection adults CD + 4 count level in 200 ~ 350/mm3 was 8.71 years;in 350 ~ 450/mm3 was 9. 33 years,over 450/mm3 was 9.09 years. Conclusion:The incubation period of adults of asymptomatic HIV infection infected by blood was the longest,infected by gay sex was the shortest.%目的:研究不同感染途径、不同水平CD4+绝对值计数对无症状期HIV感染者进入艾滋病期的发病时间(潜伏期)的影响.方法:采用横断面研究的方法,对全国10各中心1189例无症状期HIV感染者进行调查,利用Kaplan meier乘积极限法计算不同感染途径、不同CD4+绝对值计数水平的平均发病时间.结果:血液途径感染的无症状期HIV 感染者的可能发病时间为8.99年,吸毒途径感染者7.42年,同性恋性途径感染者为6.92年,异性性途径感染者发病时间为7.70年;CD4+绝对值计数200 ~ 350/mm3的无症状期HIV感染的可能发病时间为8.71年,350 ~ 450/mm3水平者9.33年,450/mm3以上者为9.09年.结论:患者的免疫功能与潜伏期呈正相关,不同传播途径的潜伏期不同,经血途径感染的无症状期HIV感染者潜伏期最长,与联合国艾滋病规划署(UNAIDS)研究结果经血途径感染潜伏期9.5年相比稍短;同性恋途径感染者潜伏期最短.

  1. Improved curve fits to summary survival data: application to economic evaluation of health technologies

    Directory of Open Access Journals (Sweden)

    Henley William

    2011-10-01

    Full Text Available Abstract Background Mean costs and quality-adjusted-life-years are central to the cost-effectiveness of health technologies. They are often calculated from time to event curves such as for overall survival and progression-free survival. Ideally, estimates should be obtained from fitting an appropriate parametric model to individual patient data. However, such data are usually not available to independent researchers. Instead, it is common to fit curves to summary Kaplan-Meier graphs, either by regression or by least squares. Here, a more accurate method of fitting survival curves to summary survival data is described. Methods First, the underlying individual patient data are estimated from the numbers of patients at risk (or other published information and from the Kaplan-Meier graph. The survival curve can then be fit by maximum likelihood estimation or other suitable approach applied to the estimated individual patient data. The accuracy of the proposed method was compared against that of the regression and least squares methods and the use of the actual individual patient data by simulating the survival of patients in many thousands of trials. The cost-effectiveness of sunitinib versus interferon-alpha for metastatic renal cell carcinoma, as recently calculated for NICE in the UK, is reassessed under several methods, including the proposed method. Results Simulation shows that the proposed method gives more accurate curve fits than the traditional methods under realistic scenarios. Furthermore, the proposed method achieves similar bias and mean square error when estimating the mean survival time to that achieved by analysis of the complete underlying individual patient data. The proposed method also naturally yields estimates of the uncertainty in curve fits, which are not available using the traditional methods. The cost-effectiveness of sunitinib versus interferon-alpha is substantially altered when the proposed method is used. Conclusions

  2. Seizure freedom score: a new simple method to predict success of epilepsy surgery.

    Science.gov (United States)

    Garcia Gracia, Camilo; Yardi, Ruta; Kattan, Michael W; Nair, Dileep; Gupta, Ajay; Najm, Imad; Bingaman, William; Gonzalez-Martinez, Jorge; Jehi, Lara

    2015-03-01

    We aim to develop a new scale that predicts seizure outcomes after resective epilepsy surgery. We retrospectively reviewed patients who underwent surgery for medically refractory epilepsy at our center between 1999 and 2012. Four predictive outcome indicators were selected: preoperative seizure frequency, history of generalized tonic-clonic seizures, brain magnetic resonance imaging (MRI), and epilepsy duration. A score of 0 or 1 was given if the indicator was associated with poor or good outcome, respectively. A seizure freedom score (SFS) was calculated by adding these four categories (total score ranged from 0 to 4). A modified SFS (m-SFS) was then calculated with two additional outcome indicators: invasive electroencephalography (EEG) evaluation (IEI) (performed or not performed) and lobe of resection (temporal vs. extratemporal), for a score ranging from 0 to 6. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom in the overall group. Statistical significance was tested using the log-rank test and comparison of 95% confidence intervals (CIs). The study population included 466 patients with 244 (52%) male. Seizure freedom rates were directly correlated with the SFS score: at 10 years, 36.9% of patients with SFS of 0 were seizure-free, as opposed to 45% for SFS = 1, 60% for SFS = 2, 72% for SFS 3 or above (p = 0.002). When calculated including the IEI and the localization, the score's performance improved: 24% of patients with a m-SFS of 0 were seizure-free at 10 years, as opposed to 38-59% for m-SFS = 1-3, and 75-79% for m-SFS of 4-6 (p seizure freedom score could be a reliable tool to synthesize multiple seizure outcome predictors into a single simple score to predict postoperative seizure freedom. This tool will help with patient and family counseling and estimation of surgical candidacy at both early (SFS) and advanced (m-SFS) stages of a surgical evaluation. Wiley Periodicals, Inc. © 2014 International League Against

  3. Bridge to success: A better method of cryoablation for atrioventricular nodal reentrant tachycardia in children.

    Science.gov (United States)

    Reddy, Charitha D; Ceresnak, Scott R; Motonaga, Kara S; Avasarala, Kishor; Feller, Christine; Trela, Anthony; Hanisch, Debra; Dubin, Anne M

    2017-07-14

    Cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is associated with higher recurrence rates than radiofrequency ablation (RFA). Junctional tachycardia marks procedural success with RFA, but no such indicator exists for cryoablation. The purpose of this study as to determine the impact of voltage mapping plus longer ablation lesions on midterm success of cryoablation for children with AVNRT. We performed a single-center retrospective analysis of pediatric patients with AVNRT who underwent cryoablation from 2011 to 2015. Patients ablated using a standard electroanatomic approach (control) were compared with patients ablated using voltage mapping (voltage group). In the voltage group, EnSite NavX navigation and visualization technology (St Jude Medical, St Paul, MN) was used to develop a "bridge" of lower voltage gradients (0.3-0.8 mV) of the posteroseptal right atrium to guide cryoablation. Kaplan-Meier analysis was used to determine freedom from recurrence of supraventricular tachycardia. In all, 122 patients were included (71 voltage, 51 control). There was no difference between groups regarding age, sex, or catheter-tip size. Short-term success was similar in both groups (98.5% voltage vs 92% control; P = .159), but recurrence rates were lower in the voltage group (0% vs 11%, P = .006). Follow-up time was shorter in the voltage group (15 ± 7 months vs 22 ± 17 months, P < .05). The 1-year freedom from recurrence was lower in the voltage group (100% vs 91.5%, P <.05). Ablation times were longer in the voltage group (43.7 ± 20.9 minutes vs 34.3 ± 20.5 minutes, P = .01), but overall procedure times were shorter in the voltage group (157 ± 40 minutes vs 198 ± 133 minutes; P = .018). No significant complication was seen in either group. Voltage gradient mapping and longer lesion time can decrease recurrence rates in pediatric patients with AVNRT. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  4. A single-arm trial indirect comparison investigation: a proof-of-concept method to predict venous leg ulcer healing time for a new acellular synthetic matrix matched to standard care control.

    Science.gov (United States)

    Shannon, Ronald; Nelson, Andrea

    2017-08-01

    To compare data on time to healing from two separate cohorts: one treated with a new acellular synthetic matrix plus standard care (SC) and one matched from four large UK pragmatic, randomised controlled trials [venous leg ulcer (VLU) evidence network]. We introduce a new proof-of-concept strategy to a VLU clinical evidence network, propensity score matching and sensitivity analysis to predict the feasibility of the new acellular synthetic matrix plus SC for success in future randomised, controlled clinical trials. Prospective data on chronic VLUs from a safety and effectiveness study on an acellular synthetic matrix conducted in one wound centre in the UK (17 patients) and three wound centres in Australia (36 patients) were compared retrospectively to propensity score-matched data from patients with comparable leg ulcer disease aetiology, age, baseline ulcer area, ulcer duration, multi-layer compression bandaging and majority of care completed in specialist wound centres (average of 1 visit per week), with the outcome measures at comparable follow-up periods from patients enrolled in four prospective, multicentre, pragmatic, randomised studies of venous ulcers in the UK (the comparison group; VLU evidence network). Analysis using Kaplan-Meier survival curves showed a mean healing time of 73·1 days for ASM plus SC (ASM) treated ulcers in comparison with 83·5 days for comparison group ulcers treated with SC alone (Log rank test, χ(2) 5·779, P = 0·016) within 12 weeks. Sensitivity analysis indicates that an unobserved covariate would have to change the odds of healing for SC by a factor of 1·1 to impact the baseline results. Results from this study predict a significant effect on healing time when using a new ASM as an adjunct to SC in the treatment of non-healing venous ulcers in the UK, but results are sensitive to unobserved covariates that may be important in healing time comparison. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  5. Prognostic analysis of non - small cell lung cancer with bone metastasis%非小细胞肺癌骨转移的预后因素分析

    Institute of Scientific and Technical Information of China (English)

    李明蔚; 邝先奎; 赵向通; 黄堃; 韩伟; 董文杰; 王丽萍

    2016-01-01

    目的:分析非小细胞肺癌(non - small cell lung cancer,NSCLC)骨转移的预后相关因素和生存情况。方法回顾性分析2013年1月至2013年6月郑州大学第一附属医院收治的78例非小细胞肺癌骨转移患者的临床资料,采用Kaplan - Meier 法估计1年和2年生存率,单因素分析采用 Log - rank 时序分析筛选预后的影响因素,多因素分析采用Cox 比例风险回归模型进一步确认独立影响因素。结果非小细胞肺癌骨转移的中位生存时间为10.5个月,Kaplan -Meier 生存分析结果显示1年和2年生存率分别为48.7%和15.4%。单因素分析显示 ECOG 评分、病理类型、骨以外的其他部位转移、化疗及分子靶向治疗与预后相关(P ﹤0.05);多因素分析显示 ECOG 评分、病理类型、骨以外的其他部位转移、化疗及分子靶向治疗为预后的独立影响因素。结论体能状况好、腺癌、单纯骨转移、接受化疗及分子靶向治疗的非小细胞骨转移患者预后更好。%Objective To investigate the prognosis - related factors of non - small cell lung cancer(NSCLC)with bone me-tastasis. Methods The clinical data of 78 NSCLC patients with bone metastasis treated in the First Affiliated Hospital of Zheng-zhou University from January of 2013 to June of 2013 were retrospectively analyzed. Kaplan - Meier method was used to estima-tethe 1 - and 2 - year survival rates of patients. Log - rank time series analysis for the univariate analysis was used to screen the factors influencing the survival of patients and Cox proportional hazard model for the multivariate analysis was used to further con-NSCLC were 48. 7% and 15. 4% . Single factor analysis showed that ECOG score,pathological type,other parts of metastasis, chemotherapy and molecular targeted therapy(MTT)were associated with the prognosis of patients(P ﹤ 0. 05). Multivariate a-nalysis showed that ECOG score,pathological type,other parts of metastasis

  6. Tempo de internação e a ocorrência de eventos adversos a medicamentos: uma questão da enfermagem Tiempo de internación y la ocurrencia de eventos adversos por medicamentos: una cuestión de la enfermería The length of stay and the occurrence of adverse drug: a question of nursing

    Directory of Open Access Journals (Sweden)

    Keroulay Estebanez Roque

    2011-09-01

    took place at a public and cardiologic hospital, located in the city of Rio de Janeiro. For the analysis of the survival, the method Kaplan-Meier was used. The probability of surviving free from an adverse event to drugs up to 30, 60 and 100 days was respectively of 96%, 93% and 73%. The adverse events to drugs represent marking conditions that describe the performance of the health services. The detection of adverse events in hospitals makes it possible to know the failures that occur in the medication system and also to implement strategies to reduce them.

  7. Survival of a cohort of women with cervical cancer diagnosed in a Brazilian cancer center Sobrevida de mujeres con cáncer de cuello uterino diagnosticadas en un centro brasileño Sobrevida de mulheres com câncer de colo uterino diagnosticadas em um centro brasileiro

    Directory of Open Access Journals (Sweden)

    Claudio Calazan do Carmo

    2011-08-01

    Full Text Available OBJECTIVE: To assess overall survival of women with cervical cancer and describe prognostic factors associated. METHODS: A total of 3,341 cases of invasive cervical cancer diagnosed at the Brazilian Cancer Institute, Rio de Janeiro, southeastern Brazil, between 1999 and 2004 were selected. Clinical and pathological characteristics and follow-up data were collected. There were performed a survival analysis using Kaplan-Meier curves and a multivariate analysis through Cox model. RESULTS: Of all cases analyzed, 68.3% had locally advanced disease at the time of diagnosis. The 5-year overall survival was 48%. After multivariate analysis, tumor staging at diagnosis was the single variable significantly associated with prognosis (pOBJETIVO: Evaluar la sobrevida global de mujeres con cáncer de cuello uterino e identificar factores pronósticos relacionados. MÉTODOS: Todos los 3.341 casos tratados en el Instituto Nacional de Cáncer, Rio de Janeiro, Sureste de Brasil, entre 1999 y 2004 fueron seleccionados y sus datos clínicos, anatomo-patológicos y de seguimiento fueron colectados. Se utilizaron la curva de Kaplan-meier y el modelo de Cox par evaluación de la sobrevida y para análisis logística múltiple, respectivamente. RESULTADOS: De los casos estudiados, 68,3% presentaban enfermedad localmente avanzada. La sobrevida en cinco años fue de 48%. Posterior al análisis múltiple, el estadio clínico al diagnóstico fue la única variable significativamente asociada con el pronóstico (pOBJETIVO: Avaliar a sobrevida global de mulheres com câncer de colo uterino e identificar fatores prognósticos relacionados. MÉTODOS: Todos os 3.341 casos tratados no Instituto Nacional de Câncer, Rio de Janeiro, RJ, entre 1999 e 2004 foram selecionados e seus dados clínicos, anatomo-patológicos e de seguimento foram coletados. Foram utilizados a curva de Kaplan-Meier e o modelo de Cox para avaliação da sobrevida e para análise logística m

  8. Transjugular intrahepatic portosystemic shunt vs endoscopic therapy in preventing variceal rebleeding

    Institute of Scientific and Technical Information of China (English)

    Hui Xue; Meng Zhang; Jack XQ Pang; Fei Yan; Ying-Chao Li; Liang-Shan Lv; Jia Yuan

    2012-01-01

    AIM:To compare early use of transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic treatment (ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years; previously received surgical treatment or endoscopic therapy for variceal bleeding; and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS (TIPS group) while 62 patients received endoscopic therapy (ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rate and cost of treatment were compared between the two groups.RESULTS:During the follow-up period (median,20.7and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group (Kaplan-Meier analysis and log-rank test,P=0.000).Rebleeding rates at any time point (6 wk,1year and 2 year) in the TIPS group were lower than in the ET group (Bonferroni correction o' =o/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test x2=4.864,P =0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates (Bonferroni correction a' =a/3).However,significant differences were observed between the two groups in the 1-year survival rates (92% and 79%) and the 2-year survival rates (89% and 64.9%)(Bonferroni correction a' =o/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy (12 patients in TIPS

  9. Measuring quality indicators in the operating room: cleaning and turnover time Mensuración de indicadores de calidad en un centro quirúrgico: tiempo de limpieza e intervalo entre cirugías Mensuração de indicadores de qualidade em centro cirúrgico: tempo de limpeza e intervalo entre cirurgias

    Directory of Open Access Journals (Sweden)

    Marli de Carvalho Jericó

    2011-10-01

    Full Text Available This exploratory-descriptive study was carried out in the Surgical Center Unit of a university hospital aiming to measure time spent with concurrent cleaning performed by the cleaning service and turnover time and also investigated potential associations between cleaning time and the surgery's magnitude and specialty, period of the day and the room's size. The sample consisted of 101 surgeries, computing cleaning time and 60 surgeries, computing turnover time. The Kaplan-Meier method was used to analyze time and Pearson's correlation to study potential correlations. The time spent in concurrent cleaning was 7.1 minutes and turnover time was 35.6 minutes. No association between cleaning time and the other variables was found. These findings can support nurses in the efficient use of resources thereby speeding up the work process in the operating room.Este estudio exploratorio y descriptivo fue conducido en la Unidad de Centro Quirúrgico de un hospital de enseñanza teniendo por objetivos mensurar el tiempo utilizado para limpieza concurrente en sala de operación (por el Servicio de Higiene y Limpieza y el intervalo entre las cirugías; e, investigar las asociaciones entre: tiempo de limpieza, porte de la cirugía, especialidad de la cirugía, período de ocurrencia y tamaño de la sala. El estudio fue constituido de 101 casos de limpieza (estudio de tiempo de limpieza y 60 cirugías (estudio de intervalo entre cirugías. El método de Kaplan-Meier fue utilizado para el análisis del tiempo y la correlación de Pearson para el estudio de las asociaciones. El tiempo promedio de limpieza concurrente de la sala fue de 7,1 minutos y el del intervalo entre cirugías de 35,6 minutos. No fue encontrada correlación entre el tiempo de limpieza y las demás variables. Estos hallazgos instrumentalizan a los enfermeros en el uso eficiente de recursos, agilizando el proceso de trabajo en el Centro Quirúrgico.Este estudo exploratório-descritivo foi

  10. Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Jin Li; Lu-Nan Yan; Jian Yang; Zhe-Yu Chen; Bo Li; Yong Zeng; Tian-Fu Wen; Ji-Chun Zhao; Wen-Tao Wang; Jia-Yin Yang; Ming-Qing Xu; Yu-Kui Ma

    2009-01-01

    AIM:To identify prognostic factors of patients with hepatocellular carcinoma (HCC), who were treated by orthotopic liver transplantation (OLT).METHODS: From January 2000 to October 2006,165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test.RESULTS: The median follow-up was 13.0 mo (2.8-69.5 mo). Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively.One-, 2-, 3- and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%,respectively. In univariate analysis, number of tumors,total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria (97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively)compared with that of patients who met the Milan or University of California, San Francisco (UCSF) criteria.CONCLUSION: Macrovascular invasion and total tumor diameter are the strongest prognostic factors.The proposed criteria do not adversely affect the

  11. Hypermethylation of testis derived transcript gene promoter significantly correlates with worse outcomes in glioblastoma patients

    Institute of Scientific and Technical Information of China (English)

    WANG Li-jia; BAI Yu; BAO Zhao-shi; CHEN Yan; YAN Zhuo-hong; ZHANG Wei; ZHANG Quan-geng

    2013-01-01

    Background Glioblastoma is the most common and lethal cancer of the central nervous system.Global genomic hypomethylation and some CpG island hypermethylation are common hallmarks of these malignancies,but the effects of these methylation abnormalities on glioblastomas are still largely unclear.Methylation of the O6-methylguanine-DNA methyltransferase promoter is currently an only confirmed molecular predictor of better outcome in temozolomide treatment.To better understand the relationship between CpG island methylation status and patient outcome,this study launched DNA methylation profiles for thirty-three primary glioblastomas (pGBMs) and nine secondary glioblastomas (sGBMs) with the expectation to identify valuable prognostic and therapeutic targets.Methods We evaluated the methylation status of testis derived transcript (TES) gene promoter by microarray analysis of glioblastomas and the prognostic value for TES methylation in the clinical outcome of pGBM patients.Significance analysis of microarrays was used for genes significantly differently methylated between 33 pGBM and nine sGBM.Survival curves were calculated according to the Kaplan-Meier method,and differences between curves were assessed using the log-rank test.Then,we treated glioblastoma cell lines (U87 and U251) with 5-aza-2-deoxycytidines (5-aza-dC) and detected cell biological behaviors.Results Microarray data analysis identified TES promoter was hypermethylated in pGBMs compared with sGBMs (P<0.05).Survival curves from the Kaplan-Meier method analysis revealed that the patients with TES hypermethylation had a short overall survival (P <0.05).This abnormality is also confirmed in glioblastoma cell lines (U87 and U251).Treating these cells with 5-aza-dC released TES protein expression resulted in significant inhibition of cell growth (P=0.013).Conclusions Hypermethylation of TES gene promoter highly correlated with worse outcome in pGBM patients.TES might represent a valuable prognostic marker

  12. Tempo até o transplante e sobrevida em pacientes com insuficiência renal crônica no Estado do Rio de Janeiro, Brasil, 1998-2002 Time to kidney transplantation in chronic renal failure patients in the State of Rio de Janeiro, Brazil, 1998-2002

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    Cynthia Braga da Cunha

    2007-04-01

    Full Text Available Neste estudo, descreveram-se as características dos 14.419 pacientes com insuficiência renal crônica tratados por hemodiálise no Estado do Rio de Janeiro, Brasil, e analisou-se o tempo até a primeira realização do transplante no período de 1998 a 2002. Técnicas de análise de sobrevida como a análise não paramétrica de Kaplan-Meier e a modelagem semiparamétrica com o modelo de riscos proporcionais de Cox foram utilizadas. Além do modelo de sobrevida para transplante, o tempo até o óbito foi estimado para a comparação das estimativas dos dois modelos. Os resultados mostraram que, no período estudado, apenas 6,3% dos pacientes foram transplantados, 32,4% foram indicados e 6,3% inscritos na lista de espera. Observa-se que a probabilidade de transplante dos pacientes indicados, inscritos para o transplante e os que estão em uma faixa etária reduzida é maior. A diabetes mellitus possui um efeito redutor de 35% no risco de realização de transplante. Todas as estimativas apresentaram direções contrárias às obtidas pelo modelo de sobrevida para óbito.This study analyzes the characteristics of 14,419 chronic renal failure patients treated with hemodialysis and time to first kidney transplantation in the State of Rio de Janeiro, Brazil, from 1998 to 2002. Survival analysis methods were used, such as the Kaplan-Meier non-parametric method and the semi-parametric method with the Cox proportional hazards model. Besides the survival model for transplantation, time to death was analyzed to compare the two models' estimates. During the period studied, only 6.3% of patients received transplants, 32.4% were referred for transplantation, and 6.3% were included on the waiting list. Odds of transplantation were greater for those who had been referred, those on the waiting list, and younger patients. Diabetes mellitus reduced the probability of conducting transplantation by 35%. All the estimates showed directions opposite to those

  13. Oligonodular hepatocellular carcinoma (HCC): MR-guided laser-induced thermotherapy (LITT); Oligonodulaeres hepatozellulaeres Karzinom (HCC): MR-gesteuerte laserinduzierte Thermotherapie (LITT)

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    Eichler, K.; Mack, M.G.; Straub, R.; Engelmann, K.; Zangos, S.; Woitaschek, D.; Vogl, T.J. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    2001-10-01

    Purpose. To prospectively evaluate the therapeutic potential of MR-guided laser-induced thermotherapy (LITT) in patients with oligonodular hepatocellular carcinoma. Material and methods. 39 patients with 61 intrahepatic lesions were treated with LITT. The Nd:YAG laser fiber was introduced with a percutaneously positioned irrigated laser application system. Qualitative and quantitative MR parameters and clinical data were evaluated. Results. All patients tolerated the procedure well under local anesthesia. All observed complications were minor and no further treatment was necessary. Online MR thermometry allowed exact visualization. Lesions p to 2 cm in diameter could be efficiently treated with a single laser application, larger lesions were treated simultaneous multiapplication. In 97.5% we achieved a complete necrosis of the tumor and a 5 mm safety margin, resulting in a complete destruction of the tumor without local recurrences. Mean survival was 4.4 years (95% Cl: 3.6-5.2 years) after the time of diagnoses of the HCC (Kaplan-Meier-method). Conclusion. In intrahepatic oligonodular involvement of hepatocellular carcinoma LITT appears to be an effective therapeutic procedure with a high tumor contol rate and better survival data. (orig.) [German] Zielsetzung. Evaluierung des therapeutischen Potenzials der MR-gesteuerten Thermotherapie (LITT) bei Patienten mit oligonodulaerem hepatozellulaerem Karzinom. Material und Methoden. 39 Patienten mit 61 intrahepatischen Laesionen wurden mittels der LITT therapiert. Dabei wurden ein Nd:YAG-Laser (1064 nm) und spezielle Power-Laser-Applikationssysteme perkutan eingesetzt. Qualitative und quantitative Parameter und klinische Daten wurden evaluiert. Ergebnisse. Alle 39 Patienten tolerierten die Therapie unter Lokalanaesthesie, ohne dass klinisch relevante Komplikationen beobachtet wurden. Unter Einsatz spezieller Thermosequenzen konnte die MR-Tomographie als Onlinemonitoring eingesetzt werden. Bei Laesionen bis zu 2 cm wird

  14. Stereotactic Body Radiation Therapy for Re-irradiation of Persistent or Recurrent Non-Small Cell Lung Cancer

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    Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Minatel, Emilio; Durofil, Elena [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Polesel, Jerry [Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Avanzo, Michele [Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Baresic, Tania [Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Bearz, Alessandra [Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Del Conte, Alessandro [Department of Medical Oncology, Pordenone General Hospital, Aviano, Pordenone (Italy); Franchin, Giovanni; Gobitti, Carlo; Rumeileh, Imad Abu; Trovo, Mauro G. [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)

    2014-04-01

    Purpose: To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity. Methods and Materials: The analysis was conducted in 17 patients with “in-field” recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test. Results: The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05). Conclusions: Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.

  15. Expression of T-Lymphocyte Markers in Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer

    Science.gov (United States)

    Lee, Changro; Kim, Joo Heung; Lim, Sung Mook; Park, Hyung Seok; Kim, Seung Il; Park, Byeong-Woo

    2016-01-01

    Purpose The present study aimed to examine the clinical implications of CD4, CD8, and FOXP3 expression on the prognosis of human epidermal growth factor receptor 2 (HER2)-positive breast cancer using a web-based database, and to compare the immunohistochemical expression of T-lymphocyte markers using primary and metastatic HER2-positive tumor tissues before and after HER2-targeted therapy. Methods Using the cBioPortal for Cancer Genomics and Kaplan-Meier plotter, the mRNA expression, association between T-lymphocyte markers, and survival in HER2-positive cancers were investigated according to various cutoff levels. Immunohistochemistry analysis was performed using paired primary and metastatic tissues of 29 HER2-positive tumors treated with systemic chemotherapy and HER2-directed therapy. Results HER2 mRNA was mutually exclusive of T-lymphocyte markers, and a significant correlation between T-cell markers was observed in the cBioPortal for Cancer Genomics. According to analysis of the Kaplan-Meier plotter, the impact of T-lymphocyte marker expression on survival was statistically insignificant in clinical HER2-positive tumors, irrespective of the cutoff levels. However, in the intrinsic HER2-positive subtype, the individual analyses of T-cell markers except for FOXP3 and combined analysis showed significantly favorable survival irrespective of cutoff points. Although the small clinical sample size made it difficult to show the statistical relevance of immunohistochemistry findings, good responses to neoadjuvant treatments might be associated with positive expression of combined T-lymphocyte markers, and approximately half of the samples showed discordance of combined markers between baseline and resistant tumors. Conclusion T-lymphocyte markers could be favorable prognostic factors in HER2-positive breast cancers; however, a consensus on patient section criteria, detection methods, and cutoff value could not be reached. The resistance to HER2-directed therapy might

  16. Relationship between LAPTM4B Gene Polymorphism and Prognosis of Patients following Tumor Resection for Colorectal and Esophageal Cancers

    Science.gov (United States)

    Xing, Xiaofang; Du, Hong; Zhou, Chunlian; Zhang, Qingyun; Hao, Chunyi; Wen, Xianzi; Ji, Jiafu

    2016-01-01

    Background Lysosome-associated transmembrane-4 beta (LAPTM4B) is an oncogene that participates tumorgenesis in a variety of human solid tumors, and it has two alleles named as LAPTM4B*1 and *2. The present study aimed to identify the association of LAPTM4B genotype with clinicopathological features and prognosis in colorectal and esophageal cancer patients. Method Genotypes of LAPTM4B were determined by PCR in 167 colon cancer cases (72 patients in a discovery cohort and 95 patients in a testing cohort), 160 rectal cancer cases and 164 esophageal cancer cases. Association between the LAPTM4B gene polymorphism and clinicopathological variables was calculated by Chi-square test or Fisher’s exact test. Patient survival differences were calculated by the Kaplan-Meier method. Prognostic factors were determined with Log-rank test and Cox regression model. Results LAPTM4B *1/1 was more frequently detected in colon cancer patients with lymph node metastasis and TNM III+IV stages in total colon cancer (discovery + testing cohorts). LAPTM4B *2/2 decreased in recurrent patients in total colon cancer patients (P = 0.045). Kaplan-Meier survival curves and Log-rank test showed that LAPTM4B*1 was correlated with shorter overall survival (OS) in discovery and testing cohorts of colon cancer (P = 0.0254 and 0.0292, respectively), but not in rectal and esophageal cancer cases (P = 0.7669 and 0.9356, respectively). Multivariate analysis showed that LAPTM4B genotype was an independent prognostic factor for OS in total colon cancer [P = 0.004, hazard ratio (HR) = 0.432; 95% confidence interval (CI) = 0.243–0.768], but not in rectal and esophageal cancers (P = 0.791, HR = 1.073, 95% CI = 0.638–1.804 and 0.998, HR = 1.000, 95% CI = 0.663–1.530, respectively). Conclusion These findings suggested that LAPTM4B allele *1 was a risk factor associated with poor prognosis in patients with colon cancer, but not in patients with rectal or esophageal cancers. LAPTM4B genotype status might

  17. Outcomes of stage IIB osteosarcoma treated by limb salvage surgery using extracorporeally irradiated (ECI autograft

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    Achmad F. Kamal

    2011-05-01

    Full Text Available Background: Extracorporeally irradiated (ECI technique is an alternative of limb salvage procedure in treating osteosarcoma regarding limitation of endoprosthesis and allograft. This study evaluated the outcomes of limb salvage surgery using extracorporeally irradiated (ECI autograft and its correlation with patient’s characteristics.Methods: Retrospective cohort design was performed to study 20 patients with stage IIB osteosarcoma treated by ECI autograft from 1995 to 2008. Survival, local recurrence, metastases, complications, union time and functional score based on Musculoskeletal Tumor Society scoring system-(MSTS were evaluated. Kaplan-Meier method was used to describe survival, local recurrence free survival, and metastases free survival. The correlation among patient’s characteristics that were age, gender, duration, site of tumor size, type of osteosarcoma, SAP (serum alkaline phosphatase level, type of biopsy, and type of Huvos were analyzed by Log rank test. Chi-square test was used to analyze the correlation between MSTS score and patient’s characteristics, local recurrence, metastases, complications.Results: Five-year survival was 54.97 ± 9.8 %, five-year local recurrence free survival was 66.5 ± 7.6%, and five year metastasis-free survival was 57.13 ± 10.04%. Six patients died, five were due to lung metastases and one due to complication of chemotherapy. Three underwent amputation after local recurrence. Kaplan-Meier curve showed that a good type of Huvos (III, IV always gave better survival, local recurrence free survival, and metastases free survival than poor type of Huvos (I,II. Normal SAP level gave better local recurrence free survival compare to increased level of SAP. Mean of union rate was 8.13 months. MSTS mean score was good (70.63% in patients with no evidence of disease. MSTS score was poor in patients with local recurrence (p = 0.025, metastases (p = 0.01, complications (p = 0.03, and the

  18. Loss of DPC4 expression and its correlation with clinicopathological parameters in pancreatic carcinoma

    Institute of Scientific and Technical Information of China (English)

    Zhan Hua; Yuan-Chun Zhang; Xiao-Ming Hu; Zhen-Geng Jia

    2003-01-01

    AIM: DPC4 is a tumor suppressor gene on chromosome 18q21.1 that has high mutant frequencies in pancreatic carcinogenesis. The purpose of this study was to investigate the role of DPC4 alterations in tumorigenesis and progression of pancreatic carcinomas.METHODS: We studied the immunohistochemical markers of DPC4 in 34 adenocarcinomas and 16 nonmalignant specimens from the pancreas. The 16 nonmalignant specimens from the pancreas included 8 non-neoplastic cysts and 8 normal pancreatic tissues. The relationship between DPC4 alterations and various clinicopathological parameters was evaluated by chi-square test or Fisher's exact test.Survivals were calculated using Kaplan-Meier method (by a log-rank test).RESULTS: All the 16 nonmalignant cases of the pancreas showed expression of DPC4 gene. Loss of DPC4 expression was seen in 8 of 34(23.5 %) pancreatic adenocarcinomas.The frequency of loss of DPC4 expression was higher in poorly differentiated adenocarcinoma (G3) than in well and moderately differentiated adenocarcinoma (G1 and G2)histologically (P=0.037). Loss of DPC4 expression of the patients at TNM stage Ⅳ was also higher than that of the patients at TNM stages Ⅰ, Ⅱ and Ⅲ (60.0 % at stage Ⅳ,versus14.3 % atstage Ⅰ, 18.2 % at stage Ⅱ, and 18.2 % at stage Ⅲ) (P=0.223). The mean and median survival in patients with DPC4 expression was longer than those in patients with loss of DPC4 expression. Kaplan-Meier survival analysis demonstrated patients with DPC4 expression had a higher survival rate than patients with loss of DPC4 expression, but the difference did not reach statistical significance (P =0.879).CONCLUSION: This study suggests that DPC4 is involved in the development of pancreatic carcinoma and is a late event in pancreatic carcinogenesis, DPC4 expression may be a molecular prognostic marker for pancreatic carcinoma.

  19. Trace elements as tumor biomarkers and prognostic factors in breast cancer: a study through energy dispersive x-ray fluorescence

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    Silva Marina P

    2012-07-01

    Full Text Available Abstract Background The application and better understanding of traditional and new breast tumor biomarkers and prognostic factors are increasing due to the fact that they are able to identify individuals at high risk of breast cancer, who may benefit from preventive interventions. Also, biomarkers can make possible for physicians to design an individualized treatment for each patient. Previous studies showed that trace elements (TEs determined by X-Ray Fluorescence (XRF techniques are found in significantly higher concentrations in neoplastic breast tissues (malignant and benign when compared with normal tissues. The aim of this work was to evaluate the potential of TEs, determined by the use of the Energy Dispersive X-Ray Fluorescence (EDXRF technique, as biomarkers and prognostic factors in breast cancer. Methods By using EDXRF, we determined Ca, Fe, Cu, and Zn trace elements concentrations in 106 samples of normal and breast cancer tissues. Cut-off values for each TE were determined through Receiver Operating Characteristic (ROC analysis from the TEs distributions. These values were used to set the positive or negative expression. This expression was subsequently correlated with clinical prognostic factors through Fisher’s exact test and chi-square test. Kaplan Meier survival curves were also evaluated to assess the effect of the expression of TEs in the overall patient survival. Results Concentrations of TEs are higher in neoplastic tissues (malignant and benign when compared with normal tissues. Results from ROC analysis showed that TEs can be considered a tumor biomarker because, after establishing a cut-off value, it was possible to classify different tissues as normal or neoplastic, as well as different types of cancer. The expression of TEs was found statistically correlated with age and menstrual status. The survival curves estimated by the Kaplan-Meier method showed that patients with positive expression for Cu presented a poor

  20. Validity of Three Recently Proposed Prognostic Grading Indexes for Breast Cancer Patients With Radiosurgically Treated Brain Metastases

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    Yamamoto, Masaaki, E-mail: BCD06275@nifty.com [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan); Department of Neurosurgery, Tokyo Women' s Medical University Medical Center E, Tokyo (Japan); Kawabe, Takuya [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan); Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Sciences, Kyoto (Japan); Higuchi, Yoshinori [Department of Neurosurgery, Chiba University Graduate School of Medicine, Chiba (Japan); Sato, Yasunori [Clinical Research Center, Chiba University Graduate School of Medicine, Chiba (Japan); Barfod, Bierta E. [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan); Kasuya, Hidetoshi [Department of Neurosurgery, Tokyo Women' s Medical University Medical Center E, Tokyo (Japan); Urakawa, Yoichi [Katsuta Hospital Mito GammaHouse, Hitachi-naka (Japan)

    2012-12-01

    Purpose: We tested the validity of 3 recently proposed prognostic indexes for breast cancer patients with brain metastases (METs) treated radiosurgically. The 3 indexes are Diagnosis-Specific Graded Prognostic Assessment (DS-GPA), New Breast Cancer (NBC)-Recursive Partitioning Analysis (RPA), and our index, sub-classification of RPA class II patients into 3 sub-classes (RPA class II-a, II-b and II-c) based on Karnofsky performance status, tumor number, original tumor status, and non-brain METs. Methods and Materials: This was an institutional review board-approved, retrospective cohort study using our database of 269 consecutive female breast cancer patients (mean age, 55 years; range, 26-86 years) who underwent Gamma Knife radiosurgery (GKRS) alone, without whole-brain radiation therapy, for brain METs during the 15-year period between 1996 and 2011. The Kaplan-Meier method was used to estimate the absolute risk of each event. Results: Kaplan-Meier plots of our patient series showed statistically significant survival differences among patients stratified into 3, 4, or 5 groups based on the 3 systems (P<.001). However, the mean survival time (MST) differences between some pairs of groups failed to reach statistical significance with all 3 systems. Thus, we attempted to regrade our 269 breast cancer patients into 3 groups by modifying our aforementioned index along with the original RPA class I and III, (ie, RPA I+II-a, II-b, and II-c+III). There were statistically significant MST differences among these 3 groups without overlap of 95% confidence intervals (CIs) between any 2 pairs of groups: 18.4 (95% CI = 14.0-29.5) months in I+II-a, 9.2 in II-b (95% CI = 6.8-12.9, P<.001 vs I+II-a) and 5.0 in II-c+III (95% CI = 4.2-6.8, P<.001 vs II-b). Conclusions: As none of the new grading systems, DS-GPS, BC-RPA and our system, was applicable to our set of radiosurgically treated patients for comparing survivals after GKRS, we slightly modified our system for breast cancer

  1. Predictors of Individual Tumor Local Control After Stereotactic Radiosurgery for Non-Small Cell Lung Cancer Brain Metastases

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    Garsa, Adam A. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Badiyan, Shahed N.; DeWees, Todd; Simpson, Joseph R.; Huang, Jiayi; Drzymala, Robert E. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Barani, Igor J. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Dowling, Joshua L.; Rich, Keith M.; Chicoine, Michael R.; Kim, Albert H.; Leuthardt, Eric C. [Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri (United States); Robinson, Clifford G., E-mail: crobinson@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2014-10-01

    Purpose: To evaluate local control rates and predictors of individual tumor local control for brain metastases from non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS). Methods and Materials: Between June 1998 and May 2011, 401 brain metastases in 228 patients were treated with Gamma Knife single-fraction SRS. Local failure was defined as an increase in lesion size after SRS. Local control was estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Receiver operating characteristic analysis was used to identify an optimal cutpoint for conformality index relative to local control. A P value <.05 was considered statistically significant. Results: Median age was 60 years (range, 27-84 years). There were 66 cerebellar metastases (16%) and 335 supratentorial metastases (84%). The median prescription dose was 20 Gy (range, 14-24 Gy). Median overall survival from time of SRS was 12.1 months. The estimated local control at 12 months was 74%. On multivariate analysis, cerebellar location (hazard ratio [HR] 1.94, P=.009), larger tumor volume (HR 1.09, P<.001), and lower conformality (HR 0.700, P=.044) were significant independent predictors of local failure. Conformality index cutpoints of 1.4-1.9 were predictive of local control, whereas a cutpoint of 1.75 was the most predictive (P=.001). The adjusted Kaplan-Meier 1-year local control for conformality index ≥1.75 was 84% versus 69% for conformality index <1.75, controlling for tumor volume and location. The 1-year adjusted local control for cerebellar lesions was 60%, compared with 77% for supratentorial lesions, controlling for tumor volume and conformality index. Conclusions: Cerebellar tumor location, lower conformality index, and larger tumor volume were significant independent predictors of local failure after SRS for brain metastases from NSCLC. These results warrant further investigation in a prospective

  2. Prognostic factors in patients with stage Ⅳ non-small cell lung cancer%Ⅳ期非小细胞肺癌预后影响因素分析

    Institute of Scientific and Technical Information of China (English)

    马美丽; 沈洁; 姜丽岩

    2006-01-01

    Objective: To investigate the prognostic factors for stage Ⅳ non-small cell lung cancer (NSCLC) with distant metastasis and establish a reliable model of clinical prognostic index.Methods: From January 1990 to April 2005,313 primary NSCLC patients with metastasis,who had been treated in Shanghai Chest Hospital,were reviewed.Survival time was estimated according to the Kaplan-Meier method.Cox proportional hazard regression model was used for multivariate analysis.Results: Among the 313 cases of non-small cell lung cancer (NSCLC) at stage Ⅳ,there were 218 and 95 patients with metastasis to single and different organs,respectively.The overall median survival time for all 313 cases of NSCLC patients was 10.8 (9.00,12.30)months and the overall 1-,2-,3-,4- and 5-year survival rate was 45%,18%,12%,4% and 0%.There were 63,174,127,36,18,11 and 5 patients with metastasis to brain (20.13%),bone (55.59%),lung (40.58%),liver (11.50%),adrenal gland (5.75%),subcutaneous (3.51%) and others,respectively.The survival time was shortest in subcutaneous metastasis (4.6 months),and liver 7.0 months,brain 8.0 months,adrenal gland 8.6 months,bone 10.6 months,lung 11.8 months.Kaplan-Meier estimation showed that patients anatomic typing,KPS,numbers of organ with metastasis,appetite,liver,adrenal gland and subcutaneous metastasis,body weight loss,smoking,index of smoking,chemotherapy,cycles of chemotherapy were the predictors of survival.Multivariate analysis showed survival statistically significant correlation with anatomic typing,KPS,appetite,liver and subcutaneous metastasis,body weight loss,cycles of chemotherapy.The relative risk (RR) was 1.51,1.97,1.55,1.67,2.56,and 2.56 respectively.Conclusion: Survival time decreases distinctly in patients who had distant metastasis to more than two different organs (P<0.01).Bone is the commonest organ for distant metastasis in lung cancer.The prognosis is poor when lung cancer appears subcutaneous metastasis and liver metastasis

  3. Concurrent chemoradiation for vaginal cancer.

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    David T Miyamoto

    Full Text Available BACKGROUND: It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT or concurrent chemoradiation therapy (CRT. METHODS: Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS and disease-free survival (DFS rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. RESULTS: The median age at diagnosis was 61 years (range, 18-92 years and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011. Twenty-three patients (45% in the RT group had a relapse at any site compared to 3 (15% in the CRT group (p = 0.027. With regard to the sites of first relapse, 10 patients (14% had local only, 4 (6% had local and regional, 9 (13% had regional only, 1 (1% had regional and distant, and 2 (3% had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10-0.97; p = 0.04. CONCLUSIONS: Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.

  4. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

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    Niklaus Daniel Labhardt

    2013-11-01

    Full Text Available Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs to scale up the provision of antiretroviral therapy (ART. We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5% started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81 and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001. These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR: 0.89, 95% confidence interval (CI: 0.73–1.09 and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96. The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93. Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities

  5. Perturbation methods

    CERN Document Server

    Nayfeh, Ali H

    2008-01-01

    1. Introduction 1 2. Straightforward Expansions and Sources of Nonuniformity 23 3. The Method of Strained Coordinates 56 4. The Methods of Matched and Composite Asymptotic Expansions 110 5. Variation of Parameters and Methods of Averaging 159 6. The Method of Multiple Scales 228 7. Asymptotic Solutions of Linear Equations 308 References and Author Index 387 Subject Index 417

  6. Clinicopathological, therapeutic and prognostic features of the triple-negative tumors in moroccan breast cancer patients (experience of Hassan II university hospital in Fez

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    Akasbi Yousra

    2011-11-01

    Full Text Available Abstract Introduction Triple-negative breast cancer (TNBC is defined as a group of breast carcinomas that are negative for expression of hormone receptors (ER, PR and Her2, we can distinguish between two groups: basal-like (ER-, PR-, Her2-, cytokeratin (CK 5/6+ and/or Her1+ and unclassified subtype (ER-, PR-, Her2-, Her1- and CK5/6-. The aim of this study is to determine the clinicopathological, histological, therapeutic and prognostic features associated with this type of breast cancer. Methods This is a retrospective study of 366 female breast cancer patients, diagnosed between January 2007 and June 2010 at the Department of Pathology. Epidemiological, clinical, histological, therapeutic and evolutive data were analyzed. OS and DFS rates were estimated by Kaplan-Meier analysis and a log-rank test to estimate outcome. Results A total of 64 women were identified as having TNBC (17.5% of all female breast cancer patients, 12.6% were basal-like, 4.9% were unclassified subtype, with a median age of 45 years. The median histological tumor diameter was 4.3 cm. TNBC were most often associated with a high grade, 49.2% grade III (53% for unclassified subtype, 47.6% for basal-like. Vascular invasion was found in 26.6% of cases (22% for unclassified subtype and 28.3% for basal-like. For the lymph node involvement: 51% had positive lymph nodes, and 22.4% had distant metastases. Neoadjuvant chemotherapy was administered to 18% patients with 26% of complete pathologic response; therefore adjuvant chemotherapy was given to 82%. 98% received anthracycline based regimen and only 30% received taxanes. The Kaplan-Meier curves based showed the lowest survival probability at 3-years (49% of OS, and 39% of DFS. Conclusion TNBC is associated with young age, high grade tumors, advanced stage at diagnosis, difference chemo response compared to other subtypes, and shortest survival. Critical to optimal future management is accurate identification of truly triple

  7. MDM2 SNP309 promoter polymorphism and p53 mutations in urinary bladder carcinoma stage T1

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    Olsson Hans

    2013-01-01

    Full Text Available Abstract Background Urinary bladder carcinoma stage T1 is an unpredictable disease that in some cases has a good prognosis with only local or no recurrence, but in others can appear as a more aggressive tumor with progression to more advanced stages. The aim here was to investigate stage T1 tumors regarding MDM2 promoter SNP309 polymorphism, mutations in the p53 gene, and expression of p53 and p16 measured by immunohistochemistry, and subsequently relate these changes to tumor recurrence and progression. We examined a cohort of patients with primary stage T1 urothelial carcinoma of the bladder and their tumors. Methods After re-evaluation of the original slides and exclusions, the study population comprised 141 patients, all with primary stage T1 urothelial carcinoma of the bladder. The hospital records were screened for clinical parameters and information concerning presence of histologically proven recurrence and progression. The paraffin-embedded tumor material was evaluated by immunohistochemistry. Any mutations found in the p53 gene were studied by single-strand conformation analysis and Sanger sequencing. The MDM2 SNP309 polymorphism was investigated by pyrosequencing. Multivariate analyses concerning association with prognosis were performed, and Kaplan-Meier analysis was conducted for a combination of changes and time to progression. Results Of the 141 patients, 82 had at least one MDM2 SNP309 G allele, and 53 had a mutation in the p53 gene, but neither of those anomalies was associated with a worse prognosis. A mutation in the p53 gene was associated with immunohistochemically visualized p53 protein expression at a cut-off value of 50%. In the group with p53 mutation Kaplan-Meier analysis showed higher rate of progression and shorter time to progression in patients with immunohistochemically abnormal p16 expression compared to them with normal p16 expression (p = 0.038. Conclusions MDM2 SNP309 promoter polymorphism and mutations in

  8. Sobrevida de cinco anos e fatores prognósticos em coorte de pacientes com câncer de mama assistidas em Juiz de Fora, Minas Gerais, Brasil Five-year survival and prognostic factors in a cohort of breast cancer patients treated in Juiz de Fora, Minas Gerais State, Brazil

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    Maximiliano Ribeiro Guerra

    2009-11-01

    Full Text Available O objetivo deste estudo foi analisar a sobrevida de cinco anos e os fatores prognósticos em mulheres com câncer invasivo da mama, submetidas à cirurgia e assistidas em Juiz de Fora, Minas Gerais, Brasil, com diagnóstico da doença entre 1998 e 2000. As variáveis analisadas foram: idade, cor, local de residência, variáveis relacionadas ao tumor e ao tratamento. Foram estimadas as funções de sobrevida pelo método de Kaplan-Meier, e o modelo de riscos proporcionais de Cox foi utilizado para avaliação prognóstica. A sobrevida estimada foi de 81,8%. Tamanho tumoral e comprometimento de linfonodos axilares foram os fatores prognósticos independentes mais importantes, com risco de óbito aumentado para mulheres com tamanho do tumor maior que 2,0cm (HR = 1,97; IC95%: 1,26-3,07 e com metástase para gânglios axilares (HR = 4,04; IC95%: 2,55-6,39. Tais achados enfatizam a importância do diagnóstico e tratamento precoces. O acesso às ações de rastreamento nos diversos níveis de assistência, especialmente para o grupo considerado como de maior risco, deve ser uma prioridade para os gestores de saúde no país.The purpose of this study was to analyze five-year survival and the main prognostic factors among women with invasive breast cancer diagnosed from 1998 to 2000 that had undergone surgical treatment in the city of Juiz de Fora, Minas Gerais State, Brazil. Study variables were: age, skin color, place of residence, tumor-related variables, and treatment-related variables. Survival functions were calculated by the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazard model. Disease-specific survival was 81.8%. Tumor size and lymph node involvement were the main independent prognostic factors in the study population, with increased risk of death for women with tumor size greater than 2.0cm (HR = 1.97; 95%CI: 1.26-3.07 and positive axillary lymph nodes (HR = 4.04; 95%CI: 2.55-6.39. The results

  9. Estudo epidemiológico da doença renal crônica terminal no oeste do Paraná: uma experiência de 878 casos atendidos em 25 anos Epidemiological study of end-stage kidney disease in western Paraná: an experience of 878 cases in 25 years

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    Luis Alberto Batista Peres

    2010-03-01

    Full Text Available INTRODUÇÃO: A incidência e prevalência dos pacientes em fase final da doença renal crônica (DRC continuam a crescer em todo o mundo. O transplante renal continua tendo preferência na terapia renal substitutiva, mas, dada a limitada oferta de doadores de órgãos, terapias dialíticas são as modalidades mais realizadas. OBJETIVOS: Avaliar um registro de pacientes admitidos para terapia renal substitutiva no período de 1984 a 2009, em um único Centro. MÉTODOS: Este é um estudo epidemiológico retrospectivo. Foram analisadas as características demográficas e clínicas, incidência, principal doença renal de base, modalidades dialíticas, mortalidade e causas de óbitos. Para comparar as variáveis, foram utilizados o teste do qui-quadrado, teste t de Student, ANOVA e teste de Tukey. Curvas de Kaplan-Meier foram utilizadas para estimar a sobrevida dos pacientes. Um valor de p INTRODUCTION: The incidence and prevalence of treated end-stage chronic kidney disease (CKD patients continue to grow throughout the world. Renal transplantation remains the preferred form of renal substitutive therapy, but given the limited number of donors, dialytic therapies are the most common modalities. OBJECTIVES: To assess a registry of patients admitted for renal substitutive therapy at a single centre from 1984 to 2009. METHODS: This is a retrospective epidemiological study. The following were analyzed: demographic and clinical characteristics; incidence of CKD; underlying kidney disease; dialysis modalities; mortality; and causes of death. The variables were compared by using the chi-square test, Student t test, ANOVA, and Tukey test. Kaplan-Meier curves were used to estimate patient's survival. A p value < 0.05 was considered statistically significant. RESULTS: In the period studied, 878 patients were admitted to dialysis. Their mean age was 47.0 ± 16.2 years, 549 (62.5% were males, and 712 (81.1% were white. The major cause of CKD was hypertension

  10. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy.

    Science.gov (United States)

    Scarsbrook, Andrew; Vaidyanathan, Sriram; Chowdhury, Fahmid; Swift, Sarah; Cooper, Rachel; Patel, Chirag

    2017-04-01

    To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4Eleven11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally

  11. The Predictive Value of Waist-To-Height Ratio for Ischemic Stroke in a Population-Based Prospective Cohort Study among Mongolian Men in China

    Science.gov (United States)

    Xu, Juan; Xu, Tian; Bu, Xiaoqing; Peng, Hao; Li, Hongmei; Zhang, Mingzhi; Zhang, Yonghong

    2014-01-01

    Objective To explore the associations between waist-to-height ratio (WHtR), body mass index (BMI) and waist circumference (WC) and risk of ischemic stroke among Mongolian men in China. Methods A population-based prospective cohort study was conducted from June 2003 to July 2012 in Inner Mongolia, an autonomous region in north China. A total of 1034 men aged 20 years and older free of cardiovascular disease were included in the cohort and followed up for an average of 9.2 years. The subjects were divided into four groups by WHtR levels (WHtR0.60). The cumulative survival rates of ischemic stroke among the four groups were estimated with the Kaplan-Meier curves and compared by log-rank test. Cox proportional hazards models and Receiver Operating Characteristic (ROC) curves were employed to evaluate the associations between obesity indices and ischemic stroke. Results A total of 47 ischemic stroke patients were observed during the follow-up period. The cumulative incidence and incidence density of ischemic stroke were 4.55% and 507.61/100 000 person-years, respectively. After the major risk factors were adjusted, individuals with WHtR>0.60 had a 3.56-fold increased risk of ischemic stroke compared with those with 0.40≤WHtR≤0.50. Hazard ratio (HR) and 95% confidence intervals (CI) of ischemic stroke for a 1-SD increase in WHtR was 1.34(95% CI: 1.00–1.81). After adding BMI or WC to models, higher WHtR remained significantly associated with increased risk of ischemic stroke. The Kaplan-Meier survival curves showed that the cumulative survival rate in the group with WHtR>0.60 was significantly lower than in the group with 0.40≤WHtR≤0.50 (log-rank test, P = 0.025). The areas under the curve for each index were as follows: 0.586 for WHtR, 0.543 for WC; 0.566 for BMI. Conclusions Higher WHtR is associated with risk of ischemic stroke in Mongolian males. WHtR may be useful in predicting ischemic stroke incidence in males. PMID:25353632

  12. Relationship between LAPTM4B Gene Polymorphism and Prognosis of Patients following Tumor Resection for Colorectal and Esophageal Cancers.

    Science.gov (United States)

    Cheng, Xiaojing; Tian, Xiuyun; Wu, Xiaojiang; Xing, Xiaofang; Du, Hong; Zhou, Chunlian; Zhang, Qingyun; Hao, Chunyi; Wen, Xianzi; Ji, Jiafu

    2016-01-01

    Lysosome-associated transmembrane-4 beta (LAPTM4B) is an oncogene that participates tumorgenesis in a variety of human solid tumors, and it has two alleles named as LAPTM4B*1 and *2. The present study aimed to identify the association of LAPTM4B genotype with clinicopathological features and prognosis in colorectal and esophageal cancer patients. Genotypes of LAPTM4B were determined by PCR in 167 colon cancer cases (72 patients in a discovery cohort and 95 patients in a testing cohort), 160 rectal cancer cases and 164 esophageal cancer cases. Association between the LAPTM4B gene polymorphism and clinicopathological variables was calculated by Chi-square test or Fisher's exact test. Patient survival differences were calculated by the Kaplan-Meier method. Prognostic factors were determined with Log-rank test and Cox regression model. LAPTM4B *1/1 was more frequently detected in colon cancer patients with lymph node metastasis and TNM III+IV stages in total colon cancer (discovery + testing cohorts). LAPTM4B *2/2 decreased in recurrent patients in total colon cancer patients (P = 0.045). Kaplan-Meier survival curves and Log-rank test showed that LAPTM4B*1 was correlated with shorter overall survival (OS) in discovery and testing cohorts of colon cancer (P = 0.0254 and 0.0292, respectively), but not in rectal and esophageal cancer cases (P = 0.7669 and 0.9356, respectively). Multivariate analysis showed that LAPTM4B genotype was an independent prognostic factor for OS in total colon cancer [P = 0.004, hazard ratio (HR) = 0.432; 95% confidence interval (CI) = 0.243-0.768], but not in rectal and esophageal cancers (P = 0.791, HR = 1.073, 95% CI = 0.638-1.804 and 0.998, HR = 1.000, 95% CI = 0.663-1.530, respectively). These findings suggested that LAPTM4B allele *1 was a risk factor associated with poor prognosis in patients with colon cancer, but not in patients with rectal or esophageal cancers. LAPTM4B genotype status might be a useful prognostic indicator for patients

  13. Relationship between LAPTM4B Gene Polymorphism and Prognosis of Patients following Tumor Resection for Colorectal and Esophageal Cancers.

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    Xiaojing Cheng

    Full Text Available Lysosome-associated transmembrane-4 beta (LAPTM4B is an oncogene that participates tumorgenesis in a variety of human solid tumors, and it has two alleles named as LAPTM4B*1 and *2. The present study aimed to identify the association of LAPTM4B genotype with clinicopathological features and prognosis in colorectal and esophageal cancer patients.Genotypes of LAPTM4B were determined by PCR in 167 colon cancer cases (72 patients in a discovery cohort and 95 patients in a testing cohort, 160 rectal cancer cases and 164 esophageal cancer cases. Association between the LAPTM4B gene polymorphism and clinicopathological variables was calculated by Chi-square test or Fisher's exact test. Patient survival differences were calculated by the Kaplan-Meier method. Prognostic factors were determined with Log-rank test and Cox regression model.LAPTM4B *1/1 was more frequently detected in colon cancer patients with lymph node metastasis and TNM III+IV stages in total colon cancer (discovery + testing cohorts. LAPTM4B *2/2 decreased in recurrent patients in total colon cancer patients (P = 0.045. Kaplan-Meier survival curves and Log-rank test showed that LAPTM4B*1 was correlated with shorter overall survival (OS in discovery and testing cohorts of colon cancer (P = 0.0254 and 0.0292, respectively, but not in rectal and esophageal cancer cases (P = 0.7669 and 0.9356, respectively. Multivariate analysis showed that LAPTM4B genotype was an independent prognostic factor for OS in total colon cancer [P = 0.004, hazard ratio (HR = 0.432; 95% confidence interval (CI = 0.243-0.768], but not in rectal and esophageal cancers (P = 0.791, HR = 1.073, 95% CI = 0.638-1.804 and 0.998, HR = 1.000, 95% CI = 0.663-1.530, respectively.These findings suggested that LAPTM4B allele *1 was a risk factor associated with poor prognosis in patients with colon cancer, but not in patients with rectal or esophageal cancers. LAPTM4B genotype status might be a useful prognostic indicator for

  14. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS: Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed ret- rospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and mul- tivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. RESULTS: The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (X2 = 4.26, P = 0.0389), tumor size (X2 = 18.48, P < 0.001), Borrmann type (X2 = 7.41, P = 0.0065), histological grade (X2 =5.07, P = 0.0243), pT category (X2 = 49.42, P < 0.001), pN category (X2 = 87.7, P < 0.001), total number of re- trieved lymph nodes (X2 = 8.22, P = 0.0042) and MLR (X2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (X2 = 7.985, P = 0.018), pT category (X2 = 30.82, P < 0.001) and MLR (X2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple lin- ear regression (β = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. CONCLUSION: The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.

  15. Fatores de risco para o desmame entre usuárias de uma unidade básica de saúde de Belo Horizonte, Minas Gerais, Brasil, entre 1980 e 2004 Risk factors for weaning among users of a primary health care unit in Belo Horizonte, Minas Gerais State, Brazil, from 1980 to 2004

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    Claudia Regina Lindgren Alves

    2008-06-01

    Full Text Available O objetivo foi analisar comparativamente os fatores que interferiram na duração do aleitamento materno entre usuárias do Centro de Saúde São Marcos, Belo Horizonte, Estado de Minas Gerais, Brasil, em 1980, 1986, 1992, 1998 e 2004. Foram realizados cinco estudos longitudinais retrospectivos (coortes históricas, utilizando o mesmo questionário. Foram entrevistadas, no total, 790 mães de menores de 24 meses. A análise estatística foi feita, ano a ano, pelo método de Kaplan-Meier e modelo de Cox. Entre 1980 e 2004, as condições significativamente associadas ao risco de desmame foram: primiparidade, dificuldade para amamentar após o parto, conceito de tempo ideal de aleitamento materno menor que seis meses, início do aleitamento materno após a alta da maternidade, não reconhecimento das vantagens da amamentação para a criança e opinião paterna desfavorável, indiferente ou desconhecida sobre o aleitamento materno. Em quatro dos cinco estudos, ter tido dificuldade para amamentar (RR: 1,70-3,97 e considerar ideal amamentar por menos de seis meses (RR: 1,67-3,27 representaram maior risco de desmame. A duração mediana do aleitamento materno foi cinco meses em 1980 e 11 meses em 2004.This study was a comparative analysis of factors affecting duration of breastfeeding among users of the São Marcos primary care clinic in Belo Horizonte, Minas Gerais State, Brazil, in 1980, 1986, 1992, 1998, and 2004. Five retrospective longitudinal studies (historical cohorts were performed with the same questionnaire, and 790 mothers of children less than 24 months of age were interviewed. The statistical analysis was conducted year-by-year using the Kaplan-Meier method and Cox model. From 1980 to 2004, conditions significantly associated with risk of weaning were: primiparity; difficulty in postpartum breastfeeding; belief in ideal breastfeeding duration of less than six months; start of breastfeeding after discharge from the maternity hospital

  16. Melanoma long non-coding RNA signature predicts prognostic survival and directs clinical risk-specific treatments.

    Science.gov (United States)

    Chen, Xijia; Guo, Wenna; Xu, Xin-Jian; Su, Fangchu; Wang, Yi; Zhang, Yingzheng; Wang, Qiang; Zhu, Liucun

    2017-03-01

    Various studies have demonstrated that the Breslow thickness, tumor ulceration and mitotic index could serve as prognostic markers in patients with cutaneous melanoma. Recently, however, as these clinicopathological biomarkers lack efficient interpretation of endogenous mechanism of melanoma, the emphasis on the prognosis of melanoma has transformed to molecular tumor markers. This study was designed to identify survival-related long non-coding RNAs (lncRNAs), and based on the different expressions of these lncRNAs, clinical risk-specific diagnosis and adjuvant therapy could be employed on melanoma patients, especially patients in the early course of disease or patients with a Breslow thickness no more than 2mm. The clinical information and corresponding RNA expression data were obtained from The Cancer Genome Atlas dataset and Gene Expression Omnibus dataset (GSE65904). All samples were categorized into one training dataset and two validation datasets. Cox proportional hazard regression analysis was then used to identify survival-related lncRNAs and risk assessment signature was constructed in training dataset. Kaplan-Meier method was used to estimate the utility of this signature in predicting the duration of survival of patients both in the training dataset and two validation datasets. Meanwhile receiver operating characteristic analyses were used to evaluate the predictive effectiveness of this signature in two validation datasets. It was found that the signature was effective while used for risk stratification, and Kaplan-Meier analyses indicated that the duration of survival of patients in high-risk groups were significantly shorter than that of low-risk groups. Moreover, areas under the receiver operating characteristic curve were 0.711 (95% confidence interval: 0.618-0.804) and 0.698 (95% confidence interval: 0.614-0.782) when this signature was used to predict the patients' duration of survival in two validation datasets respectively, indicating the

  17. Radiation therapy of regional lymph nodes in the treatment of seminomas compared with retroperitoneal lymphadenectomy. A retrospective analysis of 161 patients; Die Strahlentherapie der regionaeren Lymphknotenstationen bei der Behandlung des Seminoms im Vergleich zur retroperitonealen Lymphadenektomie. Eine retrospektive Auswertung von 161 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Warszawski, N. [Klinik fuer Strahlentherapie, Magdeburg Univ. (Germany); Schmuecking, M. [Klinik fuer Strahlentherapie, Magdeburg Univ. (Germany); Samtleben, M. [Klinik und Poliklinik fuer Urologie, Magdeburg Univ. (Germany); Gademann, G. [Klinik fuer Strahlentherapie, Magdeburg Univ. (Germany); Allhoff, E.P. [Klinik und Poliklinik fuer Urologie, Magdeburg Univ. (Germany)

    1996-05-01

    Hundred and sixty-one patients with seminoma of stage I and II were retrospectively analysed. They were treated at the University of Magdeburg between 1975 and 1991 by radiation therapy of regional lymph nodes or by retroperitoneal lymphadenectomy. After high semicastration, 98 patients were irradiated, 63 patients received a retroperitoneal lymphadenectomy. Twenty-one patients were treated by adjuvant chemotherapy, too. The 5-year survival-rates according to Kaplan-Meier were 96% for stage I, 85% for stage IIA, 92% for stage IIB, and 68% for stage IIC. The overall survival rates for all stages were 95% after 2 years, 92% after 5 years, and 89% after 10 years. Relapses located retroperitoneally occurred significantly more often after retroperitoneal lymphadenectomy (9.5%) compared with radiation therapy (2.0%), relapses outside the operation situs or radiation fields, respectively, were registrated at the same frequency (4.8% and 7.1%, respectively). Disease-free survival rates decreased significantly with increasing stage (p<0.001, Wilcoxon-test). Relapses increased from 4.1% for stage I up to 58.3% for stage IIC. After semicastration for primary treatment of seminomas radiation therapy of the regional lymph nodes is the treatment of choice. Retroperitoneal lymphadenectomy is obsolete. (orig./MG) [Deutsch] 161 Patienten mit einem histologisch gesicherten Seminom der Stadien I und II wurden von 1975 bis 1991 an der Universitaet Magdeburg behandelt und retrospektiv analysiert. Nach erfolgter hoher Semikastration erhielten 98 Patienten eine Strahlentherapie, 63 Patienten wurden einer retroperitonealen Lymphadenektomie unterzogen. 21 Patienten erhielten zusaetzlich eine adjuvante Chemotherapie. Die Fuenf-Jahres-Ueberlebensraten (Kaplan-Meier-Methode) betrugen 96% im Stadium I, 85% im Stadium IIA, 92% im Stadium IIB, 68% im Stadium IIC. Die Gesamtueberlebensraten fuer alle Stadien lagen nach zwei Jahren bei 95%, nach fuenf Jahren bei 92%, nach zehn Jahren bei 89%. Alle

  18. Comparison of outcome in 1809 patients treated with drug-eluting stents or bare-metal stents in a real-world setting

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    Vogt A

    2011-11-01

    Full Text Available Alexander Vogt1, Anke Schoelmerich1, Franziska Pollner1, Manuela Schlitt1, Uwe Raaz1, Lars Maegdefessel2, Iris Reindl1, Michael Buerke1, Karl Werdan1, Axel Schlitt11Department of Medicine III, Martin Luther-University, Halle, Germany; 2Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USAPurpose: The aim of this study was to determine the long-term safety of drug-eluting stent (DES versus bare metal stent (BMS implantation in a “real-world” setting.Patients and methods: A total of 1809 patients who were treated with implantation of either BMS or DES were assessed. Kaplan-Meier and multivariate Cox regression analyses concerning primary endpoint of cardiac mortality were performed.Results: A total of 609 patients received DES. Mean age was 66.2 ± 11.3 years, 69.4% were male, and 1517 (83.8% were treated for acute coronary syndrome (unstable angina 510 [28.2%], non-ST-elevation myocardial infarction [NSTEMI] 506 [28.0%], and ST-elevation myocardial infarction [STEMI] 501 [27.7%]. Mean follow-up was 34 ± 15 months. During follow-up, 268 patients died of cardiac causes (DES 42 [7.3%]; BMS 226 [19.6%]; P < 0.001. Univariate Kaplan-Meier analysis showed an advantage of DES over BMS concerning the primary endpoint (P < 0.001. When adjusting for classic risk factors and additional factors that affect the progression of coronary heart disease (CHD, DES was not found to be superior to BMS (hazard ratio 0.996, 95% confidence interval 0.455–2.182, P = 0.993. Severely impaired renal function was an independent predictor for cardiac mortality after stent implantation.Conclusion: Treatment with DES is safe in the long term, also in patients presenting with STEMI. However, in multivariate analyses it is not superior to BMS treatment.Keywords: coronary stent, outcome, renal insufficiency, myocardial infarction, STEMI

  19. Modelling antagonic effect of lactic acid eacteria supernatants on some pathogenic bacteria

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    Augustus Caeser Franke Portella

    2009-11-01

    Full Text Available This work presents a statistical model of survival analysis for three pathogenic bacterial strains (Escherichia coli, Listeria monocytogenes and Staphylococcus aureus, when treated with neutralized and non-neutralized filtered supernatants broth from cultures of Lactobacillus acidhophilus, Lactobacillus rhamnosus and Lactobacillus sake. Survival analysis is a method employed to determine the period of time from an initial stage up to the occurrence of a particular event of interest, as death or a particular culture growth failure. In order to evaluate the potential efficacy of the ahead mentioned lactic acid bacteria when used as bioprotective starters in foods, experimental data were statistically treated and expressed by simple representative curves. Following the methodology of Cox and Kaplan-Meier, it was possible to make the selection of the best bioprotective lactic starter, as a predictive tool for evaluation of shelf life and prevention of eventual risks in fresh sausages and other similar food products.Este trabalho apresenta um modelo estatístico de análise de sobrevivência para três bactérias patogénicas (Escherichia coli, Listeria monocytogenes e Staphylococcus aureus, quando tratados com sobrenadantes filtrados neutralizado e não neutralizado provenientes de culturas de Lactobacillus acidhophilus, Lactobacillus rhamnosus e Lactobacillus sake. A Análise de sobrevivência é um método utilizado para determinar o período de tempo a partir de uma fase inicial até a ocorrência de um determinado evento de interesse, como a morte ou a inibição de uma particular cultura, a fim de avaliar a eficácia potencial das referidas bactérias lácticas quando usadas como bioproteção em alimentos. Os dados experimentais foram tratados estatisticamente, seguindo a metodologia de Cox e Kaplan-Meier e foi possível fazer a seleção dos melhores fermentos láticos bioprotectivos, como uma ferramenta para avaliação preditiva, vida de

  20. Evaluating Protocol Lifecycle Time Intervals in HIV/AIDS Clinical Trials

    Science.gov (United States)

    Schouten, Jeffrey T.; Dixon, Dennis; Varghese, Suresh; Cope, Marie T.; Marci, Joe; Kagan, Jonathan M.

    2014-01-01

    Background Identifying efficacious interventions for the prevention and treatment of human diseases depends on the efficient development and implementation of controlled clinical trials. Essential to reducing the time and burden of completing the clinical trial lifecycle is determining which aspects take the longest, delay other stages, and may lead to better resource utilization without diminishing scientific quality, safety, or the protection of human subjects. Purpose In this study we modeled time-to-event data to explore relationships between clinical trial protocol development and implementation times, as well as identify potential correlates of prolonged development and implementation. Methods We obtained time interval and participant accrual data from 111 interventional clinical trials initiated between 2006 and 2011 by NIH’s HIV/AIDS Clinical Trials Networks. We determined the time (in days) required to complete defined phases of clinical trial protocol development and implementation. Kaplan-Meier estimates were used to assess the rates at which protocols reached specified terminal events, stratified by study purpose (therapeutic, prevention) and phase group (pilot/phase I, phase II, and phase III/ IV). We also examined several potential correlates to prolonged development and implementation intervals. Results Even though phase grouping did not determine development or implementation times of either therapeutic or prevention studies, overall we observed wide variation in protocol development times. Moreover, we detected a trend toward phase III/IV therapeutic protocols exhibiting longer developmental (median 2 ½ years) and implementation times (>3years). We also found that protocols exceeding the median number of days for completing the development interval had significantly longer implementation. Limitations The use of a relatively small set of protocols may have limited our ability to detect differences across phase groupings. Some timing effects

  1. A two-year follow-up for Chinese patients with abdominal aortic aneurysm undergoing open/endovascular repair

    Institute of Scientific and Technical Information of China (English)

    Sun Tao; Zhang Hongju; Cheng Yutong; Wang Su; Tao Ying; Zhang Donghua; Huang Ji

    2014-01-01

    Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years).Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P=0.35 and P=0.40,respectively).Cox proportional hazards regression analysis showed that level of low-density lipoprotein (HR,4.06; 95% CI:1.19-18.7,P=0.027) and AAA size (HR,2.18; 95% CI:1.28-11.65,P=0.036) were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors

  2. Multivariate analysis of factors influencing the effect of radiosynovectomy; Multivariate Analyse der Einflussfaktoren auf die Wirkung der Radiosynoviorthese bei entzuendlichen Gelenkerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Farahati, J.; Schulz, G.; Koerber, C.; Geling, M.; Schmeider, P.; Reiners, Chr. [Wuerzburg Univ. (Germany). Klinik fuer Nuklearmedizin; Wendler, J. [Erlangen-Nuernberg Univ. (Germany). Klinik fuer Innere Medizin III; Kenn, W. [Wuerzburg Univ. (Germany). Inst. fuer Roentgendiagnostik; Reidemeister, C. [Wuerzburg Univ. (Germany). Klinik fuer Innere Medizin

    2002-04-01

    Objective: In this prospective study, the time to remission after radiosynovectomy (RSV) was analyzed and the influence of age, sex, underlying disease, type of joint, and duration of illness on the success rate of RSV was determined. Methods: A total number of 57 patients with rheumatoid arthritis (n = 33) and arthrosis (n = 21) with a total number of 130 treated joints (36 knee, 66 small and 28 medium-size joints) were monitored using visual analogue scales (VAS) from one week before RSV up to four to six months after RSV. The patients had to answer 3 times daily for pain intensity of the treated joint. The time until remission was determined according to the Kaplan-Meier survivorship function. The influence of the prognosis parameters on outcome of RSV was determined by multivariate discriminant analysis. Results: After six months, the probability of pain relief of more than 20% amounted to 78% and was significantly dependent on the age of the patient (p = 0.02) and the duration of illness (p = 0.05), however not on sex (p = 0.17), underlying disease (p = 0.23), and type of joint (p = 0.69). Conclusion: Irrespective of sex, type of joint and underlying disease, a measurable pain relief can be achieved with RSV in 78% of the patients with synovitis, whereby effectiveness is decreasing with increasing age and progress of illness. (orig.) [German] Ziel: In dieser prospektiven Studie wurde die Zeit bis zur Remission nach einer Radiosynoviorthese (RSO) untersucht. Ebenso wurde der Einfluss von Alter, Geschlecht, Grunderkrankung, Gelenktyp und Erkrankungsdauer auf die Erfolgsrate der RSO ermittelt. Methodik: Bei insgesamt 57 Patienten mit rheumatoider Arthritis (n = 33) und Arthritis bei aktivierter Arthrose (n = 24) wurden 130 Gelenke (36 Kniegelenke, 66 kleine und 28 mittelgrosse Gelenke) behandelt. Die Patienten wurden unter Verwendung so genannter visueller Analogskalen eine Woche vor RSO und vier bis sechs Monate danach 3-mal taeglich zur Schmerzintensitaet des

  3. Potential clinical predictors of outcome after postoperative radiotherapy of non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Buetof, R. [Medical Faculty and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Radiation Oncology, Dresden (Germany); Medical Faculty and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, OncoRay National Center for Radiation Research in Oncology, Dresden (Germany); Kirchner, K.; Appold, S. [Medical Faculty and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Radiation Oncology, Dresden (Germany); Loeck, S. [Medical Faculty and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, OncoRay National Center for Radiation Research in Oncology, Dresden (Germany); Rolle, A. [Lungenfachklinik Coswig, Department of Thoracic and Vascular Surgery, Coswig (Germany); Hoeffken, G. [Lungenfachklinik Coswig, Department of Pneumology, Coswig (Germany); Krause, M.; Baumann, M. [Medical Faculty and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Radiation Oncology, Dresden (Germany); Medical Faculty and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, OncoRay National Center for Radiation Research in Oncology, Dresden (Germany); German Cancer Consortium (DKTK), Dresden (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany); Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany)

    2014-03-15

    The aim of this analysis was to investigate the impact of tumour-, treatment- and patient-related cofactors on local control and survival after postoperative adjuvant radiotherapy in patients with non-small cell lung cancer (NSCLC), with special focus on waiting and overall treatment times. For 100 NSCLC patients who had received postoperative radiotherapy, overall, relapse-free and metastases-free survival was retrospectively analysed using Kaplan-Meier methods. The impact of tumour-, treatment- and patient-related cofactors on treatment outcome was evaluated in uni- and multivariate Cox regression analysis. No statistically significant difference between the survival curves of the groups with a short versus a long time interval between surgery and radiotherapy could be shown in uni- or multivariate analysis. Multivariate analysis revealed a significant decrease in overall survival times for patients with prolonged overall radiotherapy treatment times exceeding 42 days (16 vs. 36 months) and for patients with radiation-induced pneumonitis (8 vs. 29 months). Radiation-induced pneumonitis and prolonged radiation treatment times significantly reduced overall survival after adjuvant radiotherapy in NSCLC patients. The negative impact of a longer radiotherapy treatment time could be shown for the first time in an adjuvant setting. The hypothesis of a negative impact of longer waiting times prior to commencement of adjuvant radiotherapy could not be confirmed. (orig.) [German] Das Ziel der vorliegenden Analyse war, den Einfluss von tumor-, patienten- und therapieabhaengigen Kofaktoren auf die lokoregionale Tumorkontrolle und das Ueberleben nach postoperativer adjuvanter Strahlentherapie bei Patienten mit einem nicht-kleinzelligen Bronchialkarzinom (NSCLC) zu untersuchen. Ein spezieller Fokus lag dabei auf der Wartezeit zwischen Operation und Beginn der Strahlentherapie sowie der Gesamtbehandlungszeit der Strahlentherapie. Fuer 100 Patienten, die eine postoperative

  4. Comparison of Long-Term Outcomes between Peritoneal Dialysis Patients with Diabetes as a Primary Renal Disease or as a Comorbid Condition.

    Directory of Open Access Journals (Sweden)

    Yutian Lei

    Full Text Available To investigate the long-term outcomes of peritoneal dialysis (PD patients with diabetes as primary renal disease and patients with diabetes as a comorbid condition.All diabetic patients who commenced PD between January 1, 1995 and June 30, 2012 at Ren Ji Hospital, China were included. Patients were divided into diabetic nephropathy group (DN group and non-diabetic nephropathy group (NDN group according to their diagnosis of primary renal disease at the initiation of PD. They were followed until death, cessation of PD, transferred to other centers or to the end of study (June 30, 2013. Outcomes were analyzed by Kaplan-Meier method and Cox regression models.A total of 163 diabetic patients were enrolled in the study, including 121 (74.2% in DN group and 42 (25.8% in NDN group. The 1-, 2-, 3- and 5-year patient survival rates were 89%, 78%, 66% and 51% for DN group, and 85%, 63%, 53% and 25% for NDN group, respectively. Kaplan-Meier analysis showed that patients in NDN group had a worse patient survival compared with DN group (log rank 4.830, P=0.028. Patients in NDN group had a marginally shorter peritonitis-free period (log rank 3.297, P=0.069, however, there was no significant difference in technique survival (log rank 0.040, P=0.841. Multivariate Cox regression analysis showed that older age (HR 1.047, 95% CI 1.022-1.073, p<0.001, cardiovascular disease comorbidity (HR 2.200, 95% CI 0.1.269-3.814, P=0.005 and diabetes as a comorbidity condition (HR 1.806, 95% CI 1.003-3.158, P=0.038 were the independent predictors of increased mortality.PD patients with diabetes as a comorbidity had an inferior patient survival compared to those with diabetic nephropathy, and closer monitoring and extra attention in the former subgroup of patients are therefore warranted.

  5. The natural history of multiple system atrophy: a prospective European cohort study.

    Science.gov (United States)

    Wenning, Gregor K; Geser, Felix; Krismer, Florian; Seppi, Klaus; Duerr, Susanne; Boesch, Sylvia; Köllensperger, Martin; Goebel, Georg; Pfeiffer, Karl P; Barone, Paolo; Pellecchia, Maria Teresa; Quinn, Niall P; Koukouni, Vasiliki; Fowler, Clare J; Schrag, Anette; Mathias, Christopher J; Giladi, Nir; Gurevich, Tanya; Dupont, Erik; Ostergaard, Karen; Nilsson, Christer F; Widner, Håkan; Oertel, Wolfgang; Eggert, Karla Maria; Albanese, Alberto; del Sorbo, Francesca; Tolosa, Eduardo; Cardozo, Adriana; Deuschl, Günther; Hellriegel, Helge; Klockgether, Thomas; Dodel, Richard; Sampaio, Cristina; Coelho, Miguel; Djaldetti, Ruth; Melamed, Eldad; Gasser, Thomas; Kamm, Christoph; Meco, Giuseppe; Colosimo, Carlo; Rascol, Olivier; Meissner, Wassilios G; Tison, François; Poewe, Werner

    2013-03-01

    Multiple system atrophy (MSA) is a fatal and still poorly understood degenerative movement disorder that is characterised by autonomic failure, cerebellar ataxia, and parkinsonism in various combinations. Here we present the final analysis of a prospective multicentre study by the European MSA Study Group to investigate the natural history of MSA. Patients with a clinical diagnosis of MSA were recruited and followed up clinically for 2 years. Vital status was ascertained 2 years after study completion. Disease progression was assessed using the unified MSA rating scale (UMSARS), a disease-specific questionnaire that enables the semiquantitative rating of autonomic and motor impairment in patients with MSA. Additional rating methods were applied to grade global disease severity, autonomic symptoms, and quality of life. Survival was calculated using a Kaplan-Meier analysis and predictors were identified in a Cox regression model. Group differences were analysed by parametric tests and non-parametric tests as appropriate. Sample size estimates were calculated using a paired two-group t test. 141 patients with moderately severe disease fulfilled the consensus criteria for MSA. Mean age at symptom onset was 56·2 (SD 8·4) years. Median survival from symptom onset as determined by Kaplan-Meier analysis was 9·8 years (95% CI 8·1-11·4). The parkinsonian variant of MSA (hazard ratio [HR] 2·08, 95% CI 1·09-3·97; p=0·026) and incomplete bladder emptying (HR 2·10, 1·02-4·30; p=0·044) predicted shorter survival. 24-month progression rates of UMSARS activities of daily living, motor examination, and total scores were 49% (9·4 [SD 5·9]), 74% (12·9 [8·5]), and 57% (21·9 [11·9]), respectively, relative to baseline scores. Autonomic symptom scores progressed throughout the follow-up. Shorter symptom duration at baseline (OR 0·68, 0·5-0·9; p=0·006) and absent levodopa response (OR 3·4, 1·1-10·2; p=0·03) predicted rapid UMSARS progression. Sample size

  6. Vigilância pós-alta das infecções de sítio cirúrgico em crianças e adolescentes em um hospital universitário de Belo Horizonte, Minas Gerais, Brasil Post-discharge surveillance of children and adolescents treated for surgical site infections at a university hospital in Belo Horizonte, Minas Gerais State, Brazil

    Directory of Open Access Journals (Sweden)

    Maria A. Martins

    2008-05-01

    Full Text Available As infecções hospitalares são as principais complicações na prática cirúrgica e, dentre estas, as infecções de sítio cirúrgico são as mais freqüentes. Apesar dessas infecções poderem se manifestar após a alta, no Brasil, a maioria dos serviços não faz vigilância pós-alta. Para avaliar a importância dessa vigilância e o perfil das infecções em crianças e adolescentes, acompanhou-se uma coorte de 730 pacientes cirúrgicos de um hospital universitário de Belo Horizonte, Minas Gerais, Brasil, de 1999 a 2001. Calculou-se a incidência acumulada, aplicou-se o teste t de Student na comparação de médias e o método de Kaplan-Meier na análise do tempo de ocorrência das infecções; considerou-se significativo o valor p Hospital infections are the main complications in surgical practice. Surgical site infections are the most frequent, and can manifest after hospital discharge. In Brazil, the majority of clinical services do not maintain infection surveillance after discharge. In order to evaluate the importance of such surveillance and the profile of these post-discharge infections, a cohort of 730 child and adolescent surgical patients was followed in a teaching hospital, from 1999 to 2001. The accumulated incidence was calculated. Student's t test was used to compare mean values and the Kaplan-Meier method to analyze the period until infection, using a p value of < 0.05. A total of 87 surgical site infections were diagnosed, 37% of which after discharge. The overall surgical infection rate was 11.9%; without outpatient follow-up, the rate would have been 7.5%. Post-charge infections were diagnosed after a mean of 11.3 ± 6.4 days, and in these patients the preoperative and postoperative hospital stays were significantly lower than in the group with in-hospital infections. The study indicates the importance of post-discharge surveillance in determining the real incidence of surgical site infections.

  7. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Scarsbrook, Andrew [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Leeds Teaching Hospitals NHS Trust, Department of Nuclear Medicine, Level 1, Bexley Wing, St James' s University Hospital, Leeds (United Kingdom); University of Leeds, Leeds Institute of Cancer and Pathology, Leeds (United Kingdom); Vaidyanathan, Sriram; Chowdhury, Fahmid; Patel, Chirag [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Leeds Teaching Hospitals NHS Trust, Department of Nuclear Medicine, Level 1, Bexley Wing, St James' s University Hospital, Leeds (United Kingdom); Swift, Sarah [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Cooper, Rachel [Leeds Teaching Hospitals NHS Trust, Department of Clinical Oncology, Leeds (United Kingdom)

    2017-04-15

    To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4). 11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally advanced

  8. Potential role for LINAC-based stereotactic radiosurgery for the treatment of 5 or more radioresistant melanoma brain metastases.

    Science.gov (United States)

    Frakes, Jessica M; Figura, Nicholas B; Ahmed, Kamran A; Juan, Tzu-Hua; Patel, Neha; Latifi, Kujtim; Sarangkasiri, Siriporn; Strom, Tobin J; Chinnaiyan, Prakash; Rao, Nikhil G; Etame, Arnold B

    2015-11-01

    Linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) is a treatment option for patients with melanoma in whom brain metastases have developed. Very limited data are available on treating patients with ≥5 lesions. The authors sought to determine the effectiveness of SRS in patients with ≥5 melanoma brain metastases. A retrospective analysis of metastatic melanoma treated with SRS in a single treatment session for ≥5 lesions was performed. Magnetic resonance imaging studies were reviewed post-SRS to evaluate local control (LC). Disease progression on imaging was defined using the 2009 Response Evaluation Criteria in Solid Tumors (RECIST). Survival curves were calculated from the date of brain metastases diagnosis or the date of SRS by using the Kaplan-Meier (KM) method. Univariate and multivariate analysis (UVA and MVA, respectively) were performed using the Cox proportional-hazards model. The authors identified 149 metastatic brain lesions treated in 28 patients. The median patient age was 60.5 years (range 38-83 years), and the majority of patients (24 [85.7%]) had extracranial metastases. Four patients (14.3%) had received previous whole-brain radiotherapy (WBRT), and 11 (39.3%) had undergone previous SRS. The median planning target volume (PTV) was 0.34 cm3 (range 0.01-12.5 cm3). Median follow-up was 6.3 months (range 1-46 months). At the time of treatment, 7% of patients were categorized as recursive partitioning analysis (RPA) Class I, 89% as RPA Class II, and 4% as RPA Class III. The rate of local failure was 11.4%. Kaplan-Meier LC estimates at 6 and 12 months were 91.3% and 82.2%, respectively. A PTV volume≥0.34 cm3 was a significant predictor of local failure on UVA (HR 16.1, 95% CI 3.2-292.6, ptreatment. The RPA class was a significant predictor of KM OS estimates from the date of treatment (p=0.02). Patients who did not receive WBRT after SRS treatment had decreased OS on MVA (HR 3.5, 95% CI 1.1-12.0, p=0.03), and patients who did not

  9. The role and prognostic significance of p53 mutation in colorectal carcinomas

    Institute of Scientific and Technical Information of China (English)

    Chen Yang Ji; DR Smith; HS Goh

    2000-01-01

    AIM To study the prognostic significance of the p53 cDNA mutation and mutant p53 protein in colorectaladenocarcinomas.METHODS p53 cDNA mutaiton was detected with RT-PCR-SSCP, and mutant p53 protein overexpressionwas detected by PAb 240 monoclonal antibody in 100 cases of colorectal adenocarcinomas. The follow-upsurvey of all patients were done within the five years after operation, and comparing with p53 cDNAmutation and mutant p53 protein overexpression for the prognostic significance of colorectaladenocarcinomas. The data is treated with SPSS computer program, Kaplan-Meier Survival Plots werecalculated and analyzed by Log-rank analysis.RESULTS Fifty-one cases of p53 eDNA mutations (51%) were found with RT-PCR-SSCP and 76 cases ofmutant p53 protein overexpression (76%) found with PAb 240 monoclonal antibody immunohistochemistrystaining in 100 cases of colorectal adenocarcinomas. There are no relationship with Dukes stage in thestatistics in p53 eDNA mutation (mutation: Dukes A 9%, B 10%, C 20%, D 12%; No mutation: A 13%, B12%, C 12%, D 12%) and mutant p53 protein overexpression (positive: Dukes A 17%, B 6%, C 27%, D16%; negative: A 5%, B 6%, C 5%, D 8%) (P<0.05). Moreover, the data show p53 cDNA mutation isassociated with mutant p53 protein overexpression (both positive 49%, single positive 29%, both negative22%) (P<0.01), p53 eDNA mutation can provide prognostic information (p53 eDNA mutation positive:alive 35, dead 16; negative: alive 42, dead 7) (P<0.05), and mutant p53 protein overexpression isambiguous and does not assess prognosis (p53 protein overexpression positive: alive 58, dead 18; negative:alive 19, dead 5) (P = 0.72) with Kaplan-Meier Survival Plots and Log-rank analysis.CONCLUSION p53 eDNA mutation is associated with mutant p53 protein overexpression (p53 eDNAmutation and mutant p53 protein overexpression both positive 49%, single positive 29%, both negative 22%)(P<0.01) and p53 eDNA mutation can provide poor prognostic information, and is the

  10. Increased expression of CD133 and reduced dystroglycan expression are strong predictors of poor outcome in colon cancer patients

    Directory of Open Access Journals (Sweden)

    Coco Claudio

    2012-09-01

    Full Text Available Abstract Background Expression levels of CD133, a cancer stem cell marker, and of the α-subunit of the dystroglycan (α-DG complex, have been previously reported to be altered in colorectal cancers. Methods Expression levels of CD133 and α-DG were assessed by immunohistochemistry in a series of colon cancers and their prognostic significance was evaluated. Results Scattered cells positive for CD133 were rarely detected at the bases of the crypts in normal colonic mucosa while in cancer cells the median percentage of positive cells was 5% (range 0–80. A significant correlation was observed with pT parameter and tumor stage but not with tumor grade and N status. Recurrence and death from disease were significantly more frequent in CD133-high expressing tumors and Kaplan-Meier curves showed a significant separation between high vs low expressor groups for both disease-free (p = 0.002 and overall (p = 0.008 survival. Expression of α-DG was reduced in a significant fraction of tumors but low α-DG staining did not correlate with any of the classical clinical-pathological parameters. Recurrence and death from the disease were significantly more frequent in α-DG-low expressing tumors and Kaplan-Meier curves showed a significant separation between high vs low expressor tumors for both disease-free (p = 0.02 and overall (p = 0.02 survival. Increased expression of CD133, but not loss of α-DG, confirmed to be an independent prognostic parameters at a multivariate analysis associated with an increased risk of recurrence (RR = 2.4; p = 0.002 and death (RR = 2.3; p = 0.003. Conclusions Loss of α-DG and increased CD133 expression are frequent events in human colon cancer and evaluation of CD133 expression could help to identify high-risk colon cancer patients.

  11. Potential prognostic marker ubiquitin carboxyl-terminal hydrolase-L1 does not predict patient survival in non-small cell lung carcinoma

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    Maxwell Perry

    2011-08-01

    Full Text Available Abstract Background Ubiquitin Carboxyl-Terminal Hydrolase-L1 (UCH-L1 is a deubiquitinating enzyme that is highly expressed throughout the central and peripheral nervous system and in cells of the diffuse neuroendocrine system. Aberrant function of UCH-L1 has been associated with neurological disorders such as Parkinson's disease and Alzheimer's disease. Moreover, UCH-L1 exhibits a variable expression pattern in cancer, acting either as a tumour suppressor or promoter, depending on the type of cancer. In non-small cell lung carcinoma primary tumour samples, UCH-L1 is highly expressed and is associated with an advanced tumour stage. This suggests UCH-L1 may be involved in oncogenic transformation and tumour invasion in NSCLC. However, the functional significance of UCH-L1 in the progression of NSCLC is unclear. The aim of this study was to investigate the role of UCH-L1 using NSCLC cell line models and to determine if it is clinically relevant as a prognostic marker for advanced stage disease. Methods UCH-L1 expression in NSCLC cell lines H838 and H157 was modulated by siRNA-knockdown, and the phenotypic changes were assessed by flow cytometry, haematoxylin & eosin (H&E staining and poly (ADP-ribose polymerase (PARP cleavage. Metastatic potential was measured by the presence of phosphorylated myosin light chain (MLC2. Tumour microarrays were examined immunohistochemically for UCH-L1 expression. Kaplan-Meier curves were generated using UCH-L1 expression levels and patient survival data extracted from Gene Expression Omnibus data files. Results Expression of UCH-L1 was decreased by siRNA in both cell lines, resulting in increased cell death in H838 adenocarcinoma cells but not in the H157 squamous cell line. However, metastatic potential was reduced in H157 cells. Immunohistochemical staining of UCH-L1 in patient tumours confirmed it was preferentially expressed in squamous cell carcinoma rather than adenocarcinoma. However the Kaplan-Meier curves

  12. A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma.

    Science.gov (United States)

    Rohde, Max; Nielsen, Anne L; Pareek, Manan; Johansen, Jørgen; Sørensen, Jens A; Diaz, Anabel; Nielsen, Mie K; Christiansen, Janus M; Asmussen, Jon T; Nguyen, Nina; Gerke, Oke; Thomassen, Anders; Alavi, Abass; Høilund-Carlsen, Poul Flemming; Godballe, Christian

    2017-09-01

    Purpose: To examine whether tumor staging by upfront (18)F-fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) leads to improved discrimination of survival, when compared with traditionally used imaging strategies based on chest X-ray + head and neck magnetic resonance imaging (CXR/MRI) or chest computed tomography + head and neck MRI (CCT/MRI) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Blinded prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited at Odense University Hospital from September 2013 to March 2016. All included patients underwent CXR/MRI, CCT/MRI, and PET/CT on the same day. Tumors were categorized as localized (stages I-II), locally advanced (stages III-IVB), or metastatic (stage IVC) disease. Discriminative abilities for each imaging modality with respect to HNSCC staging were compared using Kaplan-Meier analysis, Cox proportional-hazards regression with Harrell's C-index, and net reclassification improvement (NRI). Results: A total of 307 patients with histologically verified HNSCC were included. Use of PET/CT resulted in significantly altered stratification of tumor stage, when compared to either CXR/MRI or CCT/MRI (χ(2): P PET/CT, but not CXR/MRI or CCT/MRI, were associated with significant differences in mortality risk in Kaplan-Meier analyses (P ≤ 0.002 for all PET/CT-based comparisons). Furthermore, overall discriminative ability was significantly greater for PET/CT (C-index: 0.712) than CXR/MRI (C-index: 0.675, P = 0.04 for difference) and CCT/MRI (C-index: 0.657, P = 0.02 for difference). Finally, PET/CT was significantly associated with a positive NRI when compared with CXR/MRI (0.184, P = 0.03), but not CCT/MRI (0.094%, P = 0.31). Conclusion: Tumor stages determined by PET/CT were associated with more distinct prognostic properties in terms of survival than those determined by standard imaging strategies

  13. Long-term survival of patients with primary oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study; 5-Jahres-Ueberlebenswahrscheinlichkeit von Patienten mit primaeren Plattenepithelkarzinomen der Mundhoehle. Vergleich von zwei Behandlungsstrategien in einer prospektiven Studie

    Energy Technology Data Exchange (ETDEWEB)

    Kessler, P.; Bloch-Birkholz, A.; Neukam, F.W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Mund-, Kiefer-, Gesichtschirurgie; Grabenbauer, G.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Leher, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Medizininformatik, Biometrie und Epidemiologie; Vairaktaris, E. [Univ. of Athens Medical School (Greece). Dept. of Maxillofacial Surgery

    2007-04-15

    Background and Purpose: In recent years, different concepts for the treatment of oral squamous cell carcinomas (OSCC) have been developed; these include preoperative simultaneous neoadjuvant radiochemotherapy and one-stage surgery with tumor ablation and reconstruction. When considering long-term survival, there is substantial evidence that multimodality treatment based on a neoadjuvant radiochemotherapy is superior to adjuvant therapy concepts based on a surgical approach with postoperative irradiation. The aim of this study was to discuss the 5-year survival rate in a neoadjuvant and an adjuvant combination treatment in patients with primary OSCC. Patients and Methods: This nonrandomized longitudinal study prospectively evaluates the long-term tumor-free survival in 128 patients with oral cancer. Two groups consisting of 74 neoadjuvantly and 54 primarily surgically treated patients were formed. 99 patients suffered from stage III and IV disease according to the UICC criteria. Long-term survival was estimated according to the Kaplan-Meier assumption. Results: The neoadjuvant treatment increases the prospect of a long-term tumor-free survival. According to Kaplan-Meier assumption the estimation for a 5-year tumor-free survival in OSCC in category T1 is 83.1% in neoadjuvant, and 70.1% in adjuvant treatment, in T2 79.6% and 57.7%, in T3 68.2% and 33.2%, in T4 51.4% and 30.5%, respectively. Significance (p < 0.05) could be proven for T1 (p = 0.002), T2 (p = 0.028), and T4 (p < 0.0001) tumors. The effectiveness of the preoperative radiochemotherapy was demonstrated in the pathohistological result of tumor-free resection specimens in 28 patients of the neoadjuvant treatment group (37.8%). On the other hand, four patients died during the preoperative combination therapy. 64.8% of the patients in the adjuvant and 71.6% in the neoadjuvant treatment group survived the observation period. Conclusion: Neoadjuvant therapy is highly effective and results in a better 5-year

  14. S100蛋白在儿童髓母细胞瘤组织中的表达及与预后的关系%S100 expression and correlation with prognosis in child medulloblastoma

    Institute of Scientific and Technical Information of China (English)

    赵振宇; 王良哲; 卢明; 卢亦成

    2011-01-01

    目的 探讨S100蛋白在儿童髓母细胞瘤组织中的表达,分析与肿瘤临床特点之间的关系和对儿童髓母细胞瘤预后的影响.方法 应用免疫组化SP法检测S100蛋白在44例儿童髓母细胞瘤中的表达,并结合长期随访资料进行生存曲线分析.结果 S100阳性表达率为68.18%.S100表达与儿童髓母细胞瘤患者性别、年龄、有无侵犯四脑室、有无坏死之间相关性无统计学意义(P>0.05).19例阳性表达患儿平均生存时间为58.58个月,25例阴性表达患儿平均生存时间为97.1个月.生存曲线分析表明S100的表达与儿童髓母细胞瘤患者生存时间相关.结论 S100蛋白在儿童髓母细胞瘤细胞中表达是患者预后的危险因素.%Objective To explore the expression of S100 in child medulloblastomas ( MB ) and its correlation with clinicopathological characteristics prognosis of children medulloblastomas.Methods SP immunobistochemistry was used to detect the expression of S100 in 44 paraffinembedded child MB specimens. Follow-up data were handled by using Kaplan-Meier survival analysis. Results Positive expression ratio of S100 was 68. 18% . There was no significant correlation between S100 expression and factors of gender, age, tumor location ( fourth ventricle infiltration) and necrosis ( P > 0. 05 ) . The mean survival time of 19 positive patients was 58. 58 months while that of 25 negative ones was 97. 1 months. Kaplan-Meier survival analysis showed there was significant correlation between expression of S100 and survival time. Conclusion S100may be a valuable factor in the prognosis of children medulloblastomas.

  15. Comparison of Continuation Rates and Reasons of Discontinuation for Cyclofem and Depot -medroxyprogesterone acetate in Rural Areas of East Azerbaijan Province, Iran

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    Robab Hassanzadeh

    2012-03-01

    Full Text Available Objective: In this study continuation rate and reasons for discontinuation of Depot-medroxyprogestroneacetate (DMPAand Cyclofem have been compared.Materials and methods: A retrospective cohort study was conducted with 422 women (202 Cyclofemand220 DMPA userswho had started using the methods 12-24 months before the study in East Azerbaijanhealth houses. Data were collected by reviewing the records and interview with the clients and analysedusing Kaplan-Meier and Cox Regression.Results: The 3, 6, 9, 12 months continuation rate were 56%, 37%, 30%, 27% respectively for Cyclofemversus 75%, 59.5%, 48%, 42.5% for DMPA. Menstrual changes were reported significantly more by theDMPA users than the Cyclofem users (85% vs. 73%, P=0.008 as the main reason for thediscontinuation, the difference mainly reflected of amenorrhea (50% vs. 23%, P=0.003. None of DMPAusers and 11% of Cyclofem users claimed frequency of visits and lack of method supplies as their maindiscontinuation reason.Conclusion: Discontinuation rate was high for the both methods but it was higher for Cyclofem.Thecommon side effects mentioned as the main reasons for discontinuation of the both methods are nothealth threatening. Therefore, health care providers may help to improve their continuation rate byappropriate consultation.

  16. Prognostic factors in 165 elderly colorectal cancer patients

    Institute of Scientific and Technical Information of China (English)

    Ke-Jun Nan; Hai-Xia Qin; Guang Yang

    2003-01-01

    AIM: To analyse the prognostic factors in 165 colorectal patients aged ≥70.METHODS: One hundred and sixty-five elderly patients with colorectal cancer diagnosed by histology were entered into the retrospective study between 1994 and 2001. Patients were given optimal operation alone, chemotherapy after operation, or chemotherapy alone according to tumor stage,histology, physical strength, and co-morbid problems.Survival rate was calculated by Kaplan-Meier method, and compared with meaningful variances by Log-rank method.Prognostic factors were analyzed by Cox regression.RESULTS: The 1,2,3,4,5 year survival rate (all-cause rnortality)was 87.76%, 65.96%, 52.05%, 42.77%, 40.51%,respectively. The mean survival time was 41.89±2.33 months (95% CI: 37.33-46.45 months), and the median survival time was 37 months. Univariate analysis showed that factors such as age, nodal metastasis, treatment method, Duke's stage, gross findings, kind of histology, and degree of differentiation had influences on the survival rate. Multivariate analysis showed that factors such as treatment method,Duke's stage, kind of histology and degree of differentiation were independent prognostic factors.CONCLUSION: This study suggests that the prognosis of elderly colorectal cancer patients is influenced by several factors. Most of elderly patients can endure surgery and/or chemotherapy, and have a long-time survival and good quality of life.

  17. Inoperable esophageal cancer and outcome of palliative care

    Institute of Scientific and Technical Information of China (English)

    Sima Besharat; Ali Jabbari; Shahryar Semnani; Abbasali Keshtkar; Jeran Marjani

    2008-01-01

    AIM: To determine the outcome of esophageal cancer patients referred for palliative care, in Gorgan and Gonbad gastrointestinal clinics, northeast of Iran.METHODS: This cross-sectional study was done on inoperable esophageal cancer cases referred to gastrointestinal clinics in Gorgan and Gonbad city (2005-2006). Demographic data were collected during the procedure and cases were followed up every one month. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness.RESULTS: We recruited 39 cases into the study. Squamous cell carcinoma was the most prevalent (92.3%). The middle third of the esophagus was involved predominantly (51.3%). Dilation was the most preferred method (89.7%) and stenting was done in 4 cases. Decreasing dysphagia score was not related to palliation method or pathology type of carcinoma. Age of the patients was significantly related to the improvement of dysphagia score. Mean survival time was 137.6d and median was 103d.CONCLUSION: Results of this study showed a low survival rate after palliative care in esophageal cancer cases despite dysphagia scores' improvement after dilating or stenting.

  18. Vortex methods

    Energy Technology Data Exchange (ETDEWEB)

    Chorin, A.J. [California Univ., Berkeley, CA (United States). Dept. of Mathematics]|[Lawrence Berkeley Lab., CA (United States)

    1993-06-01

    Vortex methods originated from the observation that in incompressible inviscid flow vorticity (or, more accurately, circulation) is a conserved quantity, as can be readily deduced from the absence of tangential stresses. Thus, if the vorticity is known at time t=0, one can find the flow at a later time by simply following the vorticity. In this narrow context, a vortex method is a numerical method that follows vorticity. The author restricts himself in these lectures to a special class of numerical vortex methods, those that are based on a Lagrangian transport of vorticity in hydrodynamics by smoothed particles (blobs) and those whose analysis contributes to the understanding of blob methods. Blob methods started in the 1930`s.

  19. Mining Method

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Shik; Lee, Kyung Woon; Kim, Oak Hwan; Kim, Dae Kyung [Korea Institute of Geology Mining and Materials, Taejon (Korea, Republic of)

    1996-12-01

    The reducing coal market has been enforcing the coal industry to make exceptional rationalization and restructuring efforts since the end of the eighties. To the competition from crude oil and natural gas has been added the growing pressure from rising wages and rising production cost as the workings get deeper. To improve the competitive position of the coal mines against oil and gas through cost reduction, studies to improve mining system have been carried out. To find fields requiring improvements most, the technologies using in Tae Bak Colliery which was selected one of long running mines were investigated and analyzed. The mining method appeared the field needing improvements most to reduce the production cost. The present method, so-called inseam roadway caving method presently is using to extract the steep and thick seam. However, this method has several drawbacks. To solve the problems, two mining methods are suggested for a long term and short term method respectively. Inseam roadway caving method with long-hole blasting method is a variety of the present inseam roadway caving method modified by replacing timber sets with steel arch sets and the shovel loaders with chain conveyors. And long hole blasting is introduced to promote caving. And pillar caving method with chock supports method uses chock supports setting in the cross-cut from the hanging wall to the footwall. Two single chain conveyors are needed. One is installed in front of chock supports to clear coal from the cutting face. The other is installed behind the supports to transport caved coal from behind. This method is superior to the previous one in terms of safety from water-inrushes, production rate and productivity. The only drawback is that it needs more investment. (author). 14 tabs., 34 figs.

  20. Projection Methods

    DEFF Research Database (Denmark)

    Wagner, Falko Jens; Poulsen, Mikael Zebbelin

    1999-01-01

    When trying to solve a DAE problem of high index with more traditional methods, it often causes instability in some of the variables, and finally leads to breakdown of convergence and integration of the solution. This is nicely shown in [ESF98, p. 152 ff.].This chapter will introduce projection...... methods as a way of handling these special problems. It is assumed that we have methods for solving normal ODE systems and index-1 systems....

  1. Computing methods

    CERN Document Server

    Berezin, I S

    1965-01-01

    Computing Methods, Volume 2 is a five-chapter text that presents the numerical methods of solving sets of several mathematical equations. This volume includes computation sets of linear algebraic equations, high degree equations and transcendental equations, numerical methods of finding eigenvalues, and approximate methods of solving ordinary differential equations, partial differential equations and integral equations.The book is intended as a text-book for students in mechanical mathematical and physics-mathematical faculties specializing in computer mathematics and persons interested in the

  2. Impact of simultaneous assay, the PCNA, cyclinD1, and DNA content with specimens before and after preoperative radiotherapy on prognosis of esophageal cancer-possible incorporation into clinical TNM staging system

    Institute of Scientific and Technical Information of China (English)

    Shu-Chai Zhu; Ren Li; Yu-Xiang Wang; Wei Feng; Juan Li; Rong Qiu

    2005-01-01

    AIM: The aim of the present study is to use immunohistochemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis.METHODS: From November 1990 to December 1996, 47patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma.Immunohistochemical stain was done for PCNA, cyclinD1 protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors.RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinD1 and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely an identity between the single and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma.CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.

  3. Factors Associated with Operative Treatment of De Quervain Tendinopathy

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2015-07-01

    Full Text Available Background:  Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy.   Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment. Results:  One hundred ninety nine (7.9% patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery.  Conclusion:  Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.

  4. Intensity modulated radiotherapy with concurrent chemotherapy for larynx preservation of advanced resectable hypopharyngeal cancer

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    Chao Hsing-Lung

    2010-05-01

    Full Text Available Abstract Background To analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT plus concurrent chemotherapy, and compare the results with patients treated with primary surgery. Methods Between January 2003 and November 2007, 14 patients were treated with primary surgery and 33 patients were treated with concurrent chemoradiotherapy (CCRT using IMRT technique. Survival rate, larynx preservation rate were calculated with the Kaplan-Meier method. Multivariate analysis was conducted for significant prognostic factors with Cox-regression method. Results The median follow-up was 19.4 months for all patients, and 25.8 months for those alive. The 5-year overall survival rate was 33% and 44% for primary surgery and definitive CCRT, respectively (p = 0.788. The 5-year functional larynx-preservation survival after IMRT was 40%. Acute toxicities were common, but usually tolerable. The rates of treatment-related mucositis (≥ grade 2 and pharyngitis (≥ grade 3 were higher in the CCRT group. For multivariate analysis, treatment response and cricoid cartilage invasion strongly correlated with survival. Conclusions IMRT plus concurrent chemotherapy may preserve the larynx without compromising survival. Further studies on new effective therapeutic agents are essential.

  5. No bias of ignored bilaterality when analysing the revision risk of knee prostheses: Analysis of a population based sample of 44,590 patients with 55,298 knee prostheses from the national Swedish Knee Arthroplasty Register

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    Ranstam Jonas

    2003-02-01

    Full Text Available Abstract Background The current practice of the Swedish Knee Register is not to take into consideration if one or both knees in a patient are subject to surgery when evaluating risk of revision after arthroplasty. Risk calculations are typically done by statistical methods, such as Kaplan-Meier analyses and Cox's proportional hazards models, that are based on the assumption that observed events are independent, and this is rarely appreciated. The purpose of this study was to investigate if ignoring bilateral operations when using these methods biases the results. Methods The bias of not taking bilateral operations into account was investigated by statistically analysing 55 298 prostheses in 44 590 patients, undergoing knee arthroplasty surgery in Sweden during 1985–1999, using traditional proportional hazards analysis, which assumes that all observations are independent, and a shared gamma frailty model, which allows patients to contribute repeated observations. Results The effect of neglecting bilateral prostheses is minute, possibly because bilateral prosthesis failure is a rare event. Conclusion We conclude that the revision risk of knee prostheses in general can be analysed without consideration for subject dependency, at least in study populations with a relatively low proportion of subjects having experienced bilateral revisions.

  6. Cost-utility analysis of adjuvant goserelin (Zoladex and adjuvant chemotherapy in premenopausal women with breast cancer

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    Cheng Tsui

    2012-01-01

    Full Text Available Abstract Background Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer. Methods In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0, and to obtain the utility value by the standard gamble (SG and visual scale (VS methods. Total medical cost was assessed from the (National Health Insurance NHI payer's perspective. Results Survival at 11 years was significantly better in the groserelin group (P Conclusions Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.

  7. Survival of women with breast cancer in Kaunas Region, Lithuania.

    Science.gov (United States)

    Ivanauskienė, Rugilė; Gedminaitė, Jurgita; Juozaitytė, Elona; Vanagas, Giedrius; Simoliūnienė, Renata; Padaiga, Zilvinas

    2012-01-01

    OBJECTIVE. The assessment of breast cancer survival rates and comparison with those of other countries may help to deepen knowledge among decision makers in the health care system and to improve the inequalities in accessibility to early detection and effective treatment. The aim of this study was to evaluate breast cancer survival rates in Kaunas region, Lithuania, and to compare them with those in the selected European countries. MATERIAL AND METHODS. A retrospective study was carried out using medical records and data gathered from the Lithuanian Cancer Registry. A group of 240 patients with primary breast cancer diagnosed in 2008 in Kaunas region was analyzed. All causes of death were included in the analysis. The closing date of follow-up was September 30, 2010. Survival was determined using the life-table method and the Kaplan-Meier method. Cox proportional hazard models were used to estimate the effects of prognostic risk factors on survival. RESULTS. The median age of the patients was 63 years (range, 28-95). The 1-year and 2-year cumulative survival for breast cancer patients in Kaunas region, Lithuania, was 94.2% and 90.1%, respectively. As expected, the survival of patients with diagnosed advanced disease (stage III and IV) was significantly worse than that of patients with stage I (PLithuania was found to be similar to most European countries.

  8. Burden and outcomes of pressure ulcers in cancer patients receiving the Kerala model of home based palliative care in India: Results from a prospective observational study

    Directory of Open Access Journals (Sweden)

    Biji M Sankaran

    2015-01-01

    Full Text Available Aim: To report the prevalence and outcomes of pressure ulcers (PU seen in a cohort of cancer patients requiring home-based palliative care. Materials and Methods: All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant. Results: Twenty-one of 108 (19.4% enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9% patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56. Conclusions: The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication. Clinical Trial Registry Number: CTRI/2014/03/004477

  9. [Survival analysis of 104 cases of osteosarcoma with lung metastases].

    Science.gov (United States)

    Ren, J; Xu, Y F; Kuang, T H; Chen, J; Liu, Y X

    2017-04-23

    Objective: To investigate the prognosis of osteosarcoma patients with lung metastases and its correlated factors. Methods: The clinical data of 104 osteosarcoma patients with lung metastasis from April 2007 to September 2015 were retrospectively analyzed. Univariate analysis was performed using Kaplan-Meier and Log rank test. Multivariate Cox regression was applied to analyze independent prognostic factor for patient survival. Results: The one-year, two-year and five-year survival rates of the 104 osteosarcoma patients with lung pulmonary metastasis were 93.3%, 61.5% and 11.5%, respectively, and the median survival time was 33 months. The univariate analysis revealed that number of lung metastases, objective response of first-line chemotherapy and therapeutic methods for lung metastases were significant prognostic factors for patient survival, whereas gender, age, time to lung metastasis and time to other metastasis were not (P>0.05). The multivariate analysis indicated that number of lung metastases, objective response of first-line chemotherapy and therapeutic methods for lung metastases were independent significant prognostic factors for patient survival. Conclusions: The prognosis of osteosarcoma patients with advanced lung metastases and active treatment is better. Surgery and adjuvant chemotherapy could effectively prolong survival time for osteosarcoma patients with pulmonary metastasis.

  10. Outcomes of Induction Chemotherapy Plus Intensity-Modulated Radiotherapy (IMRT Versus IMRT Plus Concurrent Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Study

    Directory of Open Access Journals (Sweden)

    Pu-Yun OuYang

    2016-08-01

    Full Text Available PURPOSE: It deserves investigation whether induction chemotherapy (IC followed by intensity-modulated radiotherapy (IMRT is inferior to the current standard of IMRT plus concurrent chemotherapy (CC in locoregionally advanced nasopharyngeal carcinoma. METHODS: Patients who received IC (94 patients or CC (302 patients plus IMRT at our center between March 2003 and November 2012 were retrospectively analyzed. Propensity-score matching method was used to match patients in both arms at equal ratio. Failure-free survival (FFS, overall survival (OS, distant metastasis–free survival (DMFS, and locoregional relapse–free survival (LRFS were assessed with Kaplan-Meier method, log-rank test, and Cox regression. RESULTS: In the original cohort of 396 patients, IC plus IMRT resulted in similar FFS (P = .565, OS (P = .334, DMFS (P = .854, and LRFS (P = .999 to IMRT plus CC. In the propensity-matched cohort of 188 patients, no significant survival differences were observed between the two treatment approaches (3-year FFS 80.3% vs 81.0%, P = .590; OS 93.4% vs 92.1%, P = .808; DMFS 85.9% vs 87.7%, P = .275; and LRFS 93.1% vs 92.0%, P = .763. Adjusting for the known prognostic factors in multivariate analysis, IC plus IMRT did not cause higher risk of treatment failure, death, distant metastasis, or locoregional relapse. CONCLUSIONS: IC plus IMRT appeared to achieve comparable survival to IMRT plus CC in locoregionally advanced nasopharyngeal carcinoma. Further investigations were warranted.

  11. Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission

    Science.gov (United States)

    Lee, Chang Min; Lee, Dong Ho; Ahn, Byung Kyu; Hwang, Jae Jin; Yoon, Hyuk; Park, Young Soo; Shin, Cheol Min; Kim, Nayoung

    2017-01-01

    Background/Aims In gastric mucosa-associated lymphoid tissue (MALT) lymphoma, the clinical significance of various endoscopic findings has not yet been determined. This study aimed to compare the time to complete remission (CR) and relapse-free survival (RFS) in gastric MALT lymphoma based on endoscopic findings. Methods In this single-center retrospective cohort study, the medical records of 122 consecutive adult patients with gastric MALT lymphoma were collected over a period of 12 years. CR was defined by the absence of macroscopic or microscopic features of lymphoma on two subsequent follow-ups. Relapse was clinically defined by a positive endoscopic biopsy after CR. Results The median time to CR did not differ significantly between treatment methods. However, it was significantly longer in the group with polypoid endoscopic appearance than in the groups with diffuse infiltration or ulceration (7.83, 3.43, and 3.10 months, respectively; p=0.003). Six patients relapsed after CR. Kaplan-Meier analysis showed that RFS differed significantly between groups based on Ann Arbor staging, treatment methods, and initial endoscopic findings. Conclusions In gastric MALT lymphoma, the endoscopically defined polypoid type was characterized by a longer duration to CR, with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types. PMID:27009028

  12. Characteristics of Metachronous Gastric Tumors after Endoscopic Submucosal Dissection for Gastric Intraepithelial Neoplasms

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    Tomoyuki Boda

    2014-01-01

    Full Text Available Background. Recently, endoscopic submucosal dissection (ESD has become a standard treatment method for early gastric cancer and concurrent stomach preservation. However, metachronous recurrences have become a major problem. We evaluated the incidence and clinicopathologic features of and examined the risk factors for metachronous gastric tumors. Methods. A total of 357 patients who underwent ESD for gastric tumors (245 early gastric cancers and 112 adenomas and were followed up for more than 12 months without recurrence within the first 12 months were enrolled. We investigated the incidence and clinicopathologic features of metachronous tumors after ESD. We also analyzed the potential risk factors for metachronous tumors using the Kaplan-Meier method and Cox’s proportional hazards model. Results. The annual incidence of metachronous tumors after ESD was 2.4%. The median period until discovery after initial ESD was 26.0 months, and the median observation period was 52.6 months. Male patients developed metachronous tumors more frequently (P=0.04, and the hazard ratio of female to male patients was 0.36 (95% confidence interval: 0.11–0.89. Conclusions. Patients with a previous history of gastric tumors have a high risk of subsequent gastric tumor development and male patients should be carefully followed up after ESD for gastric tumor.

  13. Expression and role of AQP1 in cervical squamous carcinoma and its precancerous lesions

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective: To investigate the expression of aquaporin 1 in cervical squamous carcinomas (CSC) and cervical precancerous lesions, and the relationship between the tumor clinicopathological parameters, prognosis and the expression of AQP1. Methods: Immunohistochemical method (EliVision) was used to detect the expression of AQP1 in samples from 106 patients [20 with normal cervical tissue, 30 with cervical intraepithelial neoplasia (stage Ⅰ and Ⅱ) and 56 with CSC]. Survival analysis was performed by Kaplan-Meier method. Results: AQP1 protein was expressed in vascular endothelia of all samples. It showed upregulation of AQP1 expression in CSC. There was a significant difference between CSC and normal cervical tissues (P<0.05). AQP1 was expressed in some tumor cells and unexpressed in normal squamous epithelial cells. And APQ1-expressing tumor cells were positively related to lymph node metastasis. Patients with APQ1-expressing tumor cells had the lower survival rate than the ones without. Conclusion: Abnormal expression of AQP1 plays an important role in the development of CSC. Positive expression of AQP1 in tumor cells maybe enhances tumor metastasis and could be used as a marker for tumor prognosis.

  14. Living related donor liver transplantation in Iranian children: a 12- year experience

    Science.gov (United States)

    Hassanzade, Jafar; Mohsen Dehghani, Seyed; Bahador, Ali; Ali Malek-Hosseini, Seyed

    2013-01-01

    Aim The aim of this study was to describe our results and investigate the survival of below-18-year-old patients undergoing LRDLT and the factors affecting this. Background Living Related Donor Liver Transplantation (LRDLT) has become a good option to provide suitable grafts for children with liver diseases. Using this method, children who have no chance for life can live a much longer life. Patients and methods The present study is a historical cohort study carried on 191 patients below-18-year-sold who had undergone LRDLT for the first time in the Namazi hospital liver transplantation center. Survival rate of the patients was assessed using Kaplan-Meier method. The effect of factors related to the recipients, donors, and the transplantation process on the patients’ survival was also investigated. Results 1, 3, 5 and 11-year survival of patients was 71%, 66%, 65%, and 65%, respectively. In the univariate analysis, age, weight at transplantation, PELD/MELD score, existence of post-transplant complications were found to be effective factors on the patients’ survival. In the multivariate analysis, weight at transplantation, PELD/MELD score, and existence of post-transplant complications were the prognostic variables. Conclusion LRDLT is now well established with satisfactory results in our center. Although the survival rate of the patients is lower than the survival rate reported in other studies, but the survival of the patients who had survived 1 month after the transplantation was comparable to other studies. PMID:24834270

  15. Automated quantification of nuclear immunohistochemical markers with different complexity.

    Science.gov (United States)

    López, Carlos; Lejeune, Marylène; Salvadó, María Teresa; Escrivà, Patricia; Bosch, Ramón; Pons, Lluis E; Alvaro, Tomás; Roig, Jordi; Cugat, Xavier; Baucells, Jordi; Jaén, Joaquín

    2008-03-01

    Manual quantification of immunohistochemically stained nuclear markers is still laborious and subjective and the use of computerized systems for digital image analysis have not yet resolved the problems of nuclear clustering. In this study, we designed a new automatic procedure for quantifying various immunohistochemical nuclear markers with variable clustering complexity. This procedure consisted of two combined macros. The first, developed with a commercial software, enabled the analysis of the digital images using color and morphological segmentation including a masking process. All information extracted with this first macro was automatically exported to an Excel datasheet, where a second macro composed of four different algorithms analyzed all the information and calculated the definitive number of positive nuclei for each image. One hundred and eighteen images with different levels of clustering complexity was analyzed and compared with the manual quantification obtained by a trained observer. Statistical analysis indicated a great reliability (intra-class correlation coefficient > 0.950) and no significant differences between the two methods. Bland-Altman plot and Kaplan-Meier curves indicated that the results of both methods were concordant around 90% of analyzed images. In conclusion, this new automated procedure is an objective, faster and reproducible method that has an excellent level of accuracy, even with digital images with a high complexity.

  16. Survival estimation in two-phase cohort studies with application to biomarkers evaluation.

    Science.gov (United States)

    Rebora, Paola; Valsecchi, Maria Grazia

    2016-12-01

    Two-phase studies are attractive for their economy and efficiency in research settings where large cohorts are available for investigating the prognostic and predictive role of novel genetic and biological factors. In this type of study, information on novel factors is collected only in a convenient subcohort (phase II) drawn from the cohort (phase I) according to a given (optimal) sampling strategy. Estimation of survival in the subcohort needs to account for the design. The Kaplan-Meier method, based on counts of events and of subjects at risk in time, must be applied accounting, with suitable weights, for the sampling probabilities of the subjects in phase II, in order to recover the representativeness of the subcohort for the entire cohort. The authors derived a proper variance estimator of survival by linearization. The proposed method is applied in the context of a two-phase study on childhood acute lymphoblastic leukemia, which was planned in order to evaluate the role of genetic polymorphisms on treatment failure due to relapse. The method has shown satisfactory performance through simulations under different scenarios, including the case-control setting, and proved to be useful for describing results in the clinical example.

  17. Infant mortality in a very low birth weight cohort from a public hospital in Rio de Janeiro, RJ, Brazil

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    Regina Coeli Azeredo Cardoso

    2013-09-01

    Full Text Available OBJECTIVES: to evaluate infant mortality in very low birth weight newborns from a public hospital in Rio de Janeiro, Brazil (2002-2006. METHODS: a retrospective cohort study was performed using the probabilistic linkage method to identify infant mortality. Mortality proportions were calculated according to birth weight intervals and period of death. The Kaplan-Meier method was used to estimate overall cumulative survival probability. The association between maternal schooling and survival of very low birth weight infants was evaluated by means of Cox proportional hazard models adjusted for: prenatal care, birth weight, and gestational age. RESULTS: the study included 782 very low birth weight newborns. Of these, (28.6% died before one year of age. Neonatal mortality was 19.5%, and earlyneonatal mortality was 14.9%. Mortality was highest in the lowest weight group (71.6%. Newborns whose mothers had less than four years of schooling had 2.5 times higher risk of death than those whose mothers had eight years of schooling or more, even after adjusting for intermediate factors. CONCLUSIONS: the results showed higher mortality among very low birth weight infants. Low schooling was an independent predictor of infant death in this low-income population sample.

  18. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

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    Tomofumi Tsuboi

    2016-01-01

    Full Text Available Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC. Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01. The complication rates due to biliary drainage were 0% (0/9 with metallic stents and 72.7% (8/11 with plastic stents (p=0.01. Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p=0.012. There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

  19. Method 59

    DEFF Research Database (Denmark)

    Kjellsson, G.

    1994-01-01

    OCDE/GD(94)41. Er supplerende rapport til rapport: The OECD Workshop on Methods for Monitoring Organisms in the Environment, Ottawa 14-17 September 1992. Environment Monograph 90.......OCDE/GD(94)41. Er supplerende rapport til rapport: The OECD Workshop on Methods for Monitoring Organisms in the Environment, Ottawa 14-17 September 1992. Environment Monograph 90....

  20. Long-term retrieval success rate profile for the Günther Tulip vena cava filter.

    Science.gov (United States)

    Smouse, H Bob; Rosenthal, David; Thuong, Van Ha; Knox, Michael F; Dixon, Robert G; Voorhees, William D; McCann-Brown, Jennifer A

    2009-07-01

    To evaluate the likelihood of successful retrieval of the Günther Tulip vena cava filter after various implant durations (up to 494 days). Retrievable Günther Tulip filters were placed in 554 patients. All patients satisfied requirements for filter placement; the primary indication for placement was specified for 394 patients (71%), as follows: unspecified trauma (n = 164), bariatric procedures (n = 128), orthopedic procedures (n = 36), and other (n = 66). Filter tilt and vena cava injury were assessed at implantation. Filters were not repositioned after placement. At retrieval, filter orientation, vena cava injury, other device-related incidents, and the degree of difficulty associated with retrieval were reported. Filter retrieval was attempted in 275 patients and successful in 248 (90.2%). The mean filter indwell time was 58.9 days (range, 3-494 days). Unsuccessful retrievals (n = 27) were attributed primarily to improper hook orientation (n = 10) or excessive tissue in-growth at the filter legs (n = 16). Of the remaining 279 patients, 223 withdrew from the study, 41 were associated with a decision to keep the filter as a permanent device, 13 died for reasons unrelated to the study, and two had no reported endpoint data. A Kaplan-Meier product-limit survival estimate revealed that the probability of successful device retrieval remained greater than 94% at 12 weeks and greater than 67% at 26 weeks. This study contributes to the body of clinical data related to retrievable filters, demonstrating reliable retrieval rates at 12 weeks, with successful retrievals up to 17 months after implantation.

  1. The effect of single agent oral fusaric acid (FA) on the growth of subcutaneously xenografted SCC-1 cells in a nude mouse model.

    Science.gov (United States)

    Ruda, James M; Beus, Kirt S; Hollenbeak, Christopher S; Wilson, Ronald P; Stack, Brendan C

    2006-09-01

    To determine whether oral administration of fusaric acid (FA) inhibits tumor growth in an animal model of head and neck cancer (HNSCC). In vivo murine model, two arm controlled study. Thirty-eight (38) 5-week-old athymic nude mice were randomly assigned to a fusaric acid treatment group (1 mg/mL) (n = 19) or a sterile saline group (n = 19). A left, lateral flank subcutaneous injection of 2.0 x 10(6) UM-SCC-1 cells were administered to all mice on day 1. Both groups were gavaged daily with either 0.25 mLs of oral FA or sterile saline throughout the experiment (32 days). Latency to a measurable tumor (> or =65 mm3), and tumor volumes were recorded after tumor xenografting. Tumor weights were recorded at the conclusion of the experiment. Tumor volume growth curves were modeled as polynomial functions of time with treatment interaction effects. Survivorship functions for time to measurable tumor were estimated using the Kaplan-Meier product limit estimator. Survival analysis showed mice treated with FA developed measurable tumors after a significantly longer interval post-xenografting than control mice (p = 0.00451). By Day 9, all mice in the control group had developed measurable tumors in comparison to only 78% of mice in the FA group. Likewise, estimated growth curves for both groups suggested that mice receiving FA demonstrated significantly slower tumor growth rates throughout the entire study period (p < 0.0001). At the conclusion of the experiment, tumor weights from both the control and FA groups were also significantly different (p = 0.0142). Single agent oral fusaric acid (1 mg/mL) is an inhibitor of UM-SCC-1 in a murine model. As an orally active agent, it may have a potential role in the treatment of human squamous cell carcinoma of the head and neck.

  2. Web versus app: compliance of patients in a telehealth diabetes management programme using two different technologies.

    Science.gov (United States)

    Schreier, Günter; Eckmann, Harald; Hayn, Dieter; Kreiner, Karl; Kastner, Peter; Lovell, Nigel

    2012-12-01

    Patients with diabetes were enrolled into a telemonitoring programme. They were offered the choice of collecting their health data either by using Near Field Communication (NFC) enabled mobile phones equipped with a dedicated application (App), or by means of a web-browser based user interface (Web). At the end of the study, each patient was categorized as belonging to either the App or Web group, based on the proportion of data they had transmitted using each method. Of the 403 patients, there were 291 in the App group and 112 in the Web group. The two groups were similar in their demographics, except for gender distribution where 68% of men preferred using the App method in contrast to 95% for women (P < 0.001). Kaplan-Meier analysis showed a steady decline of the compliance rate for both groups, at a similar rate during the first year. It also showed a more rapid decline of the compliance rate thereafter for the Web group, which resulted in a significantly higher rate for the App group over the whole observation period (P = 0.03). We conclude that different types of data acquisition technologies may have an important effect on patients' willingness to participate in telehealth programmes in the long-term.

  3. Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

    Institute of Scientific and Technical Information of China (English)

    Kawin Leelawat; Siriluck Narong; Wandee Udomchaiprasertkul; Jerasak Wannaprasert; Sa-ard Treepongkaruna; Somboon Subwongcharoen; Tawee Ratanashu-ek

    2012-01-01

    AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malignant biliary tract diseases. Quantitative real-time reverse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling. RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expression, patient's age and serum bilirubin were each independently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in peripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

  4. Serum YKL-40 independently predicts outcome after transcatheter arterial chemoembolization of hepatocellular carcinoma.

    Directory of Open Access Journals (Sweden)

    Cheng-Bao Zhu

    Full Text Available BACKGROUND: Transcatheter arterial chemoembolization (TACE is the most widely used treatment option for unresectable hepatocellular carcinoma (HCC. Elevated serum YKL-40 level has been shown to predict poor prognosis in HCC patients undergoing resection. This study was designed to validate the prognostic significance of serum YKL-40 in patients with HCC undergoing TACE treatment. METHODS: Serum YKL-40 level was determined by enzyme-linked immunosorbent assay. Overall survival (OS was evaluated with the Kaplan-Meier method and compared by the log-rank test. Multivariate study with Cox proportional hazard model was used to evaluate independent prognostic variables of OS. RESULTS: The median pretreatment serum YKL-40 in HCC patients with was significantly higher than that in healthy controls (P<0.001. The YKL-40 could predict survival precisely either in a dichotomized or continuous fashion (P<0.001 and P = 0.001, respectively. Multivariate Cox regression analysis indicated that serum YKL-40 was an independent prognostic factor for OS in HCC patients (P = 0.001. In further stratified analyses, YKL-40 could discriminate the outcomes of patients with low and high alpha-fetoprotein (AFP level (P = 0.006 and 0.016, respectively. Furthermore, the combination of serum YKL-40 and AFP had more capacity to predict patients' outcomes. CONCLUSIONS: Serum YKL-40 was demonstrated to be an independent prognostic biomarker in HCC patients treated with TACE. Our results need confirmation in an independent study.

  5. Loss of CADM1/TSLC1 Expression Is Associated with Poor Clinical Outcome in Patients with Esophageal Squamous Cell Carcinoma

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    De Zeng

    2016-01-01

    Full Text Available Aims. We sought to determine the relationship between CADM1/TSLC1 expression and clinicopathological characteristics in patients with esophageal squamous cell carcinoma (ESCC and the correlation with survival. Materials and Methods. Two hundred and ninety-three ESCC tissues and paired adjacent normal esophageal tissues were immunohistochemically assessed in this study. The association of CADM1/TSLC1 with clinicopathological parameters, as well as disease-free survival (DFS and overall survival (OS, was determined based on the Kaplan-Meier method and Cox regression models. Results. CADM1/TSLC1 was detected in 236 (80.5% tumor tissues and 19 (8.0% paired adjacent normal esophageal tissues. Decreased CADM1/TSLC1 expression was correlated with more advanced histological grade. CADM1/TSLC1 negative tumors were more frequently observed in male cases than in female cases. DFS and OS in the CADM1/TSLC1 negative group were significantly shorter than those in the positive group, particularly in male patients with ESCC. Conclusion. Loss or reduction of CADM1/TSLC1 expression is associated with more advanced histological grade and predicts early recurrence and short survival duration. Thus, loss of CADM1/TSLC1 could be a prognostic factor that can be used to assess the risk of recurrence and survival.

  6. The impact of depression on survival of Parkinson's disease patients: a five-year study

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    Cláudia Débora Silberman

    2013-01-01

    Full Text Available OBJECTIVE: The aim of this study is to evaluate the survival rate in a cohort of Parkinson's disease patients with and without depression. METHODS: A total of 53 Parkinson's disease subjects were followed up from 2003-2008 and 21 were diagnosed as depressed. Mean time of follow up was 3.8 (SD 95% = 1.5 years for all the sample and there was no significant difference in mean time of follow up between depressed and nondepressed Parkinson's disease patients. Survival curves rates were fitted using the Kaplan-Meier method. In order to compare survival probabilities according to the selected covariables the Log-Rank test was used. Multivariate analysis with Cox regression was performed aiming at estimating the effect of predictive covariables on the survival. RESULTS: The cumulative global survival of this sample was 83% with nine deaths at the end of the study - five in the depressed and four in the nondepressed group, and 55.6% died in the first year of observation, and none died at the fourth and fifth year of follow up. CONCLUSION: Our finding point toward incremental death risk in depressed Parkinson's disease patients.

  7. Gliosarcoma: An audit from a single institution in India of 24 post-irradiated cases over 15 years

    Directory of Open Access Journals (Sweden)

    Kumar Piyush

    2008-01-01

    Full Text Available Background: Gliosarcomas (GS are biphasic brain tumors composed of glioblastoma multiforme (GBM and sarcomatous component. Therapeutic approaches include maximum surgical decompression with postoperative radiotherapy. Outcomes in gliosarcoma are poor despite multimodality management. Aims: To analyze the outcome in patients of GS treated in our institute over a period of 15 years and compare it with GBM treated during the same period. Settings and Design: Clinical records of the post-irradiated GS patients and GBM patients seen between 1990 and 2004 were retrieved. Materials and Methods: Demographic and treatment variables were evaluated for their influence on overall survival (OS. The survival outcomes of GBM and GS treated during the same period were also compared. Statistical Analysis: Univariate analysis was carried out using the Kaplan-Meier method and tested using log-rank test for significance. Results: During these 15 years, 24 evaluable GS patients were treated as compared to 251 evaluable patients of GBM. There was a slight male preponderance in GS (14 males vs.10 females with a median age of 50 years. All patients underwent surgery followed by post-operative radiotherapy (median dose of 60 Gy. None of the patient or treatment related factors were found to be significantly influencing their OS. Median OS in GS was 7.3 months compared to 7.5 months in GBM patients (P = 0.790. Conclusions: The OS appears to be similar for GS and GBM. None of the demographic variables appeared to prognosticate the survivals of GS.

  8. [Heterogeneity and clonal evolution in pediatric ETV6-RUNX1(+) acute lymphoblastic leukemia by quantitative multigene fluorescence in situ hybridization].

    Science.gov (United States)

    Zhang, L; Hu, L P; Liu, X M; Guo, Y; Yang, W Y; Zhang, J Y; Liu, F; Liu, T F; Wang, S C; Chen, X J; Ruan, M; Qi, B Q; Chang, L X; Chen, Y M; Zou, Y; Zhu, X F

    2017-07-14

    Objective: To evaluate heterogeneity and clonal evolution in pediatric ETV6-RUNX1(+) acute lymphoblastic leukemia (ALL) in China. Methods: Totally 48 children (<14 years) with newly diagnosed ETV6-RUNX1(+) ALL in Institute of Hematology and Blood Disease Hospital, CAMS and PUMC, from February 2006 to June 2011 were included. The copy number variations were analyzed by quantitative multigene fluorescence in situ hybridization (QM-FISH) in 48 patients. Non-normal distribution of measurement data were shown with Median (range) , count data were shown with percent (%) . Overall survival and event-free survival were estimated by the Kaplan-Meier method and compared with the log-rank test. Results: Forty-eight patients were tested by QM-FISH. Of 48 patients, 70.8% harbored one clone, 18.8% two subclones, and 10.4% three or more subclones. The clone heterogeneity was detected by two different models: the linear succession model and the branching evolution model. ETV6-RUNX1(+) ALL relapse evolved from an ancestral clone or a new clone. The patients relapsed from a new clone got the worse outcome. Conclusion: The clone evolution was detected in pediatric ETV6-RUNX1(+) ALL in China. QM-FISH might be helpful to evaluate the outcome of relapsed patients. A new clone was associated with a poorer outcome.

  9. TSP-1-1223 A/G Polymorphism as a Potential Predictor of the Recurrence Risk of Bladder Cancer in a Chinese Population

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    Xiao Yang

    2013-01-01

    Full Text Available Backgrounds. TSP-1 is a glycoprotein that functions in the biology of bladder cancer. We investigated the relationship between the distribution of TSP-1-1223 A/G polymorphism (rs2169830 and the clinical characteristics of bladder cancer. Materials and Methods. TaqMan assay was performed to determine the genotype of 609 cases and 670 control subjects in a Chinese population. Logistic regression was used to assess the association between the polymorphism and the risk of bladder cancer. Quantitative real-time polymerase chain reaction was performed to determine TSP-1 mRNA expression. Survival curves were generated using the Kaplan-Meier method. Results. No significant differences were detected in the genotype frequencies of healthy control subjects and patients with bladder cancer. By contrast, the time until the first recurrence differed significantly between genotypes (P=0.017. The expression of TSP-1 mRNA in bladder cancer tissues was lower in patients with an AG genotype than in those with an AA genotype. The lowest expression was observed in patients with a GG genotype. Conclusions. In conclusion, TSP-1-1223 A/G polymorphism may contribute to the recurrence of bladder cancer in Chinese population.

  10. The risk of healing complications in primary teeth with concussion and subluxation injury - a retrospective cohort study

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Blanche, Paul; Amaloo, Catherina

    2017-01-01

    BACKGROUND/AIM: Traumatic dental injuries (TDIs) in the primary dentition occur frequently. Long term complications may potentially cause damage to the permanent successor. The aim of this study was to report the risk of pulp necrosis (PN), pulp canal obliteration (PCO), repair related resorption...... (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR) and premature tooth loss (PTL) in primary teeth following concussion and subluxation injuries, and to identify possible risk factors for PN, PCO and PTL following subluxation. MATERIAL AND METHODS: The study...... was a retrospective analysis of a cohort comprising 31 patients (36 teeth) with concussion injury and 174 patients (241 teeth) with subluxation injury. No treatment was performed. The follow-up program included examination after 4 weeks, 8 weeks, 6 months, 1 year, and when the patients were 6 years of age. Minimum...... follow-up was 1 year or until the time of tooth loss. STATISTICS: Kaplan Meier- and Aahlen Johansson methods and Cox regression analysis. Level of significance was set at 5%. RESULTS: Risk estimated after one year. Concussion: PCO 8.6% (95% CI: 0 - 17.9), PN 5.7% (95% CI: 0 - 13.4), PTL 5.6% (95% CI: 0...

  11. Estimating Survival Rates in Gastric Cancer Based on Pathologic and Demographic Factors in Fars Cancer Registry (2001-2005

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    Rajaeifard Abdolreza

    2009-03-01

    Full Text Available Background: Gastric cancer remains as one of the leading causes of death worldwide. In patients with gastric cancer, the survival rate after diagnosis is relatively low. The present study aimed to evaluate the impact of demographic factors in estimation of survival rate in patients with gastric cancer in order to develop updated documents in these patients. Materials and Methods: All gastric cancer patients registered in Fars cancer registry from 2001-2006 were entered in the study. Vital status of the patients was asked by telephone contact. Survival rates were estimated using Kaplan-Meier method and compared by Log-rank test. All calculations were performed using STATA (v.8 software. The p value0.05. Conclusion: Our results showed that the survival rates of gastric cancer patients in our study were relatively low. Late diagnosis and delayed therapy are important reasons for low survival in these patients. Therefore, improving public education about primary symptoms of gastric cancer by media is recommended

  12. Overexpression of NK2 inhibits liver regeneration after partial hepatectomy in mice

    Institute of Scientific and Technical Information of China (English)

    Toshiyuki Otsuka; Hitoshi Takagi; Glenn Merlino; Masatomo Mori; Norio Horiguchi; Daisuke Kanda; Takashi Kosone; Yuichi Yamazaki; Kazuhisa Yuasa; Naondo Sohara; Satoru Kakizaki; Ken Sato

    2005-01-01

    AIM: To investigate the in vivo effects of NK2 on liver regeneration after partial hepatectomy (PH). METHODS: Survival after PH was observed with 21 NK2 transgenic mice and 23 wild-type (WT) mice over 10 d. Liver regeneration was analyzed using histology and immunohistochemistry. Expressions of genes were analyzed using Northern blot analysis, immunoprecipitation and immunoblotting, and reverse transcriptase polymerase chain reaction assay. KaplanMeier method and the log-rank test were used for ahalyzing the survival after PH. Differences in the resultsof immunohistochemistry and percentage of liver regeneration was determined by the Student's t-test. RESULTS: More than half of NK2 transgenic mice died within 48 h after PH. After PH, increased deposition of small lipid droplets in hepatocytes was evident and hepatic proliferation was inhibited in NK2 transgenic mice. The hepatic expression and kinase activity of HGF receptor, c-Met, were unchanged among WT mice and NK2 transgenic mice after PH. The expression of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in liver tissues were prolonged in NK2 transgenic mice that died after PH.CONCLUSION: Our findings indicate that overexpression of NK2 inhibits liver regeneration after PH.

  13. Percutaneous cryotherapy for inoperable lung malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Eun Hae; Jin, Gong Yong; Han, Young Min; Lee, Yong Chul; Kwon, Keun Sang [Chonbuk National Univ. Medical School and Hospital, Jeonju, (Korea, Republic of)

    2012-05-15

    To evaluate the therapeutic efficacy of percutaneous cryotherapy for inoperable patients with malignant pulmonary nodules. We enrolled 14 patients (7 males, 7 females, average age 68.8 years) who had inoperable lung malignancy in this study from August 2006 through July 2009. We evaluated the therapeutic efficacy of cryotherapy for complete or incomplete ablation by follow up chest CT. Using Kaplan Meier statistical methods, we estimated the survival of patients who had undergone cryotherapy and we investigated post cryotherapy complications. Five of the 14 patients underwent complete ablation (35.7%), while 9 of 14 patients underwent incomplete ablation (64.3%). The change in mean size before procedure and at last follow up CT in the complete and incomplete ablation were as follows: 13.2 {+-} 7.6 mm {yields} 3.8 {+-} 2.7 mm, and 18.1 {+-} 6.2 mm {yields} 33.7 {+-} 17.9 mm, respectively. The median survival of patients in the complete and the incomplete groups were 51.5 months and 24 months, respectively. One patient developed a small pneumothorax, which resolved spontaneously. Two patients developed hemoptysis after the procedure, which was controlled within a day. Percutaneous cryotherapy may be an effective and safe therapeutic method for inoperable patients with malignant pulmonary nodules.

  14. Preoperative chemoradiotherapy for locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Pepek Joseph M

    2013-01-01

    Full Text Available Abstract Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT for gastric cancer. Methods Patients with gastroesophageal (GE junction (Siewert type II and III or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS, local control (LC and disease-free survival (DFS were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73% had proximal (GE junction, cardia and fundus tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75% underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

  15. Impact of Triple-Negative Phenotype on Prognosis of Patients With Breast Cancer Brain Metastases

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    Xu Zhiyuan [Department of Neurosurgery, University of Virginia, Charlottesville, Virginia (United States); Schlesinger, David [Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia (United States); Toulmin, Sushila [Department of Neurosurgery, University of Virginia, Charlottesville, Virginia (United States); Rich, Tyvin [Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia (United States); Sheehan, Jason, E-mail: jps2f@virginia.edu [Department of Neurosurgery, University of Virginia, Charlottesville, Virginia (United States)

    2012-11-01

    Purpose: To elucidate survival times and identify potential prognostic factors in patients with triple-negative (TN) phenotype who harbored brain metastases arising from breast cancer and who underwent stereotactic radiosurgery (SRS). Methods and Materials: A total of 103 breast cancer patients with brain metastases were treated with SRS and then studied retrospectively. Twenty-four patients (23.3%) were TN. Survival times were estimated using the Kaplan-Meier method, with a log-rank test computing the survival time difference between groups. Univariate and multivariate analyses to predict potential prognostic factors were performed using a Cox proportional hazard regression model. Results: The presence of TN phenotype was associated with worse survival times, including overall survival after the diagnosis of primary breast cancer (43 months vs. 82 months), neurologic survival after the diagnosis of intracranial metastases, and radiosurgical survival after SRS, with median survival times being 13 months vs. 25 months and 6 months vs. 16 months, respectively (p < 0.002 in all three comparisons). On multivariate analysis, radiosurgical survival benefit was associated with non-TN status and lower recursive partitioning analysis class at the initial SRS. Conclusion: The TN phenotype represents a significant adverse prognostic factor with respect to overall survival, neurologic survival, and radiosurgical survival in breast cancer patients with intracranial metastasis. Recursive partitioning analysis class also served as an important and independent prognostic factor.

  16. Pilot Study on MAGE-C2 as a Potential Biomarker for Triple-Negative Breast Cancer

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    Qian Zhao

    2016-01-01

    Full Text Available Objective. In the current study, we measured the expression status of melanoma antigen gene c2 (MAGE-C2 in triple-negative breast cancer (TNBC and analyzed its prognostic with the clinical pathological features of patients with TNBC. Methods. The expressions statuses of MAGE-C2 were detected in TNBC tissues and paracarcinoma tissues by immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR, and western blotting. Then, we investigated the relationship of MAGE-C2 expression status and clinicopathological parameters of TNBC patients by the chi-squared test. Finally, we discussed the relations of MAGE-C2 expression state and prognosis of patients with TNBC by Kaplan-Meier method and Cox proportional hazards model. Results. High MAGE-C2 expression was found in 38.18% (42/110 of TNBC tissues. In adjacent tissues it was 9.09% (10/110. High MAGE-C2 expression in TNBC patients was closely associated with lymph node status, tumor node metastasis (TNM stage, and lymphovascular invasion (P<0.001. TNBC patients with high MAGE-C2 expression had significantly shorter survival time than low expression patients. We also found that age, lymph node status, TNM stage, lymphovascular invasion, and MAGE-C2 expression status were closely associated with overall survival of TNBC patients (P<0.05. Conclusion. High MAGE-C2 expression may serve as an independent prognostic factor for TNBC patients.

  17. Five year retrospective survival analysis of triple negative breast cancer in North-West India

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    B Sharma

    2013-01-01

    Full Text Available Background: In our institute, about 10% of total cancer is female breast cancer. This analysis was performed to check triple negativity among these patients with their survival strength up to 5 years in relation to different age groups, stage and chemotherapy protocols. Materials and Methods: 208 immunohistochemistry proved triple negative breast cancer patients registered and treated until 2008 were retrospectively selected for the study. Overall survival up to 5 years was observed on the basis of stage, different age groups and chemotherapy regimens. All patients had undergone surgery, conventional external beam radiation therapy and adjuvant chemotherapy. The survival analyses were performed using the Kaplan-Meier method. Results: The majority of patients (41% were in the age group 21-30 years. Stage IV was seen in 18% of the patients at diagnosis and mainly in 21-40 years age group. Only 3% of females were >70 years age and were of Stage I and II. Overall 5 year survival in Stage I in Cyclophosphamide, Adriamycin/Epirubicin, 5-Flurouracil group was 37.5% as compared with Docetaxel/Paclitaxel, Epirubicin group 93% (P < 0.0001. Conclusion: Triple negativity in North-West India is about 11.8%. We observed it in younger patients mainly with highly aggressive behaviors. Taxane based chemotherapy gives better result as compared with anthracycline based regimens in all stages.

  18. Galectin-1 Is an Independent Prognostic Factor for Local Recurrence and Survival After Definitive Radiation Therapy for Patients With Squamous Cell Carcinoma of the Uterine Cervix

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    Huang, Eng-Yen [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Chanchien, Chan-Chao; Lin, Hao [Department of Gynecologic Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Wang, Chung-Chi; Wang, Chong-Jong [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Huang, Chao-Cheng, E-mail: huangcc@cgmh.org.tw [Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China)

    2013-12-01

    Purpose: To investigate the role of galectin-1 in patients with cervical cancer after definitive radiation therapy. Methods and Materials: We reviewed 154 patients with International Federation of Gynecology and Obstetrics stage I-II squamous cell carcinoma. Patients underwent curative-intent radiation therapy. Paraffin-embedded tissues were analyzed using immunohistochemistry staining for galectin-1. The rates of cancer-specific survival (CSS), local recurrence (LR), and distant metastasis were compared among patient tissue samples with no, weak, and strong galectin-1 expression. The Kaplan-Meier method and the Cox proportional hazard model with hazard ratios and 95% confidence intervals (CIs) were used for univariate and multivariate analyses, respectively. Results: The areas under the curve for the intracellular expression scores of galectin-1 for both LR and CSS were significantly higher than those for stromal expression. There were no significant differences in the demographic data, such as stage and serum tumor markers, between patients with and without intracellular expression of galectin-1 in cancer tissue samples. Using multivariate analyses, the hazard ratios of LR and CSS were 2.60 (95% CI 1.50-4.52) (P=.001) and 1.94 (95% CI 1.18-3.19) (P=.010), respectively. Conclusion: Galectin-1 is an independent prognostic factor associated with LR and CSS in stage I-II cervical cancer patients undergoing definitive radiation therapy. Further studies targeting galectin-1 may improve the local control of cervical cancer.

  19. Prognostic factors in primary adenocarcinoma of the small intestine: 13-year single institution experience

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    Jacobs Michael J

    2008-01-01

    Full Text Available Abstract Background Adenocarcinoma of the small bowel is a relatively rare malignancy as compared to the other malignancies of the gastrointestinal tract. Nonspecific presentation and infrequent occurrence often leads to a delay in diagnosis and consequent poor prognosis. Various other factors are of prognostic importance while managing these tumors. Methods The medical records of a total of 27 patients treated for adenocarcinoma of the small bowel at Providence Hospital and Medical Centers from year 1990 through 2003 were reviewed retrospectively. Data were analyzed using SPSS software (version 10.0; SPSS, Inc., Chicago, IL. Survival analyses were calculated using the Kaplan Meier method with the log rank test to assess the statistical significance. The socio-demographics (age, gender were calculated using frequency analyses. Results The patients included nine males and eighteen females with a median age at diagnosis of 62 years. Only 48% of the patients had an accurate preoperative diagnosis while another 33% had a diagnosis suspicious of small bowel malignancy. None of the patients presented in stage 1. The cumulative five-year survival was 30% while the median survival was 3.3 years. There was no 30-day mortality in the postoperative period in our series. Conclusion The univariate analysis demonstrated that tumor grade, stage at presentation, lymph nodal metastasis and resection margins were significant predictors of survival.

  20. Dynamic contrast-enhanced CT (DCE-CT) as a potential biomarker in patients with metastatic renal cell carcinoma (mRCC)

    DEFF Research Database (Denmark)

    Mains, Jill Rachel; Donskov, Frede; Pedersen, Erik Morre

    Purpose To explore the impact of DCE-CT as a biomarker in mRCC.  Methods and Materials 12 patients with mRCC participating in a phase II trial with immunotherapy and bevacizumab and with a follow-up time of at least 2 years were included in this preliminary analysis. DCE-CT interpretation (max...... slope method) was performed blinded to treatment group. DCE-CT scans were performed using a Philips iCT or Brilliance 64 at baseline, 5 and 10 weeks and 6, 9, 12, 15, 18, 21 and 24 months. Perfusion (P, ml/min/100 ml), peak enhancement (PE, HU), time to peak (TTP, sec) and blood volume (BV, ml/100 g......) were calculated using a Philips Extended Brilliance workstation version 4.5.2. DCE-CT parameters were correlated with the relative changes in the sums of diameters (RECIST 1.1), progression free survival (PFS) and overall survival (OS) using Wilcoxon, Man-Whitney, Kaplan Meier and Log Rank statistics...

  1. Features of hepatocellular carcinoma in Hispanics differ from African Americans and non-Hispanic Whites

    Science.gov (United States)

    Venepalli, Neeta K; Modayil, Mary V; Berg, Stephanie A; Nair, Tad D; Parepally, Mayur; Rajaram, Priyanka; Gaba, Ron C; Bui, James T; Huang, Yue; Cotler, Scott J

    2017-01-01

    AIM To compare features of hepatocellular carcinoma (HCC) in Hispanics to those of African Americans and Whites. METHODS Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry. Data were collected retrospectively, including demographics, comorbidities, liver disease characteristics, tumor parameters, treatment, and survival (OS) outcomes. OS analyses were performed using Kaplan-Meier method. RESULTS One hundred and ninety-five patients with HCC were identified: 80.5% were male, and 22% were age 65 or older. Mean age at HCC diagnosis was 59.7 ± 9.8 years. Sixty-one point five percent of patients had Medicare or Medicaid; 4.1% were uninsured. Compared to African American (31.2%) and White (46.2%) patients, Hispanic patients (22.6%) were more likely to have diabetes (P = 0.0019), hyperlipidemia (P = 0.0001), nonalcoholic steatohepatitis (NASH) (P = 0.0021), end stage renal disease (P = 0.0057), and less likely to have hepatitis C virus (P encephalopathy (P = 0.0087). Hispanic patients with HCC had shorter OS than the other racial groups (P = 0.020), despite similarities in HCC parameters and treatment. CONCLUSION In conclusion, Hispanic patients with HCC have higher incidence of modifiable metabolic risk factors including NASH, and shorter OS than African American and White patients.

  2. Hepatic steatosis as a possible risk factor for the development of hepatocellular carcinoma after eradication of hepatitis C virus with antiviral therapy in patients with chronic hepatitis C

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To elucidate risk factors contributing to the development of hepatocellular carcinoma (HCC) among patients with sustained viral response (SVR) after interferon (IFN) treatment and to examine whether HCV-RNA still remained in the liver of SVR patients who developed HCC.METHODS: Two-hundred and sixty-six patients,who achieved SVR, were enrolled in this study. We retrospectively reviewed clinical, viral and histological features of the patients, and examined whether the development of HCC depends on several clinical variables using Kaplan-Meier Method. RT-PCR was used to seek HCV-RNA in 3 out of 7 patients in whom liver tissue was available for molecular analysis.RESULTS: Among the enrolled 266 patients with SVR,HCC developed in 7 patients (7/266; 2.6%). We failed to detect HCV-RNA both in cancer and non-cancerous liver tissue in all three patients. The cumulative incidence for HCC was significantly different depending on hepatic fibrosis (F3-4) (P=0.0028), hepatic steatosis (Grade 2-3) (P=0.0002) and age (≥ 55) (P=0.021) at the pre-interferon treatment.CONCLUSION: The current study demonstrated that age, hepatic fibrosis, and hepatic steatosis at preinterferon treatment might be risk factors for developing HCC after SVR.

  3. Do younger women with non-metastatic and non-inflammatory breast carcinoma have poor prognosis?

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    Rajan Balakrishnan

    2004-01-01

    Full Text Available Abstract Background Controversy abounds over whether breast cancer in younger women is more aggressive than those in older. The aim of the study was to assess the influence of age on long-term survival of women with breast carcinoma. Materials and Methods Patients with non-metastatic and non-inflammatory invasive breast carcinoma treated at the Regional Cancer Centre, Trivandrum, Kerala, India during 1990–93 were divided into 4 age groups as 60 years. The overall survival (OS for each age group was estimated using the Kaplan-Meier method in relation to the primary tumor (T and the axillary node status (N. The OS of the various age groups were compared using the log-rank test. Hazard ratio and 95% confidence interval for each age group was estimated using Cox-regression model after adjusting for T and N. Results Between 1990–1993, 1701 women (26%, Conclusion Women under 40 years with T3/ T4 breast lesions and/or positive axillary nodes were found to have a significantly poorer survival.

  4. Glutathione S-transferase Pi expression predicts response to adjuvant chemotherapy for stage C colon cancer: a matched historical control study

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    Jankova Lucy

    2012-05-01

    Full Text Available Abstract Background This study examined the association between overall survival and Glutathione S-transferase Pi (GST Pi expression and genetic polymorphism in stage C colon cancer patients after resection alone versus resection plus 5-fluourouracil-based adjuvant chemotherapy. Methods Patients were drawn from a hospital registry of colorectal cancer resections. Those receiving chemotherapy after it was introduced in 1992 were compared with an age and sex matched control group from the preceding period. GST Pi expression was assessed by immunohistochemistry. Overall survival was analysed by the Kaplan-Meier method and Cox regression. Results From an initial 104 patients treated with chemotherapy and 104 matched controls, 26 were excluded because of non-informative immunohistochemistry, leaving 95 in the treated group and 87 controls. Survival did not differ significantly among patients with low GST Pi who did or did not receive chemotherapy and those with high GST Pi who received chemotherapy (lowest pair-wise p = 0.11 whereas patients with high GST Pi who did not receive chemotherapy experienced markedly poorer survival than any of the other three groups (all pair-wise p Conclusion Stage C colon cancer patients with low GST Pi did not benefit from 5-fluourouracil-based adjuvant chemotherapy whereas those with high GST Pi did.

  5. The Effect of Charcot Neuroarthropathy on Limb Preservation in Diabetic Patients with Foot Wound and Critical Limb Ischemia after Balloon Angioplasty

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    Mehmet Burak Çildağ

    2017-01-01

    Full Text Available Objective. The aim of this article is to investigate one-year limb preservation rates after below-the-knee angioplasty in patients with diabetic foot wound who only have critical limb ischemia (CLI and those who have Charchot neuroarthropathy (CN accompanied by CLI. Methods. This single-center, retrospective study consists of 63 patients with diabetic foot wound who had undergone lower extremity balloon angioplasty of at least 1 below-the-knee (BTK vessel. Only those patients with postprocedural technical success of 100% were selected from the database. All patients were classified into two groups as patients with CLI and CN and patients with CLI only without CN. The Kaplan-Meier method was used to compare the limb preservation rates for the two groups. Results. There was no statistically significant difference between patient age, gender, diabetic disease duration, and comorbid disease such as chronic renal insufficiency, hypertension, and coronary artery disease of the two groups (p>0.05. Limb preservation in the 12 months was 59.1% in the CN group and 92.7% in the group without CN. Also, limb preservation rates between the two groups displayed statistically significant differences (p<0.005. Conclusion. This study showed that CLI can accompany CN in patients with diabetes. Limb preservation rates with endovascular treatment in diabetic patients with CLI only are better than in diabetic patients with CLI and CN.

  6. Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

    Science.gov (United States)

    2014-01-01

    Background Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. The delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. The dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity. Methods Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis. Results After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively. Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m2. PMID:25041714

  7. Cancer survival among children and adolescents at a state referral hospital in southeastern Brazil

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    Glaucia Perini Zouain-Figueiredo

    2013-12-01

    Full Text Available OBJECTIVES: to analyze the patient characteristics and evaluate overall survival, survival according to demographic variables, the most common tumor groups and subgroups, the stages of disease, and risk factors after at least 5 years among children and adolescents with cancer who were admitted to a state referral hospital between 2000 and 2005. METHODS: the Kaplan-Meier method was employed to estimate survival. The survival curves were compared using the log-rank test. The Cox regression model was used to estimate the effect of independent variables. RESULTS: a total of 571 new cases were registered. The most frequent cancer groups were leukemia (34%, lymphoma (18%, and central nervous system (CNS tumors (15%.The overall survival rate was 59%. The risk factors associated with lower survival were an age of more than 4 years or less than 1 year, the presence of CNS tumors, and non-localized disease. CONCLUSION: although this was not a populationbased study, it provides important epidemiological information about a state where population data on childhood and adolescent cancer are scarce and where hospital-based data do not exist. The survival rate found here should serve as a framework for future improvements, helping to guide policymakers focused on pediatric oncology in the state.

  8. Factors associated with the healing of complex surgical wounds in the breast and abdomen: retrospective cohort study

    Science.gov (United States)

    Borges, Eline Lima; Pires, José Ferreira; Abreu, Mery Natali Silva; Lima, Vera Lúcia de Araújo; Silva, Patrícia Aparecida Barbosa; Soares, Sônia Maria

    2016-01-01

    ABSTRACT Objective: to estimate the healing rate of complex surgical wounds and its associated factors. Method: retrospective cohort study from 2003 to 2014 with 160 outpatients of a Brazilian university hospital. Data were obtained through consultation of the medical records. Survival function was estimated using the Kaplan-Meier method and Cox regression model to estimate the likelihood of the occurrence of healing. Results: the complex surgical wound healing rate was 67.8% (95% CI: 60.8-74.9). Factors associated with a higher likelihood of wound healing were segmentectomy/quadrantectomy surgery, consumption of more than 20 grams/day of alcohol, wound extent of less that 17.3 cm2 and the length of existence of the wound prior to outpatient treatment of less than 15 days, while the use of hydrocolloid covering and Marlex mesh were associated with a lower likelihood of healing. Conclusion: the wound healing rate was considered high and was associated with the type of surgical intervention, alcohol consumption, type of covering, extent and length of wound existence. Preventive measures can be implemented during the monitoring of the evolution of the complex surgical wound closure, with possibilities of intervention in the modifiable risk factors. PMID:27737379

  9. “Magic” of our gastric cancer results on perioperative chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Carlos León-Espinoza; Fernando López-Mozos; Roberto Marti-Obiol; Marina Garces-Albir; Joaquin Ortega-Serrano

    2016-01-01

    AIM: To determine reproducibility of perioperative chemotherapy for gastric cancer(GC) on our settings by identifying patient’s overall survival and comparing them to larger studies.METHODS: Retrospective analysis of our series,where we present our eleven-year’s experience on GC managed according to perioperative approach of three preoperative chemotherapy cycles followed by surgery and finally three postoperative chemotherapy cycles.Chemotherapic scheme used was Xelox(Oxaliplatin and Capecitabine).Epidemiologic parameters as well as surgical variables were analysed,presented,and compared to other series with similar approaches.Survival was estimated by Kaplan Meier/log rank method and also compared to these studies.RESULTS: Mean age was 65 years old.Overall survival in our series was 37.7%,similar to other groups using perioperative schemes.Mortality was 4% and morbidity 30%,which are also similar to those groups.Survival curves were compared to larger studies,finding similarities on them.Subgroup survival analysis between chemotherapy responders and non-responders didn’t reach statically significant differences.CONCLUSION: Perioperative chemotherapic scheme can be reproduced on our setting with good results and without increasing morbidity or mortality.

  10. Percutaneous treatment of complications occurring during hemodialysis graft recanalization

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    Sofocleous, Constantinos T. E-mail: constant@pol.net; Schur, Israel; Koh, Elsie; Hinrichs, Clay; Cooper, Stanley G.; Welber, Adam; Brountzos, Elias; Kelekis, Dimitris

    2003-09-01

    Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.

  11. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data

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    Michael J. Baine

    2014-01-01

    Full Text Available Objectives. We examined the role of radiation therapy (RT in pancreatic adenocarcinoma (PA treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS were age, gender, race, stage, year of diagnosis, and treatment with surgery, chemotherapy (CT, or RT. Time to death was plotted by Kaplan-Meier method. A Cox proportional hazards model was used to evaluate prognostic factors for OS. Results. The median OS was 7.3 and 5 months for patients from UNMC and the SEER database, respectively. A Cox model of patients from UNMC showed that RT was associated with improved OS (HR 0.77, P=0.018 after adjusting for factors including age, race, gender, stage, year of diagnosis, having surgery, or having CT. Cox analysis of patients from the SEER showed similar results (HR 0.65, P<0.0001. Conclusions. RT confers an independent survival advantage in patients being treated for PA which is apparent both at UNMC and through SEER data.

  12. Early Proctoscopy is a Surrogate Endpoint of Late Rectal Toxicity in Prostate Cancer Treated With Radiotherapy

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    Ippolito, Edy; Massaccesi, Mariangela; Digesu, Cinzia; Deodato, Francesco [Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Macchia, Gabriella, E-mail: gmacchia@rm.unicatt.it [Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Pirozzi, Giuseppe Antonio [Endoscopy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Cilla, Savino [Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Cuscuna, Daniele; Di Lallo, Alessandra [Urology Unit, General Hospital A. Cardarelli, Campobasso (Italy); Mattiucci, Gian Carlo; Mantini, Giovanna [Department of Radiotherapy, Policlinico Universitario Agostino Gemelli, Universita Cattolica del S. Cuore, Rome (Italy); Pacelli, Fabio [Surgery Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Valentini, Vincenzo; Cellini, Numa [Department of Radiotherapy, Policlinico Universitario Agostino Gemelli, Universita Cattolica del S. Cuore, Rome (Italy); Ingrosso, Marcello [Endoscopy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Morganti, Alessio Giuseppe [Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Universita Cattolica del S. Cuore, Campobasso (Italy); Department of Radiotherapy, Policlinico Universitario Agostino Gemelli, Universita Cattolica del S. Cuore, Rome (Italy)

    2012-06-01

    Purpose: To predict the grade and incidence of late clinical rectal toxicity through short-term (1 year) mucosal alterations. Methods and Materials: Patients with prostate adenocarcinoma treated with curative or adjuvant radiotherapy underwent proctoscopy a year after the course of radiotherapy. Mucosal changes were classified by the Vienna Rectoscopy Score (VRS). Late toxicity data were analyzed according to the Kaplan-Meier method. Comparison between prognosis groups was performed by log-rank analysis. Results: After a median follow-up time of 45 months (range, 18-99), the 3-year incidence of grade {>=}2 rectal late toxicity according to the criteria of the European Organization for Research and Treatment of Cancer and the Radiation Therapy Oncology Group was 24%, with all patients (24/24; 100%) experiencing rectal bleeding. The occurrence of grade {>=}2 clinical rectal late toxicity was higher in patients with grade {>=}2 (32% vs. 15 %, p = 0.02) or grade {>=}3 VRS telangiectasia (47% vs. 17%, p {<=} 0.01) and an overall VRS score of {>=}2 (31% vs. 16 %, p = 0.04) or {>=}3 (48% vs. 17%, p = 0.01) at the 1-year proctoscopy. Conclusions: Early proctoscopy (1 year) predicts late rectal bleeding and therefore can be used as a surrogate endpoint for late rectal toxicity in studies aimed at reducing this frequent complication.

  13. Delirium: A predictor of mortality in the elderly

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    Matías González

    2005-09-01

    Full Text Available The frequency of delirium in elderly inpatients is high, resulting in poor hospital outcomes. The objective of this study is to assess whether delirium is an independent predictor for mortality over a three-month period. Methods: Prospective, observational study in a cohort of 171 inpatients aged over 65 years. Presence of delirium and/or dementia, severity of delirium and incapacity due to illness were assessed at baseline using DSM-IV diagnostic criteria, the Confusion Assessment Method (CAM, the MMSE, the Delirium Rating Scale (DRS and the Karnofsky Performance Status (KPS. Mortality rates were evaluated over a three-month follow-up period after enrollment. Kaplan-Meier survival curves were constructed and the adjusted effect of a set of covariates was evaluated with the Cox multiple regression analysis. Results: By 3 months after enrollment, 34.4% of the patients with delirium died, compared with 16.5% of those without delirium. The survival analysis shows a statistically significant difference between the two groups (log-rank=11.92; d.f.=1; P=0.0006. After adjustment for covariates, delirium was found to be independently associated with higher mortality. Conclusions: Delirium was found to be an independent marker for mortality in older medical patients over a three-month follow-up.

  14. A Hypothesis and Pilot Study of Age-Related Sensory Innervation of the Hard Palate: Sensory Disorder After Nasopalatine Nerve Division

    Science.gov (United States)

    Liu, Jiyuan; Li, Xiufen; Ma, Liyuan; Pan, Jian; Tang, Xiufa; Wu, Yunlong; Hua, Chengge

    2017-01-01

    Background The nasopalatine nerve may be injured during extraction of teeth embedded in the anterior hard palate. The neural recovery process and its impact on sensation in the anterior hard palatal region are controversial. In our clinical practice, we noticed a distinct recovery process in children compared with adolescents or adults after surgery. We hypothesized that the sensory innervations of the anterior palate might shift during later childhood and pre-adolescence, which is due to the development of the nasopalatine nerve along with the maxillary growth and permanent teeth eruption. Material/Method Forty patients (20 females and 20 males, mean age 11.8±2.2) with impacted supernumerary teeth in anterior palatine area were included into our study, and were divided into 3 groups according to their age. A 24-week follow-up was conducted and the sensation in the anterior hard palate region was examined at every check point. All the data were collected and analyzed by Kaplan-Meier analysis. Results Fourteen children did not complain of any numbness immediately after anesthetization, and other children with sensory disorders had shorter healing periods compared to adolescent/adult patients. Conclusions The results indicated that the dominant nerve of the anterior hard palate region was dramatically changed from the greater palatine nerve to the nasopalatine nerve, which is important in deciding when to operate and in selection of anesthesia method. PMID:28132066

  15. Adenoid cystic carcinoma of head and neck: A single institutional analysis of 66 patients treated with multi-modality approach

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    Ajeet Kumar Gandhi

    2015-01-01

    Full Text Available Background: Adenoid cystic carcinoma (ACC accounts for 1% of all head and neck (HN cancers. Materials and Methods: Demographic, clinical, treatment, and survival details of 66 patients were collected (1995-2011 and analyzed. Disease-free survival (DFS was estimated by Kaplan-Meier method. Results: Primary disease sites were sinonasal (n = 27, salivary gland (n = 30, and others (n = 9. Median follow-up was 23 months (range: 12-211 months. Estimated DFS at 2- and 5-year were 75% and 67.2%, respectively. On univariate analysis, intra-cranial extension (ICE (hazard ratio [HR]: 3.59, P = 0.0071, lymph node involvement (HR: 4.05, P = 0.0065, treatment modality (others vs. surgery plus adjuvant radiotherapy, HR: 2.39, P = 0.0286 and T stage (T3/4 vs. T1/2, HR: 3.27, P = 0.007 had significant impact on DFS. Lymph node involvement (P = 0.038 and ICE (P = 0.038 continued to have significant impact on DFS on multivariate analysis. Conclusion: Surgery followed by adjuvant radiotherapy remains the treatment of choice for HN ACC. Lymph node involvement and ICE confer poor prognosis.

  16. Analysis of the prognosis of patients with testicular seminoma

    Science.gov (United States)

    DONG, WEI; GANG, WANG; LIU, MIAOMIAO; ZHANG, HONGZHEN

    2016-01-01

    Testicular seminoma is a common malignancy, accounting for 35–50% of testicular tumors. Comprehensive therapies lead to good curative efficacy. However, the factors that affect prognosis remain to be elucidated. The aim of the present study was to analyze the 3-, 5- and 10-year survival rate of patients with testicular seminoma as well as the associated factors of prognosis. The clinical data from 58 patients diagnosed with testicular seminoma were collected betweeen January 1999 and January 2014. The survival rate for this group was evaluated using the Kaplan-Meier method. Associated factors of prognosis were analyzed using the log-rank test. The results showed that approximately 62.1% of the cases were in the 30- to 50-year age group. From this age group, 94.8% of patients survived for 3 years, 86.2% for 5 years and 70.7% for 10 years. A significant difference was identified for the different clinical stages, pathological types and postoperative treatment in the 3-, 5- and 10-year survival rates (Pseminoma. Selection of an appropriate method of treatment including the clinical stages and histological types, is the key element in testicular seminoma therapy. PMID:26893743

  17. Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: Analysis of survival and prognostic markers

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    Wickramarachchi RE

    2010-09-01

    Full Text Available Abstract Objectives This study compares clinico-pathological features in young (50 years with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. Materials and methods A twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models. Results Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05. In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%. Cancer proximal to the splenic flexure was present more in young than in older patients. Synchronous cancers were found exclusively in the young. Mucinous tumours were seen in 16% of young and 4% of older patients (p Conclusion If patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.

  18. Important prognostic factors for the long-term survival of lung cancer subjects in Taiwan

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    Ko Albert

    2008-11-01

    Full Text Available Abstract Background This study used a large-scale cancer database in determination of prognostic factors for the survival of lung cancer subjects in Taiwan. Methods Total of 24,910 subjects diagnosed with lung cancer was analysed. Survival estimates by Kaplan-Meier methods. Cox proportional-hazards model estimated the death risk (hazard ratio (HR for various prognostic factors. Results The prognostic indicators associated with a higher risk of lung cancer deaths are male gender (males versus females; HR = 1.07, 95% confidence intervals (CI: 1.03–1.11, males diagnosed in later periods (shown in 1991–1994 versus 1987–1990; HR = 1.13, older age at diagnosis, large cell carcinoma (LCC/small cell carcinoma (SCC, and supportive care therapy over chemotherapy. The overall 5-year survival rate for lung cancer death was significantly poorer for males (21.3% than females (23.6%. Subjects with squamous cell carcinoma (SQCC and treatment by surgical resection alone had better prognosis. We find surgical resections to markedly increase 5-year survival rate from LCC, decreased risk of death from LCC, and no improved survival from SCC. Conclusion Gender and clinical characteristics (i.e. diagnostic period, diagnostic age, histological type and treatment modality play important roles in determining lung cancer survival.

  19. Assessment of risk factors affecting recurrence of patients with gastric cancer in the presence of informative censoring in Iran.

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    Roshanaei, Ghodratollah; Kazemnejad, Anoshirvan; Sadighi, Sanambar

    2011-01-01

    In some survival studies, several events are taken into consideration. If the events are independent then the ordinary methods such as Kaplan-Meier, Cox or parametric models can be used. If one of the events dependently (informatively) censors the other, the results are biased. The present study was designed to assess the risk factors for recurrence of patients with gastric cancer in the presence of informative censoring using parametric models with a semi-competing risk approach. In a retrospective study, 408 cases of gastric cancer were selected from the patients referred to the Tehran Cancer Institute from March 2003 to March 2007. Gender, age at diagnosis, distant metastasis, tumor size, histology type, tumor grade, pathologic stage, tumor site, and type of treatment were studied as prognostic factors and used in the models. Parametric models such as Weibull, exponential, log-logistic were used with informative right censoring using Akaike Information Criteria (AIC) as criteria to compare models. The data were analyzed using R statistical software. A p-value of less than 0.05 was considered as statistically significant. Based on Akaike information criteria (AIC), the Weibull model best fitted to data. The effect of tumor size and pathologic stage were significant on recurrence in both univariate and multivariate analyses. Tumor site and tumor grade were significant only in univariate analysis. The results showed that semi-competing risk methods perform well in determining risk factors for disease recurrence.

  20. Liver insulin-like growth factor 2 methylation in hepatitis C virus drrhosis and further occurrence of hepatocellular carcinoma

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    Philippe Couvert; Michel Beaugrand; Nathalie Ganne-Carrié; Alain Carrié; Jacques Pariès; Jenny Vaysse; Audrey Miroglio; Antoine Kerjean; Pierre Nahon; Jamel Chelly; Jean-Claude Trinchet

    2008-01-01

    AIM: To assess the predictive value of the insulinlike growth factor 2 (Igf2) methylation profile for the occurrence of Hepatocellular Carcinoma (HCC) in hepatitis C (HCV) cirrhosis.METHODS: Patients with: (I) biopsy-proven compensated HCV cirrhosis; (2) available baseline frozen liver sample; (3) absence of detectable HCC; (4) regular screening for HCC; (5) informed consent for genetic analysis were studied.After DNA extraction from liver samples and bisulfite treatment,unbiased PCR and DHPLC analysis were performed for methylation analysis at the Igf2 locus.The predictive value of the Igf2 methylation profile for HCC was assessed by Kaplan-Meier and Cox methods.RESULTS: Among 94 included patients,20 developed an HCC during follow-up (6.9±3.2 years).The methylation profile was hypomethylated,intermediate and hypermethylated in 13,64 and 17 cases,respectively.In univariate analysis,two baseline parameters were associated with the occurrence of HCC: age (P=0.01) and prothrombin (P=0.04).The test of linear tendency between the three ordered levels of Igf2 methylation and probability of HCC occurrence was significant (Log Rank,P=0.043;Breslow,P=0.037; Tarone-Ware,P=0.039).CONCLUSION: These results suggest that hypomethylation at the Igf2 locus in the liver could be predictive for HCC occurrence in HCV cirrhosis.

  1. Analysis of WHO-Based Prognostic Scoring System (WPSS) of Myelodysplastic Syndrome and Its Comparison with International Prognostic Scoring System (IPSS) in 100 Chinese Patients

    Institute of Scientific and Technical Information of China (English)

    Jia Wei; Xiao-fen Zhou; Jian-feng Zhou; Yan Chen

    2009-01-01

    Objective: The aims of this study were to assess the prognostic significance of WHO-based Prognostic Scoring System (WPSS) in myelodysplastic syndrome (MDS) from a single center institute and to compare WPSS with the international prognostic scoring system (IPSS).Methods: A total of 100 cases with de novo MDS were reviewed and their karyotypes were detected. All of them were followed up and classified according to IPSS and WPSS risk groups. SPSS 13.0 software was applied to deal with all the data. The statistical methods included Kaplan - Meier, Log-rank test and cox regression.Results: Multivariate cox regression analysis indicated that WHO Classification (P=0.0190), karyotype abnormalities categorized according to IPSS (P=0.0159) and red blood cell (RBC) transfusion (P=0.0009) were the three most important independent factors for predicting overall survival (OS) of MDS. WPSS and IPSS both had great capacity in predicting the OS of MDS at the time of diagnosis (P<0.0001). In time-dependent analysis, WPSS can predict the OS accurately in the following three years after diagnosis (P<0.0001), while IPSS failed to predict the OS 24 months after diagnosis (P=0.1094).Conclusion: Our single center results proved that WPSS is a dynamic prognostic system which can predict the OS of MDS patients at any time during the course of their disease. This time-dependent prognostic scoring system may replace the IPSS in the near future.

  2. 卵巢切除联合依西美坦治疗绝经前激素受体阳性晚期难治性乳腺癌%Bilateral oophorectomy combined with exemestane treating advanced refractory breast cancer

    Institute of Scientific and Technical Information of China (English)

    Xinhong Wu; Yaojun Feng; Juan Xu; Yiping Gong; Biao Ma

    2011-01-01

    Objective: Taking tamoxifen orally is the main endocrine therapy of the premenopausal breast cancer with positive hormone receptor, but numerous patients developed to be advanced refractory breast cancer because of drug resistance.Our study investigated a role of the combination of bilateral oophorectomy and exemestane in the management of advanced refractory breast cancer. Methods: The bilateral oophorectomy was carried out in 17 patients. One week after the operation,exemestane was taken orally (25 mg/d). The median time to progression (TTP), the median survival time and the survival rate were calculated using Kaplan-Meier methods. Results: Seventeen patients age ranged from 26 to 44 years (median, 36 years) were treated with an overall response rate of 64.70%, TTP was 8 months and the median survival time was 31 months.The survival rate of 1-year, 3 years and 5 years was 88.24%, 64.71%, 29.41%, respectively. There have no grade Ⅲ/Ⅳ side effects appeared. Conclusion: Bilateral oophorectomy combined with exemestane is safe and effective for advanced refractory premenopausal breast cancer with positive hormone receptor and it is well-tolerated.

  3. Long-term results of interventional treatment of large unresectable hepatocellular carcinoma (HCC): significant survival benefit from combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared to TACE monotherapy; Langzeitergebnisse der interventionellen Therapie von grossen, inoperablen hepatozellulaeren Karzinomen (HCC): signifikanter Ueberlebensvorteil von transarterieller Chemoembolisation (TACE) und perkutaner Ethanolinjektion (PEI) gegenueber der TACE-Monotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Lubienski, A.; Bitsch, R.G.; Grenacher, L.; Kauffmann, G.W. [Radiologische Universitaetsklinik Heidelberg, Abt. Radiodiagnostik, Heidelberg (Germany); Schemmer, P. [Chirurgische Universitaetsklinik Heidelberg (Germany); Duex, M. [Radiologisches Zentralinstitut Krankenhaus Nordwest Frankfurt (Germany)

    2004-12-01

    Purpose: A retrospective analysis of long-term efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and TACE monotherapy was conducted in patients with large, non-resectable hepatocellular carcinoma (HCC). Methods and Materials: Fifty patients with large, unresectable HCC lesions underwent selective TACE. Liver cirrhosis was present in 42 patients, due to alcohol abuse (n = 22) and viral infection (n = 17). In three patients, the underlying cause for liver cirrhosis remained unclear. Child A cirrhosis was found in 22 and Child B cirrhosis in 20 patients. Repeated and combined TACE and PEI were performed in 22 patients and repeated TACE monotherapy was performed in 28 patients. Survival and complication rates were determined and compared. Results: The 6-, 12-, 24- and 36-month survival rates were 61%, 21%, 4%, and 4% for TACE monotherapy and 77%, 55%, 39% and 22% for combined TACE and PEI (Kaplan-Meier method). The kind of treatment significantly affected the survival rate (p=0.002 log-rank test). Severe side effects were present in two patients of the monotherapy group and in three patients of the combination therapy group. (orig.)

  4. Development and validation of a clinical scoring system for predicting risk of HCC in asymptomatic individuals seropositive for anti-HCV antibodies.

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    Mei-Hsuan Lee

    Full Text Available BACKGROUND: The development of a risk assessment tool for long-term hepatocellular carcinoma risk would be helpful in identifying high-risk patients and providing information of clinical consultation. METHODS: The model derivation and validation cohorts consisted of 975 and 572 anti-HCV seropositives, respectively. The model included age, alanine aminotransferase (ALT, the ratio of aspirate aminotransferase to ALT, serum HCV RNA levels and cirrhosis status and HCV genotype. Two risk prediction models were developed: one was for all-anti-HCV seropositives, and the other was for anti-HCV seropositives with detectable HCV RNA. The Cox's proportional hazards models were utilized to estimate regression coefficients of HCC risk predictors to derive risk scores. The cumulative HCC risks in the validation cohort were estimated by Kaplan-Meier methods. The area under receiver operating curve (AUROC was used to evaluate the performance of the risk models. RESULTS: All predictors were significantly associated with HCC. The summary risk scores of two models derived from the derivation cohort had predictability of HCC risk in the validation cohort. The summary risk score of the two risk prediction models clearly divided the validation cohort into three groups (p<0.001. The AUROC for predicting 5-year HCC risk in the validation cohort was satisfactory for the two models, with 0.73 and 0.70, respectively. CONCLUSION: Scoring systems for predicting HCC risk of HCV-infected patients had good validity and discrimination capability, which may triage patients for alternative management strategies.

  5. Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

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    Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

    2012-02-01

    Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

  6. Prognostic Factors of Ampulla of Vater Carcinoma after Radical Surgery

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    Dongbing Zhao; Yongkai Wu; Yi Shan; Chengfeng Wang; Ping Zhao

    2009-01-01

    OBJECTIVE Ampullary carcinoma is a rare disease with better prognosis than other periampullary neoplasms.This study investigated the association between clinicopathologiC factors and prognosis after radical resection of ampulla of Vater carcinoma.METHODS Clinical data from 105 patients who underwent radical pancreaticoduodenectomy from January 1990 to December 2005 were retrospectively analyzed by the Kaplan-Meier method,log-rank test,and the Cox proportional hazard model.RESULTS The in-hospital mortalitv rate was 8.6%,the lymph node metastasis rate was 37.1%,and the five-year survival rate was 42.8%.Pancreatic involvement(P=0.027),tumor diameter(P =0.008),T stage(P=0.003),TNM stage(P<0.001),and number of metastatic lymph nodes(P<0.001)were associated with prognosis when the univariate analysis was used.Multivariate analysis showed that the number of lymph node metastases (P<0.001;OR:1.923;CI:1.367-2.705)and tumot diameter(P=0.03;OR:1.432;CI:1.035-1.981) were the independent prognostic factors.CONCLUSION The number of metastatic lymph nodes and tumor diameter are important pathologic factors predicting prognosis of ampulla of Vater carcinoma after radical resection,and lymph node dissection during the radical surgery effectively improves the survival rate.

  7. Prognostic Factors in Patients with Malignant Pleural Mesothelioma

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    Vyacheslav P. Kurchin

    2015-03-01

    Full Text Available The aim of the present study was to examine the factors of prognosis in patients with malignant pleural mesothelioma (MPM after combined and multimodality treatment, including the prognostic significance of preoperative intrapleural perfusion hyperthermo-chemotherapy (IPHC. Material and Methods: The study included 20 patients (11 men and 9 women aged from 30 to 70 years (mean age 51.9±8.5 years who underwent surgical treatment for MPM. The diagnosis of MPM was verified by immunohistochemical data. The patients were divided into two groups. Group 1 included 9 patients who underwent combined treatment that included the extrapleural pneumonectomy (EPP and 4 courses of adjuvant chemotherapy. Group 2 included 11 patients who received multimodality treatment (IPHC, EPP, and 4 courses of adjuvant chemotherapy. All patients were followed prospectively at three-monthly intervals for the first year and six-monthly thereafter until the last time of contact or death. Statistical analysis was performed by using Kaplan-Meier method and the log-rank test. Cox-regression model was used for multivariate analysis. Results: Patient’s age over 60 years and the sarcomatoid type of the tumor can be regarded as prognostic factors for poor survival in patients with MPM who underwent EPP. Application of IPHC as a part of a multimodality treatment enhances the survivability of MPM patients.

  8. A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction

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    Koh, Esther; Jin, Gong Yong; Hwang, Seung Bae; Choi, Eun Jung; Song, Ji Soo; Han, Young Min; Kwon, Keun Sang [Dept. of Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

    2013-04-15

    To compare the Y type (side-by-side) and T type (stent-in-stent) bilateral biliary metal stenting in malignant hilar obstruction in terms of treatment outcomes, including post-stenting serum bilirubin level and stent patency. 41 consecutive patients with advanced hilar malignancies who underwent percutaneous placement of bilateral metallic stents - Y (n = 23) and T types (n = 18) - were retrospectively reviewed. We evaluated stent patency after the procedure by cholangiogram and abdominal CT. Pre- and post-stenting serum bilirubin level (total, direct bilirubin) at 1 week and at 1 month were compared. Student t-test and Kaplan-Meier method were used in the statistical analysis. After comparing the median stent patency according to both types, they did not differ significantly (Y: 38 days, T: 61 days; p 0.141). There was a more decrease in the total and direct bilirubin of the T type compared to the Y type after 1 week (p = 0.013, 0.025). However, no significant difference existed between the decreasing bilirubin rates of both types after 1 month (p = 0.923, 0.742). In patients with malignant hilar obstruction, both Y and T type bilateral metallic biliary stents are effective methods. Stent patency and bilirubin decrease rates were not significantly different.

  9. Prognostic value of Doppler transmitral filling patterns in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    ZHENG Zhe-lan郑哲岚; A.Meissner; B.Hausmann; H.Alexander; R.Simon

    2004-01-01

    Background Chronic heart failure is a significant cause of cardiovascular morbidity and mortality.This study tested the hypothesis that restrictive filling pattern may provide useful prognostic data for identifying patients with chronic heart failure at high risk of all-cause cardiac death.Methods Ninety patients with chronic heart failure [70 men and 20 women, mean age (58.1±11.6) years] were investigated and followed for (18. 8±7. 9) months. During this period, 14 patients died of progressive pump failure, 12 patients underwent heart transplantation, 5 patients died suddenly, and 2 patients died of acute myocardial infarction. A new criterion, the restrictive filling index (RFI), was designed to subgroup patients into a restrictive and a nonrestrictive group.Results Patients with restrictive filling pattern had a more severe left ventricular dysfunction and a higher cardiac mortality. Analysis by the Kaplan-Meier method revealed that patients in the RFI≥1 and RFI<1 groups had a cardiac events-free survival rate of 52% versus 94% at 1 year, and 27. 5% versus 92% at 2 years, respectively. The multivariate Cox proportional hazard model selected RFI as the most powerful prognostic factor (χ2 =8. 8017, P =0. 0030) for all-cause cardiac death.

  10. Prognostic value of neutrophil-to-lymphocyte ratio in metastatic colorectal cancer

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    Qianqian Yu; Hong Qiu; Mingsheng Zhang; Guangyuan Hu; Liu Huang; Xianglin Yuan 

    2016-01-01

    Objective This study investigated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in predicting clinical outcomes of patients with metastatic colorectal cancer (mCRC) undergoing irinotecan-based first-line chemotherapy. Methods This study was based on a Chinese prospective multicenter trial (NCT01282658). Baseline complete blood cel counts were performed. Survival was determined using the Kaplan-Meier method. Multivariate analyses based on the Cox regression model were performed to determine the ef ects of inde-pendent biomarkers. Results A total of 139 patients were evaluated. Values below the median NLR were associated with bet-ter progression-free survival (PFS) (9.9 vs 7.7 months, P = 0.043) and overal survival (OS) (21.8 vs 15.1 months, P = 0.013). These ef ects remained significant in multivariate analysis. Conclusion NLR is an independent prognostic marker of mCRC treated with first-line irinotecan-based therapy in a Chinese population.

  11. Improvement of recurrence-free survival after radical prostatectomy for locally advanced prostate cancer in relation to the time of surgical intervention

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    E. I. Veliev

    2016-01-01

    Full Text Available Objective: to comparatively estimate the frequency of a positive surgical margin and 5-year biochemical recurrent-free survival (BRFS rates in patients with locally advanced prostate cancer in relation to the time of radical retropubic prostatectomy.Subjects and methods. The investigation enrolled 274 patients with prostate cancer (pT3-4N0-1M0 who were divided into 2 groups of 68 and 20 patients operated on in 1997 to 2006 and 2007 to 2012, respectively. Two surgeons made surgical interventions by the standardized procedure. The 5-year BRFS rates were estimated using the Kaplan-Meier method and log-rank test. A biochemical recurrence was defined as a prostatespecific antigen level of t 0.2 ng / ml in 2 consecutive measurements or as the initiation of adjuvant therapy.Results. The detection rate of a positive surgical margin decreased from 55.9 % in 1997–2006 to 37.9 % in 2007–2012 (p = 0.01; the 5-year recurrence-free survival rates were 38.8 % versus 66.2 % (p < 0.001.Conclusion. These changes would probably be a result of surgeons» better experience and improved surgical techniques in the course of time.

  12. Breastfeeding duration and associated factors between 1960 and 2000

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    Danielle Soares de Oliveira

    Full Text Available Abstract Objective: To describe a historical series on the median duration of breastfeeding in a population of mothers whose children were born from the 1960s onwards, identifying factors associated with the interruption of breastfeeding in each decade. Methods: Data were analyzed from the Pró-Saúde Study, a longitudinal epidemiological investigation started in 1999 among technical and administrative employees of a university in the state of Rio de Janeiro. Breastfeeding duration was collected in two study phases: Phase 1 (1999, and phase 4 (2011-2012. Of these, those who had at least one child and reported the duration of breastfeeding for the first child were selected (n = 1539. To analyze the duration of breastfeeding, survival curves were constructed using the Kaplan-Meier method and the effect of covariates on the duration of breastfeeding was estimated by Cox regression model. Results: It was found that the median duration of breastfeeding was higher in the 1990s and 2000s and lower in the 1970s, compared to the 1960s. In addition, there was an association between higher income and maternal age with breastfeeding interruption, which was focused in the 1970s. Conclusion: There was shorter duration of breastfeeding in the 1970s compared to the 1960s. Increased duration and prevalence of breastfeeding from the 1970s onwards coincided with the national trend and the promotion of this practice since 1980.

  13. Complete Treatment Versus Residual Lesion - Long-Term Evolution After Acute Coronary Syndrome

    Science.gov (United States)

    Soeiro, Alexandre de Matos; Scanavini Filho, Marco Antônio; Bossa, Aline Siqueira; Zullino, Cindel Nogueira; Soeiro, Maria Carolina F. Almeida; Leal, Tatiana Carvalho Andreucci T; Serrano Jr, Carlos Vicente; Hajjar, Ludhmila Abrahão; Kalil Filho, Roberto; Oliveira Jr, Múcio Tavares

    2016-01-01

    Introduction A recently published study raised doubts about the need for percutaneous treatment of nonculprit lesions in patients with acute coronary syndromes (ACS). Methods Retrospective, unicentric, observational study. Objective To analyze the long-term outcomes in patients undergoing treatment of the culprit artery, comparing those who remained with significant residual lesions in nonculprit arteries (group I) versus those without residual lesions in other coronary artery beds (group II). The study included 580 patients (284 in group I and 296 in group II) between May 2010 and May 2013. We obtained demographic and clinical data, as well as information regarding the coronary treatment administered to the patients. In the statistical analysis, the primary outcome included combined events (reinfarction/angina, death, heart failure, and need for reintervention). The comparison between groups was performed using the chi-square test and ANOVA. The long-term analysis was conducted with the Kaplan-Meier method, with a mean follow-up of 9.86 months. Results The mean ages were 63 years in group I and 62 years in group II. On long-term follow-up, there was no significant difference in combined events in groups I and II (31.9% versus 35.6%, respectively, p = 0.76). Conclusion The strategy of treating the culprit artery alone seems safe. In this study, no long-term differences in combined endpoints were observed between patients who remained with significant lesions compared with those without other obstructions.

  14. The expressions and significance of MMP-2 and TIMP-2 in human pancreatic carcinoma

    Institute of Scientific and Technical Information of China (English)

    Dong Bo; Ma Qingyong; Li Ming

    2007-01-01

    Objective To study the expressions of MMP-2 and TIMP-2 in pancreatic carcinoma and their relationship with tumor invasion, local metastasis and prognosis of the carcinoma. Methods The expressions of MMP-2 and TIMP-2 were examined in 32 patients with pancreatic carcinomas by S-P immunohistochemical technique and the correlation with pathological tumor parameters were analyzed. Survival analysis was made by using the Kaplan-Meier method. Results The positive rates of MMP-2, TIMP-2 in 32 patients with pancreatic carcinoma were 56.25% and 75.00%, which were significantly higher than those of the controls(P<0.05). Expressions of MMP-2 and TIMP-2 were independent of sex, age, histological grading and type, but well correlated with the lymph node metastasis and TNM clinical staging(Ⅰ and Ⅲ, Ⅱ and Ⅲ). There was a significant association between MMP-2, TIMP-2 and prognosis in pancreatic carcinoma. Conclusion MMP-2 and TIMP-2 might be useful markers for biological aggressiveness of this malignancy and might contribute to the invasive properties of pancreatic carcinoma, which can be used to evaluate the prognosis of patients.

  15. WT1 gene expression as a prognostic marker in advanced serous epithelial ovarian carcinoma: an immunohistochemical study

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    Leetanaporn Roengsak

    2006-04-01

    Full Text Available Abstract Background WT1 is a tumor suppressor gene responsible for Wilms' tumor. WT1 reactivity is limited to ovarian serous carcinomas. Recent studies have shown that WT1 plays an important role in the progression of disease and indicates a poorer prognosis of human malignancies such as acute myeloid leukemia and breast cancer. The aims of this study were to determine the survival and recurrence-free survival of women with advanced serous epithelial ovarian carcinoma in relation to WT1 gene expression. Methods The study accrued women over an 18-year period, from 1987–2004. During the study period, 163 patients were diagnosed with advanced serous epithelial ovarian carcinoma and had undergone complete post-operative chemotherapy, but the final study group comprised 99 patients. The records of these women were reviewed and the paraffin-embedded tissue of these women stained with WT1 immunostaining. Survival analysis was performed using Kaplan-Meier and Cox regression methods. Results Fifty patients showed WT1 staining and forty-nine did not. Five-year survival of non-staining and staining groups were 39.4% and 10.7% (p Conclusion This study suggests that expression of WT1 gene may be indicative of an unfavorable prognosis in patients with advanced serous epithelial ovarian carcinoma.

  16. Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

    Institute of Scientific and Technical Information of China (English)

    Giuseppe S Sica; Edoardo Iaculli; Livia Biancone; Sara Di Carlo; Rosa Scaramuzzo; Cristina Fiorani; Paolo Gentileschi; Achille L Gaspari

    2011-01-01

    AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit.METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality.RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series.CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer.

  17. CD63 and GLUT-1 Overexpression Could Predict a Poor Clinical Outcome in GIST: A Study of 54 Cases with Follow-Up.

    Science.gov (United States)

    Lewitowicz, Piotr; Matykiewicz, Jarosław; Koziel, Dorota; Chrapek, Magdalena; Horecka-Lewitowicz, Agata; Gluszek, Stanislaw

    2016-01-01

    Background and Goals. In light of current knowledge, it seems that alternations underlying GISTs are well explained, although all that is enhanced by various aspects on a daily basis. More recently, attention has been pointed towards exosomes as important particles able to modify healthy and also diseased tissues including cancer. The goal of the present study was an analysis of CD9, CD63, and GLUT-1 as a marker of hypoxia status within 54 cases of GIST and evaluation of their predictive value. Methods. 54 cases of patients suffering from GIST were enrolled into the study, predominantly in the gastric location. All operated cases had no Imatinib and other chemotherapies up to the day of operation. Expression of targeted proteins was performed by immunohistochemistry and, after that, the results with tabulated clinical data were compared by Kaplan-Meier method and multivariate Cox proportional hazard model of statistical analysis. Results. Our results presented a marked dependence of worsening clinical outcome with high expression CD63 (p = 0.008) as well as with GLUT-1 (p = 0.014). We noted a strict correlation of GLUT-1 expression with CD63 expression (p = 0.03), which could confirm the thesis about the contribution of exosomes in intratumoural hypoxia status. The collected material did not confirm CD9 contribution. Conclusions. As presented here, CD63 and GLUT-1 have a prognostic value in GIST cases. The results confirm the other studies in this scope and can be used in future as an additional prognostic factor.

  18. Survival analysis: a tool in the study of post-harvest diseases in peaches

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    Cristiano Nunes Nesi

    2015-02-01

    Full Text Available Survival analysis is applied when the time until the occurrence of an event is of interest. Such data are routinely collected in plant diseases, although applications of the method are uncommon. The objective of this study was to use two studies on post-harvest diseases of peaches, considering two harvests together and the existence of random effect shared by fruits of a same tree, in order to describe the main techniques in survival analysis. The nonparametric Kaplan-Meier method, the log-rank test and the semi-parametric Cox's proportional hazards model were used to estimate the effect of cultivars and the number of days after full bloom on the survival to the brown rot symptom and the instantaneous risk of expressing it in two consecutive harvests. The joint analysis with baseline effect, varying between harvests, and the confirmation of the tree effect as a grouping factor with random effect were appropriate to interpret the phenomenon (disease evaluated and can be important tools to replace or complement the conventional analysis, respecting the nature of the variable and the phenomenon.

  19. Effectiveness of percutaneous aspiration thrombectomy for acute or subacute thromboembolism in infrainguinal arteries

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    Cha, Jung Guen; Kim, Chan Sun; Kim, Young Hwan; Kim, See Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2017-06-15

    To report the feasibility and long-term clinical outcome of percutaneous aspiration thrombectomy for treating acute or subacute arterial thromboembolism in the infrainguinal arteries. Thirty limbs of 29 patients were enrolled in this retrospective study between January 2004 and March 2014. Nine limbs underwent overnight catheter-directed thrombolysis followed by percutaneous aspiration thrombectomy (PAT). Eighteen limbs underwent PAT with adjunctive selective intra-arterial thrombolysis in a single session. The remaining three limbs underwent PAT alone. Balloon angioplasty (n = 16) or stent placement (n = 3) was performed as required. In-hospital mortality and complications were estimated. The primary patency rate and the rate of freedom from reintervention were calculated using the Kaplan-Meier method. Technical success was achieved in 28 limbs. Clinical success was achieved in 27 limbs. The mean ankle-brachial index increased from 0.17 ± 0.26 to 0.98 ± 0.19 after the procedure. Three in-hospital deaths and no major amputations were recorded. Distal embolization of crural arteries occurred as a minor complication in five limbs, but no major complications occurred. The primary patency rate and the rate of freedom from reintervention were 74.9% and 90.9% at 1 year, respectively, and 66.6% and 80.8% at 2 years, respectively. PAT is a rapid and effective method to remove a thrombus from occluded infrainguinal arteries.

  20. Sequential Oxygenation Index and Organ Dysfunction Assessment within the First 3 Days of Mechanical Ventilation Predict the Outcome of Adult Patients with Severe Acute Respiratory Failure

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    Hsu-Ching Kao

    2013-01-01

    Full Text Available Objective. To determine early predictors of outcomes of adult patients with severe acute respiratory failure. Method. 100 consecutive adult patients with severe acute respiratory failure were evaluated in this retrospective study. Data including comorbidities, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score, PaO2, FiO2, PaO2/FiO2, PEEP, mean airway pressure (mPaw, and oxygenation index (OI on the 1st and the 3rd day of mechanical ventilation, and change in OI within 3 days were recorded. Primary outcome was hospital mortality; secondary outcome measure was ventilator weaning failure. Results. 38 out of 100 (38% patients died within the study period. 48 patients (48% failed to wean from ventilator. Multivariate analysis showed day 3 OI ( and SOFA ( score were independent predictors of hospital mortality. Preexisting cerebrovascular accident (CVA ( was the predictor of weaning failure. Results from Kaplan-Meier method demonstrated that higher day 3 OI was associated with shorter survival time (log-Rank test, . Conclusion. Early OI (within 3 days and SOFA score were predictors of mortality in severe acute respiratory failure. In the future, prospective studies measuring serial OIs in a larger scale of study cohort is required to further consolidate our findings.

  1. Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success.

    Science.gov (United States)

    Garrido, Nicolás; Bellver, José; Remohí, José; Simón, Carlos; Pellicer, Antonio

    2011-07-01

    To report the use of cumulative live-birth rates (CLBRs) per ovarian stimulation cycle to measure the success of IVF is proving to be the most accurate method for advising couples who failed to conceive, although the accuracy yielded is relatively low, and cycle outcome is highly dependent on the number of embryos replaced. Our aim with this work is to report the CLBRs of IVF as a function of the number of embryos required to reach a live birth (EmbR), considering age, day of ET, and infertility etiology. Survival curves and Kaplan-Meier methods to analyze CLBR in a retrospective cohort with respect to the number of EmbR. University-affiliated infertility center. Infertile couples undergoing IVF using own oocytes. None. CLBR per embryo transferred. CLBRs increase rapidly between 1 and 5 EmbR, moderately between 5 and 15, and slowly thereafter. Live-birth rates rise more slowly when embryos are transferred on days 2-3 rather than on days 5-6, with comparable long-term results. Women's age is a negative factor from 35 to 37 years old, with a dramatic decrease in live-birth rates beyond age 40 years. In addition, there are significant worse results in endometriosis patients. The relationship between CLBR and number of EmbR provides realistic and precise information regarding IVF success and can be used to guide couples and practitioners. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. The incidence of venous thromboembolism in cervical cancer: a nationwide population-based study

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    Tsai Shiang-Jiun

    2012-06-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a life-threatening condition that occurs as a complication of cervical cancer. The aim of this study was to evaluate the incidence of VTE in cervical cancer patients during a 5-year follow-up. Methods The study analyzed data deposited between 2003 and 2008 in the National Health Insurance Research Database (NHIRD, provided by the National Health Research Institutes in Taiwan. Totally, 1013 cervical cancer patients after treatment and 2026 appendectomy patients were eligible. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the VTE risk. Results The 5-year cumulative risk for VTE was significantly higher in the cervical cancer group than in the control group (3.3% vs 0.3%, p vs 30.3%, p  Conclusions The cumulative risk of VTE was significantly higher in cervical cancer patients, and these patients also had lower survival rates. Strategies to reduce these risks need to be examined.

  3. Prognostic Impact of Radiation Therapy to the Primary Tumor in Patients With Non-small Cell Lung Cancer and Oligometastasis at Diagnosis

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    Lopez Guerra, Jose Luis [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Gomez, Daniel, E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhuang, Yan; Hong, David S. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Heymach, John V. [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swisher, Stephen G. [Department of Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Komaki, Ritsuko; Cox, James D.; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-09-01

    Purpose: We investigated prognostic factors associated with survival in patients with non-small cell lung cancer (NSCLC) and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis. Methods and Materials: From January 2000 through June 2011, 78 consecutive patients with oligometastatic NSCLC (<5 metastases) at diagnosis underwent definitive chemoradiation therapy ({>=}45 Gy) to the primary site. Forty-four of these patients also received definitive local treatment for the oligometastases. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Univariate Cox proportional hazard analysis revealed better overall survival (OS) for those patients who received at least 63 Gy of radiation to the primary site (P=.002), received definitive local treatment for oligometastasis (P=.041), had a Karnofsky performance status (KPS) score >80 (P=.007), had a gross tumor volume {<=}124 cm{sup 3} (P=.002), had adenocarcinoma histology (P=.002), or had no history of respiratory disease (P=.016). On multivariate analysis, radiation dose, performance status, and tumor volume retained significance (P=.004, P=.006, and P<.001, respectively). The radiation dose also maintained significance when patients with and without brain metastases were analyzed separately. Conclusions: Tumor volume, KPS, and receipt of at least 63 Gy to the primary tumor are associated with improved OS in patients with oligometastatic NSCLC at diagnosis. Our results suggest that a subset of such patients may benefit from definitive local therapy.

  4. A novel nonparametric measure of explained variation for survival data with an easy graphical interpretation

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    Weiß, Verena

    2015-10-01

    Full Text Available Introduction: For survival data the coefficient of determination cannot be used to describe how good a model fits to the data. Therefore, several measures of explained variation for survival data have been proposed in recent years.Methods: We analyse an existing measure of explained variation with regard to minimisation aspects and demonstrate that these are not fulfilled for the measure.Results: In analogy to the least squares method from linear regression analysis we develop a novel measure for categorical covariates which is based only on the Kaplan-Meier estimator. Hence, the novel measure is a completely nonparametric measure with an easy graphical interpretation. For the novel measure different weighting possibilities are available and a statistical test of significance can be performed. Eventually, we apply the novel measure and further measures of explained variation to a dataset comprising persons with a histopathological papillary thyroid carcinoma.Conclusion: We propose a novel measure of explained variation with a comprehensible derivation as well as a graphical interpretation, which may be used in further analyses with survival data.

  5. Phase 1 Study of Erlotinib Plus Radiation Therapy in Patients With Advanced Cutaneous Squamous Cell Carcinoma

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    Heath, C. Hope; Deep, Nicholas L.; Nabell, Lisle; Carroll, William R.; Desmond, Renee; Clemons, Lisa; Spencer, Sharon; Magnuson, J. Scott [Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama (United States); Rosenthal, Eben L., E-mail: oto@uab.edu [Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama (United States)

    2013-04-01

    Purpose: To assess the toxicity profile of erlotinib therapy combined with postoperative adjuvant radiation therapy in patients with advanced cutaneous squamous cell carcinoma. Methods and Materials: This was a single-arm, prospective, phase 1 open-label study of erlotinib with radiation therapy to treat 15 patients with advanced cutaneous head-and-neck squamous cell carcinoma. Toxicity data were summarized, and survival was analyzed with the Kaplan-Meier method. Results: The majority of patients were male (87%) and presented with T4 disease (93%). The most common toxicity attributed to erlotinib was a grade 2-3 dermatologic reaction occurring in 100% of the patients, followed by mucositis (87%). Diarrhea occurred in 20% of the patients. The 2-year recurrence rate was 26.7%, and mean time to cancer recurrence was 10.5 months. Two-year overall survival was 65%, and disease-free survival was 60%. Conclusions: Erlotinib and radiation therapy had an acceptable toxicity profile in patients with advanced cutaneous squamous cell carcinoma. The disease-free survival in this cohort was comparable to that in historical controls.

  6. Outcome analysis of high-dose chemotherapy and autologous stem cell transplantation in adolescent and young adults with relapsed or refractory Hodgkin lymphoma.

    Science.gov (United States)

    Akhtar, Saad; Rauf, Shahzad M; Elhassan, Tusneem A M; Maghfoor, Irfan

    2016-09-01

    High-dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT) can salvage many patients with relapsed or refractory Hodgkin's lymphoma (HL). We are reporting the outcome of HDC auto-SCT and the impact of 21 prognostic factors in relapsed and refractory adolescent (14-21 years) and young adult (>21-30 years) (AYA) HL patients. We used Fine and Gray's competing risk analysis method and regression model for outcome analysis. From 1996 to 2013, 290 consecutive patients with biopsy-proven HL underwent HDC auto-SCT for relapsed/refractory HL; 216 patients (74.5 %) were AYA at the time of auto-SCT. Male/female were equal, median age at auto-SCT was 22.4 years, and there were 94 adolescent (43.5 %) and 122 young adults (56.5 %). There was refractory disease in 121 (56 %) patients, relapsed in 95 (44 %). Median follow-up was 72.6 months. The Kaplan-Meier method estimated that 5-year overall survival is 62.7 % (adolescents (63.5 %), young adults (62 %)) and event-free survival was 51.3 %. Five-year cumulative incidence of disease-specific death (DS-death) is 33 % and that of DS-event is 45 %. For DS-death, the multivariate analysis identified complete remission (CR) duration of young adults.

  7. Polymorphisms of interleukin-10 promoter are not associated with prognosis of advanced gastric cancer

    Science.gov (United States)

    Liu, Jie; Song, Bao; Wang, Jia-Lin; Li, Zeng-Jun; Li, Wan-Hu; Wang, Zhe-Hai

    2011-01-01

    AIM: To evaluate the association between of the interleukin-10 (IL-10) promoter polymorphisms and survival of advanced gastric cancer (GC) patients. METHODS: The IL-10 (-1082, rs1800896; -819, rs1800871; and-592, rs1800896) genotypes in 234 patients with advanced gastric cancer and in 243 healthy controls were determined by polymerase chain reaction-restriction fragment length polymorphism assay. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by unconditional logistic regression for the associations between IL-10 genotypes and the risk of GC. The Kaplan-Meier method with log-rank testing was used to evaluate the association between genotype and survival of the patients. RESULTS: The IL-10 -1082 G allele and GCC (-1082, -819 and -592) haplotype were associated with increased gastric cancer risks (OR 1.2, 95% CI 0.6-3.2, P = 0.007, for -1082 G allele, OR = 2.3, 95% CI, 1.2-4.1, P = 0.005, for GCC haplotype, respectively). However, none of the three IL-10 gene polymorphisms (-1082, -819 and -592) was correlated with gastric cancer survival (P > 0.05), and none of the genotypes of the three IL-10 sites was found as independent prognostic risk factors in the multivariate test. CONCLUSION: IL-10 gene promoter polymorphisms may not be associated with the prognosis of advanced gastric cancer. PMID:21455338

  8. Yttrium-90 radioembolization for the treatment of unresectable liver cancer: Results of a single center

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    Özhan Özgür

    2014-03-01

    Full Text Available Objective: To determine the effects of yttrium-90 (Y-90 resin microsphere radioembolization therapy on patients with unresectable liver cancer who do not benefit from chemotherapy. Methods: Fifty-five patients underwent radioembolization therapy included in the study whose had unresectable primary or metastatic liver cancer originating from the gastrointestinal tract. Three were excluded from the study after pre-evaluation angiography. Thirteen (23.6% of the remaining 52 patients had hepatocellular carcinoma and 39 (76.4% had metastatic liver cancer. Fifty-two patients underwent Y-90 radioembolization treatment. Each patient's response to the administered treatment was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST and the overall probability of survival was displayed graphically by the Kaplan-Meier method. Results: After Y-90 therapy, 47 patients were follow-up. While 57% of the patients responded to treatment as clinical benefit, the disease progressed in 43%. The median hepatic progression-free survival time of the patients was 3.4 months (95% confidence interval (ci:1.4-5.3 and the overall survival time was 11.3 months (95%, CI:8.7-14.03. Conclusion: This study emphasizes that Y-90 resin microsphere radioembolization treatment is effective in patients with unresectable liver cancer.

  9. Clinical Experience with First-generation Epidermal Growth Factor Receptor 
Tyrosine Kinase Inhibitors in Non-small Cell Lung Cancer Patients 
with Brain Metastasis

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    Huixing DONG

    2017-02-01

    Full Text Available Background and objective A survival analysis and the influencing factors for non-small cell lung cancer (NSCLC patients with brain metastases accepting first-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs treatment have not yet been elucidated to date. In this study, we collected and analyzed the survival data of NSCLC patients with brain metastasis to obtain evidence and to provide guidance in clinical practice. Methods NSCLC patients with brain metastases who were treated with first-generation EGFR-TKIs were retrospectively collected in 2012-2013 from Shanghai Chest Hospital, Shanghai Jiao Tong University. The Kaplan-Meier method and Cox regression were performed for univariate and multivariate analyses, respectively, to explore the independent predictors influencing the survival of patients with NSCLC brain metastases. Results The median progression-free survival (PFS and median overall survival (OS of all patients treated with first-generation EGFR-TKIs were 10.0 months (95%CI: 8.3-11.7 and 28.0 months (95%CI: 22.9-33.1, respectively. Pathological subtypes were the independent predictors of PFS (P=0.001, and tumor differentiations were the independent predictors of OS (P=0.050. Conclusion First-generation EGFR-TKIs showed promising efficacy in NSCLC patients with brain metastases. PFS was longer in patients with adenocarcinoma than in those with a non-adenocarcinoma subtype. OS was longer in patients with differentiated tumors than in those who developed poorly differentiated tumors.

  10. Polymorphisms of interleukin-10 promoter are not associated with prognosis of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jie Liu; Bao Song; Jia-Lin Wang; Zeng-Jun Li; Wan-Hu Li; Zhe-Hai Wang

    2011-01-01

    AIM: To evaluate the association between of the interleukin- 10 (IL-10) promoter polymorphisms and survival of advanced gastric cancer (GC) patients. METHODS: The IL-10 (-1082, rs1800896; -819, rs1800871; and-592, rs1800896) genotypes in 234 patients with advanced gastric cancer and in 243 healthy controls were determined by polymerase chain reactionrestriction fragment length polymorphism assay. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by unconditional logistic regression for the associations between IL-10 genotypes and the risk of GC. The Kaplan-Meier method with log-rank testing was used to evaluate the association between genotype and survival of the patients. RESULTS: The IL-10 -1082 G allele and GCC (-1082, -819 and -592) haplotype were associated with increased gastric cancer risks (OR 1.2, 95% CI 0.6-3.2, P = 0.007, for -1082 G allele, OR = 2.3, 95% CI, 1.2-4.1, P = 0.005, for GCC haplotype, respectively). However, none of the three IL-10 gene polymorphisms (-1082, -819 and -592) was correlated with gastric cancer survival (P > 0.05), and none of the genotypes of the three IL-10 sites was found as independent prognostic risk factors in the multivariate test. CONCLUSION: IL-10 gene promoter polymorphisms may not be associated with the prognosis of advanced gastric cancer.

  11. Some predictors of cardiovascular mortality among the elderly population of Botucatu (SP

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    Ruiz Tania

    2001-01-01

    Full Text Available OBJECTIVE: To detect factors associated with cardiovascular mortality in the elderly of Botucatu. METHODS: We evaluated 29 variables of interest in a cohort of patients aged ³60 using data from a survey conducted between 1983/84. The elderly cohort was analyzed in 1992 to detect the occurrence of cardiovascular deaths. Survival analysis was performed using the Kaplan-Meier method, the log-rank test, and Cox regression analysis. Three models were adapted for each group of variables, and a final model was chosen from those variables selected from each group. RESULTS: We identified predictor for cardiovascular death according to age for elderly males not supporting the family, not possessing a vehicle, and previous cardiovascular disease. In elderly females, the predictor variables were previous cardiovascular disease and diabetes mellitus. CONCLUSION: Socioeconomic indicators (family heading and vehicle ownerrship may be added to well stabilished medical factors (diabete mellitus and hypertension to select target groups for programs intended to reduce deaths due to cardiovascular diseases in elderly people.

  12. Uterine Carcinosarcoma Confined to the Pelvis: A Retrospective Review and Outcome Analysis

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    Hualei Li

    2014-01-01

    Full Text Available Objective. We compared the treatments of uterine carcinosarcoma at our institution and evaluated their impact on survival. Methods. A retrospective analysis was performed on 60 eligible patients with carcinosarcoma limited to the pelvis. Subjects were divided into four categories: surgery, surgery plus chemotherapy, surgery plus radiation therapy, and a combination of surgery, chemotherapy, and RT. The most commonly used chemotherapy was cisplatin and/or carboplatin and taxol. Radiotherapy included external beam radiation therapy (EBRT alone or with high dose rate (HDR brachytherapy or HDR brachytherapy alone. Survival probability data were computed using the Kaplan-Meier method. The differences between groups were compared using the log-rank test. Results. The combination of surgery and radiation therapy with or without chemotherapy is seen to improve overall survival (OS compared to surgery alone (P=0.044 and P=0.028, resp.. Brachytherapy involving three HDR vaginal cylinder fractions shows an equally effective reduction in local recurrence compared to EBRT. Conclusion. Our study of a relatively large number of carcinosarcoma patients suggests that adjuvant radiation therapy improves OS compared to surgery alone. Brachytherapy with 3 HDR vaginal cylinder fractions is preferred because of its time-saving, better tolerance, low toxicity and equivalent OS, and local control compared to EBRT.

  13. Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes

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    King Christopher R

    2011-01-01

    Full Text Available Abstract Purpose Hypofractionated, stereotactic body radiotherapy (SBRT is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Method and Materials Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method and RTOG toxicity outcomes were assessed. Results At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%. Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusion Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

  14. Favorable Outcomes after Implantation of Biodegradable Polymer Coated Sirolimus-Eluting Stents in Diabetic Population: Results from INDOLIMUS-G Diabetic Registry

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    Anurag Polavarapu

    2015-01-01

    Full Text Available Objective. The main aim is to evaluate safety, efficacy, and clinical performance of the Indolimus (Sahajanand Medical Technologies Pvt. Ltd., Surat, India sirolimus-eluting stent in high-risk diabetic population with complex lesions. Methods. It was a multicentre, retrospective, non-randomized, single-arm study, which enrolled 372 diabetic patients treated with Indolimus. The primary endpoint of the study was major adverse cardiac events (MACE, which is a composite of cardiac death, target lesion revascularization (TLR, target vessel revascularization (TVR, myocardial infarction (MI, and stent thrombosis (ST. The clinical follow-ups were scheduled at 30 days, 6 months, and 9 months. Results. The mean age of the enrolled patients was 53.4 ± 10.2 years. A total of 437 lesions were intervened successfully with 483 stents (1.1 ± 0.3 per lesion. There were 256 (68.8% male patients. Hypertension and totally occluded lesions were found in 202 (54.3% and 45 (10.3% patients, respectively. The incidence of MACE at 30 days, 6 months and 9 months was 0 (0%, 6 (1.6%, and 8 (2.2%, respectively. The event-free survival at 9-month follow-up by Kaplan Meier method was found to be 97.8%. Conclusion. The use of biodegradable polymer coated sirolimus-eluting stent is associated with favorable outcomes. The results demonstrated in our study depict its safety and efficacy in diabetic population.

  15. Latent cluster analysis of ALS phenotypes identifies prognostically differing groups.

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    Jeban Ganesalingam

    Full Text Available BACKGROUND: Amyotrophic lateral sclerosis (ALS is a degenerative disease predominantly affecting motor neurons and manifesting as several different phenotypes. Whether these phenotypes correspond to different underlying disease processes is unknown. We used latent cluster analysis to identify groupings of clinical variables in an objective and unbiased way to improve phenotyping for clinical and research purposes. METHODS: Latent class cluster analysis was applied to a large database consisting of 1467 records of people with ALS, using discrete variables which can be readily determined at the first clinic appointment. The model was tested for clinical relevance by survival analysis of the phenotypic groupings using the Kaplan-Meier method. RESULTS: The best model generated five distinct phenotypic classes that strongly predicted survival (p<0.0001. Eight variables were used for the latent class analysis, but a good estimate of the classification could be obtained using just two variables: site of first symptoms (bulbar or limb and time from symptom onset to diagnosis (p<0.00001. CONCLUSION: The five phenotypic classes identified using latent cluster analysis can predict prognosis. They could be used to stratify patients recruited into clinical trials and generating more homogeneous disease groups for genetic, proteomic and risk factor research.

  16. Clinical and functional outcomes of tibial intercalary allograft reconstructions

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    Lucas López Millán

    2012-12-01

    Full Text Available Background The purpose of this study was to evaluate the survival, the complications and the functional outcome of intercalary tibial allografts reconstructions following tumor resections. Methods Intercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Average follow-up was 6 years. Allograft survival was determined with the Kaplan-Meier method. Function was evaluated with the Musculoskeletal Tumor Society scoring system (MSTS. Results The rate of survival was 84% (CI 95%: 90%- 70% at 5 years and 79% at 10 years (CI 95%: 95%-63%. Allografts were removed in 5 patients (3 due to infections and 2 due to local recurrences. Two patients showed diaphyseal nonunion and 3 had an incomplete fracture, but it was not necessary to remove the allografts. Average MSTS functional score was 29 points (range 27 to 30. Conclusions Despite the incidence of complications, this analysis showed an acceptable survival with excellent functional scores. The use of intercalary allograft clearly has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal and/or metaphyseal portion of the tibia.

  17. Comparative study of laparoscopic vs open gastrectomy in gastric cancer management

    Science.gov (United States)

    Sica, Giuseppe S; Iaculli, Edoardo; Biancone, Livia; Carlo, Sara Di; Scaramuzzo, Rosa; Fiorani, Cristina; Gentileschi, Paolo; Gaspari, Achille L

    2011-01-01

    AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit. METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality. RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series. CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer. PMID:22147966

  18. Locoregional Failure in Early-Stage Breast Cancer Patients Treated With Radical Mastectomy and Adjuvant Systemic Therapy: Which Patients Benefit From Postmastectomy Irradiation?

    Energy Technology Data Exchange (ETDEWEB)

    Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Durofil, Elena [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Polesel, Jerry [Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Roncadin, Mario [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Perin, Tiziana [Department of Pathology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Mileto, Mario; Piccoli, Erica [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Quitadamo, Daniela [Scientific Direction, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Massarut, Samuele [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Carbone, Antonino [Department of Pathology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Trovo, Mauro G. [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)

    2012-06-01

    Purpose: To assess the locoregional failure in patients with Stage I-II breast cancer treated with radical mastectomy and to evaluate whether a subset of these patients might be at sufficiently high risk of locoregional recurrence (LRR) to benefit from postmastectomy irradiation (PMRT). Methods and Materials: Stage I-II breast cancer patients (n = 150) treated with radical mastectomy without adjuvant irradiation between 1999 and 2005 were analyzed. The pattern of LRR was reported. Kaplan-Meier analysis was used to calculate rates of LRR, and Cox proportional hazards methods were used to evaluate potential risk factors. Results: Median follow-up was 75 months. Mean patient age was 56 years. One-hundred forty-three (95%) patients received adjuvant systemic therapy: 85 (57%) hormonal therapy alone, 14 (9%) chemotherapy alone, and 44 (29%) both chemotherapy and hormonal therapy. Statistically significant factors associated with increased risk of LRR were premenopausal status (p = 0.004), estrogen receptor negative cancer (p = 0.02), pathologic grade 3 (p = 0.02), and lymphovascular invasion (p = 0.001). T and N stage were not associated with increased risk of regional recurrence. The 5-year LRR rate for patients with zero or one, two, three, and four risk factors was 1%, 10.3%, 24.2%, and 75%, respectively. Conclusions: A subset of patients with early-stage breast cancer is at high risk of LRR, and therefore PMRT might be beneficial.

  19. New prognostic parameters for very-low-risk gastrointestinal stromal tumors

    Institute of Scientific and Technical Information of China (English)

    WU Xian-hua; HOU Ying-yong; XU Chen; LIU Ya-lan; SHI Yuan; TAN Yun-shan; ZHU Xiong-zeng

    2011-01-01

    Background According to the National Institutes of Health consensus criteria, gastrointestinal stromal tumors (GISTs) smaller than 2 cm in diameter with less than 5 mitotic figures per 50 high-power fields are considered very-low-risk GISTs, but these two indices alone cannot reliably predict a benign outcome during long-term follow-ups. Therefore, identification of additional parameters for predicting the clinical behavior of GISTs is necessary.Methods Eighty-eight patients with tumors that meet the very-low-risk GIST criteria were retrospectively investigated and morphological parameters of tumors associated with the biological behavior of very-low-risk GISTs were evaluated in the present study. The Kaplan-Meier method was used to calculate disease-free survival rates.Results Eighty-one patients were followed up for one to 16.3 years. Five cases of relapses were identified in the patients. Distinctive infiltrative growth patterns such as muscularis propria, muscularis mucosa, or nerve infiltration were identified by microscopy in 4 patients with the relapse, including three patients who experienced multiple recurrences. The infiltrative growth features became more obvious in multiple recurrent tumors compared to the single recurrent tumor, while only one developed relapse in 76 patients without infiltration (P <0.0001).Conclusion Microscopic infiltrative growth patterns of the tumor may have clinical significance in predicting the prognosis of very-low-risk GISTs.

  20. Intraoperative Electron-Beam Radiation Therapy for Pediatric Ewing Sarcomas and Rhabdomyosarcomas: Long-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Sole, Claudio V., E-mail: csole@iram.cl [Department of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); School of Medicine, Complutense University, Madrid (Spain); Calvo, Felipe A. [School of Medicine, Complutense University, Madrid (Spain); Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Polo, Alfredo [Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid (Spain); Cambeiro, Mauricio [Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona (Spain); Gonzalez, Carmen [School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Desco, Manuel [School of Medicine, Complutense University, Madrid (Spain); Department of Experimental Surgery and Medicine, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Martinez-Monge, Rafael [Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona (Spain)

    2015-08-01

    Purpose: To assess long-term outcomes and toxicity of intraoperative electron-beam radiation therapy (IOERT) in the management of pediatric patients with Ewing sarcomas (EWS) and rhabdomyosarcomas (RMS). Methods and Materials: Seventy-one sarcoma (EWS n=37, 52%; RMS n=34, 48%) patients underwent IOERT for primary (n=46, 65%) or locally recurrent sarcomas (n=25, 35%) from May 1983 to November 2012. Local control (LC), overall survival (OS), and disease-free survival were estimated using Kaplan-Meier methods. For survival outcomes, potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model. Results: After a median follow-up of 72 months (range, 4-310 months), 10-year LC, disease-free survival, and OS was 74%, 57%, and 68%, respectively. In multivariate analysis after adjustment for other covariates, disease status (P=.04 and P=.05) and R1 margin status (P<.01 and P=.04) remained significantly associated with LC and OS. Nine patients (13%) reported severe chronic toxicity events (all grade 3). Conclusions: A multimodal IOERT-containing approach is a well-tolerated component of treatment for pediatric EWS and RMS patients, allowing reduction or substitution of external beam radiation exposure while maintaining high local control rates.

  1. Survival analysis of patients with high-grade gliomas based on data mining of imaging variables.

    Science.gov (United States)

    Zacharaki, E I; Morita, N; Bhatt, P; O'Rourke, D M; Melhem, E R; Davatzikos, C

    2012-06-01

    The prediction of prognosis in HGGs is poor in the majority of patients. Our aim was to test whether multivariate prediction models constructed by machine-learning methods provide a more accurate predictor of prognosis in HGGs than histopathologic classification. The prediction of survival was based on DTI and rCBV measurements as an adjunct to conventional imaging. The relationship of survival to 55 variables, including clinical parameters (age, sex), categoric or continuous tumor descriptors (eg, tumor location, extent of resection, multifocality, edema), and imaging characteristics in ROIs, was analyzed in a multivariate fashion by using data-mining techniques. A variable selection method was applied to identify the overall most important variables. The analysis was performed on 74 HGGs (18 anaplastic gliomas WHO grades III/IV and 56 GBMs or gliosarcomas WHO grades IV/IV). Five variables were identified as the most significant, including the extent of resection, mass effect, volume of enhancing tumor, maximum B0 intensity, and mean trace intensity in the nonenhancing/edematous region. These variables were used to construct a prediction model based on a J48 classification tree. The average classification accuracy, assessed by cross-validation, was 85.1%. Kaplan-Meier survival curves showed that the constructed prediction model classified malignant gliomas in a manner that better correlates with clinical outcome than standard histopathology. Prediction models based on data-mining algorithms can provide a more accurate predictor of prognosis in malignant gliomas than histopathologic classification alone.

  2. Prognostic Importance of Cell Cycle Regulators Cyclin D1 (CCND1) and Cyclin-Dependent Kinase Inhibitor 1B (CDKN1B/p27) in Sporadic Gastric Cancers

    Science.gov (United States)

    Minarikova, Petra; Halkova, Tereza; Belsanova, Barbora; Tuckova, Inna; Belina, Frantisek; Dusek, Ladislav; Zavoral, Miroslav

    2016-01-01

    Background. Gastric cancer is known for a notable variety in the course of the disease. Clinical factors, such as tumor stage, grade, and localization, are key in patient survival. It is expected that molecular factors such as somatic mutations and gene amplifications are also underlying tumor biological behavior and may serve as factors for prognosis estimation. Aim. The purpose of this study was to examine gene amplifications from a panel of genes to uncover potential prognostic marker candidates. Methods. A panel of gene amplifications including 71 genes was tested by multiplex ligation-dependent probe amplification (MLPA) technique in 76 gastric cancer samples from a Caucasian population. The correlation of gene amplification status with patient survival was determined by the Kaplan-Meier method. Results. The amplification of two cell cycle regulators, CCND1 and CDKN1B, was identified to have a negative prognostic role. The medial survival of patients with gastric cancer displaying amplification compared to patients without amplification was 192 versus 725 days for CCND1 (P = 0.0012) and 165 versus 611 days for CDKN1B (P = 0.0098). Conclusion. Gene amplifications of CCND1 and CDKN1B are potential candidates to serve as prognostic markers for the stratification of patients based on the estimate of survival in the management of gastric cancer patients.

  3. Predictors of recurrence in early stage oral tongue squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Chandrashekar Mani

    2015-01-01

    Full Text Available Introduction: Many histopathological parameters in oral tongue squamous cell carcinoma (OTSCC have been identified as predictive factors. Certain tumor-related factors increase the risk of nodal metastasis, and many pathological factors affect survival. Objective: The objective of this study is to identify that tumor-related histopathological prognostic factors that can predict recurrence and potentially influence the decision for adjuvant radiotherapy in early stage OTSCC. Materials and Methods: A total of 51 patients who underwent surgery for early stage OTSCC (stage I, II from 2007 to 2013 were selected. Demographic and clinical details were retrieved. Histopathological reports were reviewed for the following parameters-Margin status (close <5 mm, positive - Invasive squamous cell carcinoma [SCC], carcinoma in situ, marked dysplasia, microscopic depth of invasion, skeletal muscle infiltration (SMI, tumor differentiation, perineural invasion, lymphovascular invasion. Overall survival and recurrence-free survival (RFS were calculated using the Kaplan-Meier method. Predictors of recurrence were identified using Univariate analysis. Results: Median follow-up was 22 months (range, 5-89 months, the overall survival and RFS were 88% and 81% respectively. The recurrence rate was 19.5% during this time period. The only significant predictor of recurrence in pathologically early stage OTSCC was SMI (P = 0.003 on univariate analysis. Eighty-seven percentage of the recurrences in our study occurred within the 1 st year, with a disease specific mortality rate of 12.5%. Conclusion: In early stage OTSCC, Failure occurred predominantly in patients who had SMI.

  4. An assessment of zoonotic and production limiting pathogens in rusa deer (Cervus timorensis rusa) from Mauritius.

    Science.gov (United States)

    Jori, F; Godfroid, J; Michel, A L; Potts, A D; Jaumally, M R; Sauzier, J; Roger, M

    2014-08-01

    A population of approximately 70,000 rusa deer (Cervus timorensis russa) represents the most important mammal species reared for food on the island of Mauritius, being the main source of red meat for the local population. However, very limited information is available on the circulation of pathogens affecting the productivity and health of this species. To produce baseline data on the circulation of infectious pathogens in rusa deer under production, a serological survey and/or direct pathogen detection for six selected infectious diseases was undertaken in 2007 in a sample of 53% of the herds reared in semi-free-ranging conditions in hunting estates. Seropositive results were recorded for Johne's disease with an indirect ELISA test (1.7%, n = 351), heartwater with an immunofluorescence antibody test (IFAT) (95.5%, n = 178) and leptospirosis with a Microscopic Agglutination Test (MAT) (25.9%, n = 363). Significant associations were found between seroprevalence to some of the leptospiral serogroups detected (Tarassovi, Pomona, Sejroe and Mini) and age of the animals, animal density or location of the estates (being more prevalent in hotter and more humid areas). In addition, Mycobacterium bovis and M. avium subspecies paratuberculosis were confirmed in two deer carcasses by culture and PCR, respectively. No antibodies against Brucella spp. nor Rift Valley Fever virus were detected with the use of respective indirect ELISA's. The results obtained suggest that the population of rusa deer from Mauritius is exposed to a wide range of pathogens which may affect their productivity. In addition, the results highlight the potential public health risks incurred by deer industry workers and consumers. This survey fills an important gap in knowledge regarding the health of tropical deer meat in Mauritius and justifies the need to implement more regular surveys of selected pathogens in the deer population.

  5. Antiproton production and antideuteron production limits in relativistic heavy ion collisions

    Energy Technology Data Exchange (ETDEWEB)

    Dover, C.B. [Brookhaven National Laboratory, Upton, New York 11973 (United States); Huang, H.Z.; Van Buren, G. [University of California at Los Angeles, Los Angeles, California 90095 (United States); Barish, K.N. [University of California at Riverside, Riverside, California 92521 (United States); Fadem, B.; Hill, J.C.; Hoversten, R.; Lajoie, J.G.; Libby, B.; Wohn, F.K. [Iowa State University, Ames, Iowa 50011 (United States); Rabin, M.S. [University of Massachusetts, Amherst, Massachusetts 01003 (United States); Haridas, P.; Pless, I.A. [Massachusetts Institute of Technology, Cambridge, Massachusetts 02139 (United States); Armstrong, T.A.; Smith, G.A.; Toothacker, W.S. [Pennsylvania State University, University Park, Pennsylvania 16802 (United States); Davies, R.; Hirsch, A.S.; Porile, N.T.; Rimai, A.; Scharenberg, R.P.; Tincknell, M.L. [Purdue University, West Lafayette, Indiana 47907 (United States); Lainis, T. [United States Military Academy, West Point, New York 10996 (United States); Greene, S.V.; Miller, T.E.; Reid, J.D.; Rose, A. [Vanderbilt University, Nashville, Tennessee 37235 (United States); Bennett, S.J.; Cormier, T.M.; Fachini, P.; Li, Q.; Munhoz, M.G.; Pruneau, C.A. [Wayne State University, Detroit, Michigan 48201 (United States); Batsoulli, S.; Chikanian, A.; Coe, S.D.; Finch, L.E.; George, N.K.; Kumar, B.S.; Majka, R.D.; Nagle, J.L.; Pope, J.K.; Rotondo, F.S.; Sandweiss, J.; Slaughter, A.J.; Xu, Z. [Yale University, New Haven, Connecticut 06520 (United States)

    1999-05-01

    We present results from Experiment 864 for antiproton production and antideuteron limits in Au + Pb collisions at 11.5 GeV/c per nucleon. We have measured invariant multiplicities for antiprotons for rapidities 1.4{lt}y{lt}2.4 at low transverse momentum as a function of collision geometry. When compared with the results from Experiment 878 our measurements suggest a significant contribution to the measured antiproton yield from the decay of strange antibaryons. We have also searched for antideuterons and see no statistically significant signal. Thus, we set upper limits on the production at approximately 3{times}10{sup {minus}7} per 10{percent} highest multiplicity Au+Pb interaction. {copyright} {ital 1999} {ital The American Physical Society}

  6. Method Mixins

    DEFF Research Database (Denmark)

    Ernst, Erik

    2005-01-01

    , where traditional invocation is optimized for as-is reuse of existing behavior. Tight coupling reduces flexibility, and traditional invocation tightly couples transfer of information and transfer of control. Method mixins decouple these two kinds of transfer, thereby opening the doors for new kinds......The world of programming has been conquered by the procedure call mechanism, including object-oriented method invocation which is a procedure call in context of an object. This paper presents an alternative, method mixin invocations, that is optimized for flexible creation of composite behavior...

  7. Method Mixins

    DEFF Research Database (Denmark)

    Ernst, Erik

    2002-01-01

    invocation is optimized for as-is reuse of existing behavior. Tight coupling reduces flexibility, and traditional invocation tightly couples transfer of information and transfer of control. Method mixins decouple these two kinds of transfer, thereby opening the doors for new kinds of abstraction and reuse......The procedure call mechanism has conquered the world of programming, with object-oriented method invocation being a procedure call in context of an object. This paper presents an alternative, method mixin invocations, that is optimized for flexible creation of composite behavior, where traditional...

  8. Dosimetry methods

    DEFF Research Database (Denmark)

    McLaughlin, W.L.; Miller, A.; Kovacs, A.;

    2003-01-01

    Chemical and physical radiation dosimetry methods, used for the measurement of absorbed dose mainly during the practical use of ionizing radiation, are discussed with respect to their characteristics and fields of application.......Chemical and physical radiation dosimetry methods, used for the measurement of absorbed dose mainly during the practical use of ionizing radiation, are discussed with respect to their characteristics and fields of application....

  9. Ensemble Methods

    Science.gov (United States)

    Re, Matteo; Valentini, Giorgio

    2012-03-01

    Ensemble methods are statistical and computational learning procedures reminiscent of the human social learning behavior of seeking several opinions before making any crucial decision. The idea of combining the opinions of different "experts" to obtain an overall “ensemble” decision is rooted in our culture at least from the classical age of ancient Greece, and it has been formalized during the Enlightenment with the Condorcet Jury Theorem[45]), which proved that the judgment of a committee is superior to those of individuals, provided the individuals have reasonable competence. Ensembles are sets of learning machines that combine in some way their decisions, or their learning algorithms, or different views of data, or other specific characteristics to obtain more reliable and more accurate predictions in supervised and unsupervised learning problems [48,116]. A simple example is represented by the majority vote ensemble, by which the decisions of different learning machines are combined, and the class that receives the majority of “votes” (i.e., the class predicted by the majority of the learning machines) is the class predicted by the overall ensemble [158]. In the literature, a plethora of terms other than ensembles has been used, such as fusion, combination, aggregation, and committee, to indicate sets of learning machines that work together to solve a machine learning problem [19,40,56,66,99,108,123], but in this chapter we maintain the term ensemble in its widest meaning, in order to include the whole range of combination methods. Nowadays, ensemble methods represent one of the main current research lines in machine learning [48,116], and the interest of the research community on ensemble methods is witnessed by conferences and workshops specifically devoted to ensembles, first of all the multiple classifier systems (MCS) conference organized by Roli, Kittler, Windeatt, and other researchers of this area [14,62,85,149,173]. Several theories have been

  10. Impact of chronic obstructive pulmonary disease on patient with acute myocardial infarction undergoing primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Pei-Hsun Sung

    2013-12-01

    Full Text Available Background: This study reported the incidence and prognostic outcome of chronic obstructive lung disease (COPD patients with acute ST-segment elevation myocardial infarction (STEMI undergoing primary percutaneous coronary intervention (PCI. Methods: Between January 2002 and May 2011, totally 1554 consecutive patients who experienced STEMI undergoing primary PCI were enrolled into the study. Results: Of the 1554 patients, 124 (9.7% with diagnosis of COPD and 1430 (90.3% without COPD were categorized into group 1 and group 2. Although no difference in in-hospital mortality was noted between the two groups (p = 0.726. However, the hospitalization duration was notably longer (p = 0.003, the incidences of recurrent MI and re-hospitalization for congestive heart failure were significantly higher in group 1 than in group 2 (all p < 0.02. Although Kaplan-Meier analysis demonstrated that the incidence of freedom from one-year major adverse clinical outcome (MACO (defined as recurrent MI, re-admission for congestive heart failure was significantly lower in group 1 than group 2 (p = 0.012, multivariate Cox regression analysis showed COPD was not an independent predictor of MACO-free time after adjusting traditional risk factors. Conclusion: COPD was not an independent predictor of short-term and medium-term MACO in patients with STEMI undergoing primary PCI.

  11. The Prognostic Values of Leukocyte Rho Kinase Activity in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Cheng-I. Cheng

    2014-01-01

    Full Text Available Objective. It has been reported that leukocyte ROCK activity is elevated in patients after ischemic stroke, but it is unclear whether leukocyte ROCK activity is associated with clinical outcomes following acute stroke events. The objective of this study is to investigate if leukocyte ROCK activity can predict the outcomes in patients with acute ischemic stroke. Materials and Methods. We enrolled 110 patients of acute ischemic stroke and measured the leukocyte ROCK activity and plasma level of inflammatory cytokines to correlate the clinical outcomes of these patients. Results. The leukocyte ROCK activity at 48 hours after admission in acute ischemic stroke patients was higher as compared to a risk-matched population. The leukocyte ROCK activity significantly correlated with National Institute of Health Stroke Scale (NIHSS difference between admission and 90 days after stroke event. Kaplan-Meier survival estimates showed lower stroke-free survival during follow-up period in patients with high leukocyte ROCK activity or plasma hsCRP level. Leukocyte ROCK activity independently predicted the recurrent stroke in patients with atherosclerotic stroke. Conclusions. This study shows elevated leukocyte ROCK activity in patients with ischemic stroke as compared to risk-matched subjects and is an independent predictor for recurrent stroke.

  12. Limited survival in patients with carcinomatosis from foregut malignancies after cytoreduction and continuous hyperthermic peritoneal perfusion.

    Science.gov (United States)

    Farma, Jeffrey M; Pingpank, James F; Libutti, Steven K; Bartlett, David L; Ohl, Susan; Beresneva, Tatiana; Alexander, H Richard

    2005-12-01

    Peritoneal carcinomatosis is a frequent mode of metastasis in patients with gastric, duodenal, or pancreatic cancer. Survival in this setting is short and therapeutic options are limited. This analysis examines the outcomes of 18 patients treated with operative cytoreduction and continuous hyperthermic peritoneal perfusion. Eighteen patients (6 males and 12 females) with gastric (n = 9), pancreatic (n = 7), or duodenal (n = 2) cancer were treated on protocol. Patients underwent optimal cytoreduction (complete gross resection, 11; minimal residual disease, 7) and a 90-minute perfusion with cisplatin. Clinical parameters and tumor and treatment characteristics were analyzed. Survival curves were estimated using the Kaplan-Meier method. Procedures included gastrectomy (n = 8), pancreaticoduodenectomy (n = 3), and hemicolectomy (n = 2). After cytoreduction, patients had no evidence of residual disease (n = 11), fewer than 100 implants less than 5 mm (n = 1), more than 100 implants between 5-10 mm (n = 3), or multiple implants with greater than 1 cm (n = 3). Five patients received a postoperative intraperitoneal dwell with 5-fluorouracil and paclitaxel. There was one perioperative mortality, and complications occurred in 10 patients. The median progression-free survival was 8 months (mean, 10 months; range, 1-47 months) with a median overall survival of 8 months (mean, 18 months; range, 1-74 months). In this cohort, peritoneal perfusion with cisplatin used to treat foregut malignancies has a high incidence of complications and does not significantly alter the natural history of the disease. Investigation of novel therapeutic approaches should be considered.

  13. High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-01-01

    Full Text Available Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon’s rank-sum or χ2 test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p<0.05. Median oncologic follow-up was 83 months (13–123 months in the HIFU cohort and 44 months (13–89 months in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p<0.05. No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.

  14. [Survival of the T28 femoral stem. Comparison of polished versus roughed-surface finish].

    Science.gov (United States)

    Chaidez Rosales, Pedro; Younger, Alastair; Renán León, Saúl; Poss, Robert

    2008-01-01

    Femoral stem loosening in total hip arthroplasty has a multifactorial etiology. T28 femoral stems have been made both roughed and polished-finish types, and differences in design are of interest in their effect on survival. One hundred and sixty-seven stems (84 polished and 83 roughed-finish) placed between 1975 and 1982 were evaluated. Gruen zones were used to determine loosening and survival was determined by the Kaplan-Meier method. Revision was made in 24.8% of the cases. Twenty-year survival rates were of 85.2% for roughed-finish stems and of 64.2% for polished-finish stems. We were able to confirm our hypothesis concerning the longer survival rate of the roughed-finish implant which was of 87.95% at 17 years of follow-up. The survival-time of the implant was independent of diagnosis, cementation, age and positioning. The survival-time of the T28 cemented implant does not only depend on its texture but it has a multifactorial origin.

  15. Clinical Efficiency of Two Sequences of Orthodontic Wires to Correct Crowding of the Lower Anterior Teeth

    Directory of Open Access Journals (Sweden)

    Cláudia Maria de Castro Serafim

    2015-01-01

    Full Text Available This study compared time to correction of mandibular anterior crowding using two arch wire sequences, one with conventional nickel-titanium (NiTi arch wires and the other with conventional and NiTi heat-activated arch wires. Twenty-two boys and girls (mean age: 16.68 ± 2.66 with moderate crowding (3–6 mm were assigned randomly to one of two groups and followed up for five months (six assessments when arch wires were changed. Time to crowding correction was analyzed statistically using the Kaplan-Meier method. Data were collected during the five-month follow-up, and time to correction was compared between groups using the log rank test. At the end of follow-up, mandibular crowding was corrected in 100% of the cases in the group treated with the sequence that included NiTi heat-activated arch wires, whereas about 30% of those treated with NiTi arch wires were not completely corrected. There was a significant difference in time to complete treatment between groups (log rank = 5.996; p<0.05. In the group treated with the sequence that included heat-activated wires, alignment and leveling of mandibular anterior teeth were completed earlier than in the group treated only with conventional NiTi arch wires. Clinical trial registration is found at RBR-7g5zng.

  16. On What Day of Illness Does the Dilatation of Coronary Arteries in Patients With Kawasaki Disease Begin?

    Science.gov (United States)

    Fuse, Shigeto; Mori, Toshihiko; Kuroiwa, Yuki; Hirakawa, Satoshi

    2017-08-25

    In the present study we used echocardiography to investigate coronary artery diameter at the time of diagnosis of Kawasaki disease (KD), before the start of treatment.Methods and Results:Diameters of the right, left main, left anterior descending, and left circumflex coronary arteries were determined in 410 patients before KD treatment commenced. The maximum Z-score was considered to be the pretreatment, maximum coronary artery Z-score (preZmax). The cumulative probability of coronary arterial dilatation was analyzed using the Kaplan-Meier method. In the present study, 31 patients (7.6%) had a preZmax ≥3.0, 56 (13.7%) had a preZmax ≥2.5, and 96 (23.4%) had a preZmax ≥2.0. The cumulative probability of a preZmax ≥2.0 was >20% on Day 5 of illness, 40% on Day 7, and 70% on Day 10. The positive predictive value (PPV) of a preZmax of 2.0 was approximately 0.9 on Day 5 of illness. The present study demonstrates that the coronary arteries may dilate before Day 5 of illness, and that the rate of dilatation increases gradually until Day 10. Because preZmax 2.0 has high PPV after Day 5 of illness, it is a useful marker of coronary artery dilatation in the early phase of KD.

  17. HIF1-alpha overexpression indicates a good prognosis in early stage squamous cell carcinomas of the oral floor

    Directory of Open Access Journals (Sweden)

    Joos Ulrich

    2005-07-01

    Full Text Available Abstract Background Hypoxia-inducible factor 1 (HIF-1 is a transcription factor, which plays a central role in biologic processes under hypoxic conditions, especially concerning tumour angiogenesis. HIF-1α is the relevant, oxygen-dependent subunit and its overexpression has been associated with a poor prognosis in a variety of malignant tumours. Therefore, HIF-1α expression in early stage oral carcinomas was evaluated in relation to established clinico-pathological features in order to determine its value as a prognostic marker. Methods 85 patients with histologically proven surgically treated T1/2 squamous cell carcinoma (SCC of the oral floor were eligible for the study. Tumor specimens were investigated by means of tissue micro arrays (TMAs and immunohistochemistry for the expression of HIF-1. Correlations between clinical features and the expression of HIF-1 were evaluated by Kaplan-Meier curves, log-rank tests and multivariate Cox regression analysis. Results HIF-1α was frequently overexpressed in a probably non-hypoxia related fashion. The expression of HIF-1α was related with a significantly improved 5-year survival rate (p Conclusion HIF-1α overexpression is an indicator of favourable prognosis in T1 and T2 SCC of the oral floor. Node negative patients lacking HIF-1α expression may therefore be considered for adjuvant radiotherapy.

  18. Opposite association of serum prolactin and survival in patients with colon and rectal carcinomas: influence of preoperative radiotherapy.

    Science.gov (United States)

    Barrera, Marcos Gutiéerrez De La; Trejo, Belem; Luna-Péerez, Pedro; López-Barrera, Fernándo; Escalera, Gonzalo Martínez De La; Clapp, Carmen

    2006-01-01

    Prolactin (PRL) is a pleiotropic hormone associated with the progression of various cancers, including colorectal cancer (CRC). Here we investigate whether the association of serum PRL concentration and survival is affected by tumor location and preoperative radiotherapy (PRERT) in patients with CRC cancer. Serum PRL was determined in 82 CRC patients without previous treatment. Patients with PRL concentrations at and above the 75th percentile (high PRL) or below this level (low PRL), had a significant correlation with overall survival determined using the Kaplan-Meier method. In colon cancer, there was an increased risk of mortality when PRL values were at and above the highest quartile (22% vs. 73%; P = 0.01). In contrast, in rectal cancer, high PRL values were associated with a significant overall survival advantage (88% vs. 44%; P = 0.05), which became more significant (100% vs. 34%; P = 0.005) when only rectal cancer patients receiving PRERT were compared. These findings suggest that tumor location and adjuvant radiotherapy influence the association between circulating PRL and survival in CRC.

  19. LAPTM4B allele *2 is a marker of poor prognosis following hepatic tumor resection for hepatocellular carcinoma.

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    Hua Yang

    Full Text Available BACKGROUND: Lysosomal protein transmembrane 4 beta (LAPTM4B is a gene related to hepatocellular carcinoma that has two alleles designated LAPTM4B*1 and LAPTM4B*2. This study aimed to investigate the correlation of LAPTM4B genotype with prognosis and clinicopathologic features in patients who have undergone resection for hepatocellular carcinoma (HCC. METHODOLOGY/PRINCIPAL FINDINGS: The LAPTM4B genotype was analyzed by PCR in 68 patients who had undergone curative hepatic resection for hepatocellular carcinoma. The correlation of LAPTM4B genotype with clinicopathologic parameters was assessed with the Chi-squared test. Differences in patient survival were determined by the Kaplan-Meier method. Multivariate analysis of prognostic factors was carried out with Cox regression analysis. Patients with LAPTM4B *2 had both significantly shorter overall survival (OS and shorter disease-free survival (DFS (both P<0.001. Multivariate analysis showed that LAPTM4B genotype is an independent prognostic factor for OS and DFS (both P<0.001. CONCLUSIONS/SIGNIFICANCE: Allele *2 of LAPTM4B is a risk factor associated with poor prognosis in patients with resected HCC. LAPTM4B status may be useful preoperatively as an adjunct in evaluation of the operability of HCC.

  20. Satistical Graphical User Interface Plug-In for Survival Analysis in R Statistical and Graphics Language and Environment

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    Daniel C. LEUCUŢA

    2008-12-01

    Full Text Available Introduction: R is a statistical and graphics language and environment. Although it is extensively used in command line, graphical user interfaces exist to ease the accommodation with it for new users. Rcmdr is an R package providing a basic-statistics graphical user interface to R. Survival analysis interface is not provided by Rcmdr. The AIM of this paper was to create a plug-in for Rcmdr to provide survival analysis user interface for some basic R survival analysis functions.Materials and Methods: The Rcmdr plug-in code was written in Tinn-R. The plug-in package was tested and built with Rtools. The plug-in was installed and tested in R with Rcmdr package on a Windows XP workstation with the "aml" and "kidney" data sets from survival R package.Results: The Rcmdr survival analysis plug-in was successfully built and it provides the functionality it was designed to offer: interface for Kaplan Meier and log log survival graph, interface for the log-rank test, interface to create a Cox proportional hazard regression model, interface commands to test and assess graphically the proportional hazard assumption, and influence observations. Conclusion: Rcmdr and R though their flexible and well planed structure, offer an easy way to expand their functionality that was used here to make the statistical environment more user friendly in respect with survival analysis.

  1. Characteristics and Fate of Systemic Artery Aneurysm after Kawasaki Disease.

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    Hoshino, Shinsuke; Tsuda, Etsuko; Yamada, Osamu

    2015-07-01

    To determine the long-term outcome of systemic artery aneurysms (SAAs) after Kawasaki disease (KD). We investigated the characteristics and the fate of SAAs in 20 patients using medical records and angiograms. The age of onset of KD ranged from 1 month to 20 months. The interval from the onset of KD to the latest angiogram ranged from 16 months to 24 years. The regression rate of peripheral artery aneurysm and the frequency of stenotic lesions were analyzed by the Kaplan-Meier method in 11 patients who had undergone initial angiography within 4 months. The mean duration of fever was 24 ± 12 days. All 20 patients had at least 1 symmetric pair of aneurysms in bilateral peripheral arteries, and 16 patients had multiple SAAs. The distributions of SAAs was as follows: brachial artery, 30; common iliac artery, 20; internal iliac artery, 21; abdominal aortic aneurysm, 7; and others, 29. The frequencies of regression of SAA and of the occurrence of stenotic lesions at 20 years after the onset of KD were 51% and 25%, respectively (n = 42). The diameter of all SAAs in the acute phase leading to stenotic lesions in the late period was >10 mm. SAAs occurred symmetrically and were multiple in younger infants and those with severe acute vasculitis. The fate of SAAs resembles that of coronary artery aneurysms, and depends on the diameter during the acute phase. Larger SAAs can lead to stenotic lesions in the late period. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Retrospective cohort of trisomy 18 (Edwards syndrome in southern Brazil

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    Daniela Denardin

    Full Text Available CONTEXT AND OBJECTIVE:Trisomy 18 (T18, or Edwards syndrome, is a chromosomal disease characterized by a broad clinical picture and a poor prognosis. Our aim was to describe clinical, radiological and survival data of a cohort of patients prenatally diagnosed with T18.DESIGN AND SETTING:Retrospective single cohort in the Fetal Medicine Service of Hospital Materno Infantil Presidente Vargas (HMIPV.METHODS:All sequential patients with T18 registered at the Fetal Medicine Service of HMIPV between January 2005 and September 2013 were considered. We gathered their clinical, radiological and survival data and used the Kaplan-Meier test for survival analysis.RESULTS:Ten patients were diagnosed with T18, of whom seven (70% were female. The majority (90% were referred due to malformations seen on ultrasound. The mean gestational age at the first evaluation was 25.5 weeks. At karyotyping, the defects were considered multiple in only four patients (40%. All the fetuses presented full trisomy of chromosome 18. The main abnormality observed was congenital heart disease (n = 7. Intrauterine death occurred in half of the patients (50%. All live patients (n = 5 were born through cesarean section presenting low weight and low Apgar scores. The median length of survival after birth was 18 days.CONCLUSIONS:T18 is associated with a high risk of fetal and neonatal death. The majority of the patients present major malformations identified through ultrasound, such as congenital heart defects, which could help in identifying such cases prenatally.

  3. Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study

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    Natália Maria da Silva Fernandes

    2013-01-01

    Full Text Available OBJECTIVES: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients. PATIENTS AND METHODS: Patients (n = 1911 older than 18 years of age recruited from 114 dialysis centers (Dec/ 2004-Oct/2007 and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died. RESULTS: Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female. The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index 30 kg/m². Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: +7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles. CONCLUSION: These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil.

  4. Marriage and divorce of immigrants and descendants of immigrants in Sweden

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    Gunnar Andersson

    2015-07-01

    Full Text Available Background: Immigrants and their second-generation descendants make up more than a quarter of the current Swedish population. Their nuptiality patterns can be viewed as crucial indicators of their integration into Swedish society. Objective: This study provides data on levels of and patterns in marriage formation, divorce, and re-marriage of people in Sweden, by country of origin. Methods: The study is based on analyses of longitudinal register data that cover all residents born in 1951 and later who ever lived in Sweden during 1983−2007. Kaplan-Meier survivor functions demonstrate levels in nuptiality; multivariate event-history analyses demonstrate relative risks of marriage formation and divorce, by country group of origin. Results: We find evidence of variation among immigrant groups and between migrants and Swedish-born people in marriage and divorce patterns. A few groups of migrants have relatively high churning rates in family dynamics, with high levels of marriage formation, divorce, and re-marriage. Conclusions: Many factors relate to the nuptiality behavior of immigrants in Sweden. Differences in family systems seem to have some influence on behavior in the contemporary Swedish context. Other factors relate to the migration process itself and to the selectivity of migrants to Sweden.

  5. A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory events following removal of unerupted mandibular third molars.

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    Costa, F W G; Soares, E C S; Esses, D F S; Silva, P G deB; Bezerra, T P; Scarparo, H C; Ribeiro, T R; Fonteles, C S R

    2015-09-01

    Pain after third molar extraction has been considered the most suitable pharmaceutical model to evaluate acute pain. This study aimed to evaluate the pre-emptive analgesic/anti-inflammatory efficacy of etoricoxib 120 mg following mandibular third molar surgery. A split-mouth, randomized, triple-blind, placebo-controlled study was conducted with patients undergoing the surgical removal of mandibular third molars. All volunteers were allocated randomly to receive either etoricoxib 120 mg or placebo 1h preoperatively, and inflammatory events were evaluated. An estimated sample of 18 surgical units per group was required based on a pilot study (95% confidence level and 80% statistical power). Rescue medication was analyzed by Kaplan-Meier method through log-rank Mantel-Cox test and Pearson linear correlation (Pplacebo (Pplacebo group over the study period (P<0.05). There was no statistically significant difference between groups related to swelling and trismus. The pre-emptive administration of etoricoxib 120 mg significantly reduced the postoperative pain intensity and the need for rescue medication, but did not reduce swelling or trismus.

  6. Prognostic factors and epidemiological characteristics of cutaneous and mucosal head and neck melanoma.

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    Berzina, Anna; Azarjana, Kristine; Cema, Ingrida; Pjanova, Dace; Rivosh, Alexander

    2011-01-01

    OBJECTIVE. To describe the prognostic factors and epidemiological characteristics of cutaneous and mucosal head and neck melanoma and to identify the variables associated with mortality from this disease. MATERIAL AND METHODS. Patients treated for head and neck melanoma in the Oncology Centre of Latvia, Riga during a 10-year period were identified. Records from 124 cases were analyzed in a descriptive, retrospective study. For each patient, information regarding age, sex, tumor anatomic site, as well as ulceration, histological tumor subtypes, Breslow thickness and Clark invasion level was viewed. Disease specific survival rates were calculated. The frequencies of all study variables and their 95% confidence intervals were determined. Kaplan-Meier survival curves were produced to illustrate the survival differences for each variable. RESULTS. The patients' mean age was 67.36 years. The study included 81 females (65.32%) and 43 males (34.67%). The prevalent anatomical site for cutaneous head and neck melanoma was the cheek - 49% (n=55) and the intraocular site for mucosal melanoma (61.5%). A high percentage of thick cutaneous melanoma was detected. In 53 cases (47.3%) out of 112 cutaneous melanoma the tumor ulceration was found. Nodular melanoma subtype was predominating (38%). The incidence of cutaneous melanoma has increased unequally whereas mucosal melanoma of the head and neck is an uncommon cancer and the incidence rates in Latvia during a ten year period are decreasing. CONCLUSION. Female sex, advanced age, facial skin, tumor thickness, nodular subtype and ulceration carried a relevant risk of poor prognosis.

  7. Predictors of post-recurrence survival in patients with non-small-cell lung cancer initially completely resected.

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    Takahashi, Yusuke; Horio, Hirotoshi; Hato, Tai; Harada, Masahiko; Matsutani, Noriyuki; Kawamura, Masafumi

    2015-07-01

    Despite recent progress in diagnostic technology and therapeutic approaches to non-small-cell lung cancer (NSCLC), 30-75% of patients develop tumour recurrence after resection. However, the details of post-recurrence survival (PRS) are not well understood. We aimed to investigate the predictors of PRS in patients with NSCLC initially completely resected. A series of 568 NSCLC patients who had undergone complete resection between 2000 and 2009 were evaluated retrospectively. Patients who had developed recurrent NSCLC after complete resection were subjected to the current analysis. We examined PRS using the Kaplan-Meier method and multivariate Cox regression analyses. Of the 568 patients, 138 (24.3%) were identified as having disease recurrence. The 2-year and 5-year PRS rates were 44.6 and 25.9%, respectively, while the median PRS time was 22.5 months. Non-adenocarcinoma histology [hazard ratio (HR) = 2.825, 95% confidence interval (CI): 1.825-4.367, P recurrence ≥5.0 mg/dl (HR = 2.205, 95% CI: 1.453-3.344, P recurrence and no systemic chemotherapy were independent unfavourable post-recurrence prognostic factors. The current data can be informative for patient follow-up after complete resection and further clinical investigation may give us more information about PRS and accurate treatment strategy for recurrent NSCLC after initial complete resection. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Incidence and Prognostic Significance of Proteinuria in Patients with Gastric Carcinoma

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    Jianshe Liu; Xuebin Wang

    2005-01-01

    OBJECTIVE The present study was designed to evaluate the epidemiological and prognostic significance of proteinuria in patients with gastric cancer (GC).METHODS We retrospectively reviewed the frequency of proteinuria in patients with GC and analyzed its relationship with the GC biological characteristics, treatment and survival.RESULTS Proteinuria incidence in GC patients was 24.06%, which was significantly higher than that found in a control group (P<0.01); the frequency of proteinuria was significantly correlated with an advanced disease stage(P<0.01). We also found that the post-treatment mean value of proteinuria was remarkably lower than the pre-treatment value (P<0.001). KaplanMeier analysis revealed a significant correlation between proteinuria and survival of GC patients (P<0.05). Multivariate analysis demonstrated that the TNM stage, lymph node status and proteinuria may serve as independent prognostic markers in patients with GC (P <0.01).CONCLUSION A high prevalence of increased urinary protein excretion was observed in GC patients complicated with nephritis. Proteinuria may be used as one of the prognostic markers for patients with GC.

  9. Survival analysis of mandibular complete dentures with acrylic-based resilient liners.

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    Kimoto, Suguru; Kimoto, Katsuhiko; Murakami, Hiroshi; Gunji, Atsuko; Ito, Nana; Kawai, Yasuhiko

    2013-09-01

    The purpose of this long-term randomised controlled trial was to compare the longevity of dentures constructed using a conventional acrylic resin (CAR) to that of dentures constructed using an acrylic-based resilient liner (ARL). The follow-up study was essentially carried out by annual telephone calls to each of the 67 participants. The Kaplan-Meier method and life-table analysis were used for univariate analyses. The Cox proportional-hazards test was used as a final model for statistically adjusting predictor variables such as sex, clinician type, mandibular denture type and age at denture delivery. The denture type was likely to affect the survival time of the dentures, while the sex and clinician type were not. The group using acrylic-based resilient denture liners had twice the risk of having shorter denture-survival times than those using conventional acrylic resin dentures. Younger participants were likely to have a reduced risk of having shorter denture-survival times than older participants. We conclude that mandibular complete dentures constructed using ARL are twice as likely as dentures constructed using CAR to have shorter denture survival times, mainly because of material deterioration. © 2012 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  10. Survival of living donor renal transplant recipients in Sri Lanka: a single-center study.

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    Galabada, Dinith Prasanna; Nazar, Abdul L M; Ariyaratne, Prasad

    2014-11-01

    Chronic kidney disease is one of the main public health concerns in Sri Lanka. In comparison with dialysis, successful kidney transplantation improves both patient survival and quality of life, relieves the burden of dialysis in patients suffering from end-stage renal disease and decreases the cost of healthcare to the society and government. The objective of this retrospective cohort study was to evaluate graft and patient survival rates in patients who were transplanted from living donors at the Nephrology Unit of the National Hospital of Sri Lanka from January 2005 to January 2011. Data were collected using an interviewer-administered questionnaire and through a review of past medical records. The Kaplan-Meier method was used to determine the survival rate, the log rank test was used to compare survival curves and the Cox proportional hazard model was used for multivariate analysis. Mean follow-up was 26.44±16.6 months. The five-year death-censored graft survival of kidney transplant recipients from living donors in our center was 93.5% and the five-year patient survival was 82.2%, which is comparable with other transplant programs around the world. The number of acute rejection episodes was an independent risk factor for graft survival. Delayed graft function, younger recipient age and unknown cause of end-stage renal disease were found to be risk factors for graft failure but after adjusting for confounding factors, and the difference was not apparent.

  11. Survival of living donor renal transplant recipients in Sri Lanka: A single-center study

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    Dinith Prasanna Galabada

    2014-01-01

    Full Text Available Chronic kidney disease is one of the main public health concerns in Sri Lanka. In comparison with dialysis, successful kidney transplantation improves both patient survival and quality of life, relieves the burden of dialysis in patients suffering from end-stage renal disease and decreases the cost of healthcare to the society and government. The objective of this retrospective cohort study was to evaluate graft and patient survival rates in patients who were transplanted from living donors at the Nephrology Unit of the National Hospital of Sri Lanka from January 2005 to January 2011. Data were collected using an interviewer-administered questionnaire and through a review of past medical records. The Kaplan-Meier method was used to determine the survival rate, the log rank test was used to compare survival curves and the Cox proportional hazard model was used for multivariate analysis. Mean follow-up was 26.44 ± 16.6 months. The five-year death-censored graft survival of kidney transplant recipients from living donors in our center was 93.5% and the five-year patient survival was 82.2%, which is comparable with other transplant programs around the world. The number of acute rejection episodes was an independent risk factor for graft survival. Delayed graft function, younger recipient age and unknown cause of end-stage renal disease were found to be risk factors for graft failure but after adjusting for confounding factors, and the difference was not apparent.

  12. Clinical and evolving features of women diagnosed with precancerous cervical lesions, screened and treated in the Amazon region of Brazil

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    Patricia Rezende do Prado

    2014-09-01

    Full Text Available The objective of the study was to determine the dynamics of precancerous lesions in women of a cohort treated for cervical intraepithelial neoplasia (CIN and followed up over the next two years. The conditional probability of failure was calculated using the Kaplan-Meier method, and the raw and adjusted hazard ratios (HR were determined using Cox regression with a p-value entry of < 0.05. Of the 237 women who were treated, 51.5% were accompanied over 24 months, and treatment failed for 21.9% of those accompanied. Women who had five or more pregnancies (adjusted HR = 3.10, 95%CI: 1.28-7.51 or an initial histological diagnosis of CIN II/III demonstrated an independent risk of treatment failure (adjusted HR = 3.14, 95%CI: 1.20-8.19. Being in a stable relationship was a protective factor against treatment failure (adjusted HR = 0.47, 95%CI: 0.24-0.89. A history of more frequent pregnancies and a histological diagnosis of CIN II/III are directly correlated with risk of CIN treatment failure, whereas being in a stable relationship is inversely correlated with this risk.

  13. Hepatic stiffness measurement by using MR elastography: prognostic values after hepatic resection for hepatocellular carcinoma

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    Lee, Dong Ho [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Lee, Jeong Min; Han, Joon Koo [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of); Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk [Seoul National University Hospital, Department of Surgery, Seoul (Korea, Republic of); Lee, Jeong-Hoon [Seoul National University Hospital, Department of Internal Medicine, Seoul (Korea, Republic of); Lee, Kyung Bun [Seoul National University Hospital, Department of Pathology, Seoul (Korea, Republic of)

    2017-04-15

    To evaluate prognostic value of hepatic stiffness (HS) measurement using MR elastography (MRE) in patients with hepatocellular carcinoma (HCC) treated by hepatic resection (HR). We enrolled 144 patients with Barcelona Clinic Liver Cancer stage A HCCs initially treated by HR who underwent preoperative liver MRE between January 2010 and June 2013. HS values were measured using MRE. Receiver operating characteristics (ROC) and multivariate logistic regression analyses were used to determine significant predictive factors for posthepatecomy liver failure (PHLF). Overall survival (OS) was analyzed by evaluating prognostic factors using the Kaplan-Meier method and Cox proportional hazard regression model. After HR, 43 patients (29.9 %) experienced PHLF. HS values were significant predictive factors for PHLF. In ROC analysis, the area under the curve of HS was 0.740 (P = 0.001) for PHLF. Thirty-one patients had HS values ≥ 4.02 kPa; the estimated 1, 3, 5-year survival were 90.0 %, 74.7 % and 65.4 %, respectively, versus 98.1 %, 96.5 % and 96.5 % in 113 patients with HS values < 4.02 kPa (P = 0.015). An HS value ≥ 4.02 kPa was the only significant affecting factor for OS. HS values measured by MRE could predict PHLF development post-HR. Furthermore, an HS value ≥4.02 kPa was a significant predicting factor for poor OS post-HR. (orig.)

  14. Molecular genetics analysis of hereditary breast and ovarian cancer patients in India

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    Soumittra Nagasamy

    2009-08-01

    Full Text Available Abstract Background Hereditary cancers account for 5–10% of cancers. In this study BRCA1, BRCA2 and CHEK2*(1100delC were analyzed for mutations in 91 HBOC/HBC/HOC families and early onset breast and early onset ovarian cancer cases. Methods PCR-DHPLC was used for mutation screening followed by DNA sequencing for identification and confirmation of mutations. Kaplan-Meier survival probabilities were computed for five-year survival data on Breast and Ovarian cancer cases separately, and differences were tested using the Log-rank test. Results Fifteen (16% pathogenic mutations (12 in BRCA1 and 3 in BRCA2, of which six were novel BRCA1 mutations were identified. None of the cases showed CHEK2*1100delC mutation. Many reported polymorphisms in the exonic and intronic regions of BRCA1 and BRCA2 were also seen. The mutation status and the polymorphisms were analyzed for association with the clinico-pathological features like age, stage, grade, histology, disease status, survival (overall and disease free and with prognostic molecular markers (ER, PR, c-erbB2 and p53. Conclusion The stage of the disease at diagnosis was the only statistically significant (p

  15. Effect of Fiber Layers on the Fracture Resistance of Fiber Reinforced Composite Bridges

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    A Fazel

    2011-08-01

    Full Text Available Introduction: The purpose of this in vitro study was to introduce the fiber reinforced composite bridges and evaluate the most suitable site and position for placement of fibers in order to get maximum strength. Methods: The study included 20 second premolars and 20 second molars selected for fabricating twenty fiber reinforced composite bridges. Twenty specimens were selected for one fiber layer and the remaining teeth for two fiber layers. In the first group, fibers were placed in the inferior third and in the second group, fibers were placed in both the middle and inferior third region. After tooth preparation, the restorations were fabricated, thermocycled and then loaded with universal testing machine in the middle of the pontics with crosshead speed of 1mm/min. Data was analyzed by Kolmogorov-Smirnov test, Independent sample t test and Kaplan-Meier test. Mode of failure was evaluated using stereomicroscope. Results: Mean fracture resistance for the first and second groups was 1416±467N and 1349±397N, respectively. No significant differences were observed between the groups (P>0.05.In the first group, 5 specimens had delamintation and 5 specimens had detachment between fibers and resin composite. In the second group, there were 4 and 6 delaminations and detachments, respectively. There was no fracture within the fiber. Conclusion: In the fiber reinforced fixed partial dentures, fibers reinforce the tensile side of the connectors but placement of additional fibers at other sites does not increase the fracture resistance of the restoration.

  16. The prognosis outcome of oral squamous cell carcinoma using HIF-2α.

    Science.gov (United States)

    Lim, Elva; Kuo, Chia-Chun; Tu, Hsi-Feng; Yang, Cheng-Chieh

    2017-07-06

    Hypoxia-induced factors (HIF) has a role in angiogenesis and regulate tumorigenesis of cancer cell. The HIF is the best-identified mechanism that shows imbalance between consumption and oxygen supply in progressing tumor. This study of HIF-2α expression in oral squamous cell carcinoma (OSCC) aimed to investigate the relationship of HIF-2α and pathology characteristics related to its clinical correlation. Fifty-eight samples of OSCC and adjacent tissues were fixed in paraffin for microarray preparation. The tissue array then was stained using primary antibody HIF-2α (NB100-122) and autoprobe II ABC universal staining kit. Each tissue sample was captured using camera microscope, and images were analyzed with Photoshop 6.0 using the CMYK method. A statistical analysis was performed with the two-tailed t-test, Kaplan-Meier and log-rank test using Prism for Windows version 5.0. The samples of the non-cancerous matched tissues (NCMTs) paired with their OSCC samples showed HIF-2α overexpression with significance difference p serve as a good biomarker for cancer status for all tumor stages and may predict an early recurrence within two years. Copyright © 2017. Published by Elsevier Taiwan LLC.

  17. Diffusion-weighted magnetic resonance imaging predicts survival in patients with liver-predominant metastatic colorectal cancer shortly after selective internal radiation therapy

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    Schmeel, Frederic Carsten; Simon, Birgit; Luetkens, Julian Alexander; Traeber, Frank; Schmeel, Leonard Christopher; Schild, Hans Heinz; Hadizadeh, Dariusch Reza [University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universitaet Bonn, Department of Radiology, Bonn (Germany); Sabet, Amir [University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universitaet Bonn, Department of Nuclear Medicine, Bonn (Germany); University Hospital Essen, Universitaet Duisburg-Essen, Department of Nuclear Medicine, Essen (Germany); Ezziddin, Samer [University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universitaet Bonn, Department of Nuclear Medicine, Bonn (Germany); University Hospital Saarland, Universitaet des Saarlandes, Department of Nuclear Medicine, Homburg (Germany)

    2017-03-15

    To investigate whether quantifications of apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) can predict overall survival (OS) in patients with liver-predominant metastatic colorectal cancer (CRC) following selective internal radiation therapy with {sup 90}Yttrium-microspheres (SIRT). Forty-four patients underwent DWI 19 ± 16 days before and 36 ± 10 days after SIRT. Tumour-size and intratumoral minimal ADC (minADC) values were measured for 132 liver metastases on baseline and follow-up DWI. Optimal functional imaging response to treatment was determined by receiver operating characteristics and defined as ≥22 % increase in post-therapeutic minADC. Survival analysis was performed with the Kaplan-Meier method and Cox-regression comparing various variables with potential impact on OS. Median OS was 8 months. The following parameters were significantly associated with median OS: optimal functional imaging response (18 vs. 5 months; p < 0.001), hepatic tumour burden <50 % (8 vs. 5 months; p = 0.018), Eastern Cooperative Oncology Group performance scale <1 (10 vs. 4 months; p = 0.012) and progressive disease according to Response and Evaluation Criteria in Solid Tumours (8 vs. 3 months; p = 0.001). On multivariate analysis, optimal functional imaging response and hepatic tumour burden remained independent predictors of OS. Functional imaging response assessment using minADC changes on DWI may predict survival in CRC shortly after SIRT. (orig.)

  18. Geographical variation in cardiovascular incidence: results from the British Women's Heart and Health Study

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    Ebrahim Shah

    2010-11-01

    Full Text Available Abstract Background Prevalence of cardiovascular disease (CVD in women shows regional variations not explained by common risk factors. Analysis of CVD incidence will provide insight into whether there is further divergence between regions with increasing age. Methods Seven-year follow-up data on 2685 women aged 59-80 (mean 69 at baseline from 23 towns in the UK were available from the British Women's Heart and Health Study. Time to fatal or non-fatal CVD was analyzed using Cox regression with adjustment for risk factors, using multiple imputation for missing values. Results Compared to South England, CVD incidence is similar in North England (HR 1.05 (95% CI 0.84, 1.31 and Scotland (0.93 (0.68, 1.27, but lower in Midlands/Wales (0.85 (0.64, 1.12. Event severity influenced regional variation, with South England showing lower fatal incident CVD than other regions, but higher non-fatal incident CVD. Kaplan-Meier plots suggested that regional divergence in CVD occurred before baseline (before mean baseline age of 69. Conclusions In women, regional differences in CVD early in adult life do not further diverge in later life. This may be due to regional differences in early detection, survivorship of women entering the study, or event severity. Targeting health care resources for CVD by geographic variation may not be appropriate for older age-groups.

  19. Prognostic and survival analysis of presbyopia: The healthy twin study

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    Lira, Adiyani; Sung, Joohon

    2015-12-01

    Presbyopia, a vision condition in which the eye loses its flexibility to focus on near objects, is part of ageing process which mostly perceptible in the early or mid 40s. It is well known that age is its major risk factor, while sex, alcohol, poor nutrition, ocular and systemic diseases are known as common risk factors. However, many other variables might influence the prognosis. Therefore in this paper we developed a prognostic model to estimate survival from presbyopia. 1645 participants which part of the Healthy Twin Study, a prospective cohort study that has recruited Korean adult twins and their family members based on a nation-wide registry at public health agencies since 2005, were collected and analyzed by univariate analysis as well as Cox proportional hazard model to reveal the prognostic factors for presbyopia while survival curves were calculated by Kaplan-Meier method. Besides age, sex, diabetes, and myopia; the proposed model shows that education level (especially engineering program) also contribute to the occurrence of presbyopia as well. Generally, at 47 years old, the chance of getting presbyopia becomes higher with the survival probability is less than 50%. Furthermore, our study shows that by stratifying the survival curve, MZ has shorter survival with average onset time about 45.8 compare to DZ and siblings with 47.5 years old. By providing factors that have more effects and mainly associate with presbyopia, we expect that we could help to design an intervention to control or delay its onset time.

  20. Prognostic significance of γ-H2AX in laryngeal squamous cell carcinoma after surgery

    Institute of Scientific and Technical Information of China (English)

    Zhang Jingyi; Cheng Lei; Zhou Liang

    2014-01-01

    Background The clinical significance of γ-H2AX in laryngeal squamous cell carcinoma (LSCC) has not yet been established.This study was performed to assess the expression of nuclear γ-H2AX in benign and malignant laryngeal lesions and to assess its clinicopathological significance.Methods A total of 70 LSCC tumor-normal tissue paired samples were evaluated for γ-H2AX expression using immunohistochemical staining.Their expression was correlated with different clinicopathological parameters.Results Nuclear γ-H2AX expression was frequently detected in LSCC tissues (P <0.001).High nuclear γ-H2AX levels were not associated with any clinicopathological characteristics of LSCC (P >0.05).Univariate Kaplan-Meier analysis showed that positive nuclear γ-H2AX expression was associated with a decreased overall survival (P=0.017).Multivariate Cox regression analysis showed that nuclear γ-H2AX expression was an independent risk factor for overall survival.Conclusion The expression of nuclear γ-H2AX might be closely related to the prognosis of LSCC.

  1. Risk analysis for autonomous underwater vehicle operations in extreme environments.

    Science.gov (United States)

    Brito, Mario Paulo; Griffiths, Gwyn; Challenor, Peter

    2010-12-01

    Autonomous underwater vehicles (AUVs) are used increasingly to explore hazardous marine environments. Risk assessment for such complex systems is based on subjective judgment and expert knowledge as much as on hard statistics. Here, we describe the use of a risk management process tailored to AUV operations, the implementation of which requires the elicitation of expert judgment. We conducted a formal judgment elicitation process where eight world experts in AUV design and operation were asked to assign a probability of AUV loss given the emergence of each fault or incident from the vehicle's life history of 63 faults and incidents. After discussing methods of aggregation and analysis, we show how the aggregated risk estimates obtained from the expert judgments were used to create a risk model. To estimate AUV survival with mission distance, we adopted a statistical survival function based on the nonparametric Kaplan-Meier estimator. We present theoretical formulations for the estimator, its variance, and confidence limits. We also present a numerical example where the approach is applied to estimate the probability that the Autosub3 AUV would survive a set of missions under Pine Island Glacier, Antarctica in January-March 2009.

  2. CLINICAL OUTCOMES OF FIVE-YEAR FOLLOW-UP OF EARLY AND LONG-TERM TREATMENT WITH CAPTOPRIL ON THE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

    Institute of Scientific and Technical Information of China (English)

    蔡煦; 苏静英; 沈卫峰; 龚兰生

    2002-01-01

    Objective To investigate clinical outcomes of early and long-term treatment with captopril on patients with acute myocardial infarction (AMI) during a five-year follow-up. Methods In a randomi-zed trial, 822 patients (623 males, 199 females) with a first AMI with less 72h of symptoms were treated with captopril (treatment group, n=478, dosage from a first 6.25mg to 25mg t.i.d) and conventional treatment (control group, n=344). Multivariable Cox regression were used to analyze relative risk of independent variables. Cumulative survival of both groups were calculated with Kaplan-Meier analysis and analyzed by using log-rank comparison. Results During the five-year follow-up, the age, Killip class (≥Ⅱ), anterior infarction, diabetes mellitus, and peak CPK increased relative risk of death after AML, but the effects of captopril, beta-blocker, antiplatelet drug, and thrombolytic therapy on the relative risk of death were contrary. The cumulative survival in different time during follow-up was higher in patients with captopril than controls (P<0.001). Conclusion Early and long-term treatment with captopril was related to a beneficial outcome during the five-year follow-up after AMI.

  3. Safety and Biocompatibility of a New High-Density Polyethylene-Based Spherical Integrated Porous Orbital Implant: An Experimental Study in Rabbits

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    Ivan Fernandez-Bueno

    2015-01-01

    Full Text Available Purpose. To evaluate clinically and histologically the safety and biocompatibility of a new HDPE-based spherical porous orbital implants in rabbits. Methods. MEDPOR (Porex Surgical, Inc., Fairburn, GA, USA, OCULFIT I, and OCULFIT II (AJL Ophthalmic S.A., Vitoria, Spain implants were implanted in eviscerated rabbis. Animals were randomly divided into 6 groups (n=4 each according to the 3 implant materials tested and 2 follow-up times of 90 or 180 days. Signs of regional pain and presence of eyelid swelling, conjunctival hyperemia, and amount of exudate were semiquantitatively evaluated. After animals sacrifice, the implants and surrounding ocular tissues were processed for histological staining and polarized light evaluation. Statistical study was performed by ANOVA and Kaplan-Meier analysis. Results. No statistically significant differences in regional pain, eyelid swelling, or conjunctival hyperemia were shown between implants and/or time points evaluated. However, amount of exudate differed, with OCULFIT I causing the smallest amount. No remarkable clinical complications were observed. Histological findings were similar in all three types of implants and agree with minor inflammatory response. Conclusions. OCULFIT ophthalmic tolerance and biocompatibility in rabbits were comparable to the clinically used MEDPOR. Clinical studies are needed to determine if OCULFIT is superior to the orbital implants commercially available.

  4. Correlation between rest-activity rhythm and survival in cancer patients experiencing pain.

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    Chang, Wen-Pei; Lin, Chia-Chin

    2014-10-01

    The purpose of this study was to investigate the influence of rest-activity rhythm on the survival of cancer patients. This study collected data related to cancer patients experiencing pain who had been hospitalized for treatment between August 2006 and October 2007. Data included the Karnofsky Performance Status Index as a representation of functional condition as well as the Brief Pain Inventory and the Pittsburgh Sleep Quality Index. Actigraphic methods were used to record the dichotomy index (I rest-activity rhythms over periods of three consecutive days. Patients were closely followed until 31 July 2013. Results were analyzed using Kaplan-Meier survival analysis, log-rank testing and Cox proportional hazards regression analysis to evaluate whether alterations in the rest-activity rhythm affected the survival rate of the patients. Of the 68 hospitalized cancer patients experiencing pain at the time of admission, 51 subsequently died within the study period. A significant difference was observed in the survival curves between the regular I rest-activity rhythm were negatively correlated with the survival of hospitalized cancer patients experiencing pain. Effects were particularly pronounced in cancer patients with poor performance status.

  5. CT-guided brachytherapy as salvage therapy for intrahepatic recurrence of HCC after surgical resection.

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    Schnapauff, Dirk; Collettini, Federico; Hartwig, Kerstin; Wieners, Gero; Chopra, Sascha; Hamm, Bernd; Gebauer, Bernhard

    2015-01-01

    Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previous resection is rising. The purpose of this study was to determine survival of patients undergoing computed tomography-guided brachytherapy (CT-HDRBT). Altogether 19 patients with unresectable HCC recurrence were treated with CT-HDRBT at our Institution. Patients underwent single-fraction high-dose irradiation by an iridium-192 source after CT fluoroscopy-guided catheter placement. The median tumor-enclosing target dose was 20 Gy. The median follow-up was 33 months. According to the Kaplan-Meier method, median overall survival after CT-HDRBT was 50 months, and median survival after first hepatic resection was 87 months. The median duration of local tumor control was 32 months and time to disease progression was 20 months. There were no serious complications after CT-HDRBT and no treatment-related deaths. CT-HDRBT is a safe, potentially life prolonging technique in patients with recurrence of HCC who have few therapeutic options. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  6. Computed tomography-guided interstitial HDR brachytherapy (CT-HDRBT) of the liver in patients with irresectable intrahepatic cholangiocarcinoma.

    Science.gov (United States)

    Schnapauff, Dirk; Denecke, Timm; Grieser, Christian; Collettini, Federico; Colletini, Federico; Seehofer, Daniel; Sinn, Marianne; Banzer, Jan; Lopez-Hänninen, Enrique; Hamm, Bernd; Wust, Peter; Gebauer, Bernhard

    2012-06-01

    This study was designed to investigate the clinical outcome of patients with irresectable, intrahepatic cholangiocarcinoma (IHC) treated with computed tomography (CT)-guided HDR-brachytherapy (CT-HDRBT) for local tumor ablation. Fifteen consecutive patients with histologically proven cholangiocarcinoma were selected for this retrospective study. Patients were treated by high-dose-rate internal brachytherapy (HDRBT) using an Iridium-192 source in afterloading technique through CT-guided percutaneous placed catheters. A total of 27 brachytherapy treatments were performed in these patients between 2006 and 2009. Median tumor enclosing target dose was 20 Gy, and mean target volume of the radiated tumors was 131 (±90) ml (range, 10-257 ml). Follow-up consisted of clinical visits and magnetic resonance imaging of the liver every third month. Statistical evaluation included survival analysis using the Kaplan-Meier method. After a median follow-up of 18 (range, 1-27) months after local ablation, 6 of the 15 patients are still alive; 4 of them did not get further chemotherapy and are regarded as disease-free. The reached median local tumor control was 10 months; median local tumor control, including repetitive local ablation, was 11 months. Median survival after local ablation was 14 months and after primary diagnosis 21 months. In view of current clinical data on the clinical outcome of cholangiocarcinoma, locally ablative treatment with CT-HDRBT represents a promising and safe technique for patients who are not eligible for tumor resection.

  7. Prognostic Value of FDG-PET, Based on the Revised Response Criteria, in Patients with Malignant Lymphoma: A Comparison with CT/MRI Evaluations, Based on the International Working Group/ Cotswolds Meeting Criteria

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    Kayako Isohashi

    2015-07-01

    Full Text Available Objective(s: Post-treatment evaluations by CT/MRI (based on the International Working Group/ Cotswolds meeting guidelines and PET (based on Revised Response Criteria, were examined in terms of progression-free survival (PFS in patients with malignant lymphoma (ML. Methods: 79 patients, undergoing CT/MRI for the examination of suspected lesions and whole-body PET/CT before and after therapy, were included in the study during April 2007-January 2013. The relationship between post-treatment evaluations (CT/MRI and PET and PFS during the follow-up period was examined, using Kaplan-Meier survival analysis. The patients were grouped according to the histological type into Hodgkin’s lymphoma (HL, diffuse large B-cell lymphoma (DLBCL, and other histological types. The association between post-treatment evaluations (PET or PET combined with CT/ MRI and PFS was examined separately. Moreover, the relationship between disease recurrence and serum soluble interleukin-2 receptor, lactic dehydrogenase, and C-reactive protein levels was evaluated before and after the treatment. Results: Patients with incomplete remission on both CT/MRI and PET had a significantly shorter PFS, compared to patients with complete remission on both CT/MRI and PET and those exhibiting incomplete remission on CT/MRI and complete remission on PET (P

  8. Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

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    Richard Mwase

    2017-01-01

    Full Text Available Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.” Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous ketamine (0.25 mg/kg offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number PACTR201404000807178.

  9. Socioeconomic status is an independent predictor of biochemical recurrence among patients with prostate cancer who undergo radical prostatectomy

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    Victor Srougi

    2011-08-01

    Full Text Available PURPOSE: Socioeconomic status (SES may influence cancer characteristics and behavior in several aspects. We analyzed PCa characteristics and behavior among low income uninsured men, and compare them to high income patients with health insurance in a developing country. MATERIALS AND METHODS: A retrospective case-control study was performed on 934 patients with clinically localized PCa who underwent radical prostatectomy between March, 1999 and July, 2009. Patients were divided in two groups, according to their SES. In group 1 (n=380, all had low income, low educational levels and couldn't afford medical insurance. In group 2 (n=554, all had higher income, higher education and had medical insurance. RESULTS: Patients from group 1 were older, had higher Gleason scores, higher rates of seminal vesicle and bladder neck involvement. The Kaplan Meier disease-free survival curve demonstrated that after a follow-up of four years, about 50% of uninsured patients had biochemical recurrence, versus 21% of insured patients (Log rank test: p < 0.001. A multivariate Cox regression analysis for the risk of disease recurrence demonstrated that only PSA levels, Gleason score, seminal vesicle involvement and SES were statistically significant variables. Patients with a low SES presented 1.8 times the risk of recurrence as compared to patients with a high SES. CONCLUSIONS: Patients with low SES were older, presented more aggressive PCa characteristics and a high rate of disease recurrence. A low SES constituted an independent predictor for disease recurrence.

  10. Validation of different staging systems for hepatocellular carcinoma in a cohort of 249 patients undergoing radiotherapy

    Science.gov (United States)

    Lu, Hui-Rong; Li, Ye-Fei; Liang, Shi-Xiong; Zhang, Chun-Yan

    2017-01-01

    There is no consensus on predicting prognosis for hepatocellular carcinoma patients undergoing radiotherapy. This study aims to evaluate the validity of different staging systems. Overall, 249 hepatocellular carcinoma patients were evaluated retrospectively. All patients were classified by different staging systems. The cumulative survival rates were calculated using the Kaplan-Meier method, and survival curves were compared using the log-rank test. Harrell's concordance index (c-index) was calculated. The 1-, 3-, and 5-year overall survival rates were 58%, 31% and 20%, respectively. Significant differences in overall survival were observed between stages I and II of the Okuda staging system (p=0.004), between scores of 3 and 4 of Cancer of the Liver Italian Program prognostic score (p=0.009), between Chinese University Prognostic Index low-risk and intermediate-risk groups (p=0.01), between 1 and 2 points of the Japan Integrated Staging score (p=0.037), between stages III and IV of American Joint Committee on Cancer 1997 TNM staging system (p=0.011), between stages II and III of American Joint Committee on Cancer 2002 TNM staging system (p=0.026) and between stages I and II of Guangzhou 2001 staging system (p=0.000). In conclusion, the Okuda staging system, Chinese University Prognostic Index, and Chinese Guangzhou 2001 staging system were more discriminative than the other staging systems in the prognostic stratification for hepatocellular carcinoma patients undergoing radiotherapy. PMID:28147327

  11. Heterogeneous cell-cycle behavior in response to UVB irradiation by a population of single cancer cells visualized by time-lapse FUCCI imaging.

    Science.gov (United States)

    Miwa, Shinji; Yano, Shuya; Kimura, Hiroaki; Yamamoto, Mako; Toneri, Makoto; Murakami, Takashi; Hayashi, Katsuhiro; Yamamoto, Norio; Fujiwara, Toshiyoshi; Tsuchiya, Hiroyuki; Hoffman, Robert M

    2015-01-01

    The present study analyzed the heterogeneous cell-cycle dependence and fate of single cancer cells in a population treated with UVB using a fluorescence ubiquitination-based cell-cycle (FUCCI) imaging system. HeLa cells expressing FUCCI were irradiated by 100 or 200 J/m(2) UVB. Modulation of the cell-cycle and apoptosis were observed by time-lapse confocal microscopy imaging every 30 min for 72 h. Correlation between cell survival and factors including cell-cycle phase at the time of the irradiation of UVB, mitosis and the G1/S transition were analyzed using the Kaplan-Meier method along with the log rank test. Time-lapse FUCCI imaging of HeLa cells demonstrated that UVB irradiation induced cell-cycle arrest in S/G2/M phase in the majority of the cells. The cells irradiated by 100 or 200 J/m(2) UVB during G0/G1 phase had a higher survival rate than the cells irradiated during S/G2/M phase. A minority of cells could escape S/G2/M arrest and undergo mitosis which significantly correlated with decreased survival of the cells. In contrast, G1/S transition significantly correlated with increased survival of the cells after UVB irradiation. UVB at 200 J/m(2) resulted in a greater number of apoptotic cells.

  12. Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint:Pressure drop coefficient in patients with coronary artery dysfunction

    Institute of Scientific and Technical Information of China (English)

    Mohamed A Effat; Srikara Viswanath Peelukhana; Rupak K Banerjee

    2016-01-01

    AIM:To combine pressure and flow parameter, pressure drop coefficient(CDP) will result in better clinical outcomes in comparison to the fractional flow reserve(FFR) group. METHODS:To test this hypothesis, a comparison was made between the FFR 27.9 groups in this study, for the major adverse cardiac events [major adverse cardiac events(MACE): Primary outcome] and patients’ quality of life(secondary outcome). Further, a comparison was also made between the survival curves for the FFR 27.9 groups. Two-tailed χ~2 test proportions were performed for the comparison of primary and secondary outcomes. Kaplan-Meier survival analysis was performed to compare the survival curves of FFR 27.9 groups(MedcalcV10.2, Mariakerke, Belgium). Results were considered statistically significant for P 27.9 group(8.57%, 2 out of 35). Noteworthy is the reduction in the %MACE in the CDP > 27.9 group, in comparison to the FFR 27.9 groups. Survival analysis results suggest that the survival time for the CDP > 27.9 group(n = 35) is significantly higher(P = 0.048) in comparison to the survival time for the FFR < 0.75 group(n = 20). The results remained similar for a FFR = 0.80 cut-off. CONCLUSION: Based on the above, CDP could prove to be a better diagnostic end-point for clinical revascularization decision-making in the cardiac catheterization laboratories.

  13. Effect of an Oral Adsorbent, AST-120, on Dialysis Initiation and Survival in Patients with Chronic Kidney Disease

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    Shingo Hatakeyama

    2012-01-01

    Full Text Available The oral adsorbent AST-120 has the potential to delay dialysis initiation and improve survival of patients on dialysis. We evaluated the effect of AST-120 on dialysis initiation and its potential to improve survival in patients with chronic kidney disease. The present retrospective pair-matched study included 560 patients, grouped according to whether or not they received AST-120 before dialysis (AST-120 and non-AST-120 groups. The cumulative dialysis initiation free rate and survival rate were compared by the Kaplan-Meier method. Multivariate analysis was used to determine the impact of AST-120 on dialysis initiation. Our results showed significant differences in the 12- and 24-month dialysis initiation free rate (P<0.001, although no significant difference was observed in the survival rate between the two groups. In conclusion, AST-120 delays dialysis initiation in chronic kidney disease (CKD patients but has no effect on survival. AST-120 is an effective therapy for delaying the progression of CKD.

  14. Outcomes and predictive factors of pediatric kidney transplants: an analysis of the Thai Transplant Registry.

    Science.gov (United States)

    Rianthavorn, Pornpimol; Kerr, Stephen J; Lumpaopong, Adisorn; Jiravuttipong, Apichat; Pattaragarn, Anirut; Tangnararatchakit, Kanchana; Avihingsanon, Yingyos; Thirakupt, Prapaipim; Sumethkul, Vasant

    2013-03-01

    As universal coverage for pediatric kidney transplantation (KT) was introduced in Thailand in 2008, the number of recipients has been increasing. We evaluated predictive factors for graft failure to understand how to improve clinical outcomes in these children. Using data obtained from the National Transplant registry, we assessed the risk of graft failure using the Kaplan-Meier method and Cox proportional hazards regression. Altogether, 201 recipients aged <21 yr at the time of KT were studied. Living donors (LD) were significantly older than deceased donor (DD). Mean cold ischemia time of DD was 17 h. The mean donor glomerular filtration rate (GFR) was 84.0 mL/min/1.73 m(2) . Induction immunosuppressive therapy was administered more frequently in DD than in LDKT. Delayed graft function (DGF) occurred in 36 transplants. Over 719 person years of follow-up, 42 graft failures occurred. Graft survival at one, three, and five yr post-transplant were 95%, 88% and 76%, respectively. Two factors independently predicted graft failure in multivariate analysis. The hazard ratios for graft failure in patients with DGF and in patients with donor GFR of ≤30 mL/min/1.73 m(2) were 2.5 and 9.7, respectively. Pediatric recipients should receive the first priority for allografts from young DD with a good GFR, and DGF should be meticulously prevented.

  15. Combination of Strong MMP-2 and Weak TIMP-2 Immunostainings Is a Significant Prognostic Factor in Endometrial Carcinoma

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    Maria Honkavuori-Toivola

    2013-01-01

    Full Text Available Objective. The aim of this study was to evaluate the combined effe