579 Risk Stratification of Patients With Gastric Indefinite for Dysplasia; Is Endoscopic Follow-Up With Recurrent Biopsy Enough for a Definite Diagnosis of Gastric Indefinite for Dysplasia?

Background/Aims. “Indefinite for dysplasia” (IND) conditions of the stomach have high malignancy rates (22.6%–75.0%). Endoscopic resection is sometimes used for follow-up, but criteria for selecting this follow-up method are not established. We investigated pathologic factors to subclassify the IND of the stomach and select appropriate follow-up methods. Methods. In total, 123 IND cases with final diagnoses of cancer (29.3%), high-grade dysplasia (6.5%), low-grade dysplasia (11.4%), and nonneoplasm (52.8%) were randomly divided into test set ( n = 27 ) and validation set ( n = 96 ). By the image analysis, size, pleomorphism, hyperchromasia, irregularity of nuclei, and ratios of structural atypia area (SAA) to total IND area were measured in the test set. Using the validation set, consensus meetings were held for the evaluation of pathologic factors that predict the final diagnosis. Results. By image analysis, the only ratio of SAA to total IND area was associated with the final diagnosis ( p < 0.001 ). In the consensus meeting for validation, the nuclear factors, except loss of nuclear polarity ( p = 0.004 – 0.026 ), could not predict the final diagnosis. Conversely, most structural factors could predict the final diagnosis. In particular, SAA > 25 % was the most powerful predictive factor. We proposed criteria of risk stratification by using SAA > 25 % , loss of surface maturation (LOSM), and loss of nuclear polarity (LONP) (Malignancy rate; Category 0: SAA ≤ 25 % without LOSM and LONP; 0%, Category 1: SAA ≤ 25 % with any of LOSM or LONP; 15.2%–16.7%, Category 2: SAA > 25 % without LOSM and LONP; 44.4%–50.0%, Category 3: SAA > 25 % with any of LOSM or LONP 54.5%–55.6%). Conclusions. Structural atypia was more helpful than nuclear atypia and SAA > 25 % was the most powerful predictor for the diagnosis of INDs of the stomach. We propose shortening the follow-up period to six months for Category 1, endoscopic resection for Category 2 and 3, postresection follow-up periods of one year for Category 2, and six months for Category 3.

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Risk assessment in precapillary pulmonary hypertension: a comparative analysis

Respiratory Research ◽

10.1186/s12931-021-01624-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Thomas Sonnweber ◽

Eva-Maria Schneider ◽

Manfred Nairz ◽

Igor Theurl ◽

Günter Weiss ◽

...

Keyword(s):

Risk Assessment ◽

Pulmonary Hypertension ◽

High Risk ◽

Risk Stratification ◽

Risk Prediction ◽

Mortality Risk ◽

Assessment Tool ◽

Risk Models ◽

Non Invasive

Abstract Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

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Endocardial vs endo-epicardial ablation of ventricular arrhythmia in arrhythmogenic right ventricular cardiomyopathy: a single center experience

European Heart Journal ◽

10.1093/ehjci/ehaa946.0433 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.A Simonova ◽

A.V Kamenev ◽

R.B Tatarskiy ◽

M.A Naymushin ◽

V.S Orshanskaya ◽

...

Keyword(s):

Ventricular Arrhythmia ◽

Low Voltage ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Control Group ◽

Definite Diagnosis ◽

Premature Ventricular Contractions ◽

Single Center Experience ◽

Voltage Mapping ◽

Epicardial Access

Abstract Background The majority of patients have a sub-epicardial scar as a substrate for VT episodes. Purpose We sought to compare the efficacy of endocardial (ENDO) and epicardial (EPI) substrate modification in patients with ARVC. Methods 20 consecutive ARVC patients (mean age 41,4±13,8, 70% males; ICD previously implanted in 10 patients) with indications to ventricular arrhythmia ablation (RFA) were included into a prospective observational study. The EPI group consisted of 10 patients with sustained ventricular tachycardia (VT) (definite diagnosis ARVC – 8 patients; borderline – 1, possible – 1) who signed an informed consent to epicardial access. The ENDO group included 10 patients (definite diagnosis ARVC – 9 patients), five of them demonstrated sustained VT and 5 patients had frequent symptomatic premature ventricular contractions (PVC). Epicardial access in the EPI group was obtained through subxyphoid puncture. Bi- and unipolar voltage mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of local abnormal ventricular electrical activity (LAVA, low-voltage areas and sites with highly fractionated or late activity). Ablation was performed at sites of LAVA on either side of the ventricular wall. In the ENDO group endocardial only ablation at LAVA sites was performed. RF energy ablation was 40W at the epicardial surface and 40–50W at the endocardial surface. Results In the EPI group endocardially mapped area of unipolar endocardial low voltage zone (LVZ) significantly prevailed over bipolar endocardial area of LVZ: 75.4 cm2 [IQR: 23.2; 211.9] vs 6.7 cm2 [IQR: 4.4; 35.5](P=0.009). Epicardial bipolar LVZ area prevailed over unipolar epicardial LVZ area: 65.3 cm2 [IQR: 55.6; 91.3] vs 6.7 cm2 [IQR: 4.4; 35.3] (P=0.005). Endocardial unipolar LVZ area in the EPI group was larger than in the ENDO group (P>0,05). After ablation non-inducibility of any ventricular arrhythmia was achieved in 90% of patients in the EPI group and in 80% of cases in the ENDO group. During a mean follow-up period of 22.3±10.5 months freedom of ventricular arrhythmia recurrence was 70% in the EPI group and 100% in the control group. Conclusions Although epicardial area of abnormal potentials significantly prevails over endocardial area, endocardial unipolar mapping and higher RF ablation power allow performing successful ventricular arrhythmia treatment in the majority of ARVC patients. Funding Acknowledgement Type of funding source: None

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Copy Number Alteration Profile Provides Additional Prognostic Value for Acute Lymphoblastic Leukemia Patients Treated on BFM Protocols

Cancers ◽

10.3390/cancers13133289 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3289

Author(s):

Μirella Αmpatzidou ◽

Lina Florentin ◽

Vassilios Papadakis ◽

Georgios Paterakis ◽

Marianna Tzanoudaki ◽

...

Keyword(s):

Risk Stratification ◽

Copy Number ◽

Copy Number Alteration ◽

Lymphoblastic Leukemia ◽

Risk Index ◽

Outcome Predictor ◽

Distinct Subgroup ◽

Genomic Risk ◽

Good Risk

We present our data of a novel proposed CNA-profile risk-index, applied on a Greek ALLIC-BFM-treated cohort, aiming at further refining genomic risk-stratification. Eighty-five of 227 consecutively treated ALL patients were analyzed for the copy-number-status of eight genes (IKZF1/CDKN2A/2B/PAR1/BTG1/EBF1/PAX5/ETV6/RB1). Using the MLPA-assay, patients were stratified as: (1) Good-risk(GR)-CNA-profile (n = 51), with no deletion of IKZF1/CDKN2A/B/PAR1/BTG1/EBF1/PAX5/ETV6/RB1 or isolated deletions of ETV6/PAX5/BTG1 or ETV6 deletions with a single additional deletion of BTG1/PAX5/CDKN2A/B. (2) Poor-risk(PR)-CNA-profile (n = 34), with any deletion of ΙΚΖF1/PAR1/EBF1/RB1 or any other CΝΑ. With a median follow-up time of 49.9 months, EFS for GR-CNA-profile and PR-CNA-profile patients was 96.0% vs. 57.6% (p < 0.001). For IR-group and HR-group patients, EFS for the GR-CNA/PR-CNA subgroups was 100.0% vs. 60.0% (p < 0.001) and 88.2% vs. 55.6% (p = 0.047), respectively. Among FC-MRDd15 + patients (MRDd15 ≥ 10−4), EFS rates were 95.3% vs. 51.7% for GR-CNA/PR-CNA subjects (p < 0.001). Similarly, among FC-MRDd33 + patients (MRDd33 ≥ 10−4), EFS was 92.9% vs. 27.3% (p < 0.001) and for patients FC-MRDd33 − (MRDd33 < 10−4), EFS was 97.2% vs. 72.7% (p = 0.004), for GR-CNA/PR-CNA patients, respectively. In a multivariate analysis, the CNA-profile was the most important outcome predictor. In conclusion, the CNA-profile can establish a new genomic risk-index, identifying a distinct subgroup with increased relapse risk among the IR-group, as well as a subgroup of patients with superior prognosis among HR-patients. The CNA-profile is feasible in BFM-based protocols, further refining MRD-based risk-stratification.

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Implantable cardiac monitor after cryptogenic stroke: atrial fibrillation detection and predictors

European Heart Journal ◽

10.1093/ehjci/ehaa946.0382 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Ebrille ◽

C Amellone ◽

M.T Lucciola ◽

F Orlando ◽

M Suppo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Risk Stratification ◽

Median Time ◽

Remote Monitoring ◽

Cryptogenic Stroke ◽

Screening Process ◽

Cardiac Monitor ◽

Implantable Cardiac Monitor

Abstract Objective The main objective of our study was to analyze the incidence and predictors of atrial fibrillation (AF) in patients with cryptogenic stroke (CS) who received an implantable cardiac monitor (ICM) at our Institution. Methods From November 2013 to October 2017, a total of 133 patients who had suffered a CS were implanted with an ICM after a thorough screening process. The median time between the thromboembolic event and ICM implantation was 64 days [IQ range: 16–111]. All implanted patients were followed with remote monitoring until the first detected episode of AF or up to December 2018. Every remote monitoring transmission and related electrograms were analyzed by the dedicated Electrophysiology Nursing team and confirmed by experienced Electrophysiologists. AF was defined by any episode lasting greater than or equal to 2 minutes. Results During a median follow-up of 14.8 months [IQ range: 3.0–31.2], AF was detected in 65 out of 133 patients (48.9%). The median time from ICM implantation and AF detection was 3.5 months [IQ range: 0.9–6.7]. The prevalence of AF was 22.6%, 34.4%, 40.8% and 48.3% at 3, 6, 12 and 24 months respectively. At the multivariate analysis, high premature atrial contractions (PAC) burden and left atrium (LA) dilation were the only independent predictors of AF detection (HR 2.82, 95% CI 1.64–4.83, p<0.001 for PAC; HR 1.75, 95% CI 1.03–2.97, p=0.038 for LA dimension). Patients were dived into categories based on the probability of AF detection (low, intermediate and high risk) and a new risk stratification algorithm was implemented (Figure 1). Conclusion After a thorough screening process, AF detection in patients with CS and ILM was quite high. Having a high PAC burden and LA dilation predicted AF episodes at the multivariate analysis. A new risk stratification algorithm was developed. Figure 1 Funding Acknowledgement Type of funding source: None

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Midcarpal instability

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415617756 ◽

2015 ◽

Vol 41 (1) ◽

pp. 86-93 ◽

Cited By ~ 10

Author(s):

D. G. Hargreaves

Keyword(s):

Surgical Treatment ◽

Treatment Options ◽

Case Series ◽

Definite Diagnosis ◽

Stress Tests ◽

Functional Instability ◽

Painful Wrist ◽

Relative Rarity ◽

Passive Stress

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

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Development and Validation of a Prognostic Nomogram Model for Recurrence of Non-Muscle Invasive Bladder Cancer

10.21203/rs.3.rs-691739/v1 ◽

2021 ◽

Author(s):

Sanhe Liu ◽

Yongzhi Li ◽

Diansheng Cui ◽

Yuexia Jiao ◽

Liqun Duan ◽

...

Keyword(s):

Bladder Cancer ◽

Risk Stratification ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Muscle Invasive Bladder Cancer ◽

Clinicopathologic Characteristics ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Muscle Invasive

Abstract BackgroundDifferent recurrence probability of non-muscle invasive bladder cancer (NMIBC) requests different adjuvant treatments and follow-up strategies. However, there is no simple, intuitive, and generally accepted clinical recurrence predictive model available for NMIBC. This study aims to construct a predictive model for the recurrence of NMIBC based on demographics and clinicopathologic characteristics from two independent centers. MethodsDemographics and clinicopathologic characteristics of 511 patients with NMIBC were retrospectively collected. Recurrence free survival (RFS) was estimated using the Kaplan-Meier method and log-rank tests. Univariate Cox proportional hazards regression analysis was used to screen variables associated with RFS, and a multivariate Cox proportional hazards regression model with a stepwise procedure was used to identify those factors of significance. A final nomogram model was built using the multivariable Cox method. The performance of the nomogram model was evaluated with respect to its calibration, discrimination, and clinical usefulness. Internal validation was assessed with bootstrap resampling. X-tile software was used for risk stratification calculated by the nomogram model. ResultsIndependent prognostic factors including tumor stage, recurrence status, and European Association of Urology (EAU) risk stratification group were introduced to the nomogram model. The model showed acceptable calibration and discrimination (area under the receiver operating characteristic [ROC] curve was 0.85; the consistency index [C-index] was 0.79 [95% CI: 0.76 to 0.82]), which was superior to the EAU risk stratification group alone. The decision curve also proved well clinical usefulness. Moreover, all populations could be stratified into three distinct risk groups by the nomogram model. ConclusionsWe established and validated a novel nomogram model that can provide individual prediction of RFS for patients with NMIBC. This intuitively prognostic nomogram model may help clinicians in postoperative treatment and follow-up decision-making.

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A case of nodular episcleritis mimicking a solitary giant episcleral mass

European Journal of Ophthalmology ◽

10.1177/11206721211052879 ◽

2021 ◽

pp. 112067212110528

Author(s):

Lan Zhou ◽

Juanjuan Wang ◽

Guihua Xu ◽

Dingding Wang ◽

Xiaoyi Wang ◽

...

Keyword(s):

Topical Steroid ◽

Inflammatory Cells ◽

Systemic Hypertension ◽

Eye Drops ◽

Definite Diagnosis ◽

Imaging Studies ◽

Immunohistochemical Examination ◽

History Of ◽

Inflammatory Drugs

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

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Analysis of Efficacy and Prognostic Factors of CLAG Treatment in Chinese Patients with Refractory or Relapsed Acute Myeloid Leukemia

Acta Haematologica ◽

10.1159/000493250 ◽

2018 ◽

Vol 141 (1) ◽

pp. 43-53 ◽

Cited By ~ 4

Author(s):

Li Wang ◽

Jun Xu ◽

Xiaolong Tian ◽

Tingting Lv ◽

Guolin Yuan

Keyword(s):

Acute Myeloid Leukemia ◽

High Risk ◽

Risk Stratification ◽

Salvage Therapy ◽

Myeloid Leukemia ◽

Median Overall Survival ◽

Remission Rate ◽

Chinese Patients ◽

Acute Myeloid

Background/Aims: The aim of this work was to investigate the efficacy and predictive factors of CLAG treatment in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients. Methods: Sixty-seven R/R AML patients were enrolled in this prospective cohort study and treated by a CLAG regimen: 5 mg/m2/day cladribine (days 1–5), 2 g/m2/day cytarabine (days 1–5), and 300 μg/day filgrastim (days 0–5). The median follow-up duration was 10 months. Results: A total of 57 out of 67 patients were evaluable for remission after CLAG therapy, of whom 57.9% achieved a complete remission (CR) and the overall remission rate was 77.2%. The median overall survival (OS) was 10.0 months, with a 1-year OS of 40.3 ± 6.0% and 3-year OS of 16.7 ± 5.7%. CR at first induction after the initial diagnosis was associated with a favorable CR. Age above 60 years, high risk stratification, second or higher salvage therapy, and bone marrow (BM) blasts ≥42.1% were correlated with an unfavorable CR. Secondary disease, age ≥60 years, high risk stratification, and second or higher salvage therapy were associated with worse OS. Patients developed thrombocytopenia (41, 61%), febrile neutropenia (37, 55%), leukopenia (33, 49%), neutropenia (18, 27%), and anemia (9, 13%). Conclusion: CLAG was effective and well tolerated for R/R AML. BM blasts ≥42.1%, age ≥60 years, high risk stratification, and second or higher salvage therapy were independent factors for a poor prognosis.

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Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

Endocrine Related Cancer ◽

10.1530/erc-17-0270 ◽

2017 ◽

Vol 24 (11) ◽

pp. R387-R402 ◽

Cited By ~ 10

Author(s):

Jolanta Krajewska ◽

Ewa Chmielik ◽

Barbara Jarząb

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Risk Stratification ◽

Prospective Studies ◽

Response To Treatment ◽

Dynamic Risk ◽

Primary Surgery ◽

Risk Patients ◽

Near Future

The adequate risk stratification in thyroid carcinoma is crucial to avoid on one hand the overtreatment of low-risk and on the other hand the undertreatment of high-risk patients. The question how to properly assess the risk of relapse has been discussed during recent years and resulted in a substantial change in our approach to risk stratification in differentiated thyroid cancer, proposed by the newest ATA guidelines. First initial risk stratification, based on histopathological data is carried out just after primary surgery. It should be emphasized, that a high quality of histopathological report is crucial for proper risk stratification. Next, during the follow-up, patients are restratified considering their response to treatment applied and classified to one of the following categories: excellent response, biochemical incomplete response, structural incomplete or indeterminate response. This new approach is called dynamic risk stratification as, in contrary to the previous rigid evaluation performed at diagnosis, reflects a real-time prognosis and thereby substantially influences and personalizes disease management. In this review, we raise some unresolved questions, among them the lack of prospective studies, fulfilling evidence-based criteria, necessary to validate this model of risk stratification. We also provided some data concerning the use of dynamic risk stratification in medullary thyroid cancer, not yet reflected in ATA guidelines. In conclusion, dynamic risk stratification allows for better prediction of the risk of recurrence in thyroid carcinoma, what has been demonstrated in numerous retrospective analyses. However, the validation of this approach in prospective studies seems to be our task for near future.

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