P.04.12 ROLE OF CYST FEATURES AND PATIENTS' FACTORS IN PREDICTING THE RISK OF PROGRESSION IN BD-IPMN UNDERGOING FOLLOW-UP

2018 ◽  
Vol 50 (2) ◽  
pp. e160
Author(s):  
G. Zerboni ◽  
G. Vanella ◽  
S. Stigliano ◽  
L. Archibugi ◽  
M. Signoretti ◽  
...  
Keyword(s):  
Risk Of Progression

Outcome of 116 cases of pleuropulmonary blastoma type I and type Ir (regressed): A report from the International PPB Registry (IPPBR).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9522-9522 ◽  
Author(s):  
Yoav H. Messinger ◽  
Gretchen M Williams ◽  
John R. Priest ◽  
Anne Harris ◽  
Leslie Ann Doros ◽  
...  
Keyword(s):  
Lung Neoplasm ◽  
Pleuropulmonary Blastoma ◽  
Type I ◽  
High Grade ◽  
Type Ii ◽  
Exact Test ◽  
Risk Of Progression ◽  
High Grade Sarcoma

9522 Background: Pleuropulmonary blastoma (PPB) is a rare dysembryonic lung neoplasm of early childhood with progression from a purely cystic Type I (T-I) lesion to cystic solid and solid high grade sarcoma (Type II and Type III). A regressed form of PPB (T-Ir) has been recognized pathologically. The outcome of both T-I and T-Ir has been only partially described. Methods: Retrospective analysis of 345 IPPBR cases showed 116 T-I or T-Ir. In all cases the PPB diagnosis was made on surgically removed cysts. The treating physician decided whether to use chemotherapy after surgery. Results: The pathologic diagnosis of the 91 PPB T-I and 25 T-Ir is now confirmed by central review (LPD and DAH). Patients with T-I were younger than T-Ir (median: 8 months vs. 48 months).Diagnosis after age 6 years included only one T-I compared to 10 T-Ir patients. Therapy is not known for 28 T-I and 2 T-Ir. Surgery was followed by chemotherapy in 31 T-I and 2 T-Ir. Six (5%) recurred with the same type, all were alive at last follow-up: 5 (5.5%) T-I, 1 (4%) T-Ir. Progression to high-grade Type II or III occurred in 9/91 (10%) T-I and 2/25 (8%) T-Ir. The addition of chemotherapy did not significantly reduce progressions (Fisher’s exact test). All of the tumor progressions were seen by 75 months of age; this finding is similar to broader IPPBR data: > 95% of patients are diagnosed with Type II/III by 72 months of age. Of the 9 patients with T-I who progressed, 5 ultimately died, whereas the 2 T-Ir who progressed were alive. At last follow-up 111/116 (95.6%) were alive. Conclusions: A cyst in an older individual most likely will be Type Ir. Type I and Type Ir are clinically similar with a small risk of progression to the advanced Type II/III up to 6 years of age. Outcome for those whose cystic PPBs progressed is poor. The role of chemotherapy remains uncertain for the prevention of progression in the pure cystic PPB Type I or Ir. [Table: see text]

Active surveillance of prostate cancer in African-Americans during the MRI era.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 108-108
Author(s):  
Jonathan Bloom ◽  
Samuel Gold ◽  
Graham R. Hale ◽  
Kareem Rayn ◽  
Vladimir Valera ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Aggressive Disease ◽  
Time Period ◽  
Risk Prostate Cancer ◽  
Risk Of Progression ◽  
Low Risk Prostate Cancer ◽  
Primary Management

108 Background: Many patients with low-risk prostate cancer are encouraged by their physicians to pursue active surveillance (AS). AS has increasingly been utilized, however there remains anxiety by patients and their physicians that more aggressive disease will be missed and allowed to progress. African-American (AA) patients may present with more aggressive disease and higher rates of upgrading at the time of radical prostatectomy. Due to these factors, physicians may be hesitant to recommend AS to AA patients. We examined the role of AS in these patients in the era of MRI targeted biopsies. Methods: A prospectively maintained database was queried for all patients who underwent an MRI guided fusion biopsy from 2007 to 2016 and chose AS as their primary management strategy. Patents with Gleason Group (GG) 1 or 2 were eligible. Patients were then followed with yearly PSA, exam, MRI and biopsy if warranted. MRI Fusion biopsies were reviewed to determine any GG progression. Results: A total of 19 AA and 143 non-AA patients were reviewed with median follow up times of 31.63 (15.42 -89.50) and 30.87 (3.45 – 99.85) months, respectively. AA and non-AA patients had similar baseline PSA values (6.08 ± 2.93 vs. 5.89 ± 4.23, p = 0.85), proportion of GG 1 (15.89% vs 21.68%, p = 0.55) and PSA density (0.103 ± 0.041 vs. 0.123 ± 0.041, p = 0.36. However, AA patients did present at an earlier age (58.89 ± 6.64 vs. 63.69 ± 6.64, p = 0.004). A total of 8/19 (42.1%) AA and 46/143 (32.2%) non-AA had GG upgrading while on AS, p = 0.34. The median time until progression for AA and non-AA patients was 60.76 and 77.42 months, p = 0.68. Conclusions: In our study, AA men did begin AS at an earlier age than non-AA men. While both groups had statistically similar rates of progression, the relative risk of progression was higher in the AA cohort during this time period. Therefore, in the era of MRI and fusion biopsies we are better able to detect upgrading and somewhat mitigate the the risks associated with upgrading during AS irrespective of race but larger studies are needed to determine whether there are meaningful differences in the rates of progression between AA and non-AA men. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.

scholarly journals Low levels of circulating anti-ageing hormone Klotho predict the onset and progression of diabetic retinopathy

2020 ◽  
Vol 17 (6) ◽  
pp. 147916412097090
Author(s):  
Antonella Corcillo ◽  
Nikolaos Fountoulakis ◽  
Angela Sohal ◽  
Frederick Farrow ◽  
Salma Ayis ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Primary Outcome ◽  
Increased Risk ◽  
Risk Of Progression ◽  
Diabetic Eye Disease ◽  
Circulating Levels

Background: Klotho is a circulating anti-ageing hormone that predicts progression of cardiovascular and renal disease. The role of Klotho in diabetic retinopathy is unknown. Methods: We performed a single-centre observational study of 81 people (males 62%) with type 2 diabetes followed for a median of 44 months. Circulating levels of Klotho and other markers, were measured from stored samples. The primary outcome was progression of retinopathy defined as new onset retinopathy or step change in retinopathy grading. Results: During follow-up, 46 (57%) people reached the primary outcome. People with progression of retinopathy had lower levels of serum Klotho as compared to those without (median (interquartile range) 226.9 (171.1–394.0) vs 484.5 (221.8–709.9) pg/ml, p = 0.001). In multivariable logistic regression analyses, baseline Klotho level was the only variable independently associated with reduced risk of progression of retinopathy. Our results suggest that a halving of circulating Klotho levels increases the risk of retinopathy progression by 44%. Conclusion: In people with type 2 diabetes, lower circulating levels of the vascular protective hormone Klotho are associated with increased risk of progression of diabetic retinopathy. Klotho may be a novel biomarker and potential treatment target for diabetic eye disease.

MO040LONG-TERM FOLLOW-UP OF IGA NEPHROPATHY PATIENTS AT HIGH RISK OF PROGRESSION ACCORDING TO THE THERAPEUTIC APPROACH EMPLOYED: A MULTICENTER RETROSPECTIVE STUDY OF 947 PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Federico Alberici ◽  
Ivano Baragetti ◽  
Francesca Ferrario ◽  
Serena Ponti ◽  
Chiara Salviani ◽  
...  
Keyword(s):  
High Risk ◽  
Therapeutic Approach ◽  
Immunosuppressive Drugs ◽  
Free Survival ◽  
Risk Of Progression ◽  
Time Average ◽  
Group 2 ◽  
Group 1

Abstract Background and Aims IgA-nephropathy (IgA-N) is a frequent cause of CKD and ESRD. The optimal therapeutic approach and the role of glucocorticoids and immunosuppression is still debated. Aim of this study was to perform a survey across several Italian centers focusing on the long-term outcome of patients with IgA-N at high risk of progression stratified according to the therapeutic approach employed. Method All the consecutive patients affected by biopsy proven IgA-N, proteinuria >1g/day and a follow-up longer than 24 months have been collected across 48 centers. The population has been divided in three groups according to the therapeutic approach: group-1 received ACEi or ARBs alone, group-2 a six months course of glucocorticoids while group-3 glucocorticoids and immunosuppressive drugs. Primary endpoints have been ESRD free-survival, halving of the eGFR free-survival and rate of non-responders (NR, proteinuria >1 g/day). Secondary endpoints have been assessment of the prognostic role of the time average proteinuria (TAP) as well as of the time average slope of proteinuria (TASP) and rate of severe adverse events (SAEs). Results 947 patients have been included and followed for a median time of 60 months (IQR 24-96). Baseline eGFR and proteinuria in the three groups have been respectively 68.1 (95%CI 63.9-72.4)-67.8 (95%CI 65.3-70.3)-63.3 (95%CI 58.5-68.1) ml/min/1.73m2 (p=0.191) and 2.38 (95%CI 2-2.77)-2.65 (95%CI 2.49-2.82)-3.26 (95%CI 2.89-3.64) g/day (p<0.001). Respectively 76/586 (13%) and 28/167 (17%) of the patients in group-2 and 3 required re-treatment with glucocorticoids alone or in combination with immunosuppressive drugs after a median of 24 months from the first cycle. ESRD free-survival has been longer in the group-2 (p=0.004) (figure, panel A); at subgroup analysis this was restricted to the patients with a eGFR<50 ml/min (p=0.004) (figure, panel B) while only a trend was observed in the ones with eGFR ≥50 ml/min (p=0.0631). The halving of the eGFR free-survival has been longer in group-2 only when limiting the analyses to the subgroup with eGFR<50 ml/min (p=0.026) (figure, panel C). The proportion of NR has been significantly lower in group-2 compared to group-1 throughout the first 36 months of follow-up (figure, panel D); of note being NR during the first 36 months increased the risk of developing ESRD during the follow-up (OR 4 95%CI 2.2-7.3, p<0.0001). The TAP and TASP of the first 24 months have been higher in the patients developing ESRD (respectively, mean 2.48 95%CI 2.14-2.82 and 0.81 95%CI 0.70-0.92) compared to the other patients (mean 1.12 95%CI 1.2-1.32 and 0.59 95%CI 0.56-0.61) (p<0.0001 for both comparisons). Of note the 24 months TASP of group-2 was lower compared to group-1 (respectively mean 0.56 95%CI 0.54-0.59 and 0.79 95%CI 0.71-0.87) (p<0.0001). The rate of patients experiencing SAEs during the first 6 months of therapy in the three groups has been respectively 2%, 7% and 16%; of these withdrawn of the therapeutic approach employed has been necessary in 67%, 21% and 48%. During the whole follow-up the number of SAEs per 100 patients/years has been respectively 1.9-2.7 and 2.5 in the 3 groups. Conclusion In this large multicenter retrospective survey, the use of glucocorticoids in patients with IgA-N at high risk of progression has been associated to longer ESRD free-survival, longer time to the halving of the eGFR in the subgroup with eGFR <50 ml/min, lower rate of non-response during the first 36 months of follow-up as well as lower TASP during the first 24 months. The overall rate of SAEs has been low but higher in the group receiving glucocorticoids alone or in combination with immunosuppressors.

Is CTNNB1 mutational analysis predictive for progression in patients with sporadic desmoid tumors primarily observed?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10016-10016
Author(s):  
Chiara Colombo ◽  
Rosalba Miceli ◽  
Julien Domont ◽  
Federica Perrone ◽  
Marco Fiore ◽  
...  
Keyword(s):  
Mutational Analysis ◽  
Rank Test ◽  
Clear Trend ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Risk Of Progression ◽  
Wait And See ◽  
Ctnnb1 Mutation

10016 Background: Recently, a wait and see (W&S) approach has been proposed for patients affected by desmoid tumor (DT). Specific CTNNB1 mutation has been correlated with higher risk of recurrence after surgical resection. Aim of this study was to evaluate the correlation between CTNNB1 mutation type and time to progression in patients primarily observed (TTP). Methods: We included all consecutive patients:(1) primarily observed at the Fondazione IRCSS Istituto Nazionale Tumori (Milano, Italy) or Institut Gustave Roussy (Paris, France) for primary sporadic DTs (2) with available FFPE preserved tissue for CTNNB1 mutational analysis, (3) with measurable disease and adequate follow-up. TTP from date of diagnosis to date of radiological (PRO-R) or symptomatic (PRO-S) progression were conducted by Kaplan-Meier method and log-rank test to compare strata. Results: A total of 79 patients (August 2002- July 2011) were included (81% female, 19% male); median age was 34 (IQ, 10-77); sites distribution: abdominal/chest wall (75%), extremity (21%), intra-abdominal (4%). CTNNB1 mutations were observed in 76% of DT samples: 41A (48%), 45F (25%), 45P (2%); 24% were WT. Median follow-up was 19 mo (IQ, 11-28). Thirty-six patients experienced progression (86% PRO-R, 14% PRO-S): 41A (47%), 45F (55%), 45P (100%), WT (26%). An inferior TTP at 36 months was observed in mutated patients vs WT, while no difference was detected for specific subtype mutated patients (WT 68%, 45F 24%, 41/45P 35%, p= 0.045). A variety of different treatments including surgery, hormonal therapy, chemotherapy, antiCOX2 or persistent W&S approach were proposed at progression. Forty-two patients did not receive any treatment. Conclusions: A clear trend towards a lower risk of progression was observed in WT patients, but no difference between specific mutated patients (45F vs 41/45P) was observed. Prospective studies to eventually clarify the potential role of CTNNB1 as prognostic tool in tailoring desmoids treatment are presently underway.

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

Abusive head trauma (AHT) outcome at long-term follow-up and the role of elective neurosurgical approach: A report of 22 cases

2013 ◽  
Author(s):  
Francesca Menegazzo ◽  
Melissa Rosa Rizzotto ◽  
Martina Bua ◽  
Luisa Pinello ◽  
Elisabetta Tono ◽  
...  
Keyword(s):  
Head Trauma ◽  
Abusive Head Trauma ◽  
Long Term Follow Up

The role of ultrasound examination in early detection and follow-up of arterio-portal shunts

2008 ◽  
Vol 29 (S 1) ◽  
Author(s):  
S Ioanitescu ◽  
L Micu ◽  
A Rampoldi ◽  
N Masala ◽  
V Marcu ◽  
...  
Keyword(s):  
Early Detection ◽  
Ultrasound Examination

Tax evasion in the medical profession An Empirical Study in the General Tax Authority in Iraq

2019 ◽  
Vol 118 (11) ◽  
pp. 80-88
Author(s):  
Ramyar Rzgar Ahmed ◽  
Hawkar Qasim Birdawod ◽  
S. Rabiyathul Basariya
Keyword(s):  
Tax Evasion ◽  
Income Tax ◽  
Medical Profession ◽  
Great Influence ◽  
Tax Law ◽  
Degree Of Confidence ◽  
Medical Professions ◽  
Shed Light

The study dealt with tax evasion in the medical profession, where the problem was the existence of many cases of tax evasion, especially tax evasion in the income tax of medical professions. The aim of the study is to try to shed light on the phenomenon of tax evasion and the role of the tax authority in the development of controls and means that reduce the phenomenon of tax evasion. The most important results of the low level of tax awareness and lack of knowledge of the tax law and the unwillingness to read it and the sense of taxpayers unfairness of the tax all lead to an increase in cases of tax evasion and in suggested tightening control and follow-up on the offices of auditors, through the investigation and auditing The reports of certified accountants and the use of computers for this purpose in order to raise the degree of confidence in these reports and bring them closer to the required truth and coordination and cooperation with the Union of Accountants and Auditors and inform them about each case of violations of the auditors and accountants N because of its great influence in the rejection of the organization of the accounts and not to ratify fake accounts lead to show taxpayers accounts on a non-truth in order to tax evasion.

Peranan Ombudsman Republik Indonesia Perwakilan Sumatera Utara Dalam Pengawasan Pelayanan Dinas Kependudukan dan Catatan Sipil Kota Medan

2019 ◽  
Vol 1 (1) ◽  
pp. 1-12
Author(s):  
Putri Ananda Sari ◽  
Abdul Kadir ◽  
Beby Mashito Batu Bara
Keyword(s):  
Service Provider ◽  
Qualitative Approach ◽  
First Report ◽  
The North ◽  
Supervision Process ◽  
The Republic ◽  
North Sumatra

This study aims to determine the role of the Ombudsman of the Republic of Indonesia in North Sumatra Representative in the Supervision of Population and Civil Registry Service in Medan City. This study uses a qualitative approach with descriptive methods describing information about the data obtained from the field in the form of written and oral data from the parties studied. Data is collected based on interviews and documentation. The results of this study indicate that the role of the Ombudsman of the Republic of Indonesia in North Sumatra was carried out in the form of external supervision. External supervision is supervision carried out by the Ombudsman of the Republic of Indonesia Representative of North Sumatra to the Medan Population and Civil Registry Service. Actions taken in the supervision process are incoming reports, follow-up of the first report and follow-up of the report. Based on the research that has been carried out, it has been concluded that the role of the Ombudsman of the Republic of Indonesia in the North Sumatra Representative in supervising the service provider of the Population and Civil Registry services is carried out in the form of external supervision. In supervising the handling of public reports of alleged poor service in the area of population administration, it has been effective, with several efforts to handle reports such as: (1) Clarification; (2) Investigation; (3) Recommendations; (4) Monitoring.

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