Hyoid kinematic features for poor swallowing prognosis in patients with post-stroke dysphagia

AbstractIdentification of prognostic factors for swallowing recovery in patients with post-stroke dysphagia is crucial for determining therapeutic strategies. We aimed at exploring hyoid kinematic features of poor swallowing prognosis in patients with post-stroke dysphagia. Of 122 patients who experienced dysphagia following ischemic stroke, 18 with poor prognosis, and 18 age- and sex-matched patients with good prognosis were selected and retrospectively reviewed. Positional data of the hyoid bone during swallowing were obtained from the initial videofluoroscopic swallowing study after stroke onset. Normalized hyoid profiles of displacement/velocity and direction angle were analyzed using functional regression analysis, and maximal or mean values were compared between the good and poor prognosis patient groups. Kinematic analysis showed that maximal horizontal displacement (P = 0.031) and velocity (P = 0.034) in forward hyoid motions were significantly reduced in patients with poor prognosis compared to those with good prognosis. Mean direction angle for the initial swallowing phase was significantly lower in patients with poor prognosis than in those with good prognosis (P = 0.0498). Our study revealed that reduced horizontal forward and altered initial backward motions of the hyoid bone during swallowing can be novel kinematic features indicating poor swallowing prognosis in patients with post-stroke dysphagia.

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Determination of efficacy of TIP combination (paclitaxel, ifosfamide, cisplatin) as first salvage therapy for patients with relapsed germ cell tumors in a poor prognosis group

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16049 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16049-e16049

Author(s):

J. Mardiak ◽

K. Rejlekova ◽

M. Mego ◽

J. Rajec ◽

Z. Sycova-Mila ◽

...

Keyword(s):

Germ Cell ◽

Salvage Therapy ◽

Poor Prognosis ◽

Chemotherapy Regimen ◽

Germ Cell Tumors ◽

Complete Response ◽

Good Prognosis ◽

Prognostic Features ◽

Patients With Poor Prognosis

e16049 Background: The efficacy of TIP appears to be suitable salvage therapy for patients with relapsed germ cell tumors (GCTs) with good prognostic features.The aim of our study was to determine the efficacy of TIP as first salvage therapy for patients with relapsed GCTs with poor prognostic features. Methods: Thirty seven patients with relapsed GCTs were treated with TIP as first salvage therapy. Sixteen (43%) patients had favorable prognostic features for response (testis primary tumor site and prior complete response to induction chemotherapy regimen) and 21 (57%) patients had poor prognostic features (either extragonadal site or incomplete response to induction chemotherapy regimen). Four cycles of paclitaxel (175 to 250 mg/m2), ifosfamide 6 g/m2, and cisplatin 100 mg/m2 were given 21 days apart with GC-SF support, followed by resection of resectable radiographic residua. Results: Ten (69%) out of 16 patients with good prognostic features achieved a favorable response to TIP, and all 10 (100%) patients achieved complete response (CR). Six (60%) of the favorable responses remain durable at a median follow-up of 50,6 months. 9 (43%) of 21 patients with poor prognosis achieved a favorable response to chemotherapy, from whom only 1 (10%) patient achieved CR, but 5 patients achieved durable response at a median follow-up duration of 60,6 months. Estimated 2-year overall survival rate (OS) for patients with good prognosis was 56% (95 % CI 54–100%) and 33% (95% CI 21–68%) for patients with poor prognosis. Despite this results, estimated 5-year OS was even more positive for patients with poor prognosis 19% (95% CI 15–61%) comparing to 13% (95% CI 23–80%) for patients with good prognosis. Conclusions: Demonstrated long-term survival of patients with poor prognosis in our nonrandomised study with limited number of patients refers to the TIP being suitable therapy also for patients with relapsed GCTs with poor prognosis. These results warrant the need to continue investigation of real effectiveness of TIP as a first salvage therapy even for patients with poor prognostic features. No significant financial relationships to disclose.

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Therapeutic Management of Acute Myeloid Leukemia Patients after Stratification on Age, Prognosis and Allogeneic Hematopoietic Stem Cell Transplantation Eligibility

Blood ◽

10.1182/blood.v124.21.3691.3691 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3691-3691 ◽

Cited By ~ 1

Author(s):

Mauricette Michallet ◽

Mohamad Sobh ◽

Mohamed Elhamri ◽

Jeremy Monfray ◽

Helene Labussiere-Wallet ◽

...

Keyword(s):

Poor Prognosis ◽

Good Prognosis ◽

Moderate Intensity ◽

Intensive Chemotherapy ◽

Newly Diagnosed ◽

Hematopoietic Stem ◽

Group 4 ◽

Group 3 ◽

Group 2 ◽

Patients With Poor Prognosis

Abstract We evaluated in this study the therapeutic management of all newly diagnosed acute myeloid leukemia (AML) patients followed in our center between July 2007 and September 2013, after stratification on age, prognostic factors, whether they were candidate to allogeneic hematopoietic stem cell transplantation (allo-HSCT), transplanted or not with the evaluation of each therapeutic strategy and its impact on overall survival. A total of 572 consecutive newly diagnosed AML patients were included; there were 311 (54%) males and 261 females with a median age of 63 years (range: 20-92), 406 (71%) were de novo AML and 166 (29%) secondary AML. Complete cytogenetic and molecular biology data were collected for all patients and prognosis was differentiated according to the European LeukemiaNet classification (Dohner et al. Blood 2010). Accordingly, 335 (59%) patients were unfavorable, 83 (15%) favorable, 48 (8%) intermediate I and 106 (18%) were in intermediate II category. Following the Acute Leukemia French Association (ALFA) guidelines for allo-HSCT in AML, patients with intermediate II and unfavorable prognosis ≤ 65 years should receive intensive chemotherapy followed by allo-HSCT in the presence of related or unrelated HSCT donors. We divided the population into two sub-populations, the first was considered as young with age ≤ 65 years (N=318, 56%) and the second considered as old with age > 65 years (N=254, 44%). In the young population, there was 4 groups, group 1: patients with good prognosis (favorable/intermediate1) who received intensive chemotherapy within or according to ALFA protocols (N=105, median age= 47 years); group 2: patients with poor prognosis (intermediate2 /unfavorable) who received intensive chemotherapy within or according to ALFA protocols followed by allo-HSCT (N=126, median age= 50 years), group 3: patients with poor prognosis who received only intensive chemotherapy without allo-HSCT (N=69, median age= 57 years), and group 4: patients with poor prognosis who could not be treated due to early death (N=18). In the old population we distinguished, group 1: patients with good prognosis who received moderate intensity chemotherapy within or according to ALFA protocols (N=25, median age=73 years); group 2: patients with poor prognosis who received azacitidine (N=25, median age=76 years), group 3: patients with poor prognosis who received moderate intensity chemotherapy (N=89, median age=76 years), group 4: patients with poor prognosis who received low dose Ara-C (N=28, median age=76 years), group 5: patients with poor prognosis who received other treatment (N=38, median age=77 years) and finally group 6: patients with poor prognosis considered as palliative or who did not receive any treatment (N=49, median age=77 years). After a median follow-up of 34 months (range: 4-77) for surviving patients, the 2-years probability of overall survival (OS) in the young population for groups 1,2,3 and 4 was 84%, 56%, 31% and 0% respectively; and in the old group it was 71%, 37%, 31%, 5%, 21% and 0% for groups 1,2,3,4,5 and 6 respectively (figure). We showed that newly diagnosed AML patients with good prognosis all ages included could achieve very good survival rates after intensive chemotherapy; allo-HSCT after induction chemotherapy remains the best therapeutic option for fit patients with poor prognosis while the same fit patients with no donor have significantly lower survival (p<0.001) and for whom allo-HSCT could be proposed by using haploidentical donors in case of cord blood or unrelated donors absence. Interestingly, in the old population, we showed that poor prognosis patients receiving azacytidine had a significantly better survival compared to those receiving low dose Ara-C (p=0.015), with a comparable outcome to those receiving induction chemotherapy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Correlation between the initial CT chest findings and short-term prognosis in Egyptian patients with COVID-19 pneumonia

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00685-w ◽

2022 ◽

Vol 53 (1) ◽

Author(s):

Mohamed Mohamed Hefeda ◽

Dalia Ezzat Elsharawy ◽

Tamer Mahmoud Dawoud

Keyword(s):

Severity Score ◽

Poor Prognosis ◽

Good Prognosis ◽

Short Term ◽

High Severity ◽

Halo Sign ◽

The Mean ◽

Ct Finding ◽

High Severity Score ◽

Patients With Poor Prognosis

Abstract Background The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. This study aimed to highlight the encountered CT findings in 910 patients with COVID-19 pneumonia in Egypt including the mean severity score and also correlation between the initial CT finding and the short-term prognosis in 320 patients. Results All patients had confirmed COVID-19 infection. Non-contrast CT chest was performed for all cases; in addition, the correlation between each CT finding and disease severity or the short-term prognosis was reported. The mean age was higher for patients with unfavorable prognosis (P < 0.01). The patchy pattern was the most common, found in 532/910 patients (58.4%), the nodular pattern was the least common 123/910 (13.5%). The diffuse pattern was reported in 124 (13.6%). The ground glass density was the most common reported density in the study 512/910 (56.2%). The crazy pavement sign was reported more frequently in patients required hospitalization or ICU and was reported in 53 (56.9%) of patients required hospitalization and in 29 (40.2%) patients needed ICU, and it was reported in 11 (39.2%) deceased patients. Air bronchogram was reported more frequently in patients with poor prognosis than patients with good prognosis (16/100; 26% Vs 12/220; 5.4%). The mean CT severity score for patients with poor prognosis was 15.2. The mean CT severity score for patients with good prognosis 8.7., with statistically significant difference (P = 0.001). Conclusion Our results confirm the important role of the initial CT findings in the prediction of clinical outcome and short-term prognosis. Some signs like subpleural lines, halo sign, reversed halo sign and nodular shape of the lesions predict mild disease and favorable prognosis. The crazy paving sign, dense vessel sign, consolidation, diffuse shape and high severity score predict more severe disease and probably warrant early hospitalization. The high severity score is most important in prediction of unfavorable prognosis. The nodular shape of the lesions is the most important predictor of good prognosis.

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Role of Sprouty2 in the Pathogenesis of Chronic Lymphocytic Leukemia

Blood ◽

10.1182/blood.v124.21.719.719 ◽

2014 ◽

Vol 124 (21) ◽

pp. 719-719

Author(s):

Ashima Shukla ◽

Karan Rai ◽

Gregory Bociek ◽

Samuel J Pirruccello ◽

Runqing Lu ◽

...

Keyword(s):

Cell Proliferation ◽

B Cells ◽

Poor Prognosis ◽

Ectopic Expression ◽

Akt Signaling ◽

Good Prognosis ◽

Lymphocytic Leukemia ◽

Spontaneous Apoptosis ◽

Feedback Regulator ◽

Patients With Poor Prognosis

Abstract INTRODUCTION: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in adults representing about 35% of all adult leukemias in the United States. CLL is a B-cell neoplasm which is characterized by accumulation of long lived mature B-cells in peripheral blood (PB), bone marrow (BM) and lymph nodes (LN). We and others have reported that CLL cells in tissue microenvironments have constitutively activated MAPK-Erk and AKT signaling pathways, which promotes their proliferation and survival. However, the molecular mechanisms and the gene(s) responsible for the activation of these pathways in CLL are not clearly understood. We performed gene expression profiling of CLL cells from PB, BM and LN and transcriptome analyses of CLL cells from PB from good and poor prognosis patients. Our studies identified Sprouty 2 (Spry2), a negative feedback regulator as one of the key genes involved in the regulation of MAPK-Erk and Akt pathways in CLL. We observed that Spry2 levels were down-regulated in poor prognosis CLL cells. Interestingly, Spry2 is epigenetically silenced in most human and mouse lymphomas and ectopic expression of Spry2 induces apoptosis in mouse B cells. We categorized CLL patients into good and poor prognosis to further evaluate Spry2 in CLL biology. Poor prognosis patients were defined by unmutated immunoglobulin variable heavy chain (IgVH), 11q22 deletion, 17p deletion, trisomy 12 or high CD38 and Zap70 expression. Good prognosis patients were defined as having mutated IgVH, 13q14 deletions or low CD38 and Zap70 expression. RESULTS: We found that Spry2 expression was significantly decreased by 3.2 log2-fold, (p=0.0001) at transcript and protein levels, respectively, in CLL cells from patients with poor prognosis compared to patients with good prognosis. Spry2 is a negative feedback regulator which attenuates cell proliferation, migration and survival. To determine the effect of Spry2 on CLL cells we transfected Mec-1 cells (stable human CLL cell line) and primary human CLL cells with a Spry2 cDNA containing vector. Ectopic expression of Spry2 induced spontaneous apoptosis in Mec-1 cells and primary CLL cells from poor prognosis patients. These results indicate that Spry2 negatively regulates the survival of human CLL cells. CLL cells have been shown to have active B-cell receptor (BCR) signaling promoting proliferation in vivo. To study the effect of BCR stimulation on Spry2 we stimulated BCR on Mec-1 and primary CLL cells by BCR cross-linking. Unexpectedly, the rate of proliferation of Mec-1 cells decreased upon BCR stimulation. We were able to demonstrate a transient increase in Spry2 levels that peaked at 12 hours post BCR stimulation, which we suspected was mediating the decrease in proliferation observed. We therefore repeated the BCR stimulation experiment using siRNA to inhibit the transient increase in Spry2 in primary CLL cells from seven good prognosis patients and in the Mec-1 cells. As predicted, we observed a significant increase in proliferation in all primary CLL samples and in the Mec-1 cells upon Spry2 knock down following BCR stimulation. Spry2 attenuates ligand induced MAPK-Erk and AKT signaling leading to suppression of proliferation and survival. We also examined the effect of Spry2 on MAPK-Erk and Akt signaling in CLL cells. Upon induction of exogenous Spry2 expression in Mec-1 cells there was a significant decrease in p-Akt and p-Erk levels. Conversely, Spry2 knock down resulted in an increase in p-Erk and p-Akt and enhanced cell proliferation. CONCLUSIONS: Spry2 is significantly down-regulated in the B-cells from patients with poor prognosis CLL. Down-regulation of Spry2 in CLL cells leads to hyperactivation of MAPK-Erk and Akt signaling and exogenous and endogenous expression of Spry2 leads to spontaneous apoptosis in human CLL cells. These results identify Spry2 as a negative regulator of CLL cell survival and proliferation and provide a potential molecular target for therapeutic intervention. Disclosures Bociek: Seattle Genetics, Inc.: Research Funding.

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Dysbiotic microbiota to complement TNM staging or HPV status for prognostic indication of head and neck cancer

10.21203/rs.3.rs-80076/v1 ◽

2020 ◽

Author(s):

Yu Dou ◽

Chao Ma ◽

Ketao Wang ◽

Shaohua Liu ◽

Jintang Sun ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck ◽

Late Stage ◽

Poor Prognosis ◽

Good Prognosis ◽

Tnm Staging ◽

Primary Tumors ◽

Predictive Values ◽

Hpv Status ◽

Patients With Poor Prognosis

Abstract Background: Microbiota has been found associated with the incidence of head and neck cancers (HNCs), however, the association of microbiota with the prognosis of HNCs remains unknown. In the present study, the relationship between tumoral microbiata and survival was examined. The prognosis predictive value of tumoral microbiota to complement classic TNM staging and Human Papillomavirus (HPV) status was also investigated.Results: We conducted a retrospective study including 158 primary tumors using 16S rRNA sequencing. The tumoral microbiota in the HNC patients with poor prognosis were significantly different from that of the patients with good prognosis. A greater abundance of Schlegelella or Methyloversatilis was characterized in HNC patients with poor prognosis and a greater abundance of Lactobacillus or Bacillus was characterized in HNC patients with good prognosis. Strikingly, the microbial dysbiosis index (MDI), the ratio of above poor and good prognosis associated genera, was strongly associated with overall survival [hazard ratio (HR) 3.24; 95% confidence interval (CI), 1.88 to 5.59; P < 0.001] and disease free survival (HR 2.11; 95% CI, 1.34 to 3.34; P = 0.001), independently of age, TNM staging, differentiation and HPV status. Intriguingly, the combination of the MDI and HPV status significantly improved the prognostic performance of HPV status (AUC of 0.719 and 0.581 respectively, P = 0.024). Moreover, the MDI showed higher risk for overall survival in the late stage patients (HR 3.35; 95% CI, 1.73 to 6.49; P < 0.001) compared with the early stage patients (HR 2.41; 95% CI, 1.00 to 5.84; P = 0.051). Conclusion: Together, the MDI could serve as an applicable indicator of the prognosis of HNCs, and complements the predictive values of TNM staging and HPV status. Moreover, the findings of the higher risk of the MDI in the late stage patients supply directions for future studies that microbial modulation might be valuable in survival improvement of HNCs, especially for the late stage patients.

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Rich Patients With Poor Prognosis Get More Treatment

Internal Medicine News ◽

10.1016/s1097-8690(11)70628-x ◽

2011 ◽

Vol 44 (12) ◽

pp. 65

Author(s):

MARY JO M. DALES

Keyword(s):

Poor Prognosis ◽

Patients With Poor Prognosis

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Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: To compensate or not to compensate?

Journal of Orthodontics ◽

10.1177/1465312521991831 ◽

2021 ◽

pp. 146531252199183

Author(s):

Jed Lee ◽

Joanna Johnson ◽

Dirk Bister ◽

Mohsin Chaudhary ◽

Golfam Khoshkhounejad

Keyword(s):

Teaching Hospital ◽

Poor Prognosis ◽

Service Evaluation ◽

Good Prognosis ◽

Final Decision ◽

National Guidelines ◽

High Quality Research ◽

Permanent Molars ◽

First Permanent Molars

Objective: To observe whether paediatric dentists and orthodontists balance and compensate the extraction of first permanent molars (FPMs) in children aged 7–11 years. Design: Service evaluation. Setting: UK dental teaching hospital. Methods: Retrospective analysis of FPM extraction patterns in patients aged 7–11 years that attended for extraction of FPMs from 1 January 2019 to 31 January 2020 (13-month period). Results: A total of 194 patients were included and they collectively had 435 FPMs extracted. No balancing extractions to prevent dental centreline shifts and no lower FPM compensatory extractions were performed. Compensatory extraction of good prognosis upper FPMs were performed in 64% (94/146) of cases to avoid overeruption. Orthodontic input was sought for poor prognosis lower FPMs in 76% of cases compared to 51% for poor prognosis upper FPMs. Conclusion: Compensatory extraction of good prognosis upper FPMs to avoid overeruption appears to be a common practice at Guy’s and St Thomas’ Hospitals. There was also higher demand for orthodontic advice for cases presenting with poor prognosis lower FPMs compared to poor prognosis upper FPMs, which suggests that paediatric dentists may prefer for the final decision on upper FPM compensatory extractions to be made by an orthodontist, even with national guidelines available. More high-quality research on the topic is required to determine the necessity of this practice for achieving optimal long-term oral health in children.

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Prediction of clinical course of bipolar manic depressive illness treated with lithium

Psychological Medicine ◽

10.1017/s0033291700044093 ◽

1980 ◽

Vol 10 (2) ◽

pp. 329-334 ◽

Cited By ~ 26

Author(s):

B. B. Johnston ◽

G. J. Naylor ◽

E. G. Dick ◽

S. E. Hopwood ◽

D. A. T. Dick

Keyword(s):

Atpase Activity ◽

Clinical Response ◽

Poor Prognosis ◽

Clinical Course ◽

Lithium Concentration ◽

Good Prognosis ◽

Depressive Illness ◽

Manic Depressive Illness ◽

Manic Depressive ◽

Depressive Patients

SYNOPSISA group of bipolar manic depressive patients attending a routine lithium clinic were investigated. The results suggest that, when on treatment with lithium, manic depressive patients with a good prognosis tend to have a higher erythrocyte Na-K ATPase and higher plasma and erythrocyte lithium concentrations than those with a poor prognosis. There was no evidence to suggest that the erythrocyte: plasma lithium ratio was useful in predicting clinical response to lithium therapy. There was also a positive correlation between plasma lithium concentration and Na–K ATPase activity, confirming that in manic depressive subjects lithium produces a rise in erythrocyte Na–K ATPase activity.

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