scholarly journals P105 PREVENTION OF INCISIONAL HERNIA WITH A REINFORCED TENSION LINE (RTL) VS PRIMARY SUTURE ONLY IN MIDLINE LAPAROTOMIES: 3 YEARS FOLLOW UP

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Edgard Efren Lozada Hernandez ◽  
Elizabeth Escamilla Chavez ◽  
Leticia Hernandez Villegas
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Cox Regression ◽  
Risk Groups ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Number Needed To Treat ◽  
Primary Suture ◽  
Midline Laparotomy

Abstract Aim “Incisional hernia (IH) has an incidence of 10–23%, which can increase to 38% in specific risk groups. The objective of this study is to report the results at 3 years of follow-up of the use of the reinforced tension line (RTL) technique compared with primary suture only (PSO) closure in the prevention of IH in high-risk patients undergoing laparotomy.” Material and Methods “Open randomized controlled clinical trial. Included were patients older than 18 years who underwent midline laparotomy, emergency or scheduled, who were considered high risk, and who completed 3-year follow-up. The patients were randomized 1:1 to the RTL technique or to PSO. The objective was to report the incidence of IH and the complications associated with the closure method. Intention-to-treat analysis and Cox regression were performed.” Results “A total of 124 patients were randomized; 51 patients from the RTL group and 53 patients from the PSO group finished the 3-year follow-up. The incidence of IH was higher in the PSO group (15/53, 28.3%) than the RTL group (5/51, 9.8%) (p = 0.016, OR 0.35, 95% CI 0.14–0.88, number needed to treat 5.4, log-rank test p = 0.017). The groups were similar in the rates of surgical site infection, hematoma, seroma, and postoperative pain during follow-up.” Conclusions “The RTL technique is useful in the prevention of IH when compared with PSO in high-risk midline laparotomy patients, and it is not associated with a higher percentage of complications. Clinical trials NCT02136628, retrospectively registered”

scholarly journals P106 PROPHYLACTIC MESH FOR PREVENTION OF INCISIONAL HERNIA IN HIGH-RISK PATIENTS: PVDF “VISIBLE” MESH BEHAVIOUR ON MRI

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Beatriz Carrasco Aguilera ◽  
Marina da Silva Torres ◽  
Jose Rodicio ◽  
Ana Fernández del Valle ◽  
Maria Moreno ◽  
...  
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Gastrointestinal Surgery ◽  
Safe Procedure ◽  
Prophylactic Mesh ◽  
Midline Laparotomy ◽  
Linea Alba ◽  
High Risk Patients ◽  
Risk Patients

Abstract Aim According to the guidelines, prophylactic mesh placement appears to be an effective, safe procedure in high-risk patients for the prevention of incisional hernia (IH) after midline laparotomy, without its use being standardized. Knowing its radiological behaviour can resolve doubts about its use. Material and Methods This was a prospective observational cohort study. The included patients needed to have more than one risk factor for IH (age> 60 years old, Body Mass Index > 30kg/m2, diabetes, chronic bronchopathy, heart disease, smoking, kidney disease, neoplasia, liver disease, immunosuppression or an emergency operation). Follow-up included 6-week and 12-month postoperative magnetic resonance imaging (MRI). If MRI was not performed, we used the follow-up computed tomography (CT). Results Between July 2016 and March 2021, 54 patients were enrolled in the study. Surgery was emergent in 14.8% of cases, clean-contaminated in 87% and upper gastrointestinal surgery in 51.9%. A total of 43 MRI and 3 CT at 6-week and 30 MRI and 2 CT at 12-month were carried out. The median of the mesh area were 150.7 vs 150,1cm2 respectively. 91% of cases had the mesh lined to the fascia at 12 months. The bridging in the linea alba was zero in 61% at 6-weeks and 24% at 12-month follow-up, mean 9 vs 19mm (p = 0.001). Conclusions The use of imaging tests to know the postoperative behaviour of a Polyvinylidenfluorid (PVDF) “visible” mesh shows us that there is no mesh contraction at one year or detachment of the fascia, however we observe a significant tendency in the separation of the linea alba.

Application of the French prognostic score (FPS) to assess overall survival (OS) in a U.S.-based cohort of patients (pts) treated with azacitidine (Aza).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7126-7126
Author(s):  
Amer Zeidan ◽  
Zhuoxin Sun ◽  
Thomas Prebet ◽  
Peter Greenberg ◽  
Mark Juckett ◽  
...  
Keyword(s):  
High Risk ◽  
Cox Model ◽  
Prognostic Score ◽  
Performance Status ◽  
Risk Groups ◽  
Therapeutic Interventions ◽  
Rank Test ◽  
Clinical Criteria ◽  
Entire Cohort

7126 Background: In pts with IPSS high-risk myelodysplastic syndrome (HR-MDS), Aza prolonged OS. The FPS was developed for Aza-treated HR-MDS pts based on 4 baseline clinical criteria: Performance status, karyotype, presence of circulating blasts, and RBC transfusion dependency (TD) (Itzykson et al, Blood 2011). The FPS discriminated 3 risk groups [low-risk [LR), intermediate-risk (IR), and high-risk (HR), with significantly different median OS at 32, 15, and 6 months (M), respectively. We sought to validate the FPS in a U.S.-based cohort. Methods: The North American Leukemia Intergroup Trial E1905 randomized 150 pts with MDS, CMML, and AML with dysplastic changes to Aza 50 mg/m2/day (d) for 10 d +/- entinostat (Ent) 4 mg/m2/d on d3 and d10. OS was defined as time from registration to death from any cause, with follow-up censored at last contact. Kaplan-Meier estimates were used for survival distribution. Results: The FPS could be determined for 115 pts. Median follow-up was 48.5 M. The median OS was significantly different between the HR, IR, and LR FPS groups in the 115 pts (9.7, 14.7, 25.3 M, respectively, log Rank test P=0.017), and for pts in Aza arm (n=55) (7.8, 19.3, 26.4 M, respectively, P=0.008), but not for patients in the Aza+Ent arm (n=60) (12.5, 12.4, 24.1 M, respectively, P=0.21). Using multivariate Cox model with WBC count, hemoglobin, disease type, and platelet TD, the prognostic effect of HR vs. LR FPS groups remained significant for the entire cohort (P=0.046) and for the Aza arm (P=0.037). No significant differences in response rates were observed. Conclusions: The FPS warrants further evaluation as a baseline prognostic tool that can define a subgroup of pts with lower probabilities of achieving survival benefit from Aza therapy. Such pts might be considered from alternative therapeutic interventions.

scholarly journals Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

2021 ◽  
Vol 11 (11) ◽  
pp. 1065
Author(s):  
Jia Kou ◽  
Lu-Lu Zhang ◽  
Xing-Li Yang ◽  
Dan-Wan Wen ◽  
Guan-Qun Zhou ◽  
...  
Keyword(s):  
High Risk ◽  
Nasopharyngeal Carcinoma ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Cox Regression ◽  
Risk Group ◽  
Disease Free Survival ◽  
Risk Groups ◽  
Rank Test ◽  
Cox Regression Analysis

(1) Purpose: This study aims to explore risk-adapted treatment for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) according to their pretreatment risk stratification and the degree of comorbidity. (2) Methods: A total of 583 elderly LA-NPC patients diagnosed from January 2011 to January 2018 are retrospectively studied. A nomogram for disease-free survival (DFS) is constructed based on multivariate Cox regression analysis. The performance of the model is evaluated by using the area under the curve (AUC) of the receiver operating characteristic curve and Harrell concordance index (C-index). Then, the entire cohort is divided into different risk groups according to the nomogram cutoff value determined by X-tile analysis. The degree of comorbidities is assessed by the Charlson Comorbidity Index (CCI). Finally, survival rates are estimated and compared by the Kaplan–Meier method and the log-rank test. (3) Results: A nomogram for DFS is constructed with T/N classification, Epstein-Barr virus DNA and albumin. The nomogram shows well prognostic performance and significantly outperformed the tumor-node-metastasis staging system for estimating DFS (AUC, 0.710 vs. 0.607; C-index, 0.668 vs. 0.585; both p < 0.001). The high-risk group generated by nomogram has significantly poorer survival compared with the low-risk group (3-year DFS, 76.7% vs. 44.6%, p < 0.001). For high-risk patients with fewer comorbidities (CCI = 2), chemotherapy combined with radiotherapy is associated with significantly better survival (p < 0.05) than radiotherapy alone. (4) Conclusion: A prognostic nomogram for DFS is constructed with generating two risk groups. Combining risk stratification and the degree of comorbidities can guide risk-adapted treatment for elderly LA-NPC patients.

scholarly journals Oncological results of neoadjuvant chemohormonal therapy in patients with high and very high-risk prostate cancer

2020 ◽  
Vol 16 (1) ◽  
pp. 54-63
Author(s):  
M. V. Berkut ◽  
A. S. Artemjeva ◽  
S. A. Reva ◽  
S. S. Tolmachev ◽  
S. B. Petrov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Specific Antigen ◽  
Risk Groups ◽  
Rank Test ◽  
Chemohormonal Therapy ◽  
Log Rank Test ◽  
Oncological Results ◽  
Very High

Tolsotogo St., Saint Petersburg 197022, RussiaBackground. Prostate cancer (PCa) of a high and very high risk is a potentially fatal disease that requires an active multimodal approach, including the use of neoadjuvant drug treatment. As option for this treatment is neoadjuvant chemohormonal therapy (NCHT) followed by radical prostatectomy (RPE). However, data on the oncological results of treatment of such patients are still limited and the role of neoadjuvant therapy in the treatment of high and very high-risk PCa remains not fully understood.Objective: to assess the oncological results of treatment patients with localized and locally advanced PCa of high and very high risk after NCHT. Materials and methods. This was a prospective randomized study: patients with PCa of high and very high-risk groups (prostate specific antigen levels (PSA) >20 ng/ml and/or Gleason score ³8 and/or clinical stage >T2c) were treated with RPE only (group RPE; n = 35) or NCHT followed by RPE (NCHT/RPE group; n = 36). The neoadjuvant course included the intravenous administration of docetaxel once every 21 days (75 mg/m2 up to 6 cycles) and the antagonist of the gonadotropin releasing hormone degarelix according to the standard scheme (6 subcutaneous injections every 28 days). After a follow-up examination evaluating the result of the neoadjuvant regimen, patients underwent RPE with extanded lymphadenectomy.Results. A mean follow-up was 37.08 ± 20.46 months. A statistically significant reduction of prostate specific antigen >50 % post-chemohormonal therapy was observed in all 36 cases. Lower postoperative stage was noticed in 38.5 % in NCHT/RPE group compared with 2.7 % in RPE group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy – 40 and 25 % (RPE group). Cancerspecific survival was 97.2 % in NCHT/RPE group and 87.56 % in the RP group (p = 0.037), cancer specific survival rate – 91.4 % and 97.2 % respectively (log-rank test p = 0.22). At the same time, no statistically significant differences were obtained in 3-year recurrence free survival between groups: 38.8 % in NCHT/RPE group versus 43.6 % in the RPE group (log-rank test p = 0.36).Conclusion. Conducting NCHT before RPE is a safe and effective strategy in patients with PCa of high and very high risk groups and could improve oncological results.

scholarly journals Disability in people clinically at high risk of psychosis

2010 ◽  
Vol 197 (4) ◽  
pp. 278-284 ◽  
Author(s):  
Eva Velthorst ◽  
Dorien H. Nieman ◽  
Don Linszen ◽  
Hiske Becker ◽  
Lieuwe de Haan ◽  
...  
Keyword(s):  
High Risk ◽  
Help Seeking ◽  
Cox Regression ◽  
World Health ◽  
Disability Assessment ◽  
Community Activities ◽  
Transition Group ◽  
The World ◽  
Health Organization

BackgroundDecline in social functioning occurs in individuals who later develop psychosis.AimsTo investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition.MethodProspective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS–II).ResultsAt baseline, the transition group displayed significantly greater difficulties in making new friends (z =−3.40, P = 0.001), maintaining a friendship (z =−3.00, P = 0.003), dealing with people they do not know (z =−2.28, P = 0.023) and joining community activities (z =−2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (β = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238–2.550).ConclusionsCertain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.

Survival Outcomes for Induction vs Adjuvant Chemotherapy in Squamous Cell Carcinoma of the Maxillary Sinus

2018 ◽  
Vol 160 (4) ◽  
pp. 658-663 ◽  
Author(s):  
Phoebe Kuo ◽  
Sina J. Torabi ◽  
Dennis Kraus ◽  
Benjamin L. Judson
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Maxillary Sinus ◽  
Induction Chemotherapy ◽  
Squamous Cell ◽  
Cox Regression ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Log Rank Test ◽  
Kaplan Meier

Objective In advanced maxillary sinus cancers treated with surgery and radiotherapy, poor local control rates and the potential for organ preservation have prompted interest in the use of systemic therapy. Our objective was to present outcomes for induction compared to adjuvant chemotherapy in the maxillary sinus. Study Design Secondary database analysis. Setting National Cancer Database (NCDB). Subjects and Methods In total, 218 cases of squamous cell maxillary sinus cancer treated with surgery, radiation, and chemotherapy between 2004 and 2012 were identified from the NCDB and stratified into induction chemotherapy and adjuvant chemotherapy cohorts. Univariate Kaplan-Meier analyses were compared by log-rank test, and multivariate Cox regression was performed to evaluate overall survival when adjusting for other prognostic factors. Propensity score matching was also used for further comparison. Results Twenty-three patients received induction chemotherapy (10.6%) and 195 adjuvant chemotherapy (89.4%). The log-rank test comparing induction to adjuvant chemotherapy was not significant ( P = .076). In multivariate Cox regression when adjusting for age, sex, race, comorbidity, grade, insurance, and T/N stage, there was a significant mortality hazard ratio of 2.305 for adjuvant relative to induction chemotherapy (confidence interval, 1.076-4.937; P = .032). Conclusion Induction chemotherapy was associated with improved overall survival in comparison to adjuvant chemotherapy in a relatively small cohort of patients (in whom treatment choice cannot be characterized), suggesting that this question warrants further investigation in a controlled clinical trial before any recommendations are made.

scholarly journals Triglyceride glucose-body mass index in identifying high-risk groups of pre-diabetes

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chunyuan Jiang ◽  
Ruijuan Yang ◽  
Maobin Kuang ◽  
Meng Yu ◽  
Mingchun Zhong ◽  
...  
Keyword(s):  
Body Mass Index ◽  
High Risk ◽  
Diagnostic Criteria ◽  
Body Mass ◽  
Cox Regression ◽  
Risk Groups ◽  
World Health ◽  
Obese People ◽  
Cox Regression Analysis ◽  
Health Organization

Abstract Background Triglyceride glucose-body mass index (TyG-BMI) has been recommended as an alternative indicator of insulin resistance. However, the association between TyG-BMI and pre-diabetes remains to be elucidated. Methods More than 100,000 subjects with normal glucose at baseline received follow-up. The main outcome event of concern was pre-diabetes defined according to the diagnostic criteria recommended by the American Diabetes Association (ADA) in 2018 and the World Health Organization (WHO) in 1999. A Cox proportional hazard regression model was used to evaluate the role of TyG-BMI in identifying people at high risk of pre-diabetes. Results At a mean observation period of 3.1 years, the incidence of pre-diabetes in the cohort was 3.70 and 12.31% according to the WHO and ADA diagnostic criteria for pre-diabetes, respectively. The multivariate Cox regression analysis demonstrated that TyG-BMI was independently positively correlated with pre-diabetes, and there was a special population dependence phenomenon. Among them, non-obese people, women and people under 50 years old had a significantly higher risk of TyG-BMI-related pre-diabetes (P-interaction< 0.05). Conclusions These findings suggest that a higher TyG-BMI significantly increases an individual’s risk of pre-diabetes, and this risk is significantly higher in women, non-obese individuals, and individuals younger than 50 years of age.

scholarly journals Development and Verification of the Hypoxia- and Immune-Associated Prognostic Signature for Pancreatic Ductal Adenocarcinoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Dongjie Chen ◽  
Hui Huang ◽  
Longjun Zang ◽  
Wenzhe Gao ◽  
Hongwei Zhu ◽  
...  
Keyword(s):  
High Risk ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Risk Score ◽  
Cox Regression ◽  
Pearson Correlation ◽  
Risk Groups ◽  
Low Risk ◽  
Ductal Adenocarcinoma ◽  
Prognostic Signature ◽  
Score Model

We aim to construct a hypoxia- and immune-associated risk score model to predict the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC). By unsupervised consensus clustering algorithms, we generate two different hypoxia clusters. Then, we screened out 682 hypoxia-associated and 528 immune-associated PDAC differentially expressed genes (DEGs) of PDAC using Pearson correlation analysis based on the Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression project (GTEx) dataset. Seven hypoxia and immune-associated signature genes (S100A16, PPP3CA, SEMA3C, PLAU, IL18, GDF11, and NR0B1) were identified to construct a risk score model using the Univariate Cox regression and the Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression, which stratified patients into high- and low-risk groups and were further validated in the GEO and ICGC cohort. Patients in the low-risk group showed superior overall survival (OS) to their high-risk counterparts (p &lt; 0.05). Moreover, it was suggested by multivariate Cox regression that our constructed hypoxia-associated and immune-associated prognosis signature might be used as the independent factor for prognosis prediction (p &lt; 0.001). By CIBERSORT and ESTIMATE algorithms, we discovered that patients in high-risk groups had lower immune score, stromal score, and immune checkpoint expression such as PD-L1, and different immunocyte infiltration states compared with those low-risk patients. The mutation spectrum also differs between high- and low-risk groups. To sum up, our hypoxia- and immune-associated prognostic signature can be used as an approach to stratify the risk of PDAC.

scholarly journals Does pre-emptive onlay mesh reinforcement of midline laparotomies reduce incidence of incisional hernia in high–risk patients?

2019 ◽  
Vol 6 (7) ◽  
pp. 2300
Author(s):  
Hosam F. Abdelhameed ◽  
Samir A. Abdelmageed
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Chronic Wound ◽  
Midline Laparotomy ◽  
High Risk Patients ◽  
Wound Pain ◽  
Risk Patients ◽  
Onlay Mesh ◽  
Group 2 ◽  
Group 1

Background: One of the major morbidity after abdominal surgery is incisional hernia. In high risk patients its incidence reaches 11-20% despite various optimal closure techniques for midline laparotomy. Our aim is to evaluate the efficacy of onlay mesh placement in reducing the incidence of incisional hernia in those high risk patients.Methods: A total of 65 high risk patients suspected to develop post-operative incisional hernia underwent midline abdominal laparotomies. Patients were divided into two groups; group1 (30 patients) for whom the incision was closed by conventional method and group2 (35 patients) for whom the incision was closed with reinforcement by onlay polypropylene mesh. The primary end point was the occurrence of incisional hernia while the secondary end point was post-operative complications including subcutaneous seroma, chronic wound pain, and surgical site infection (SSI). Patients were followed up for two years.Results: The base line characteristics of the two groups were similar. The incidence of incisional hernia is significantly reduced 1/35 (2.8%) in group 2 while it was 6/30 (20%) in group 1. As regard seroma and chronic wound pain they increased in (group2) 6/35 (17.14%) and 5/35(14.28%) respectively compared to (group 1) which was 4/30 (13.33%) and 2/30 (6.66%). SSI occurred in 1/35 (2.85%) in group 2 and in 1/30 (3.33%) in group 1.Conclusions: Prophylactic onlay mesh reinforcement of the midline laparotomy for high risk patients can be used safely and markedly reduces the incidence of incisional hernia with little morbidity.

scholarly journals Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes and complications

2019 ◽  
Author(s):  
Young Suk Suk Kwon ◽  
Wei Wang ◽  
Arnav Srivast ◽  
Thomas L Jang ◽  
Singer A Eric ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Cox Regression ◽  
Survival Outcomes ◽  
Study Cohort ◽  
High Risk Prostate Cancer ◽  
Pathologic Features ◽  
Risk Prostate Cancer

Abstract Introduction: While early radiotherapy (eRT) after radical prostatectomy (RP) has shown to improve oncologic outcomes in patients with high-risk prostate cancer (PCa) in a recent clinical trial, controversy remains regarding its benefit. We aimed to illustrate national trends of post-RP radiotherapy and compare outcomes and toxicities in patients receiving eRT vs. observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥ pT3N0 and/or positive surgical margins). Our study cohort was consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (IRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both IRT and observation. Trends of post-RP radiotherapy were compared using the Cochran-Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan-Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk PCa after RP, 12.7% (n=959), 13.2% (n=1710), and 74.1% (n=4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p=0.004). Multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Radiation related toxicities, including urinary incontinence, erectile dysfunction, and urethral stricture, were higher in the eRT group when compared to the lRT group. Conclusions: Our results suggest that a blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.

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