Follow-up and symptom persistence after esophageal food impaction

2021 ◽  
Author(s):  
Kent Rosenwald ◽  
Zhaoxing Pan ◽  
Rachel Andrews ◽  
Calies Menard-Katcher
Keyword(s):  
Multivariate Analysis ◽  
Telephone Survey ◽  
Symptom Burden ◽  
Factors Associated ◽  
Esophageal Food Impaction ◽  
Care Outcomes ◽  
Modifiable Factor ◽  
Multiple Variables ◽  
Pediatric Subspecialty

Abstract Esophageal food impactions (EFI) are associated with esophageal pathology, most commonly eosinophilic esophagitis (EoE). Obtaining biopsies provides opportunity for diagnosis, which is important since treatment of EoE decreases the risk for future EFI. Outpatient follow-up rates remain suboptimal and outcomes of patients without timely follow-up are unknown. We aimed to identify the factors associated with pediatric subspecialty follow-up post-EFI and to determine the symptom burden in patients without follow-up. We performed a retrospective review of patients presenting with EFI at a tertiary children’s hospital between 2010 and 2018. Patients without subspecialty follow-up within 1 year of EFI were included in a prospective telephone survey investigating the barriers to care, outcomes, and symptoms. Clinical characteristics were compared between groups. Multivariate analysis was used to control for multiple variables. There were 127 EFI identified in 123 individuals (73% male, mean age: 12.2 years). Esophageal biopsies were collected in 76% of cases, and 49% of patients had follow-up. Individuals with follow-up were more likely (P ≤ 0.05) to have had biopsies. In a multivariate analysis, written recommendation for follow-up (Odds Ratio: 6.9 [2.4–19.5], P = 0.001) as well as atopic history and identified stricture were associated with a higher likelihood of follow-up. Those without follow-up had subsequent stricture (35%), dilation (44%), or EFI (39%), and 55% (12/22) described ongoing esophageal symptoms. Identification of treatable findings at time of EFI and ongoing symptom burden after EFI support an imperative for follow-up after EFI. Clear recommendations are a modifiable factor that may improve follow-up in this population.

Factors associated with regression of cervical dysplasia in adolescents: A retrospective study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5582-5582
Author(s):  
C. Chen ◽  
F. Campbell ◽  
J. Patruno ◽  
S. Kimmel ◽  
R. Boulay ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pap Smear ◽  
Demographic Data ◽  
Cervical Dysplasia ◽  
Smoking History ◽  
Pap Smears ◽  
Factors Associated ◽  
Increased Risk ◽  
Chi Square Analysis

5582 Background: Sexually active adolescents have high rates of infection with human papilloma virus (HPV) and abnormal pap smears. They are considered a special population as they are likely to regress to normal cytology. The aim of our study was to identify factors associated with regression of cervical dysplasia in adolescents. Methods: We identified adolescent patients (aged 12–21 years) who had abnormal pap smears at the Center for Women's Medicine at Lehigh Valley Hospital in Allentown, PA, by CPT code from a database between Jan 2004 and Dec 2006. A chart review was performed to capture demographic data, cytology, smoking history, number of sexual partners, parity, race, contraceptive choice, use of barrier contraception. Chi-square analysis with logistic regression and multivariate analysis were used to identify factors associated with regression of cervical dysplasia. Results: Two-hundred two patients were identified. Mean age was 18.84 years (14–22 years). One hundred twenty-two (57.8%) were Hispanic, 71 (33.6%) Caucasian, and 16 (7.6%) Black. Fifty-two (24.6%) were pregnant at the time of diagnosis. Seventy-six (36%) were smokers. There were 125 (61.9%) cases of ASCUS, 33.7% (68 cases) LGSIL and 4.5% (9 cases) HGSIL on initial pap smear. One hundred eighteen (55.9%) patients had colposcopy, and of these, 32 (15.2%) had surgical intervention. Follow-up demonstrated that 72 (57.6%) patients had disease regression, 24 (19.2%) persistence and 29 (23.2%) progression. On multivariate analysis, patients who did not smoke were significantly more likely to show regression of cervical dysplasia on pap smear than women who smoked (OR 2.17, 95% CI 1.03–4.55, p = 0.039). Other factors were not statistically significant in predicting regression of cervical dysplasia. Conclusions: Adolescents who smoke were more likely to have persistent cervical dysplasia than non-smoking adolescents, putting smokers at an increased risk of advanced disease. We suggest that this subset have follow-up at shorter intervals and be enrolled in a smoking cessation program. No significant financial relationships to disclose.

scholarly journals OP0052 FACTORS ASSOCIATED WITH REMISSION AT 5 YEARS OF FOLLOW-UP IN EARLY ONSET AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE DESIR COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 27.1-28
Author(s):  
L. Pina Vegas ◽  
E. Sbidian ◽  
D. Wendling ◽  
P. Goupille ◽  
S. Ferkal ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Activity Index ◽  
Sensitivity Analyses ◽  
Factors Associated ◽  
Tnfα Inhibitors ◽  
Baseline Factors ◽  
Active Disease

Background:The disease course of axial SpA (axSpA) is highly variable and can be characterized by ongoing axial inflammation and radiographic progression associated with restricted mobility of the spine, reduced function and disability leading to impairment in quality of life. Control of disease activity is a primary aim in axSpA management. To assess disease activity the Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) is often considered as a reference tool. The data on remission are spare in axSpA and the identification of long-term remission factors, enabling the patient’s management to be adapted, seems necessary but remains unclear.Objectives:To evaluate the proportion of patients in remission according to ASDAS-CRP at 5 years of follow-up, to describe their characteristics in comparison with patients with active disease at that time, and to identify baseline factors associated with remission at 5 years of follow-up.Methods:We included all patients from the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort with available data on ASDAS-CRP at 5-year follow-up and TNFα inhibitors exposure. Patients in remission, defined as an ASDAS-CRP<1.3, and with active disease were compared according to their main demographic, clinical, biological and radiological characteristics. A logistic model stratified on TNFα inhibitors exposure was used in the main analysis. Sensitivity analyses among patients with axSpA diagnosis confirmed by rheumatologist at 5-years were performed.Results:A total of 614 patients were followed in the DESIR cohort at M60. After excluding those with missing data on ASDAS score (n= 163) and TNFα inhibitors exposure (n= 2), analyzed patients were 449 (73%). Excluded patients had similar baseline characteristics to those included in the analysis. Among patients unexposed to TNFα inhibitors (n=247), 77 (31%) were in remission (37,8±8,3 years; 55% men, 58% NSAID users), 170 (69%) weren’t (39,8±8,6 years; 42% men, 81% NSAID users). Among exposed patients (n=202), 34 (17%) were in remission (36,1±8,1 years; 71% men, 29% NSAID users), 168 (83%) weren’t (39,5±9,0 years; 41% men, 63% NSAID users) (Figure 1). Overall, patients in remission were more frequently men, HLA-B27+, with high education and lower BMI at 5-year of follow-up. The baseline factors associated with remission at 5 years of follow-up from the multivariate analysis are presented in Table 1.Table 1.Baseline factors associated with remission at 5-year follow-up (multivariate analysis)TNFα: Tumor Necrosis Factor alpha; ORa: adjusted Odd Ratio; 95%IC: 95% confidence interval; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BMI: Body Mass Index.Conclusion:The overall remission rate at 5 years was 25%, 31% among patients unexposed to TNFα inhibitors and 17% among those exposed. This study reveals the difficulty in achieving 5-year remission in recent axSpA, especially in the most active forms at baseline; socio-educational factors and overweight also appear to be related.Acknowledgements:L Pina Vegas received a Master 2 grant from the French Society of Rheumatology (Bourse Master 2ème Année 2019)Disclosure of Interests:Laura Pina Vegas: None declared, Emilie Sbidian: None declared, Daniel Wendling: None declared, Philippe Goupille: None declared, Salah Ferkal: None declared, Philippe Le Corvoisier: None declared, Bijan Ghaleh: None declared, Alain Luciani: None declared, Pascal Claudepierre Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, Pfizer, Roche-Chugai, Bristol-Myers Squibb, MSD, UCB, Novartis, Janssen, Lilly, Celgene (consulting fees, less than 10,000 $ each)., Employee of: Roche Chugai, Sanofi Aventis, Celgene, Pfizer, MSD, Novartis and BMS (investigator).

scholarly journals SURG-11. Surgery for control of brain metastases after prior checkpoint inhibitor immunotherapy: a single-center series

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii25-iii26
Author(s):  
Ramin Morshed ◽  
Jason Chung ◽  
Vivek Sudhakar ◽  
Daniel Cummins ◽  
Jacob Young ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Checkpoint Inhibitor ◽  
Leptomeningeal Disease ◽  
Single Center ◽  
Factors Associated ◽  
Local Progression ◽  
Inhibitor Treatment

Abstract Background Despite the promising results for treating metastatic cancer with checkpoint inhibitor immunotherapies, there are limited data on surgical outcomes for brain metastases (BMs) that have progressed after prior checkpoint inhibitor treatment. The objective of this study was to identify factors associated with local progression, leptomeningeal disease, and survival for patients undergoing surgical resection of a BM in patients previously treated with checkpoint inhibitor immunotherapy. Methods A retrospective, single-center cohort study was conducted with inclusion of adult patients undergoing surgical resection of a BM in the setting of progression after prior checkpoint inhibitor treatment. Univariate and multivariate analyses were performed to identify factors associated with outcomes of interest. Results Over an 8-year period, 26 patients who underwent resection of 30 BMs met inclusion criteria. Median patient age at surgery was 63.9 years, and median clinical follow-up was 6.9 months (range 0.1 – 52.9). Extracranial disease was present at the time of surgery in 73.3% of cases. There were 6 postoperative complication events (20% of cases) by 30-days. By last follow-up, 65.4% of the cohort had died with a median censored survival of 7.6 months from surgery. Eight patients (30.8%) died within 3 months of surgery. On multivariate analysis, postoperative complications were associated with worse survival (HR 5.33, 95%CI 1.15–24.77, p=0.03). Four BMs had local progression (13.3%), and 60% of procedures were associated with distant progression within a median time of 3.6 months. Leptomeningeal disease developed in 32% of cases. On multivariate analysis, increased time from BM diagnosis to surgery was associated with a greater risk of leptomeningeal disease (OR 1.2, 95%CI 1.00–1.43, p=0.021). Conclusion Patients who require BM resection after prior checkpoint inhibitor treatment have an overall poor prognosis. Although local control rates are acceptable, these patients are at high risk for developing leptomeningeal disease postoperatively.

scholarly journals Allogeneic Hematopoietic Stem Cell Transplantation for Primary Refractory Acute Lymphoblastic Leukemia - a Report from the Acute Leukemia Working Party of the EBMT

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4668-4668
Author(s):  
Jiří Pavlů ◽  
Myriam Labopin ◽  
Johanna Tischer ◽  
Ioanna Sakellari ◽  
Matthias Stelljes ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Prognostic Factor ◽  
Board Of Directors ◽  
Acute Gvhd ◽  
Lymphoblastic Leukemia ◽  
Advisory Committees ◽  
Factors Associated

Abstract Patients with acute lymphoblastic leukemia (ALL) who are refractory to initial and re-induction chemotherapy have a dismal prognosis unless they undergo allogeneic hematopoietic cell transplantation (HCT). Due to a lack of studies investigating primary refractory (PREF) ALL there are no known factors potentially influencing transplantation outcomes in these patients. We believe it is important to identify these factors and clarify outcomes of HCT in PREF ALL in this era of novel therapies for chemo-refractory ALL. The outcomes of 86 adult patients who underwent their first HCT for PREF ALL between 2000 and 2012 were reported to the European Society for Blood and Marrow Transplantation (EBMT) Registry. PREF disease was defined as failure to achieve complete remission (CR, <5% of blasts in the bone marrow) after two or more courses of induction chemotherapy. A total of 70 patients were transplanted using a myeloablative conditioning regimen, of whom 52 received a total body irradiation (TBI)-based regimen (median dose 12 Gy; range: 8-14). Sixteen patients were transplanted using a reduced-intensity conditioning (RIC) regimen, as defined by the EBMT criteria. In 6 patients, the RIC regimen incorporated TBI at a dose of 6 Gy or less. In vivo T-cell depletion was used in 28 (33%) patients (anti-thymocyte globulin was used in all but 6 who received alemtuzumab). The median duration of follow-up in live patients was 106 months (range 9-181 months). Study main endpoints were survival, CR rate, leukemia free survival (LFS), and non-relapse mortality (NRM). A total of 76 (89%) patients demonstrated neutrophil engraftment at a median of 18 days (9-87) and 9 (11%) patients experienced primary graft failure. Grade II or higher acute GVHD was documented in 28 (34%) patients, while 14 (17%) patients experienced grade III/IV acute GVHD. Chronic GVHD of any severity developed in 27 (32%) patients of those surviving more than 100 days. With a median follow-up of 106 months, 20 patients were alive and free of leukemia. The probability of survival (Figure A) for the whole group was 36% (95% confidence interval (CI) 25 - 46) at 2 years and 23% (95% CI 13 - 32) at 5 years. The probabilities of LFS and NRM at 2 and 5 years were 28% (95% CI 18 - 38) and 17% (95% CI 8 - 25) and 20% (95% CI 12 - 29) and 29% (95% CI 19 - 39), respectively. In all, 66 (76%) patients achieved CR after transplant at a median time of 31 days (28 - 147 days). For patients achieving CR, the survival was 36% (95% CI 25 - 46) and 29% (95% CI 18 - 41) and relapse incidence was 51% (95% CI 38 - 63) and 54% (95% CI 41 - 66) at 2 and 5 years, respectively. The following factors associated with improved survival and LFS with P <0.10 in univariate analysis entered multivariate analysis: the use of TBI, absence of extramedullary disease, no more than 2 induction courses, male sex, and infusion of female cells into male recipient. In multivariate analysis, use of TBI was associated with improved survival (Hazard Ratio (HR) 0.53; 95% CI 0.29-0.973; P=0.04), (Figure B). Similarly, factors associated with improved LFS were: use of TBI (HR 0.44; 95% CI 0.24-0.82; P=0.01) and infusion of female hematopoietic cells into male recipient (HR 0.45; 95% CI 0.23-0.90; P=0.01). Presence of extramedullary disease was associated with increased NRM (HR 4.92; 95% CI 1.85-13.02; P=0.001). We developed a score using the summation of the number of prognostic factors found to be significant for LFS by multivariate analysis: use of TBI and infusion of female hematopoietic cells into male recipient. This allows delineation of three prognostic groups as follows: score 0 (both prognostic factors present): (N=14), 5 year survival: 57% (95% CI 31 - 83) and 5 year LFS: 50% (95% CI 24 - 76); score 1 (only 1 prognostic factor): (N=45), 5 year survival: 22% (95% CI 9 - 34); and 5 year LFS 12% (95% CI 2 - 22); score 2 (no prognostic factor): (N=24), 5 year survival and LFS: 8 (95% CI 0 - 19) (Figure C). In conclusion, our data support the use of allogeneic HCT in selected patients with PREF ALL who cannot reach CR. Conditioning regimens should contain TBI and male patients may benefit from a female donor. Clearly there is a need for introduction of modern therapies capable of improving anti-leukemic control prior to and after transplantation. Figure 1 Figure 1. Disclosures Stelljes: Pfizer: Consultancy. Fanin:Novartis: Speakers Bureau. Bloor:Janssen: Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; GSK: Consultancy, Speakers Bureau; Gilead: Honoraria; Abbvie: Membership on an entity's Board of Directors or advisory committees.

Clinical Significance of Severity and Subcategory of Chronic GVHD Evaluated by NIH Consensus Criteria.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2218-2218
Author(s):  
Takayuki Sato ◽  
Tatsuo Ichinohe ◽  
Junya Kanda ◽  
Kouhei Yamashita ◽  
Tadakazu Kondo ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Significance ◽  
Chronic Gvhd ◽  
Overlap Syndrome ◽  
Regression Analyses ◽  
Severity Scoring ◽  
Factors Associated ◽  
High Risk Disease ◽  
Nih Consensus Criteria

Abstract Abstract 2218 Poster Board II-195 Introduction: Chronic GVHD (cGVHD) represents a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-SCT). Recently, NIH consensus criteria were proposed to standardize the diagnosis and global assessment of cGVHD with a new severity scoring system based on organ-specific manifestations taking functional impact into account. However, clinical significance of this grading system is not fully established although several studies have shown its impact on post-GVHD survival. Patients and Methods: We retrospectively evaluated the incidence and outcome of cGVHD defined by NIH consensus criteria in 294 patients with hematologic disorders who consecutively underwent allo-SCT between January 2000 and December 2008 at our department. After excluding patients who received two allogeneic transplants, rejected graft, died or relapsed before day 100 after allo-SCT, and received donor lymphocyte infusion before day 100, a total of 213 patients with a median age of 46 (range 17-69) years, 120 males and 93 females, were evaluated in the study; 113 had myeloid neoplasms, 93 had lymphoid neoplasms, and the remaining 7 had non-malignant diseases. Non-malignant disease and hematologic malignancy in fist complete remission, first chronic phase or without prior chemotherapy were classified as standard risk disease (n=107). All other disease statuses were classified as high risk disease (n=106). A total of 129 patients received myeloablative conditioning and 84 received reduced-intensity regimens. Stem cell sources included peripheral blood (n=44) or bone marrow (n=62) from related donors, and bone marrow (n=91) or cord blood (n=16) from unrelated donors. Diagnosis and global scoring of cGVHD were performed according to NIH consensus criteria. cGVHD-specific survival (cGSS) was defined as the length from the day of cGVHD diagnosis to the day of death, relapse, or last follow-up. Competing risk regression analyses were used to evaluate risk factors associated with development of cGVHD and time from diagnosis of cGVHD to discontinuation of systemic immunosuppressive therapy (IST). Multivariate Cox regression analyses were used to evaluate factors associated with cGSS. Results: After a median follow-up of 1133 days (range 101-3396 days), 96 patients developed diagnostic or distinctive manifestations of cGVHD according to NIH consensus criteria with a median time to diagnosis of 205 days (range 64-911 days); 77 (80%) patients were subcategorized into classic cGVHD and 19 (20%) into overlap syndrome. In multivariate analysis, the prior occurrence of grade 2-4 acute GVHD (hazard ratio [HR]=1.50, 95% confidence interval [CI]=1.01-2.24, p=0.047) was significantly associated with the development of cGVHD. Four-year probabilities of cGSS among the patients with classic cGVHD and overlap syndrome were 88% and 63%, respectively, while those among patients graded to have mild (n=20; 21%), moderate (n=53; 55%) and severe cGVHD (n=23; 24%) were 100%, 86%, 62%, respectively. Patients with overlap syndrome had marginally lower cGSS as compared to those with classic cGVHD (HR=2.77, 95%CI=0.96-7.98, p=0.06), while patients with severe cGVHD had significantly lower cGSS as compared to those with mild or moderate cGVHD (HR=3.11, 95%CI=1.09-8.87, p=0.034) in multivariate analysis. Among 82 patients who received systemic IST as initial treatment of cGVHD, the probability of withdrawal of systemic IST at 2 years was 36 %. Multivariate analysis revealed that the use of corticosteroid at cGVHD diagnosis (HR=0.40, 95%CI=0.19-0.84, p=0.015) and high risk disease status at transplant (HR=0.39, 95%CI=0.20-0.77, p=0.007) were significantly associated with prolonged systemic IST. Conclusions: Our results suggest that the global severity scoring and subcategory of cGVHD evaluated by NIH consensus criteria have prognostic value for predicting cGSS among Japanese patients with cGVHD, implying the applicability of these criteria for the study encompassing participants from various ethnic backgrounds. Larger and prospective studies are warranted to more precisely validate clinical significance of NIH consensus criteria for cGVHD. Disclosures: No relevant conflicts of interest to declare.

Higher Non-Relapse Mortality with BuCyVP Compared to BuCy In Allogeneic Hematopoietic Stem Cell Transplant

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1340-1340
Author(s):  
Hien Duong ◽  
Brian J. Bolwell ◽  
Lisa Rybicki ◽  
Matt Kalaycio ◽  
Steven Andresen ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Comorbidity Score ◽  
Factors Associated ◽  
High Comorbidity

Abstract Abstract 1340 We analyzed results of allogeneic hematopoietic stem cell transplantation from 1/2000 to 1/2009 in 520 adult patients, receiving either bone marrow or peripheral stem cells, in order to identify factors associated with non-relapse mortality (NRM). Median age at transplant was 47 years (range 18–70). Median follow up was 43 months (range 5–122 months). Two hundred eighty four (55%) patients were male. Diagnoses included: acute myeloid leukemia 210 (40%), acute lymphoblastic leukemia 68 (13%), myelodysplastic syndrome 66 (13%), non-Hodgkin or Hodgkin lymphoma 64 (12%), chronic myelogenous leukemia 45 (9%), or other (13%). High scores (≤3) on hematopoietic cell transplant-specific comorbidity index were identified in 162 (31%) patients. For preparative regimens, 187 (36%) received BuCy (busulfan 1mg/kg oral given every 6 hours × 16 doses days -8 to -4, followed by cyclophosphamide 60mg/kg × 2 days -3 to -2), 91 (18%) received BuCyVP (busulfan 1mg/kg oral every 6 hours × 16 doses days -9 to -5, followed by etoposide 60mg/kg days -5 to -4, then cyclophosphamide 60mg/kg days -3 to -2), 225 (43%) received TBI-based therapy, and 17 (3%) received other therapy. Two hundred ninety five (57%) underwent related transplant. A majority (67%) received stem cells derived from bone marrow. In univariable analysis, male recipient (p=0.07), high comoborbidity score (p=0.004), more prior chemothepary regimens (p=0.037), BuCyVP (p<0.001) or TBI-based preparative regimen (relative to BuCy, p=0.045) and unrelated donor (p=.001) were associated with high NRM. In multivariate analysis, male recipient (p=0.008), high comorbidity score (p=0.002), and BuCyVP compared to BuCy (p<0.001) remained independent risk factors for NRM. There were no significant differences in the proportions of identified cause of death between regimens. Figure 1 illustrates the sustained influence of preparative therapy on NRM: Factors associated with poor overall survival (OS) and relapse-free survival (RFS) on multivariate analysis included male recipient (p=0.001, p=0.003, respectively), older age at transplant (p=0.048 for RFS), high comorbidity score (p<0.001, p<0.001), more prior chemotherapy regimens (per 1 regimen increase, p=0.22, p=0.02 respectively), and BuCyVP compared to BuCy (p=0.007, p=0.021). Long-term follow-up of a large cohort of patients indicates that compared to BuCy, BuCyVP is associated with significantly higher NRM and lower OS and RFS. Disclosures: Sweetenham: Pfizer: Research Funding.

Risk of multiple sclerosis after a first demyelinating syndrome in an Australian Paediatric cohort: clinical, radiological features and application of the McDonald 2010 MRI criteria

2013 ◽  
Vol 19 (13) ◽  
pp. 1749-1759 ◽  
Author(s):  
Esther M Tantsis ◽  
Kristina Prelog ◽  
Fabienne Brilot ◽  
Russell C Dale
Keyword(s):  
Multiple Sclerosis ◽  
Multivariate Analysis ◽  
Sensitivity And Specificity ◽  
Early Recognition ◽  
New South ◽  
New South Wales ◽  
Radiological Features ◽  
South Wales ◽  
Multiple Variables

Background: The risk of multiple sclerosis (MS) is dependent on multiple variables, including geographical location. There is increasing interest in the early recognition and treatment of MS in children. Method: Using univariate and multivariate analysis, we determined the clinical and radiological features that were predictive of MS in 88 children from New South Wales, Australia, with a first acute demyelinating syndrome (ADS) who were followed for a minimum of one year. We tested the McDonald, KIDMUS, Callen and Verhey MRI criteria for paediatric MS. Results: After a mean follow-up of 5.2 years, 13/88 (15%) of children had MS. Using multivariate analysis, preceding infection was protective of MS, and corpus callosal lesions, the combined presence of both well and poorly demarcated lesions, and contrast-enhancing lesions on MRI were predictive of MS. The sensitivity and specificity of the respective radiological criteria were McDonald 2005 (69%, 68%), McDonald 2010 (58%, 95%), KIDMUS (8%, 100%), Callen (69%, 85%) and Verhey (62%, 84%). When McDonald 2010 criteria were applied to baseline and serial scans, the sensitivity and specificity was 91% and 93%. Conclusion: Despite the long follow-up, the risk of MS appears lower in New South Wales children compared to previously reported cohorts. Radiological features are more predictive than clinical features in predicting MS. The McDonald 2010 criteria performed well although the dissemination in time criteria on baseline scans is difficult to apply to children with encephalopathy.

scholarly journals Progression of the Psychological ACL-RSI Score and Return to Sport After Anterior Cruciate Ligament Reconstruction: A Prospective 2-Year Follow-up Study From the French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study (FAST)

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881281 ◽  
Author(s):  
Mansour Sadeqi ◽  
Shahnaz Klouche ◽  
Yoann Bohu ◽  
Serge Herman ◽  
Nicolas Lefevre ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Multivariate Analysis ◽  
Acl Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Cruciate Ligament Reconstruction ◽  
Factors Associated ◽  
Anterior Cruciate

Background: Successful return to sport after anterior cruciate ligament (ACL) reconstruction requires optimal physical and psychological recovery. The main validated tool to quantify a patient’s psychological readiness to return to sport after this surgery is the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale. Purpose: The primary aim was to analyze the progression of the ACL-RSI score from preoperatively to 2-year follow-up. A secondary goal was to identify the factors associated with returning to the same preinjury sport. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective study included athletes older than 16 years in all sports and levels of play who underwent primary and revision isolated ACL reconstruction from 2012 to 2015 and responded to all study questionnaires at 2-year follow-up. The primary outcome was the ACL-RSI score obtained preoperatively and at 4-month, 6-month, 1-year, and 2-year follow-up. The secondary outcomes were return to sport (running and the same preinjury sport) and various functional scores. The optimal threshold value of the ACL-RSI score for returning to the same preinjury sport was determined with the receiver operating characteristic curve. Multivariate analysis was performed to identify other factors associated with returning to the same sport at 2-year follow-up. Results: A total of 681 patients were analyzed (467 men, 214 women; mean age, 30.2 ± 9.5 years); 298 (43.8%) patients were professional or competitive athletes. The ACL-RSI score improved significantly over time: 41.3 ± 25.4 preoperatively, 55.1 ± 21.3 at 4 months, 58.3 ± 22.3 at 6 months, 64.7 ± 24.2 at 1 year, and 65.2 ± 25.3 at 2 years ( P < .00001). At 2-year follow-up, 74.9% of patients had returned to running and 58.4% to their same preinjury sport. The ACL-RSI score was significantly higher in patients who had returned to sport and in those who returned to the same level of play or higher ( P < .00001). The optimal ACL-RSI score threshold to return to the same sport at 2-year follow-up was ≥65. Multivariate analysis showed that the predictive factors of returning to the same preinjury sport at 2-year follow-up were primary reconstruction, professional or competitive level of play, an ACL-RSI score ≥60 at 6-month follow-up, and the absence of postoperative complications. Conclusion: The psychological ACL-RSI score improved regularly after ACL reconstruction and was strongly and significantly associated with return to sport. Registration: NCT02511158 ( ClinicalTrials.gov identifier)

scholarly journals Pre- and postoperative need for pituitary hormone replacement in non-adenomatous sellar and parasellar lesions: importance of the sellar encroachment score

2020 ◽  
Vol 162 (10) ◽  
pp. 2371-2379
Author(s):  
Mueez Waqar ◽  
Shiva Rampersad ◽  
David Bennett ◽  
Tara Kearney ◽  
Kanna K. Gnanalingham
Keyword(s):  
Multivariate Analysis ◽  
Hormone Replacement ◽  
Significant Proportion ◽  
Binary Logistic Regression ◽  
Pituitary Hormones ◽  
Pituitary Hormone ◽  
Factors Associated ◽  
Pituitary Dysfunction ◽  
Postoperative Risk

Abstract Background Pre-/postoperative pituitary endocrine deficiencies in patients with sellar/parasellar non-adenomatous lesions are poorly described and studies have not considered the effect of sellar invasion on endocrine outcome. The aim of this study was to relate the need for pituitary hormone replacement pre-/postoperatively, with sellar invasion, in non-adenomatous sellar/parasellar lesions. Methods Single-centre review of adults with histologically confirmed non-adenomatous sellar/parasellar lesion and follow-up ≥ 3 months or until postop radiotherapy. Pituitary dysfunction was defined by hormone replacement. The sellar encroachment score (0–6) was calculated as the sum of the thirds of radiological encroachment into the sellar region in the coronal and sagittal planes. Multivariate analysis with binary logistic regression was used to determine factors associated with pituitary hormone replacement. Results One hundred and seventeen patients were included with a median age of 49 years (range 16–84 years) and median follow-up of 13 months. Surgery was trans-sphenoidal (53%), trans-cranial (36%) or a combination (11%). The commonest histology types were meningioma (n = 33, 28%) and craniopharyngioma (n = 20, 17%). The median sellar encroachment score was 6 (range 0–6). Most (n = 86, 74%) did not require pituitary hormone replacement preoperatively. The need for pituitary hormones increased after surgery in 41 (35%) patients. In multivariate analysis, the sellar encroachment score was the only factor predictive of pre- (OR = 2.6, 95% CI = 1.2–5.5; p = 0.01) and postoperative risk of new pituitary hormone replacement (OR = 4.1, 95% CI = 1.7–10.1, p = 0.002). Conclusion A significant proportion of these patients present with need for pituitary hormone replacement that may worsen postoperatively. The degree of sellar encroachment is predictive of pituitary hormone replacement status pre-/postoperatively.

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