scholarly journals Colorectal Perforation in Patients with Connective Tissue Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Kiichi Sugimoto ◽  
Kazuhiro Sakamoto ◽  
Yu Okazawa ◽  
Rina Takahashi ◽  
Kosuke Mizukoshi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Odds Ratio ◽  
Colorectal Perforation ◽  
Fecal Peritonitis ◽  
Colonoscopic Examination ◽  
Cumulative Survival ◽  
Significant Difference

Purpose.The goal of this retrospective study was to identify prognostic factors associated with mortality after surgery for colorectal perforation among patients with connective tissue disease (CTD) and to review postoperative outcomes based on these prognostic factors.Methods.The subjects were 105 patients (CTD group: n=26, 24.8%; non-CTD group: n=79, 75.2%) who underwent surgery for colorectal perforation at our department. Cases with iatrogenic perforation due to colonoscopic examination were excluded from the study. We retrospectively investigated perioperative clinicopathological factors in patients undergoing surgery for colorectal perforation.Results.There were 7 patients (6.7%) who died within 28 days after surgery in all patients. In multivariate analysis, CTD and fecal peritonitis emerged as significant independent prognostic factors (p=0.005, odds ratio=12.39; p=0.04, odds ratio=7.10, respectively). There were 5 patients (19.2%) who died within 28 days after surgery in the CTD group. In multivariate analysis, fecal peritonitis emerged as a significant independent prognostic factor in the CTD group (p=0.03, odds ratio=31.96). The cumulative survival curve in the CTD group was significantly worse than that in the non-CTD group (p=0.006). An analysis based on the presence of fecal peritonitis indicated no significant difference in cumulative survival curves for patients without fecal peritonitis in the CTD and non-CTD groups (p=0.55) but a significant difference in these curves for patients with fecal peritonitis in the two groups (p<0.0001).Conclusions.This study demonstrated that cumulative survival in patients with CTD is significantly worse than that in patients without CTD after surgery for colorectal perforation.

scholarly journals Increased expression of caspase 1 during active phase of connective tissue disease

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7321
Author(s):  
Rentian Cai ◽  
Qiongqiong Wang ◽  
Gongmin Zhu ◽  
Liying Zhu ◽  
Zhen Tao
Keyword(s):  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Active Phase ◽  
Stable Phase ◽  
Stable Group ◽  
Health Control ◽  
Caspase 1 ◽  
Health Group ◽  
Significant Difference ◽  
Healthy Control

Key factors of pyroptosis play an important role in the inflammatory response to connective tissue disease (CTD). However, information on active and stable stages of CTD is scarce. To distinguish the differences of concentrations of C-reactive protein (CRP), caspase 1, caspase 4, caspase 5 and sCD14 in plasma between the patients with active and stable stages of CTD. A cohort study was conducted to recruit patients diagnosed with CTD of active phase and stable phase as well as health control. These data included the analysis of the concentration of sCD14, caspase 1, caspase 4 and caspase 5 in peripheral plasma by ELISA. The Wilcoxon rank-sum test was used to compare the two groups. The sex ratio and ages of the three groups were not different statistically. The concentrations of sCD14, caspase4 and caspase5 of plasma in the CTD of active phase and the stable phase as well as the health control. The concentration of caspase 1 in active phase of CTD (470.19 [422.33–513.14] pmol/L) was significantly higher than that in stable group (203.95 [160.94–236.12] pmol/L) and healthy control (201.65 [191.11–240.35] pmol/L] pmol/L) (p < 0.001, both), but there was no significant difference between stable group and healthy control (p = 0.2312). Similarly, the concentration of CRP in the active phase of CTD (8.96 [3.06–20.28] mg/L) was significantly higher than that in the stable group (3.00 [1.30–11.40] mg/L) and the healthy control (3.70 [2.30–4.73] mg/L) (p = 0.0013, p = 0.0006, respectively), but there was no significant difference between the stable group and the healthy control (p = 0.3205). However, there were no significant differences in the concentration of sCD14, caspase 4 and caspase 5 in the active phase of CTD and the stable group as well as the health group. Consequently, the patients of the active phase of CTD showed increased expression of caspase 1.

Sirolimus for patients with connective tissue disease-related refractory thrombocytopenia: a single-arm, open-label clinical trial

Rheumatology ◽  
2020 ◽  
Author(s):  
Chanyuan Wu ◽  
Qian Wang ◽  
Dong Xu ◽  
Mengtao Li ◽  
Xiaofeng Zeng
Keyword(s):  
Complete Remission ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Remission Rate ◽  
Complete Remission Rate ◽  
Severe Side Effect ◽  
Open Label ◽  
First Line Therapy ◽  
Primary Endpoints ◽  
Significant Difference

Abstract Objectives Connective tissue disease-related thrombocytopenia (CTD-TP) is a problematic disorder in clinical practice. Because the first-line therapy of glucocorticoid and/or immunosuppressants is not effective for refractory cases, alternative treatment approaches are urgently needed. The present study investigated the efficacy and safety of sirolimus in refractory CTD-TP patients. Methods This single-centre, single-arm, phase II study enrolled 20 refractory CTD-TP patients between September 2017 and September 2018 (registered on ClinicalTrials.gov: NCT03688191). Oral sirolimus administration was dose-adjusted to maintain a therapeutic range of 6–15 ng/ml for 6 months. The primary endpoints were partial and complete remission rates at 6 months. Results Twelve (60%) patients achieved the primary end point with a 50% complete remission rate after 6 months. Among the 14 SLE patients, the overall response rate was 71.4%, with a complete remission rate of 64.3%. None of the primary Sjögren's syndrome cases responded to sirolimus. There was no significant difference in baseline clinical characteristics or lymphocyte subpopulations between responders and non-responders. No severe side effect was detected during the study. Conclusion Sirolimus is an effective and safe treatment option for refractory CTD-TP patients. Trial registration https://clinicaltrials.gov, NCT03688191.

ABCA3 Expression Predicts Response to Gemtuzumab Ozogamicin in AML

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3946-3946 ◽  
Author(s):  
Antony Ceraulo ◽  
Aminetou Mint-Mohamed ◽  
Delphine Maucort-Boulch ◽  
Etienne Paubelle ◽  
Xavier Thomas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Relapse Rate ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Gemtuzumab Ozogamicin ◽  
Small Sample ◽  
Control Group ◽  
Prognostic Impact ◽  
Significant Difference

Abstract Background. The ATP binding cassette transporter 3 (ABCA3) has been recently found to induce a significant reduction in cytotoxicity following exposure to anthracyclines, mitoxantrone, etoposide, Ara-C, vincristine, and rituximab. ABCA3 acts through the modulation of multivesicular bodies (MVB) and contributes to drug sequestration in late endosomal organelles, i.e. MVB and lysosomes. Studies having investigated the prognostic impact of ABCA3 expression in AML have yielded conflicting results as ABCA3 expression has both been reported to exert unfavorable or neutral effects on patient outcomes. In addition, the small sample size of these studies precluded the use of multivariate analyses. Methods. Our goal was to investigate the prognostic impact of ABCA3 expression in adult patients with AML treated with IC with or without gemtuzumab ozogamicin (GO). To this end we investigated the relationship between ABCA3 expression and EFS in a representative series of 221 AML homogeneously treated in the ALFA-0701 trial. qRTPCR amplification of conserved ABCA3 mRNA sequences, as identified with FasterDB database, was performed with GUS and ABL as reference genes. Primer sets were complementary to conserved ABCA3 exons 6-7 and exon 19-20 junctions. Patients were given a 3+7 induction course without (control group, n=110) or with fractionated intravenous GO (n=111) (Castaigne S, Lancet 2012; 379:1508-1516). Results. Among the 278 randomized patients, 221 had available bone-marrow diagnostic samples with high-quality RNA. The same benefits associated with GO were observed in the 221 patients from the present study as in the entire trial population. Overall, median age, CR rate, relapse rate, median follow-up, 3-years EFS were 62.1 years, 76.5%, 66%, 47.45 months, 28±3%, respectively. There was no significant difference in the level of ABCA3 expression between responders and non-responders. In the 169 responders, ABCA3 expression at diagnosis was more than 3-fold higher in the 111 remitters who subsequently relapsed than in the 58 patients who remained in persistent CR (p=0.033). The level of ABCA3 expression was significantly lower in ELN favorable group than in intermediate and adverse risk AML (p= 0.004) and negatively correlated with CD33 expression (R=-0.272, p<10-4). Through univariate analysis, higher ABCA3 expression was associated with shorter EFS (3-years: 22±3 vs 45±7 % p=0.002). Multivariate analysis identified age, treatment arm, and ELN risk group as independent prognostic factors for EFS. In the control group, there was no significant association between ABCA3 expression and CR rate, relapse rate, and EFS. In the 111 patients within the GO arm, there was no significant difference in the level of ABCA3 expression between responders and non-responder whereas in the 89 responders, ABCA3 expression at diagnosis was more than 7-fold higher in the 53 remitters who subsequently relapsed than in the 36 patients who remained in persistent CR (p=0.006). Through univariate analysis, higher ABCA3 expression was associated with shorter EFS (3-years: 22±5 vs 64±9 % p=0.0002). Multivariate analysis identified ABCA3 expression, cytogenetics, CD33 expression, and ECOG as independent prognostic factors for EFS (Figure 1). Conclusion. WhileABCB1 has been previously found to attenuate GO-induced cytotoxicity in AML cells (Walter RB, Blood 2003; 102:1466-1473), present results indicate that higher ABCA3 expression independently predicts poor outcome in AML patients treated with fractionated GO and intensive chemotherapy (IC). GO is an anti-CD33 antibody carrying a toxic calicheamicin derivative that, after hydrolytic release within lysosomal vesicles, induces DNA strand breaks, apoptosis, and cell death. Whether the clinical effect of ABCA3 expression relies on the modulation of CD33 internalization, calicheamicin release or combination thereof is under investigation. Finally our results encourage inhibiting ABCA3, such as with indomethacin, in order to overcome drug resistance in AML treated with GO-IC. Figure 1 Figure 1. Disclosures Thomas: Pfizer: Consultancy.

Depth of invasion in early oral cancers: Is it an independent prognostic factor?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6058-6058
Author(s):  
Harsh Dhar ◽  
Anil D'Cruz ◽  
Richa Vaish ◽  
Rohini W Hawaldar ◽  
Sudeep Gupta ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Controlled Trial ◽  
Tnm Staging ◽  
Rank Test ◽  
Depth Of Invasion ◽  
Entire Cohort ◽  
Oral Cancers ◽  
T Stage ◽  
Significant Difference

6058 Background: Depth of invasion (DOI) has been incorporated in the new AJCC TNM staging (8th edition) for oral cancers. We hypothesized that the negative effect of increasing DOI on outcomes was a result of an increased propensity to node metastasis and appropriate neck treatment would negate its detrimental effect on outcomes. Methods: Patients with T1/ T2 oral squamous cell carcinoma, clinically node negative, from a previously reported Randomized Controlled Trial (NCT 00193765) formed the cohort for this study. Patients were restaged according to the new staging system . Overall survival(OS) was estimated by the revised T stage for the entire cohort and separately for those who underwent END and those who did not (TND arm) using Kaplan Meier and log rank test . Multivariate analysis was performed using Cox proportional hazard model making adjustment for neck treatment, T stage, site, prognostic factors and the interaction between revised T stage and neck treatment. Results: Of the 596 patients 577 were evaluable, with a median follow up of 77.57 months. Initial pT staging was pT1, 389(67.4%); pT2, 181(31.4%); pT3, 7(1.2%) and was modified to pT1, 195(33.8%); pT2, 280(48.5%); pT3, 102(17.7%) on restaging . 288 patients underwent END and 289 did not (TND arm). For the entire cohort 5-year OS rates were 79.0% [95 %CI, 73.12-84.88] for pT1, 69.4% [95% CI, 63.91-74.89] for pT2 and 53.0% [95% CI, 43.2 -62.8] for pT3 with significant difference between the 3 groups (p < 0.001). In those without upfront neck treatment( TND ), OS difference was maintained between the pT1 and pT2 groups [81.1% (95%CI, 73.26-88.94) vs 65.0% (95%CI, 56.77-73.23)], p = 0.004. This difference was not apparent in the END arm ,pT1 -76.9% (95 %CI, 68.47-85.33) vs pT2 -73.7% (95%CI, 66.25-81.15), p = 0.73. T3 tumours had uniformly poor survival irrespective of neck treatment. On multivariate analysis of the revised pT1/T2 cohort (n = 475), pT stage, neck treatment and grade were independent prognostic factors impacting OS. There was a significant interaction between the T stage and neck treatment (p = 0.03). Conclusions: When DOI < 10 mm, END supplants the prognostic implication of depth with similar outcomes for T1 and T2 tumours (new AJCC staging). The exact role of DOI on outcomes warrants further research. Clinical trial information: NCT00193765.

scholarly journals Doctor! Will I be dry? Factors determining recurrence after vesicovaginal fistula repair

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Aziz Abdullah ◽  
Sher Shah Syed ◽  
Nuzhat Farooqui ◽  
Sajjad Siddiqui
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Vesicovaginal Fistula ◽  
Surgical Repair ◽  
Recurrence Risk ◽  
Fistula Repair ◽  
Careful Evaluation ◽  
Delayed Reconstruction

Aims: To evaluate various prognostic factors which determine outcome after surgical repair of VVF. Methods: A retrospective analysis of the record of 640 patients which underwent surgical repair of VVF during a period from Jan 2006 to June 2011. Multivariate analysis of the record was done using SPSS-19 software determining odds ratio with 95% confidence interval. Results: 640 patients underwent surgical repair of VVF. Overall success rate was 87.2%. Multivariate analysis determined that recurrence of VVF was significantly related to multiplicity (5 fold recurrence risk), pre-operative size of VVF (3 fold risk), secondary repair (3 fold risk) and etiology of the fistula (2 fold risk). Interposition of flap and delayed reconstruction was related to successful surgical outcome. Age, parity, route of repair and location of fistula were not significant prognostic factors for recurrence. Conclusions: Successful surgical repair of VVF require careful evaluation of various factors including number, size, previous attempts to surgical repair and etiology of VVF. One should opt for transabdominal route with delayed reconstruction and interposition of flap if above mentioned factors are present. 

Remnant pancreatic volume to predict short-term and long-term outcomes in patients with resected pancreatic cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15713-e15713
Author(s):  
Ryoichi Miyamoto ◽  
Yukio Oshiro ◽  
Nobuhiro Ohkohchi
Keyword(s):  
Pancreatic Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Perioperative Outcomes ◽  
Long Term Outcomes ◽  
Short Term ◽  
Significant Difference ◽  
Pancreatic Volume

e15713 Background: Remnant pancreatic volume (RPV) is a well-known marker for short-term outcomes in patients with resectable pancreatic cancer. However, in terms of the long-term outcomes, the significance of the RPV remains unclear. Here, we addressed whether the RPV is a predictor of long-term outcomes in pancreatic cancer patients by comparing various cancer-, patient-, and surgery-related prognostic factors and systemic inflammatory response markers in a retrospective cohort. Methods: The RPV was measured on the 3D image, revealing the actual pancreatic parenchymal remnant volume. Ninety-one patients who underwent pancreaticoduodenectomy (PD) were retrospectively enrolled. We divided the cohort into high- and low-RPV groups based on a cut-off value ( > 35.5 cm3, n = 66 and ≤ 35.5 cm3, n = 25, respectively). The patient characteristics, perioperative outcomes and median survival times (MSTs) were respectively compared between the two groups. Using multivariate analysis, the RPV and other well-known prognostic factors were independently assessed. Results: A significant difference in the RPV value was observed with respect to the incidence of postoperative pancreatic fistula (high, 18 [55%] vs. low, 9 [16%], p < 0.001). The MSTs (days) were significantly different between the two groups (high, 823 vs. low, 482, p = 0.001). Multivariate analysis identified the RPV (≤ 31.5 cm3) (hazard ratio [HR], 2.015; p = 0.011), lymph node metastasis (HR, 8.415; p = 0.002), adjuvant chemotherapy (HR, 5.352; p < 0.001), presence of stage III/IV disease (HR, 2.352; p = 0.029), and pathological fibrosis (HR, 1.771; p = 0.031) as independent prognostic factors. Conclusions: The present study suggests that the RPV is an additional useful predictor of both long-term and short-term outcomes in pancreatic cancer patients after PD.

Surgical Consideration for Patients with Repeatedly Recurrent Spinal Chordoma: A Systematic Analysis of Prognostic Factors and Quality of Life

2020 ◽  
Author(s):  
Kehan Xu ◽  
Yue Zhang ◽  
Xiaolin Li ◽  
Lin Li ◽  
Bo Li ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Local Recurrence ◽  
Life Expectancy ◽  
Surgical Margin ◽  
Treatment Method ◽  
Spinal Chordoma ◽  
Significant Difference

Abstract Background: A retrospective study of patients with repeatedly recurrent spinal chordoma (RRSC) was performed. The objective of this study was to evaluate the independent prognostic factors for RRSC improving life expectancy and discuss the most appropriate treatment modality. Methods: Medical data and follow-up record of patients who were diagnosed as RRSC and were surgically treated in Changzheng hospital between July 2010 and September 2017 were reviewed systematically. Univariate and multivariate analysis were performed to identify possible independent prognostic factors for patients with RRSC. Recurrence-free survival (RFS) and overall survival (OS) were estimated by Kaplan-Meier method. Factors with P < 0.1 were subjected to multivariate analysis by Cox regression analysis. P < 0.05 was considered statistically significant. Results: Sixty-five consecutive patients with RRSC were included in this study. Local recurrence was detected in thirty-three patients, while death was occurred in twenty-one patients. The mean follow-up period was 34.3 months. The statistical results revealed that number of recurrence (NOR), surgical method, and surgical margin were independent prognostic factors for RFS and preoperative Frankel score (PFS) was favorable prognostic factor for OS. Moreover, subtype analysis suggested that treatment method could make significant difference for prognosis of patients with RRSC. Conclusion: Less NOR, total resection, and wide surgical margin could significantly reduce the risk of local recurrence of RRSC. PFS of A-C was adverse prognostic factor for OS. Total en bloc resection or total piecemeal resection with postoperative radiotherapy is recommended as ideal treatment method for prolonging life expectancy.

Prognostic Factors and Response Duration in 419 MDS Treated with Erythropoietin±GCSF: The GFM Experience.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 522-522 ◽  
Author(s):  
S. Park ◽  
C. Kelaidi ◽  
S. Grabar ◽  
O. Beyne-Rauzy ◽  
S. Cheze ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Predictive Factors ◽  
Response Rate ◽  
Response Duration ◽  
Response Rates ◽  
Multilineage Dysplasia ◽  
Major Response ◽  
Significant Difference ◽  
The Impact

Abstract Background: EPO and its derivative darbepoietin alfa (DAR) are important treatments of anemia in lower risk MDS. Prognostic factors of response and of its duration have been recently updated (Blood, 2005, 106, 803–11) and we reanalyzed them in a large series of patients (pts) treated in France and Belgium. Patients: 419 MDS pts were treated with EPO (≥30000UI/wk for at least 12 wks) or DAR (300μg/wk)± GCSF in 25 GFM centers between 1998 and 2006 (160 prospectively analyzed in 3 consecutive trials, and 259 retrospectively analyzed). Median follow-up was 54 months, median age: 73.5 years. WHO classification: RA (14%), RCMD (16%), 5q- syndrome (4%), RARS (21%) RCMD-RS (13%), RAEB-1 (22%), RAEB-2 (6%), and also 4%CMML (FAB); karyotype: 64% FAV, 16% INT, and 4% UNFAV (16% failure or not done). IPSS: 34% LOW, 40% INT-1, 8% INT-2, 2% HIGH (16% unavailable). 185, 126, 80 and 28 pts received EPO alone (alfa or beta), DAR, EPO+G and DAR+G respectively. Median pre-treatment EPO level was 76 UI/l (only 7% pts>500 UI/l). All pts had Hb<10g/dl and 54% required RBC transfusions (including 36% with >2 RBC units/month). Results: 63% pts responded (IWG criteria: 43%HI-E major and 20% HI-E minor), including 57%, 63%, 57%, 66%, 63% with EPO alfa alone, beta alone, EPO+G, DAR alone, DAR+G response (p=ns). Median response duration was 20 mos (range 3–74 mos), 25 and 14 mos for major and minor responses (p= 0.001). Relapse was associated with treatment discontinuation (45%), progression to higher grade MDS (12%) or AML (13%), but without evident cause in 30% cases. In univariate analysis, significantly higher response rates were observed in pts with <10% blasts (p= 0.002), low and INT-1 IPSS score (p=0.001), transfusion <2 RBC units/month (p<0.0001), EPO level<200UI/l (p<0.0001) whereas no significant difference in response rate were seen between RA (69%,) RCMD (72%), RARS (59%), RCMD-RS (71%), RAEB-1 (60%) and 5q- syndrome (52%), and between cytogenetic groups. The response rate in RARS and RCMD-RS was similar with EPO or DAR alone (62.5%), and EPO or DAR+G (60%). In multivariate analysis, EPO <200UI/l (p=0.008), transfusion requirement (p<0.0001) and IPSS (p=0.047) remained predictive factors of response. Longer response duration was significantly associated with blasts<10% (20 mos vs 8 mos for blasts>10%, p=0.007), major response (vs minor), IPSS low-INT-1 (median 22 mos vs 8 mos for INT-2/HIGH, p=0.001) and in pts with absence of multilineage dysplasia (24 mos vs 16 mos, p=0.01). In multivariate analysis, blasts <10% and major response remained predictive factors of longer response. Conclusions: EPO level <200UI/l, RBC transfusions <2 units/month were confirmed as major prognostic factors of response to EPO±G. Good response rates were seen in RAEB-1, and with EPO alone, in RARS and RCMD-RS. Multilineage dysplasia was not associated with lower response rates, but with shorter response duration. Other prognostic factors of shorter response duration were minor response (vs major), and blasts >10%. A case control study with pts of the International MDS risk Analysis Workshop, who received RBC transfusion alone, is in progress to evaluate the impact of EPO treatment on leukemia-free survival and overall survival, and its results will be presented.

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