Five Decades of Enucleations for Uveal Melanoma in One Center: More Tumors with High Risk Factors, No Improvement in Survival over Time

Background: In order to improve medical care for uveal melanoma (UM) patients, we need to monitor disease and survival to guide our research efforts. We analyzed the data of UM patients who underwent an enucleation at the Leiden University Medical Center over the last five decades and investigated trends in patient and tumor characteristics and survival. Methods: Data were collected from charts and pathology reports from all patients who underwent an enucleation for UM between 1973 and 2019 (n = 1,212), of which 1,066 were primary enucleations; data were analyzed according to five time periods: 1973–1979 (n = 209), 1980–1989 (n = 148), 1990–1999 (n = 174), 2000–2009 (n = 280), and 2010–2019 (n = 401). Results: Over time, mean patient age at the time of enucleation for UM increased from 54.9 to 64.7 years (p < 0.001), more tumors showed histopathological involvement of the ciliary body (p < 0.001), and were classified in a high TNM/AJCC class (p < 0.001). Overall, the 5- and 10-year UM-related survival rates were 0.68 and 0.59, respectively. Over time, survival showed no change in patients with tumors in AJCC stages I or III, with recently a slightly worse survival in stage II UM (p = 0.02). Conclusion: Between 1973 and 2019, we found similar rates of UM-related survival following enucleation, although we noticed a strong increase in more unfavorable patient and tumor characteristics over time, such as an older age and larger tumor size. The lack of improvement indicates that more research should take place to develop adjuvant treatments to prevent metastases and efficient treatments once metastases develop.

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Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽

10.1159/000515899 ◽

2021 ◽

pp. 1-9

Author(s):

Matthias Fröhlich ◽

Tatjana Tissen-Diabaté ◽

Christoph Bührer ◽

Stephanie Roll

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Hospital Stay ◽

Very Low Birth Weight ◽

Survival Rates ◽

Length Of Hospital Stay ◽

Mortality Rates ◽

Vlbw Infants ◽

Postmenstrual Age ◽

Over Time

Introduction: In very low birth weight (<1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. Methods: This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. Results: In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). Discussion/Conclusions: LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

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Community characteristics of forest understory birds along an elevational gradient in the Horn of Africa: A multi-year baseline

The Condor ◽

10.1093/ornithapp/duab009 ◽

2021 ◽

Author(s):

Kyle D Kittelberger ◽

Montague H C Neate-Clegg ◽

Evan R Buechley ◽

Çağan Hakkı Şekercioğlu

Keyword(s):

Species Richness ◽

Species Turnover ◽

Survival Rates ◽

Elevational Gradient ◽

Forest Understory ◽

Bird Abundance ◽

Tropical Mountains ◽

Demographic Rates ◽

Understory Birds ◽

Over Time

Abstract Tropical mountains are global hotspots for birdlife. However, there is a dearth of baseline avifaunal data along elevational gradients, particularly in Africa, limiting our ability to observe and assess changes over time in tropical montane avian communities. In this study, we undertook a multi-year assessment of understory birds along a 1,750 m elevational gradient (1,430–3,186 m) in an Afrotropical moist evergreen montane forest within Ethiopia’s Bale Mountains. Analyzing 6 years of systematic bird-banding data from 5 sites, we describe the patterns of species richness, abundance, community composition, and demographic rates over space and time. We found bimodal patterns in observed and estimated species richness across the elevational gradient (peaking at 1,430 and 2,388 m), although no sites reached asymptotic species richness throughout the study. Species turnover was high across the gradient, though forested sites at mid-elevations resembled each other in species composition. We found significant variation across sites in bird abundance in some of the dietary and habitat guilds. However, we did not find any significant trends in species richness or guild abundances over time. For the majority of analyzed species, capture rates did not change over time and there were no changes in species’ mean elevations. Population growth rates, recruitment rates, and apparent survival rates averaged 1.02, 0.52, and 0.51 respectively, and there were no elevational patterns in demographic rates. This study establishes a multi-year baseline for Afrotropical birds along an elevational gradient in an under-studied international biodiversity hotspot. These data will be critical in assessing the long-term responses of tropical montane birdlife to climate change and habitat degradation.

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Implications of Standardized Uptake Values of Oral Squamous Cell Carcinoma in PET-CT on Prognosis, Tumor Characteristics and Mitochondrial DNA Heteroplasmy

Cancers ◽

10.3390/cancers13092273 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2273

Author(s):

Lukas Latzko ◽

Bernd Schöpf ◽

Hansi Weissensteiner ◽

Federica Fazzini ◽

Liane Fendt ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Mitochondrial Dna ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Survival Rates ◽

Tumor Characteristics ◽

Dna Mutations ◽

Standardized Uptake Values ◽

Pet Ct

Under aerobic conditions, some cancers switch to glycolysis to cover their energy requirements. Taking advantage of this process, functional imaging techniques such as PET-CT can be used to detect and assess tumorous tissues. The aim of this study was to investigate standardized uptake values and mitochondrial DNA mutations in oral squamous cell carcinoma. A cohort of 57 patients underwent 18[F]FDG-PET-CT and standardized uptake values were collected. In 15 patients, data on mitochondrial DNA mutations of the tumor were available. Kaplan–Meier curves were calculated, and correlation analyses as well as univariate Cox proportional hazard models were performed. Using ROC analysis to determine a statistical threshold for SUVmax in PET investigations, a cut-off value was determined at 9.765 MB/mL. Survival analysis for SUVmax in these groups showed a Hazard Ratio of 4 (95% CI 1.7–9) in the high SUVmax group with 5-year survival rates of 23.5% (p = 0.00042). For SUVmax and clinicopathological tumor features, significant correlations were found. A tendency towards higher mtDNA heteroplasmy levels in high SUVmax groups could be observed. We were able to confirm the prognostic value of SUVmax in OSCC, showing higher survival rates at lower SUVmax levels. Correlations between SUVmax and distinct tumor characteristics were highly significant, providing evidence that SUVmax may act as a reliable diagnostic parameter. Correlation analysis of mtDNA mutations suggests an influence on metabolic activity in OSCC.

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Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01442-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ofir Koren ◽

Asaf Israeli ◽

Ehud Rozner ◽

Nassem Darawshy ◽

Yoav Turgeman

Keyword(s):

Heart Failure ◽

Medical Center ◽

Success Rates ◽

Mitral Valvuloplasty ◽

Percutaneous Balloon Mitral Valvuloplasty ◽

Developing Heart ◽

Percutaneous Balloon ◽

Study Population ◽

Procedural Success ◽

Over Time

Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). Conclusion Our research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

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LINC-42. EPIDEMIOLOGICAL OVERVIEW OF CHILDHOOD CNS TUMORS IN THE NEUROSURGICAL UNIT IN YEREVAN, ARMENIA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.475 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii386-iii386

Author(s):

Nune Karapetyan ◽

Samvel Danielyan ◽

Gevorg Tamamyan ◽

Armen Tananyan ◽

Liana Safaryan ◽

...

Keyword(s):

Medical Center ◽

Survival Rates ◽

Developed Countries ◽

Cns Tumors ◽

Malignant Neoplasms ◽

Low Grade ◽

Embryonal Tumors ◽

Low Grade Gliomas ◽

Neurosurgical Treatment

Abstract BACKGROUND Central nervous system (CNS) tumors are the second most common malignant neoplasms among children worldwide. The current paper aims to analyze the situation in pediatric neuro-oncology in Armenia from the neurosurgical perspective. METHODS We have collected data of pediatric patients with CNS tumors treated in the Neurosurgery department of “Surb Astvasamayr” Medical Center from 01.01.2010 till 01.12.2019. Incidence by gender, age at diagnosis, and histopathology results were calculated. Survival rates were calculated based on the follow-up results performed until 30.12.2019. RESULTS Hospital-based data showed that during the previous 10 years 47 patients with CNS tumors received neurosurgical treatment in the unit, among them 66% were females. 38.3%, 31.9% and 29.8% of diagnosed patients were aged 0–4, 5–9, and 10–18 respectively. In 41 cases, the disease was not disseminated at diagnosis. The most common observed malignancies were low-grade gliomas (21.3%) and embryonal tumors (19.1%), followed by high-grade gliomas (14.9%) and ependymal tumors (8.5%). Follow-up information only for 33 patients is available. From them, 14 are dead and 19 alive. Survival rates in most common groups were 62.5%, 80%, 50%, and 50% respectively. The median follow-up time was 18 months (range 1–113 months). CONCLUSION Similar to the data reported in the literature, low-grade gliomas, and embryonal tumors are the most frequent pediatric CNS tumors in Armenia. On the other hand, the pediatric CNS tumor survival rates are lower compared to those reported in developed countries.

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Natural course of untreated cluster headache: A retrospective cohort study

Cephalalgia ◽

10.1177/0333102417706350 ◽

2017 ◽

Vol 38 (4) ◽

pp. 655-661 ◽

Cited By ~ 2

Author(s):

Mi Ji Lee ◽

Hyun Ah Choi ◽

Jong Hwa Shin ◽

Hea Ree Park ◽

Chin-Sang Chung

Keyword(s):

Cluster Headache ◽

Disease Duration ◽

Medical Center ◽

Natural Course ◽

Duration Of Disease ◽

Lost To Follow Up ◽

Active Patients ◽

Single Predictor ◽

Over Time

Objective To determine the natural course of cluster headache. Methods We screened patients with cluster headache who were diagnosed at Samsung Medical Center and lost to follow-up for ≥5 years. Eligible patients were interviewed by phone about the longitudinal changes in headache characteristics and disease course. Remission was defined as symptom-free 1) for longer than twice the longest between-bout period and 2) for ≥5 years. Results Forty-two patients lost to follow-up for mean 7.5 (range, 5.0–15.7) years were included. The length of the last bout did not differ from the first one, while the last between-bout period was longer than the first one ( p = 0.012). Characteristics of cluster headache decreased over time: Side-locked unilaterality (from 92.9% to 78.9%), seasonal and circadian rhythmicity (from 63.9% to 60.9% and from 62.2 to 40.5%, respectively), and autonomic symptoms (from 95.2% to 75.0%). Remission occurred in 14 (33.3%) patients at a mean age of 42.3 (range, 27–65) years, which was not different from the age of last bouts in active patients ( p = 0.623). There was a trend for more seasonal and circadian predilection at baseline in the active group ( p = 0.056 and 0.063, respectively) and fewer lifetime bouts and shorter disease duration in patients in remission ( p = 0.063 and 0.090). Conclusions This study first shows the natural courses of cluster headache. Features of cluster headache become less prominent over time. Remission occurred regardless of age. Although no single predictor of remission was found, our data suggest that remission of cluster headache might not be a consequence of more advanced age, longer duration of disease, or accumulation of lifetime bouts.

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Abstract 18: Trends in Median CPR Duration Over Time in Patients With and Without Return of Spontaneous Circulation

Circulation ◽

10.1161/circ.140.suppl_2.18 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Katherine M Berg ◽

Michael Donnino ◽

Ari Moskowitz ◽

Mathias J Holmberg ◽

Sebastian Wiberg ◽

...

Keyword(s):

Survival Rates ◽

Nonparametric Test ◽

Spontaneous Circulation ◽

Hospital Level ◽

Gender And Race ◽

Increasing Trend ◽

Trends Over Time ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest ◽

Over Time

Introduction: Survival after in-hospital cardiac arrest (IHCA) is increasing. In the Get-With-The-Guidelines-Resuscitation (GWTG-R) registry, longer median CPR duration in patients not achieving ROSC is associated with higher survival rates at the hospital level. We analyzed trends over time in median CPR duration by hospital in patients who achieved ROSC and those who did not, and stratified this analysis by age, gender and race. Methods: We included adult IHCA cases in GWTG-R from 2001-2017, excluding data from a given hospital and year if fewer than 5 eligible arrests were recorded. A nonparametric test for trend was done to evaluate median CPR duration over time in those with and without ROSC, in all patients and in groups stratified by age (<60, 61-80 and >80 years), gender, and race (white and black). Linear regression was done to evaluate the amount of change per year. Association with survival was tested using Pearsons correlation. Results: Of 359,107 IHCA events, 31,189 were excluded, leaving 327,918 for analysis. Over time, there was a significant increase in median CPR duration in patients who did not achieve ROSC, and a decrease in those who did attain ROSC.(Fig.) These trends persisted when stratified by gender, race and age. Each year was associated with a decrease in median CPR duration of 0.37 min (95% CI -0.41 to -0.33 min) in those with ROSC and an increase of 0.29 min (95% CI 0.25 to 0.33 min) in those without. There was a small but significant correlation between median CPR duration in those without ROSC and adjusted survival by hospital over time (r=0.224, p<0.0001). Conclusions: In the GWTG-R registry, median duration of CPR is decreasing over time in patients achieving ROSC, but increasing in those not achieving ROSC. The increasing trend in CPR duration in those without ROSC correlates positively with the trend in survival. Whether the increase in median CPR duration in those without ROSC is contributing causally to improvements in survival warrants further study.

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Differences in transitions of care among cancer patients with and without venous thromboembolism (VTE) events.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18636 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18636-e18636

Author(s):

Cinduja Nathan

Keyword(s):

Venous Thromboembolism ◽

Patient Care ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Medical Center ◽

Survival Rates ◽

Transitions Of Care ◽

Office Visits ◽

Oncology Patient ◽

History Of

e18636 Background: Transitions of care are an important part of medical care, as they provide opportunities to address patient concerns, refine goals to match current needs and prevent unforeseen complications and comorbidities. One such common and prevalent comorbidity amongst cancer patients is venous thromboembolism (VTE) events. Common VTE events include the occurrence of pulmonary embolism (PE), deep vein thrombosis (DVT) or both at the time of diagnosis or any time thereafter. It is estimated that approximately 4–20% of cancer patients will experience a VTE. Cancer patients developing VTE is a serious concern as it can adversely affect the patients’ quality of life and reduce overall survival rates and prognosis. Methods: This study is designed as a case control study. The subject group consists of 87 cancer patients who had one or several VTE events after their cancer diagnosis. Patients were selected from the UVM Medical Center electronic health record database. The goal of this project was to quantify and compare the average number of transitions of care in cancer patients with and without venous thromboembolism (VTE) events. This was achieved by reviewing the patients charts three months following a VTE event and evaluating whether these patients had a greater number of transitions compared to the three months prior to their VTE event. Transitions of care in our study were defined as office visits, ED visits, and inpatient admissions related to their VTE. Results: Initial evaluation of the results showed that there were more transitions of care amongst cancer patients with a VTE than without. Preliminary data of the 87 patients shows that patients who developed a VTE event after their cancer diagnosis had on average 1.3 more transitions of care within the three months following their VTE event compared to cancer patients without a VTE event. A t test will be used to determine whether the difference between the means (number of transitions of care) of the two groups (cancer patients with VTE and those without VTE) is significant. Conclusions: The implications of having greater transitions of care amongst cancer patients with VTE events are profound. Having more transitions of care exemplifies better implementation, patient care and involvement of health care teams given a history of VTE. Furthermore, the results of this study will provide further insight on ways to improve clinical outcomes and oncology patient care given a history of VTE.

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The Value of Second Opinion in Gastrointestinal and Liver Pathology

Archives of Pathology & Laboratory Medicine ◽

10.5858/2001-125-0736-tvosoi ◽

2001 ◽

Vol 125 (6) ◽

pp. 736-739 ◽

Cited By ~ 8

Author(s):

Geoffrey K. Hahm ◽

Theodore H. Niemann ◽

Joel G. Lucas ◽

Wendy L. Frankel

Keyword(s):

Clinical Significance ◽

Medical Center ◽

Ohio State University ◽

Second Opinion ◽

State University ◽

Missing Information ◽

Additional Information ◽

Pertinent Information ◽

Impact On Treatment ◽

Pathology Reports

Abstract Objective.—The value of routine second opinion review of liver and gastrointestinal pathologic material was evaluated to determine whether there were discrepancies in diagnoses and if these discrepancies had an impact on treatment or prognosis. Materials and Methods.—All gastrointestinal and hepatobiliary histopathology referral diagnoses made during a 1-year period for patients being treated at Ohio State University Medical Center were compared with the outside pathologic diagnosis. All major discrepant diagnoses were reviewed by at least 2 pathologists. Diagnoses were classified as no diagnostic disagreement, diagnostic disagreement, or no diagnostic disagreement but pertinent information missing or terminology unclear. Discrepant cases were also classified according to the clinical significance of the discrepancy. Results.—Pathology reports from 194 hepatobiliary and gastrointestinal cases were reviewed. Of the hepatobiliary cases, 57 (64.8%) of 88 cases showed no discrepancies. Discrepancies were noted in 31 cases (35.2%), including missing information or unclear terminology in the diagnosis in 23 cases (26.1%) and diagnostic disagreement in 8 cases (9.1%). Of the cases with discrepancies, 6 (6.8%) were of major significance. Of the gastrointestinal cases, 87 (82.1%) of 106 cases showed no discrepancies. Discrepancies were noted in 19 cases (17.9%), including missing or unclear information in 3 cases (2.8%) and diagnostic disagreements in 16 cases (15.1%). The cases with discrepancies included 8 cases (7.5%) for which the change was of major clinical significance. Conclusions.—Routine pathologic review of gastrointestinal and hepatobiliary cases revealed notable discrepancies in diagnoses. In 14 cases (7.2%), the change in diagnosis or additional information had a significant effect on the proper treatment or a significant prognostic implication. Routine review of all pertinent pathologic material should be performed on all patients being transferred to a second institution for treatment or second opinion.

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Abstract 12436: App-Based EMS to ED Communication May Improve Survival to Discharge Rates for OHCA Survivors

Circulation ◽

10.1161/circ.144.suppl_2.12436 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Christian Abrahim ◽

Alina Capatina ◽

Arvind Kalyan-Sundaram ◽

Amir Lotfi

Keyword(s):

Mobile Application ◽

Emergency Services ◽

Survival Rates ◽

Gps Tracking ◽

Standard Group ◽

Single Center ◽

Appropriate Care ◽

Discharge Rates ◽

Improvement In Survival ◽

Hospital Cardiac Arrest

Background: Survival rates for Out-of-Hospital Cardiac Arrest (OHCA) remain low despite advances in therapeutics. Although it seems intuitive, there is little evidence to support a benefit from early activation of emergency services at receiving hospitals from improved Emergency Medical Services provider (EMS) communication. We hypothesize that early, app-based communication from EMS in the field to in-hospital providers may improve survival to discharge rates. Methods: We utilized the General Devices Company, Inc. e-BridgeTM mobile application. EMS Providers were trained to use the app and dedicated devices and staff were stationed to monitor EMS transmissions to the emergency department (ED). A single-center, retrospective observational study was conducted on patients transferred to our institution for resuscitated OHCA. We identified 45 cases with OHCA admitted to our institution between February and July 2020 that utilized the app. We excluded interfacility transfers as well as patients certified deceased on the field. Given that standard, radio-based communication with EMS occurs 5 minutes prior to presentation, we used 5 minutes as the cutoff between our standard and intervention groups. Results: Of 45 cases, 29 had established communication using the app prior to 5 minutes, with the remaining 16 being considered in the standard group. We noted that 24% of patients (7 of 29) with early EMS notification survived to discharge compared to 0 of the 16 patients in the standard group. There was also an improvement in door-admission times from the ED to appropriate care units in this group (156 versus 228 minutes). Conclusion: Implementation of app-based communication between EMS providers and in-hospital providers with GPS tracking led to a trend to improvement in survival to discharge as well as time to admission from the ED in patients admitted for OHCA.

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