Second Report of Clinical Significance of sFas for DLBCL Treated with CHOP and New Analysis of sFas for DLBCL Treated with R-CHOP.

Abstract Introduction: We have previously reported serum concentration of sFas predict a clinical outcome of patients with DLBCL. Here, we added the number of patients and confirmed that a high serum sFas level was associated with unfavorable prognosis of patients with DLBCL. Patients and methods: We used a prospective, consecutive entry design, and the study protocol was approved by the Institution’s Review Board. Between October 1995 and September 2002 previously untreated 132 patients with DLBCL (Group A: patients treated without rituximab) and between December 2002 and March 2007 previously untreated 75 patients with DLBCL (Group B: patients treated with rituximab) confirmed by biopsy participated in this study. We considered eligible for this study all patients with histologically confirmed diagnosis of DLBCL, according to the Working-Formulation and the WHO classification. Serum sFas was determined using ELISA. Patients were assigned to receive eight cycles of CHOP or THP (tetrahydropyranyl-adriamycin) -COP therapy before September 2002. The patients who had been registered after October, 2002 received the R-CHOP or R-THP-COP therapy. A serum sFas level of 3.0ng /ml was used as the cut-off value in this study. All follow-up data were updated on March 1, 2007. Results: In Group A: 132 patients were enrolled in this category (82 males, 50 females, age; 14 to 92 years, median; 66 years). IPI scoring was available in all patients; accordingly 18.2% patients were classified as low risk, 25.8% as low-intermediate; 32.6% as high-intermediate, and 23.5% as high risk. Overall, the CR rate was 73.5%; PRs were observed in 7.6% and failures in 18.9%. The CR rates for patients with an sFas level of 3.0ng /ml and over and less than 3.0ng /ml were 51.1% and 81.6%, respectively (P<0.0005). The 5-year OS rates for patients with an sFas level of 3.0ng /ml and over and less than 3.0ng /ml were 19.8% and 61.9%, respectively (P<0.0001). In Group B: 75 patients were enrolled in this category (42 males, 33 females, age; 24 to 88 years, median; 69 years). IPI scoring was as follows; 22.6% patients were classified as low risk, 26.6% as low-intermediate; 21.3% as high-intermediate, and 29.3% as high risk. Overall, the CR rate was 72.0%; PRs were observed in 22.7% and failures in 5.3%. The CR rates for patients with a sFas level of 3.0ng /ml and over and less than 3.0ng /ml were 65.6% and 76.7%, respectively (NS). The 2-year OS rates for patients with an sFas level of 3.0ng /ml and over and less than 3.0ng /ml were 54.7% and 92.2, respectively (P<0.01). Multivariate analysis using the proportional hazards model revealed that sFas concentration significantly correlated with overall survival in both group A and B (p<0.05). Discussion: The IPI is now considered as the most reliable index. After introduction of rituximab to treat for B cell lymphoma, the change of the prognostic factor is expected. In this examination, initially, we could confirm that sFas was an important prognostic factor for DLBCL in the patients who are treated with CHOP regimen as a result of extending the period of surveillance. In addition, we could show that sFas is a useful prognostic factor for DLBCL in the patients who are treated with R-CHOP regimen, too. Conclusion: Serum sFas is a significant prognostic factor for DLBCL and a useful tool for selecting the appropriate therapeutic strategy in patients with DLBCL.

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Different scales for assessing adverse cardiovascular events for patients in daily practice: which one is better?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.233 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

O Marchenko ◽

N Rudenko ◽

O Vnukov

Keyword(s):

High Risk ◽

Adverse Events ◽

Low Risk ◽

Number Of Patients ◽

Group A ◽

Ascvd Risk ◽

Risk Estimator ◽

Artery Disease ◽

Group B ◽

Very High

Abstract Funding Acknowledgements Type of funding sources: None. Background. Coronary artery disease is the main cause of morbidity and mortality despite the effort of the healthcare system in different countries. There are numerous scores for estimation of developing adverse events we can use for patients. But it is the doctor`s discretion to select the scale. Purpose. To calculate the risk of developing adverse events from the cardiovascular system for patients on different scales and compare it with the data obtained from additional examinations. Methods. We examined 131 patients and calculated the risks of developing adverse events as for primary prevention patients on 3 scales, namely HeartScore (HS), Framingham Risk Score (FRS), and ASCVD Risk Estimator Plus. Patients were divided into 3 groups depending on coronary angiography results. Group A included patients without coronary lesion, group B – patients with non-stenotic coronary lesions or single-vessel disease, group C – patients with multivessel disease. Results. Patients were divided into three groups : group A contained 30 patients, group B and C–35 and 66 patients respectively. The groups were comparable in age (p = 0.39), body mass index (p = 0.43), and comorbidities. For the HS 9 patients (6,9%) had total cholesterol (TC) lower than 3 mmol/l and it was the reason for exclusion. For 7 patients (5.3%) the reasons to exclude for FRS was age (more than 79 years old) and very low TC (lower than 2.5 mmol/l). And 19 patients (14.5%) were excluded from calculated ASCVD Risk Estimator Plus due to age, low TC and low-density lipoprotein (LDL). According to the HS no groups have low risk of developing adverse events. In group A patients with moderate risk (53.3%) prevailed. Group B contained half of patients with high risk (51.7 %). Group C had 41.4% patients with high risk and 43.1% patients with very high risk of developing adverse events. FRS had dissimilar results in group A and showed that 73.3% of patients had low risk. Group B presented 34.5%, 41.4%, and 24.1% patients with low, moderate and high risk respectively. Group C had 41.4% of patients with moderate risk and 32.8% with high risk. ASCVD Risk Estimator Plus showed the following results. The majority of patients (41.4%) had intermediate risk in group A. Group B represented the largest number of patients with high risk (46.7%). Group C contained the biggest group of patients with high risk (58.5%). Results are represented in Figure 1 Conclusion. All scales have certain limitations such as the level of TC, LDL, age. Nevertheless, the FRS showed the highest percentage of low risk for patients who did not have coronary artery disease. At the same time HS revealed the largest number of patients in group C with multivessels diseases. These patients had a high and very high risk of developing cardiovascular events (84.5% in total). ASCVD Risk Estimator Plus has no advantages from the Scores. An additional disadvantage is that a lot of patients were excluded from the calculation (14.5%). Abstract Figure. Results of the different scores

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The Role of Pathological Method and Clearance Definition for the Evaluation of Margin Status after Pancreatoduodenectomy for Periampullary Cancer. Results of a Multicenter Prospective Randomized Trial

Cancers ◽

10.3390/cancers13092097 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2097

Author(s):

Gennaro Nappo ◽

Domenico Borzomati ◽

Alessandro Zerbi ◽

Paola Spaggiari ◽

Ugo Boggi ◽

...

Keyword(s):

Prognostic Factor ◽

Randomized Study ◽

Periampullary Cancer ◽

Significant Prognostic Factor ◽

Prognostic Role ◽

R1 Resection ◽

Group A ◽

Group B

Background: There is extreme heterogeneity in the available literature on the determination of R1 resection rate after pancreatoduodenectomy (PD); consequently, its prognostic role is still debated. The aims of this multicenter randomized study were to evaluate the effect of sampling and clearance definition in determining R1 rate after PD for periampullary cancer and to assess the prognostic role of R1 resection. Methods: PD specimens were randomized to Leeds Pathology Protocol (LEEPP) (group A) or the conventional method adopted before the study (group B). R1 rate was determined by adopting 0- and 1-mm clearance; the association between R1, local recurrence (LR) and overall survival (OS) was also evaluated. Results. One-hundred-sixty-eight PD specimens were included. With 0 mm clearance, R1 rate was 26.2% and 20.2% for groups A and B, respectively; with 1 mm, R1 rate was 60.7% and 57.1%, respectively (p > 0.05). Only in group A was R1 found to be a significant prognostic factor: at 0 mm, median OS was 36 and 20 months for R0 and R1, respectively, while at 1 mm, median OS was not reached and 30 months. At multivariate analysis, R1 resection was found to be a significant prognostic factor independent of clearance definition only in the case of the adoption of LEEPP. Conclusions. The 1 mm clearance is the most effective factor in determining the R1 rate after PD. However, the pathological method is crucial to accurately evaluate its prognostic role: only R1 resections obtained with the adoption of LEEPP seem to significantly affect prognosis.

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Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽

10.1182/blood.v110.11.3613.3613 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3613-3613 ◽

Cited By ~ 1

Author(s):

Vittorio Montefusco ◽

Francesca Gay ◽

Francesco Spina ◽

Maria Teresa Ambrosini ◽

Massimo Maniezzo ◽

...

Keyword(s):

Risk Factors ◽

Zoledronic Acid ◽

High Risk ◽

Antibiotic Prophylaxis ◽

Low Risk ◽

Dental Procedure ◽

Dental Procedures ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p<0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

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Conservative Chemotherapy in Gestational Trophoblastic Disease: Experience With Etoposide, Methotrexate, and Dactinomycin Chemotherapy

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000671 ◽

2016 ◽

Vol 26 (4) ◽

pp. 790-795 ◽

Cited By ~ 2

Author(s):

Seung Won Byun ◽

Tae Chul Park ◽

Seog Nyeon Bae

Keyword(s):

High Risk ◽

Gestational Trophoblastic Disease ◽

Low Risk ◽

The Other ◽

World Health ◽

Who Grade ◽

Trophoblastic Disease ◽

Group A ◽

Group B ◽

Health Organization

ObjectiveThe goal of this study was to evaluate the efficacy, toxicity, and survival of patients in our institution treated by EMA (etoposide, methotrexate [MTX], and dactinomycin) chemotherapy for 3 groups of patients: ones that had low-risk gestational trophoblastic disease (GTD) that was resistant to MTX (group A), those with high-risk GTD (group B), and the group having low-risk GTD but the cancer being metastatic (group C).MethodsThe medical records of 58 patients who received EMA chemotherapy in groups A, B, and C in the 2000 to 2012 period at St Mary’s Hospital were examined. Clinical characteristics, chemotherapy responses, causes of treatment failure, and cases of drug toxicity were analyzed retrospectively.ResultsTreatment with the EMA regimen resulted in primary remission in 52 (96%) of 54 patients and resistance in 2 of the patients (3%). In the resistance group, one belonged to group B and was treated with etoposide, MTX, and actinomycin D with cyclophosphamide and vincristine (EMA-EP) and the other belonged to group A and died of refractory disease. World Health Organization (WHO) grade 4 leukocytopenia and thrombocytopenia with the EMA regimen occurred in 6% and 0.4% of the cycles, respectively; the other toxic effects were acceptable and manageable. Median cycles of EMA chemotherapy during the treatment were 7, 8, and 8 in groups A, B, and C, respectively. There was some reduction in total chemo cycle and toxicity, as compared with a previously reported study using the alternative cyclophosphamide and vincristine regimen. Among the EMA treated patients, 1 patient with a second malignancy of breast cancer was documented. In addition, 5 child births for the treated patients were recorded during the follow-up period of mostly 10 years.ConclusionsThe EMA chemotherapy seemed to reduce treatment duration and the relapse rate without increasing the adverse effects in patients with MTX resistance and low-risk GTD, but having confirmed metastatic lesions. Although this study had some limitations regarding the high-risk GTD, our findings will provide a basis for the use of EMA chemotherapy when cyclophosphamide and vincristine is contraindicated due to toxicity.

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Allogeneic Hematopoietic Stem Cell Transplantation (allo HSCT) in Patients with IPSS Low or Intermediate-1 Myelodysplastic Syndrome (MDS): A Prospective Multicenter Phase II Study Based on Donor Availability By the GFM & SFGM-TC "MDS-ALLO-Risk"

Blood ◽

10.1182/blood-2021-146846 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1842-1842

Author(s):

Marie Sebert ◽

Cendrine Chaffaut ◽

Sylvain Thepot ◽

Corentin Orvain ◽

Thomas Cluzeau ◽

...

Keyword(s):

High Risk ◽

Lower Risk ◽

Research Funding ◽

Low Risk ◽

Donor Group ◽

Hematopoietic Stem ◽

The Past ◽

Group A ◽

Group B

Abstract Background: Allo HSCT is a potentially curative treatment in MDS which, in higher risk (IPSS high and int 2) MDS demonstrated an overall survival (OS) advantage over conventional treatment (especially HMAs) in retrospective (Koreth et al., JCO 2013) and prospective (Robin et al. leukemia 2015) studies. Retrospective studies, on the other hand, suggested no OS advantage for allo HSCT in lower risk MDS (IPSS low and int 1), except possibly in the "poorest" lower risk MDS subsets, as classified by the WPSS (Alessandrino et al. AMJH 2013) However, about 25% of lower risk MDS patients are reclassified as higher risk by the R-IPSS and a proportion of other lower risk MDS can also harbor some higher risk features that compromise their outcome. MDS-ALLO-RISK trial (clinicaltrial.gov NCT02757989), was designed to assess outcome of lower risk MDS patients with some high-risk features after HLA-matched donor HSCT. Method: The primary objective of this study was to demonstrate an OS improvement in lower risk MDS patients with some high risk features with a donor compared with those without a donor (with a 3 year OS of 70% versus 40%, respectively) . Inclusion criteria were: IPSS low or int1 MDS with at least one of the following characteristics: 1) R-IPSS intermediate or higher 2) RBC transfusion dependent anemia and failure to two or more treatments (including EPO, Lenalidomide or HMA ); 3) platelets < 20 G/L requiring transfusions 4) ANC < 0.5 G/L with severe infection 5) no contra indication to allo HSCT 6) age <70 years 7) HLA identical donor (sibling or 10/10 unrelated) 105 inclusions were planned: 62 in group with a donor (group A) and 43 in group without a donor (group B). Recruitment began in June 2016 and stopped in March 2021 due to futility on the interim analysis. Median follow-up was 20 months. Data cut off analysis was June 2021. Results: 79 patients were included, 64 in group A and 15 in group B. Median age was 62.4 (IQR: 58-65) years in group A and 66 (IQR: 60.5-68) years in group B. Patients in group A were more frequently males (73 vs 40%, p=0.029), WHO was CMML in 8 (10%), MDS-SLD in 5 (8%), MDS-MLD in 9 (11%), MDS-EB1 in 41 (52%), MDS-RS in 12 (15%), unclassified in 4 (6%) without significant differences between the two groups. IPSS /IPSS-R was similar in both groups: IPSS low in 10% (11% in group A and 7% in group B) and Int-1 in 90%. IPSS-R: very low risk (6% vs 0%); low risk (25% vs 27%); intermediate (50% vs 47%); high (19% vs 27%); no very high risk. Among the 64 patients with a donor, 58 (92%) received HSCT, 2 died before HSCT; 2 had progressive disease and 2 are planned for HSCT. Transplanted patients received reduced intensity conditioning regimen with busulfan 6.4mg/kg, fludarabine 150mg/m2 and ATG (rabbit antithymocyte globulin therapy, grafalon®) 30mg/kg and cyclosporine-mycophenolate mofetil as GVHD prophylaxis. In group A, 21/64 had died, including 13 died from a non-relapse cause. In group B, 4/15 patients had died, 3 from MDS progression and one from CNS bleeding. Three-year OS was 60% (95%CI: 46.9-76.8) in group A and 64.2% (41.3-99.6) in group B (p=NS). At the time of analysis, 20 and 5 patients had progressed/relapsed in group A and B respectively. with a cumulative incidence of relapse/progression (from inclusion) of 27.4% (IC95%: 15;39.8) in group A and 41.7% (IC95%:9.2;74.2) in group B (p=0.71). Among the 58 transplanted patients, 11 (19%) died without disease progression, including one death from a solid tumor. 3 years non-relapse mortality in transplanted patients was 23.4% (IC95%:9.7;37). 3 years Incidence of grade 2 to 4 acute GVHD was 40.8% and 3 years chronic GVHD was 24.9%. Conclusion: In this, to our knowledge, first prospective study in IPSS lower risk patients with some unfavorable clinical or biological features, HLA identical donor (sibling or 10/10 unrelated) HSCT yielded a 3-year OS of 60%. Non relapse mortality was however 23%, and OS somewhat lower than expected (70% at 3 years) and similar to that observed in patients without a donor. Long-term follow-up is needed to better define subgroups of IPSS lower risk MDS that may benefit from allo HSCT. Disclosures Sebert: Abbvie: Consultancy; BMS: Consultancy. Cluzeau: Pfizer: Other: travel, accommodations, expenses; Astellas: Speakers Bureau; Amgen: Speakers Bureau; Agios: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel, accommodations, expenses, Speakers Bureau; Roche: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria, Speakers Bureau; Takeda: Other: travel, accommodations, expenses; Jazz Pharma: Consultancy, Honoraria; BMS/Celgene: Consultancy, Honoraria, Speakers Bureau. Loschi: AbbVie: Ended employment in the past 24 months, Honoraria; CELGENE/BMS: Honoraria; Gilead: Ended employment in the past 24 months, Honoraria; Novartis: Ended employment in the past 24 months, Honoraria; Servier: Ended employment in the past 24 months, Honoraria; MSD: Honoraria. Huynh: Jazz Pharmaceuticals: Honoraria. Ades: ABBVIE: Honoraria; NOVARTIS: Honoraria; CELGENE/BMS: Honoraria; CELGENE: Research Funding; JAZZ: Honoraria, Research Funding; TAKEDA: Honoraria. Fenaux: JAZZ: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Celgene/BMS: Honoraria, Research Funding; Syros Pharmaceuticals: Honoraria. Robin: NEOVII MEDAC NOVARTIS: Research Funding.

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Should Hematopoietic Stem Cell Transplantation in First Complete Remission Be Restricted to High-Risk Patients in Childhood Acute Myeloid Leukemia?.

Blood ◽

10.1182/blood.v110.11.1094.1094 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1094-1094

Author(s):

Hideki Muramatsu ◽

Nobuhiro Nishio ◽

Asahito Hama ◽

Hiroshi Yagasaki ◽

Yoshiyuki Takahashi ◽

...

Keyword(s):

High Risk ◽

Myeloid Leukemia ◽

Chromosomal Abnormalities ◽

Low Risk ◽

Hematopoietic Stem ◽

High Risk Patients ◽

Risk Patients ◽

Group A ◽

Group B ◽

First Complete Remission

Abstract Hematopoietic stem cell transplantation (HSCT) has been used as an effective consolidation therapy for children with acute myeloid leukemia (AML) in first complete remission (CR). Although it is effective in relapse prevention, often it causes severe late sequelae, such as short stature and infertility. There is a recent trend to restrict the use of HSCT in first CR for high-risk patients. However, there is no study comparing which strategy is better, risk-adapted or general recommendation for HSCT in AML children in first CR. In our institutes, all such children in first CR were recommended either allogeneic or autologous HSCT until 1997. After 1998, patients were classified into three risk-groups. Low-risk patients (t(8;21) and inv(16)) were not recommended to undergo HSCT. High-risk patients (−7, 5q-, Ph1, t(16;21) and remission failure) were recommended to undergo HSCT. Intermediate-risk (other karyotypes) patients received HSCT in first CR if a suitable donor was available. In this study, we retrospectively compared the prognosis of 66 patients who were diagnosed with de novo AML between 1991 and 1997 (group A; n=37) and between 1998 and 2003 (group B; n=29). AML with Down syndrome and AML-M3 were excluded. The median (range) age was five (0–15) years. FAB classifications were M0 (n = 1), M1 (n = 10), M2 (n = 22), M4 (n = 6), M4E (n = 5), M5 (n = 14), M6 (n = 0), and M7 (n = 8). Chromosome analysis data were t(8;21) (n = 18), inv(16) (n = 4), 11q23 (n = 10), other abnormalities (n = 14), normal karyotype (n = 14), and unknown (n = 6). Induction chemotherapy comprised VP-16, cytarabine, and mitoxantrone. Sixty-three of 66 patients (95.5%) achieved CR. HSCT in first CR was done in 24 patients (64.9%) in group A and seven patients (24.1%) in group B (p = 0.0044). Age, sex, WBC count at diagnosis, FAB classification and chromosomal abnormalities did not differ between the two groups. Fourteen (five in group A and nine in group B) patients relapsed. Six (three in group A and three in group B) of them were salvaged by HSCT. Both 5-year event-free survival (EFS) and overall survival (OS) were statistically higher in group A than in group B (5-year EFS: 83.8 ± 6.1% versus 62.1 ± 9.0%, p = 0.0404; 5-year OS: 91.6 ± 4.7% versus 71.6 ± 8.5%, p = 0.0364). Although intensified chemotherapy without HSCT for low-risk AML patients is desirable to avoid the late complications of HSCT, our analysis showed that the introduction of risk-stratified treatment strategy significantly worsened the chances of EFS and OS. Our risk stratification based on chromosomal abnormalities only may be insufficient to identify low-risk AML children. Development of more sophisticated risk classification, including molecular markers, may be required to identify true low-risk patients who should avoid HSCT in first CR.

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Ultrasound Assessment of Low Risk versus High Risk Pregnancy and Perinatal Outcome

JMS SKIMS ◽

10.33883/jms.v17i1.226 ◽

2014 ◽

Vol 17 (1) ◽

pp. 6-10

Author(s):

Rita Thakur ◽

Rabia Khurshid ◽

Swarn Kanta Gupta ◽

Cimona Lynsandanha ◽

Abida Ahmad

Keyword(s):

High Risk ◽

Perinatal Mortality ◽

Perinatal Outcome ◽

Low Risk ◽

Neonatal Deaths ◽

High Risk Patients ◽

Still Births ◽

Risk Patients ◽

Group A ◽

Group B

Objective: To determine the maturational changes in the placenta by ultrasonography at various gestational ages in low risk vs. high risk pregnancies and their correlation with perinatal outcome. Subjects: Study was conducted in 100 patients with singleton pregnancies, divided into two groups: Group A (control group) having no medical or obstetrical complications in the current pregnancy and Group B (study group) having medical or obstetrical complication. All the patients were subjected to ultrasonography between 28-31 weeks, 32-37 weeks and after 37 weeks of gestation. All cases were followed till pregnancy outcome and neonates followed up to 7 days after birth. Perinatal outcome of group A and group B was compared. Results: It was observed that placental maturity increased with GA in both groups but placenta matured earlier in high risk cases. 8% patients in group A and 26% in group B showed earlier placental maturation. Patients of diabetes mellitus showed delayed maturity and lower grades were found even at termination. Incidence of LSCS was 44%in group B and 20% in group A. Good apgar score was shown when placental maturity was of higher grade. Respiratory distress syndrome was seen in only 4% neonates in group A and 8% in group B at termination with grade III placenta. 19% neonates in group A required admission to an ICU as compared to 37% in group B. Perinatal mortality was high in patients who had placental grade 0 and 1 at termination in both the groups. There was 10% perinatal mortality (4% still births and 6% neonatal deaths) in group A and 14% (4% still births and 10% neonatal deaths) in group B as high risk patients were there in group B. Conclusion: Placental grading by ultrasonography is a reliable index of foetal pulmonary maturity and it can assist the obstetrician in the management of high risk patients, thus making ultrasonography a useful tool for predicting the perinatal outcome and planning treatment modalities for termination of pregnancy. JMS 2014;17(1):6-10

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Utility of Stimulated Thyroglobulin in the Differentiate Thyroid Cancer

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1786 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A874-A874

Author(s):

Fabiola Romero ◽

Sandra Galeano ◽

Francisco Cabrera ◽

Liliana Vigo ◽

Carlos Laterza ◽

...

Keyword(s):

High Risk ◽

Radioactive Iodine ◽

Differentiated Thyroid Carcinoma ◽

Low Risk ◽

Intermediate Risk ◽

Body Scan ◽

Risk Patients ◽

Group A ◽

Total Body ◽

Group B

Abstract Introduction: The treatment of differentiated thyroid cancer has changed considerably, total thyroidectomy and radioactive iodine ablation represented the initial treatment for these patients, currently with a great debate around the choice of which patient should undergo ablation with radioactive iodine in the post-surgical period. Objective: To determine the values of stimulated thyroglobulin (in hypothyroidism) in patients with differentiated thyroid carcinoma who have had surgery and its relationship with the ATA 2015 recurrence risk stratification and the presence of distant or locoregional metastasis in post ablative total body scan with I131 Methodology: Retrospective study, which included patients with differentiated thyroid carcinoma, patients who have had total thyroidectomy surgery and subsequent ablation with I131 in 45 days at the Central Hospital of Instituto de Prevision Social, from 2011 to 2018. There were evaluated: post-surgical thyroglobulin dosage in hypothyroidism, antithyroglobulin antibody measurement, and total body scan results at 72 hours post ablation with I131. There were excluded: Patients with positive antithyroglobulin antibodies, eu /hyperthyroidism, or incomplete data. Results: 100 patients conformed by women (88.0%), whose average age was 44.7 (± 16.1), intermediate risk 60%, high risk 31% and low risk 9%. According to the stimulated thyroglobulin values, 3 groups were classified: Group A thyroglobulin less than 1 ng/dl 32%, Group B 1 to 10 ng/dl 39%, Group C greater than 10 ng/dl 29%. Of the patients at intermediate risk n: 60, 23 (38%) belonged to group A, 27 (45%) to group B and 10 (17%) to group C. Of high-risk patients n: 31, 7 (22%) belonged to group A, 8 (26%) to group B, and 16 (52%) to group C. Of low risk patients n: 9, 2 (22%) belonged to group A, 4 (44%), group B, and 3 (33%) to group C. Post-ablative body scan detected locoregional or distant metastases in 23 (23%) patients, of which 2 (8.6%) belonged to group A, 6 (26%) to group B, 15 (65%) to group C. They were intermediate risk 10 (43%) and high risk 13 (57%) of them. No low-risk patient presented a positive RCT. There was found a relationship between thyroglobulin and high ATA risk (p <0.05) with positive RCT. Association between thyroglobulin> 10ng / dL and the presence of metastasis (p = 0.0001), Exp (B) 15.1 with R2 25 and 35%. Conclusion: A stimulated postoperative thyroglobulin dosage greater than 10 ng/ dL increases the chances of recurrence 15 times, with 25 to 37% chance of it. So, it would be important to consider ablation with iodine 131 in this type of patients.

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40 Weeks of Gestation is as High-Risk Gestation as 41 Weeks in Low-Risk Pregnancies

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i4.1454 ◽

2020 ◽

Vol 24 (4) ◽

pp. 358-362

Author(s):

Aqsa Ikram Ul Haq ◽

Shama Bashir ◽

Nargis Shabana ◽

Nadia Sadiq ◽

Fatima Chaudhry Inayat ◽

...

Keyword(s):

High Risk ◽

Vaginal Delivery ◽

Low Risk ◽

P Value ◽

Gestation Age ◽

B 41 ◽

Group A ◽

Study Population ◽

Group B ◽

Meconium Stained Amniotic Fluid

Introduction: Postdate pregnancy is associated with a higher frequency of obstetrical complications and perinatal morbidity. The incidence of meconium-stained amniotic fluid is 30% at 40 weeks which is very high. This study aimed to find out the need for fetal surveillance and delivery in our population, keeping in view that 40 weeks of gestation is as high risk as 41 weeks gestation in low-risk pregnancies.Material and Methods: The study was conducted at Obstetrics & Gynecology Department, Unit-II, Holy Family Hospital, and Rawalpindi from 16 February to 15 August 2019 after ethical clearance. Postdate pregnant women from 40 to 41 weeks who meet study criteria were enrolled in the study. We divided participants into two groups. Group A (40 to 40+6 weeks of gestation) while group B had Group B (41 to 41+6 weeks of gestation). Results: A total of 236 postdate mothers presented of which 148(62%) were in group A while 88 (38%) were in group B. Mean gestational age in our study was 40.88 ± 0.71 weeks. overall vaginal delivery, cesarean delivery, and meconium stained liquor were found in 75.84%, 24.16%, and 35.17% patients respectively. 82 (34.7%) participants presented with meconium-stained liquor meconium-stained liquor with women in group B has a higher frequency of meconium-stained liquor, 45 (30.41%) in group A and 37 (42.04%) in group B, P-value 0.069. rate of vaginal delivery was 71.62% in group A and 82.95% in group B which was statistically significant. P-value 0.049Conclusion: High percentage of meconium-stained liquor was observed in the study population. Frequency of vaginal delivery increases if postdate women waited till 41 weeks. 30% of women at gestation age 40 to 40+6 have meconium-stained liquor which shows almost 1/3 of pregnant ladies are exposed to the compromised fetal status which is a considerable risk. This increases further as the gestation age advances. Appropriate interventions should be taken at 40 weeks in low-risk pregnancies to avoid perinatal risk.

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The effect of prophylactic chemotherapy on treatment outcome of postmolar gestational trophoblastic neoplasia

10.21203/rs.3.rs-226761/v1 ◽

2021 ◽

Author(s):

Yuanyuan Liu ◽

Yaqiong Ye ◽

Xiaodong Cheng ◽

Weiguo Lu ◽

Xing Xie ◽

...

Keyword(s):

Drug Resistance ◽

High Risk ◽

Low Risk ◽

Control Group ◽

Gestational Trophoblastic Neoplasia ◽

Alternative Agent ◽

Group A ◽

Group B ◽

Prophylactic Chemotherapy ◽

And Control

Abstract Background: Prophylactic chemotherapy (P-chem) was considered as an effective method to prevent malignant transformation of high-risk HM. However, P-chem might increase the risk of subsequent drug resistance and delay the time to diagnosis of gestational trophoblastic neoplasia (GTN). The objective of this study was to evaluate whether P-chem increased the drug resistance rate of postmolar GTN and whether the first-line chemotherapy of low-risk GTN after P-chem should be different from P-chem.Methods: Postmolar GTN were divided into P-Chem group and control group, according to whether they received P-Chem. The control group and P-Chem group were matched according to age, high-risk/low-risk GTN. Postmolar GTN patients without P-chem were randomly selected as the control group at 3:1. The clinical parameters of these patients were collected and compared.Results: Totally 455 low-risk and 32 high-risk postmolar GTN patients were treated at our hospital between 2008.01.01 and 2017.12.31. WHO risk score, chemotherapy cycles to achieve hCG normalization and resistant rate were similar between P-chem (27 cases) and control (81 cases) group, no matter in low-risk or high-risk GTN. Among low-risk GTN patients, interval from hydatidiform mole to GTN was significantly longer in P-chem group than control (44 vs 69 days, P=0.001). Total chemotherapy cycles and resistant rate were similar between low-risk GTN treated with same agent as P-chem (group A) and alternative agent (group B). But group A needed more chemotherapy cycles to achieve hCG normalization than group B, no matter in all 24 GTN received P-chem (4.4 vs 2.8, p=0.024) or in 22 GTN received methotrexate as P-chem (3 vs 2, p=0.004).Conclusions: P-chem delayed the time to GTN diagnosis, but didn’t increase risk score or lead to drug resistance of postmolar GTN. Alternative agent different from P-chem had the potential of increasing chemotherapy response in low- risk postmolar GTN.

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