Splenectomy in Patients with Myeloproliferative Neoplasms (MPNs): Efficacy, Complications and Impact On Survival and Transformation.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2853-2853
Author(s):  
Fabio P S Santos ◽  
Constantine S. Tam ◽  
Hagop M. Kantarjian ◽  
Jorge E. Cortes ◽  
Deborah A. Thomas ◽  
...  
Keyword(s):  
Myeloproliferative Neoplasms ◽  
Therapeutic Option ◽  
Splenic Vein ◽  
Time Dependent ◽  
Chromosome 17 ◽  
Short Term ◽  
Post Surgery ◽  
Impact On Survival ◽  
Md Anderson

Abstract Abstract 2853 Introduction: Splenectomy may be an effective therapeutic option for treating massive splenomegaly in patients with MPNs. There is still limited data on its short- and long-term benefits and risks. Objective: To describe short-term outcomes, complications and impact on survival and transformation to acute myeloid leukemia (AML) in patients with MPNs who underwent splenectomy. Methods: First, efficacy and short-term complications were analyzed in 94 patients with different MPNs who underwent splenectomy at MD Anderson between 1981–2009. Second, medical records of 696 patients with myelofibrosis (MF) seen at MD Anderson between 1966–2009 were reviewed (among which 91 underwent splenectomy either at or outside MD Anderson) to evaluate the long-term impact of splenectomy on overall survival (OS) and transformation-free survival (TFS). Improvement in anemia and thrombocytopenia were defined by the International Working Group on Myelofibrosis Research and Treatment response criteria. Survival was estimated by Kaplan-Meier method, and hazard ratios (HR) were determined by Cox multivariate analysis. Splenectomy was analyzed as a time-dependent covariate. Risk in patients with MF was determined by the Dynamic International Prognostic Scoring System (DIPSS). Accelerated phase (AP) criteria in MF were determined as thrombocytopenia <50×109/L, chromosome 17 abnormalities and blasts >10% in peripheral blood (PB) or bone marrow (BM). Results: Splenectomy improved spleen pain, anemia and thrombocytopenia in 84%, 47% and 66% of patients, respectively. Among patients with MF, improvement in anemia and thrombocytopenia was seen in 44% and 75% of patients, respectively. Hematological complications included post-operative leukocytosis (76%) and thrombocytosis (43%), developing within a median time of 1 day and 5 days post-surgery, respectively. Early (<7 days) intervention for control of elevated white blood cell and/or platelet count was needed in 37% of patients. Forty-six percent of patients developed non-hematological clinical complications, and the most common was venous thromboembolism (VTE; 16%). VTE sites included portal vein (N=11), supra-hepatic vein (N=3) and superior vena cava, pulmonary embolism and splenic vein (N=1 each). Post-operative mortality was 5%. Median survival post-splenectomy was 19.2 months, and 5-year survival 16.1%. In the second cohort of patients with MF, requirement for splenectomy was associated with decreased OS (HR=2.84, p<0.0001) and TFS (HR=2.79, p<0.0001). In the multivariable model, the time dependent covariate splenectomyremained an independent risk factor for inferior OS and TFS in patients with MF, alongside male sex, transfusion dependency, DIPSS score and AP criteria (Table). Conclusions: Splenectomyis a possible therapeutic option for patients with MF and other MPNs, and its greatest benefits are related to improvement in spleen pain and discomfort, anemia and thrombocytopenia. However, in patients with MF it appears to be associated with increased mortality and risk of transformation to AML. Disclosures: No relevant conflicts of interest to declare.

Selected Contribution: Chronic intermittent hypoxia enhances respiratory long-term facilitation in geriatric female rats

2003 ◽  
Vol 95 (6) ◽  
pp. 2614-2623 ◽  
Author(s):  
A. G. Zabka ◽  
G. S. Mitchell ◽  
E. B. Olson ◽  
M. Behan
Keyword(s):  
Intermittent Hypoxia ◽  
Young Female ◽  
Time Dependent ◽  
Female Rats ◽  
Chronic Intermittent Hypoxia ◽  
Middle Aged ◽  
Short Term ◽  
Hypoxic Response ◽  
Long Term Facilitation

Age and the estrus cycle affect time-dependent respiratory responses to episodic hypoxia in female rats. Respiratory long-term facilitation (LTF) is enhanced in middle-aged vs. young female rats ( 72 ). We tested the hypothesis that phrenic and hypoglossal (XII) LTF are diminished in acyclic geriatric rats when fluctuating sex hormone levels no longer establish conditions that enhance LTF. Chronic intermittent hypoxia (CIH) enhances LTF ( 41 ); thus we further predicted that CIH would restore LTF in geriatric female rats. LTF was measured in young (3-4 mo) and geriatric (20-22 mo) female Sasco Sprague-Dawley rats and in a group of geriatric rats exposed to 1 wk of nocturnal CIH (11 vs. 21% O2 at 5-min intervals, 12 h/night). In anesthetized, paralyzed, vagotomized, and ventilated rats, time-dependent hypoxic phrenic and XII responses were assessed. The short-term hypoxic response was measured during the first of three 5-min episodes of isocapnic hypoxia (arterial Po2 35-45 Torr). LTF was assessed 15, 30, and 60 min postepisodic hypoxia. Phrenic and XII short-term hypoxic response was not different among groups, regardless of CIH treatment ( P > 0.05). LTF in geriatric female rats was smaller than previously reported for middle-aged rats but comparable to that in young female rats. CIH augmented phrenic and XII LTF to levels similar to those of middle-aged female rats without CIH ( P < 0.05). The magnitude of phrenic and XII LTF in all groups was inversely related to the ratio of progesterone to estradiol serum levels ( P < 0.05). Thus CIH and sex hormones influence the magnitude of LTF in geriatric female rats.

scholarly journals A Case of Myeloproliferative Neoplasm with BCR-FGFR1 Rearrangement: Favorable Outcome after Haploidentical Allogeneic Transplantation

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Paola Villafuerte-Gutiérrez ◽  
Montserrat López Rubio ◽  
Pilar Herrera ◽  
Eva Arranz
Keyword(s):  
Kinase Inhibitors ◽  
Fusion Gene ◽  
Myeloproliferative Neoplasms ◽  
Therapeutic Option ◽  
Myeloproliferative Neoplasm ◽  
Allogeneic Transplantation ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Health Organization

Hematopoietic myeloproliferative neoplasms with FGFR1 rearrangement result in the 8p11 myeloproliferative syndrome that in the current Word Health Organization classification is designated as “myeloid and lymphoid neoplasm with FGFR1 abnormalities.” We report the case of a 66-year-old man who had clinical features that resembled chronic myeloid leukaemia (CML), but bone marrow cytogenetic and fluorescent in situ hybridization (FISH) studies showed t(8;22)(p11;q11) and BCR-FGFR1 fusion gene. He was initially managed with hydroxyurea, and given the aggressive nature of this disease, four months later, the patient underwent an allogeneic hematopoietic stem-cell transplantation (HSCT) from an HLA-haploidentical relative. Currently, HSCT may be the only therapeutic option for long-term survival at least until more efficacious tyrosine kinase inhibitors (TKIs) become available.

Abstract 84: Late (5-20 Years) Outcome After STA-MCA Anastomosis and Ultimate Indirect Bypass in Patients With Moyamoya Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Satoshi Kuroda ◽  
Naoki Nakayama ◽  
Shusuke Yamamoto ◽  
Daina Kashiwazaki ◽  
Haruto Uchino ◽  
...  
Keyword(s):  
Disease Progression ◽  
Moyamoya Disease ◽  
Hemorrhagic Stroke ◽  
Short Term ◽  
Post Surgery ◽  
Initial Surgery ◽  
Cerebrovascular Events ◽  
Late Morbidity

Background and Purpose: Surgical revascularization is now known to improve the outcome in patients with moyamoya disease. However, majority of previous studies reported their short-term (<5 years) outcome. Therefore, this study was aimed to evaluate long-term (5 to 20 years) outcome after STA-MCA anastomosis and ultimate indirect bypass, encephalo-duro-myo- arterio-pericranial synangiosis (EDMAPS). Methods: Cumulative incidence of late morbidity/mortality and disease progression were evaluated among 93 patients who underwent STA-MCA anastomosis and EDMAPS. All of them were prospectively followed up for longer than 5 years post-surgery (mean, 10.5±4.4 years). There were 35 pediatric and 58 adult patients. Clinical diagnosis included TIA or ischemic stroke in 80 patients, hemorrhagic stroke in 10, and asymptomatic in 3. STA-MCA anastomosis and EDMAPS were performed onto their 141 hemispheres. MRI and MRA were performed every 6 or 12 years during follow-up periods. Results: During follow-up periods, 92/93 patients were free from any stroke or death, but one recurred hemorrhagic stroke (0.10% per patient-year). Disease progression occurred in the territory of the contralateral carotid or posterior cerebral artery (PCA) in 19 hemispheres of 15 patients (1.5% per patient-year). The interval between initial surgery and disease progression varied from 0.5 to 15 years. Repeat bypass surgery for anterior and posterior circulations resolved ischemic attacks in all 10 patients. Conclusion: STA-MCA anastomosis and EDMAPS would be the best choice to prevent further cerebrovascular events for longer than 10 years by widely providing surgical collaterals to both the MCA and ACA territories. However, regular follow-up would be essential for longer than 10 years post-surgery to identify the disease progression in the territory of contralateral carotid artery and PCA and prevent late cerebrovascular events.

Does meloxicam provide adequate pain management as a post-operative analgesic in canine ovariohysterectomy patients?

2020 ◽  
Vol 11 (4) ◽  
pp. 192-197
Author(s):  
Gavin Goldsbrough ◽  
Helen Reynolds
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Pain Scale ◽  
Short Term ◽  
Post Surgery ◽  
Pain Scores ◽  
Significant Difference ◽  
Time Frames ◽  
Adequate Pain Management

Background: Meloxicam is an analgesic agent with anti-inflammatory properties, commonly used in veterinary practices to treat a variety of different long-term medical conditions and is also used as a short-term pain relief following particularly traumatic surgeries. Aims: An observational study was conducted to determine whether meloxicam provides adequate pain management as a post-operative analgesic for canine ovariohysterectomies. Methods: 13 canines were admitted for ovariohysterectomy. Each patient was assessed using the Glasgow composite pain scale (CMPS) prior to surgery during the admission procedure, 15 minutes post-operatively, at discharge and at their post-operative check (POC) 3–5 days after surgery. Results: Data were statistically analysed to determine the overall effectiveness of meloxicam in reducing pain following canine ovariohysterectomy. The results showed a statistically significant difference (Kruskal-Wallis test: H3 =12.98, p=0.005) in pain scores between admission, 15 minutes post operatively, discharge and 3–5 days POC. The greatest decrease in pain score was between 15 minutes post-operatively and POC (Mann-Whitney U test: W=236, n=13, 13, p=0.0014) and between discharge and POC (Mann-Whitney U test: W=227, n=13, 13, p=0.0060). Overall, this demonstrated that there was an improvement in pain suggesting meloxicam is effective between these time frames. In addition, 69.2% (n=9) of patients in the study showed a pain score of 0, indicating an absence of pain, on their final POC. Statistical analysis was also used to determine if there was any difference in pain score between the 3, 4 or 5 day POC pain score. The results show there was no significant difference (Kruskal-Wallis test: H2 =0.090, p=0.638) suggesting that meloxicam's effectiveness was similar across this range of time post surgery. Conclusion: The results from the study indicate that meloxicam is an effective post-operative analgesic for canine patients undergoing an ovariohysterectomy.

Glucocorticoids Decrease the Conversion of Thyroxine into 3,5,3′-Tri-Iodothyronine by Isolated Rat Renal Tubules

1982 ◽  
Vol 62 (2) ◽  
pp. 215-220 ◽  
Author(s):  
P. Heyma ◽  
R. G. Larkins
Keyword(s):  
Strong Evidence ◽  
Glucocorticoid Receptors ◽  
Actinomycin D ◽  
Time Dependent ◽  
Renal Tubules ◽  
Short Term ◽  
Collagenase Digestion ◽  
Isolated Rat

1. The effect of glucocorticoids on the deiodination of thyroxine (T4) to 3,5,3′-tri-iodothyronine (T3) was studied in rat renal tubules prepared by collagenase digestion. 2. In short-term (6 h) experiments, cortisol and dexamethasone inhibited the conversion of T4 into T3 at concentrations of 2 × 10-4 mol/l and 2 × 10-5 mol/l respectively. The inhibition by cortisol and dexamethasone was time dependent and was prevented by actinomycin D and progesterone, suggesting that the inhibition is mediated by an effect on nuclear transcription dependent on binding to glucocorticoid receptors. 3. In long-term (16 h) experiments, cortisol and dexamethasone inhibited T4 to T3 conversion by the tubules at concentrations of 1 × 10-12 mol/l and above. In addition, physiological concentrations of corticosterone (1 × 10-8 mol/l) were able to decrease T3 generation from T4. 4. Our data provide strong evidence that physiological concentrations of glucocorticoids are able to affect T3 production from T4 directly and suggest that they may be important regulators of T4 deiodination.

Seasonal to multi-annual speedup and slowdown of Greenland outlet glaciers inferred from time-dependent remote sensing observations

2020 ◽  
Author(s):  
Lizz Ultee ◽  
Bryan Riel ◽  
Brent Minchew
Keyword(s):  
Time Series ◽  
Flow Velocity ◽  
Ice Sheet ◽  
Surface Air Temperature ◽  
Greenland Ice Sheet ◽  
Time Dependent ◽  
Surface Velocity ◽  
Short Term ◽  
Ice Flow

&lt;p&gt;The rate of ice flux from the Greenland Ice Sheet to the ocean depends on the ice flow velocity through outlet glaciers. Ice flow velocity, in turn, evolves in response to multiple geographic and environmental forcings at different timescales. For example, velocity may vary daily in response to ocean tides, seasonally in response to surface air temperature, and multi-annually in response to long-term trends in climate. The satellite observations processed as part of the NASA MEaSUREs Greenland Ice Sheet Velocity Map allow us to analyse variations in ice surface velocity at multiple timescales. Here, we decompose short-term and long-term signals in time-dependent velocity fields for Greenland outlet glaciers based on the methods of Riel et al. (2018). Patterns found in short-term signals can constrain basal sliding relations and ice rheology, while the longer-term signals hint at decadal in/stability of outlet glaciers. We present example velocity time series for outlets including Sermeq Kujalleq (Jakobshavn Isbrae) and Helheim Glacier, and we highlight features indicative of dynamic drawdown or advective restabilization. Finally, we comment on the capabilities of a time series analysis software under development for glaciological applications.&lt;/p&gt;

Association of adrenal hormone metabolites and mortality over a 6-year follow-up in COPD patients with acute exacerbation

2018 ◽  
Vol 56 (4) ◽  
pp. 669-680 ◽  
Author(s):  
Seline Zurfluh ◽  
Manuela Nickler ◽  
Manuel Ottiger ◽  
Christian Steuer ◽  
Alexander Kutz ◽  
...  
Keyword(s):  
Cox Regression ◽  
Time Dependent ◽  
Chronic Obstructive ◽  
Short Term ◽  
Therapeutic Implications ◽  
Adrenal Hormone ◽  
Copd Patients ◽  
Short And Long Term ◽  
Long Term Mortality

Abstract Background: The release of hormones from the adrenal gland is vital in acute and chronic illnesses such as chronic obstructive pulmonary disease (COPD) involving recurrent exacerbations. Using a metabolomic approach, we aim to investigate associations of different adrenal hormone metabolites with short- and long-term mortality in COPD patients. Methods: We prospectively followed 172 COPD patients (median age 75 years, 62% male) from a previous Swiss multicenter trial. At baseline, we measured levels of a comprehensive spectrum of adrenal hormone metabolites, including glucocorticoid, mineralocorticoid and androgen hormones by liquid chromatography coupled with tandem mass spectrometry (MS). We calculated Cox regression models adjusted for gender, age, comorbidities and previous corticosteroid therapy. Results: Mortality was 6.4% after 30 days and increased to 61.6% after 6 years. Higher initial androgen hormones predicted lower long-term mortality with significant results for dehydroepiandrosterone (DHEA) [adjusted hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70–0.98; p=0.026] and dehydroepiandrosterone sulfate (DHEA-S) (adjusted HR, 0.68; 95% CI, 0.50–0.91; p=0.009). An activation of stress hormones (particularly cortisol and cortisone) showed a time-dependent effect with higher levels pointing towards higher mortality at short term, but lower mortality at long term. Activation of the mineralocorticoid axis tended to be associated with increased short-term mortality (adjusted HR of aldosterone, 2.76; 95% CI, 0.79–9.65; p=0.111). Conclusions: Independent of age, gender, corticosteroid exposure and exacerbation type, adrenal hormones are associated with mortality at short and long term in patients with COPD exacerbation with different time-dependent effects of glucocorticoids, androgens and mineralocorticoids. A better physiopathological understanding of the causality of these effects may have therapeutic implications.

scholarly journals EARTHQUAKE FORECAST BY TIME-DEPENDENT HAZARD MODELS

2017 ◽  
Vol 50 (3) ◽  
pp. 1309
Author(s):  
R. Console
Keyword(s):  
Epidemic Model ◽  
Stress Change ◽  
Time Dependent ◽  
Occurrence Rate ◽  
Hazard Models ◽  
Short Term ◽  
Probability Of Occurrence ◽  
Seismogenic Structures ◽  
Definition Of

This presentation outlines methodological aspects of earthquake forecasting. The recurring debates concerning predictability of earthquakes clearly show how this problem is centred on the difficulty of systematically testing the numerous methodologies that in the years have been proposed and sustained by the supporters of prediction. This difficulty starts, sometimes, from the lack of a quantitative and rigorous definition of the concerned precursor, and other times from the lack of continuous observations, upon which statistical analyses could be based. After an introduction concerning the definition of earthquake precursors, the way how to validate forecast hypotheses and the cost associated to their operational application, I give two examples of time-dependent hazard models, for long-term and short-term earthquake forecasts respectively. Considering the long-term forecast modelling, the effect of stress change due to previous historical earthquakes on the probability of occurrence of future earthquakes on neighbouring faults is taken into account. Following a standard methodology developed a couple of decades ago, the probability of occurrence in the next 50 years for a characteristic earthquake on known seismogenic structures can be estimated by a time-dependent renewal model. Then, a physical model for the Coulomb stress change caused by previous earthquakes on these structures is applied. The influence of this stress change on the occurrence rate of characteristic earthquakes is computed taking into account the permanent perturbation (clock advance). The method so developed is applied to the computation of earthquake hazard of the main seismogenic structures recognized in the Southern Apennines region, for which both historical and paleoseismological data are available. A popular short-term time dependent hazard forecast model is the epidemic model. In this model earthquakes are regarded as the realization of a stochastic point process, and their magnitude distribution is described by the Gutenberg-Richter law with a constant b-value. The occurrence rate density is computed by the sum of two terms, one representing the independent, or spontaneous activity, and the other representing the activity induced by previous earthquakes. While the first term depends only on space, the second one is factored into three terms that respectively include the magnitude, time and location of the past earthquakes. An example of application of the epidemic model to the 2009 L’Aquila seismic series is shown.

scholarly journals The Clinical Effectiveness and Cost Effectiveness of Bariatric Metabolic Surgery for Obese with Poorly Controlled Type 2 Diabetes Patients In Malaysia - A Study Protocol

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1634-1634
Author(s):  
Jo Ann Galvan ◽  
Karuthan Chinna ◽  
Rusli Nordin ◽  
Nik Kosai Mahmood ◽  
Chin Kin Fah ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Cost Effectiveness ◽  
Study Protocol ◽  
Diabetes Care ◽  
Clinical Effectiveness ◽  
Term Effect ◽  
Short Term ◽  
Post Surgery ◽  
Obesity And Diabetes

Abstract Objectives Bariatric Surgery is a major breakthrough in diabetes care. Complete remission is attainable in a great percentage of patients. However, there is slow progress in this procedure in Malaysia. With the overwhelming rate of obesity and diabetes in the country, the potential advantage of this treatment modality is underestimated. Conventional diabetes care only controls 22% of the diabetics and healthcare expenditure has ballooned due to complications costs amounting to at least RM 2 billion in a year eating up 10% of the government's budget on healthcare. Furthermore, this burden will increase in the next decades as diabetes is predicted to increase by 69% by 2030. While this procedure is beneficial, it is an expensive intervention with risks of complications. This raises the question of whether bariatric surgery is cost-effective in the context of this country? Evidence must be available to decision-makers weighing the risk-benefit ratio of the procedure. This study aims to assess the clinical effectiveness and cost-effectiveness of bariatric surgery in managing obesity among the Malaysian population. It will specifically investigate the short term and long-term effects of the procedure investigating anthropometric and metabolic disease blood indicator changes while assessing direct, indirect costs, QALYs gained and complications associated with the procedure. Methods We will review charts of all patients who have undergone bariatric surgery procedures from 2014 to 2016 in HUKM, Department of Surgery and in Andrea Bariatric Surgery Clinic. We will look at their weight, BMI, and some blood parameter results before and after surgery one-year post-surgery for the short-term effect and 3–5 years post-surgery for the long-term effect. We will also assess the mortality risks and complications of the procedures. Study Population: All patients who underwent Bariatric Surgery procedures from 2014–206 in HUKM and in Andrea Bariatric Surgery ClinicStudy Site/Location: HUKM, Department of Surgery & Andrea Bariatric Surgery Clinic Results N/A - Study Protocol Conclusions The result of this study can contribute to the decision making of patients, doctors, and Health Insurance Companies in Malaysia Funding Sources Center for Research Management, Taylor's University.

Characteristics of gastrointestinal stromal tumor (GIST) patients receiving short-term versus long-term imatinib (IM) adjuvant therapy: A chart review analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10094-10094
Author(s):  
Annie Guerin ◽  
Anthony Paul Conley ◽  
Medha Sasane ◽  
Genevieve Gauthier ◽  
Frances Schwiep ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Clinical Information ◽  
Extended Period ◽  
Risk Profile ◽  
Prescribing Patterns ◽  
Short Term ◽  
Online Data ◽  
Chi Square ◽  
Post Surgery

10094 Background: In clinical practice, significant variability is seen in duration of adjuvant IM use. The objective of this study is to compare characteristics of GIST pts receiving adjuvant IM for a short (6-12 months) vs extended period (≥24 months) to better understand factors that may influence treatment (trt) duration decisions. Methods: Physician prescribing patterns and clinical information on adult pts with primary resectable Kit positive GIST initiating IM ≤84 days post-surgery was collected from 248 U.S. oncologists using online data collection forms. In addition to physicians’ perception of short- vs long-term use, pts’ risk assessment, trt, demographics, and comorbidities were collected for 246 short-term and 395 long-term IM pts. Characteristics were compared using Wilcoxon and Chi-square tests. Results: While pts were similar in age [59.0 vs. 58.1, P =.23], ethnicity, and region of residence, the short-term group included fewer males (57.7% vs 69.6%, P <.01) and had a higher prevalence of cardiovascular (11.4% vs 5.8%, P = .01) and ischemic heart diseases (5.3% vs 1.5%, P<.01). Differences were also observed in indicators of pre-treatment risk profile (tumor size, location, and rupture during surgery, mitotic count, and Miettinen score) (Table). Findings were consistent with main reasons reported by physicians for prescribing adjuvant IM over longer duration; in addition to pt risk profile (76.6%), tolerability (70.6%), younger pts (59.7%), safety (39.1%), trt response (29.8%), and economic reasons (26.2%) were other reasons impacting trt decisions. Conclusions: Pt risk is an important factor in physicians’ decisions to prescribe adjuvant IM for extended duration. However, age, tolerability, and comorbidities, also play an important role. [Table: see text]

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