Cancer-related outcomes in oncology patients admitted to physical rehabilitation facilities.

e18643 Background: Admission to a physical rehabilitation facility (RF) can improve mobility and quality of life metrics in cancer patients, however, limited data exist on how these admissions impact cancer-related outcomes. We hypothesized that admissions to a RF following hospitalization delays cancer-directed treatment and increases mortality compared to those who are discharged home. Methods: A retrospective chart review identified oncology patients who were being treated with either intravenous or subcutaneous cancer-directed therapy between 2010-2020 and admitted to either a RF or home following hospitalization. Exclusion criteria were patients not on active cancer-directed treatment or going to hospice. Comparisons of RF vs. home were made using a chi-square test or Fisher’s exact test for categorical outcomes. Median days to next chemotherapy for each group were assessed with Kaplan-Meier/Product-Limit Estimates with a corresponding 95% confidence interval. Results: Of 189 patients, 24 were admitted to a RF and 165 went home. The median age of the study population was 65.6 years, with more males (66.7%) admitted to a RF vs. discharged home (49.7%), and both groups having >50% advanced stage cancer; primarily GI malignancies (25.9%) (Table). There was a statistically significant increase in the percent of patients who experienced delays in the time to their next anticipated chemotherapy date in the RF group vs. home (70.8% vs. 30.3%, P<0.0001), as well as median days to next chemotherapy (38.5 vs. 22, P<0.007). 30-day readmission rates were higher in patients at a RF vs. home (50% vs 29%, P<0.04). There were no significant differences in mortality comparing RF vs. home at 3, 6, or 12 months from the index inpatient hospitalization. Conclusions: Hospitalized oncology patients who were admitted to a RF had significant delays in cancer-directed therapy. Despite the smaller sample size of patients in a RF, their 30-day readmission rates were higher, suggesting a need to carefully select patients who can afford delays in cancer treatment.[Table: see text]

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Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wmp61 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Bryan Eckerle ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

Charles J Moomaw ◽

Matthew Flaherty ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Decision Making ◽

Retrospective Chart Review ◽

Clinical Decision ◽

Imaging Method ◽

Chi Square ◽

Exact Test ◽

High Prevalence ◽

Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

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Adherence to Symptom-Based Care Guidelines for Down Syndrome

Clinical Pediatrics ◽

10.1177/0009922816652416 ◽

2016 ◽

Vol 56 (2) ◽

pp. 150-156 ◽

Cited By ~ 8

Author(s):

Stephanie L. Santoro ◽

Han Yin ◽

Robert J. Hopkin

Keyword(s):

Down Syndrome ◽

Tissue Transglutaminase ◽

Retrospective Chart Review ◽

Pediatric Care ◽

Chi Square ◽

Sleep Study ◽

Exact Test ◽

Spine Radiograph ◽

Chi Square Test ◽

Cervical Spine Radiograph

To assess adherence to symptom-based studies recommended in the health supervision guidelines for Down syndrome from the American Academy of Pediatrics (AAP), 24 pediatric care sites participated in retrospective chart review. Symptom-based screening and 4 associated recommendations, including cervical spine radiograph, video swallow study, celiac study with tissue transglutaminase and sleep study were analyzed by reviewing well-child visit notes of 264 children with Down syndrome. Given trends toward symptom-based screens, Pearson’s chi-square test and Fisher’s exact test were used to determine the association between symptom presence and receiving corresponding symptom-based screens. Adherence rates were widely variable ranging from 0% to 79% completion. Symptom-based studies were performed in 22% to 36% of patients. Symptom screens were documented positive in many patients, but the presence of symptoms did not correlate with completion of symptom-based screens. Symptom-based screening is low; associated studies were performed in patients without documented symptoms contrary to AAP recommendation.

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Survival Benefit with Palliative Local Radiotherapy in Metastatic Nasopharyngeal Carcinoma

10.21203/rs.3.rs-79462/v1 ◽

2020 ◽

Author(s):

Wen Wen ◽

Ji-Jin Yao ◽

Qing-Nan Tang ◽

Xin Hua ◽

Ya-Nan Jin ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Southern China ◽

Univariate Analysis ◽

Fisher Exact Test ◽

Chi Square ◽

Exact Test ◽

Kaplan Meier ◽

Metastatic Nasopharyngeal Carcinoma ◽

Chi Square Test ◽

Group 5

Abstract Background: The purpose of this study was to evaluate the benefit to be gained from the addition of local radiotherapy to systemic chemotherapy in patients with newly diagnosed metastatic nasopharyngeal carcinoma in endemic areas of Southern China.Methods: The data of patients with metastatic nasopharyngeal carcinoma (n = 649) were retrospectively analyzed: 313 patients received only chemotherapy and 336 received chemotherapy plus radiotherapy. The characteristics of the radiotherapy and chemoradiotherapy groups were compared using the chi-square test or Fisher exact test. Survival was analyzed using the Kaplan–Meier method. A Cox proportional hazard model was used to identify the factors independently associated with survival.Results: Median follow-up was for 36 months. In univariate analysis, radiotherapy was significantly associated with improved survival (median OS 27 vs. 18 months; 5-year OS 36.4% vs. 20.1%; P < 0.001). In multivariate analysis, radiotherapy was an independent predictor of survival (HR, 0.65; CI, 0.53-0.79; P < 0.001). Other independent prognostic factors included number of metastatic organs, smoking, body mass index, hemoglobin, and N stage. In subgroup analysis, chemoradiotherapy was associated with improved survival in both the single-organ metastasis group (5-year OS, 38.5% vs. 25.1%; P < 0.001) and the multiorgan metastases group (5-year OS, 25.0% vs. 9.7%; P = 0.003）.Conclusion: The addition of local radiotherapy to chemotherapy appears to improve survival in patients with metastatic nasopharyngeal carcinoma. Even patients with multiorgan metastases may benefit from radiotherapy.

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Overexpression of MAL2 Correlates with Immune Infiltration and Poor Prognosis in Breast Cancer

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/5557873 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Yue Zhong ◽

Zhenjie Zhuang ◽

PeiJu Mo ◽

Qi Shang ◽

Mandi Lin ◽

...

Keyword(s):

Breast Cancer ◽

Dendritic Cells ◽

Poor Prognosis ◽

Cox Regression ◽

Plasmacytoid Dendritic Cells ◽

Chi Square ◽

Exact Test ◽

Kaplan Meier ◽

Chi Square Test ◽

The Relationship

Background. Myelin and lymphocyte, T cell differentiation protein 2 (MAL2) is highly expressed in various cancers and associated with the development and prognosis of cancer. However, the relationship between MAL2 and breast cancer requires further investigation. This study aimed to explore the prognostic significance of MAL2 in breast cancer. Methods. MAL2 expression was initially assessed using the Oncomine database and The Cancer Genome Atlas (TCGA) database and verified by quantitative real-time polymerase chain reaction (RT-qPCR). The chi-square test or Fisher’s exact test was used to explore the association between clinical characteristics and MAL2 expression. The prognostic value of MAL2 in breast cancer was assessed by the Kaplan–Meier method and Cox regression analysis. Gene set enrichment analysis (GSEA) was performed to identify the biological pathways correlated with MAL2 expression in breast cancer. Besides, a single-sample GSEA (ssGSEA) was used to assess the relationship between the level of immune infiltration and MAL2 in breast cancer. Results. Both bioinformatics and RT-qPCR results showed that MAL2 was expressed at high levels in breast cancer tissues compared with the adjacent tissues. The chi-square test or Fisher’s exact test indicated that MAL2 expression was related to stage, M classification, and vital status. Kaplan–Meier curves implicated that high MAL2 expression was significantly associated with the poor prognosis. Cox regression models showed that high MAL2 expression could be an independent risk factor for breast cancer. GSEA showed that 14 signaling pathways were enriched in the high-MAL2-expression group. Besides, the MAL2 expression level negatively correlated with infiltrating levels of eosinophils and plasmacytoid dendritic cells in breast cancer. Conclusion. Overexpression of MAL2 correlates with poor prognosis and lower immune infiltrating levels of eosinophils and plasmacytoid dendritic cells in breast cancer and may become a biomarker for breast cancer prognosis.

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Sarcopenia as a Risk Factor of Morbimortality in Colorectal Cancer Surgery

Gastrointestinal Disorders ◽

10.3390/gidisord2020010 ◽

2020 ◽

Vol 2 (2) ◽

pp. 107-117

Author(s):

Mariana Pereira ◽

Ana Pereira ◽

Patrícia Silva ◽

Catarina Costa ◽

Sandra F. Martins

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Independent Predictor ◽

Chi Square ◽

Colorectal Cancer Surgery ◽

Free Survival ◽

Exact Test ◽

Kaplan Meier ◽

Qualitative Variables ◽

Chi Square Test

Background: Colorectal cancer (CRC) surgery is associated with high rates of postoperative morbimortality. Sarcopenia has been identified as an independent predictor of these surgical outcomes. Methods: A sample of 272 patients who underwent CRC surgery between January 2005 and May 2010 at Braga Hospital, was selected. Sarcopenia was defined by the skeletal muscle mass index, measured by preoperative computed tomography (CT), at L3 level, using ImageJ® software. Associations between sarcopenia and qualitative variables were analyzed by Chi-Square Test (χ2) or Fisher’s Exact Test and, for quantitative variables, by Mann-Whitney Test. A multivariate logistic regression was performed to assess if sarcopenia was an independent predictor of major morbidity. The overall and recurrence-free survivals were analyzed by Kaplan-Meier method and multivariate Cox regression was performed for recurrence-free survival. Results: The prevalence of sarcopenia was 19.1%. Sarcopenia was associated with male gender, no CRC family history and colon tumour (p < 0.001, p = 0.029 and p = 0.017, respectively). The presence of sarcopenia was associated with postoperative morbidity Clavien–Dindo classification (p = 0.003), and sarcopenia was an independent predictor for major complications (grade ≥ III) (p = 0.003). Conclusions: The evaluation of sarcopenia in patients undergoing CRC surgical resection allows to predict a higher probability of major postoperative morbimortality.

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Characterization and clinical evaluation of microsatellite instability and loss of heterozygosity within tumor-related genes in colorectal cancer

BMC Medical Genomics ◽

10.1186/s12920-021-01051-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Xueyun Huo ◽

Dandan Feng ◽

Shuangyue Zhang ◽

Zhenkun Li ◽

Xiaohong Li ◽

...

Keyword(s):

Colorectal Cancer ◽

Microsatellite Instability ◽

Loss Of Heterozygosity ◽

Clinical Features ◽

Mucinous Carcinoma ◽

Chi Square ◽

Exact Test ◽

Kaplan Meier ◽

Chi Square Test ◽

The Relationship

Abstract Background Microsatellite instability (MSI) is a biomarker for better outcomes in colorectal cancer (CRC). However, this conclusion is controversial. In addition, MSs can be a useful marker for loss of heterozygosity (LOH) of genes, but this finding has not been well studied. Here, we aimed to clarify the predictive value of MSI/LOH within tumor-related genes in CRC. Methods We detected MSI/LOH of MSs in tumor-related genes and the Bethesda (B5) panel by STR scanning and cloning/sequencing. We further analyzed the relationship between MSI/LOH status and clinical features or outcomes by Pearson’s Chi-square test, Fisher’s exact test and the Kaplan–Meier method. Results The findings indicated that the MSI rates of B5 loci were all higher than those of loci in tumor-related genes. Interestingly, MSI/LOH of 2 loci in the B5 panel and 12 loci in tumor-related genes were associated with poorer outcomes, while MSI/LOH of the B5 panel failed to predict outcomes in CRC. MSI of BAT25, MSI/LOH of BAT26 and MSI of the B5 panel showed closer relationships with mucinous carcinoma. In addition, LOH-H of the B5 panel was associated with increased lymphatic metastasis. Conclusions In summary, MSI/LOH of certain loci or the whole panel of B5 is related to clinical features, and several loci within tumor-related genes showed prognostic value in the outcomes of CRC.

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Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211022598 ◽

2021 ◽

pp. 153857442110225

Author(s):

Joel Mathew John ◽

Vimalin Samuel ◽

Dheepak Selvaraj ◽

Prabhu Premkumar ◽

Albert A Kota ◽

...

Keyword(s):

Clinical Outcomes ◽

Interventional Procedure ◽

Tertiary Care ◽

Arterial Disease ◽

Multivariable Logistic Regression Analysis ◽

Tertiary Care Centre ◽

Chi Square ◽

Exact Test ◽

Institutional Review ◽

Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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1591. Antibiotic Utilization Trends in Veterans Affairs (VA) Patients with Carbapenem Resistant Enterobacteriaceae (CRE) Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1771 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S792-S792

Author(s):

Alfredo Traversa ◽

Linda Poggensee ◽

Geneva M Wilson ◽

Katie J Suda ◽

Charlesnika T Evans ◽

...

Keyword(s):

Treatment Options ◽

Blood Stream ◽

Chi Square ◽

Blood Stream Infections ◽

Exact Test ◽

Carbapenem Resistant ◽

Extended Spectrum ◽

New Antibiotics ◽

Chi Square Test ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an “urgent threat” to public health. Historically, colistin and tigecycline had been considered the drugs of choice for CRE infections, while other agents such as aminoglycosides and carbapenems had been used as adjunctive therapy. However, the FDA approval of ceftazidime-avibactam in 2015, meropenem-vaborbactam in 2017, and plazomicin in 2018 has expanded treatment options. Our purpose was to assess trends in CRE treatment for “new” antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) as compared with other antibiotics with CRE activity. Methods This was a retrospective cohort study describing treatment of CRE blood stream infections (BSI) across 134 VA facilities from 2012-2018. Patients were censored at their first positive blood culture with CRE. Categorical data was assessed with a Fisher’s exact test or chi-square test. Trends test and logistic regression were used to describe changes in CRE treatment over time. Results 724 patients with positive blood cultures for CRE were identified during the study period. Most patients were male (94%), white (32%) or Hispanic (38%), and the mean age was 71.5+11.9. Of those patients that received antibiotics (N=697), 53.4% carbapenems, 40.3% received aminoglycosides, 39.3% received polymyxins, 32.9% penicillins, 32.6% extended spectrum cephalosporins, 26.1% fluoroquinolones, 11.6% ceftazidime/avibactam, and 0.4% ceftolazone/tazobactam. Over the study period, there was decreased utilization of aminoglycosides (P < 0.0026) and colistin (P< 0.002) and increases in extended spectrum cephalosporins (P < 0.001) and ceftazidime/avibactam (P < 0.001). Conclusion Utilization of “older” agents such as aminoglycosides and polymyxins for the treatment of CRE blood stream infections is decreasing in the VA. Treating CRE with ceftazidime/avibactam, a newly approved antibiotic, and extended spectrum cephalosporins are increasing. Disclosures All Authors: No reported disclosures

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Association of cervical carcinogenesis risk with HPV16 E6 and E7 variants in the Taizhou area, China

BMC Cancer ◽

10.1186/s12885-021-08531-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mei-Zhen Dai ◽

Yi Qiu ◽

Xing-Hong Di ◽

Wei-Wu Shi ◽

Hui-Hui Xu

Keyword(s):

Cervical Cancer ◽

Cervical Carcinogenesis ◽

Chi Square ◽

Major Health Problem ◽

Hpv16 E6 ◽

Exact Test ◽

Chi Square Test ◽

E6 And E7

Abstract Background Human papillomavirus (HPV) type 16 accounts for a larger share of cervical cancer and has been a major health problem worldwide for decades. The progression of initial infection to cervical cancer has been linked to viral sequence properties; however, the role of HPV16 variants in the risk of cervical carcinogenesis, especially with longitudinal follow-up, is not fully understood in China. Methods We aimed to investigate the genetic variability of HPV16 E6 and E7 oncogenes in isolates from cervical exfoliated cells. Between December 2012 and December 2014, a total of 310 single HPV16-positive samples were selected from women living in the Taizhou area, China. Sequences of all E6 and E7 oncogenes were analysed by PCR-sequencing assay. Detailed sequence comparison, genetic heterogeneity analyses and maximum-likelihood phylogenetic tree construction were performed with BioEdit Sequence Alignment Editor and MEGA X software. Data for cytology tests and histological diagnoses were obtained from our Taizhou Area Study with longitudinal follow-up for at least 5 years. The relationship between HPV16 variants and cervical carcinogenesis risk was analysed by the chi-square test or Fisher’s exact test. Results In this study, we obtained 64 distinct variation patterns with the accession GenBank numbers MT681266-MT681329. Phylogenetic analysis revealed that 98.3% of HPV16 variants belong to lineage A, in which the A4 (Asian) sublineage was dominant (64.8%), followed by A2 (12.1%), A1 (11.4%), and A3 (10.0%). The A4 (Asian) sublineage had a higher risk of CIN2+ than the A1–3 (European) sublineages (OR = 2.69, 95% CI = 1.04–6.97, P < 0.05). Furthermore, nucleotide variation in HPV16 E6 T178G is associated with the development of cervical cancer. Conclusion These data could provide novel insights into the role of HPV16 variants in cervical carcinogenesis risk in China.

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