scholarly journals Risk Factors of Survival in Dedifferentiated Liposarcoma

2021 ◽  
pp. 1-7
Author(s):  
Kevin Nguyen ◽  
Kevin Nguyen ◽  
Jonathan Gootee ◽  
Sarah Aurit ◽  
Sara Albagoush ◽  
...  
Keyword(s):  
Risk Factors ◽  
Therapeutic Option ◽  
Multivariable Analysis ◽  
Tumor Grade ◽  
Residual Tumor ◽  
Older Age ◽  
Surgical Margins ◽  
Dedifferentiated Liposarcoma ◽  
Anatomic Site ◽  
Increased Risk

Background: Liposarcoma is the most common malignant soft tissue sarcoma for which surgical resection is the most utilized therapeutic option. In this study, we aimed to explore the associations of surgical margins among other risk factors on survival in patients with dedifferentiated liposarcoma. Patients and Methods: The National Cancer Database (NCDB) was used to select patients with dedifferentiated liposarcoma to determine if surgical margins were associated with worse overall survival after controlling for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis. Results: Multivariable analyses showed that mortality risk increased for dedifferentiated liposarcoma patients with the following: older age, male, metastasis, high tumor grade, macroscopic residual tumor compared to no residual tumor. Conclusion: Older age, male sex, presence of metastasis, retroperitoneal/abdomen primary site, high grade tumors, and macroscopic residual tumor present after surgery led to an increased risk of mortality.

The importance of surgical margins in dedifferentiated liposarcoma survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e22528-e22528
Author(s):  
Sara Albagoush ◽  
Jonathan Gootee ◽  
Kevin Nguyen ◽  
Sarah J Aurit ◽  
Christina Curtin ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Soft Tissue Sarcomas ◽  
Residual Tumor ◽  
Surgical Margins ◽  
Dedifferentiated Liposarcoma ◽  
High Grade ◽  
Anatomic Site ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

e22528 Background: Among the types of soft tissue sarcomas (STS), liposarcoma is the most common malignant STS. Considering therapeutic options, surgical resection is the most utilized therapeutic option. In this study, we aim to explore the effects of varying degrees of surgical margins on survival in patients with dedifferentiated liposarcoma. Methods: The National Cancer Database (NCDB) was used to select patients with dedifferentiated liposarcoma to determine if surgical margins and other variables were associated with worse overall survival after accounting for age, gender, race, Charlson-Deyo score, anatomic site, treatment approach, tumor size, tumor grade, and presence of metastases through multivariable analysis. Results: Of the 1,004 patients, 64.4% were male, 87.0% were white, and the median age was 63 years. Approximately 95% had no metastases at the time of diagnosis, and 91.5% had high grade liposarcoma. For the status of surgical margins, 50.8% had no residual tumors, 26.1% had microscopic residual tumors, and 4.3% had macroscopic residual tumors. In general, the risk of death was higher for older males (25.8% increased risk of mortality) and those with metastases (312.9% increased risk of mortality) as well as patients with high grade liposarcoma (112.4% increased risk of mortality). When compared to no residual tumor after surgery, patients with macroscopic residual tumors, had a 96.7% increased risk of death (HR 95% CI:1.24 to 3.13; p= 0.004). Conclusions: Older age, presence of metastasis, male patients, retroperitoneal/abdomen primary site, high grade tumors, and macroscopic or residual tumor present after surgery led to an increased risk of mortality.

scholarly journals Older age and diclofenac are associated with increased risk of upper gastrointestinal bleeding in gout patients

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11468
Author(s):  
Wan Syamimee Wan Ghazali ◽  
Wan Mohd Khairul Bin Wan Zainudin ◽  
Nurul Khaiza Yahya ◽  
Asmahan Mohamed Ismail ◽  
Kah Keng Wong
Keyword(s):  
Risk Factors ◽  
Uric Acid ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Gouty Arthritis ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Older Age ◽  
Increased Risk ◽  
Upper Gastrointestinal

Background Gouty arthritis is a disease of global burden in which defective metabolism of uric acid causes arthritis. Gouty arthritis or medications used for its treatment may lead to uric acid-associated complications such as upper gastrointestinal bleeding (UGIB) and renal impairment. Methods In this cross-sectional study with retrospective record review, 403 established gouty arthritis patients were recruited to determine the incidence of UGIB and associated factors among gout patients who were on regular nonsteroidal anti-inflammatory drugs (NSAIDs). Results The mean age of the 403 gouty arthritis patients was 55.7 years old and the majority (n = 359/403; 89.1%) were male. The incidence of UGIB among gouty arthritis patients who were on NSAIDs was 7.2% (n = 29/403). Older age (p < 0.001), diclofenac medication (p = 0.003), pantoprazole medication (p = 0.003), end-stage renal failure (ESRF) (p = 0.007), smoking (p = 0.035), hypertension (p = 0.042) and creatinine (p = 0.045) were significant risk factors for UGIB among the gouty arthritis patients in univariable analysis. Older age (p = 0.001) and diclofenac medication (p < 0.001) remained significant risk factors for UGIB among the gouty arthritis patients in multivariable analysis. Conclusions Age and diclofenac were significantly associated with UGIB among patients with gouty arthritis on regular NSAIDs, indicating that these factors increased the risks of developing UGIB in gout patients. Hence, these high-risk groups of gouty arthritis patients should be routinely monitored to avoid the potential onset of UGIB. Our data also suggest that diclofenac should be prescribed for the shortest duration possible to minimize the risk of developing UGIB in gout patients.

The Identification of Hypercoagulable Markers in Patients with Malignant Gliomas and Venous Thromboembolism.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4097-4097
Author(s):  
Rachel P. Rosovsky ◽  
Patrick Wen ◽  
Santosh Kesari ◽  
Elizabeth M. Van Cott ◽  
David J. Kuter
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Malignant Gliomas ◽  
Tumor Grade ◽  
Residual Tumor ◽  
Time To Death ◽  
Increased Risk ◽  
Batch Testing ◽  
Initiation Of Therapy ◽  
D Dimer

Abstract Introduction: Patients with malignant gliomas have a high incidence of thrombotic events. There is no definitive data on what specific factors induce or predict for this hypercoagulable state. Aim: The purpose of this prospective study was to identify specific risk factors for venous thromboembolism (VTE) in patients with malignant gliomas by examining suspected procoagulant markers in their plasma. Patients and Methods: Adult patients who presented for outpatient consultation to the neuro-oncology clinic at the Dana-Farber Cancer Institute from 9/4/2003 to 6/9/2005 with a pathologically documented diagnosis of malignant glioma were evaluated for study. Patients with a prior diagnosis of VTE or on current chemotherapy or anticoagulant therapy were excluded. Upon study entry and prior to the initiation of radiation therapy or chemotherapy, a single peripheral blood sample was collected. Citrated plasma was stored at −80°C until batch testing occurred. Tests for D-dimer, von Willebrand factor antigen, fibrinogen, factor VIII, plasminogen, lupus anticoagulant, thrombin-antithrombin, and prothrombin fragment 1+2 were performed at reference laboratories. All patients were prospectively followed for development of symptomatic VTE (confirmed by radiological testing). Of the twenty-nine patients on study, twenty-five died and four are still alive. Time to death, number of recurrences, and number of hospitalizations were collected to determine if there was an association between these events and presence of VTE. Results: Twenty-nine patients who met criteria and had analyzable blood samples were included in study. The rate of symptomatic VTE was 24% and VTE occurred 1–13 months after entry onto the study. Development of VTE was associated with elevated levels of D-dimer [defined as greater than 500 mg/dL (p=0.0230)] and elevated levels of fibrinogen [defined as greater than 400% (p=0.0164)]. The median levels of D-dimer and fibrinogen were significantly greater in the patients who developed VTE compared to those who did not develop VTE (953 mg/dL v 481 mg/dL, p=0.0249 and 425% v 290%, p=0.0312, respectively). The number of hospitalizations was also significantly associated with the presence of VTE (p=0.0130). There was no association between the number of tumor recurrences/progressions or time to death and presence of VTE. All patients underwent surgery prior to study enrollment. There was no difference between the patients who developed VTE and those who did not in terms of timing of the surgery, presence of residual tumor, grade or type of tumor, or steroid use. Conclusion: The incidence of symptomatic VTE in patients with malignant gliomas was 24%. Elevated levels of D-dimer and fibrinogen at initiation of therapy were associated with the development of VTE. These risk factors may help determine which patients are at increased risk of VTE and might benefit from prophylactic anticoagulation. These suggestive results need to be confirmed in a larger trial.

scholarly journals Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110337
Author(s):  
Iván Ferraz-Amaro ◽  
Javier Rueda-Gotor ◽  
Fernanda Genre ◽  
Alfonso Corrales ◽  
Ricardo Blanco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Multivariable Analysis ◽  
Activity Score ◽  
Increased Risk ◽  
Activity Measurements ◽  
Beta Coefficient

Background: Axial spondyloarthritis (axSpA) patients are known to have a higher prevalence of several comorbidities, including, among others, an increased risk of atherosclerosis, hypertension, dyslipidemia, and diabetes. The purpose of the present study was to determine whether the sum of traditional cardiovascular (CV) risk factors is related to disease characteristics, such as disease activity, in patients with axSpA. Methods: A cross-sectional study that encompassed 804 patients with axSpA was conducted. Patients were assessed for the presence of five traditional CV risk factors (diabetes mellitus, dyslipidemia, hypertension, obesity, and smoking status), and disease activity measurements. A multivariable regression analysis was performed to evaluate whether the number of classic CV risk factors was independently associated with specific features of the disease, to include disease activity. Results: A multivariable analysis showed that Ankylosing Spondylitis Disease Activity Score–C reactive protein (ASDAS-CRP) activity score was significantly higher in patients with 1 [beta coefficient 0.3 (95% confidence interval (CI) 0.1–0.5), p = 0.001] and ⩾2 [beta coefficient 0.5 (95% CI 0.3–0.7), p = 0.000] CV risk factors compared with those without CV risk factors. Similarly, patients with 1 [OR 2.00 (95%CI 0.99–4.02), p = 0.053] and ⩾2 [OR 3.39 (95%CI 1.82–6.31), p = 0.000] CV risk factors had a higher odds ratio for the presence of high disease activity compared with the zero CV category. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) activity score was significantly associated with the number of CV risk factors, being higher in patients with more CV risk factors. These relationships showed a CV risk factor-dependent effect being beta coefficients and ORs higher for the effect of ⩾2 over 1 CV risk factor. Conclusion: Among patients with axSpA, as the number of traditional CV risk factors increased, disease activity similarly increases in an independent manner.

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

scholarly journals Genetic and Environmental Risk Factors for Intracerebral Hemorrhage

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 321-321
Author(s):  
Daniel Woo ◽  
Laura Sauerbeck ◽  
Brett M Kissela ◽  
Jane C Khoury ◽  
Rakesh Shukla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Environmental Risk ◽  
Multivariable Analysis ◽  
Population Based ◽  
Environmental Risk Factors ◽  
Degree Relative ◽  
Increased Risk ◽  
Apo E ◽  
Apo E Genotype

27 Introduction: We report a planned midpoint analysis of a prospective, population-based, case-control study of the genetic and environmental risk factors of spontaneous, non-traumatic, intracerebral hemorrhage (ICH). Methods: Cases were matched to two controls by age, race and gender. Data was obtained by direct interview and review of all available medical and neuroimaging data. Apolipoprotein E (Apo E)genotype was determined by polymerase chain reaction. Multivariable analyses were performed using logistic regression modeling. Results: Between 6/97 and 2/00, 189 cases of ICH (150 white/39 black; 68 lobar/121 non-lobar) and 368 controls were enrolled into the study. Independent risk factors for multivariable analysis are listed in the table. Only prior stroke was an independent risk factor for both lobar and non-lobar ICH. Conclusions: The importance of individual genetic and environmental risk factors for ICH vary substantially by location of ICH. A history of a first-degree relative with ICH was associated with an increased risk of lobar ICH, independent of Apo E genotype. This finding indicates that other genetic risk factors may be important in the development of ICH.

scholarly journals Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

2017 ◽  
Vol 176 (5) ◽  
pp. 591-602 ◽  
Author(s):  
Jinhao Liu ◽  
Wei Sun ◽  
Wenwu Dong ◽  
Zhihong Wang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neck Dissection ◽  
Thyroid Surgery ◽  
Meta Analysis ◽  
Older Age ◽  
Graves Disease ◽  
Malignant Tumours ◽  
Antithrombotic Agents ◽  
Increased Risk ◽  
Male Sex

BackgroundPost-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage.MethodsThe PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data.ResultsTwenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09–5.52,P < 0.00001), male sex (OR = 1.73, 95% CI = 1.54–1.94,P < 0.00001), Graves’ disease (OR = 1.76, 95% CI = 1.44–2.15,P < 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55–2.49,P < 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50–1.96,P < 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11–2.11,P = 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12–2.34,P = 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89–1.28,P = 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74–2.18,P = 0.4) were not associated with post-thyroidectomy haemorrhage.ConclusionOur systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves’ disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.

Corneal neovascularisation following deep anterior lamellar keratoplasty for corneal ectasia: incidence, timing and risk factors

2021 ◽  
pp. bjophthalmol-2021-319339
Author(s):  
Marco Pellegrini ◽  
Vincenzo Scorcia ◽  
Giuseppe Giannaccare ◽  
Andrea Lucisano ◽  
Sabrina Vaccaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Age ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Topical Steroids ◽  
Ocular Allergy ◽  
Early Discontinuation ◽  
Corneal Ectasia ◽  
Increased Risk ◽  
Anterior Lamellar Keratoplasty

BackgroundThe purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia.MethodsThis study included 616 eyes who underwent DALK between 2012 and 2020 in two tertiary referral centres. In one centre topical corticosteroids were discontinued after complete suture removal 1 year after surgery, whereas in the other they were discontinued 3–4 months after surgery. The presence and severity of corneal NV was ascertained based on slit lamp photographs. Potential risk factors for corneal NV were evaluated using the Cox proportional hazards model.ResultsThe cumulative incidence of corneal NV was 8.7% at 1 year after surgery and 13.2% at 5 years. Mean time interval from surgery to development of corneal NV was 12.8±16.2 months, with 68.9% of cases occurring before complete suture removal. Early discontinuation of topical steroids, older age and ocular allergy were associated with an increased risk of developing corneal NV (respectively, HR=2.625, HR=1.019, HR=3.726, all p<0.05).ConclusionsThe risk of corneal NV is higher in the first year following DALK. Early discontinuation of topical steroids, ocular allergy and older age are significant predictors of corneal NV.

Abstract 56: Change in Midlife Fitness is an Independent Predictor of Heart Failure in Older Age

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ambarish Pandey ◽  
Benjamin Willis ◽  
David Leonard ◽  
Laura DeFina ◽  
Ang Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Recurrent Events ◽  
Middle Age ◽  
Older Age ◽  
Administrative Claims ◽  
Metabolic Equivalents ◽  
Failure Risk ◽  
Increased Risk ◽  
Fitness Levels

Background: Low mid-life fitness is associated with increased risk for heart failure (HF) events decades later. However, the association between changes in mid-life fitness and heart failure risk has not been studied. Methods: We included 9050 subjects (15% Females, mean age 48 years) with no prior cardiovascular disease who underwent two cardiorespiratory fitness measurements approximately 8 years apart. Fitness was estimated in metabolic equivalents (METs) according to Balke treadmill time, with low fitness defined as the lowest quintile of fitness and high fitness defined as quintiles 2-5. Change in fitness was defined categorically according to fitness quintiles (see figure legend) and continuously as the change in METs between the two examinations. Baseline data from the CCLS were matched with Medicare administrative claims data from the Center for Medicare and Medicaid Services. Hospitalization for HF was determined from Medicare claims files. The association between change in fitness and HF hospitalization was assessed by applying a proportional hazard recurrent events model to the failure time data and adjusted for traditional risk factors. Results: After 60,635 person years of Medicare follow up, we observed 242 hospitalizations for HF. Compared to individuals with persistently low fitness levels in middle-age, individuals who increased their fitness levels had a lower rate of HF hospitalization (0.88 vs. 0.64%/year). After multivariable adjustment for baseline fitness level and other risk factors, each 1 MET increase in middle age fitness was associated with 5% less risk for HF hospitalization in later life [HR 0.95 (0.93-0.97) per MET]. Conclusion: Change in mid-life fitness is associated with HF risk in older age. These findings suggest that the heart failure risk related to low fitness may be modifiable with exercise training.

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