scholarly journals UPDATES IN THE MANAGEMENT OF NEUROBLASTOMA

2016 ◽  
Vol 2 (2) ◽  
Author(s):  
Roly Squire
Keyword(s):  
Risk Factors ◽  
Risk Groups ◽  
Low Risk ◽  
Current Therapy ◽  
Genetic Profile ◽  
Therapeutic Effects ◽  
Excellent Outcome ◽  
Key Words Neuroblastoma ◽  
Near Future ◽  
Risk Grouping

Through international collaboration we are at the start of a new age in the management of this enigmatic tumour. Tumours are now grouped at diagnosis using the International Neuroblastoma Risk Grouping (INRG), which uses information from tumour tissue reflecting tumour biology, as well as radiology to define Image-defined risk factors (IDRF). Tumours in high risk groups receive maximal therapy in an attempt to try and improve outcomes which are still poor. Intermediate risk tumours, which have better outcomes due to better response to current therapy, are treated aggressively with combination therapies with proven therapeutic effects, but with increasing attention to the minimising adverse treatment effects. The treatment of low risk tumours is now vastly reduced, acknowledging the excellent outcome in these children using minimal therapy. It has become apparent that the consequences of therapy in these children can easily be worse than those from the tumour itself. For very low risk tumours trials are exploring the outcomes without any treatment. INRG allows more precise comparison of results between different international groups, and provides a template into which new prognostic variables can be introduced, and their value assessed. In many centres multi-array analysis is studying the genetic profile of each tumour; perhaps this will allow increasing individualisation of treatment programmes in the near future. Key words: Neuroblastoma, International Neuroblastoma Risk Grouping, Image defined risk factors. 

Validation of Postpartum Hemorrhage Admission Risk Factor Stratification in a Large Obstetrics Population

2020 ◽  
Author(s):  
Halley Ruppel ◽  
Vincent X. Liu ◽  
Neeru R. Gupta ◽  
Lauren Soltesz ◽  
Gabriel J. Escobar
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Hemorrhage Risk ◽  
Present On Admission

Abstract Objective This study aimed to evaluate the performance of the California Maternal Quality Care Collaborative (CMQCC) admission risk criteria for stratifying postpartum hemorrhage risk in a large obstetrics population. Study Design Using detailed electronic health record data, we classified 261,964 delivery hospitalizations from Kaiser Permanente Northern California hospitals between 2010 and 2017 into high-, medium-, and low-risk groups based on CMQCC criteria. We used logistic regression to assess associations between CMQCC risk groups and postpartum hemorrhage using two different postpartum hemorrhage definitions, standard postpartum hemorrhage (blood loss ≥1,000 mL) and severe postpartum hemorrhage (based on transfusion, laboratory, and blood loss data). Among the low-risk group, we also evaluated associations between additional present-on-admission factors and severe postpartum hemorrhage. Results Using the standard definition, postpartum hemorrhage occurred in approximately 5% of hospitalizations (n = 13,479), with a rate of 3.2, 10.5, and 10.2% in the low-, medium-, and high-risk groups. Severe postpartum hemorrhage occurred in 824 hospitalizations (0.3%), with a rate of 0.2, 0.5, and 1.3% in the low-, medium-, and high-risk groups. For either definition, the odds of postpartum hemorrhage were significantly higher in medium- and high-risk groups compared with the low-risk group. Over 40% of postpartum hemorrhages occurred in hospitalizations that were classified as low risk. Among the low-risk group, risk factors including hypertension and diabetes were associated with higher odds of severe postpartum hemorrhage. Conclusion We found that the CMQCC admission risk assessment criteria stratified women by increasing rates of severe postpartum hemorrhage in our sample, which enables early preparation for many postpartum hemorrhages. However, the CMQCC risk factors missed a substantial proportion of postpartum hemorrhages. Efforts to improve postpartum hemorrhage risk assessment using present-on-admission risk factors should consider inclusion of other nonobstetrical factors.

A Risk Score to Predict CMV Viremia within the First 100 Days after Allogeneic Stem Cell Transplantation Based on Pre-Transplant Parameters

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3877-3877
Author(s):  
Feras Alfraih ◽  
John Kuruvilla ◽  
Naheed Alam ◽  
Anna Lambie ◽  
Vikas Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Cmv Infection ◽  
Allogeneic Hsct ◽  
Very High

Abstract Introduction: Cytomegalovirus (CMV) is a major infectious complication following allogeneic hematopoietic stem cell transplantation (HSCT). Risk of CMV infection varies between patients and individualized strategies for monitoring and therapy for CMV are needed. In this study, we attempted to establish a clinical score based on patient and transplant characteristics in order to predict the probability for early CMV viremia (CMV-V) within the first 100 days after HSCT. Methods: A total of 548 patients were evaluated after receiving HSCT between 2005 and 2012 at Princess Margaret Cancer Centre. CMV sero-negative recipients with CMV sero-negative donors (R-D-) were excluded. CMV-V was diagnosed in peripheral blood samples obtained on two occasions either by PCR (>200 IU/ml) or antigenemia testing (>2 positive cells/100000). A total of 378 patients were included into the study. Uni- and multivariable analyses were performed to identify risk factors for CMV-V. A weighted score was assigned to each factor based on the odds ratios determined by the multivariable analysis. A total score was calculated for each patient and used for assignment into one of 4 risk categories, the low risk (score 0-1), the intermediate (score 2-3), the high (score 4-5) and the very high (score 6-8). Median age for all patients was 51 years (range 17-71) and 173 (46%) were female. Matched related donors were used for two hundred fifteen patients (57%). Two hundred forty-three patients (64%) were transplanted for myeloid and 108 (29%) for lymphoid malignancies. One hundred thirteen patients (30%) were CMV sero-positive with a negative donor (R+D-) while 191 (51%) were recipient and donor CMV sero-positivity (R+D+). Graft versus host disease (GVHD) prophylaxis included CSA/MMF (n=200, 52%), and CSA/MTX (n=178, 48%). Myeloablative conditioning regimens were administered to 220 patients (58%), 158 patients (42%) were treated with a reduced intensity regimen. Three hundred-thirty seven patients (89%) received peripheral blood stem cells as a stem cell source. In vivo T cell depletion (TCD) with alemtuzumab was used in 138 (37%). Results: CMV-V occurred in 246 (64%) patients by day 100 post HSCT. The impact of patient and HSCT characteristics on the risk of CMV-V was assessed by multivariable analysis. The significant factors were CMV sero-status R+D- and R+D+, TCD, GVHD prophylaxis with MMF administration of myeloablative preparative regimens (Table 1). Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT Table 1. Multivariate analysis for risk factors of CMV infection following allogeneic HSCT CMV-V rates on the 4 new risk categories amounted to 93% in the very high-risk, 78% in high-risk, 41% in intermediate-risk and 11% in low-risk group (Fig 1). The risk score was also predictive for the occurrence of multiple CMV-V reactivations with rates of 71%, 45%, 19% and 4% for the very high, high, intermediate and low-risk groups, respectively. The overall survival (OS) rate at 2 years was 33%(n=56) in the very high-risk group compared to 50% in other-risk groups (n=147) (P=0.01) (Fig 2). Non-relapse mortality (NRM) was 53% in the very high-risk versus 33% in other-risk groups (P<0.001). However, there was no difference on cumulative incidence of relapse between the groups (P=0.3). The cumulative incidence of grades 1-4 acute GVHD, grades 2-4, grades 3-4 at day 120 and overall chronic GVHD at 2 years was 68%, 47%, 25% and 39% in very high-risk group versus 65%, 52%, 21% and 52% in other-risk groups, suggesting slightly lower incidence of chronic GVHD in very high-risk vs other-risk groups. Conclusion: We present a new clinical scoring system to stratify the risk of early CMV viremia after allogeneic HSCT based on patients and HSCT characteristics. Identifying the risk for each patient would facilitate decision making with respect to strategies including CMV prophylaxis, pre-emptive treatment or inclusion into clinical trials, as well directing the CMV monitoring policy post-transplant. In addition, the risk score was associated with higher risk of overall mortality and NRM in the very high-risk versus other-risk groups. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Gestational trophoblastic disease: Experience at a tertiary care center from a developing country

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16041-16041
Author(s):  
R. Hariprasad ◽  
K. Ganessan ◽  
A. Gupta ◽  
L. Kumar ◽  
S. Kumar ◽  
...  
Keyword(s):  
High Risk ◽  
Actinomycin D ◽  
Care Center ◽  
Tertiary Care ◽  
Risk Groups ◽  
Gestational Trophoblastic Disease ◽  
Low Risk ◽  
Molar Pregnancy ◽  
Excellent Outcome ◽  
Trophoblastic Disease

16041 Background: We retrospectively analyzed case records of patients diagnosed to have Gestational Trophoblastic Disease (GTD) to determine clinical characteristics, risk groups, treatment outcome, and reproductive function post treatment. Methods: Between Jan 1991 to Dec 2005, 102 patients (mean age: 28.2 years, range 19–50) were diagnosed to have GTD. 35 patients were nulliparous and 8 had prior molar pregnancy. Vaginal bleeding was the most common presenting symptom (77.5%). The antecedent pregnancy was vesicular mole in 50%, abortion - 34.3%, ectopic pregnancy - 4% and term pregnancy in 11.8% patients. The mean value of B hCG was 1225386 mIU/ml. The histopathology (n=85) was complete mole in 30, partial mole - 28, invasive mole- 9, PSTT -1 and choriocarcinoma in 17 patients. 68(66.7%) patients had non-metastatic disease. Sites of metastasis were - lung (38.2%), vagina (11%), brain (8.8%), liver (6.9%) and kidney, Urinary bladder and peritoneum in one patient each. According to modified WHO risk scoring - 78(76.5% had low risk and 24 (23.5%) were high risk. Results: Eighty-seven (85.3%) patients received chemotherapy using methotrexate with leucovorin (n=63), EMA/CO (n=19) and BEP (n=5). 77/87 (89.5%) achieved complete remission (CR) ; the response rate was higher in non-metastatic GTD (p<0.05). Two of 7(28.6%) patients with liver and 5/9 (55,6%) of brain metastasis achieved CR. Two patients had grade III oral mucositis and diarrhoea with methotrexate. One patient died of Methotrexate hypersensitivity. 19 patients received second line chemotherapy using EMA/CO (n=11), EMA/EP (n=2), BEP (n=1), actinomycin-D (n=1) and MAC (methotrexate, actinomycin D and Cyclophosphamide) n=1; 14 patients achieved CR. At a mean follow up of 180 months, 5-year survival for patients with low risk is 100% and that of high risk is 95%. Eight patients had recurrent disease including recurrent molar pregnancy in four. 16 patients had 24 successful deliveries after completion of treatment and 10 of them were primiparae. No fetal abnormalities were found. We did not observe second malignancy or other therapy related sequele. Conclusions: Present study confirms excellent outcome for patients with gestational trophoblastic disease. The potential for childbearing is well maintained. No significant financial relationships to disclose.

Validation of the AJCC staging system (7th edition) in Asian patients with localized prostate cancer undergoing radical radiotherapy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 112-112
Author(s):  
M. Wong ◽  
C. Yip ◽  
X. Hou ◽  
P. Tan ◽  
H. Huang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Univariate Analysis ◽  
Staging System ◽  
Risk Groups ◽  
Radical Radiotherapy ◽  
Seventh Edition ◽  
Delivery Technique ◽  
Significant Difference ◽  
Risk Grouping

112 Background: The epidemiology of prostate cancer (PCa) varies widely internationally. Although prostate cancer is usually regarded as uncommon in Asia, dramatic rises in recent years have resulted in it being ranking third by incidence in Singapore. Conventional prognostic parameters derived from Western populations have been integrated into systems such as the new AJCC seventh edition staging system, the validity of which is unclear in Asia. We thus sought to validate its performance, alongside other prognostic factors in a large Asian series of radiotherapy patients. Methods: A retrospective review of 404 consecutive Singaporean patients receiving radical radiotherapy between 1997 and 2005 at the National Cancer Centre was performed. The primary outcome was biochemical relapse free survival (BRFS), defined by the Phoenix criteria. Prognostic risk groups were defined using AJCC seventh edition. Univariate analysis (UVA) and multivariate analysis (MVA) was performed for other putative risk factors: age, race, Gleason score, prognostic risk grouping, tumour classification, radiation delivery technique, radiotherapy dose, hormonal therapy (HT) and initial PSA. Results: Median age was 69; median BRFS was 55 months with 71 biochemical relapses. 4 risk factors showed univariate association with BRFS: AJCC risk groups (p=0.038), T-stage (p=0.018), RT dose (p=0.025) and initial PSA value (p=0.013) with AJCC risk groups and initial PSA value remaining significant after MVA ( Table ). Harrell's c-index for AJCC risk grouping was 0.56, with no significant difference seen in outcomes between AJCC risk group II and III. Conclusions: Our results validate the new AJCC seventh edition prostate cancer prognostic risk grouping in an Asian radiotherapy population for the first time; the actual association however is relatively weak possibly due to differences in biology, screening or epidemiology. [Table: see text] No significant financial relationships to disclose.

A Disease and Stage Risk Grouping System for Patients Undergoing Allogeneic Stem Cell Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 327-327
Author(s):  
Philippe Armand ◽  
Christopher J Gibson ◽  
Corey Cutler ◽  
Vincent T Ho ◽  
John Koreth ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Risk Groups ◽  
Low Risk ◽  
Disease Stage ◽  
Reduced Intensity Conditioning ◽  
T Cell Lymphomas ◽  
Risk Grouping ◽  
Reduced Intensity

Abstract Abstract 327 Background: The outcome of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) varies significantly based on the patients' disease and stage at the time of HSCT. When analyzing outcomes of HSCT in heterogeneous patient populations, whether in retrospective or prospective studies, it is therefore necessary to stratify patients based on their disease/stage risk. At present, there is no robust method for doing so; the most commonly used breakdowns are based on older data that may not be applicable today, and do not incorporate cytogenetics for myeloid diseases, which are an important prognostic factor. Methods: We analyzed a cohort of 1539 patients transplanted between 2000 and 2009 at Dana-Farber/Brigham and Women's Hospital, and reviewed their disease type (including cytogenetics) and stage at HSCT. Based on proportional hazards modeling for overall survival (with a median follow-up of 35 months), we defined disease and stage risk groups, with independent analyses performed in the 812 patients who underwent myeloablative conditioning (MAC) and the 727 who underwent reduced intensity conditioning (RIC). We used the results to define overall disease/stage risk groups for both MAC and RIC HSCT. Results: Interestingly, the disease risk groups turned out to be identical for MAC and RIC; the stage risk groups were very similar, except for the assignment of CR>1 to low risk in MAC but high risk in RIC. The groups were as follows: Low-risk disease: AML with favorable cytogenetics, CLL, CML, Hodgkin lymphoma, and non-Hodgkin lymphoma (excluding extranodal T-cell lymphomas) Intermediate-risk disease: ALL, AML or MDS with intermediate cytogenetics, myeloproliferative neoplasms, and multiple myeloma High-risk disease: AML or MDS with adverse cytogenetics, extranodal T-cell lymphomas Low-risk stage: CR1, CR>1 (for MAC), PR1, untreated disease, CP CML High-risk stage: CR>1 (for RIC), PR>1, induction failure or active relapse, accelerated or blast phase CML Those groups could be combined to form 4 overall groups with highly significantly different OS and PFS (Table and Figure). Conclusion: We propose a disease/stage risk grouping scheme for patients undergoing HSCT, applicable to both myeloablative and reduced intensity conditioning transplantation, which separates patients into 4 groups with significantly different OS and PFS. This scheme could be used for prognostic purposes, and to stratify patients in retrospective studies or in clinical trials. In the future, it may be further validated and refined through registry studies. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Post-operative oral chemoprophylaxis in patients undergoing hip arthroscopy mitigates VTE risk with a low side-effect profile

2020 ◽  
Author(s):  
Wesley A M Verhoogt ◽  
Jurek R T Pietrzak ◽  
Olufemi R Ayeni ◽  
Josip N Cakic
Keyword(s):  
Risk Factors ◽  
Hip Arthroscopy ◽  
Risk Groups ◽  
Low Risk ◽  
Labral Repair ◽  
Vte Prophylaxis ◽  
True Incidence ◽  
Risk Patients ◽  
Prevention Protocol ◽  
A Prospective Study

Abstract Hip arthroscopy (HA) has increased exponentially over the last decade. A recent systematic review found that the risk of venous thromboembolism (VTE) is 2%. This was higher than previous reports which may have underestimated the true incidence of VTE in HA. Thus, protocols to mediate VTE may be more necessary than previously thought. The aim of this article is to present a VTE prevention protocol and evaluate its subsequent efficacy. This is a prospective study of 880 consecutive HA cases. All patients were treated according to a predetermined VTE protocol which classified patients as high (≥1 risk factors) or low (no risk factors) risk for post-operative VTE. In high-risk patients, the protocol followed that of low-risk patients but additionally included rivaroxaban for 2 weeks post-operatively. The incidence of VTE was recorded and analysed in this study. A total of 880 HA cases at an average age of 35.4 years were evaluated, with 76.6% (n = 674) undergoing labral repair and concomitant cam and/or pincer resection, 17.2% (n = 151) of cases for isolated labral tear repaired, and 6.1% (n = 55) classified as other. The overall incidence of VTE was 0.45%. The incidence of VTE was 1.2% and 0.16% in high- and low-risk groups, respectively. Oral VTE prophylaxis was not associated with post-operative complications. This study demonstrated a lower rate of VTE in both risk groups. It highlights the value of a predetermined risk-adjusted protocol to VTE prophylaxis. Rivaroxaban prophylaxis is safe and efficacious in HA with a low associated morbidity.

A Risk Score Integrating BAALC, ERG and WT1 Expression Can Be Used To Improve Risk Stratification In Acute Promyelocytic Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1323-1323
Author(s):  
Anna Hecht ◽  
Florian Nolte ◽  
Daniel Nowak ◽  
Verena Nowak ◽  
Benjamin Hanfstein ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Expression Levels ◽  
Improve Risk Stratification

Abstract Introduction With current therapy regimens over 75% of patients with de novo acute promyelocytic leukemia (APL) can be cured. Approaches to further improve patient outcome by stratifying patients at the time of initial diagnosis according to their individual risk and to adjust therapy accordingly have been based on clinical features only. Molecular markers have not been established for risk stratification as yet. Recently, we have shown that high expression levels of the genes brain and acute leukemia, cytoplasmic (BAALC) and ets related gene (ERG) are associated with inferior outcome in APL patients. In addition, data indicate that aberrant expression of the gene Wilms’ tumor 1 (WT1) is a negative prognostic factor with regard to overall survival (OS) after complete remission (CR) and relapse free survival (RFS) in APL. In this study we evaluated the prognostic relevance of a combined score integrating the expression levels of the above mentioned genes to further improve risk stratification in APL patients. Methods Expression levels of BAALC, ERG and WT1 of 62 patients with newly diagnosed APL were retrospectively analyzed in bone marrow mononuclear cells using multiplex reverse transcriptase quantitative real-time PCR (qRT-PCR). Median age of patients was 47 years (range: 19 to 82y). All patients gave informed consent. Patients were diagnosed and treated in the German AML Cooperative Group (AMLCG) study with a treatment of simultaneous ATRA and double induction chemotherapy including high-dose ara-C, consolidation and maintenance chemotherapy. The following gene expression levels were identified as negative risk factors in preceding studies: BAALC expression ≥25th percentile (BAALChigh), ERG expression >75th percentile (ERGhigh) and WT1 expression ≤25th percentile or ≥75th percentile (WT1low/high). A risk score was developed as follows: for the presence of one of the mentioned risk factors one scoring point was assigned to a respective patient, i.e. a maximum of 3 points (one point for BAALChigh, ERGhigh and WT1low/high, respectively) and a minimum of 0 points (i.e. presenting with none of the aforementioned risk factors) could be allocated to one patient. Accordingly, patients were divided into four risk groups: 7 patients scored 0 points (= low risk), 27 patients scored 1 point (= intermediate 1 risk), 19 patients scored 2 points (= intermediate 2 risk) and 9 patients scored 3 points (= high risk). Subsequently, OS, RFS and relapse free interval (RFI) were calculated using the Kaplan-Meier method and a log-rank test was used to compare differences between the four risk groups (p<0.05). Results The integrative risk score divided patients into four groups with significantly different outcome. The low risk group showed a RFS of 100% at 10 years of follow-up compared to the intermediate 1 risk group with 81%, the intermediate 2 risk group with 58% and the high risk group with a RFS of 42% only (median survival: 4.6y) (p=0.02). In accordance, the RFI differed significantly between the four groups: low risk 100%, intermediate 1 risk 100%, intermediate 2 risk 89% and high risk 71% (p=0.049). There was no statistically significant difference between the 4 groups with regard to OS in the entire patient cohort. However, there was a clear trend towards a difference in OS in patients who achieved a CR after induction therapy: low risk 100%, intermediate 1 risk 81%, intermediate 2 risk 68% and high risk 53% survival at 10 years of follow-up (p=0.09). Conclusion Integration of expression levels of the genes BAALC, ERG and WT1 into a scoring system identifies 4 risk groups with significantly different outcome with regard to RFS and RFI. It might be a promising approach to guide therapeutic decisions in patients with APL. However, multivariate analyses and validation of these data in an independent patient cohort is warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Novel prognostic model for stratifying survival in stage I lung adenocarcinoma patients

2019 ◽  
Vol 146 (3) ◽  
pp. 801-807 ◽  
Author(s):  
Di-Han Liu ◽  
Zheng-Hao Ye ◽  
Si Chen ◽  
Xue-Song Sun ◽  
Jing-Yu Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Model ◽  
Cox Regression ◽  
Prognostic Score ◽  
Risk Groups ◽  
Low Risk ◽  
Stage I ◽  
Prognostic Scores ◽  
Individual Treatment ◽  
Lung Adenocarcinomas

Abstract Purpose We combined conventional clinical and pathological characteristics and pathological architectural grading scores to develop a prognostic model to identify a specific group of patients with stage I lung adenocarcinomas with poor survival following surgery. Methods This retrospective study included 198 patients with stage I lung adenocarcinomas recruited from 2004 to 2013. Multivariate analyses were used to confirm independent risk factors, which were checked for internal validity using the bootstrapping method. The prognostic scores, derived from β-coefficients using the Cox regression model, classified patients into high- and low-risk groups. The predictive performance and discriminative ability of the model were assessed by the area under the receiver operating characteristic curve (AUC), concordance index (C-index) and Kaplan–Meier survival analyses. Results Three risk factors were identified: T2 (rounding of β-coefficients = 81), necrosis (rounding of β-coefficients = 67), and pathological architectural score of 5–6 (rounding of β-coefficients = 58). The final prognostic score was the sum of points. The derived prognostic scores stratified patients into low- (score ≤ 103) and high- (score > 103) risk groups, with significant differences in 5-year overall survival (high vs. low risk: 49.3% vs. 88.0%, respectively; hazard ratio: 4.55; p < 0.001). The AUC for the proposed model was 0.717. The C-index of the model was 0.693. Conclusion An integrated prognostic model was developed to discriminate resected stage I adenocarcinoma patients into low- and high-risk groups, which will help clinicians select individual treatment strategies.

scholarly journals Timely Detection of Glaucoma in General Practice as a Means Prevent Late Diagnosis

2016 ◽  
pp. 143-145
Author(s):  
Nataliia Medvedovskaya ◽  
Zoreslava Povch
Keyword(s):  
Risk Factors ◽  
Early Stage ◽  
Low Vision ◽  
Family Doctor ◽  
Risk Groups ◽  
Sociological Research ◽  
Timely Diagnosis ◽  
Treatment And Prevention ◽  
The Family ◽  
Near Future

The objective: justification of need of the organization of introduction of measures for timely identification of an ophthalmic hypertension in practice of the family doctor for timely diagnosis of glaucoma, the prevention of development of her terminal stage became a research objective. Patients and methods. Outpatient and polyclinic units of five healthcare institutions of the city of Kiev in which primary help by the principles of the general medical practice – family medicine is given became scientific base of a research. Forms of account No. 12 «The report on the diseases registered at patients who live in the district of service of treatment and prevention facility» and questionnaires of a sociological research of risk factors of glaucoma (820 questionnaires) were primary material. Achievement of goals of a research demanded use of a complex of methods of a research, a basis for which was a systemic approach, namely: bibliosemantic, sociological, medico-statistical methods. Results. Of a research it has turned out that prevalence of glaucoma continues to increase enough in high gear (for 14,9% from 2010 to 2014) that proves relevance of a problem of the prevention of a blindness and a low vision because of glaucoma in Ukraine and in the near future. Owning knowledge of modern risk factors which has the proved influence on formation of an oftalmogipertenziya, and over time and glaucomas, physicians of primary contact can actively form risk groups on glaucoma that will allow to unify and to individualize at the same time preventively – improving, medical and diagnostic medical care in each case and to objectify assessment of her results in dynamics. Conclusion. Interaction in form of cooperation of the family doctor and ophthalmologist within the competences allows to perform effective long accounting of patients, preventing loss of visual functions by them for the account, first of all timely diagnosis of a disease (at an early stage), possible correction of the available risk factors of origin and progressing of glaucoma.

scholarly journals Development and Validation of a Clinical-Radiomic Model for Preoperative Prediction of Lymph Node Metastasis and Overall Survival in Rectal Cancer: A Retrospective Study

2020 ◽  
Author(s):  
Yuzhou Zhu ◽  
Kaibo Sun ◽  
Tinghan Yang ◽  
Qingbin Wu ◽  
Yinzhi Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Risk Groups ◽  
Low Risk ◽  
Lasso Regression ◽  
Combined Model ◽  
Portal Venous Phase ◽  
Preoperative Prediction

Abstract Background: Preoperative lymph node (LN) metastasis is essential to therapeutic strategies for rectal cancer (RC) patients without distal metastasis, and is one of the major predictive risk factors. Unfortunately, it is difficult to predict the preoperative LN metastasis. Thus, we established a clinical-radiomic model to assist in predicting LN metastasis and overall survival (OS) in RC patients preoperatively. Methods: The prediction model was established and validated in a primary cohort consisting of 150 patients with pathologically confirmed RC, and data was gathered from January 2013 and December 2015. Radiomic features were extracted from the CT images of portal venous phase (PVP). For selection of the features, LASSO regression method was used. We established a clinical-radiomic model by incorporating the radiomic features and independent clinical risk factors. Then we adopted this combined model to classify RC patients into high- and low-risk groups for 3-year OS analysis.Results: A total of 49 patients were proved to have LN metastasis pathologically, and 101 patients had no metastasis of LN. The Rad-score consisted of 2 selected features. The combined clinical-radiomic model included preoperative clinical T stage, preoperative clinical N stage and the Rad-score. The combined model showed good performance of discrimination, with a AUC of 0.847 in the training cohort and 0.782 in the validation cohort. Significant differences existed in OS between high- and low-risk groups in both the training (p=0.026) and validation (p=0.034) cohort. Conclusion: This combined clinical-radiomic model could be conveniently used to facilitate the preoperative prediction of LN metastasis and prognosis in patients with RC.Trial registration: This research was retrospectively registered at our institution’s medical ethics committee (NO.2019-1159)

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