Journal articles on the topic 'Multivariate categorical time-series'
To see the other types of publications on this topic, follow the link: Multivariate categorical time-series.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 25 journal articles for your research on the topic 'Multivariate categorical time-series.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Davis, Ginger M., and Katherine B. Ensor. "Multivariate Time-Series Analysis With Categorical and Continuous Variables in an Lstr Model." Journal of Time Series Analysis 28, no. 6 (November 2007): 867–85. http://dx.doi.org/10.1111/j.1467-9892.2007.00537.x.
Full text
2
Xu, Dongting, Zhisheng Zhang, and Jinfei Shi. "Training Data Selection by Categorical Variables for Better Rare Event Prediction in Multiple Products Production Line." Electronics 11, no. 7 (March 28, 2022): 1056. http://dx.doi.org/10.3390/electronics11071056.
Full textAbstract:
Manufacturers are struggling to use data from multiple products production lines to predict rare events. Improving the quality of training data is a common way to improve the performance of algorithms. However, there is little research about how to select training data quantitatively. In this study, a training data selection method is proposed to improve the performance of deep learning models. The proposed method can represent different time length multivariate time series spilt by categorical variables and measure the (dis)similarities by the distance matrix and clustering method. The contributions are: (1) The proposed method can find the changes to the training data caused by categorical variables in a multivariate time series dataset; (2) according to the proposed method, the multivariate time series data from the production line can be clustered into many small training datasets; and (3) same structure but different parameters prediction models are built instead of one model which is different from the traditional way. In practice, the proposed method is applied in a real multiple products production line dataset and the result shows it can not only significantly improve the performance of the reconstruction model but it can also quantitively measure the (dis)similarities of the production behaviors.
3
Xue, Feng, Weizhong Yan, Tianyi Wang, Hao Huang, and Bojun Feng. "Deep anomaly detection for industrial systems: a case study." Annual Conference of the PHM Society 12, no. 1 (November 3, 2020): 8. http://dx.doi.org/10.36001/phmconf.2020.v12i1.1186.
Full textAbstract:
We explore the use of deep neural networks for anomaly detection of industrial systems where the data are multivariate time series measurements. We formulate the problem as a self-supervised learning where data under normal operation is used to train a deep neural network autoregressive model, i.e., use a window of time series data to predict future data values. The aim of such a model is to learn to represent the system dynamic behavior under normal conditions, while expect higher model vs. measurement discrepancies under faulty conditions. In real world applications, many control settings are categorical in nature. In this paper, vector embedding and joint losses are employed to deal with such situations. Both LSTM and CNN based deep neural network backbones are studied on the Secure Water Treatment (SWaT) testbed datasets. Also, Support Vector Data Description (SVDD) method is adapted to such anomaly detection settings with deep neural networks. Evaluation methods and results are discussed based on the SWaT dataset along with potential pitfalls.
4
Tew-Kai, Emilie, Victor Quilfen, Marie Cachera, and Martial Boutet. "Dynamic Coastal-Shelf Seascapes to Support Marine Policies Using Operational Coastal Oceanography: The French Example." Journal of Marine Science and Engineering 8, no. 8 (August 5, 2020): 585. http://dx.doi.org/10.3390/jmse8080585.
Full textAbstract:
In the context of maritime spatial planning and the implementation of spatialized Good Environmental Status indicators in the Marine Strategy Framework Directive (MSFD), the definition of a mosaic composed of coherent and standardised spatial units is necessary. We propose here a characterization of seascapes in time and space within the specific framework of the MSFD in the English Channel and the Bay of Biscay areas. A spatio-temporal classification of coastal-shelf water masses is carried out using twelve essential oceanographic and derived variables from operational coastal oceanography using the HYCOM model. Partitioning is computed using a multivariate hybrid two-step clustering process defining a time series of categorical maps representing hydrographical patch classes. Main patch occurrence is analyzed to understand their spatio-temporal dynamics and their oceanographic characteristics. Finally, patch classes are combined with MSFD marine sub-region delimitations to build seascapes, including ecosystem approach management and marine policy considerations.
5
Maravelakis, Petros. "The use of statistics in social sciences." Journal of Humanities and Applied Social Sciences 1, no. 2 (November 15, 2019): 87–97. http://dx.doi.org/10.1108/jhass-08-2019-0038.
Full textAbstract:
Purpose The purpose this paper is to review some of the statistical methods used in the field of social sciences. Design/methodology/approach A review of some of the statistical methodologies used in areas like survey methodology, official statistics, sociology, psychology, political science, criminology, public policy, marketing research, demography, education and economics. Findings Several areas are presented such as parametric modeling, nonparametric modeling and multivariate methods. Focus is also given to time series modeling, analysis of categorical data and sampling issues and other useful techniques for the analysis of data in the social sciences. Indicative references are given for all the above methods along with some insights for the application of these techniques. Originality/value This paper reviews some statistical methods that are used in social sciences and the authors draw the attention of researchers on less popular methods. The purpose is not to give technical details and also not to refer to all the existing techniques or to all the possible areas of statistics. The focus is mainly on the applied aspect of the techniques and the authors give insights about techniques that can be used to answer problems in the abovementioned areas of research.
6
Lin, Luotao, Jiaqi Guo, Marah Aqeel, Anindya Bhadra, Saul Gelfand, Edward Delp, Elizabeth Richards, Erin Hennessy, and Heather Eicher-Miller. "Temporal Patterning Integrating Diet and Physical Activity Shows Stronger Links to Health Indicators Compared to Patterning of Either Diet or Physical Activity Alone." Current Developments in Nutrition 5, Supplement_2 (June 2021): 469. http://dx.doi.org/10.1093/cdn/nzab039_005.
Full textAbstract:
Abstract Objectives Daily temporal patterns of energy intake (temporal dietary patterns, TDPs) and physical activity (temporal PA patterns, TPAPs) have been independently and jointly (joint temporal dietary and PA patterns, TDPAPs) associated with health indicators. The strength of the association between clusters of each pattern and health indicators including body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), hemoglobin A1c (A1c), triglyceride (TAG), high-density lipoprotein cholesterol (HDL-C), total cholesterol (Total-C), blood pressure, type 2 diabetes (T2D), metabolic syndrome (MetS), and obesity, were compared. Methods The reported energy throughout a day from one reliable 24-hour weekday dietary recall and activity counts from a random weekday of PA accelerometer data of 1,836 U.S. adults from the National Health and Nutrition Examination Survey (2003–2006) were used to create TDP and TPAP respectively, and jointly for TDPAP. Constrained dynamic time warping distances computed over the time series were partitioned to four clusters using kernel-k means clustering algorithm. Measured BMI, WC, FPG, A1c, TAG, HDL-C, Total-C, and classified T2DM, MetS, and obesity were outcomes in multivariate regression models to determine associations with the clusters representing each pattern, controlling for potential confounders and adjusting for multiple comparisons (P < 0.05/6). Adjusted R2 and Akaike information criterion (AIC) compared the strength of the associations between clusters and continuous or categorical health indicators. Results All temporal patterns were significantly associated with BMI, WC, and obesity. Adjusted R2 of BMI and WC models for significant predictors’ effects were higher for TDPAPs (0.129 and 0.194) than TDPs (0.117 and 0.186) or TPAPs (0.077 and 0.143), and AIC of obesity for the TDPAPs (234,752,082) was smaller than for TDPs (236,650,170) or TPAPs (239,810,423). Conclusions TDPAPs incorporating time of day with energy intake and PA had the strongest associations with BMI, WC, and obesity compared with either independent temporal dietary or PA patterns. Patterns representing the integration of multiple daily behavioral habits hold promise for early detection of obesity. Funding Sources NIH (R21CA224764) and Purdue University.
7
Knapik, Derrick M., Ian M. Clapp, Daniel Wichman, and Shane J. Nho. "Use of Younger Patient Age and Greater Anterior Center-Edge Angle to Predict the Need for Bilateral Hip Arthroscopy in Patients With Bilateral Femoroacetabular Impingement–Related Hip Pain." American Journal of Sports Medicine 49, no. 8 (June 3, 2021): 2110–16. http://dx.doi.org/10.1177/03635465211015431.
Full textAbstract:
Background: In patients with symptomatic femoroacetabular impingement syndrome, bilateral hip pain has been reported to occur in high frequency. However, not all patients require bilateral hip arthroscopy. Purpose: To determine the incidence, patient-specific variables, and postoperative outcomes in patients who presented with bilateral hip pain at the time of index hip arthroscopy and underwent subsequent contralateral arthroscopic hip surgery. Study Design: Case series; Level of evidence, 4. Methods: Patients who presented with bilateral hip pain, underwent primary hip arthroscopy between January 2012 and June 2018 for indication of femoroacetabular impingement syndrome, and had minimum 2-year follow-up were retrospectively analyzed. Baseline descriptive data, preoperative hip range of motion, and radiographic measurements were recorded with pre- and postoperative patient-reported outcomes (PROs). Independent samples t test was used to compare continuous variables, and chi-square test was used to compare categorical variables between patients undergoing unilateral and bilateral surgery. Bivariate correlations and a multivariable binary logistic regression were performed to determine factors predictive of the need for future contralateral hip arthroscopy. Results: In total, 108 patients were identified who reported bilateral hip pain during the index evaluation, underwent primary hip arthroscopy, and had 2-year follow-up. Among these, 42% (n = 45) elected to undergo hip arthroscopy on the contralateral hip at a mean of 6.0 months (range, 1-17 months) after the index surgery. Patients requiring bilateral surgery were significantly younger ( P = .004) and had a larger preoperative anterior center-edge angle (ACEA; P = .038) when compared with patients who had unilateral surgery. There were no significant differences in alpha angle measurements between patients who had unilateral and bilateral surgery. On bivariate analysis, younger age at the time of the index surgery ( r = −0.272; P = .005) and preoperative ACEA ( r = 0.249; P = .016) were significantly correlated with the need for bilateral surgery. On multivariate analysis, younger age remained a significant predictor for bilateral surgery (odds ratio, 0.95; 95% CI, 0.91-0.99). Patients who underwent bilateral hip arthroscopy reported significant improvement in all PROs ( P < .001), with a significantly greater mean Hip Outcome Score− Sports Specific Subscale score when compared with patients undergoing unilateral surgery ( P = .037). Conclusion: Subsequent contralateral hip arthroscopy was performed in 42% of patients who presented with bilateral hip pain. Younger age at the time of the index surgery and greater ACEA were predictive of the need for contralateral surgery. Patients undergoing bilateral surgery reported significantly improvement in PROs at minimum 2-year follow-up.
8
Hasegawa, Daiichiro, Satoshi Hirase, Hironobu Takahashi, Atsuro Saito, Aiko Kozaki, Toshiaki Ishida, Tomoko Yanai, et al. "Absolute Lymphocyte Counts at the End of Induction Is a Prognostic Indicator in Childhood Acute Lymphoblastic Leukemia." Blood 124, no. 21 (December 6, 2014): 2264. http://dx.doi.org/10.1182/blood.v124.21.2264.2264.
Full textAbstract:
Abstract BACKGROUND: Recently, several studies have demonstrated that absolute lymphocyte counts (ALC) after induction therapy predicted treatment outcome. To address this issue, we here assessed the impact of the ALC at the end of induction therapy on outcomes in childhood ALL. METHODS: We reviewed 141 cases of pediatric ALL with 1-21 years of age treated on the Japan Association Childhood Leukemia Study group ALL-02 series of treatment trials between 2002 and 2013. Patients with Philadelphia chromosome-positive ALL were excluded. Variables retrospectively analyzed included ALC at several time points during remission induction, age at diagnosis, gender, initial white blood cell count (WBC), cytogenetics, immunological phenotype, stratified risk, treatment response for bone marrow (the percentage of blasts at day 15), and outcome. Events in the analysis of event-free survival (EFS) included induction failure, death, relapse and secondary malignant neoplasm. The comparison of categorical variables between groups was performed by chi-square test. The probability of EFS and overall survival (OS) were analyzed with the use of the Kaplan–Meier method and a stratified log-rank test. A multivariate analysis of survival was performed with the use of a Cox proportional-hazard model to evaluate the treatment effect with adjustment for stratification factors. RESULTS: The subjects included 121 of B-precursor ALL, 10 of T cell ALL, and 4 of acute mixed lineage leukemia/ acute unclassified leukemia. We found high WBC count at diagnosis (>100K/microL) and slow early responder for bone marrow at day 15 to be an unfavorable prognostic indicator, and also the ALC at the end of induction (day29) to be a statistically significant predictor of improved OS and EFS in our cohort. Patients with ALC ≥ 800/microL had a superior 5-year overall survival (100 ± 1.7% vs 88.1 ± 4.3 %, p=0.0001) and EFS (98.3 ± 1.7% vs 81.8 ± 5.0 %, p=0.0001). Multivariate analysis demonstrated that ALC at day29 was an independent, clinically significant predictor of improved EFS and OS after controlling WBC at diagnosis, gender, age at diagnosis, and cytogenetics. Multiple regression analysis adjusting for initial WBC count, peripheral blast counts at day8, and cytogenetics, also revealed an independent relationship (p=0.005) between treatment response (the percentage of blasts at day 15) and ALC at day29. CONCLUSIONS: ALC is a simple, statistically significant prognostic factor in childhood ALL that may refine current risk stratification algorithms. Disclosures No relevant conflicts of interest to declare.
9
Lone, Zaeem M., Tarik Benidir, Magdalena Rainey, Monica Nair, Elai Davicioni, Ewan Gibb, Sean Williamson, et al. "A genomic classifier for prostate cancer correlates with adverse pathologic features: Transcriptomic features of cribriform and intraductal carcinoma of the prostate." Journal of Clinical Oncology 40, no. 6_suppl (February 20, 2022): 268. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.268.
Full textAbstract:
268 Background: Invasive cribriform and intraductal carcinoma (CF/IDC) portends an unfavorable prognosis for patients diagnosed with prostate cancer (CaP). Limited studies with small sample sizes have explored whether genomic classifiers are associated with IDC and/or CF status. We investigated the correlation between Decipher genomic risk score and IDC/CF status and assessed PCa transcriptomic features. Methods: We performed a retrospective review of CaP patients who had Decipher testing at a single high volume center between 2009-2020. The highest grade index lesion from radical prostatectomy specimens was identified by GU pathologists and used for Decipher testing. Genitourinary pathologists reviewed prostatectomy specimens for the presence of CF and IDC features. Patients were divided into three groups based on pathologic features, absent CF/IDC (CF-/IDC-), CF positive only (CF+/IDC-), and CF/IDC positive (CF+/IDC+). Categorical clinical, genomic, and pathologic variables were assessed using the Pearson Chi-Square test, quantitative with the Kruskal-Wallis test. Multivariable logistic regression was used to identify predictors of high-risk Decipher GC scores. The Kaplan-Meier method with log-rank was used to compare biochemical recurrence free survival. Differential gene expression and gene network analysis was used to identify genes and pathways associated with IDC/CF features. Results: 463 patients were included with a median follow-up of 25 months. Patients who were CF+/IDC+ had higher GC scores (CF+/IDC+: 0.77 vs. CF+/IDC-: 0.71 vs. CF-/IDC-: 0.61, p<0.001). Patients who were CF+/IDC+ had a higher percentage of Gleason grade group >3 (CF+/IDC+: 79% vs. CF+/IDC-: 52% vs. CF-/IDC-: 52%, p<0.001). On multivariate logistic regression, predictors of high-risk GC score were presence of CF+/IDC+ features on final pathology (OR: 3.94, p<0.001) and pathologic Gleason grade group >3 (OR: 1.58, p=0.04). Transcriptomic analysis revealed that the hallmark androgen response pathway was significantly upregulated in CF+/IDC+ patients (Log fold change: 15.7, p<0001). Conclusions: This is the largest series investigating the association of a clinically validated genomic classifier and pathologic features such as cribriform and intraductal carcinoma. These findings have implications for the use of genomic classifiers in settings where expert GU pathology is not readily available and in potentially unmasking adverse histology at the time of biopsy.[Table: see text]
10
Mondaca, Sebastian, Henry S. Walch, Subhiksha Nandakumar, Walid K. Chatila, Jaclyn Frances Hechtman, Andrea Cercek, Luis A. Diaz, et al. "Influence of WNT and DNA damage response pathway alterations on outcomes in patients with unresectable metastatic colorectal cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 3585. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.3585.
Full textAbstract:
3585 Background: We assembled a large series of consecutive patients with unresectable metastatic colorectal cancer (mCRC) to identify genomic biomarkers of response and survival. Methods: Patients with unresectable mCRC treated at Memorial Sloan Kettering with genomic tumor profiling between 2014 and 2017 were included. Patients who underwent upfront metastasectomy or received neoadjuvant/conversion chemotherapy were excluded. Clinical information was retrieved from electronic medical records, and we evaluated associations between genomic profiles with progression free survival (PFS) on first-line chemotherapy and overall survival (OS). Categorical data were analyzed by Fisher exact test and time-to-event data were analyzed by Cox proportional hazards models. Results: Of 1453 mCRCs profiled in this period, 471 patients met the study criteria. Median age was 59 years (range, 18 to 95), and 73% of patients were stage IV at diagnosis. Most tumors (91%) were microsatellite stable (MSS). The most frequent first-line regimen was FOLFOX +/- bevacizumab (66%). Among MSS patients treated with oxaliplatin-containing regimens (n = 305), 7% harbored alterations in genes associated with DNA damage response (DDR) (BRCA1, BRCA2, ATM, PALB2). DDR gene alterations were not associated with PFS (P = 0.94) nor were different quartiles of large-state transitions (P = 0.54). Genomic alterations that significantly varied by duration of response included BRAF (16%, 10%, and 5% for PFS < 6 months, 6-12 months, and > 12 months, respectively) and APC (62%, 74%, and 80% for PFS < 6 months, 6-12 months, and > 12 months, respectively). APC mutation, single or dual, was associated with significantly longer PFS (HR 0.67) and OS (HR 0.59) in multivariate analysis versus no WNT pathway alteration or alterations in other WNT pathway genes (RNF43, AXIN2, CTNNB1). Conclusions: In unresectable mCRC patients, mutations in APC were associated with better outcomes; absence of an APC alteration or the occurrence of other WNT pathway alterations was associated with shorter survival. Somatic alterations in DDR genes were not associated with outcomes in mCRC patients receiving oxaliplatin-containing regimen.
11
Sharpe, B. Dale, M. P. Ebaugh, Mark A. Prissel, Christopher F. Hyer, Terrence M. Philbin, Gregory C. Berlet, and David A. Goss. "Direct Plantar Approach to Plantar Plate Repair and Associated Wound Complications." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0043. http://dx.doi.org/10.1177/2473011420s00438.
Full textAbstract:
Category: Lesser Toes Introduction/Purpose: Lesser toe metatarsophalangeal joint instability, secondary to plantar plate tear, has been the focus of numerous recent publications, majority reporting on repair through a dorsal approach. A plantar approach has been described with the advantage of direct ligamentous repair or repair to bone, which follows conventional techniques employed throughout the body. Previous clinical studies have shown success in deformity correction and longevity of both approaches. The proponents of the dorsal approach advocate that indirect repair of the plantar plate avoids perceived risks of complications with a plantar incision, without evidence of superior outcomes. The purpose of this study was to investigate the safety and efficacy of direct plantar approach to plantar plate repairs by reporting the rate of specific complications in a large clinical series. Methods: This was an IRB approved retrospective study of 204 plantar plate repairs, in 185 patients, (194 lesser MTP, 10 hallux MTP) with average age of 56 and mean BMI of 28. Surgical technique involved repair with absorbable braided suture (88%) versus suture anchor (12%) with or without MTPJ pinning (80%). Mean follow up was 53 weeks (range 5-170). Patients were screened for associated risk factors including diabetes mellitus (8%), tobacco use (5%), neuropathy (1%) and additional concurrent procedures (96%). Complications were defined as superficial or deep infection, painful scar, and reoperation. Analysis was conducted by using Wilcoxon-Mann-Whitney test or Fisher’s exact tests for continuous and categorical variables, respectively. Risk factors were analyzed using univariate logistic analysis to produce odds ratios (OR) with 95% confidence interval (CI) and an inclusion criterion of a p-value > 0.2 for multivariate analysis as determined by Wald tests (significance at p<0.05 for final modeling). Results: Overall, there were 31 total complications (15%) demonstrated by 14 superficial infections (6.8%) and 17 painful scars (8.3%) along with three reoperations (1.4%). All reoperations were performed for deformity or instability, not scar revision. There were no deep infections. No increased odds of complications were found with suture anchor repair, MTPJ pinning, neuropathy, or diabetes. Patients that used tobacco had 7.5 (CI 1.66- 34.06) the odds of developing any wound complication compared with nonsmokers. Tobacco use was also found to significantly increase the odds for superficial infection by 9.8 (CI 2.08 - 46.15). There was no increase in painful scar or reoperation in tobacco users. This study did not find an increased complication rate with additional ipsilateral procedures performed at the time of surgery. Conclusion: To our knowledge, this is the largest study evaluating the direct plantar approach to plantar plate repair, as well as the evaluation of associated complications with the plantar incision. With low complication and minimal reoperation rates, the results of this study have demonstrated the clinical viability of plantar based incisions. Previous studies have demonstrated the success of plantar plate repair and correction of deformity with a direct approach. This case series further demonstrates the safety and efficacy of plantar based incisions, particularly for direct plantar plate repairs.
12
Wespes, Catherine, Daniel Hurtmans, Simon Chabrillat, Gaétane Ronsmans, Cathy Clerbaux, and Pierre-François Coheur. "Is the recovery of stratospheric O<sub>3</sub> speeding up in the Southern Hemisphere? An evaluation from the first IASI decadal record (2008–2017)." Atmospheric Chemistry and Physics 19, no. 22 (November 21, 2019): 14031–56. http://dx.doi.org/10.5194/acp-19-14031-2019.
Full textAbstract:
Abstract. In this paper, we present the global fingerprint of recent changes in middle–upper stratosphere (MUSt; <25 hPa) ozone (O3) in comparison with lower stratosphere (LSt; 150–25 hPa) O3 derived from the first 10 years of the IASI/Metop-A satellite measurements (January 2008–December 2017). The IASI instrument provides vertically resolved O3 profiles with very high spatial and temporal (twice daily) samplings, allowing O3 changes to be monitored in these two regions of the stratosphere. By applying multivariate regression models with adapted geophysical proxies on daily mean O3 time series, we discriminate anthropogenic trends from various modes of natural variability, such as the El Niño–Southern Oscillation (ENSO). The representativeness of the O3 response to its natural drivers is first examined. One important finding relies on a pronounced contrast between a positive LSt O3 response to ENSO in the extratropics and a negative one in the tropics, with a delay of 3 months, which supports a stratospheric pathway for the ENSO influence on lower stratospheric and tropospheric O3. In terms of trends, we find an unequivocal O3 recovery from the available period of measurements in winter–spring at middle to high latitudes for the two stratospheric layers sounded by IASI (>∼35∘ N–S in the MUSt and >∼45∘ S in the LSt) as well as in the total columns at southern latitudes (>∼45∘ S) where the increase reaches its maximum. These results confirm the effectiveness of the Montreal Protocol and its amendments and represent the first detection of a significant recovery of O3 concurrently in the lower, in the middle–upper stratosphere and in the total column from one single satellite dataset. A significant decline in O3 at northern mid-latitudes in the LSt is also detected, especially in winter–spring of the Northern Hemisphere. Given counteracting trends in the LSt and MUSt at these latitudes, the decline is not categorical in total O3. When freezing the regression coefficients determined for each natural driver over the whole IASI period but adjusting a trend, we calculate a significant speeding up in the O3 response to the decline of O3-depleting substances (ODSs) in the total column, in the LSt and, to a lesser extent, in the MUSt, at high southern latitudes over the year. Results also show a small significant acceleration of the O3 decline at northern mid-latitudes in the LSt and in the total column over the last few years. That, specifically, needs urgent investigation to identify its exact origin and apprehend its impact on climate change. Additional years of IASI measurements would, however, be required to confirm the O3 change rates observed in the stratospheric layers over the last few years.
13
Ríos-Tamayo, Rafael, Juan Sáinz Pérez, Manuel Jurado, Jose Manuel Puerta Puerta, Pedro Antonio González Sierra, Antonio Romero Aguilar, Elisa Lopez Fernandez, et al. "Multiple Myeloma with Prior Precursor Disease Shows Better Outcome." Blood 126, no. 23 (December 3, 2015): 1756. http://dx.doi.org/10.1182/blood.v126.23.1756.1756.
Full textAbstract:
Abstract Introduction All symptomatic multiple myeloma (MM) patients are virtually preceded by a precursor disease (PD). However, the PD is rarely known at the time of diagnosis of MM. Several PD can progress to MM: monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM) and solitary plasmacytoma (SP). Sigurdardottir et al have recently demonstrated that only 2.7% in a series of 14798 MM patients had prior knowledge of MGUS. This group had better overall survival (OS), stressing the importance of clinical follow-up in MGUS and suggesting that earlier treatment of MM leads to better OS. Nonetheless, we have recently shown that diagnostic delay in MM have a paradoxical effect on OS. Furthermore, little is known about the outcome of MM with prior knowledge of other PD. Methods All symptomatic MM patients diagnosed between January 1993 and July 2015 in our MM population-based registry, excluding palliative patients, were selected. Information about any prior PD was checked, as well as baseline common prognostic factors such as age, sex, lactate dehydrogenase (LDH), creatinine (Cr), International Staging System (ISS), high-risk FISH, and diagnostic delay. Comparisons among groups were made with the χ2-testfor categorical and t-test for quantitative variables. OS was estimated in months (m) by the Kaplan-Meier method in patients with or without specific PD or any PD as a whole. Log-rank test was used to compare curves. A Cox proportional hazard model was used to assess the simultaneous impact on survival of prior PD and other predictors. Results 473 MM patients fulfilled the inclusion criteria. 383 of them (81%) had available data concerning prior PD. There were 233 men and 240 women (50.7%), median age 67 years (12-87). 19 patients (5%), 10 (2.6%) and 5 (1.3%) had prior MGUS, SP and SMM, respectively. The group without prior PD had significantly higher values of serum Cr (2.09 vs 1.09 mg/dL, p<0.001), LDH (317.3 vs 256.2 U/L, p=0.09), ISS3 (49.6% vs 22.2, p=0.02), but less delay (5.6 vs 10.9 m, p=0.002). Median OS of patients with prior MGUS was 87.7 m (57.1-118.2) vs 34.4 (27.8-41.1)(p=0.112), with prior SP 88 m (46.9-129) vs 34.9 (28.4-41.5)(p=0.101) and prior SMM 104.1 m vs 36 (29.9-42.1)(p=0.102). Median OS of any PD (Fig 1) was 88 m (82.6-93.3) vs 32.7 (26.2-39.2)(p=0.006). In the multivariate model, age, LDH and Cr are significantly associated with survival. The presence of prior PD, when adjusting for these factors, is also significantly associated with survival, acting as a protective factor. When ISS is added to the model, prior PD remains only marginally significant. Conclusion Prior knowledge of PD is infrequent at the moment of MM diagnosis. MM with any previously documented PD seems to have better outcome. The reason for this finding is not an earlier diagnosis, but rather a better prognostic profile. However, we cannot rule out other underlying biological mechanisms. More and larger studies are warranted to confirm our results. Disclosures No relevant conflicts of interest to declare.
14
Komrokji, Rami S., Austin G. Kulasekararaj, Najla H. Al Ali, Shahram Y. Kordasti, Emily Bart-smith, Craig Benjamin, Eric Padron, et al. "Characteristics and Outcome Of Myelodysplastic Syndromes (MDS) Patients With Autoimmune Diseases." Blood 122, no. 21 (November 15, 2013): 746. http://dx.doi.org/10.1182/blood.v122.21.746.746.
Full textAbstract:
Abstract Background Immune derangements and altered T cell hemostasis play an important role in the pathogenesis of Myelodysplastic syndromes (MDS) contributing to the increased clone susceptibility to accelerated apoptosis. In addition, escape of immune surveillance may be a mechanism of MDS disease progression. The association between MDS and autoimmune diseases (AID) is well described. Small case series reported distinct clinical features and outcome for MDS patients with AID. We report here the largest cohort examining the prevalence of AID among MDS patients, compare characteristics and outcome of MDS patients with and without AID. Methods We identified all confirmed MDS cases through the Moffitt Cancer Center (MCC) MDS database and King's College Hospital (KCH). Therapy related MDS (t-MDS) cases were excluded. All charts were reviewed for documented past or active AID and its treatment. Patients were divided into 2 groups, those with de novo MDS associated with AID (AIDA-MDS) and those with no documented AID (non AIDA-MDS). Baseline characteristics were compared between the two groups. Chi square test was used for comparison of categorical variables and t-test for continuous variables. Kaplan-Meier estimates were used for overall survival (OS). Results At time of this analysis 1408 pts were included, 1044 cases from MCC and 364 at KCH. We identified 391 MDS patients with AID (28%). The median duration of follow up was 74 months (mo) (95% CI 69-78) Hypothyroidism was the most common AID identified, accounting for 44% (n=171) of cases with AID (12% among all MDS cases in this analysis). Other AID with ≥5% prevalence included ITP 12% (n=46), rheumatoid arthritis 10% (n= 41), gout 9% (n=36), and psoriasis 7% (n=28). To confirm the observed rate of hypothyroidism among our cohort, we explored the rate among MDS pts in the SEER registry where 45% of those registered as MDS had one or more hypothyroid claims (ICD code 244.9) among Medicare beneficiaries (2000-2005). (The prevalence of subclinical hypothyroidism is about 5% of women and in 3% of men with higher prevalence in elderly general population) Baseline characteristics comparing AIDA-MDS (n=391) and non-AIDA-MDS (n=1017) (summarized in Table-1) were similar except AID were more common in females, RA or RCMDWHO subtype and pts were less RBC transfusion dependent. Median OS was 60 mo (95% CI 50-70) for AIDA-MDS compared to 45 mo (95% 40-49) for those with no AIDA-MDS (log rank test, p = 0.006). By multivariate analysis adjusting for revised IPSS and age >60, AID was a statistically significant independent factor for OS (HR 0.78 (95% CI 0.66-0.92) (p=0.004). The rate of AML transformation was 23% (n=89) among AIDA-MDS compared to 30% (n=301) in non AIDA-MDS (p=0.006). There were no observed differences in response to treatment including azacitidine or Lenalidomide among evaluable patients for response. Conclusion AID are commonly associated with MDS, accounting for 28% of patients in our large cohort. Hypothyroidism was the most prevalent AID (12%) with similar high observation among Medicare MDS beneficiaries. AID was significantly more common in women, and associated with more RA/RCMD WHO subtypes with significantly reduced risk of AML transformation and death. Disclosures: No relevant conflicts of interest to declare.
15
Sami, Souidi, Pierre Loap, Alain Fourquet, and Youlia M. Kirova. "Abstract P1-10-01: Postmastectomy electron beams radiation therapy (PMERT) : long term results." Cancer Research 83, no. 5_Supplement (March 1, 2023): P1–10–01—P1–10–01. http://dx.doi.org/10.1158/1538-7445.sabcs22-p1-10-01.
Full textAbstract:
Abstract Background/Purpose: This study evaluates the toxicity after radiotherapy after mastectomy without reconstruction in patients irradiated to the chest wall using previously reported technique of PMERT. Materials/Methods: We included all women irradiated after mastectomy for not metastatic breast cancer with PMERT between 2007 and 2011 in the Department of Radiation Oncology of the Institut Curie. Previously reported technique using mostly electrons was evaluated in terms of efficacy and toxicity. Acute and late toxicities were assessed retrospectively using CTCAE v.4.0. A clinical exam was weekly performed during radiotherapy and one and three months following the completion of radiotherapy. Patients were then followed as recommended in Institut Curie guidelines (Senorif). Quantitative and qualitative data were described respectively as means and proportions. Statistical comparisons were computed using X² or Fischer’s exact test for categorical data. Recurrence free survival (RFS) was defined as the time between the end of treatment and the date of recurrence or death. Overall survival was the same but recurrences were not taken into account. Patients who did not experienced any event were censored at the date of last news. Results: Among the 796 women included, 51.3% had multifocal lesions, 10.1% a triple negative (TN) status and 18.8% a HER2+ positive status; 196 (24.6%) received a neoadjuvant chemotherapy, and 208 (26.1 %) a systemic therapy during radiotherapy (chemotherapy and/or targeted therapy); 514 (64.6%) had at least one positive lymph node (LN). Internal mammary chain (IMC) was treated in 85.6% of cases, supraclavicular LN (L4) in 88.3% of cases, infraclavicular (L3-2-IP+/- L1) LN in 77.9% of cases and low axilla (L1) in 14.9% of cases. With a median follow up of 113 months [range : 2-164] locoregional recurrence-free survival and overall survival at 10 years were respectively 94.02 (IC95% : 92.13-98.94) and 79.84 (IC95% : 76.83-82.97). The median survival was not reached. In the long term, 29.6% of patients had telangiectasia (grade 1: 23.3%, grade 2: 5.2% Grade 3: 1.1%). Totally 279 patients (35.1%) had breast reconstruction, on average 21 months after the end of radiotherapy. Twenty-five patients (3%) had early esophageal toxicity, not exceeding the grade 1. Of these patients, 21 had had chemotherapy and all were irradiated on the lymph nodes (24 including the IMC). Irradiation of the IMC was not associated with an increased chronic lung toxicity (OR=1.03 [0.98-1.09]). There were 35 patients who developed heart disease after the end of the treatment. Of them, 30 patients had received anthracyclines (p=1.05) and 9 trastuzumab (p =1.09). Four patients developed ischemic heart disease, 3/4 irradiated on the left chest wall, all on the CMI and supra and infraclavicular LN, but all of them presented multiple cardiovascular risk factors (2 to 4). Conclusions: Our series have shown that the PMERT using the Institut Curie technique is effective and well tolerated. Table 1. patients and tumor characteristics (n=796). HR+ : hormonal receptor positive HER2+ : HER-2 overexpressed Cardiovascular risk factor : (smoking, hypertension, dyslipidemia, diabetes, obesity, family history of coronary heart disease or vascular events) as described by the French Health Authority (HAS, Haute Autorité de Santé). Table 2. Efficiency (n=796, median follow-up: 113 months; range : [2-164]). HR+ : hormonal receptor positive HER 2+ : Her-2 overexpressed TNBC : Triple negative or basal-like cancer, OS : overall survival LRFS : local recurrence free survival LRRFS : locoregional recurrence free survival MFS : metastasis free survival Multivariate analysis : long term toxicity IMC irradiation : Irradiation of the internal mammary chain, OR : Odd ratio Citation Format: Souidi Sami, Pierre Loap, Alain Fourquet, Youlia M. Kirova. Postmastectomy electron beams radiation therapy (PMERT) : long term results [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-01.
16
Cabrero, Monica, Guillermo Garcia-Manero, Koji Sasaki, Naval Daver, Gautam Borthakur, Courtney D. DiNardo, Jorge E. Cortes, et al. "Comparison of Continuation of HMA Vs Allogeneic Stem Cell Transplant and Its Timing in Myelodysplastic Syndromes: Can It Wait? Results of a Retrospective Study." Blood 124, no. 21 (December 6, 2014): 4666. http://dx.doi.org/10.1182/blood.v124.21.4666.4666.
Full textAbstract:
Abstract Background: Allogeneic stem cell transplant (ASCT) is a curative option for patients with higher risk myelodysplastic syndromes (MDS). Hypomethylating agents (HMA) have been shown to improve survival of patients with MDS and have an excellent toxicity profile. In eligible patients, HMA and ASCT are used as complementary strategies. The aim of this study is to compare outcome with HMA alone vs HMA+ASCT where ASCT is used as consolidation approach or as salvage therapy after HMA failure. Methods: We performed a retrospective analysis of 216 patients with high-risk MDS who received HMA treatment at our institution from between April 2004 and October 2012; after HMA therapy, 61 (28%) patients underwent ASCT: 25 (41%) of them received as a consolidation treatment and 36 (59%) as a salvage therapy. The remaining 155 patients continued on HMA therapy until relapse or progression and did not receive a further ASCT. We used SPSS v.20 for all statistical analysis. Categorical and continuous variables were compared by chi-square and Student’s t test, respectively, and survival analysis was conducted using Kaplan-Meier analysis with the log-rank test and Cox regression for multivariate models. We also implemented a landmark survival analysis that considered median time to transplant. Results: Median age was 65 (20-89), and patients were older in the group that did not receive ASCT (69 vs 58 years; p=0.000). WHO diagnoses were RA/RARS in 31 patients (15%), RCMD in 43 patients (19.9%), RAEB in 133 patients (62%), CMML in 23 patients (11%), and unclassifiable MDS in 18 patients (8.3%). IPSS risk was int-2 in 107 patients (50%) and high in 61 (28%), and the percentage of inttermediate-2/high-risk MDS was higher in the ASCT group (89% vs 73%; p=0.001). High-risk cytogenetics were found in 71% of patients (82% in ASCT vs 67% in HMA alone; p=0.02). Patients received a median of 6 (1-58) courses of HMA. Overall response rate (ORR) to HMA was 45% (n=97), with 38% (n=82) having complete response (CR), 2% (n=5) partial response, and 5% (n=10) hematologic improvement. There were no significant differences between response to HMA in the ASCT group when compared to the group that did not receive ASCT (ORR: 46% vs 43%, p=0.3; CR: 38% vs 37%, p= 0.5). When we further analyzed the 61 ASCT patients, 25 (41%) received it as a consolidation after achieving response and 36 (59%) as a salvage therapy after treatment failure. Response to ASCT was CR in 65% of patients, and 20% were not evaluable due to early mortality. Median overall survival (OS) for the whole series was 14 months (12-16), with 1- and 2-year OS rates of 57% and 24%, respectively. To adjust for early mortality after ASCT and to eliminate any bias, we performed a landmark analysis after a median time of 7 months after ASCT. Patients who received ASCT had better survival. This advantage was more evident among patients who received ASCT as salvage therapy, although there were no differences between both strategies, with respective median survivals of 14 months for consolidation ASCT and 23 months for salvage ASCT (p=0.29)Furthermore, no significant differences in survival were observed between patients who received HMA alone and those who received ASCT as a consolidation therapy (median survival of 14 and 16 months; p=0.498), although there was a tendency for a better OS after 2 years of follow up: the OS for HMA treatment and HMA+ASCT consolidation were 68% and 56% at 1 year, 25% and 31% at 2 years, and 10% and 31% at 3 years. The 1-year survival rates for patients who received HMA alone, HMA followed by ASCT as consolidation, and HMA followed by ASCT as salvage were 68%, 56%, and 78%, respectively, and the 2-year survival rates were 25%, 31%, and 42%, respectively. In a Cox regression model to analyze effects on OS, receiving an ASCT (median OS of 13 (7-19) vs 10 months (8-12); HR 0.62 [0.42 – 0.92], p=0.018) and hemoglobin levels at diagnosis (HR 0.829 [0.73 – 0.93], p=0.002) had a significant impact. Conclusions: ASCT is a feasible and curative strategy for patients with MDS, both as a consolidation or a salvage therapy, and thus it can be a good option after HMA failure. However, its benefits as a consolidation therapy after HMA treatment compared with continuation of HMA treatment are not clear owing to early mortality related to procedure, so ASCT should be carefully considered in patients responding to HMA. Disclosures Borthakur: Tetralogic Pharmaceuticals: Research Funding. Cortes:Ariad: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Teva: Consultancy, Research Funding. Ravandi:Incyte Corporation: Research Funding. Kadia:GSK: Research Funding; ARIAD: Honoraria. Champlin:Otsuka: Research Funding. Kantarjian:ARIAD: Research Funding; Pfizer: Research Funding; Amgen: Research Funding.
17
Visentin, Andrea, Nicolò Compagno, Monica Castelli, Francesco Cinetto, Renato Zambello, Francesco Piazza, Giampietro Semenzato, Carlo Agostini, and Livio Trentin. "Analysis of Major Infection Risk in 706 Patients with Chronic Lymphocytic Leukemia." Blood 124, no. 21 (December 6, 2014): 3321. http://dx.doi.org/10.1182/blood.v124.21.3321.3321.
Full textAbstract:
Abstract Background Chronic lymphocytic leukemia (CLL) is the most common leukemia in western country. Although the prognosis is improved in the last years, CLL is still an incurable disease and infections are the major cause of morbidity and mortality. Susceptibility to infections in CLL patients can be an intrinsic characteristic of the disease or due to chemo-immunotherapy. Immunoglobulin (Ig) replacement therapy is a safe and effective way to prevent infectious events in CLL patients, but indications to their use are not strictly defined. The aim of this study was to determine risk factors to serious bacterial infections in CLL patients and to identify a clinical phenotype of patients characterized by a high infectious risk, in which Ig replacement therapy (IgRT) is appropriate. Methods We retrospectively analyzed clinical and biochemical data of 706 patients, referred to the Hematology and Clinical Immunology Unit of Padua University Hospital since 1982. In this series, we identify patients with at least one episode of major infections (MI), defined as pneumonia, sepsis, meningitis, and endocarditis. We considered only non neutropenic MI. FISH analyses (n=450), CD38 expression (n=529), ZAP70 (n=502), IGHV (n=473), TP53, NOTCH1, BIRC3, SF3B1 (176 genes tested) mutational status, were evaluated before at diagnosis or before starting treatment. Staging and Ig levels were collected at the time of the MI; for patients who didnÕt complain any MI we recorded the last available data. Inferior normal values for IgG, IgA and IgM were 7.0, 0.70 and 0.40g/dL, respectively. Continuous variables were compared by Mann-Whiney test, while categorical variables by Fisher exact test or Chi-square test, when appropriated. Overall survival (OS) was calculated from the date of initial presentation to death for any cause (event) or last known follow-up (censored). Survival analyses were performed by Kaplan-Meier method. Log-rank test was used to compare overall survival curves between groups and Cox regression models to estimate hazard ratios. The proportional hazard assumption was tested in all cox models. p values <0.05 were considered significant and <0.0005 as highly significant. 95% confidential intervals (CI), positive predictive value (PPV) and negative predictive valure (NPV) were also reported. Results 69 patients (9.8%) had 89 MI, among these 62 were pneumonia (3 pulmonary aspergillosis), 21 sepsis, 1 meningitides, 1 cerebral abscess, 1 uveitis and 1 endocarditis. We observed a higher risk of MI in subject with at least 2 Ig isotypes deficiencies (Figure 1, Odds Ratio 10.1 (CI 5.78-17.6), p<0.0001); PPV and NPV were 29% and 96%, respectively. By contrast, patients with only 1 Ig deficiency did not show a higher risk of MI. Clinical-biological characteristics between patients with MI (PwI) and without MI (PwoI) were skewed, in particular the formers harbored a high-risk cytogenetic (i.e. del17p and del11q, p<0.0001), unmutated IGHV (homology>98%, p=0.0043), CD38+ (>30%, p=0.0205), were at a more advance stage (Rai III-IV, p<0.0001) and experienced treatment (p<0.0001). No differences were found neither for ZAP70 expression (>20%, p=0.6775), nor TP53, NOTCH1, BIRC3, SF3B1 gene mutations (p=0.9998), nor chemotherapy regiments (p=0.1587). Considering PwI and at least 2 Ig isotypes deficiencies (n=47), 21 patients treated with IgRT showed a reduction of the incidence of MI (0.70 MI/patient/year in the 12 months before IgRT and 0.27 MI/patient/year during replacement therapy). Kaplan-Meier analysis showed that PwI had a shorter OS than PwoI with a median OS of 196 months vs not reached, respectively (Figure 2, p<0.0001). 10-years OS were 64.7% and 83.4% for PwI and PwoI, respectively. In multivariate analysis highly significant variables were history of MI, del17p and U-IGHV. In particular PwI had 2.3 (CI 1.5-3.6, p<0.0001) higher risk of death than PwoI patients. Discussion In our work, we described the prognostic role of MI in CLL patients, superimposable to other main prognostic factors. Moreover, we identified the clinical profile of patients at high risk of major infections: low levels of at least 2 Ig isotypes, aggressive disease (U-IGHV, del17p) and previous treatment. We also described the reduction of the incidence of MI in a small cohort of 21 patients after IgRT. Taking advantage from this study, we will investigate safety and usefulness of Ig prophylaxis in a bigger subset of patients. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.
18
Donzelli, Grace F., Jeffrey Nelson, David McCoy, Charles E. McCulloch, Steven W. Hetts, Matthew R. Amans, Christopher F. Dowd, et al. "The effect of preoperative embolization and flow dynamics on resection of brain arteriovenous malformations." Journal of Neurosurgery 132, no. 6 (June 2020): 1836–44. http://dx.doi.org/10.3171/2019.2.jns182743.
Full textAbstract:
OBJECTIVEPreoperative embolization of brain arteriovenous malformations (AVMs) is performed to facilitate resection, although its impact on surgical performance has not been clearly defined. The authors tested for associations between embolization and surgical performance metrics.METHODSThe authors analyzed AVM cases resected by one neurosurgeon from 2006 to 2017. They tested whether cases with and without embolization differed from one another with respect to patient and AVM characteristics using t-tests for continuous variables and Fisher’s exact tests for categorical variables. They used simple and multivariable regression models to test whether surgical outcomes (blood loss, resection time, surgical clip usage, and modified Rankin Scale [mRS] score) were associated with embolization. Additional regression analyses integrated the peak arterial afferent contrast normalized for the size of the region of interest (Cmax/ROI) into models as an additional predictor.RESULTSThe authors included 319 patients, of whom 151 (47%) had preoperative embolization. Embolized AVMs tended to be larger (38% with diameter > 3 cm vs 19%, p = 0.001), less likely to have hemorrhaged (48% vs 63%, p = 0.013), or be diffuse (19% vs 29%, p = 0.045). Embolized AVMs were more likely to have both superficial and deep venous drainage and less likely to have exclusively deep drainage (32% vs 17% and 12% vs 23%, respectively; p = 0.002). In multivariable analysis, embolization was not a significant predictor of blood loss or mRS score changes, but did predict longer operating times (+29 minutes, 95% CI 2–56 minutes; p = 0.034) and increased clip usage (OR 2.61, 95% CI 1.45–4.71; p = 0.001). Cmax/ROI was not a significant predictor, although cases with large Cmax/ROI tended to have longer procedure times (+25 minutes per doubling of Cmax/ROI, 95% CI 0–50 minutes; p = 0.051).CONCLUSIONSIn this series, preoperative embolization was associated with longer median resection times and had no association with intraoperative blood loss or mRS score changes.
19
Strati, Paolo, Pritviraj Bose, Katie Gaw, Lingsha Zhou, Sherry Pierce, Julie Huynh-Lu, Carlos E. Bueso-Ramos, and Srdan Verstovsek. "Immature Platelet Fraction Is Associated with JAK2 V617F Mutation and Features of Advanced Disease in Myelofibrosis." Blood 128, no. 22 (December 2, 2016): 1933. http://dx.doi.org/10.1182/blood.v128.22.1933.1933.
Full textAbstract:
Abstract Introduction: The Immature Platelet Fraction (IPF) is a generally available hematological parameter, identifying a portion of "young" and hemostatically more active platelets, typically increasing in presence of thrombocytopenia. A high IPF has been associated with JAK2 mutation and increased risk of thrombosis in patients with polycythemia vera (PV) and essential thrombocytemia (ET). However its significance has never been explored in patient with myelofibrosis (MF). Methods: IPF was measured using the Sysmex XN-Series analyzer; an IPF greater than 6.2% was defined high, in accordance with previous studies. Categorical and continuous variables were compared using the χ2 or Fisher exact tests, and the Mann-Whitney test, as appropriate. Logistic regression was used for multivariable analysis of categorical variable. Survival was calculated using the method of Kaplan and Meier, and univariable comparisons were made using the log-rank test. All p-values < 0.05 were considered significant. Results. One hundred and forty-two sequential unselected patients with MF were included in the study; baseline characteristics at time of IPF measurement are shown in the Table. Seventy (49%) patients had a high IPF. Factors associated with high IPF on univariate analysis were elevated white blood count (p=0.04), elevated peripheral blasts (p=0.04), low platelet count (<0.001), secondary MF (p=0.004), JAK2 mutation (p=0.002), and previous therapy (p=0.007). On multivariable analysis, the factors which remained associated with high IPF were elevated peripheral blasts (odd ratio [OR] 3.3, 95% confidence interval [CI] 1.4-8.1; p=0.009), low platelet count (OR 3.7, 95% CI 1.6-8.8; p=0.003), JAK2 mutation (OR 4.3, 95% CI 1.7-10.8; p=0.002) and previous therapy (OR 2.6, 95% CI 1.2-5.8; p=0.02). After a median follow-up of 22 months (range, 1-26) from the date of IPF measurement, no thrombotic events were reported, 11 patients developed secondary acute myeloid leukemia, and 25 patients died. Median overall survival has not been reached. IPF was not significantly associated with any of these outcomes. Discussion. Similarly to PV and ET, also in patient with MF high IPF associates with JAK-2 mutation, suggesting an interaction between the JAK-STAT pathway and platelet activation in these patients; in addition, high IPF associates with markers of advanced disease, such as elevated peripheral blasts, low platelets and previous exposure to therapy. Longer follow-up is needed to assess the impact of IPF on the risk of thrombosis and transformation, and survival. Table Table. Disclosures Verstovsek: Geron: Research Funding; Pfizer: Research Funding; Genentech: Research Funding; Bristol-Myers Squibb: Research Funding; Promedior: Research Funding; CTI BioPharma Corp: Research Funding; NS Pharma: Research Funding; Lilly Oncology: Research Funding; AstraZeneca: Research Funding; Roche: Research Funding; Incyte Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding; Galena BioPharma: Research Funding; Seattle Genetics: Research Funding; Gilead: Research Funding; Celgene: Research Funding.
20
Debie, Degu, Bethlehem Belay, and Melat Tesfaye. "Assessment of knowledge and practice of gynecology/obstetrics residents and midwives towards essential newborn care At Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia." Ethiopian Journal of Pediatrics and Child Health 17, no. 2 (December 28, 2022): 132–44. http://dx.doi.org/10.4314/ejpch.v17i2.6.
Full textAbstract:
Background: A time-bound and chronologically ordered series of medical interventions that a baby receives at birth are referred to as the "essential newborn protocol." This period of immediate care is critical for the babies' subsequent well-being and adaptation. However, there are still reports of health workers lacking good knowledge and practice with newborn care, which was not investigated in our hospital.
Methods: A hospital-based cross-sectional study was conducted in TASH with 114 selected gynecology and obstetrics residents and midwives. Using the SPSS version 25 software package, continuous data were described using the mean and standard deviation, while categorical data were de-scribed using frequency and percentage. To identify factors related to knowledge and practice, multivariable binary logistic regression analyses were used.
Result: Eighty-eight residents and 26 midwives were included. Nearly a quarter (24.6%) of participants had good knowledge about essential newborn care. Regarding knowledge level by profession, 31.8% of the residents had good knowledge of essential newborn care, and all the midwives had poor knowledge. The odds of having good knowledge of ENC were 96.3% lower for first-year residents and 90.5% lower for second-year residents as compared to year four. Untrained participants had an 84 percent lower chance of having good knowledge of essential newborn care than trained participants. Regarding practice level by profession, more than two-thirds of 68 (77.3%) residents and 21 (80.8%) midwives had sufficient skill in essential newborn care.
Conclusion: A substantial number of healthcare providers lacked essential newborn care knowledge and practice. The availability of service or on-the-job training, as well as the year of residency, were factors influencing newborn care knowledge. In-service training, encouraging supervision, and provisions should be reinforced to improve newborn care activities.
21
Abraha, Hiluf Ebuy, Kebede Embaye Gezae, Alemayehu Bayray Kahsay, and Mengistu Hagazi Tequare. "Incidence and predictors of first-year unplanned discontinuation of Implanon at Ayder comprehensive specialized hospital, northern Ethiopia: A retrospective follow-up study." PLOS ONE 17, no. 1 (January 26, 2022): e0259234. http://dx.doi.org/10.1371/journal.pone.0259234.
Full textAbstract:
Background Discontinuing contraception without switching to a different type of family planning (FP) method contributes to unwanted pregnancy and unsafe abortion. Unplanned discontinuation of Implanon (which is discontinuation of Implanon without switching, but not for reasons of wanting to get pregnant) during the first year and its possible determinants have not been well investigated in Ethiopia. Therefore, this study aimed to determine the incidence and predictors of unplanned discontinuation of Implanon during the first year. Methods A retrospective follow-up study was conducted among 413 consecutive series of eligible women at Ayder Comprehensive Specialized Hospital in Northern Ethiopia. Data were drawn from both FP initiation and removal registration books and from contacting users by phone over a one-year period (April 2016 and March 2017). The inclusion of the categorical predictor in the final Cox model was considered if the test had a P-value of <0.25 in the log-rank test. We identified predictors of time to unplanned discontinuation using a multivariable Cox regression analysis. Adjusted hazard ratios with 95% confidence intervals (CI) were used to assess the association of covariates with the risk of discontinuation. There were no statistically significant interaction terms and proportionality assumption was fulfilled. Results The unplanned discontinuation rate of Implanon during the first year was 18.2%, with an incidence density of 16.3 discontinuations/1000 women-months. Compared with those under 20 years of age, women aged 20 to 24 years (AHR = 0.42; 95% CI: 0.19–0.91) had a protective effect against discontinuation. On the other hand, clients whose partner’s educational level was lower than secondary (AHR = 2.20; 95% CI: 1.08–4.49) and who had never used any modern contraception method before (AHR = 3.26; 95% CI: 1.61–6.61) had a higher risk of discontinuation. Conclusions Our findings have significant implications for understanding why Implanon is discontinued in an unplanned manner, and will help policy makers plan the interventions needed to improve Implanon continuity by overcoming identified barriers. Providers in similar settings should pay more attention to clients whose partners have lower educational status and who are new acceptors.
22
Bedrin, Micheal, Bobby Yow, Sarah Nelson, Lance LeClere, Jonathan Dickens, and Patrick Mescher. "Paper 06: The Natural History of Nonoperative Treatment of Posterior Instability in a High Demand Population." Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0057. http://dx.doi.org/10.1177/2325967121s00570.
Full textAbstract:
Objectives: Nonoperative management of posterior shoulder instability is common, however there is limited data available to assess the pathomorphology of nonoperative management. The purpose of this study is to evaluate glenohumeral pathomorphology in shoulders with posterior glenohumeral instability treated nonoperatively. Methods: We conducted a retrospective review of a consecutive series of patient with isolated posterior shoulder instability defined as an isolated posterior labral tear with a corresponding positive Jerk or Kim test. Patients were excluded if they had prior shoulder surgery or absence of a Jerk or Kim test. Non-operative management was defined as a trial of formal physical therapy pursuit of nonsurgical modalities for a minimum 6 months. Patients who underwent non-operative management and subsequently had a repeat MRI of the initially injured shoulder were identified, and the two studies were compared to evaluate for changes in glenoid bone loss, glenoid morphology, cartilage injuries, and the presence of concurrent pathology. Our primary outcome was glenoid changes associated with failure of non-operative management, which was defined as reoperation and/or medical separation from the military due to the injured shoulder. Secondary outcomes included evaluation of potential risk factors for failure of non-operative management including glenoid bone loss, glenoid version, and posterior humeral head subluxation. Continuous variables were compared with student’s t-test or Fisher exact test when appropriate. Categorical variables were analyzed using Chi-squared. Multivariable regression analysis was used to evaluate risk factors for failure. Results: 42/90 (46.7%) patients failed a 6-month trial of nonoperative management after being diagnosed with posterior glenohumeral instability and went onto receive an arthroscopic stabilization procedure. The failure group demonstrated a significantly greater humeral head subluxation ratio than the cohort of patients who survived nonoperative management (0.65 ± 0.2 vs 0.62 ± 0.2; p = 0.0375). Of those who failed nonoperative management only 17 had repeat MRI’s for comparison with initial MRI’s, which revealed a significantly greater increase in glenoid bone loss (6.54 ± 1.59 vs 2.68 ±1.71; p = 0.00274). The mean time from index MRI and repeat MRI was 488 days (95% CI 317 to 658). Conclusions: In patients that underwent 6-months of nonoperative management for isolated posterior glenohumeral instability, failure occurred approximately 47% of the time and was associated with a greater posterior humeral head subluxation ratio on index MRI than those who did not fail. Additionally, those who had repeat MRI on average 1.3 years later demonstrated greater glenoid bone loss when compared to the index MRI.
23
Bewersdorf, Jan Philipp, Nishita Parmar, Scott Gettinger, Gary Israel, and Alfred Ian Lee. "Clinical Characteristics and Outcomes of Splenic Infarction in Cancer Patients - a Retrospective, Single Center Report of 206 Cases." Blood 136, Supplement 1 (November 5, 2020): 22–23. http://dx.doi.org/10.1182/blood-2020-136646.
Full textAbstract:
Introduction:Splenic infarct (SI) is caused by thromboembolic events or other local or systemic factors leading to insufficient splenic blood supply. One of the most common causes of SI is an underlying malignancy, which has been associated with nontraumatic SI in up to a third of cases. The incidence, underlying etiology, optimal treatment, and prognostic relevance of SI in cancer patients (pts) are poorly characterized with data limited to a few, retrospective, single center case series. Methods:We conducted a retrospective analysis of all radiologically-confirmed cases of SI in pts with any history of malignancy treated at Yale-New Haven Hospital during 2008-2017 to describe the incidence, treatment, and risk of recurrence of SI in cancer pts. Pediatric pts and cases of traumatic SI were excluded. Electronic medical records of eligible pts were reviewed and demographic, clinical, imaging and treatment characteristics as well as SI recurrence documented. Categorical and continuous variables among pts with and without recurrence of SI were compared using Pearson's χ2 test or Fisher's exact test and t-test with unequal variances, respectively. Multivariable logistic regression models that included variables associated with a higher risk of SI recurrence at a p-value of <0.2 in bivariate analysis were conducted to evaluate the impact of those variables on SI recurrence. Results:206 pts were included in the analysis with baseline characteristics shown inTable 1.Thirty-four pts (16.5%) had a prior venous thromboembolic event (VTE), while 40 pts (19.5%) had been on anticoagulation (AC) for other indications at the time of SI. Diagnosis of SI was often made incidentally on CT or MRI during routine cancer surveillance (44.2%; n = 91) or initial cancer staging (5.8%; n = 12). Splenomegaly was present in 33% of cases (n = 68) with 90.8% of pts (n = 188) having an unremarkable splenic vasculature. Abnormalities in the splenic vasculature included splenic artery/vein thrombosis (2.9%; n = 6) or occlusion (1.5%; n = 3), external compression by local tumor (1.5%; n = 3), direct tumor invasion into the splenic vasculature (2.9%; n = 6), and portal vein thrombosis (4.9%; n = 10). Following a diagnosis of SI, 22 pts (10.7%) were newly started on therapeutic AC and 36 pts (17.5%) continued on previously prescribed AC. Compared to those who were not anticoagulated, pts who were started or continued on AC after their diagnosis of SI were statistically more likely to have atrial fibrillation/flutter (29.3% vs. 12.2%; p = 0.003) or to have had a prior VTE (46.6% vs. 4.7%; p < 0.001). Pts newly started on AC following SI were more likely to have had a prior VTE (27.2% vs. 4.7%; p < 0.001) compared to pts who did not receive AC without a statistically significant difference in the rates of atrial fibrillation/flutter (22.7% vs. 12.2%; p = 0.186). Five of the 22 pts (22.7%) initiated on and five of the 36 pts (13.9%) continued on AC developed a subsequent VTE, respectively. There was no statistically significant difference in the risk of subsequent VTE among pts who continued or initiated AC compared to pts who did not receive AC (17.2% [10 out of 58 pts] vs. 12.8% [19 out of 148 pts]; p = 0.414). Follow-up imaging was available for 152 of the 206 pts (73.8%). A recurrent or enlarging SI was detected in 6 pts (4.0%) at a median of 35 days following initial SI (range: 8-734 days). Anticoagulation was not associated with a reduction in the risk of subsequent SI. In bivariate analysis none of the baseline patient, treatment, or imaging characteristics were statistically significantly associated with a higher chance of SI recurrence, although prior and subsequent VTE (p = 0.063) and atrial fibrillation/flutter (p = 0.076) showed trends towards statistical significance (Table 2). In a multivariable logistic regression model, no variables were identified that were associated with a higher risk of SI recurrence. Conclusion:In this large retrospective study of 206 cancer pts with SI, we showed that SI in this patient population are often an incidental finding with low risk of recurrence that is not impacted by AC. SI recurrence in cancer pts has a nonsignificant association with atrial fibrillation and prior VTE and therefore might arise as a cardioembolic event or as part of the underlying hypercoagulable state of malignancy. Additional prospective studies are needed to evaluate the risk and benefits of AC in this setting. Disclosures No relevant conflicts of interest to declare.
24
Sidana, Surbhi, Beth Faiman, Paul Elson, Mitchell R. Smith, Robert M. Dean, Jason Valent, Christy Samaras, et al. "Neuropathy and Efficacy Of Weekly Subcutaneous Bortezomib In Myeloma and AL Amyloidosis." Blood 122, no. 21 (November 15, 2013): 1975. http://dx.doi.org/10.1182/blood.v122.21.1975.1975.
Full textAbstract:
Abstract Background Information is limited on the efficacy and long-term tolerability of weekly ubcutaneous (SC) bortezomib (BTZ), especially when given alone or combined only with glucocorticoids. We implemented use of SC BTZ in 12/2010 and based on equal AUC and efficacy with twice a week SC as IV BTZ (Moreau et al. Lancet Oncology 2011) at reduced but still significant neurotoxicity allowed weekly SC, maintaining the BTZ starting dose at 1.3mg/m2. Methods Multiple myeloma (MM) and AL amyloidosis (ALA) patients (pts) who had received SC BTZ by February 2013 were identified from our plasma cell disorder registry. After IRB approval, their electronic medical records were reviewed for occurrence, severity, and evolution of PNP with each BTZ containing regimen, administration schedule of BTZ, presence of underlying PNP and neuropathy risk factors (diabetes mellitus, ESRD, spinal cord compression/disease, vitamin B12 deficiency, alcoholism, chronic liver disease, hyperlipidemia, hypothyroidism), concurrently used antineoplastic agents, physician assigned responses, and reasons for BTZ dose reductions or discontinuation. To compare first BTZ regimen administration schedules Fisher’s exact test and chi-square tests were used for categorical data, Kruskal-Wallis and Wilcoxon rank sum test for age and interval from diagnosis to treatment, and logrank test for treatment duration. Proportional hazards models were used to assess the impact of BTZ administration schedule on neuropathy and response. The impact of prior regimens before first BTZ administration on response was estimated by logistic regression models. Results 136 patients were identified, 12 were excluded due to insufficient data (not followed at our Center). The remaining 124 pts began their first BTZ regimen between 02/2005 and 02/2013. 81% had MM, 12 % ALA, and 7% both MM and amyloidosis. Patients received a median of 2 BTZ containing regimens (range 1-9); overall 312 BTZ regimens were analyzed. In 114 SC weekly, 32 SC twice a week, 59 IV weekly, 62 IV twice a week, and 11 twice a week SC/IV followed by weekly BTZ regimens, neuropathy led to BTZ discontinuation in 7.9% (n=9), 9.4% (n=3), 13.6% (n=8), 22.6% (n=14), 9.1% (n=1), respectively, and to dose reduction in 5.3% (n=6), 3.2% (n=1), 6.8% (n=4), 6.5% (n=4), 9.1% (n=1), respectively. Patients who received weekly SC BTZ as their first BTZ containing regimen (n=37) had received a median of 0 prior regimens (range 0-10), 27% (n=10) had mild (n=8) or severe (n=2) underlying neuropathy, and most (68%) received BTZ with only glucocorticoids (n=23) or alone (n=2), while lenalidomide (n=8) or other agents (n=4) were added to 32%. After a median treatment duration of 4.3 months (0.2-23.3+), 26 of these 37 pts (70%) developed no neuropathy (n=20) or no worsening of pre-existing neuropathy (n=6), but 7 (19%) required BTZ dose reduction (n=2) or supportive medications (n=5) for neuropathy and in 4 (11%) BTZ was discontinued because of neuropathy. In multivariable analyses for neurotoxicity and lack of response, use of schedules other than weekly SC as the first BTZ administration schedule caused more neuropathy (HR 2.3, 95% C.I. 1.0-5.3, p=0.05), while age and underlying disease associated with neuropathy had no impact (p=0.57 and 0.61, respectively); lack of response tended to be more common with schedules other than weekly SC (HR 2.0, 95% C.I. 0.9-4.5, p=0.09) but age and disease (MM vs. AL amyloid) did not affect response (p=0.33 and 0.32, respectively). A response rate of 71% (n=22) to the first SC weekly bortezomib containing regimen in 37 pts who had received a median of 0 (range 0-10) previous regimens was within the expected range for standard administration schedules; of 8 pts who received weekly SC BTZ with not more than a total of 40mg dexamethasone per week as upfront therapy for myeloma, 5 achieved VGPR, 1 PR, and one MR; in 6 evaluable AL amyloid patients this upfront treatment led to VGPR in 3 and PR in 1 patient. Conclusions Weekly SC BTZ, even if administered only with glucocorticoids, is effective and better tolerated than other BTZ administration schedules. However, neuropathy continues to impact therapy, affecting about a third of patients in our series who received BTZ for the first time. Disclosures: Off Label Use: Upfront weekly SC bortezomib. Faiman:Onyx: Consultancy, Speakers Bureau; Millennium: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau. Valent:Millennium: Speakers Bureau; Clegene: Speakers Bureau. Duong:Celgene: Honoraria, Research Funding. Reu:Onyx: Speakers Bureau; Celgene: Research Funding.
25
Sharpe, B. Dale, M. Pierce Ebaugh, Terrence M. Philbin, Mark A. Prissel, Christopher F. Hyer, Gregory C. Berlet, and David A. Goss. "Direct Plantar Approach to Plantar Plate Repair and Associated Wound Complications." Foot & Ankle Specialist, August 25, 2022, 193864002211185. http://dx.doi.org/10.1177/19386400221118500.
Full textAbstract:
Background: Lesser toe metatarsophalangeal joint (MTPJ) instability, secondary to plantar plate tear, has been the focus of numerous recent publications, the majority reporting on repair through a dorsal approach. A plantar approach has been described with the advantage of direct ligamentous repair or repair to bone, which follows conventional techniques employed throughout the body. Previous clinical studies have shown success in deformity correction and the longevity of both approaches. The proponents of the dorsal approach advocate that indirect repair of the plantar plate avoids perceived risks of complications with a plantar incision without evidence of superior outcomes. The purpose of this study was to investigate the safety and efficacy of the direct plantar approach to plantar plate repairs (PPRs) by reporting the rate of specific complications in a large clinical series. Methods: This was the institutional review board (IRB) approved retrospective study of 204 PPRs in 185 patients (194 lesser MTP, 10 hallux MTP) with an average age of 56 and a mean body mass index (BMI) of 28. Surgical technique involved repair with absorbable braided suture (88%) versus suture anchor (12%) with or without MTPJ pinning (80%). Mean follow up was 53 weeks (range 5–170). Patients were screened for associated risk factors, including diabetes mellitus (8%), tobacco use (5%), neuropathy (1%), and additional concurrent procedures (96%). Complications were defined as superficial or deep infection, painful scars, and reoperation. Analysis was conducted using the Wilcoxon-Mann-Whitney test or Fisher’s exact tests for continuous and categorical variables, respectively. Risk factors were analyzed using univariate logistic analysis to produce odds ratios (OR) with a 95% confidence interval (CI) and an inclusion criterion of a P-value, P > .2 for multivariate analysis as determined by Wald tests (significance at P < .05 for final modeling). Results: Overall, there were 31 total complications (15%) demonstrated by 14 superficial infections (6.8%) and 17 painful scars (8.3%) along with three reoperations (1.4%). All reoperations were performed for deformity or instability, not scar revision. There were no deep infections. No increased odds of complications were found with suture anchor repair, MTPJ pinning, neuropathy, or diabetes. Patients that used tobacco had 7.5 (CI 1.66, 34.06) the odds of developing any wound complication compared with nonsmokers. Tobacco use was also found to significantly increase the odds of superficial infection by 9.8 (CI 2.08, 46.15). There was no increase in painful scars or reoperation in tobacco users. This study did not find an increased complication rate with additional ipsilateral procedures performed at the time of surgery. Conclusion: To our knowledge, this is the largest study evaluating the direct plantar approach to PPR as well as the evaluation of associated complications with the plantar incision. With low complication and minimal reoperation rates, the results of this study have demonstrated the clinical viability of plantar-based incisions. Previous studies have demonstrated the success of PPR and correction of deformity with a direct approach. This case series further demonstrates the safety and efficacy of plantar-based incisions, particularly for direct PPRs. Level of Evidence: IV Retrospective Case Series Category: Lesser Toes