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Wang, Shun, Yongbo Li, Khandaker Noman, Dong Wang, Ke Feng, Zheng Liu e Zichen Deng. "Cumulative spectrum distribution entropy for rotating machinery fault diagnosis". Mechanical Systems and Signal Processing 206 (gennaio 2024): 110905. http://dx.doi.org/10.1016/j.ymssp.2023.110905.
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Ponsioen, Cyriel Y. "Diagnosis, Differential Diagnosis, and Epidemiology of Primary Sclerosing Cholangitis". Digestive Diseases 33, Suppl. 2 (2015): 134–39. http://dx.doi.org/10.1159/000440823.
Abstract (sommario):
According to recent guidelines, primary sclerosing cholangitis (PSC) is diagnosed when a patient has a cholestatic liver enzyme profile, characteristic bile duct changes on imaging, and when secondary causes of sclerosing cholangitis are excluded. In patients with a clinical suspicion but normal cholangiography, a liver biopsy is indicated to establish a diagnosis of small duct PSC. Several other disease entities such as IgG4-associated cholangitis (IAC), cholangiocarcinoma (CCA), and secondary causes of sclerosing cholangitis such as choledocholithiasis, AIDS-cholangiopathy, ischemia, surgical bile duct trauma, or mast cell cholangiopathy can mimic PSC. IAC can be differentiated from PSC by applying the HISORt criteria including the serum IgG4 level. In cases where serum IgG4 is less than 2 × ULN, the ratio of IgG4/IgG1 >0.24 is indicative for IAC. Choledocholithiasis with recurrent cholangitis as a cause of sclerosing cholangitis can pose a conundrum, since PSC itself is associated with an increased prevalence of gallstones. The epidemiology of PSC worldwide has been poorly described. Incidence and prevalence rates vary from 0-1.3 and 0-16.2 per 100,000 inhabitants respectively. However, these figures are not based on population-based cohorts. A recent large population-based cohort from the Netherlands reported an incidence of 0.5 and a prevalence of 6/100,000. Approximately 10% fulfil the criteria for small duct PSC. At diagnosis of PSC, concurrent inflammatory bowel disease (IBD), primarily ulcerative colitis or Crohn's colitis is present in 50%, but increasing to 80%, 10 years or more after diagnosis. Conversely, 3% of IBD patients will develop PSC. PSC predisposes to malignancy. The estimated cumulative risk of developing CCA after 30 years is 20%. For colorectal carcinoma in PSC/colitis patients, the estimated cumulative risk at 30 years is 13%.
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Rosenberg, Rebecca E., Walter E. Kaufmann, J. Kiely Law e Paul A. Law. "Parent Report of Community Psychiatric Comorbid Diagnoses in Autism Spectrum Disorders". Autism Research and Treatment 2011 (2011): 1–10. http://dx.doi.org/10.1155/2011/405849.
Abstract (sommario):
We used a national online registry to examine variation in cumulative prevalence of community diagnosis of psychiatric comorbidity in 4343 children with autism spectrum disorders (ASD). Adjusted multivariate logistic regression models compared influence of individual, family, and geographic factors on cumulative prevalence of parent-reported anxiety disorder, depression, bipolar disorder, and attention deficit/hyperactivity disorder or attention deficit disorder. Adjusted odds of community-assigned lifetime psychiatric comorbidity were significantly higher with each additional year of life, with increasing autism severity, and with Asperger syndrome and pervasive developmental disorder—not otherwise specified compared with autistic disorder. Overall, in this largest study of parent-reported community diagnoses of psychiatric comorbidity, gender, autistic regression, autism severity, and type of ASD all emerged as significant factors correlating with cumulative prevalence. These findings could suggest both underlying trends in actual comorbidity as well as variation in community interpretation and application of comorbid diagnoses in ASD.
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SHIVASHANKAR, RAINA, EDWARD V. LOFTUS, WILLIAM J. TREMAINE, TIM BONGARTZ, W. SCOTT HARMSEN, ALAN R. ZINSMEISTER e ERIC L. MATTESON. "Incidence of Spondyloarthropathy in Patients with Crohn’s Disease: A Population-based Study". Journal of Rheumatology 39, n. 11 (15 settembre 2012): 2148–52. http://dx.doi.org/10.3899/jrheum.120321.
Abstract (sommario):
Objective.Spondyloarthritis (SpA) is an extraintestinal manifestation of inflammatory bowel disease with significant clinical effects, although the frequency is uncertain. We assessed the cumulative incidence and clinical spectrum of SpA in patients with Crohn’s disease (CD) in a population-based cohort.Methods.The medical records of a population-based cohort of Olmsted County, Minnesota, residents diagnosed with CD between 1970 and 2004 were reviewed. Patients were followed longitudinally until migration, death, or December 31, 2010. We used the European Spondylarthropathy Study Group, Assessment of Spondyloarthritis international Society (ASAS) criteria and modified New York criteria to identify patients with SpA. The Kaplan-Meier method was used to estimate the cumulative incidence of SpA following diagnosis of CD.Results.The cohort included 311 patients with CD (49.8% females; median age 29.9 yrs, range 8–89). Thirty-two patients developed SpA based on ASAS criteria. The cumulative incidence of SpA after CD diagnosis was 6.7% (95% CI 2.5%–6.7%) at 10 years, 13.9% (95% CI 8.7%–18.8%) at 20 years, and 18.6% (95% CI 11.0%–25.5%) at 30 years. The 10-year cumulative incidence of ankylosing spondylitis was 0, while both the 20-year and 30-year cumulative incidences were 0.5% (95% CI 0–1.6%).Conclusion.We have for the first time defined the actual cumulative incidence of SpA in CD using complete medical record information in a population-based cohort. The cumulative incidence of all forms of SpA increased to approximately 19% by 30 years from diagnosis of CD. Our results emphasize the importance of maintaining a high level of suspicion for SpA when following patients with CD.
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Cohen, Lisa R., Denise A. Hien e Sarai Batchelder. "The Impact of Cumulative Maternal Trauma and Diagnosis on Parenting Behavior". Child Maltreatment 13, n. 1 (febbraio 2008): 27–38. http://dx.doi.org/10.1177/1077559507310045.
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Dannefer, Dale. "Racism and Cumulative Dis/Advantage in Healthcare Access: Implications for the Life Course". Innovation in Aging 4, Supplement_1 (1 dicembre 2020): 586. http://dx.doi.org/10.1093/geroni/igaa057.1958.
Abstract (sommario):
Abstract Despite its origins in the study of race in America in Gunnar Myrdal’s American Dilemma, research on cumulative dis/advantage (CDA) and the life course has paid little attention to the significance of racism in the overall production and patterning of CDA. Building on recent work that has reviewed the life-course implications of the inscribing of racist interests in social policy, this paper explores the life-course implications of race bias in another domain, specifically the domain of medical diagnosis, where algorithm formulas have been shown to disadvantage black patients based on economic and other parameters. Even with training, experimental evidence comparing human and AI diagnostics have demonstrated that despite improvements, residual racism is evident in differential diagnoses. We consider the life-course implications of this and similar race-based differentials in organizational decision-making as a component in systems of cumulating dis/advantage.
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Stuver, Robert, Nivetha Ganesan, Ahmet Dogan, Zachary D. Epstein-Peterson, Paola Ghione, William Johnson, Natasha Lewis et al. "Cumulative Incidence of Myeloid Neoplasms in Patients with Nodal T-Follicular Helper Cell Lymphoma". Blood 142, Supplement 1 (28 novembre 2023): 4438. http://dx.doi.org/10.1182/blood-2023-182272.
Abstract (sommario):
Introduction: Certain T-cell lymphomas (TCL), in particular nodal T-follicular helper (TFH) cell lymphomas, including angioimmunoblastic TCL (AITL), commonly develop on a background of mutations identified in clonal hematopoiesis (CH). Divergent clonal evolution can result in both nodal TFH cell lymphomas and myeloid neoplasms (MN). As peripheral TCLs are commonly treated with combination and dose intensive chemotherapy, there is a risk that these therapies could promote an evolution to MN. The frequency at which this occurs is unclear. Methods: We conducted a retrospective search for any patient with an International Classification of Disease (ICD) code referring to a TCL. Then, we identified patients with a concomitant ICD code referring to either myelodysplastic syndromes (MDS), acutemyeloid leukemia (AML), or a myeloproliferative neoplasm (MPN). Once the initial query was performed, we individually reviewed each patient and included only patients meeting the following criteria: (1) A histologically-confirmed diagnosis of either peripheral TCL, not otherwise specified (PTCL-NOS) or nodal TFH cell lymphoma by an MSK hematopathologist between 1/1/02 and 7/1/23; (2) Presentation to MSK at lymphoma diagnosis; (3) At least 6 months of follow-up (unless death from lymphoma); (4) if relevant, a histologically-confirmed diagnosis of a MN by an MSK hematopathologist. Histological diagnoses were recorded as documented in the pathology electronic record in accordance with the WHO criteria in place at the time of diagnosis. In particular, at our center, prior to 2016, cases of PTCL-NOS were not routinely assessed for TFH phenotype, as nodal TFH cell lymphoma was only added to the WHO classification in 2016. Cases documented herein as PTCL-NOS were not re-reviewed to determine TFH phenotype. Only patients who received systemic treatment were included (systemic steroids were not considered systemic treatment). CI of MN was evaluated using the reverse Kaplan-Meier method treating death as a competing risk. Results: We identified a total of 376 patients with either PTCL-NOS (N=178) or nodal TFH cell lymphoma (N=198; AITL N=184; nodal TFH cell lymphoma, NOS N=13; nodal TFH cell lymphoma, follicular-type=1). In total, 24 patients with a MN and either PTCL-NOS or nodal TFH cell lymphoma were identified. Nine had a MN that preceded the TCL diagnosis (AML: 2; MDS: 1; myelofibrosis: 2; CMML: 2; MDS/MPN: 1; polycythemia vera: 1)-these patients were excluded for CI calculation. Fifteen patients were diagnosed with a MN subsequent to lymphoma diagnosis and treatment (AML: 5; MDS: 8; CMML: 1; chronic neutrophilic leukemia: 1). Of the 198 patients with nodal TFH cell lymphoma, nine developed a MN. The CI of developing a MN among all patients at 2, 5, 10, and 15 years was 1.1%, 4.4%, 4.8%, and 5.8%. The CI of developing a MN among those with known nodal TFH cell lymphoma at the same timepoints were 1.6%, 4.5%, 5.3% and 7.1%. The median follow up among survivors was 4.1 years (range: 0.5-18). The median age at MN diagnosis was 72.6 years (range: 45-81), and the median time from lymphoma diagnosis to MN diagnosis was 2.6 years (range: 0.3-10.4). Four patients had either prior RT or chemotherapy for non-lymphoma conditions. Prior to MN diagnosis, ten patients (67%) received etoposide and seven patients (47%) received autologous stem cell transplant (ASCT) (six with BEAM, one with cyclophosphamide plus total body irradiation). The median number of therapies (including ASCT) prior to MN diagnosis was 2 (range: 1-5). At the time of MN diagnosis, 10 patients had relapsed TCL and were receiving lymphoma therapy. No patients had undergone alloSCT prior to the diagnosis of a MN. Next generation mutational profiling with MSK-IMPACT-Heme had previously been performed for eight of the 15 patients (on lymphoma tissue). All except one had mutations in TET2 and/or DNMT3A. Conclusions: Herein we report the CI of MN in a cohort of patients with TCL, with particular attention to nodal TFH cell lymphomas given known CH mutations and the genotoxic stress of combination chemotherapy. As more patients have prolonged survival after initial therapy for TCL, further analysis, including baseline genetics and prospective characterization for clonal expansion and acquired mutations during therapy, could identify those at highest risk for developing a MN. Further characterization of our cohort and comparison to patients who did not develop a MN is ongoing.
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Tzur Bitan, Dana, Daniella Berzin, Khalaf Kridin, Yaron Sela e Arnon Cohen. "Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Population-based Study". Acta Dermato-Venereologica 102 (14 marzo 2022): adv00669. http://dx.doi.org/10.2340/actadv.v102.1622.
Abstract (sommario):
Alopecia areata and depression tend to co-occur; however, their temporal association has not been comprehensively investigated. The aim of this study was to examine the temporal association between alopecia areata and depression. The study included only cases with a comorbid presentation of alopecia areata and depression (n = 1,936), extracted from the databases of the Clalit Health Services, Israel. Survival analyses were used to assess the cumulative probability of receiving alopecia areata as comorbid diagnosis in the years following depression, and vice versa, compared with the opposite trajectory. The results indicate that patients with alopecia areata had greater odds of subsequent depression within 2 years from alopecia areata diagnosis, and showed a steeper increase in cumulative probability of depression as time progressed (log-rank =336.38, p < 0.001), compared with the opposite trajectory. All patients with alopecia areata had comorbid depression within 10 years of alopecia areata, compared with 70% of depression patients receiving diagnoses of comorbid alopecia areata within the same time-frame.
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Anto, Marissa, Shannon C. Shipley, Shavonne Massey e Christina L. Szperka. "Adverse Childhood Experiences Are Associated With Seizures in Children". Neurology: Clinical Practice 13, n. 2 (10 marzo 2023): e200136. http://dx.doi.org/10.1212/cpj.0000000000200136.
Abstract (sommario):
Background and ObjectiveTo assess the relationship between adverse childhood experiences (ACE/ACEs) and epilepsy.MethodsWe performed a cross-sectional retrospective cohort analysis using population-based data from the 2018 and 2019 National Survey of Children's Health to examine caregiver-reported ACE exposures and their relationship to caregiver-reported physician diagnoses of epilepsy or seizure disorder in children. ACEs elicited in the survey included questions about experience of violence, household dysfunction, and food and housing insecurity. Adjusting for age, race, and income level, we used logistic regression to test the relationships between cumulative ACE score and current seizure disorder or epilepsy diagnosis and to examine which specific ACEs were individually associated with current seizure disorder or epilepsy diagnosis.ResultsThe study population consisted of 59,963 participants; 52.2% were female, and 47.8% were male. Participant ages ranged from 0 to 17 years. A current diagnosis of epilepsy or seizure disorder was reported in 377 (0.63%) participants, and 22,749 (37.9%) participants had one or more ACE exposures. As the number of ACEs increased, odds of current epilepsy or seizure disorder diagnosis increased by 1.14 (95% confidence interval 1.07–1.22). Five ACE exposures demonstrated a high association with a current diagnosis of epilepsy or seizure disorder: food/housing insecurity, witnessing domestic violence, household mental illness, neighborhood violence, and parent/guardian incarceration.DiscussionMultiple ACE exposures were individually associated with reporting a diagnosis of epilepsy or seizure disorder. An increase in cumulative ACE exposures increased odds of having current diagnosis of epilepsy or seizure disorder.
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Stevenson, Carl W., e Meghan M. Leis. "The Cumulative Complexity Model and Repeat Falls". Professional Case Management 23, n. 4 (2018): 190–203. http://dx.doi.org/10.1097/ncm.0000000000000279.
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de Blank, Peter M. K., Katharine R. Lange, Mengqi Xing, Sedigheh Mirzaei Salehabadi, Deokumar Srivatava, Tara M. Brinkman, Kirsten K. Ness et al. "LGG-15. Late mortality and morbidity of adult survivors of childhood glioma treated across three decades: a report from the Childhood Cancer Survivor Study". Neuro-Oncology 24, Supplement_1 (1 giugno 2022): i90—i91. http://dx.doi.org/10.1093/neuonc/noac079.330.
Abstract (sommario):
Abstract PURPOSE: Pediatric low-grade glioma therapy has evolved to delay or eliminate radiation. The impact of therapy changes on long-term outcomes remains unknown. METHODS: Cumulative incidence of late mortality (death >5 years from diagnosis), subsequent neoplasms (SNs), and chronic health conditions (CHCs, CTCAE grading criteria) were evaluated in the Childhood Cancer Survivor Study among 5-year survivors of glioma diagnosed 1970-1999. Outcomes were evaluated by diagnosis decade and by treatment exposures received ≤5 years following diagnosis (surgery-only, chemotherapy ± surgery, and cranial radiation ± surgery or chemotherapy). Relative risk (RRs) with 95%CIs estimated long-term outcomes using multivariable piecewise exponential models. RESULTS: Among 2,684 eligible survivors (age at diagnosis (median [range]), 7 years [0-20 years]; time from diagnosis, 24 years [5-48 years]), exposure to cranial radiation decreased [51% (1970s), 45% (1980s), 25% (1990s)] along with late tumor recurrence (>5 & ≤15 years from diagnosis) [9.8% (1970s), 8.8% (1980s), 5.0% (1990s)]. The 15-year cumulative incidence of late mortality was 10.3% (1970s), 6.5% (1980s), and 6.0% (1990s) (p<0.001, comparison of cumulative incidence curves). The 15-year cumulative incidence of grade 3-5 CHCs was 19.7% (1970s), 17.8% (1980s), and 14.2% (1990s) (p<0.0001). A reduction in SN incidence was not observed. In multivariable analyses excluding treatment exposure, later diagnosis (1990s vs. 1970s) was associated with lower risk of late mortality, grade 3-5 CHCs and SNs. Inclusion of treatment exposure in the model attenuated the effect of diagnosis decade. Radiation or chemotherapy exposure increased risk compared to surgery alone for late mortality (radiation RR 4.95, 95%CI 3.79-6.47; chemotherapy RR 2.88, 95%CI 1.85-4.48), CHCs (radiation RR 4.02, 95%CI 3.28-4.94; chemotherapy RR 1.66, 95%CI 1.13-2.45), and SNs (radiation RR 4.02, 95%CI 3.06-6.13, chemotherapy RR 2.08, 95%CI 1.03-4.23)). CONCLUSION: Late mortality and CHCs decreased in childhood glioma survivors diagnosed from 1970-1999 largely due to therapy changes, particularly avoidance of cranial radiation, without increased late recurrence.
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Margel, David, David R. Urbach, Lorraine L. Lipscombe, Chaim M. Bell, Girish Kulkarni, Peter C. Austin e Neil Fleshner. "Metformin Use and All-Cause and Prostate Cancer–Specific Mortality Among Men With Diabetes". Journal of Clinical Oncology 31, n. 25 (1 settembre 2013): 3069–75. http://dx.doi.org/10.1200/jco.2012.46.7043.
Abstract (sommario):
Purpose To evaluate the association between cumulative duration of metformin use after prostate cancer (PC) diagnosis and all-cause and PC-specific mortality among patients with diabetes. Patients and Methods We used a population-based retrospective cohort design. Data were obtained from several Ontario health care administrative databases. Within a cohort of men older than age 66 years with incident diabetes who subsequently developed PC, we examined the effect of duration of antidiabetic medication exposure after PC diagnosis on all-cause and PC-specific mortality. Crude and adjusted hazard ratios (HRs) were calculated by using a time-varying Cox proportional hazard model to estimate effects. Results The cohort consisted of 3,837 patients. Median age at diagnosis of PC was 75 years (interquartile range [IQR], 72 to 79 years). During a median follow-up of 4.64 years (IQR, 2.7 to 7.1 years), 1,343 (35%) died, and 291 patients (7.6%) died as a result of PC. Cumulative duration of metformin treatment after PC diagnosis was associated with a significant decreased risk of PC-specific and all-cause mortality in a dose-dependent fashion. Adjusted HR for PC-specific mortality was 0.76 (95% CI, 0.64 to 0.89) for each additional 6 months of metformin use. The association with all-cause mortality was also significant but declined over time from an HR of 0.76 in the first 6 months to 0.93 between 24 and 30 months. There was no relationship between cumulative use of other antidiabetic drugs and either outcome. Conclusion Increased cumulative duration of metformin exposure after PC diagnosis was associated with decreases in both all-cause and PC-specific mortality among diabetic men.
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Margel, David, David R. Urbach, Lorraine Lipscombe, Chaim Bell, Girish Kilkarni, Peter Austin, Anthony Michael Joshua e Neil Eric Fleshner. "Metformin use and all-cause and prostate-cancer-specific mortality among diabetic men." Journal of Clinical Oncology 31, n. 15_suppl (20 maggio 2013): 5007. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.5007.
Abstract (sommario):
5007 Background: To evaluate the association between cumulative duration of metformin use after prostate cancer diagnosis and all-cause and prostate cancer-specific mortality among diabetic patients. Methods: We used a population-based retrospective cohort design. Data were obtained from several Ontario health care administrative databases. Within a cohort of men over the age of 66 with incident diabetes who subsequently developed prostate cancer, we examined the effect of duration of anti-diabetic medication exposure, after prostate cancer diagnosis, on all-cause and prostate cancer-specific mortality. Crude and adjusted hazard ratios were calculated using a time-varying Cox proportional hazard model to estimate effects. Results: The cohort consisted of 3,837 patients. Median age (interquartile range IQR) at diagnosis of prostate cancer was 75 (72-79) years. During a median (IQR) follow up of 4.64 (2.7-7.1) years, 1,343 (35%) died, and 291 patients died of prostate cancer (7.6%). Cumulative duration of metformin treatment, after prostate cancer diagnosis, was associated with a significant decreased risk of prostate cancer-specific and all-cause mortality in a dose-dependent fashion. The adjusted hazard ratio, for prostate cancer-specific mortality was 0.76 (95% confidence interval, 0.64-0.89) for each additional six months of metformin use. The association with all-cause mortality was also significant but declined over-time from a HR of 0.76 in the first 6 months to 0.93 between 24-30 months. There was no relationship between cumulative use of other anti-diabetic drugs and either outcome. Conclusions: Increased cumulative duration of metformin exposure after prostate cancer diagnosis was associated with decreases in both all-cause and prostate-cancer-specific mortality among diabetic men.
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Verpoest, W., P. Haentjens, M. De Rycke, C. Staessen, K. Sermon, M. Bonduelle, P. Devroey e I. Liebaers. "Cumulative reproductive outcome after preimplantation genetic diagnosis: a report on 1498 couples". Human Reproduction 24, n. 11 (3 agosto 2009): 2951–59. http://dx.doi.org/10.1093/humrep/dep272.
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Rosenberg, Eli S., James M. Tesoriero, Elizabeth M. Rosenthal, Rakkoo Chung, Meredith A. Barranco, Linda M. Styer, Monica M. Parker et al. "Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York". Annals of Epidemiology 48 (agosto 2020): 23–29. http://dx.doi.org/10.1016/j.annepidem.2020.06.004.
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Duan, MingHui, LiQing Liu, Chuang Yao, JunJi Feng, Xiaoguang Ma, JuFang Wei, He Zhang e Hao Ma. "Research on cumulative effect and diagnosis method of transformer short-circuit impulse". Journal of Physics: Conference Series 2477, n. 1 (1 aprile 2023): 012034. http://dx.doi.org/10.1088/1742-6596/2477/1/012034.
Abstract (sommario):
Abstract After transformers suffer from short-circuit impact, their mechanical performance decreases significantly. This article establishes a two-wire vibration model to represent the coupling between forces and mechanics and analyzes the transient vibration signals of a 400 V transformer during 22 short-circuits impact. To illustrate the cumulative effect of short-circuits, the vibration entropy, and energy ratio of the main vibration frequency and half frequency are adopted. The results show that transient vibration signals of transformer in short-circuits contain half frequency components, such as 25 Hz and 75, etc., and with the increase of the number of short-circuits, plastic deformation exists in insulation material, which leads to the loss of winding clamping pressure, the reduction of natural frequency, and the upsurge of parametric resonance. With the increase of short circuits, the vibration entropy and half-frequency energy ratio increase, and the main frequency energy ratio decreases. After winding completely lose the axial stability, the vibration entropy and half frequency ratio decrease, and the main frequency ratio increases. The conclusion is of great significance to the analysis of the cumulative effect of short circuits on power transformers.
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Matthews, T. J. "P589 Stable Trends in Radiation Exposure Amongst Patients with a New Diagnosis of Inflammatory Bowel Disease at an Irish Tertiary Referral Hospital". Journal of Crohn's and Colitis 15, Supplement_1 (1 maggio 2021): S539—S540. http://dx.doi.org/10.1093/ecco-jcc/jjab076.710.
Abstract (sommario):
Abstract Background The utilisation of diagnostic imaging has risen dramatically over time. IBD patients are particularly vulnerable to this inclination. We evaluated trends in the radiation doses to which our service exposed our new IBD referrals over time. Methods Searches of new referrals to our IBD clinic during two 24-month periods beginning 01/06/2005 (n=84) and 01/01/2013 (n=63) were conducted. The numbers of AXRs, CT APs, Barium Swallows, Meals, Follow-Throughs and Enemas, CT Colonographies and MRI SBs were collated for each patient for the five-year period subsequent to their first attendance. The dataset was irrevocably anonymised. Cumulative effective radiation doses were calculated using estimates provided in leading radiology journals. Linear regression using the ordinary least squares method examined the relationship between cumulative dose, period of diagnosis, age, gender and category of IBD. Results The mean cumulative effective radiation doses for the earlier and later periods were 4.7mSv (95% CI, 1.86 to 7.54) and 7.4mSv (95% CI, 3.60 to 11.26) respectively. No significant relationship was demonstrated between age (-0.03mSv, 95%CIs: -0.20, 0.12), male gender (0.69mSv, 95%CIs: -4.00, 5.39), or later referral period (3.06mSv, 95%CIs: -1.67, 7.78) and cumulative dose. A diagnosis of Crohn’s (as opposed to UC) had a strongly positive relationship with total radiation dose (5.89, 95%CI: 1.07, 10.70). 12 MRI small bowels were completed during period 2, none during period 1. Conclusion Our evaluation shows an upward trend, failing to meet statistical significance, in the radiation doses to which patients with new diagnoses of IBD were exposed to by our service.
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Mahoney, James. "Cumulative trauma disorders and carpal tunnel syndrome: Sorting out the confusion". Canadian Journal of Plastic Surgery 3, n. 4 (dicembre 1995): 17–25. http://dx.doi.org/10.1177/229255039500300404.
Abstract (sommario):
Chronic work injury will be implicated as a cause of upper extremity musculoskeletal disorders in increasing numbers of patients. A wide variety of conditions, some with a specific diagnosis (eg, carpal tunnel syndrome) and a known response to treatment in contrast to more generalized disorders (eg, tendonitis) where the prognosis is uncertain form part of the spectrum. Experience has demonstrated that as the diagnosis becomes less specific, job related and emotional factors can significantly affect the patient's presentation, response to treatment and timing to return to work. Care needs to be exercised in implicating work in the etiology. General terms such as ‘cumulative trauma disorder’ and ‘repetitive strain injury’ need to be avoided.
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Hyun, H. K., J. W. Kim, J. Lee, Y. T. Jeen, T. O. Kim, J. S. Kim, J. J. Park et al. "P631 Effectiveness of Early Thiopurine Use in Korean Patients with Moderate-to-Severe Ulcerative Colitis: A Prospective Multicenter Cohort (MOSAIK) study". Journal of Crohn's and Colitis 18, Supplement_1 (1 gennaio 2024): i1211—i1213. http://dx.doi.org/10.1093/ecco-jcc/jjad212.0761.
Abstract (sommario):
Abstract Background Thiopurines play an important role in the management of steroid-refractory steroid-dependent ulcerative colitis (UC). However, the effectiveness of the early use of thiopurines in UC remains controversial. Methods In this multicenter prospective cohort study, we divided patients with UC into those who underwent early (within 6 months of diagnosis) and late (6 months after diagnosis) thiopurine therapy to determine the effectiveness of early thiopurine treatment. The primary outcome was the cumulative rate of clinical relapse (Mayo score >2 points). Multivariate Cox proportional hazards regression was used to identify independent clinical factors associated with the outcomes. Results Overall, 333 patients with moderate-to-severe UC were included in the MOSAIK study. Of the 118 patients treated with thiopurines, 65 (55.1%) and 53 (44.9%) received thiopurine therapy within and after 6 months of diagnosis. The cumulative use rate of thiopurines was 38.96% at 3 years after diagnosis. The median initial dose of thiopurines was 0.7 mg/kg (0.3–2.0), and the median maintenance dose was 1.1 mg/kg (0.3–2.4). The cumulative rate of clinical relapse was not significantly different between patients who started thiopurine therapy within 6 months of diagnosis and those who started therapy 6 months after diagnosis during a 3–year period (p = 0.712). Multivariate analysis showed that the presence of extraintestinal manifestations (hazard ratio [HR]: 4.674, 95% CI: 1.210–18.061, p = 0.025) independently predicted an increased risk of clinical relapse. Conclusion Patients with UC who received early thiopurine therapy did not differ significantly in terms of clinical relapse compared with those who received late therapy.
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Ramin, Cody, Diana Withrow, Brittny Davis Lynn, Gretchen Gierach e Amy Berrington de González. "Contralateral breast cancer risk according to first breast cancer characteristics among United States women from 1992 to 2015." Journal of Clinical Oncology 37, n. 15_suppl (20 maggio 2019): 1549. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.1549.
Abstract (sommario):
1549 Background: After recent advances in breast cancer treatment and increasing uptake of contralateral prophylactic mastectomies, estimates of contralateral breast cancer (CBC) risk by year of diagnosis and other patient characteristics are needed to help inform decision making. Methods: We estimated CBC risk in 399,032 1-year survivors of a first primary breast cancer (stage I-III) in the US Surveillance, Epidemiology, and End Results Database (1992-2015). CBC was defined as an invasive second breast cancer diagnosed in the opposite breast 12+ months after the first breast cancer diagnosis. We estimated standardized incidence ratios (SIRs) and 5-year cumulative incidence of CBC by calendar period, age, breast cancer subtype, and receipt of hormonal therapy for the initial breast cancer. SIRs were calculated as the observed number of CBCs among survivors compared to the expected number of first breast cancers in the general population. Cumulative incidence was estimated in women without contralateral prophylactic mastectomies and accounted for competing risks. Results: Among 399,032 breast cancer survivors, 11,365 cases of CBC were diagnosed through 2015. Risk of CBC was elevated over the entire study period (SIR = 2.23, 95% CI = 2.19-2.27). SIRs for CBC declined over calendar period and this decreasing trend was observed irrespective of age, estrogen receptor (ER) status, and hormonal therapy. Survivors had an overall 5-year cumulative incidence of CBC of 1.49% (95% CI = 1.44%-1.54%), which decreased over time to 1.31% (95% CI = 1.23%-1.41%) in 2008-2014. For recent diagnoses, the 5-year cumulative incidence of CBC was higher after ER-negative (1.80%, 95% CI = 1.55%-2.07%) and triple negative tumors (1.98%, 95% CI = 1.52%-2.55%), and lowest for women who received hormonal therapy (1.01%, 95% CI = 0.90%-1.13%). Conclusions: Although CBC risk is declining in the US from 1992-2015, survivors have approximately twice the risk of an incident breast cancer (in the contralateral breast) compared to the general population. The 5-year cumulative risk of CBC is highest after ER-negative/triple negative tumors highlighting the need for medical surveillance and targeted interventions among these patients.
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Lucas, Mitchell R., Janice L. Atkins, Luke C. Pilling, Jeremy D. Shearman e David Melzer. "HFEgenotypes, haemochromatosis diagnosis and clinical outcomes at age 80 years: a prospective cohort study in the UK Biobank". BMJ Open 14, n. 3 (marzo 2024): e081926. http://dx.doi.org/10.1136/bmjopen-2023-081926.
Abstract (sommario):
ObjectivesHFEhaemochromatosis genetic variants have an uncertain clinical penetrance, especially to older ages and in undiagnosed groups. We estimated p.C282Y and p.H63D variant cumulative incidence of multiple clinical outcomes in a large community cohort.DesignProspective cohort study.Setting22 assessment centres across England, Scotland, and Wales in the UK Biobank (2006–2010).Participants451 270 participants genetically similar to the 1000 Genomes European reference population, with a mean of 13.3-year follow-up through hospital inpatient, cancer registries and death certificate data.Main outcome measuresCox proportional HRs of incident clinical outcomes and mortality in those withHFEp.C282Y/p.H63D mutations compared with those with no variants, stratified by sex and adjusted for age, assessment centre and genetic stratification. Cumulative incidences were estimated from age 40 years to 80 years.Results12.1% of p.C282Y+/+ males had baseline (mean age 57 years) haemochromatosis diagnoses, with a cumulative incidence of 56.4% at age 80 years. 33.1% died vs 25.4% withoutHFEvariants (HR 1.29, 95% CI: 1.12 to 1.48, p=4.7×10-4); 27.9% vs 17.1% had joint replacements, 20.3% vs 8.3% had liver disease, and there were excess delirium, dementia, and Parkinson’s disease but not depression. Associations, including excess mortality, were similar in the group undiagnosed with haemochromatosis. 3.4% of women with p.C282Y+/+ had baseline haemochromatosis diagnoses, with a cumulative incidence of 40.5% at age 80 years. There were excess incident liver disease (8.9% vs 6.8%; HR 1.62, 95% CI: 1.27 to 2.05, p=7.8×10-5), joint replacements and delirium, with similar results in the undiagnosed. p.C282Y/p.H63D and p.H63D+/+ men or women had no statistically significant excess fatigue or depression at baseline and no excess incident outcomes.ConclusionsMale and female p.C282Y homozygotes experienced greater excess morbidity than previously documented, including those undiagnosed with haemochromatosis in the community. As haemochromatosis diagnosis rates were low at baseline despite treatment being considered effective, trials of screening to identify people with p.C282Y homozygosity early appear justified.
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Jáuregui-Renaud, Kathrine, Ismael Velázquez-Ramírez, Jetzabel de Jetzenay Hernández-Tenorio, María del Carmen Solis-Cruz, Constanza Miriam Aguilar-Jiménez, Ofelia de Jesús Morales-Sánchez e Milliteotl Rincón-Rojas. "Sick Leave Due to Ear Diagnoses, a Nationwide Representative Registry of Mexico". Healthcare 11, n. 8 (13 aprile 2023): 1112. http://dx.doi.org/10.3390/healthcare11081112.
Abstract (sommario):
Sickness absence from work is a measure of both poor health and social functioning. In order to assess the frequency of sick leave due to ear-related diagnoses, we performed a retrospective analysis on the registry of paid sick leave certificates supplied by the main social security institution in Mexico during the years 2018 and 2019, just prior to the SARS-CoV-2 pandemic. We observed that, in the two years, 22,053 sick leave certificates due to ear-related diagnoses were provided to 18,033 workers. The most frequent ear-related diagnoses were those of vestibular disorders (94.64%); among them, the most common diagnosis was Benign Paroxysmal Positional Vertigo (75.16%), followed by Labrynthitis and Meniere’s disease (circa 8% each). A total of 4.63% of the diagnoses were related to external and middle ear disorders, and 0.71% were mainly related to hearing. Consistently, the highest cumulative days of sick leave required were given for the group of diagnoses related to vestibular disorders; although the less frequent diagnoses required the highest cumulative days per case (e.g., ototoxicity). During 2018 and 2019, the most frequent diagnoses of ear-related sick leave were due to vestibular diagnoses (particularly Benign Paroxysmal Positional Vertigo).
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Rutigliano, Grazia, Sergio Merlino, Amedeo Minichino, Rashmi Patel, Cathy Davies, Dominic Oliver, Andrea De Micheli, Philip McGuire e Paolo Fusar-Poli. "Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions". European Psychiatry 52 (agosto 2018): 126–33. http://dx.doi.org/10.1016/j.eurpsy.2018.05.004.
Abstract (sommario):
AbstractBackground:Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.Methods:Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.Results:A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).Conclusions:Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.
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Young, Grace J., Sean Harrison, Emma L. Turner, Eleanor I. Walsh, Steven E. Oliver, Yoav Ben-Shlomo, Simon Evans et al. "Prostate-specific antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study". BMJ Open 7, n. 10 (ottobre 2017): e017729. http://dx.doi.org/10.1136/bmjopen-2017-017729.
Abstract (sommario):
ObjectivesCross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa).Setting, participants and outcome measuresPatient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man’s age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study.ResultsThe 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45–49 years to 53.0% for men aged 65–69 years (p for trend <0.001). For those with a PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively).ConclusionA high proportion of men aged 45–69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa.Trial registration numberISRCTN20141297,NCT02044172.
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Reda, Islam, Ashraf Khalil, Mohammed Elmogy, Ahmed Abou El-Fetouh, Ahmed Shalaby, Mohamed Abou El-Ghar, Adel Elmaghraby, Mohammed Ghazal e Ayman El-Baz. "Deep Learning Role in Early Diagnosis of Prostate Cancer". Technology in Cancer Research & Treatment 17 (1 gennaio 2018): 153303461877553. http://dx.doi.org/10.1177/1533034618775530.
Abstract (sommario):
The objective of this work is to develop a computer-aided diagnostic system for early diagnosis of prostate cancer. The presented system integrates both clinical biomarkers (prostate-specific antigen) and extracted features from diffusion-weighted magnetic resonance imaging collected at multiple b values. The presented system performs 3 major processing steps. First, prostate delineation using a hybrid approach that combines a level-set model with nonnegative matrix factorization. Second, estimation and normalization of diffusion parameters, which are the apparent diffusion coefficients of the delineated prostate volumes at different b values followed by refinement of those apparent diffusion coefficients using a generalized Gaussian Markov random field model. Then, construction of the cumulative distribution functions of the processed apparent diffusion coefficients at multiple b values. In parallel, a K-nearest neighbor classifier is employed to transform the prostate-specific antigen results into diagnostic probabilities. Finally, those prostate-specific antigen–based probabilities are integrated with the initial diagnostic probabilities obtained using stacked nonnegativity constraint sparse autoencoders that employ apparent diffusion coefficient–cumulative distribution functions for better diagnostic accuracy. Experiments conducted on 18 diffusion-weighted magnetic resonance imaging data sets achieved 94.4% diagnosis accuracy (sensitivity = 88.9% and specificity = 100%), which indicate the promising results of the presented computer-aided diagnostic system.
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Rajaratnam, Rameshshanker, Ana Wilson, Siwan Thomas-Gibson, Nuala R. O'Shea, Abdulkani Yusuf e Brian P. Saunders. "Sa1105 Learning Curve for Optical Diagnosis of Colorectal Polyps Using Cumulative Sum Analysis". Gastrointestinal Endoscopy 85, n. 5 (maggio 2017): AB193. http://dx.doi.org/10.1016/j.gie.2017.03.424.
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Pedersen, Rikke Nørgaard, Buket Öztürk Esen, Lene Mellemkjær, Peer Christiansen, Bent Ejlertsen, Timothy Lee Lash, Mette Nørgaard e Deirdre Cronin-Fenton. "The Incidence of Breast Cancer Recurrence 10-32 Years After Primary Diagnosis". JNCI: Journal of the National Cancer Institute 114, n. 3 (8 novembre 2021): 391–99. http://dx.doi.org/10.1093/jnci/djab202.
Abstract (sommario):
Abstract Background Extended, more effective breast cancer treatments have increased the prevalence of long-term survivors. We investigated the risk of late breast cancer recurrence (BCR), 10 years or more after primary diagnosis, and associations between patient and tumor characteristics at primary diagnosis and late BCR up to 32 years after primary breast cancer diagnosis. Methods Using the Danish Breast Cancer Group clinical database, we identified all women with an incident early breast cancer diagnosed during 1987-2004. We restricted to women who survived 10 years without a recurrence or second cancer (10-year disease-free survivors) and followed them from 10 years after breast cancer diagnosis date until late recurrence, death, emigration, second cancer, or December 31, 2018. We calculated incidence rates per 1000 person-years and cumulative incidences for late BCR, stratifying by patient and tumor characteristics. Using Cox regression, we calculated adjusted hazard ratios for late BCR accounting for competing risks. Results Among 36 924 women with breast cancer, 20 315 became 10-year disease-free survivors. Of these, 2595 developed late BCR (incidence rate = 15.53 per 1000 person-years, 95% confidence interval = 14.94 to 16.14; cumulative incidence = 16.6%, 95% confidence interval = 15.8% to 17.5%) from year 10 to 32 after primary diagnosis. Tumor size larger than 20 mm, lymph node–positive disease, and estrogen receptor–positive tumors were associated with increased cumulative incidences and hazards for late BCR. Conclusions Recurrences continued to occur up to 32 years after primary diagnosis. Women with high lymph node burden, large tumor size, and estrogen receptor–positive tumors had increased risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches.
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Kornfeld, D., A. Ekbom e T. Ihre. "Is there an excess risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based study". Gut 41, n. 4 (1 ottobre 1997): 522–25. http://dx.doi.org/10.1136/gut.41.4.522.
Abstract (sommario):
Background—Patients with ulcerative colitis have an increased risk of colorectal cancer. Duration, age, and extent of the disease at diagnosis are the only established risk factors. Patients with ulcerative colitis and concomitant primary sclerosing cholangitis (PSC) have been reported to have a higher frequency of colonic DNA aneuploidy and/or dysplasia than expected, findings indicating an increased risk of colorectal cancer compared with other patients with ulcerative colitis.Methods—A population based cohort consisting of 125 patients with a verified diagnosis of PSC was followed up by linkage to the Swedish Cancer Registry for the occurrence of colorectal cancer.Results—There were 12 colorectal cancers. Six cancers were diagnosed prior to the diagnosis of PSC. Among the 104 patients with an intact colon at the time of the diagnosis of PSC there was a cumulative risk for colorectal cancer of 16% after 10 years. Among the 58 patients with a diagnosis of ulcerative colitis and colorectal cancer prior to the diagnosis of PSC, there were five colorectal cancers corresponding to a cumulative risk of 25% after 10 years.Conclusions—Patients with ulcerative colitis and concomitant PSC seem to constitute a subgroup with a high risk for colorectal cancer.
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Goddard, Laura, Mirjam Kaestli, Enes Makalic e Anna P. Ralph. "Outcomes of possible and probable rheumatic fever: A cohort study using northern Australian register data, 2013–2019". PLOS Global Public Health 4, n. 1 (3 gennaio 2024): e0002064. http://dx.doi.org/10.1371/journal.pgph.0002064.
Abstract (sommario):
In Australia, there is a high burden of acute rheumatic fever (ARF) among Aboriginal and Torres Strait Islander peoples. Clinical diagnostic criteria can result in a diagnosis of ‘definite’, ‘probable’ or ‘possible’ ARF and outcomes range from recovery to severe rheumatic heart disease (RHD). We compared outcomes by ARF diagnosis, where the main outcome was defined as disease progression from: possible to probable ARF, definite ARF or RHD; probable to definite ARF or RHD; or definite ARF to definite ARF recurrence or RHD. Data were extracted from the Northern Territory RHD register for Indigenous Australians with an initial diagnosis of ARF during the 5.5-year study period (01/01/2013–30/06/2019). Descriptive statistics were used to describe cohort characteristics, probability of survival, and cumulative incidence risk of disease progression. Cox proportional hazards regression was used to determine whether time to disease progression differed according to ARF diagnosis. Sub-analyses on RHD outcome, clinical manifestations, and antibiotic adherence were also performed. In total there were 913 cases with an initial ARF diagnosis. Of these, 92 (13%) experienced disease progression. The probability of disease progression significantly differed between ARF diagnoses (p = 0.0043; log rank test). Cumulative incidence risk of disease progression at 5.5 years was 33.6% (95% CI 23.6–46.2) for definite, 13.5% (95% CI 8.8–20.6) for probable and 11.4% (95% CI 6.0–21.3) for possible ARF. Disease progression was 2.19 times more likely in those with definite ARF than those with possible ARF (p = 0.026). Progression to RHD was reported in 52/732 (7%) of ARF cases with normal baseline echocardiography. There was a significantly higher risk of progression from no RHD to RHD if the initial diagnosis was definite compared to possible ARF (p<0.001). These data provide a useful way to stratify risk and guide prognosis for people diagnosed with ARF and can help inform practice.
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Nelson, Tyler J., Margaret F. Meagher, Austin Leonard, Isabella Dolendo, Leah N. Deshler, Kylie M. Morgan, Elizabeth A. Duran et al. "Impact of chemotherapy on anxiety, depression, and suicidality amongst testicular cancer survivors." Journal of Clinical Oncology 41, n. 6_suppl (20 febbraio 2023): 418. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.418.
Abstract (sommario):
418 Background: Chemotherapy for testicular cancer (TC) is highly effective yet associated with significant consequences on long-term health-related quality of life. We evaluate the impact of chemotherapy on anxiety, depression, and suicidality amongst TC survivors. Methods: We conducted a retrospective cohort study of US veterans diagnosed with TC in the Veterans Health Affairs database from 1990-2016. Patients with non-primary germ cell tumor histologies were excluded. Baseline disease characteristics and treatment received were ascertained from the VA Central Cancer Registry. Anxiety or depression was a composite endpoint comprised of diagnosis codes for anxiety, depression, or administration of medications used to treat these diagnoses. Incident suicidality was defined as a diagnosis code for suicidal ideation. Time to event was defined as time from diagnosis to event or censor at the time of last follow-up. Rates of outcomes were reported through cumulative incidences. Associations with outcomes and receipt of chemotherapy were assessed through multivariable Cox regression models. Results: In total, 1684 patients (1174 seminoma, 510 nonseminoma) were included in the cohort. Median age at diagnosis in the cohort was 40 years old. Median follow up time was 7.67 years for surviving patients. 1506 (89.4%) patients were white, 114 (6.8%) were African American, and 64 (3.8%) were another or unknown race. There were 1066 (63.3%) stage I patients, 191 (11.3%) stage II, 198 (11.8%) stage III, and 229 (13.6%) unknown stage patients. 579 (34.4%) patients received chemotherapy. At the time of diagnosis, 104 (6.2%) patients already experienced anxiety or depression. At 10 years, cumulative incidence of the diagnosis of anxiety or depression as 44.1% in the entire cohort. At 10 years, cumulative incidence of the diagnosis of suicidality was 5.5%. On multivariable Cox regression, factors associated with a higher risk of anxiety or depression were older age at diagnosis (Hazard Ratio (HR): 1.11 per standard deviation increase, p=0.01), being unemployed (HR: 1.25, p=0.01), and receipt of chemotherapy (HR: 1.43, p<0.001). Race, stage, alcohol or tobacco use and seminoma type were nonsignificant. Factors associated with increased risks of suicidality were being unemployed (HR: 2.00, p=0.01) and not being married (HR: 2.50, p=0.001). Stage, age, race, alcohol and tobacco use, seminoma type, and receipt of chemotherapy were not significantly associated with suicidality. Conclusions: Psychosocial morbidity is high among TC survivors. Despite being effective and necessary for maintaining excellent oncologic outcomes, chemotherapy appears to increase the rates of psychosocial morbidity. Socioeconomic risk factors, including employment and marriage, may also impact psychosocial health. Clinicians should be proactive in identifying support systems for TC survivors.
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de Blank, Peter, Katharine R. Lange, Mengqi Xing, Sedigheh Mirzaei Salehabadi, Deokumar Srivastava, Tara M. Brinkman, Kirsten K. Ness et al. "Late mortality and morbidity among adult survivors of childhood glioma treated over three decades: A report from the Childhood Cancer Survivor Study." Journal of Clinical Oncology 40, n. 16_suppl (1 giugno 2022): 10007. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.10007.
Abstract (sommario):
10007 Background: Therapy for pediatric low-grade glioma has evolved to delay or eliminate the need for cranial radiation. The impact of this change in approach on long-term outcomes remains unknown. Methods: Cumulative incidence of late mortality (death ≥5 years from diagnosis), subsequent neoplasms (SNs), and chronic health conditions (CHCs, graded using CTCAE criteria) were evaluated in the Childhood Cancer Survivor Study among 5-year survivors of glioma diagnosed between 1970 and 1999. Outcomes were evaluated by diagnosis decade (1970s, 1980s, 1990s) and by treatment exposure in the first five years from diagnosis [surgery only, chemotherapy (with or without surgery), and cranial radiation (with or without surgery or chemotherapy)]. Relative Risk (RRs) with 95% CIs estimated long-term outcomes using multivariable piecewise exponential models. Results: Among 2,684 eligible survivors (median age at diagnosis, 7 years [range, 0 to 20 years]; median time from diagnosis, 24 years [range, 5 to 48 years]), the proportion exposed to cranial radiation decreased from 51% (1970s) to 45% (1980s) and 25% (1990s) while the rate of recurrence within > 5 years but ≤15 years of diagnosis decreased from 9.8% (1970s) to 8.8% (1980s) and 5.0% (1990s). The 15-year cumulative incidence rate of all-cause late mortality was 10.3% (1970s), 6.5% (1980s), and 6.0% (1990s) (p < 0.001, comparison of cumulative incidence curves). The 15-year cumulative incidence rates of severe, disabling or life-threatening (grade 3-5) CHCs also decreased between 1970 and 1999: 19.7% (1970s), 17.8% (1980s), and 14.2% (1990s) (p < 0.0001). Lower rates of SN were not observed. In a multivariable analysis adjusted for age at diagnosis, attained age, race, sex and diagnosis decade, later diagnosis (1990s vs. 1970s) was associated with lower risk of late mortality (RR 0.86, 95% CI 0.74-0.99), grade 3-5 CHCs (RR 0.65, 95% CI 0.51-0.82) and SN (RR 0.64, 95% CI 0.44-0.94). In addition, when treatment exposure was added to the multivariable model, the effect of diagnosis decade was attenuated and no longer significant. Exposure to radiation or chemotherapy both increased risk compared to surgery alone: all-cause mortality (radiation RR 4.95, 95% CI 3.79-6.47; chemotherapy RR 2.88, 95% CI 1.85-4.48), grade 3-5 CHCs (radiation RR 4.02, 95% CI 3.28-4.94; chemotherapy RR 1.66, 95% CI 1.13-2.45), SNs (radiation RR 4.02, 95% CI 3.06-6.13, chemotherapy RR 2.08, 95% CI 1.03-4.23)). The effect of delayed radiation (> 1year to ≤5 years from diagnosis) on all-cause late mortality, grade 3-5 CHCs, or SNs was not different compared to radiation within one year of diagnosis. Conclusions: Late mortality and CHCs decreased in childhood glioma survivors diagnosed from 1970-1999 largely due to therapy changes, particularly avoidance of cranial radiation, without increased late recurrence.
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Yancheva, Nina, Dimitar Strashimirov, Dragomir Dardanov, Bojidar Kamenov e Atanas Radinoff. "Case of Non-Langerhans Cell Histiocytosis in a Person Living with HIV - Clinical and Therapeutic Challenge". Journal of the International Association of Providers of AIDS Care (JIAPAC) 21 (gennaio 2022): 232595822211095. http://dx.doi.org/10.1177/23259582221109567.
Abstract (sommario):
Non-Langerhans cell histiocytosis is a rare disease which seldom affects adults. We report a case of a 32-year-old Bulgarian woman living with HIV. She developed severe anemia, extreme splenomegaly, requiring splenectomy and vertebral tumor formations leading to fracture. The diagnosis was confirmed by histological examination of the spleen, but subsequently questioned and a cumulative disease was discussed. After genetic testing, a cumulative disease was ruled out and the condition was determined to be Non-Langerhans cell histiocytosis. According to literature data, the disease has a high mortality rate. However, in our case, we should also note that there was a delay in diagnosis by several months due to difficulties in the clarification of the hematological disorder.
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Poh, Christina, Ann M. Brunson, Theresa H. M. Keegan, Ted Wun e Anjlee Mahajan. "Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Non-Hodgkin's Lymphoma: Analysis of the California Cancer Registry". Blood 134, Supplement_1 (13 novembre 2019): 932. http://dx.doi.org/10.1182/blood-2019-124249.
Abstract (sommario):
Background Venous thromboembolism (VTE) is a known complication in patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and non-Hodgkin's lymphoma (NHL). However, the cumulative incidence, risk factors, rate of subsequent VTE and impact on mortality of upper extremity deep vein thrombosis (UE DVT) in these diseases is not well-described. Methods Using the California Cancer Registry, we identified patients with a first primary diagnosis of AML, ALL and NHL from 2005-2014 and linked these patients with the statewide hospitalization and emergency department databases to identify an incident UE DVT event using specific ICD-9-CM codes. Patients with VTE prior to or at the time of malignancy diagnosis or who were not treated with chemotherapy were excluded. We determined the cumulative incidence of first UE DVT, adjusted for the competing risk of death. We also examined the cumulative incidence of subsequent VTE (UE DVT, lower extremity deep vein thrombosis (LE DVT) and pulmonary embolism (PE)) and major bleeding after incident UE DVT. Using Cox proportional hazards regression models, stratified by tumor type and adjusted for other prognostic covariates including sex, race/ethnicity, age at diagnosis, neighborhood, sociodemographic status and central venous catheter (CVC) placement, we identified risk factors for development of incident UE DVT, the effect of incident UE DVT on PE and/or LE DVT development, and impact of incident UE DVT on cancer specific survival. The association of CVC placement with incident UE DVT was not assessed in acute leukemia patients, as all who undergo treatment were assumed to have a CVC. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results Among 37,282 patients included in this analysis, 6,213 had AML, 3,730 had ALL and 27,339 had NHL. The 3- and 12-month cumulative incidence of UE DVT was 2.6% and 3.6% for AML, 2.1% and 3% for ALL and 1.0% and 1.6% for NHL respectively (Figure 1A). Most (56-64%) incident UE DVT events occurred within the first 3 months of malignancy diagnosis. African Americans (HR 1.66; CI 1.22-2.28) and Hispanics (HR 1.35; CI 1.10-1.66) with NHL had an increased risk of incident UE DVT compared to non-Hispanics Whites. NHL patients with a CVC had over a 2-fold increased risk of incident UE DVT (HR 2.05; CI 1.68-2.51) compared to those without a CVC. UE DVT was a risk factor for development of PE or LE DVT in ALL (HR 2.53; CI 1.29-4.95) and NHL (HR 1.63; CI 1.11-2.39) but not in AML. The 12-month cumulative incidence of subsequent VTE after an incident UE DVT diagnosis was 6.4% for AML, 12.0% for ALL and 7.6% for NHL. 46-58% of subsequent VTEs occurred within the first 3 months of incident UE DVT diagnosis. The majority of subsequent VTEs were UE DVT which had a 12-month cumulative incidence of 4.6% for AML, 6.6% for ALL and 4.0% for NHL (Figure 1B). The 12-month cumulative incidence of subsequent LE DVT was 1.3% for AML, 1.6% for ALL and 1.9% for NHL (Figure 1C). The 12-month cumulative incidence of subsequent PE was 0.4% for AML, 4.1% for ALL and 1.8% for NHL (Figure 1D). The 12-month cumulative incidence of major bleeding after an UE DVT diagnosis was 29% for AML, 29% for ALL and 20% for NHL. Common major bleeding events included gastrointestinal (GI) bleeds, epistaxis and intracranial hemorrhage. GI bleeding was the most common major bleeding event among all three malignancies (14.2% in AML, 9.6% in ALL and 12.4% in NHL). The rate of intracranial hemorrhage was 6% in AML, 3.5% in ALL and 1.7% in NHL. A diagnosis of incident UE DVT was associated with an increased risk of cancer-specific mortality in all three malignancies (HR 1.38; CI 1.16-1.65 in AML, HR 2.16; CI 1.66-2.82 in ALL, HR 2.38; CI 2.06-2.75 in NHL). Conclusions UE DVT is an important complication among patients with AML, ALL and NHL, with the majority of UE DVT events occurring within the first 3 months of diagnosis. The most common VTE event after an index UE DVT was another UE DVT, although patients also had subsequent PE and LE DVT. UE DVT was a risk factor for development of PE or LE DVT in ALL and NHL, but not in AML. Major bleeding after an UE DVT was high in all three malignancies (>20%), with GI bleeds being the most common. UE DVT in patients with AML, ALL and NHL is associated with increased risk of mortality. Disclosures Wun: Janssen: Other: Steering committee; Pfizer: Other: Steering committee.
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Shivashankar, Raina, Edward V. Loftus, William J. Tremaine, W. Scott Harmsen, Alan R. Zinsmeister e Eric L. Matteson. "Incidence of Spondyloarthropathy in Patients with Ulcerative Colitis: A Population-based Study". Journal of Rheumatology 40, n. 7 (15 maggio 2013): 1153–57. http://dx.doi.org/10.3899/jrheum.121029.
Abstract (sommario):
Objective.Spondyloarthritis (SpA) is an important extraintestinal manifestation of inflammatory bowel disease (IBD). We assessed the cumulative incidence and clinical spectrum of SpA in a population-based cohort of patients with ulcerative colitis (UC).Methods.The medical records of a population-based cohort of residents of Olmsted County, Minnesota, USA, diagnosed with UC from 1970 through 2004 were reviewed. Patients were followed longitudinally until moving from Olmsted County, death, or June 30, 2011. We used the European Spondylarthropathy Study Group, Assessment of Spondyloarthritis International Society (ASAS) criteria, and modified New York criteria to identify patients with SpA.Results.The cohort included 365 patients with UC, of whom 41.9% were women. The median age at diagnosis of UC was 38.6 years (range 1.2–91.4). Forty patients developed SpA based on the ASAS criteria. The cumulative incidence of a diagnosis of SpA after an established diagnosis of UC was 4.8% at 10 years (95% CI 95% CI 2.2%–7.3%), 13.7% at 20 years (95% CI 9.0%–18.1%), and 22.1% at 30 years (95% CI 4.3%–29.1%).Conclusion.The cumulative incidence of all forms of SpA increased to about 22% by 30 years from UC diagnosis. This value is slightly greater than what we previously described in a population-based cohort of Crohn disease diagnosed in Olmsted County over the same time period. SpA and its features are associated with UC, and heightened awareness on the part of clinicians is needed for diagnosing and managing them.
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Chourghal, N., H. Belguerri, K. Maamri, F. Bahlouli, A. Salamani e M. Benaini. "Diagnosis of the rainfall-wheat yield relationship in the current and future climate change conditions in Eastern Algeria". Biosystems Diversity 31, n. 2 (2 maggio 2023): 158–62. http://dx.doi.org/10.15421/012316.
Abstract (sommario):
Future projections indicate that rain-fed agriculture in North Africa is among the most vulnerable in the world in the context of future climate change. This article aims to diagnose the relationship between rainfall and wheat yield in both current and future climatic situations in a semi arid agro-climatic conditions represented by the region of Bordj Bou Arreridj. For the current situation, we used 15 years (1995–2009) of recorded rainfall and durum wheat yield series. Future rainfall projections (2071–2100) were generated by the MED-CORDEX climate model version CCLM4-8-19 under RCP 6.0 scenario. Simulated data over the observed period and that of the future on the maximum evapotranspiration (ETM) of durum wheat and the water deficit (WD) accumulated over the cycle as well as future yields are obtained using a simple agro meteorological crop simulation model, previously validated. In both current and future situations, precipitations, ETM, WD and yields data are first analyzed, then yields are related by regression to three components of rainfall: annual rainfall, cumulative rainfall over the crop cycle (November–June) and cumulative rainfall during spring (March–May). In the observed climate, annual precipitation averages 382.3 ± 96.3 mm, cumulative rainfall over the crop cycle (November–June) averages 278.3 mm and cumulative rainfall during spring is 101.9 mm. These last decrease to 303.7 ± 99.4, 232.3 and 83.3 mm in the future situation. Observed yields (1995–2009) averages1.9 ± 0.64 q/ha in the observed situation and decrease to 15.5 ± 0.54 q/ha in future climate. ETM are low and WD values are high in the current climate, with a worsening of the situation in the future climate, particularly during spring. The correlation between yields and précitations is always positive in both weather conditions, but the best R2 are 0.65 and 0.82 and concern spring rains. In semi-arid regions, cumulative rainfall towards the end of the growing season is currently impacting the grain yield of durum wheat and will become more decisive in the context of future climate change.
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Zhang, Michael, Ann Lazar, Jason Chan, Chelsea Xu, August Anderson, Javier Villanueva-Meyer, Mike McDermott et al. "CMET-35. COMPETING RISKS ANALYSIS OF FACTORS INFLUENCING DEVELOPMENT OF LEPTOMENINGEAL METASTASIS IN BREAST CANCER PATIENTS RECEIVING STEREOTACTIC RADIOSURGERY FOR LIMITED BRAIN METASTASES". Neuro-Oncology 21, Supplement_6 (novembre 2019): vi59. http://dx.doi.org/10.1093/neuonc/noz175.236.
Abstract (sommario):
Abstract Leptomeningeal metastasis (LM) is a late stage manifestation of advanced breast cancer frequently managed with whole brain radiotherapy (WBRT) and/or intrathecal chemotherapy. A subset of breast cancer patients who undergo stereotactic radiosurgery (SRS) for limited brain metastases (BM) ultimately develop LM. We hypothesized that this subset of high-risk patients may be identified by patient, disease, and/or treatment parameters. Clinical records from 133 breast cancer patients from a single institution who underwent SRS for BM between February 2010 and March 2018 were retrospectively analyzed. Variables including histopathology, BM features, systemic disease burden, and prior treatments were analyzed. Cumulative incidence rates were estimated with death as a competing risk. Dichotomous variable cutoffs were based on the 75th percentile value. In our cohort, 27 (20.3%) patients ultimately developed LM. With a median follow up of 21.2 months after diagnosis of BM, the actuarial rate of LM at 24 months was 15.2% (95% CI, 8.7%-21.7%). Median OS after diagnosis of LM was 7.0 (95% CI, 3.1–15.4) months. There was significantly increased risk of LM with ≥9 vs < 9 BM at BM diagnosis (28.1% vs 10.8% [24-month actuarial risk], subdistribution HR 2.4, p=0.027), and ≥11 vs < 11 cumulative number of BM treated (25.7% vs 11.7% [24-month actuarial risk], subdistribution HR 2.7, p=0.01). Variables not significantly associated with the risk of LM included tumor receptor status (ER, PR, HER2, triple negative), graded prognostic assessment, KPS, extracranial metastases, total BM volume, prior WBRT, or prior surgical resection. Time intervals between SRS treatments immediately preceding LM diagnosis was not significantly different from other time intervals. In conclusion, patients with a larger number of brain metastases at BM diagnosis (≥9) or cumulatively treated (≥11) appear to be at higher risk of developing LM and may benefit from stronger consideration of WBRT, intrathecal chemotherapy, and/or brain-penetrating systemic therapy.
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Lipshultz, Steven E., Stuart R. Lipsitz, Stephen E. Sallan, Virginia M. Dalton, Suzanne M. Mone, Richard D. Gelber e Steven D. Colan. "Chronic Progressive Cardiac Dysfunction Years After Doxorubicin Therapy for Childhood Acute Lymphoblastic Leukemia". Journal of Clinical Oncology 23, n. 12 (20 aprile 2005): 2629–36. http://dx.doi.org/10.1200/jco.2005.12.121.
Abstract (sommario):
Purpose Cross-sectional studies show that cardiac abnormalities are common in long-term survivors of doxorubicin-treated childhood malignancies. Longitudinal data, however, are rare. Methods Serial echocardiograms (N = 499) were obtained from 115 doxorubicin-treated long-term survivors of childhood acute lymphoblastic leukemia (median age at diagnosis, 4.8 years; median follow-up after completion of doxorubicin, 11.8 years). Results were expressed as z scores to indicate the number of standard deviations (SDs) above (+) or below (−) the normal predicted value. Median individual and cumulative doxorubicin doses were 30 mg/m2 per dose and 352 mg/m2, respectively. Results Left ventricular fractional shortening was significantly reduced after doxorubicin therapy, and the reduction was related to cumulative dose. z scores for fractional shortening transiently improved before falling to −2.76 more than 12 years after diagnosis. Reduced fractional shortening was related to impaired contractility and increasing afterload, consequences of a progressive reduction of ventricular mass, and wall thickness relative to body-surface area. Left ventricular contractility fell significantly over time and was depressed at last follow-up in patients receiving more than 300 mg/m2 of doxorubicin. Systolic and diastolic blood pressures were below normal more than 9 years after diagnosis. Even patients receiving lower cumulative doxorubicin doses experienced reduced mass and dimension. Fractional shortening and dimension at the end of therapy predicted these parameters 11.8 years later. Conclusion Cardiac abnormalities were persistent and progressive after doxorubicin therapy. Inadequate ventricular mass with chronic afterload excess was associated with progressive contractile deficit and possibly reduced cardiac output and restrictive cardiomyopathy. The deficits were worst after highest cumulative doses of doxorubicin, but appeared even after low doses.
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Lei, Xiudong, Shaheenah S. Dawood, Constance T. Albarracin, Rebecca Dent, Sudeep Gupta, Javier Cortes, Elizabeth Ann Mittendorf, Thomas A. Buchholz e Ana M. Gonzalez-Angulo. "Incidence and characteristics of breast cancer following a diagnosis of ductal carcinoma in situ." Journal of Clinical Oncology 31, n. 15_suppl (20 maggio 2013): 1131. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.1131.
Abstract (sommario):
1131 Background: Recent data indicate that the incidence of DCIS is rising. The purpose of this retrospective population based study was to examine incidence of and factors that contribute to the development of a subsequent breast primary. Methods: Using the SEER registry we identified female pts with a primary DCIS diagnosed between 1990 to 2005. Pts who had an invasive or in situ malignancy diagnosed prior to a diagnosis of DCIS were excluded. Cumulative incidence of a subsequent breast primary (invasive/non invasive) was estimated and compared across groups using the Chi-square test. Multivariable logistic regression models were then fitted to determine factors that could predict for the development of a subsequent breast primary. Results: 96,130 pts were identified of whom 14,573 (15.2%) had subsequent primaries. 9,037 (62%) pts had a subsequent primary in the breast of which 5,915 (65.5%) pts had an invasive breast cancer. Among pts who developed an invasive breast cancer 68% had hormone receptor positive disease, 59% had grade I/II disease and 80% had stage I/II disease. 2 and 5-year cumulative incidence of developing a subsequent breast primary was 3.2% and 5.9% respectively. 2 and 5-year cumulative incidence of developing a subsequent invasive breast primary was 1.6% and 3.4% respectively. 5-year cumulative incidence of developing a subsequent breast primary among pts who were of white, black and other race was 5.8%, 6.8% and 6.1% respectively (P<0.001). In the multivariable logistic model the probability of developing a subsequent breast primary decreased with each increasing year of diagnosis of DCIS (OR 0.91, 95%CI 0.91-0.92, p<0.001). Other factors that predicted for the development of a subsequent breast primary included younger age at diagnosis, non-white race and lack of surgical or radiation therapy for DCIS. Conclusions: Our results indicate that a significant proportion of pts with a diagnosis of DCIS go on to develop invasive breast cancer and may warrant further investigation to determine biological risk factors, appropriate screening procedures and possible interventions to decrease incidence. Target groups that may benefit include pts who are young and of non white race at the time of diagnosis of DCIS.
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Vrzic-Petronijevic, S., I. Likic-Ladjevic, M. Petronijevic, R. Argirovic e N. N. Ladjevic. "Diagnosis and surgical therapy of uterine sarkoma". Acta chirurgica Iugoslavica 53, n. 3 (2006): 67–72. http://dx.doi.org/10.2298/aci0603067v.
Abstract (sommario):
Introduction: Uterine sarcomas are rare gynecological neoplasms and their classification is complicated. Uterine sarcoma is usually diagnosed in postmenopausal women and the diagnosis is often accidental and postoperative. Aim of this study was to present clinical and pathological characteristics of uterine sarcomas, diagnostic procedures, treatment and two-, three- and five-years cumulative survival rates. Materials and methods: The retrospective study of 61 cases of uterine sarcomas was conducted. Cases were distributed into groups based on definitive diagnosis of uterine sarcoma: group of leiomyosarcomas (LMS), carcinosarcoma (CS), endometrial stromal sarcomas (ESS), adenosarcomas (AS) and other rare uterine sarcomas. We investigated patients with clinical and pathological characteristics of uterine sarcomas, diagnostic procedures and treatment. Survival rate was calculated by Kaplan-Meier method. Results: From 61 patients 43 patients (70.49%) were postmenopausal. Mean period from menopause until appearance of symptoms was 14,63 years. One or more risk factors were present in 46 (75.4%) patients. Diagnosis of uterine sarcoma were established averagely 7.38 months after appearance of symptoms. 50 patients (82.0%) underwent one or more diagnostic procedures. Preoperative diagnosis of uterine sarcoma was established in 42.5% of patients. 53 (86.9%) of patients were treated operatively. The most used operative procedure (60,7%) was total hysterectomy with bilateral salpingooophorectomy. Postoperative pathohistologic analysis showed that low grade (LG) leiomyosarcoma were present in 19 (35.9%) cases, high grade (HG) leiomyosarcoma in 1 (1.9%) case, carcinosarcoma in 14 (26.4%) cases, low grade (LG) endometrial stromal sarcoma in 5 (9.4%) cases, high grade (HG) endometrial stromal sarcoma in 9 (17.0%) cases, adenosarcoma in 2 (3.8%) cases, and 2 cases of rare uterine sarcomas: 1 (1.9%) MALT HG lymphoma and 1(1.9%) malignant hemangiopericytoma. In one case of ESS (1.9%) only adenomyosis was found postoperatively suggesting that the whole tumour was removed during diagnostic procedure. Eight patients were not treated operatively. Two-years cumulative survival rate was 74.3%, three-years cumulative survival rate was 71.1%, and five years survival rate was 64.3%. Discussion: Average age, percent of postmenopausal patients and the mean age at the time of menopause in our studied correlate with current data. Clinical presentation of uterine sarcoma is associated with obesity and hypertension in more than 30% of cases, which is approved in our study. For early diagnostics it is important to notice that risk factors are similar to those connected with far more frequent endometrial carcinoma. Postmenopausal abnormal bleeding was the main reason for medical examination, explaining relatively short period for establishing the diagnosis in this group of patients. The variety of clinical findings in our studied group showed that the diagnosis must be based on preoperative pathohistology. Conclusion: Adequate diagnosis and treatment of uterine sarcoma is possible with regular yearly or more frequent follow-up, especially in postmenopausal women with known risk factors present. We need special attention for unclear symptoms and postmenopausal bleeding and we need to use all diagnostic procedures soon as possible including preoperative histology because early metastases are characteristic for uterine sarcomas. Factor of the most important predictive value is histologic grade. .
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Van Lierop, L., M. E. W. Derks, M. te Groen, C. D. Tran, E. Lytvyak, G. Dijkstra, A. J. Montano-Loza e F. Hoentjen. "P188 Cumulative inflammatory burden as a risk factor for colorectal neoplasia in inflammatory bowel disease patients with primary sclerosing cholangitis: a multi-center case-control study". Journal of Crohn's and Colitis 18, Supplement_1 (1 gennaio 2024): i499. http://dx.doi.org/10.1093/ecco-jcc/jjad212.0318.
Abstract (sommario):
Abstract Background Inflammatory bowel disease (IBD) patients with concomitant primary sclerosing cholangitis (PSC-IBD) have a 25-year cumulative risk of up to 50% to develop colorectal neoplasia (CRN). Mucosal inflammation is an important driver of CRN, but it is unknown whether this also applies to PSC-IBD patients. We aimed to assess the impact of chronic mucosal inflammation per colonic segment on CRN risk in PSC-IBD patients. Methods This is a multi-center case-control study including cases with PSC-IBD and CRN and controls with PSC-IBD without CRN. Subjects were included from 8 medical centers in Canada and the Netherlands. Exclusion criteria were a CRN diagnosis prior to IBD or PSC diagnosis, familial CRC syndromes, and <2 available colonoscopy reports. Data was collected on demographics, IBD and PSC disease characteristics, CRN lesions, and endoscopy reports between 1977 and 2023. Pan-colonic and segmental (right colon, transverse colon, left colon, rectum) endoscopic cumulative inflammatory burden scores were calculated as the sum of (mean) endoscopic inflammation severity between colonoscopies x length of the surveillance interval until index procedure. The index procedure was the colonoscopy during which CRN was detected (cases) or randomly selected and matched for disease duration (controls). The primary outcome was a CRN diagnosis, secondary outcomes were CRN grade and location, time to CRN (Kaplan-Meier curve), pan-colonic cumulative inflammatory burden, cumulative inflammatory burden per colonic segment harboring CRN, and colonic surgery. Results We included 335 PSC-IBD patients (224 UC, 101 CD) with a median follow-up of 8 years (IQR: 5.0-14.0) and 6 endoscopies (IQR: 4.0-8.0). Median disease duration was 19.5 years for IBD (IQR: 11.0-26.0) and 13 years for PSC (IQR: 7.0-19.0). Advanced neoplasia (HGD or CRC) was found in 35 out of 102 cases (34%). Fifty-six (55%) cases were diagnosed with > 1 lesion, and 43 (42%) had ≥ 1 right-sided lesion. Median time to index CRN was 17 years (IQR: 8.0-24.0). Sixty-six patients underwent (sub)total colectomy or proctocolectomy, including 49 (74%) due to CRN diagnosis. There was no difference in pan-colonic cumulative inflammatory burden scores (mean scores: 4.7 (cases) and 3.7 (controls); P=0.21, 95%-CI: -2.52-.56) and segmental scores (mean scores: 4.9 (cases) and 4.1 (controls); P=0.27, 95%-CI: -2.29-.65) between cases and controls. Mortality was 13% (n=45.) Conclusion In this large multi-center cohort study, the risk for CRN-associated colectomy in PSC-IBD was high, while pan-colonic and segmental cumulative inflammatory burden scores were not associated with CRN risk.
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Poh, Christina, Ann Brunson, Theresa Keegan, Ted Wun e Anjlee Mahajan. "Incidence of Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Effect on Mortality". TH Open 04, n. 04 (ottobre 2020): e309-e317. http://dx.doi.org/10.1055/s-0040-1718883.
Abstract (sommario):
AbstractThe cumulative incidence, risk factors, rate of subsequent venous thromboembolism (VTE) and bleeding and impact on mortality of isolated upper extremity deep vein thrombosis (UE DVT) in acute leukemia are not well-described. The California Cancer Registry, used to identify treated patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) diagnosed between 2009 and 2014, was linked with the statewide hospitalization database to determine cumulative incidences of UE DVT and subsequent VTE and bleeding after UE DVT diagnosis. Cox proportional hazards regression models were used to assess the association of UE DVT on the risk of subsequent pulmonary embolism (PE) or lower extremity deep vein thrombosis (LE DVT) and subsequent bleeding, and the impact of UE DVT on mortality. There were 5,072 patients identified: 3,252 had AML and 1,820 had ALL. Three- and 12-month cumulative incidences of UE DVT were 4.8% (95% confidence interval [CI]: 4.1–5.6) and 6.6% (95% CI: 5.8–7.5) for AML and 4.1% (95% CI: 3.2–5.1) and 5.9% (95% CI: 4.9–7.1) for ALL, respectively. Twelve-month cumulative incidences of subsequent VTE after an incident UE DVT diagnosis were 5.3% for AML and 12.2% for ALL. Twelve-month cumulative incidences of subsequent bleeding after an incident UE DVT diagnosis were 15.4% for AML and 21.1% for ALL. UE DVT was associated with an increased risk of subsequent bleeding for both AML (hazard ratio [HR]: 2.07; 95% CI: 1.60–2.68) and ALL (HR: 1.62; 95% CI: 1.02–2.57) but was not an independent risk factor for subsequent PE or LE DVT for either leukemia subtype. Isolated incident UE DVT was associated with increased leukemia-specific mortality for AML (HR: 1.42; 95% CI: 1.16–1.73) and ALL (HR: 1.80; 95% CI: 1.31–2.47). UE DVT is a relatively common complication among patients with AML and ALL and has a significant impact on bleeding and mortality. Further research is needed to determine appropriate therapy for this high-risk population.
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Stanic, Karmen, Matjaz Zwitter, Nina Turnsek Hitij, Izidor Kern, Aleksander Sadikov e Tanja Cufer. "Brain metastases in lung adenocarcinoma: impact of EGFR mutation status on incidence and survival". Radiology and Oncology 48, n. 2 (1 giugno 2014): 173–83. http://dx.doi.org/10.2478/raon-2014-0016.
Abstract (sommario):
AbstractBackground. The brain represents a frequent progression site in lung adenocarcinoma. This study was designed to analyse the association between the epidermal growth factor receptor (EGFR) mutation status and the frequency of brain metastases (BM) and survival in routine clinical practice.Patients and methods. We retrospectively analysed the medical records of 629 patients with adenocarcinoma in Slovenia who were tested for EGFR mutations in order to analyse the cumulative incidence of BM, the time from the diagnosis to the development of BM (TDBM), the time from BM to death (TTD) and the median survival.Results. Out of 629 patients, 168 (27%) had BM, 90 patients already at the time of diagnosis. Additional 78 patients developed BM after a median interval of 14.3 months; 25.8 months in EGFR positive and 11.8 months in EGFR negative patients, respectively (p = 0.002). EGFR mutations were present in 47 (28%) patients with BM. The curves for cumulative incidence of BM in EGFR positive and negative patients demonstrate a trend for a higher incidence of BM in EGFR mutant patients at diagnosis (19% vs. 13%, p = 0.078), but no difference later during the course of the disease. The patients with BM at diagnosis had a statistically longer TTD (7.3 months) than patients who developed BM later (3.1 months). The TTD in EGFR positive patients with BM at diagnosis was longer than in EGFR negative patients (12.6 vs. 6.8, p = 0.005), while there was no impact of EGFR status on the TTD of patients who developed BM later.Conclusions. Except for a non-significant increase of frequency of BM at diagnosis in EGFR positive patients, EGFR status had no influence upon the cumulative incidence of BM. EGFR positive patients had a longer time to CNS progression. While EGFR positive patients with BM at diagnosis had a longer survival, EGFR status had no influence on TTD in patients who developed BM later during the course of disease.
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Azizova, T. V., M. B. Moseeva, E. S. Grigoryeva, G. V. Zhuntova, M. V. Bannikova, G. V. Sychugov e E. L. Kazachkov. "Registry of plutonium-induced lung fibrosis in a cohort of nuclear workers of the Mayak Production Association". "Radiation and Risk" Bulletin of the National Radiation and Epidemiological Registry 30, n. 3 (2021): 56–67. http://dx.doi.org/10.21870/0131-3878-2021-30-3-56-67.
Abstract (sommario):
The registry of plutonium-induced lung fibrosis cases (PuLF) diagnosed in members of a cohort of the first Russian nuclear industry facility Mayak Production Association was established in the clinical department of the Southern Urals Biophysics Institute of the Federal Medical-Biological Agency (SUBI). The registry includes 188 plutonium-induced lung fibrosis diagnoses: 117 (62.23%) in males and 71 (37.77%) in females. This paper describes the structure and detailed characteristics of the registry. The number of PuLF cases was shown to have no association with cumulative lung absorbed dose from external gamma rays as of the date of diagnosis. On the contrary, the PuLF rate was shown to be associated with cumulative lung absorbed dose from in-corporated alpha particles and to increase significantly with increasing dose from internal radia-tion exposure. This paper discusses potential applications of the registry to scientific investiga-tions in the future.
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Princic, Nicole, Xue Song, Vincent Lin e Ze Cong. "Healthcare Costs Associated with Adult Philadelphia Chromosome-Negative (Ph-) Acute Lymphoblastic Leukemia (ALL) in the US". Blood 128, n. 22 (2 dicembre 2016): 5940. http://dx.doi.org/10.1182/blood.v128.22.5940.5940.
Abstract (sommario):
Abstract Background: Ph- ALL in adults is a very rare disease with poor prognosis. Literature on the economic burden of Ph- ALL in adults is sparse. This study quantifies the economic burden by estimating the total healthcare costs of Ph- ALL in adults from initial diagnosis until relapse and from relapse until death from US payer's perspective. Methods: This is a retrospective, observational study using the MarketScan® Commercial Claims and Encounters (Commercial) database, which contains information on approximately 40 million employees and their dependents. Patients were included if they are newly diagnosed with ALL, defined by absence of ALL ICD-9-CM diagnosis (204.0x) 90 days prior the first ALL diagnosis, and have at least one inpatient claim with ALL diagnosis (204.0x) as the primary discharge diagnosis during the study period (4/1/2009-12/31/2014). Patients with less than 6 months of continuous enrollment prior to the index date were excluded. Patient with Ph+ disease (defined by the use of any prescriptions for tyrosine kinase inhibitors) were also excluded. Relapse ALL cases were defined by patients with records of relapse code (204.02). The admission date of the hospitalization with ALL primary discharge diagnosis was the index date. Patients were followed from the index date until death, loss of follow up, or end of the study period, whichever came first. Direct medical and pharmacy costs (plan reimbursed amounts) were the primary outcomes in this analysis. All costs were inflated to 2014 dollars based on the Medical Care component of the Consumer Price Index. Costs were evaluated monthly and cumulatively. To account for censoring in cost data, the Kaplan Meier Survival Estimator (KMSE) method (Lin et al Biometrics 1997;53:419-434) was employed to adjust the monthly costs by the Kaplan Meier curves. The total per patient cost from ALL diagnosis to death was calculated by adding the 12-month KMSE adjusted cumulative costs from ALL diagnosis to relapse and from relapse to death. Results: A total of 362 newly diagnosed patients with Ph- ALL met all the study criteria. The average age was 41.2 (SD 15.1). Mean duration of follow-up was 409.5 days (SD 371.6) and 19% (n=69) of patients relapsed during follow-up. Mean monthly costs were the greatest during the first month following initial ALL diagnosis ($150,969) and during the first month following the relapse diagnosis ($155,321). The KMSE adjusted cumulative costs from initial ALL diagnosis until relapse per patient were estimated to be $412,231 at 6 months, and $595,509 at 12 months. The KMSE adjusted cumulative costs per patient from relapse to death were estimated to be $414,787 at 6 months, and $501,084 at 12 months. When combined, the calculated total cost per patient from newly diagnosed to relapse and from relapse until death was $1,096,593. Conclusions and Limitations: Ph- ALL in adults is associated with significant economic burden in the US. For an average patient, the total healthcare cost from ALL diagnosis until death is more than $1 million with almost half of the expense incurred after relapse. The primary limitation for this analysis is the small sample size for the relapse ALL patients. However, it is expected given the rarity of the disease. Disclosures Princic: Truven Health Analytics: Employment. Song:Truven Health Analytics: Employment; Amgen: Other: This study was funded by Amgen.. Lin:Amgen: Employment. Cong:Amgen: Employment.
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Sjoberg, Jan, Cat Halthur, Sigurdur Y. Kristinsson, Ola Landgren, Paul W. Dickman e Magnus Bjorkholm. "Improved Patient Survival and Cure for Hodgkin Lymphoma: A Population-Based Study of 6,136 Patients Diagnosed in Sweden 1973-2005." Blood 114, n. 22 (20 novembre 2009): 1553. http://dx.doi.org/10.1182/blood.v114.22.1553.1553.
Abstract (sommario):
Abstract Abstract 1553 Poster Board I-576 We evaluated survival for all patients diagnosed with Hodgkin lymphoma (HL) in Sweden 1973-2005 (n=6,136; 3,515 men and 2,621 women; median age 40 years). Patients were categorized into six age groups and four calendar periods (1973-1980, 1981-1988, 1989-1996, and 1997-2005). Relative survival ratios (RSRs) were computed as measures of patient survival. Cumulative relative survival improved over time in all age groups with the greatest improvement in patients 51-65 years. Also in patients 66-80 years, significant improvements were recorded in both five- and ten year RSRs. Importantly, a plateau in relative survival was observed after 5 years in patients below ≤ 35 years of age during the last calendar period suggesting a lack of long-term treatment-related mortality. The ten-year RSRs in this calendar period were 0.95, 0.95, 0.92, 0.80, and 0.51 for the age groups 0-18, 19-35, 36-50, 51-65, and 66-80, respectively. Thus, despite this progress, age at diagnosis remains an important predictor of outcome. We also found a significantly better survival for women when adjusted for age and calendar period. During the study period, refined treatment options for patients with limited and advanced-stage HL have contributed to an increasing cure rate. In addition, our findings support that long-term mortality of HL therapy has decreased. Elderly patients still do poorly and targeted treatment options associated with fewer side effects will advance the clinical HL field. Cumulative relative survival stratified by age at diagnosis and calendar period of diagnosis Cumulative relative survival stratified by age at diagnosis and calendar period of diagnosis Disclosures No relevant conflicts of interest to declare.
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Gangaraju, Radhika, Smita Bhatia e Kelly Kenzik. "Venous-Thromboembolism in Elderly Patients with Acute Myeloid Leukemia". Blood 134, Supplement_1 (13 novembre 2019): 4679. http://dx.doi.org/10.1182/blood-2019-124464.
Abstract (sommario):
BACKGROUND: Venous-thromboembolism (VTE) is a debilitating condition and is associated with excess mortality. Small, single institution studies suggest that the risk of VTE in acute myeloid leukemia (AML) patients is elevated and is similar to that seen in solid tumor patients. However, population-based studies describing VTE risk and predictors of VTE in elderly AML patients are lacking. We used Medicare-linked SEER (Surveillance, Epidemiology, and End Results) data to address this knowledge gap. METHODS: We identified 4,166 Medicare beneficiaries diagnosed with AML at age ≥67y between 2007 and 2013. We ascertained baseline sociodemographics and pre-existing comorbidities for 2y prior to AML diagnosis. Patients were followed from AML diagnosis until development of post-AML VTE, or, in the absence of VTE diagnosis, for 2y (if alive), or until death, blood or marrow transplant, or end of study (12/31/2014), whichever came first. VTE diagnosis was based on ICD 9 codes using validated claims algorithms, and included deep vein thrombosis (DVT), pulmonary embolism (PE) and thrombophlebitis. Statistical Analysis: Cumulative incidence functions were used to assess post-AML VTE risk (overall, new-onset). Cox regression models examined the following risk factors associated with VTE: age at AML diagnosis, sex, race/ethnicity, socioeconomic status, history of pre-AML VTE, and pre-existing co-morbid conditions (hypertension, dyslipidemia, diabetes, stroke, rheumatoid arthritis, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, congestive heart failure, atrial fibrillation, anemia and peripheral vascular disease). RESULTS: Median age at AML diagnosis was 79y (range: 67-105y); 52% were male, 83% non-Hispanic white and 20% resided in an area where >20% of the population lived below poverty level; 50% of the cohort received chemotherapy. Prior to AML diagnosis, 15% were receiving anticoagulants; 2% were on anticoagulation for pre-AML VTE. Cumulative Incidence of VTE: Overall, 167 (4.0%) patients were diagnosed with post-AML VTE (DVT [63%], PE [32%], thrombophlebitis [5%]); 38% had >1 VTE. Of the 167 patients with post-AML VTE, only 25 (15%) had new-onset VTE; the remaining 142 carried a history of pre-AML VTE. The 2y cumulative incidence of any post-AML VTE was 4.3% (95%CI: 3.6%-5.1%) (Fig 1). Fifty-six percent of VTE episodes occurred within 3 months of AML diagnosis. The incidence was 0.6% (95% CI: 0.5%-0.8%) for new-onset VTE and was 1.9% (95%CI 1.3-2.6) for multiple VTEs. The 2y cumulative incidence of post-AML VTE among those with a history of pre-AML VTE was 17.1% (95% CI: 13.3-21.9%). Risk factors for VTE: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty, and co-morbid conditions, AML patients who had pre-AML VTE, were at 7.6-fold increased risk of post-AML VTE (95%CI: 4.8-12.0, p<0.001). No other risk factors were associated with post-AML VTE risk, with the exception of a marginal association between a prior history of peripheral vascular disease and new-onset VTE (HR=3.5, 95%CI: 0.9-14.8, p=0.08) (Table 1). Risk factors for VTE among patients receiving chemotherapy: Adjusting for age at diagnosis, race/ethnicity, census-tract poverty and co-morbid conditions, AML patients with pre-AML VTE were at 8.1-fold increased risk of any post-AML VTE (95%CI: 4.4-14.7, p<0.001). Mortality associated with VTE: The 2y cumulative incidence of mortality for those with no pre-AML VTE was 91%, compared to 95% for those with a pre-AML VTE (HR 1.23, p=0.017). New-onset VTE after the diagnosis of AML was not associated with an increased risk in mortality (HR 1.04, p=0.705). CONCLUSION: History of VTE prior to diagnosis of AML significantly increases the risk of post-AML VTE and overall mortality. These findings can be used to inform appropriate thromboprophylaxis in elderly AML patients who carry a pre-AML diagnosis of VTE. Disclosures No relevant conflicts of interest to declare.
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Campbell, Marjorie S., Kevin O’Gallagher, Derek J. Smolenski, Lindsay Stewart, Jean Otto, Bradley E. Belsher e Daniel P. Evatt. "Longitudinal Relationship of Combat Exposure With Mental Health Diagnoses in the Military Health System". Military Medicine 186, Supplement_1 (1 gennaio 2021): 160–66. http://dx.doi.org/10.1093/milmed/usaa301.
Abstract (sommario):
ABSTRACT Introduction Combat deployment is associated with mental and physical health disorders and functional impairment. Mental health (MH) diagnoses such as adjustment and anxiety disorders have received little research attention but may reflect important postdeployment sequelae. The purpose of this study was to investigate the association of combat exposure with the acquisition of a wide range of mental health diagnoses over 2 years. Materials and Methods This retrospective longitudinal study utilized multiple administrative Military Health System datasets compiled for all individuals who entered active duty in the U.S. Army from FY2005 to FY2011. A total eligible cohort of 289,922 Service members was stratified into three mutually exclusive groups according to their deployment status after 2 years in service: Deployed, Combat-Exposed; Deployed, Not-Combat-Exposed; and Not Deployed. Outcomes of interest were new mental health diagnoses grouped into six categories—posttraumatic stress disorder, anxiety, adjustment, mood, substance use disorders, and any MH diagnosis. Survival analyses over 2 years were conducted and adjusted hazard ratios were calculated. Results Combat exposure in the first 2 years of military service was associated with significantly higher rates of a wide range of mental health diagnoses over a two-year follow-up period, compared with deployment with no combat exposure and no deployment. Adjusted cumulative failure proportions demonstrated that approximately a third of the Combat-Exposed group, a quarter of the Not-Combat-Exposed, and a fifth of the Not Deployed groups received a MH diagnosis over 2 years. For all groups, cumulative failure proportions and incidence rates were highest for adjustment disorder and lowest for posttraumatic stress disorder diagnoses. Conclusions Researchers and providers should be alerted to the impact of combat exposure and the wide range of MH conditions and diagnoses that may represent important postdeployment sequelae.
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Iwanowski, J., H. Piwowarska-Bilska, P. Wawrykow, A. Walecka, J. Peregud-Pogorzelski e B. Birkenfeld. "Exposure of children with neuroblastoma to ionizing radiation during computed tomography and nuclear medicine imaging – a single centre experience". Radioprotection 54, n. 3 (luglio 2019): 181–85. http://dx.doi.org/10.1051/radiopro/2019025.
Abstract (sommario):
Purpose: To calculate cumulative doses of ionizing radiation absorbed by children with neuroblastoma during diagnostic CT and NM scans. Method: Retrospective analysis of 267 CT and NM scans performed in 21 children treated in 2009–2015. Results: The cumulative effective dose absorbed per child ranged from 58 to 536 mSv and was highest in infants under 3 years. Conclusion: Children with suspected neuroblastoma may be exposed to significant doses of radiation during the whole period of diagnosis and monitoring the progress of treatment.
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te Winkel, Mariel L., Rob Pieters, Wim C. J. Hop, Jan C. Roos, Inge M. van der Sluis, Jos P. M. Bökkerink, Jan A. Leeuw et al. "Bone Mineral Density At Diagnosis Determines Fracture Rate in Children Treated According to the DCOG-ALL9 Protocol". Blood 120, n. 21 (16 novembre 2012): 1469. http://dx.doi.org/10.1182/blood.v120.21.1469.1469.
Abstract (sommario):
Abstract Abstract 1469 Purpose As survival rates for pediatric acute lymphoblastic leukemia (ALL) have significantly improved, awareness of side effects such as skeletal toxicity becomes increasingly important. As BMD decrease over time might be associated with an increased risk of fractures, we performed repeated measurements of BMD in a large nation-wide study and studied the incidence of fractures in these children treated for ALL. Methods Prospectively, serial measurements (at diagnosis, after 32 weeks, after 2 years (at cessation of therapy) and after 3 years (1 year after cessation of therapy)) of bone mineral density of the lumbar spine (BMDLS) were performed in 399 ALL patients using dual energy X-ray absorptiometry (DXA). Using logistic multivariate regression, we evaluated the following putative risk factors for a low BMDLS:age at diagnosis, gender, risk group of ALL treatment, weight and height at diagnosis. Moreover, Kaplan-Meier survival analysis was used to assess the cumulative incidence of fractures in 672 patients treated with the dexamethasone-based DCOG-ALL9 protocol. All reported fractures were symptomatic, and confirmed by X-ray. Cumulative incidences of fractures for different subgroups were compared with the Log-Rank test. Results At diagnosis, mean BMDLS of ALL patients was lower than that of healthy peers (mean BMDLS= −1.10 SDS, P< 0.001), and this remained significant lower during and after treatment (8 months: BMDLS = −1.10 SDS, P< 0.001; 24 months: BMDLS = −1,27 SDS, P< 0.001; 36 months: BMDLS = −0.95 SDS, P< 0.001). Multivariate linear regression analysis showed that after correction for weight, height and gender, treatment according to the HR treatment arm and older age at diagnosis had a significant negative effect on the decline of BMDLS during treatment (high-risk group: b = −0.50, P<0.001 and age at diagnosis: b = −0.15, P<0.001). The cumulative incidence of fractures at 3 years was 17.8%. Cumulative incidences of fractures between risk groups and age groups were not significantly different (NHR 18.8% vs. HR 15.7%, P = 0.18 and <10 years 17.7% vs. ≥10 years 17.6%, P = 0.85). Patients who developed fractures had a lower BMDLS during treatment than those without fractures. Treatment-related bone loss was similar in patients without fractures and patients with fractures (respectively: Δ BMDLS = −0.12 SDS vs. Δ BMDLS= −0.36 SDS; interaction group time, P = 0.295). Conclusion This large prospective study shows that the low value of BMDLS both at diagnosis and during treatment, rather than the treatment-related decline of BMDLS, determines the markedly increased fracture risk of 17.8%. Disclosures: No relevant conflicts of interest to declare.
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Chaparro, M., A. Garre, A. Núñez Ortiz, S. Rubio, M. T. Diz-Lois Palomares, S. Riestra, H. Alonso-Galán et al. "P1170 Long-term outcomes of newly diagnosed Inflammatory Bowel Disease (IBD) patients: results from the nationwide EpidemIBD study of GETECCU". Journal of Crohn's and Colitis 18, Supplement_1 (1 gennaio 2024): i2085—i2088. http://dx.doi.org/10.1093/ecco-jcc/jjad212.1300.
Abstract (sommario):
Abstract Background Aims: 1) To describe the main epidemiological and clinical characteristics of patients at IBD diagnosis and the long-term outcomes; 2) to analyse the use of drugs for IBD, and the need of hospitalisations and surgeries; 3) to compare IBD management based on the type of disease and the resources of the hospitals. Methods Prospective, population-based nationwide registry. Adult patients diagnosed with IBD, Crohn’s Disease (CD), Ulcerative Colitis (UC) or IBD unclassified, during 2017 in the 17 Spanish regions were included. Patients who consented were followed-up for 5 years (yr) after diagnosis. Treatment was grouped into 5 categories: mesalamine (oral or topical), steroids (intravenous, oral, or topical), immunomodulators (thiopurines, methotrexate or cyclosporine), biologics (anti-TNF, vedolizumab, ustekinumab) or JAK inhibitors (JAKi), and surgery. Hospitals were classified into high resources and low resources ones. Cumulative incidence of exposure to each of the studied treatments was estimated by Kaplan-Meier curves; curves were compared with log-rank test. Results 3,301 incident cases of IBD diagnosed during 2017 in 108 hospitals, covering over 22 million inhabitants in Spain (about 50% of the population), were enrolled into the follow-up study. Main characteristics of the cohort are summarised in table 1. Median diagnosis delayed was 3.5 months (5.6 in CD and 2.7 in UC, p<0.001). During the 5-yr follow-up, 25% of UC patients progressed to more extensive involvement, while 8% of CD patients with inflammatory behaviour progressed to either stricturing or fistulising behaviour. Most of the patients who received mesalamine, corticosteroids, or immunomodulators initiated treatment within the first 2 years after diagnosis (figure 1). However, the cumulative incidence of biologics/JAKi usage steadily increased over time, reaching 49% by the 5-yr timepoint in CD. In terms of surgeries, a progressive increase in cumulative incidence was observed in CD; the incidence of colectomy remained stable in UC from the 2nd year post-diagnosis. A higher cumulative incidence of biologics/JAKi usage, hospitalisations, and surgeries was observed in CD at high resources hospitals; no differences were observed in the use of other therapeutic resources or the management of UC. Conclusion In the EpidemIBD large-scale epidemiological study, we have observed that the delay in diagnosing IBD is shorter than previously described. Approximately 50% of patients with CD and 20% of patients with UC ended up receiving biologics/JAKi in the first 5 yrs following diagnosis. The percentage of patients undergoing surgery was lower than previously reported; in the case of UC, the majority of colectomies occurred within the first 2 yrs after diagnosis.