Two-Year Outcomes of Orbital Atherectomy Combined With Drug-Coated Balloon Angioplasty for Treatment of Heavily Calcified Femoropopliteal Lesions

2020 ◽  
Vol 27 (3) ◽  
pp. 492-501 ◽  
Author(s):  
Damianos G. Kokkinidis ◽  
Omar Jawaid ◽  
David Cantu ◽  
Brad J. Martinsen ◽  
Zsuzsanna Igyarto ◽  
...  

Purpose: To examine whether the combination of orbital atherectomy (OA) and drug-coated balloons (DCB) can lead to superior procedural and 2-year outcomes compared with DCB only in heavily calcified femoropopliteal (FP) lesions. Materials and Methods: A retrospective chart review was conducted to identify patients treated with DCB only or OA+DCB for de novo FP lesions at a single center over a 4-year period (2014–2017). In the observation period, 113 patients met the inclusion criteria: 63 treated with DCB only (mean age 69.0±8.6 years; 62 men) vs 50 treated with OA+DCB (mean age 70.3±7.1 years; 48 men). The OA+DCB group had higher calcification rates (78% with severe calcification vs 37% in the DCB only group). Propensity score matching (PSM) was used to adjust for baseline differences between the 2 groups. Cox regression analysis was used to compare the follow-up outcomes between lesions treated with OA+DCB vs DCB only. Results: No difference in procedural complications or success was found. After PSM adjustment, the OA+DCB group was associated with lower bailout stenting rates (39.4% vs 66.7% in the DCB only group; p=0.026). The 2 groups had similar long-term outcomes, although the OA+DCB arm had a trend toward reduced TLR rates that did not reach statistical significance. The Kaplan-Meier estimates for 2-year freedom from TLR were 76.1% for the OA+DCB group vs 55.5% for the DCB only group (p=0.109). Conclusion: OA+DCB is a safe and effective combination for the treatment of calcified FP lesions. The combined therapy decreased the bailout stenting rates in the adjusted analysis. Larger cohorts and randomized trials are needed to examine OA efficacy in FP lesions.

2019 ◽  
Vol 3 (Issue 4) ◽  
pp. 243
Author(s):  
Zhanybek Gaibyldaev ◽  
Zhamalbek Ashimov ◽  
Damirbek Abibillaev ◽  
Fuat Kocyigit

In our study we conducted survival analysis of 204 patients visited Scientific-Research Institute of Heart Surgery and Organs transplantation and who underwent renal transplantation in Kyrgyzstan and other Eurasian countries between 2005 and 2016 years (age range: 9-71 years, mean: 38.21 (12.74) years, median: 34.0 (0.89) years; gender: 142 male (69.6%)). During follow-up period, mortality event was observed in 16 (7.84%) patients. Survival function probabilities of patients and rational risk factors of survival functions were evaluated by Kaplan-Meier and Cox regression analyses, respectively. According to Kaplan-Meier results survival probabilities calculated for 1st year: 0.96 (0.014), for 3rd year: 0.94 (0.018), for 5th year: 0.86 (0.04), for 7th year: 0.75 (0.10). Among age groups 28-39 age ranges prevailed by 11 patients. Nevertheless, that difference did not show statistical significance: p˃0.322. The intensity of transplantation also analyzed according to years, which revealed increasing in numbers of operations by time. For instance, when in 2006 only two cases were registered in our center, but numbers of transplanted patients reached up to 48 in 2015. The association of mortality states and years of transplantation found significantly by Kaplan-Meier test (Breslow p˂0.001). The survival analysis was compared according to countries and revealed significant results (Breslow p˂0.05). From other factors influencing mortality, sex did not show strong impact on survival by Kaplan-Meier analysis, but significant association was found by Cox regression analysis.


2015 ◽  
Vol 134 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Umit Yavuz Malkan ◽  
Gursel Gunes ◽  
Ayse Isik ◽  
Eylem Eliacik ◽  
Sezgin Etgul ◽  
...  

There are very few data about the relationship between acute myeloid leukemia (AML) prognosis and bone marrow recovery kinetics following chemotherapy. In this study, we aimed to assess the prognostic importance and clinical associations of neutrophil and platelet recovery rates and rebound thrombocytosis (RT) or neutrophilia (RN) in the postchemotherapy period for newly diagnosed AML patients. De novo AML patients diagnosed between October 2002 and December 2013 were evaluated retrospectively. One hundred patients were suitable for inclusion. Cox regression analysis using need for reinduction chemotherapy as a stratification parameter revealed RT as the only parameter predictive of OS, with borderline statistical significance (p = 0.06, OR = 7; 95% CI 0.92-53), and it was the only parameter predictive of DFS (p = 0.024, OR = 10; 95% CI 1.3-75). In order to understand whether RT or RN was related to a better marrow capacity or late consolidation, we considered neutrophil recovery time and platelet recovery time and nadir-first consolidation durations in all patients in the cohort. Both the marrow recovery duration and the time between marrow aplasia and first consolidation were shorter in RT and RN patients. To our knowledge, this is the first study to report a correlation between RT/RN and prognosis in AML.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17007-e17007
Author(s):  
Ariel Ann Nelson ◽  
Robert Cronk ◽  
Aniko Szabo ◽  
Emily Lemke ◽  
Thomas A. Giever ◽  
...  

e17007 Background: Outcomes of patients (pts) with mUC with EOM have not thoroughly been described in the age of immuno-oncology. We hypothesized that EOM is associated with worse outcomes when compared to pts with non-osseous metastases (NOM). Methods: We used a multi-institutional database of pts with mUC who received systemic treatment (trt) between March 2005 and August 2019, to assess survival and palliative outcomes of pts with EOM vs NOM at the time of metastatic diagnosis (met dx). Wilcoxon rank-sum and chi-square tests were performed. Survival was estimated by Kaplan-Meier method, Cox regression analysis was performed. Results: We identified 270 pts, 72% men, mean age 67 ± 11 years, 28% never smokers. At met dx, 27% (n = 72) had ≥ 1 EOM; these pts were more likely to have de novo metastases vs. those with recurrent metastases (42% vs 19%, p < 0.001). Pts with EOM were more likely to have a change or stop in 1st line trt due to clinical progression (30.6% vs 15.7%, p = 0.006), and received fewer total lines of systemic trt, median of 1.0 (1.0-5.0) vs. 2.0 (1.0-8.0), p = 0.05. Pts with EOM had shorter median overall survival (OS) vs. those with NOM, (6.1 vs 13.7 months, p < .0001), HR = 2.79 (95% CI:1.95-3.97, p < .0001). Median OS was shorter for pts with EOM who received 1st line immune checkpoint inhibitor (n = 14) vs platinum-based chemotherapy (n = 43), (1.6 vs 9.1 months, p = 0.003). Pts with EOM received higher opioid analgesic doses at the first and last oncology outpatient visits compared to pts with NOM with mean morphine milligram equivalent (MME) dose of 60 ± 91 vs 28 ± 65 at first visit, p = 0.004, and 171 ± 214 vs. 94 ± 229 at last visit, p < 0.001. Conclusions: The presence of EOM in mUC is associated with worse outcomes vs. pts with NOM. Pts with EOM may benefit from 1st line platinum-based chemotherapy vs. checkpoint immunotherapy. Furthermore, pts with EOM experience more pain than pts with NOM and may benefit from early engagement with palliative care. Pts with EOM represent a population with a highly unmet need for systemic, targeted and/or radiation interventions. Molecular subtypes may further define these pts and analysis is planned. We encourage ongoing clinical trials to report outcomes in pts with EOM. A consensus on reporting of non-measurable disease is also needed. [Table: see text]


2021 ◽  
Author(s):  
Chanpreet Singh Arhi ◽  
Roise Dudley ◽  
Osama Moussa ◽  
Maddalena Ardissino ◽  
Samantha Scholtz ◽  
...  

Abstract Background Although bariatric surgery has been shown to reduce weight loss and obesity-related conditions, an improvement in depression remains unclear. The aim of this study was to determine whether bariatric surgery is associated with a resolution of depression, and the prevention of its onset. Method Patients with a BMI ≥ 30 kg/m2 who had undergone bariatric surgery were identified from the Clinical Practice Research Datalink (CPRD), matched 5:1 to controls. Cox regression analysis was used to determine the risk of developing de novo depression. Kaplan-Meier analysis compared the proportion of patients with no further consultations related to depression between the two groups. Results In total, 3534 patients who underwent surgery, of which 2018 (57%) had pre-existing depression, were matched to 15,480 controls. Cox proportional hazard modelling demonstrated surgery was associated with a HR of 1.50 (95% CI 1.32–1.71, p < 0.005) for developing de novo depression. For those with pre-existing depression, by 5 years, just over 20% of post-surgical patients had no further depression episodes compared with 17% of controls. Conclusion In individuals with a history of depression, bariatric surgery is associated with an improvement in mental health. On the contrary, the finding of increased de novo diagnoses of depression following surgery indicates the need for further study of the mechanisms by which bariatric surgery is associated with depression in this subset of patients.


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2283-2283
Author(s):  
Umit Yavuz Malkan ◽  
Gursel Gunes ◽  
Hakan Goker ◽  
Eylem Eliacik ◽  
Ayse Isik ◽  
...  

Abstract We investigated the prognostic importance and clinical associations of neutrophil and platelet recovery rates and rebound thrombocytosis (RT) or neutrophilia (RN) in post-chemotherapy newly diagnosed AML patients. De novo AML patients who were diagnosed between October 2002 and December 2013 were evaluated retrospectively. The patients who attained first complete remission (CR) after one or two induction therapies were selected and their marrow aplasia periods preceding CR were considered. The patients who were transplanted were excluded. Neutrophil (NRT) and platelet recovery times (PRT) were accepted as the periods between neutrophil nadir and ³1000/µl neutrophil count and platelet nadir and ³50000/µl platelet count, respectively. The platelet nadir-to-first consolidation (PCT) and neutrophil nadir-to-first consolidation times (NCT) were computed. RN and RT thresholds were accepted as 7000/µl and 450000/µl respectively. There were 100 patients suitable for inclusion. The frequency of RT was 11/31, 6/19, 5/50 in patients with favorable ELN cytogenetic categories, normal karyotype, other cases, respectively (p=0.1). Cox regression analysis using need of reinduction therapy as stratification parameter revealed RT as the only parameter predicting both OS (p=0.06) and DFS (p=0.024). After understanding that RT525 (threshold 525000/ µl) is an independent prognostic parameter in AML patients, we tried to find its prognostics value in subgroups. There were 15 APL patients. Prognostic value of RT525 could not be determined due to low event rates. Only two patients experienced an event. Both events were mortalities during consolidation. There was one mortality in RT525 and no- RT525 groups each. There were 16 CBF-type AML patients. Four patients experienced an event. All events were relapses. All four events occurred in 12 cases without RT525 while none of four patients with RT525 experienced an event. However, statistical significance was not observed between groups in DFS (figure 1) and OS comparisons due to low event rates (p=0.17 and p=0.18 respectively). In other AML patients, there were 35 events (25 relapse, 10 deaths in CR). All of the events occurred in no-RT525 group. All RT525 cases in this group were living with CR at last follow-up. Both DFS (median [95% confidence interval] not reached versus 13.2 (6.1 - 20.2) months, p=0.004) (figure 2) and OS (not reached versus 17.0 (0 - 34.6) months, p<0.001) rates were higher in RT525 cases. In order to understand whether RT or RN were related to better marrow capacity or late consolidation, we considered NRT and PRT and nadir-first consolidation durations in all patients cohort. For RT group, the PRT was 10.3±5.2 days whereas it was 12.8±8.5 days for no-RT group (p=0.43). The NRT was 15.8±7.8 and 20.3±9.7 days in RN and no-RN groups respectively (p=0.07). For RT group, the PCT was 27.8±7.9 whereas it was 29.1±15.2 days for the group with no-RT (p=0.07). NCT was 30.2±11.2 and 34.6±18.2 days for RN and no-RN groups respectively (p=0.12). Both the marrow recovery duration and the time between marrow aplasia and first consolidation were shorter in RT and RN patients. To our knowledge, this is the first study that reports a correlation between RT/RN and prognosis in AML. Interestingly, RT was the only significant independent parameter in multivariate analyses also including classical prognostic risk factors for OS and DFS. The favorable prognosis associated with RT525 was evident in AML patients other than APL and CBF-type disease. However it could not be demonstrated in APL and CBF-type disease probably due to low event rates. In accordance with this suggestion there was a trend towards statistical significance in CBF-type disease (0/4 versus 4/12 relapses in RT525 and no-RT525 cases respectively, p=0.17). The marrow recovery time and the duration between marrow aplasia and first consolidation were shorter in RT and RN cases indicating better healthy hematopoiesis/marrow capacity in this group. As RT and RN are very easy to detect, they can be used as prognostic indicators in countries with limited laboratory facilities. These findings should be confirmed in other patient cohorts and preferably prospective studies. Figure 1. <![if !vml]><![endif]> Figure 1. <![if !vml]><![endif]> Figure 2. <![if !vml]><![endif]> Figure 2. <![if !vml]><![endif]> Disclosures No relevant conflicts of interest to declare.


2008 ◽  
Vol 14 (5) ◽  
pp. 636-639 ◽  
Author(s):  
I Bosca ◽  
F Coret ◽  
C Valero ◽  
AM Pascual ◽  
MJ Magraner ◽  
...  

Observational study designed to explore the effect of demographical variables and number of relapses over the disability progression in the two first years of beta-interferon treatment for multiple sclerosis. One hundred and sixty two patients treated with beta-interferon for at least two years were included, 70.9% females, mean age 33.4 years, mean disease duration 75.1 months, mean EDSS 2.4, previous year relapse rate 1.3. Main end-point was defined as a sustained EDSS increase (1.5 if previous EDSS 0-2.0; 1.0 if previous EDSS 2.5-4.0; 0.5 if previous EDSS 4.5 or higher). 62.3% of patients presented one or more relapses and 32.7% patients reached sustained disability increase. The univariate and multivariate Cox regression analysis only showed statistical significance for the relapses in the two first years after the treatment (HR 1 relapse: 3.4, p = 0.05; HR ≥ 2 relapses: 4.3, p < 0.001). The Kaplan-Meier survival analysis showed a higher probability of EDSS progression for patients with one relapse (log rank 10.9, p = 0.02) and with ≥ 2 relapses (log rank 17.7, p < 0.001), with no differences between them ( p = 0.38). In conclusion, patients with one or more relapses in the first two years of interferon treatment developed an earlier sustained progression of the disability.


Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4443-4443
Author(s):  
Eduardo Salido ◽  
Maria Juliana Majado ◽  
Alfredo Minguela ◽  
Jose Maria Moraleda ◽  
Consuelo Gonzalez ◽  
...  

Abstract Absolute lymphocyte count (ALC) at diagnosis (ALC-D), as well as ALC recovery, have been described as prognostic factors in overall survival (OS) and progression free survival (PFS) in patients with non-Hodgkin’s and Hodgkin’s lymphoma(NHL and HL) who underwent autologous stem cell transplantation (ASCT). The aim of this study is to verify those findings, as well as the influence of infused lymphocyte, MNC, CD19 and CD3 in OS and PFS in our patients, in order to give some support to the importance of the immune system for disease control. A total of 55 patients were reviewed, 35 males and 20 females, 44 had NHL and 12 HL. Variables analyzed with regard to PFS and OS were: ALC-D, ALC at day 15 post-transplant (ALC15), infused lymphocyte ×106/Kg, MNC X108 / Kg, CD19 X106/ Kg and CD3×106/ Kg. Variables were dichotomized at the median, and PFS and OS estimates were calculated with the Kaplan-Meier method and compared using log-rank test; regression Cox test was used for multivariate study. Results: The median follow-up was 71 months (14–180). Relapse or progression occurred in 20 patients (36%) between 1 and 148 months (median 32). Eighteen patients (33%) died at a median of 28 months (14–110). Median ALC-D was 1.5×109/L (0.2–5.2 ×109/L). ALC15 count was 0.6 ×109/L (0.1–1.9). Infused MNC were 5.0×108/Kg (0.04– 22.2). Infused lymphocytes were 241.6 ×106/Kg (0.1–1222). Median CD19 cells infused were 1.12 ×106/Kg (0.0–79.7). Infused CD3 cells were 106.8 ×106/Kg (0.02–678.2). No difference was found in OS or PFS in patients in groups above and below median in ALC-D, ALC15 counts, neither in MNC, lymphocytes, CD19 nor CD3 cells infused in Kaplan-Meier study. MNC infused have statistical significance in OS (p=0.042) and PFS (p=0.023) in Cox regression analysis. In our series we do not find a clear predictor in relation to the immune reconstitution in NHL and HL patients receiving an ASCT; althoug it is possible that among MNC should be immune progenitors able to offer a better outcome to these patients, that could be studied in future.


2020 ◽  
Vol 14 (12) ◽  
pp. 1127-1137
Author(s):  
Tong-Tong Zhang ◽  
Yi-Qing Zhu ◽  
Hong-Qing Cai ◽  
Jun-Wen Zheng ◽  
Jia-Jie Hao ◽  
...  

Aim: This study aimed to develop an effective risk predictor for patients with stage II and III colorectal cancer (CRC). Materials & methods: The prognostic value of p-mTOR (Ser2448) levels was analyzed using Kaplan–Meier survival analysis and Cox regression analysis. Results: The levels of p-mTOR were increased in CRC specimens and significantly correlated with poor prognosis in patients with stage II and III CRC. Notably, the p-mTOR level was an independent poor prognostic factor for disease-free survival and overall survival in stage II CRC. Conclusion: Aberrant mTOR activation was significantly associated with the risk of recurrence or death in patients with stage II and III CRC, thus this activated proteins that may serve as a potential biomarker for high-risk CRC.


2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Chi-Feng Pan ◽  
Chih-Kuang Chuang ◽  
Fang-Ju Sun ◽  
Duen-Jen Wang ◽  
...  

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yoshida ◽  
A Shibata ◽  
A Tanihata ◽  
H Hayashi ◽  
Y Ichikawa ◽  
...  

Abstract Background Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also intramuscular fat (IMF) has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with non-ischemic cardiomyopathy. Purpose We investigated whether ectopic fat in the thigh affects the prognosis with non-ischemic cardiomyopathy. Methods We recruited 105 patients who were diagnosed with non-ischemic cardiomyopathy by cardiac catheterization and echocardiographic date between September 2017 and November 2019. Finally 73 patients with reduced EF (EF 40% or less) enrolled in this prospective study. Functional status was evaluated by using cardiopulmonary exercise test at baseline. All patients were measured quantity of epicardial fat and thigh IMF percentage (%IMF) using computed tomography scan. Demographic, laboratory and echocardiographic date were collected from the patients' medical records. Clinical endpoints were unexpected readmission. Results During the follow-up period 18 patients had adverse events. The %IMF was significantly higher in the group with adverse events than without (5.57±5.70 and 3.02±2.44%, respectively; p&lt;0.01). Spearman correlation coefficient analysis showed a modest correlation between %IMF and lower limb extension strength (Spearman r=−0.280; p=0.0315), but there was no significant correlation between %IMF and exercise tolerance such as anaerobic threshold and peak oxygen uptake. Patients were divided into 2 groups according to the median values of %IMF. Kaplan-Meier analysis demonstrated that events were significantly higher in the high %IMF group (log-rank p=0.033). Multivariate Cox regression analysis adjusted for left ventricular end-diastolic diameter and peak ventricular oxygen consumption found %IMF as an independent factor of adverse events (hazard ratio 1.545; 95% confidential interval 1.151–2.087; p=0.004). Conclusions In non-ischemic cardiomyopathy patients with reduced EF, %IMF may have important adverse consequences such as increased cardiac-related events. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None


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