The difference of long‐term outcome according to baseline dementia severity in Korean Alzheimer’s disease patients treated with anti‐dementia medications

Abstract The aim of this study was to evaluate long-term outcome of acute myeloid leukemia (AML) patients treated within the PALG 1999 DAC vs. DA Study. [b][Within 3 years (1999–2002) 445 patients, aged 18–60, were randomized 1:1 to the induction treatment DAC-7: daunorubicin 60 mg/m2/d iv 1–3; cytarabine 200 mg/m2/d ci d 1–7; cladribine (2-CdA) 5 mg/m2 2h inf. iv d 1–5 and standard DA-7 regimen (the same therapy excluding cladribine). Patients achieving CR received two courses of subsequent intensive consolidation: HAM (HD AraC, mitoxantrone) HD AraC with or without cladribine in the DAC-7 or DA-7 arm, respectively. In case of PR after the first induction course the same regimen was repeated, Post-consolidation therapy was comparable in both arms with following proportions of autoHCT, alloHCT and maintenance: DAC-7 17%, 14%, 69%; DA-7 21%, 14%, 65%, respectively. As previously reported, a single course of DAC-7 induction resulted in 17% higher CR rate compared to the DA-7 treatment (p=0,0008). The difference was particularly pronounced in patients: aged >40 years and with initial WBC >100x109/L. In the latter subgroup also the overall CR rate (achieved after entire induction program) was higher in the DAC-7 arm (71% vs. 43%). [Leukemia.2004;18:989–97] In the present report we analyzed seven-year long-term outcome (median follow-up 5 yrs) in the whole study population and in subgroups stratified according to age, initial WBC, cytogenetics, sex, FAB subtype, and preceding myelodysplasia. In the whole group the overall survival (OS) rate equaled 29,5% for DAC-7 and 24% for DA-7 arm (p=NS) and leukemia free survivall (LFS) 30% vs. 28% (p=NS), respectively. Of note, in patients aged >40 years, the therapy containing cladribine was associated with improved OS (26% vs. 14,5%, p=0.03), and LFS (28% for DAC-7 vs. 18,5% for DA-7, p=0.02). Other subgroup analyses revealed higher probability of the OS in patients with initial WBC ≥ 50 G/l assigned to DAC-7 compared to DA-7 arm (32% vs. 20,5%, p=0.04). The LFS rate equaled 35% and 27% (p=NS), respectively. In women receiving DAC-7 induction therapy in comparison with those treated in arm without 2-CdA reached higher OS: 29% vs. 19,5%, p=0,03, respectively. LFS in these subgroups was comparable: 25% vs. 22%, p=NS, respectively. We conclude that addition of cladribine to induction and consolidation therapy of AML improves long-term outcome in patients: older than 40 y, as well as in those with high tumour burden. The better outcome in older patients results mainly from reduced risk of relapse, whether that in cases with high WBC seems to be linked to a higher CR rate.

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Stroke admission outside daytime working hours delays mechanical thrombectomy and worsens short-term outcome

International Journal of Stroke ◽

10.1177/1747493018790079 ◽

2018 ◽

Vol 14 (5) ◽

pp. 517-521 ◽

Cited By ~ 1

Author(s):

Robert Hoepner ◽

Ralph Weber ◽

Gernot Reimann ◽

Klaus Berger ◽

Martin Kitzrow ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Working Hours ◽

Stroke Outcome ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Therapeutic Decisions ◽

The Difference

Background and purpose Rapid therapeutic decisions in acute stroke patients leading to earlier initiation of revascularization therapies are associated with better outcome. An association between regular working hours and reduced time to initiation of intravenous thrombolysis has been reported. However, its influence on mechanical thrombectomy (MT) remains uncertain. We aimed to analyze the effects of admission time on door-to-groin time and stroke outcome in a large prospective stroke registry of the Neurovascular Net Ruhr in Germany. Methods Procedural times of a total of 512 patients treated with MT were analyzed. Admission to hospital during regular working days and hours (Monday to Friday, 8 am to 4 pm) was compared with admission outside these times. Door-to-groin time and the difference in NIH Stroke Scale between admission and discharge served as primary outcome parameters. Long-term functional outcome was centrally assessed with modified Rankin scale. Results MT outside regular working hours was associated with a significant mean initiation delay of 20 min. By multivariate regression analysis, every 20 min delay of MT reduced the difference in NIHSS score between admission and discharge by 0.76 points (95% CI −1.24 to −0.28, p = 0.002). Favorable long-term outcome did not differ between both treatment groups. Conclusions Treatment outside regular working hours caused a significant delay in the initiation of MT, which was associated with a decreased short-term clinical efficacy of thrombectomy. Strategies like compulsory attendance of the interventional neuroradiologist at the hospital 24/7 might result in shorter door-to-groin times and consecutive in better stroke outcome.

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P0596LONG TERM FOLLOW UP OF CONTRAST INDUCED ACUTE KIDNEY INJURY IN A TERTIARY JORDANIAN HOSPITAL

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0596 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ashraf Oweis ◽

Sameeha Alshelleh

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

The Other ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Effect ◽

Observational Study Design ◽

The Difference

Abstract Background and Aims Contrast induced acute kidney injury (CI-AKI) is potentially preventable and reversable cause of acute kidney injury (AKI). Multiple factors are associated with the development of CI-AKI, some are modifiable such as drugs, type and amount of contrast, others are not like preexisting chronic kidney disease (CKD), heart failure. Though it’s usually a reversable condition, there is increasing evidence of adverse long-term outcome (increasing morbidity and mortality). The aim of this study to evaluate the long-term outcome of CI-AKI on mortality, the rate of re-catheterization and the development of CKD. Method In a prospective observational study design, we evaluated all patients admitted for cardiac catheterization between June 2015 and January 2016. A total of 326 patients signed the consent to participate in the study. Patients had blood withdrawn 48 hours after the procedure for their creatinine level. CI-AKI was defined as an increase in serum creatinine by >25% or 44 mmol/l from the baseline level (48-72) hours after contrast administration, without any other obvious cause. We used only low osmolality contrast media (CM) (Lopamidol, Bayer, Germany). Of the 326 patients included, 202 patients had their second sample taken, thus, were eligible to continue in the study. Patients were followed for at least 3 years. Results The incidence of CI-AKI was 14.8% (30 patients), for baseline characteristics see table 1. At the end of follow up; a total of 7 patients died; 6 in the non CI-AKI group vs. 1 in the CI-AKI group (p= ), though the difference between the mean eGFR was not statistically significant by the end of the follow up (85.4ml/min for the CI-AKI vs. 79.2ml/min for the other group (P=0.31)), but the decline in eGFR for the CI-AKI was significant ( a drop from 105.4 ml/min to 85.4ml/min vs. 85.2ml/min to 79.2ml/min, P=0.004). The rate of re-catheterization was not statistically significant between the two groups (61 for the non CI-AKI vs. 12 for the other group; P=0.63). Conclusion CI-AKI carries a higher negative long-term effect on eGFR, while did not affect the mortality in our cohort.

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Long-term outcome of primary endocrine non-Hodgkin lymphomas: does the site make the difference?

QJM ◽

10.1093/qjmed/hct048 ◽

2013 ◽

Vol 106 (7) ◽

pp. 623-630

Author(s):

E. Hatjiharissi ◽

M. D. Diamantidis ◽

M. Papaioannou ◽

T. Dimou ◽

A. Chrisoulidou ◽

...

Keyword(s):

Term Outcome ◽

Long Term Outcome ◽

The Difference

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The association of traumatic brain injury with rate of progression of cognitive and functional impairment in a population-based cohort of Alzheimer's disease: the Cache County dementia progression study by Gilbertet al. Late effects of traumatic brain injury on dementia progression

International Psychogeriatrics ◽

10.1017/s1041610214001689 ◽

2014 ◽

Vol 26 (10) ◽

pp. 1591-1592 ◽

Cited By ~ 3

Author(s):

David J. Sharp

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Road Traffic ◽

Population Based ◽

Term Outcome ◽

Long Term Outcome ◽

History Of ◽

First Time

There is compelling evidence that traumatic brain injury (TBI) can trigger neurodegeneration, and that this is a major determinant of long-term outcome (Smithet al., 2013). A single significant injury such as a road traffic accident or exposure to a bomb blast can predispose an individual to Alzheimer's disease (AD), and here Gilbert and colleagues show for the first time that a history of TBI also alters the progression the disease.

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