scholarly journals Sex Differences in Predictors of Seizure in Contrast-Enhancing Gliomas at Clinical Presentation: A Network Approach

2019 ◽  
Author(s):  
Sandra K Johnston ◽  
Aditya Khurana ◽  
Paula Whitmire ◽  
Sara Ranjbar ◽  
Akanksha Sharma ◽  
...  
Keyword(s):  
Machine Learning ◽  
Tumor Size ◽  
Clinical Presentation ◽  
Tumor Location ◽  
Data Repository ◽  
Patient Age ◽  
Entire Cohort ◽  
Prescription Practices ◽  
Patient Âgé ◽  
Co Morbidity

ABSTRACTBackgroundBrain tumor related epilepsy (BTE) is a major co-morbidity related to the management of patients with brain cancer. Despite published practice guidelines recommending against anti-epileptic drug (AED) utilization in patients with gliomas, there is heterogeneity in prescription practices of AEDs in these patients. In an attempt to impact BTE management, we statistically analyzed clinically relevant attributes (sex, age, tumor size, tumor growth kinetics, and tumor location) pertaining to seizure at presentation and used them to build a computational machine learning model to predict the probability of a seizure (at presentation).MethodsFrom our clinical data repository, we identified 223 patients (females, n=86; males, n=137) with pathologically-determined glioma and known seizure status at clinical presentation. Non-parametric and Fisher’s Exact tests were used to identify statistical differences in clinical characteristics. We utilized a random forest machine learning method for generating our predictive models by entire cohort and separated by male and female.FindingsPatients were divided into those that presented with seizure (SP, n=96, 43%; F, n= 28; M, n= 68) and those that presented without seizure (nSP, n=127, 57%, F n=58, M n=69). Females presented with seizures significantly less often than males (x2=6·28, p=0·01). SP patients had significantly smaller T1Gd radius compared to nSP (SP 11·30mm, nSP 18.66mm, p<0·0001). Tumor size and patient age were significant negative predictors for SP; patients with larger tumors, older age and less tumor diffusivity (p/D) were at lower risk for SP.InterpretationDespite heterogeneity across our patient cohort, there is strong evidence of a role for patient sex, tumor size, tumor invasion, and patient age in predicting the incidence of seizures at diagnosis. Future studies, with prospectively detailed data collection, may provide clearer insights into the incidence of seizures through a patient’s treatment course.

scholarly journals Chart review of diagnostic methods, baseline characteristics and symptoms for European patients with pancreatic cancer

2021 ◽  
Vol 17 (15) ◽  
pp. 1843-1854
Author(s):  
Alfredo Carrato ◽  
Davide Melisi ◽  
Gerald Prager ◽  
Christoph B Westphalen ◽  
Anabel Ferreras ◽  
...  
Keyword(s):  
Chart Review ◽  
Diagnostic Technique ◽  
Tumor Location ◽  
Diagnostic Methods ◽  
Ductal Adenocarcinoma ◽  
Inclusion Criteria ◽  
First Line ◽  
Patient Age ◽  
Patient Âgé ◽  
Baseline Characteristics

Aim: To survey European physicians managing patients with metastatic pancreatic ductal adenocarcinoma (PDAC) and understand differences in baseline characteristics, diagnostic methods, symptoms and co-morbidities. Materials & methods: Patient record inclusion criteria were: ≥18 years old, metastatic PDAC diagnosis and completion of first-line treatment between July 2014 and January 2016. Records were grouped by patient age, gender and primary tumor location. Results: Records (n = 2565) were collected from nine countries. Baseline characteristics varied between subgroups. Computed tomography was the most frequently used diagnostic technique. Symptoms at diagnosis included abdominal and/or mid-back pain (72% of patients) and weight loss (61.5%). Co-morbidities varied with patient age. Conclusion: Greater awareness of symptoms, diagnostic methods and co-morbidities present at PDAC diagnosis may support better patient management decisions.

Biologic and clinicopathologic factors as indicators of specific relapse types in node-negative breast cancer.

1995 ◽  
Vol 13 (3) ◽  
pp. 697-704 ◽  
Author(s):  
R Silvestrini ◽  
M G Daidone ◽  
A Luisi ◽  
P Boracchi ◽  
M Mezzetti ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Tumor Size ◽  
Locoregional Recurrence ◽  
Hormone Receptors ◽  
Distant Metastases ◽  
Locoregional Therapy ◽  
Patient Age ◽  
Node Negative ◽  
Patient Âgé ◽  
Different Types

PURPOSE AND METHODS We evaluated, in 1,800 patients with node-negative tumors treated with locoregional therapy until relapse, the competitive risks for different types of metastasis by cell proliferation (3H-thymidine labeling index [3H-dT LI]), estrogen receptors (ERs), and progesterone receptors (PgRs), and by the integration of biologic and clinicopathologic information. RESULTS Hormone receptor status and proliferative activity of the primary tumor were not indicative of contralateral failures. Hormone receptors failed to predict the 8-year incidence of locoregional recurrence, but they were significant indicators of distant metastasis and overall survival. The latter finding was confirmed even in multivariate analysis. Conversely, cell proliferation predicted both locoregional and distant metastases and survival, regardless of patient age, tumor size, and ER and PgR status. Recursive partitioning and amalgamation analysis ascribed to cell proliferation an important prognostic role for locoregional recurrence together with patient age and tumor size. CONCLUSION Biologic markers, in particular cell proliferation, provide information for the different types of relapse and could complement the predictive role of pathologic staging.

Association of proliferative activity and size in acoustic neuroma: implications for timing of surgery

2003 ◽  
Vol 98 (4) ◽  
pp. 807-811 ◽  
Author(s):  
Anan Bedavanija ◽  
Jürgen Brieger ◽  
Hans-Anton Lehr ◽  
Jan Maurer ◽  
Wolf J. Mann
Keyword(s):  
Acoustic Neuroma ◽  
Growth Rates ◽  
Tumor Size ◽  
Proliferative Activity ◽  
Ki 67 ◽  
Patient Age ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Patient Âgé ◽  
Fine Print

Object. Acoustic neuroma is the most frequent benign tumor of the cerebellopontine angle, and surgery is still the most common form of treatment. To gain better insight into the dysregulated mechanisms causing growth of acoustic neuroma, the authors studied the proliferative activity of 34 consecutive samples by analyzing immunohistochemical staining with Ki-67 and proliferating cell nuclear antigen (PCNA), and apoptosis based on the terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick-end labeling. Data from these analyses were correlated with clinical parameters (that is, tumor size, duration of symptoms, and patient age). Methods. Apoptotic cells were found in none of the tumors. Proliferation measured on staining with Ki-67 and PCNA correlated with tumor size, but not with patient age or duration of symptoms. The authors demonstrated that tumors 18 mm or smaller in diameter have lower proliferation indices and growth rates, compared with tumors larger than 18 mm with high proliferative indices and growth rates. Additionally, they observed that these more aggressive, larger tumors occur mostly in patients younger than 50 years of age. Conclusions. Patients with tumors larger than 18 mm in diameter and who are younger than 50 years of age sustain an enhanced risk for fast-growing tumors because of these lesions' enhanced proliferative activity. For these patients the authors recommend active therapy.

Retrospective Comparison of Using or Not Using Donor Lymphocyte Transfusion in the Treatment of Hematological Relapse after Allogeneic Stem Cell Transplantation in 489 Adults with Acute Myeloid Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 298-298
Author(s):  
Christoph Schmid ◽  
Myriam Labopin ◽  
Juergen Finke ◽  
Gerhard Ehninger ◽  
Olle Ringden ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
De Novo ◽  
Patient Age ◽  
Entire Cohort ◽  
Post Transplant ◽  
Patient Âgé ◽  
Retrospective Comparison ◽  
De Novo Aml

Abstract Relapsed AML after allogeneic SCT has a poor prognosis. So far, no standard therapy could be defined. Donor lymphocyte transfusion (DLT) has been effective in a minority, however, no data is available to identify patients who will benefit from the procedure. Neither, the outcome of patients treated with or without DLT have been compared. We retrospectively evaluated overall survival (OS) of 489 adults with de novo AML in hematological relapse after SCT, receiving DLT (n=190) or not (n=299). DLT and noDLTgroups were well balanced in terms of patient age (median:37y in both groups), donor age, cytogenetics (good:5vs7%, intermediate:83vs79%, poor:12%vs14%), WBC at diagnosis, donor type (geno-id:71vs72%, MUD:18% both, mismatched:11vs10%), status at transplantation (CR1:38vs41%, CR2:13vs15%, advanced:49vs44%), conditioning, source of stem cells, and time from transplant to relapse (5vs4.5 months). However, DLT patients had a median of 39% BM blasts, as compared to 54% for the noDLT group (p=0.03). Follow-up was 32 and 30 months. Within the DLT group, chemotherapy was additionally given in 130 cases. Nevertheless, only 33% of patients received DLT in CR or aplasia, 67% had measurable disease. AGvHD developed in 41% of patients following DLT. CR and PR were achieved in 31.1% and 4.8% of DLT patients. In a multivariate analysis, younger patient age (&lt;36 years) (HR=1.53,p=0.02) and a longer interval (&gt; 5 months) from transplant to relapse (HR=7.74,p=0.002) were associated with better OS after DLT. When comparing the outcome of patients receiving or not DLT, OS at 2 years was 10±1% for the entire cohort, 18±3% for DLT and 6±1% for noDLT (p&lt;.0001). In a multivariate analysis, use of DLT (HR=2.11,p&lt;0.0001); recipient’s age&lt;36 y (HR=1.69, p&lt;0.001); longer interval (&gt;5 months) from transplant to relapse (HR=2.40, p&lt;0.0001) and number of BM blasts (&lt;48%) at relapse (HR=1.56,p=0.002) were favorable for OS. In this retrospective analysis the results suggest that DLT may be of advantage in the treatment of AML relapse post transplant, at least in younger patients with a longer post transplant remission and relapsing with smaller amounts of blasts in BM. However, patients receiving DLT might represent a positive selection among all relapsed cases, since a considerable number from the noDLT cohort had died too early to proceed to DLT. An intetion-to-treat analysis and further prospective studies should investigate the role of DLT and other approaches, such as second reduced intensity SCT.

scholarly journals Path Analysis on the Determinants of Hospital Lost Under INA-CBGS Reimbursement for Patient with Dengue Hemorrhagic Fever in Ngawi Regional Public Hospital, East Java

2020 ◽  
Author(s):  
Betty Nurizky Ariwardani ◽  
◽  
Didik Gunawan Tamtomo ◽  
Bhisma Murti ◽  
◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Length Of Stay ◽  
Path Analysis ◽  
Dengue Hemorrhagic Fever ◽  
Hemorrhagic Fever ◽  
Medical Services ◽  
Analysis Model ◽  
Patient Age ◽  
Patient Âgé ◽  
Co Morbidity

ABSTRACT Background: Hospitals are demanded to be more efficient and effective in providing medical services to avoid losses in the era of National Health Insurance. The increase in cases of dengue hemorrhagic fever (DHF) is a burden on the cost of medical services in Indonesia. This study aimed to examine the determinants of hospital lost under Indonesia Case-Based Groups (INA-CBGs) reimbursement for patients with dengue hemorrhagic fever (DHF). Subjects and Method: A cross-sectional study was carried out at dr. Soeroto hospital, Ngawi, East Java, from September to October 2019. A sample of 200 in-patients was selected by simple random sampling. The dependent variable was tariff difference between INA-CBGs and hospital cost. The independent variables were class of treatment, length of stay, blood transfusion, co-morbidity, and complication. The data were obtained from DHF in-patients’ medical record. The data were analyzed by path analysis model run on Stata 13. Results: Tariff difference was directly and positively affected by length of stay (b= 2.77; 95% CI= 1.78 to 3.75; p<0.001), blood transfusion (b= 2.95; 95% CI= 0.36 to 5.54; p= 0.025), patients age (b= 0.09; 95% CI= -1.52 to 1.71; p= 0.907), co-morbidity (b= 0.58; 95% CI= -1.07 to 2.22; p= 0.491), and complication (b= 0.34; 95% CI= -1.69 to 2.36; p= 0.743). Tariff difference was directly and negatively affected by type of treatment (b= -0.81; 95% CI= -2.02 to 0.40; p= 0.191). Tariff difference was indirectly affected by co-morbidity, complication, class of treatment, and patient age. Conclusion: Tariff difference is directly and positively affected by length of stay, blood transfusion, patient age, co-morbidity, and complication. Tariff difference is directly and negatively affected by type of treatment. Tariff difference is indirectly affected by co-morbidity, complication, class of treatment, and patient age. Keywords: INA CBGs, hospital tariff, care cost, dengue hemorrhagic fever Correspondence: Betty Nurizky Ariwardani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: [email protected]. Mobile: 082233243164. DOI: https://doi.org/10.26911/the7thicph.04.35

scholarly journals A machine-learning classifier trained with microRNA ratios to distinguish melanomas from nevi

2018 ◽  
Author(s):  
Rodrigo Torres ◽  
Ursula E Lang ◽  
Miroslav Hejna ◽  
Samuel J Shelton ◽  
Nancy M Joseph ◽  
...  
Keyword(s):  
Machine Learning ◽  
Tumor Cell ◽  
Small Rna Sequencing ◽  
Cell Content ◽  
Patient Age ◽  
Learning Classifier ◽  
Melanocytic Lesions ◽  
Patient Âgé ◽  
Confounding Variables ◽  
Effective Use

The use of microRNAs as biomarkers has been proposed for many diseases including the diagnosis of melanoma. Although hundreds of microRNAs have been identified as differentially expressed in melanomas as compared to benign melanocytic lesions, limited consensus has been achieved across studies, constraining the effective use of these potentially useful markers. In this study we quantified microRNAs by next-generation sequencing from melanomas and their adjacent benign precursor nevi. We applied a machine learning-based pipeline to identify a microRNA signature that separated melanomas from nevi and was unaffected by confounding variables, such as patient age and tumor cell content. By employing the ratios of microRNAs that were either enriched or depleted in melanoma compared to nevi as a normalization strategy, the classifier performed similarly across multiple published microRNA datasets, obtained by microarray, small RNA sequencing, or RT-qPCR. Validation on separate cohorts of melanomas and nevi correctly classified lesions with 83% sensitivity and 71-83% specificity, independent of variation in tumor cell content of the sample or patient age.

Predicting Aggressive Behavior in Nonfunctional Pancreatic Neuroendocrine Tumors With Emphasis on Tumor Size Significance and Survival Trends: A Population-Based Analysis of 1787 Patients

2020 ◽  
Vol 86 (5) ◽  
pp. 458-466
Author(s):  
Amir H. Fathi ◽  
Jonathan Romanyshyn ◽  
Mehdi Barati ◽  
Uzair Choudhury ◽  
Allen Chen ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Cox Proportional Hazards ◽  
Pancreatic Neuroendocrine Tumors ◽  
Clinicopathologic Characteristics ◽  
Patient Age ◽  
Patient Âgé ◽  
The Impact

Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with continued controversies in management. This study aims to identify demographic and clinicopathologic characteristics associated with aggressive behavior and survival. Methods The Surveillance, Epidemiology, and End Results database was used to identify patients with NF-PNETs from 1988 to 2012. Multivariate regression analysis and Cox proportional hazards modeling were used to assess the impact of patient, tumor, and treatment characteristics on tumor behavior and overall survival. Results In 1787 patients identified, size was a major determinant of aggressive behavior. The probability of aggressiveness increased 100% for tumor size ≥2 cm. For tumors ≥2 cm, every 1-cm increase in size was associated with an increase in probability of aggressive behavior by 11.3%. Patient age, tumor grade, and surgical resection were independent predictors of survival. Surgical resection was associated with improved survival but not grade I or II tumors with size <2 cm. Discussion Patient age, tumor size, and grade should be in the decision-making process around the surgical management of NF-PNETs. For tumors ≤2 cm with histologic grades of I or II, the probability of aggressive behavior is low, and surgical resection does not appear to afford survival benefit. Therefore, close observation could be justified.

Stage IIA1 Versus Stage IIA2 Cervical Cancer: Does the New Staging Criteria Predict Survival?

2011 ◽  
Vol 21 (4) ◽  
pp. 711-716 ◽  
Author(s):  
Gunjal Garg ◽  
Jay P. Shah ◽  
Eugene P. Toy ◽  
Carl Christensen ◽  
Gunter Deppe ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Radical Hysterectomy ◽  
Tumor Size ◽  
International Federation ◽  
Primary Radiation ◽  
Adjuvant Radiation ◽  
Patient Age ◽  
Gynecology And Obstetrics ◽  
Patient Âgé

Objective:(1) To determine the correlation of 2008 International Federation of Gynecology and Obstetrics staging system with survival in patients with stage IIA cervical cancer, (2) to elucidate the treatment patterns in stage IIA1 and stage IIA2 cervical cancer, and (3) to investigate whether radical hysterectomy or radiation influenced overall survival.Methods:Data were extracted from the Surveillance, Epidemiology and End Results database between 1988 and 2005. Statistical analysis usedχ2test, Kaplan-Meier method, Cox regression, and logistic regression.Results:Of the 560 women, 271 (48.4%) had stage IIA1, and 289 (51.6%) had stage IIA2 cervical cancer. Stage IIA2 patients were younger than stage IIA1 patients (mean age, 49 years vs 54 years;P= 0.01). Stage IIA1, compared with stage IIA2, differed significantly regarding the administration of primary radiation (47.2% vs 64.7%,P< 0.001) and adjuvant radiation (60.5% vs 77.5%,P= 0.006). The following variables were significantly associated with the performance of radical hysterectomy: patient age, 65 years or younger, tumor size, ≤2 cm or lesser, high tumor grade, and nonsquamous tumor histology. The incidence of adjuvant radiation after radical hysterectomy was high (48% [tumor size, ≤2 cm] to 86% [tumor size, >6 cm]). The 5-year overall survival was not significantly different between stages IIA1 and IIA2 (65.8% vs 59.5%,P= 0.2). Only patient age (P= 0.01), tumor size (P= 0.02), and lymph node status (P= 0.002) were independent predictors of survival. When controlled for other contributing factors, there was no significant difference in survival between patients treated by radical hysterectomy and primary radiation.Conclusions:The 2008 International Federation of Gynecology and Obstetrics staging criteria is not an independent predictor of survival in stage IIA cervical cancer. Given the equivalent efficacy of radical hysterectomy and radiation, attention should be paid to the high risk of adjuvant radiation in these patients.

Length of stay as risk factor for inappropriate hospital days: interaction with patient age and co-morbidity

2011 ◽  
Vol 19 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Riccardo Barisonzo ◽  
Wolfgang Wiedermann ◽  
Matthias Unterhuber ◽  
Christian J. Wiedermann
Keyword(s):  
Risk Factor ◽  
Length Of Stay ◽  
Patient Age ◽  
Patient Âgé ◽  
Co Morbidity ◽  
Hospital Days
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