Factors influencing the development of recurrence and continued growth of primary extramedullary tumors removed using Nd:YAG laser

Objective. To assess the significance of clinical factors of extramedullary tumors and new methods of their resection as potential predictors of their recurrence and continued growth.Material and Methods. The long-term results of removal of primary extramedullary tumors in 412 patients operated on in 1998–2014 were analyzed comparing the use of standard methods of microsurgical technique for tumor removal (277 patients) and of those with additional use of neodymium laser radiation (135 patients).Results. The use of laser technologies for resection of extramedullary tumors can significantly reduce the number of their recurrences and continued growth, along with other clinical factors is a significant prognostic indicator in determining the nature of the disease course and can be a predictor of their occurrence. The most reliable clinical factors determining the prognosis of a decrease in the incidence of recurrences and continued growth when using laser techniques of surgical resection were repeated operations (p = 0.002), the presence of ependymomas of the cone and cauda equina (p = 0.017), operations for primary tumors in the thoracic spine (p = 0.039) and extramedullary tumors with Grade I anaplasia (p = 0.007). An increase in the number of these conditions was associated with operations on the cervical spine (p = 0.027), the presence of a tumor with Grade II anaplasia (p = 0.007), and a primary extramedullary tumor involving more than three vertebrae (p = 0.017).Conclusion. The use of the laser is indicated for reoperations when removing neoplasms, that have arisen as a result of recurrence or continued growth of extramedullary tumors of any level and length after removal of primary neoplasms with a Grade I malignancy confirmed by intraoperative cytological examination involving no more than three vertebrae in the thoracic, lumbar and sacral spine and during resection of ependymomas with extramedullary growth.

Investigating the efficacy of medical management for canine structural epilepsy

BackgroundStructural epilepsy in dogs is often treated medically with a combination of antiseizure drugs (ASDs) and other concurrent therapies for the primary condition. Unlike idiopathic epilepsy, there have been few studies on the efficacy of medical management in structural epilepsy. This study investigated factors affecting treatment outcomes in dogs medically managed for structural epilepsy.MethodsCases of 71 dogs diagnosed with structural epilepsy were identified from a referral hospital database and data were analysed retrospectively. Efficacy of treatment was assessed by survival time, seizure-free period after diagnosis and overall seizure control.ResultsResults showed that the most significant prognostic indicator was the occurrence of status epilepticus (SE) before diagnosis, with these dogs having reduced survival times, shorter seizure-free periods after diagnosis and overall worse seizure control. Cluster seizure history showed similar, although not statistically significant, trends in treatment efficacy. Treatment outcomes were not significantly impacted by ASD therapy used or by specific diagnosis, with the exception of meningoencephalitis of unknown aetiology cases surviving longer.ConclusionOverall, medical management of canine structural epilepsy achieves the best treatment outcomes when the patient has no history of SE. This study may provide a basis for future investigations into the treatment of canine structural epilepsies.

Pseudomonas aeruginosaisolation in patients with non-cystic fibrosis bronchiectasis: a retrospective study

ObjectivesPseudomonas aeruginosa (P. aeruginosa)occupies an important niche in the pathogenic microbiome of bronchiectasis. The objective of this study is to evaluate the clinical characteristics and prognostic value ofP. aeruginosain Chinese adult patients with bronchiectasis.MethodsThis retrospective and follow-up study enrolled 1188 patients diagnosed with bronchiectasis at Shanghai Pulmonary Hospital between January 2011 and December 2012. The patients’ clinical data including anthropometry, clinical symptoms, serum biomarkers, radiographic manifestations and lung function indices were reviewed. The median follow-up duration (IQR) was 44 (40-54) months, during which 289 patients were lost to follow-up. Data from 899 patients were collected and analysed for the outcomes of mortality, annual exacerbation frequency and health-related quality of life.ResultsP. aeruginosawas isolated from 232 patients, alongside other pathogens such asAspergillus(n=75) andCandida albicans(n=72). There were 74 deaths (12% of patients withP. aeruginosa, 7.3% of those without) over the course of the follow-up. The isolation ofP. aeruginosawas a risk factor for all-cause mortality (HR, 3.07; 95% CI 1.32 to 7.15) and was associated with high rates of exacerbations (ie, ≥3 exacerbations per year of follow-up) (HR, 2.40; 95% CI 1.20 to 4.79). Patients withP. aeruginosaalso had worse scores on the Hospital Anxiety and Depression Scale (anxiety, p=0.005; depression, p<0.001), the Leicester Cough Questionnaire (p=0.033) and the modified Medical Research Council scale (p=0.001) compared with those withoutP. aeruginosa.ConclusionsIsolation ofP. aeruginosain patients with bronchiectasis is a significant prognostic indicator and should be a major factor in the clinical management of the disease.

Prognostic Significance of Weight Loss and BMI during Induction Chemotherapy of Newly Diagnosed Acute Myeloid Leukemia (AML) Patients

Background: A wide landscape of factors exists to stratify the prognosis of patients with newly diagnosed AML including age, race, cytogenetics, and functional status. However, weight loss and malnutrition have yet to be fully evaluated as possible prognostic indicators for the patient with AML. Aim: This study aims to 1) investigate how weight loss and nutritional markers (BMI and albumin) change over the course of treatment and 2) their prognostic significance in terms of overall survival (OS) and complete remission (CR) in patients with newly diagnosed AML. Methods: We retrospectively analyzed patients from January 2000 to June 2012 diagnosed with AML over 18 years of age, who were treated at OUHSC with induction chemotherapy. 215 AML patients were identified. BMI and albumin levels were examined using mean plots over 3 time points. Patients treated before 2005 were eventually excluded due to the poor documentation of the height and weight. A total of 121 patients had BMI measurements for the first 2 time periods, while 89 had BMI measures at all 3 time periods. Simple descriptive statistics were created for all covariates [mean and SD for continuous covariates; n (%) for categorical variables]. For aim 1, to evaluate changes in BMI and albumin over time, mixed models were used including age (<60 years and ≥ 60 year) and gender.To examine aim 2, a Cox proportional hazards model was used to assess the univariate association of each covariate with survival. A final model was then created using all covariates from the univariate models with p-values <0.25. All two-way interactions with BMI group were explored. Binary logistic regression models were created to examine the association of each covariate with CR. BMI was categorized into two groups according to increase or decrease in BMI over time period. Results: Among the 121 patients mean age was 53 years (range 16 to 89 years). BMI (mean 29.85, 28.75, and 27.9 across the three time points) and albumin (mean 3.30, 3.21, and 2.55 across the three time points) both decrease over time and these changes were not different by age or gender. For OS, a significant interaction between cytogenetic risk group and BMI group was identified; therefore, patients were stratified by these risk groups. Age (p=0.0012) was found to be a more significant prognostic indicator than BMI group in the unfavorable risk group. Among patients in the intermediate cytogenetic risk group, BMI group (p=0.0210) was significantly associated with OS; those with increased BMI have 2.38 times the hazard of death relative to those with a BMI decrease, adjusting for age group. BMI group is not significantly associated with OS in any other model. Albumin was not associated with OS in any model. Conclusion: Age was found to be a more significant prognostic indicator than BMI in the unfavorable risk group, and BMI increase was found to have an increased hazard of death in the intermediate risk group. Further studies are needed to examine the prognostic significance of weight loss during induction chemotherapy. Disclosures No relevant conflicts of interest to declare.