Abstract
Introduction: Multiple myelomas (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Despite the remarkable improvement in survival ...rates with different treatment approaches; multiple myeloma patients are at higher risk of cardiovascular and thromboembolic events. Therefore, we aim to identify high-risk patients for cardiovascular mortality and provoke awareness among physicians for choosing appropriate therapy for better survival rates in those patients.
Methods Surveillance, Epidemiology, and End Results Program database used for this work. Kaplan Meier survival curves were constructed to compare the survival probabilities. Furthermore, Cox regression analysis was conducted to detect the most important factors determining the survival time. The significant variables were used to construct nomogram and its fit was assessed using c-index.
Results The cohort included 55991 multiple myeloma patients with 4510 deaths by cardiovascular and thromboembolic events. There was a significant difference in age between both groups (P-value < 0.001). There was a significant difference between both groups regarding the treatment choices, type of radiation, race and marital status. SEER database identified four diseases as a cause of death in multiple myeloma: Aortic aneurysm and dissection (n = 39), atherosclerosis (n = 88), cerebrovascular diseases (n = 1861) and diseases of the heart (n = 3799). Kaplan Meier survival curves revealed a significant difference in the survival probability between the multiple myeloma grades (P < 0.001). We found that hypertension with multiple myeloma has the best median survival (median =1, 95% CI (0.133,1) and the worst survival was in patients diagnosed with an aortic aneurysm and dissection (median =0.09, 95% CI (0.03,0.25). Cardiac causes of death had less survival than other reported causes of death. The log-rank test found significantly different median survival between different cardiac causes (p<0.0001). Cox proportional hazard ratio regression revealed that gender Male (HR = 1.39, SE = 0.03, P-value = 0.005, age (HR = 1.07, SE = 0.0015, P-value = 0.005), marital status (HR = 0.81, SE = 0.064, P-value = 0.0014), grade and surgery were significant risk factors for death with thromboembolic and cardiovascular diseases. These variables were used in nomogram. The c-index of the nomogram was 0.72, 95%CI (0.71 - 0.73). The prediction error (OOB) of the tree was 0.10. We found that random forest model had less survival over time than cox regression.
Conclusion: The mortality from by cardiovascular and thromboembolic events in MM was associated with several factors. Our considerations and further investigations of them is needful. It may aid in identifying the patients who can get the uppermost benefits of cardiovascular and thromboembolic prophylaxis and treatment measures.
Citation Format: Muhammed Khaled Elfaituri, Sara Morsy, Amr Ehab El-Qushayri, Hazem Abdelkarem Faraj, Minh-Duc Nguyen Tran, Amr Ebied, Amr Ebied, Nguyen Tien Huy. Cardiovascular and thromboembolic diseases as a cause of death in multiple myeloma patients: A population based study abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3302.
Objective
The objective of the study was to assess the role of regulatory T cells (Tregs) in type 2 diabetic nephropathy (DN), particularly the contribution of Tregs to the degree of albuminuria as a ...marker of renal damage.
Background
Treg cells have immunoregulatory roles that might be involved in the pathogenesis of DN. Self-tolerance and allogeneic tolerance are mediated by Treg cells, and expression of this category of lymphocytes may be supposed to mediate the development of type 2 DN.
Patients and methods
We conducted a cross-sectional study on 45 patients with type 2 diabetes mellitus who were classified into three groups according to the degree of albuminuria, with group I representing normoalbuminuric patients, group II representing patients with moderately increased albuminuria (microalbuminuria), and group III representing patients with severely increased albuminuria (macroalbuminuria). Demographic data were recorded. Blood samples for laboratory variables were collected and measured using the standard methods. Flow cytometry analysis was used to assess the expression of Treg cells in the peripheral blood samples obtained from the three groups.
Results
CD4+CD25+Foxp3+ Treg cells expression in peripheral blood by flow cytometry analysis was significantly decreased among microalbuminuric patients when compared with normoalbuminuric patients and also macroalbuminuric patients showed a significant lowered expression of CD4+CD25+Foxp3+ Treg cells when compared with normoalbuminuric patients. There were statistically significant correlations between the median of Treg/lymphocyte percent and the following parameters: urinary albumin-creatinine ratio, duration of diabetes mellitus, and glomerular filtration rate among the three studied groups. Multivariate analysis showed that only Treg percent was an independent predictor of albuminuria (P = 0.046).
Conclusion
The results of this study suggest that Tregs might have a correlation with diabetic kidney disease development.
Background
Intraoperative bleeding during functional endoscopic sinus surgery (FESS) poses a challenge to both surgeon and anesthetist. The primary aim of this study was to evaluate the effectiveness ...of local, intravenous and combined use of tranexamic acid (TA) in improving the surgical field quality during FESS.
Methods
We conducted a randomized controlled double‐blinded prospective trial on 120 patients scheduled for elective FESS. After induction of general anesthesia, patients were randomly and evenly assigned to one of four groups; IV TA, local TA, both IV and local TA, and placebo. Surgical field was assessed using five‐point Boezaart scale. Total fentanyl and esmolol consumption, operative time, recovery time, and postoperative complications were recorded.
Results
Surgical field quality score was the best in IV and local TA group compared to others (p < 0.001). Mean operative time was found significantly shorter in IV and local TA group than placebo one. Total fentanyl consumption was significantly lower in IV and local TA group comparing to others (p = 0.025). Mean recovery time was significantly shorter for IV and local TA group compared to others. Total fentanyl consumption was significantly lower in IV and local TA group comparing to others. No significant differences were found of mean arterial pressure and heart rate decline in four groups. None of the patients in four groups required esmolol administration. No statistically significant differences were found in change of hemoglobin, hematocrit, prothrombin time, and partial thromboplastin time over time in all groups.
Conclusion
The combined use of topical and intravenous TA provided the best surgical field in FESS, less fentanyl consumption, and less recovery time without causing significant side effects.
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e19069
Background: The prognostic factors influencing survival and optimal management of primary pulmonary lymphomas (PPLs) have not been clearly defined due to rarity of the disease. ...This study sought to characterize the significant prognostic factors of PPL and develop a prognostic nomogram for individualized prediction of survival outcomes in patients with PPL. Methods: Patients diagnosed with PPL between 1983 and 2010 were identified using the Surveillance, Epidemiology, and End Results (SEER) Program database. Kaplan-Meier survival analysis and Cox proportional hazards regression model were performed to identify significant independent prognostic factors for overall survival (OS) in patients with PPL. A nomogram was constructed for the prediction of 5-year OS probability based on these variables. Results: The study cohort of 2325 PPL patients has a 5-year OS rate of 52% and a median OS of 67 months. Older age at diagnosis (HR 1.031; 95% CI, 1.026-1.036; p<0.001, males (HR 1.434; 95% CI, 1.267-1.622; p<0.001), Hispanic race (HR 1.370; 95% CI, 1.113-1.687; p=0.003), non-marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT) histology (p<0.001), primary site at main bronchus (HR 1.326; 95% CI, 1.014-1.735; p=0.039), Ann Arbor stage IV (HR 1.542; 95% CI, 1.324-1.795; p<0.001) were significantly associated with worse OS. All treatment modalities, including chemotherapy (HR 0.615; 95% CI, 0.536-0.706; p<0.001), surgery (HR 0.666;95% CI, 0.577-0.769; p<0.001) and radiotherapy (HR 0.829; 95% CI, 0.693-0.992; p=0.041) were independent predictors of survival. The nomogram constructed using these variables has a higher concordance index of 0.716 (95% CI, 0.699-0.734) compared to that of Ann Arbor staging system 0.571 (95% CI,0.552-0.591); p<0.001. Conclusions: Older age, male sex, Hispanic race, non-MALT histology, primary site at main bronchus, advanced Ann Arbor stage, not receiving treatment were independent prognostic factors that are associated with worse OS in patients with PPL. The nomogram demonstrated good agreement between the predicted probabilities and actual observations on calibration plots.
Primary pulmonary lymphomas (PPLs) are rare lymphoproliferative malignancies arising from the lungs. The prognostic factors and optimal management of PPL have not been clearly defined due to its ...rarity. This study sought to characterize the significant prognostic factors and develop a validated nomogram for individualized prediction of survival outcomes in patients with PPL. A total of 2325 patients diagnosed with PPL between 1983 and 2010 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Older age at diagnosis, males, Hispanic race, non-marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue histology, Ann Arbor stage IV were significantly associated with worse OS on multivariable analysis. All treatment modalities, including chemotherapy, surgery, and radiotherapy were independent predictors of survival on univariable analysis. The nomogram built demonstrated good discriminative ability and calibration, with the C-index of 0.690 and 0.730 in the training and validation cohorts, respectively.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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e17576
Background: With the increase in survival of cancer patients, consequently, increasing their quality of life is mandatory as well. Sleep disturbances, particularly Obstructive ...Sleep Apnea (OSA), is one of the main complaints of cancer patients in which patients face frequent episodes of upper airway closure during sleep. Possible causes for OSA include either the specific cancer or its treatment whether sedatives, narcotics, radiotherapy, or chemotherapy, but the primary cause is still hard to prove. Our aim was to investigate the association between the occurrence of OSA and radiotherapy in cancer patients. Methods: On the 9th of September, 2018, we have searched comprehensively 12 electronic databases to retrieve relevant studies. All eligible studies that assess the association between OSA and radiotherapy in cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tool for cohort and cross-sectional studies. Results: Fourteen studies met our selection criteria, eight studies were eligible for our meta-analysis. There was a positive association between the occurrence of OSA and radiotherapy in cancer patients (OR 1.16, 95% CI 0.52–2.56; P = 0.718). OSA was noted in 103 of 181 cancer patients who received radiotherapy, yielding a remarkable overall prevalence of 63% (95% CI 0.36–0.85; P = 0.343). A positive risk ratio for the development of OSA in cancer patients treated with radiotherapy was detected (RRs 1.27, 95% CI 0.81–2.00; P = 0.297). The overall mean of apnea hypopnea index (AHI) for patients with OSA in six studies was 22.45. Conclusions: These findings point to a striking association between OSA risk and radiotherapy in cancer patients. Since the early recognition and management of OSA in such patients may play an important role in improving their quality of life, we recommend screening all cancer patients treated with radiation for early signs of OSA to further improve their survival.
Background and Objectives
Iron overload in thalassaemia is a crucial prognostic factor and a major cause of death due to heart failure or arrhythmia. Therefore, previous research has recommended ...amlodipine as an auxiliary treatment to current chelating agents for reducing iron overload in thalassaemia patients.
Materials and Methods
A systematic review and meta‐analysis of the results of three randomized clinical trials evaluating the use of amlodipine in thalassaemia patients through 12 databases were carried out.
Results
Our final cohort included 130 patients. Insignificant difference in decreasing liver iron concentrations was found between amlodipine and control groups {weighted mean difference = −0·2, 95% confidence interval = (−0·55–0·15), P = 0·26}. As regards serum ferritin, our analysis also showed no significant difference in serum ferritin between amlodipine and control groups {weighted mean difference 95% confidence interval = −0·16 (−0·51–0·19), P = 0·36}. Similarly, there was insignificant difference in cardiac T2* between amlodipine and control groups {weighted mean difference 95% confidence interval = 0·34 (−0·01–0·69), P = 0·06}.
Conclusions
Despite the growing evidence supporting the role of amlodipine in reducing iron overload in thalassaemia patients, our meta‐analysis did not find that evidence collectively significant. The results of our simulation suggest that when more data are available, a meta‐analysis with more randomized clinical trials could provide more conclusive insights.
Summary
Background
Degranulation of mast cells (MCs) releases several mediators such as vascular endothelial growth factor (VEGF), chymase, tryptase, histamine, and cytokines, which all have ...important roles in the severity of dengue infection. We aimed to investigate the role of MCs in severity of dengue.
Methods
We searched for relevant studies in 10 databases on 15 August 2016. Meta‐analysis (MA) was conducted by R version 3.5.0.
Results
We included 24 studies. in vivo and in vitro studies showed higher MC products released from infected mice/cells with dengue virus. In addition, when administering MC stabilizers or antihistaminic drugs, there was a decrease in vascular/capillary permeability. In human and at early stages, studies revealed an insignificant difference in VEGF levels in dengue fever (DF) versus dengue hemorrhagic fever (DHF) (standardized mean difference SMD 0.145; 95% confidence interval CI, −0.348‐0.638). Meanwhile, at acute stages and compared with healthy controls, high heterogeneity with an inconclusive difference in VEGF levels were noted in DF and DHF. However, pooled serum and plasma levels of VEGF were increased significantly in dengue shock syndrome (DSS) versus healthy controls (SMD 0.65; 95% CI, 0.3‐0.95). There were also significantly higher chymase levels in DHF patients compared with DF during the acute phase (MD −6.531; 95% CI, −12.2 to −0.9).
Conclusion
VEGF and chymase levels are mediators in dengue pathogenesis. However, limited data were available to support their role in severe dengue cases. Further studies are needed to evaluate the function of other mediators in dengue severity.
Little is known about the association between specific primary lymph node (LN) sites and the risk of developing second primary cancers in Hodgkin lymphoma (HL) patients.
To fill this knowledge gap, ...we used the multiple primary standardized incidence ratio function of the SEER*stat program to explore such an association for multiple latency periods.
Several SPCs occurred at various time points following different primary LN presentations of HL.
HL survivors may benefit from a tailored primary LN site-specific follow-up screening.
