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Risk Stratification

Laura J Davidson, Charles J Davidson
Stroke leads to significant morbidity, disability, and mortality after TAVR. CKD and prior stroke are risk factors for stroke. Stratification of stroke risk would improve outcomes associated with TAVR. Ongoing prospective randomized trials on embolic protection and post implant anticoagulation are promising strategies to reduce stroke risk and new brain MRI lesions.
October 2016: Catheterization and Cardiovascular Interventions
Jolanta Skalska-Sadowska, Małgorzata Dawidowska, Bronisława Szarzyńska-Zawadzka, Małgorzata Jarmuż-Szymczak, Joanna Czerwińska-Rybak, Ludomiła Machowska, Katarzyna Derwich
We report a pediatric case of acute T-lymphoblastic leukemia (T-ALL) with NOTCH1(wt) , FBXW7(wt) , STIL/TAL1, and PTEN (exons 2, 3, 4, 5) monoallelic deletions, biallelic CDKN2A/B deletion, and a minor t(8;14)(q24;q11)-positive subclone. Undetectable by a flow cytometric minimal residual disease assay, the t(8;14)(q24;q11) subclone expanded as detected by fluorescence in situ hybridization from 5% at diagnosis to 26% before consolidation and 100% at relapse bearing a monoallelic deletion (exons 2, 3) with a new frameshift mutation of PTEN and the same set of remaining molecular alterations...
October 19, 2016: Pediatric Blood & Cancer
Gleim Dias de Souza, Luciana Rodrigues Queiroz Souza, Ronaldo Máfia Cuenca, Bárbara Stephane de Medeiros Jerônimo, Guilherme Medeiros de Souza, Vinícius Martins Vilela
Introduction: Contrast computed tomography and magnetic resonance imaging are widely used due to its image quality and ability to study pancreatic and peripancreatic morphology. The understanding of the various subtypes of the disease and identification of possible complications requires a familiarity with the terminology, which allows effective communication between the different members of the multidisciplinary team. Aim: Demonstrate the terminology and parameters to identify the different classifications and findings of the disease based on the international consensus for acute pancreatitis ( Atlanta Classification 2012)...
July 2016: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
Rossella Letizia Mancusi, Massimo Andreoni, Daniela d'Angela, Cesare Sarrecchia, Federico Spandonaro
Between western European countries, the hepatitis C virus (HCV) endemic is highest in Italy. The main objective of this paper is to estimate the endemic diffusion of hepatitis C at the national level and by geographical area, with an extrapolation at the regional level and by uniform cohorts of subjects (by sex and year of birth). The secondary objective is a stratification by gravity of the estimated statistical figures to provide an overview of possible targets of the new anti-HCV treatments.PubMed and the Cochrane Library were searched for relevant Italian populations studies regarding HCV prevalence...
October 2016: Medicine (Baltimore)
Antonino Neri, Katia Todoerti, Marta Lionetti, Vittorio Simeon, Marzia Barbieri, Filomena Nozza, Gabriella Vona, Alessandra Pompa, Luca Baldini, Pellegrino Musto
Primary plasma cell leukemia (PPCL) is a rare and aggressive variant of multiple myeloma. The introduction of novel agents and modern technologies has recently partially changed the clinical and biological scenario of this malignancy, allowing limited, but not negligible, progresses. Areas covered: We will discuss the complex landscape of genetic alterations in PPCL, derived from conventional and high-throughput technologies; the best available treatments for PPCL; the possible future therapeutic perspectives...
October 19, 2016: Expert Review of Hematology
Richard Quek, Mohamad Farid, Yada Kanjanapan, Cindy Lim, Iain Beehuat Tan, Sittampalam Kesavan, Tony Kiat Hon Lim, Lynette Lin-Ean Oon, Brian Kp Goh, Weng Hoong Chan, Melissa Teo, Alexander Yf Chung, Hock Soo Ong, Wai Keong Wong, Patrick Tan, Desmond Yip
AIM: Benefit of adjuvant imatinib therapy following curative resection in patients with intermediate-risk gastrointestinal stromal tumor (GIST) is unclear. GIST-specific exon mutations, in particular exon 11 deletions, have been shown to be prognostic. We hypothesize that specific KIT mutations may improve risk stratification in patients with intermediate-risk GIST, identifying a subgroup of patients who may benefit from adjuvant therapy. METHODS: In total, 142 GIST patients with complete clinicopathologic and mutational data from two sites were included...
October 17, 2016: Asia-Pacific Journal of Clinical Oncology
Mario I Fernández, Stephen B Williams, Daniel L Willis, Rebecca S Slack, Rian J Dickstein, Sahil Parikh, Edmund Chiong, Arlene O Siefker-Radtke, Charles C Guo, Bogdan A Czerniak, David J McConkey, Jay B Shah, Louis L Pisters, H Barton Grossman, Colin P N Dinney, Ashish M Kamat
OBJECTIVE: To analyze survival in clinically localized, surgically resectable micropapillary bladder cancer patients undergoing radical cystectomy with and without neoadjuvant chemotherapy and develop risk strata based on outcome data. PATIENTS AND METHODS: A review of our database identified 103 patients with surgically resectable (≤cT4acN0cM0) micropapillary bladder cancer who underwent radical cystectomy. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests...
October 18, 2016: BJU International
C-Y Hsu, P-R Chen, H-J Chen, J-A Liang
The present study investigated the association between radical prostatectomy (RP) and the risk of herpes zoster (HZ). Male patients aged ≥ 40 years and diagnosed with prostate cancer (PCa) between 2000 and 2005 were included in this study. Patients who underwent RP for the first time during 2000-2006 were included in the RP group. Randomly selected individuals from among the remaining patients with PCa who did not undergo RP were included in the non-RP group. Univariate and multivariate Cox regression models were used to analyze the association between PCa and HZ...
October 18, 2016: European Journal of Clinical Microbiology & Infectious Diseases
Daniel Corrigan, Christiana Prucnal, Christopher Kabrhel
The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis...
September 2016: Clin Exp Emerg Med
William R Fox, Deborah B Diercks
Troponins are proteins commonly found in cardiac tissue that are released during myocardial ischemia or necrosis. These troponins can be detected by assays that can then be used to guide clinical decision-making and disposition, especially if the suspected insult is related to acute coronary syndrome. Timing of troponin measurement can be important as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays...
March 2016: Clin Exp Emerg Med
Thomas Schwartz, Louise Pyndt Diederichsen, Ingrid E Lundberg, Ivar Sjaastad, Helga Sanner
Idiopathic inflammatory myopathies (IIM) include the main subgroups polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM) and juvenile DM (JDM). The mentioned subgroups are characterised by inflammation of skeletal muscles leading to muscle weakness and other organs can also be affected as well. Even though clinically significant heart involvement is uncommon, heart disease is one of the major causes of death in IIM. Recent studies show an increased prevalence of traditional cardiovascular risk factors in JDM and DM/PM, which need attention...
2016: RMD Open
Mamatha Bhat, Peter Ghali, Benoît Dupont, Roy Hilzenrat, Mahmood Tazari, André Roy, Prosanto Chaudhury, Fernando Alvarez, Michel Carrier, Marc Bilodeau
BACKGROUND & AIMS: Patients listed with exception points for Hepatocellular carcinoma (HCC) have been more likely to be transplanted than those listed for chronic liver failure (LF) based on the Model for End-Stage Liver Disease (MELD) score. The aim of this study was to determine outcomes in the 5-year experience of a scoring system designed to reflect heterogeneity of tumor load of patients listed for HCC. METHODS: A novel MELD exception point system based on size and number of HCC was implemented in July 2009...
October 14, 2016: Journal of Hepatology
M Sánchez Mollá, I Candela García, F J Gómez-Romero, D Orozco Beltrán, M Ollero Baturone
OBJECTIVE: To determine the prevalence of patients with multiple chronic diseases in Primary Care using the multiple morbidity criteria and Clinical Risk Groups, and the agreement in identifying high-risk patients that require case management with both methods. MATERIAL AND METHOD: A cross-sectional study was conducted on 240 patients, selected by random sampling of 16 care quotas from two Primary Health Care centres of a health area. Informed consent was obtained to access their electronic medical records for the study, and a record was made of age, sex, health status of Clinical Risk Groups, severity, multiple morbidity criteria, and Charlson index by physicians during clinical practice...
October 14, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Søren Due Andersen, Torben Bjerregaard Larsen, Anders Gorst-Rasmussen, Yousef Yavarian, Gregory Y H Lip, Flemming W Bach
BACKGROUND: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous...
October 18, 2016: Cerebrovascular Diseases
Brian H Lang, Tony Shek, Angel On-Kei Chan, C Y Lo, Koon Yat Wan
Background To balance the risk of disease progression, morbidity and efficacy of reoperative central neck dissection (RCND) in papillary thyroid carcinoma, the latest clinical guidelines recommend early surgery over surveillance when the largest diseased node is >8 mm in its smallest dimension. However, the evidence remains scarce. To determine an appropriate size for first-time RCND, we examined the relationship between size of largest diseased central node, morbidity and response-to-therapy following RCND...
October 17, 2016: Thyroid: Official Journal of the American Thyroid Association
Seul Gi Lee, Woo Kyung Lee, Hye Sun Lee, Jieun Moon, Cho Rok Lee, Sang Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Young Suk Jo, Jandee Lee
BACKGROUND: The 2015 American Thyroid Association (ATA) management guidelines for adult patients with differentiated thyroid cancer (DTC) propose the use of the modified initial risk stratification and response to therapy re-stratification systems. This study was conducted to validate the practicality of the revised guidelines for predicting tumor recurrence in patients with DTC. METHODS: Patients with papillary thyroid cancer (n=2425) who underwent total thyroidectomy with central neck node dissection with or without modified radical neck node dissection at a single institution between October 1985 and July 2009 were retrospectively enrolled...
October 17, 2016: Thyroid: Official Journal of the American Thyroid Association
Sarit Shimony-Kanat, Julie Benbenishty
OBJECTIVE: To characterize trauma-related falls in infants and toddlers aged 0 to 3 years over a 4-year period and develop a risk stratification model of causes of fall injuries. METHODS: Data on falls of 0 to 3 year olds from 2009 to 2012 were identified from a Jerusalem tertiary hospital trauma registry (N = 422) and the National Trauma Registry of Israel (N = 4,131). RESULTS: Almost half of falls occurred during the first year of life, and 57% of the children were Jewish...
October 4, 2016: Pediatric Emergency Care
Edward Chia-Cheng Lai, Cheng-Yang Hsieh, Chien-Chou Su, Yea-Huei Kao Yang, Chin-Wei Huang, Swu-Jane Lin, Soko Setoguchi
We compared persistence of antiepileptic drugs (AEDs) including carbamazepine, oxcarbazepine, gabapentin, lamotrigine, topiramate, valproic acid, and phenytoin in an Asian population with epilepsy.A retrospective cohort study was conducted by analyzing Taiwan's National Health Insurance Research Database (NHIRD). Adult epilepsy patients newly prescribed with AEDs between 2005 and 2009 were included. The primary outcome was persistence, defined as the treatment duration from the date of AED initiation to the date of AED discontinuation, switching, hospitalization due to seizure or disenrollment from databases, whichever came first...
August 2016: Medicine (Baltimore)
Xuemei Gao, Xiao Zhang, Yajing Zhang, Wenjuan Hua, Yusufu Maimaiti, Zairong Gao
The increasing detection of papillary thyroid microcarcinoma (PTMC) has created management dilemmas. To clarify the clinical significance of postsurgery stimulated thyroglobulin (ps-Tg) in PTMC who undergo thyroidectomy and radioactive iodine (RAI), we retrospectively reviewed the 358 PTMC patients who were treated with RAI and followed up in our hospital. Those with an excessive anti-Tg antibody, ultrasound-detected residual were excluded, thereby resulting in the inclusion of 280 cases. Their clinical and histopathological information and clinical outcomes were collected and summarized...
October 2016: Medicine (Baltimore)
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed ( was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
September 30, 2016: Pediatric Critical Care Medicine
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