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Sample records for ablation predicts outcome

  1. Planning Irreversible Electroporation in the Porcine Kidney: Are Numerical Simulations Reliable for Predicting Empiric Ablation Outcomes?

    SciTech Connect

    Wimmer, Thomas Srimathveeravalli, Govindarajan; Gutta, Narendra; Ezell, Paula C.; Monette, Sebastien; Maybody, Majid; Erinjery, Joseph P.; Durack, Jeremy C.; Coleman, Jonathan A.; Solomon, Stephen B.

    2015-02-15

    PurposeNumerical simulations are used for treatment planning in clinical applications of irreversible electroporation (IRE) to determine ablation size and shape. To assess the reliability of simulations for treatment planning, we compared simulation results with empiric outcomes of renal IRE using computed tomography (CT) and histology in an animal model.MethodsThe ablation size and shape for six different IRE parameter sets (70–90 pulses, 2,000–2,700 V, 70–100 µs) for monopolar and bipolar electrodes was simulated using a numerical model. Employing these treatment parameters, 35 CT-guided IRE ablations were created in both kidneys of six pigs and followed up with CT immediately and after 24 h. Histopathology was analyzed from postablation day 1.ResultsAblation zones on CT measured 81 ± 18 % (day 0, p ≤ 0.05) and 115 ± 18 % (day 1, p ≤ 0.09) of the simulated size for monopolar electrodes, and 190 ± 33 % (day 0, p ≤ 0.001) and 234 ± 12 % (day 1, p ≤ 0.0001) for bipolar electrodes. Histopathology indicated smaller ablation zones than simulated (71 ± 41 %, p ≤ 0.047) and measured on CT (47 ± 16 %, p ≤ 0.005) with complete ablation of kidney parenchyma within the central zone and incomplete ablation in the periphery.ConclusionBoth numerical simulations for planning renal IRE and CT measurements may overestimate the size of ablation compared to histology, and ablation effects may be incomplete in the periphery.

  2. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    PubMed Central

    Lobo, Tasso Julio; Pachon, Carlos Thiene; Pachon, Jose Carlos; Pachon, Enrique Indalecio; Pachon, Maria Zelia; Pachon, Juan Carlos; Santillana, Tomas Guillermo; Zerpa, Juan Carlos; Albornoz, Remy Nelson; Jatene, Adib Domingos

    2015-01-01

    Background Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement. PMID:25387404

  3. Kidney function outcomes following thermal ablation of small renal masses

    PubMed Central

    Raman, Jay D; Jafri, Syed M; Qi, David

    2016-01-01

    The diagnosis of small renal masses (SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit. PMID:27152264

  4. Kidney function outcomes following thermal ablation of small renal masses.

    PubMed

    Raman, Jay D; Jafri, Syed M; Qi, David

    2016-05-01

    The diagnosis of small renal masses (SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit. PMID:27152264

  5. Predictive value of pyramidal lobe, percentage thyroid uptake and age for ablation outcome after 15 mCi fixed dose of radioiodine-131 in Graves’ disease

    PubMed Central

    Zaman, Maseeh uz; Fatima, Nosheen; Zaman, Unaiza; Sajjad, Zafar; Zaman, Areeba; Tahseen, Rabia

    2015-01-01

    Purpose: The purpose was to find out the efficacy of fixed 15 mCi radioactive iodine-131 (RAI) dose and predictive values of various factors for inducing hypothyroidism in Graves’ disease (GD). Materials and Methods: Retrospective study conducted from January 2012 till August 2014. Patients with GD who had a technetium-99m thyroid scan, thyroid antibodies, received fixed 15 mCi RAI and did follow endocrine clinics for at least 6 months were selected. RAI was considered successful if within 6 months of RAI therapy patients developed hypothyroidism. Results: Of the 370 patients with GD who had RAI during study period, 210 (57%) qualified study criteria. Mean age of patients was 48 ± 15 years with female: male ratio of 69:31, positive thyroid antibodies in 61%, means thyroid uptake of 15.09 ± 11.23%, and presence of pyramidal lobe in 40% of total population. Hypothyroidism was achieved in 161 (77%) patients while 49 (23%) patients failed to achieve it (remained either hyperthyroid or euthyroid on antithyroid medication). Patients who became hypothyroid were significantly younger with higher proportion of presence of thyroid antibodies and pyramidal lobe and lower percentage thyroid uptake than those who failed. Multiple logistic regression analysis revealed that age (odds ratio; OR = 2.074), pyramidal lobe (OR = 3.317), thyroid antibodies (OR = 8.198), and percentage thyroid uptake (OR = 3.043) were found to be significant prognostic risk factors for post-RAI hypothyroidism. Gender was found to have nonsignificant association with the development of hypothyroidism. Receiver operating characteristic analysis revealed age <42 years and thyroid uptake <15% as threshold values for the development of post-RAI hypothyroidism. Conclusion: We conclude that fixed (15 mCi) RAI dose is highly effective in rendering hypothyroidism in patients with GD. Age (≤42 years), thyroid uptake (≤15%) and presence of pyramidal lobe are strong predictors of hypothyroidism and must be

  6. Predicting cancer outcome

    SciTech Connect

    Gardner, S N; Fernandes, M

    2005-03-24

    We read with interest the paper by Michiels et al on the prediction of cancer with microarrays and the commentary by Ioannidis listing the potential as well as the limitations of this approach (February 5, p 488 and 454). Cancer is a disease characterized by complex, heterogeneous mechanisms and studies to define factors that can direct new drug discovery and use should be encouraged. However, this is easier said than done. Casti teaches that a better understanding does not necessarily extrapolate to better prediction, and that useful prediction is possible without complete understanding (1). To attempt both, explanation and prediction, in a single nonmathematical construct, is a tall order (Figure 1).

  7. Contact force sensing during atrial fibrillation ablation: clinical experience and effects on outcomes.

    PubMed

    Liang, Jackson J; Santangeli, Pasquale

    2016-06-01

    Catheter ablation is an effective treatment option for atrial fibrillation (AF), and pulmonary vein isolation (PVI) is the cornerstone of AF ablation. When AF recurs after ablation, PV reconnection is frequently seen during repeat ablation. As such, achieving durable chronic PVI by delivering effective, transmural lesions during the index ablation is key to optimize long-term outcomes. The development of contact force (CF) sensing technologies integrated into ablation catheters now allow for real-time visualization of applied CF during PVI and have been shown to improve ablation efficacy and safety. The aim of this review is to describe the CF technology, summarize the literature on the outcomes of CF-guided ablation, and to discuss procedural aspects that are crucial when using CF. PMID:26998886

  8. Outcome of Endovenous Laser Ablation of Varicose Veins

    PubMed Central

    Rustempasic, Nedzad; Cvorak, Alemko; Agincic, Alija

    2014-01-01

    ABSTRACT Introduction: In Bosnia and Herzegovina according to available data, treatment of incompetent superficial lower extremity varicose veins by endovenous laser ablation (EVLA) has been introduced two years ago and so far no paper has been published regarding results of EVLA treatment of patients from our country. We wanted to present our results with EVLA treatment. Aim of study: to evaluate and compare primary posttreatment outcomes of endovenous laser ablation (EVLA) with classical surgical method of varicose vein treatment. Patients and methods: The study was clinical and prospective. It was carried out at Clinic for vascular surgery in Sarajevo where fifty-eight (58) patients received surgical treatment for varicose veins and in Aesthetic Surgery Center “Nasa mala klinika” in Sarajevo were sixty-one (61) patients with varicose veins were treated by endovenous laser ablation. Total 119 patients (limbs) with pathologic reflux only in great saphenous vein were evaluated between 1st of January 2013 and 31st of April 2014. Following primary outcome endpoints were evaluated smean day of return to normal everyday activities, patient subjective quantification of pain during first seven days after intervention, incidence of deep venous thrombosis (DVT), incidence of wound bleeding requiring surgical intervention, incidence of peri-saphenous vein hematoma and infection rate. Results: Mean of return to normal activities (expressed in days after intervention); EVLA vs. stripping (surgery) =1.21vs12.24, T test 13,619; p=0, 000, p<0,05. T test was used for comparing Mean value of visual pain analog scale for the first 7 days between groups, for all seven days pain was significantly higher in surgical group of patients as compared to EVLA group; p<0,05. Incidence of hematoma greater than 1% of total body surface area was significantly higher in patients receiving surgical treatment; Pearson Chi Square=23,830, p<0,05; odds ratio:10,453. Incidences of infection, deep

  9. Predictive analysis of optical ablation in several dermatological tumoral tissues

    NASA Astrophysics Data System (ADS)

    Fanjul-Vélez, F.; Blanco-Gutiérrez, A.; Salas-García, I.; Ortega-Quijano, N.; Arce-Diego, J. L.

    2013-06-01

    Optical techniques for treatment and characterization of biological tissues are revolutionizing several branches of medical praxis, for example in ophthalmology or dermatology. The non-invasive, non-contact and non-ionizing character of optical radiation makes it specially suitable for these applications. Optical radiation can be employed in medical ablation applications, either for tissue resection or surgery. Optical ablation may provide a controlled and clean cut on a biological tissue. This is particularly relevant in tumoral tissue resection, where a small amount of cancerous cells could make the tumor appear again. A very important aspect of tissue optical ablation is then the estimation of the affected volume. In this work we propose a complete predictive model of tissue ablation that provides an estimation of the resected volume. The model is based on a Monte Carlo approach for the optical propagation of radiation inside the tissue, and a blow-off model for tissue ablation. This model is applied to several types of dermatological tumoral tissues, specifically squamous cells, basocellular and infiltrative carcinomas. The parameters of the optical source are varied and the estimated resected volume is calculated. The results for the different tumor types are presented and compared. This model can be used for surgical planning, in order to assure the complete resection of the tumoral tissue.

  10. Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes

    PubMed Central

    Noheria, Amit; Deshmukh, Abhishek; Asirvatham, Samuel J.

    2015-01-01

    We reviewed the underlying principles that allow for safe and effective ablation for premature ventricular complexes. Clinical scenarios that necessitate consideration for ablation, the underlying anatomy, and the unique consideration to maximize energy delivery without compromising safety are sequentially examined. PMID:26306129

  11. Repeated Radiofrequency Ablation Combined With Ablated Lesion Elimination and Transarterial Chemoembolization Improves the Outcome of Solitary Huge Hepatocellular Carcinomas 10 cm or Larger.

    PubMed

    Ke, Shan; Gao, Jun; Kong, Jian; Ding, Xue-Mei; Niu, Hai-Gang; Xin, Zong-Hai; Ning, Chun-Min; Guo, Shi-Gang; Li, Xiao-Long; Zhang, Long; Dong, Yong-Hong; Sun, Wen-Bing

    2016-04-01

    This study investigated the effectiveness of a new strategy, repeated radiofrequency (RF) ablation combined with ablated lesion elimination following transarterial chemoembolization (TACE)/transarterial embolization (TAE), for solitary huge hepatocellular carcinoma (SHHCC) 10 cm or larger.From July 2008 to October 2015, 39 consecutive patients with SHHCC were screened. Of these, 12 were treated with TACE/TAE and repeated RF ablation (TACE/TAE + RF ablation group) and the remaining 27 patients were treated with the aforementioned new strategy (new strategy group). Local tumor progression (LTP)-free survival, intrahepatic distant recurrence (IDR)-free survival, and overall survival (OS) rates were obtained using the Kaplan-Meier method. Univariate and multivariate analyses were performed on several clinicopathological variables to identify factors affecting long-term outcome and intrahepatic recurrence. Correlation analysis was also performed.The 1-, 2-, and 3-year LTP-free survival rates and OS rates were significantly higher in the new strategy group than in the TACE/TAE + RF ablation group (82.9% vs 58.3%, 73.9% vs 29.2%, 18.5% vs 9.7%, P = 0.002; 92.0% vs 75.0%, 84.0% vs 33.3%, 32.7% vs 16.7%, P = 0.025). However, there was no significant difference between the 2 groups in the 1-, 2-, and 3-year IDR-free survival rates (P = 0.108). Using univariate analysis, alpha-fetoprotein (AFP > 200 ng/mL), ablative margin (AM > 1.0 cm), and well-differentiated cells were found to be significant factors for predicting LTP, IDR, and OS. Surgical elimination was found to be a significant factor only for predicting OS. In multivariate analyses, AFP (>200 ng/mL), AM (>1.0 cm), and well-differentiated cells were found to be significant independent factors linked to LTP, IDR, and OS. Correlation analysis indicated that AM > 1.0 cm was strongly associated with surgical elimination (P < 0.001, correlation coefficient = 0.877).For patients with SHHCC

  12. Repeated Radiofrequency Ablation Combined With Ablated Lesion Elimination and Transarterial Chemoembolization Improves the Outcome of Solitary Huge Hepatocellular Carcinomas 10 cm or Larger

    PubMed Central

    Ke, Shan; Gao, Jun; Kong, Jian; Ding, Xue-Mei; Niu, Hai-Gang; Xin, Zong-Hai; Ning, Chun-Min; Guo, Shi-Gang; Li, Xiao-Long; Zhang, Long; Dong, Yong-Hong; Sun, Wen-Bing

    2016-01-01

    Abstract This study investigated the effectiveness of a new strategy, repeated radiofrequency (RF) ablation combined with ablated lesion elimination following transarterial chemoembolization (TACE)/transarterial embolization (TAE), for solitary huge hepatocellular carcinoma (SHHCC) 10 cm or larger. From July 2008 to October 2015, 39 consecutive patients with SHHCC were screened. Of these, 12 were treated with TACE/TAE and repeated RF ablation (TACE/TAE + RF ablation group) and the remaining 27 patients were treated with the aforementioned new strategy (new strategy group). Local tumor progression (LTP)-free survival, intrahepatic distant recurrence (IDR)-free survival, and overall survival (OS) rates were obtained using the Kaplan–Meier method. Univariate and multivariate analyses were performed on several clinicopathological variables to identify factors affecting long-term outcome and intrahepatic recurrence. Correlation analysis was also performed. The 1-, 2-, and 3-year LTP-free survival rates and OS rates were significantly higher in the new strategy group than in the TACE/TAE + RF ablation group (82.9% vs 58.3%, 73.9% vs 29.2%, 18.5% vs 9.7%, P = 0.002; 92.0% vs 75.0%, 84.0% vs 33.3%, 32.7% vs 16.7%, P = 0.025). However, there was no significant difference between the 2 groups in the 1-, 2-, and 3-year IDR-free survival rates (P = 0.108). Using univariate analysis, alpha-fetoprotein (AFP > 200 ng/mL), ablative margin (AM > 1.0 cm), and well-differentiated cells were found to be significant factors for predicting LTP, IDR, and OS. Surgical elimination was found to be a significant factor only for predicting OS. In multivariate analyses, AFP (>200 ng/mL), AM (>1.0 cm), and well-differentiated cells were found to be significant independent factors linked to LTP, IDR, and OS. Correlation analysis indicated that AM > 1.0 cm was strongly associated with surgical elimination (P < 0.001, correlation coefficient = 0.877). For patients

  13. Microwave Ablation of Porcine Kidneys in vivo: Effect of two Different Ablation Modes ('Temperature Control' and 'Power Control') on Procedural Outcome

    SciTech Connect

    Sommer, C. M.; Arnegger, F.; Koch, V.; Pap, B.; Holzschuh, M.; Bellemann, N.; Gehrig, T.; Senft, J.; Nickel, F.; Mogler, C.; Zelzer, S.; Meinzer, H. P.; Stampfl, U.; Kauczor, H. U.; Radeleff, B. A.

    2012-06-15

    Purpose: This study was designed to analyze the effect of two different ablation modes ('temperature control' and 'power control') of a microwave system on procedural outcome in porcine kidneys in vivo. Methods: A commercially available microwave system (Avecure Microwave Generator; MedWaves, San Diego, CA) was used. The system offers the possibility to ablate with two different ablation modes: temperature control and power control. Thirty-two microwave ablations were performed in 16 kidneys of 8 pigs. In each animal, one kidney was ablated twice by applying temperature control (ablation duration set point at 60 s, ablation temperature set point at 96 Degree-Sign C, automatic power set point; group I). The other kidney was ablated twice by applying power control (ablation duration set point at 60 s, ablation temperature set point at 96 Degree-Sign C, ablation power set point at 24 W; group II). Procedural outcome was analyzed: (1) technical success (e.g., system failures, duration of the ablation cycle), and (2) ablation geometry (e.g., long axis diameter, short axis diameter, and circularity). Results: System failures occurred in 0% in group I and 13% in group II. Duration of the ablation cycle was 60 {+-} 0 s in group I and 102 {+-} 21 s in group II. Long axis diameter was 20.3 {+-} 4.6 mm in group I and 19.8 {+-} 3.5 mm in group II (not significant (NS)). Short axis diameter was 10.3 {+-} 2 mm in group I and 10.5 {+-} 2.4 mm in group II (NS). Circularity was 0.5 {+-} 0.1 in group I and 0.5 {+-} 0.1 in group II (NS). Conclusions: Microwave ablations performed with temperature control showed fewer system failures and were finished faster. Both ablation modes demonstrated no significant differences with respect to ablation geometry.

  14. Predicting the outcome of roulette.

    PubMed

    Small, Michael; Tse, Chi Kong

    2012-09-01

    There have been several popular reports of various groups exploiting the deterministic nature of the game of roulette for profit. Moreover, through its history, the inherent determinism in the game of roulette has attracted the attention of many luminaries of chaos theory. In this paper, we provide a short review of that history and then set out to determine to what extent that determinism can really be exploited for profit. To do this, we provide a very simple model for the motion of a roulette wheel and ball and demonstrate that knowledge of initial position, velocity, and acceleration is sufficient to predict the outcome with adequate certainty to achieve a positive expected return. We describe two physically realizable systems to obtain this knowledge both incognito and in situ. The first system relies only on a mechanical count of rotation of the ball and the wheel to measure the relevant parameters. By applying these techniques to a standard casino-grade European roulette wheel, we demonstrate an expected return of at least 18%, well above the -2.7% expected of a random bet. With a more sophisticated, albeit more intrusive, system (mounting a digital camera above the wheel), we demonstrate a range of systematic and statistically significant biases which can be exploited to provide an improved guess of the outcome. Finally, our analysis demonstrates that even a very slight slant in the roulette table leads to a very pronounced bias which could be further exploited to substantially enhance returns. PMID:23020489

  15. Predicting the outcome of roulette

    NASA Astrophysics Data System (ADS)

    Small, Michael; Tse, Chi Kong

    2012-09-01

    There have been several popular reports of various groups exploiting the deterministic nature of the game of roulette for profit. Moreover, through its history, the inherent determinism in the game of roulette has attracted the attention of many luminaries of chaos theory. In this paper, we provide a short review of that history and then set out to determine to what extent that determinism can really be exploited for profit. To do this, we provide a very simple model for the motion of a roulette wheel and ball and demonstrate that knowledge of initial position, velocity, and acceleration is sufficient to predict the outcome with adequate certainty to achieve a positive expected return. We describe two physically realizable systems to obtain this knowledge both incognito and in situ. The first system relies only on a mechanical count of rotation of the ball and the wheel to measure the relevant parameters. By applying these techniques to a standard casino-grade European roulette wheel, we demonstrate an expected return of at least 18%, well above the -2.7% expected of a random bet. With a more sophisticated, albeit more intrusive, system (mounting a digital camera above the wheel), we demonstrate a range of systematic and statistically significant biases which can be exploited to provide an improved guess of the outcome. Finally, our analysis demonstrates that even a very slight slant in the roulette table leads to a very pronounced bias which could be further exploited to substantially enhance returns.

  16. Early Temporal and Spatial Regularization of Persistent Atrial Fibrillation Predicts Termination and Arrhythmia-Free Outcome

    PubMed Central

    Forclaz, Andrei; Narayan, Sanjiv M.; Scherr, Daniel; Linton, Nick; Jadidi, Amir S.; Nault, Isabelle; Rivard, Lena; Miyazaki, Shinsuke; Linton, Nick; Uldry, Laurent; Wright, Matthew; Shah, Ashok J; Liu, Xingpeng; Xhaet, Olivier; Derval, Nicolas; Knecht, Sébastien; Sacher, Frédéric; Jaïs, Pierre; Hocini, Mélèze; Haïssaguerre, Michel

    2011-01-01

    Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint, but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intra-procedural AF termination and outcome. Objective To test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity) and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage, proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared to 16 patients without termination (p < 0.05). AFCL prolonged in both groups. From ROC analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with PPV 96 %, NPV 53 %, sensitivity 71 % and specificity 91 %. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. Conclusions Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence. PMID:21699850

  17. Adjusted Left Atrial Emptying Fraction as a Predictor of Procedural Outcome after Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Im, Sung Il; Kim, Sun Won; Choi, Cheol Ung; Kim, Jin Won; Yong, Hwan Seok; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Lim, Hong Euy

    2015-01-01

    Structural remodeling of the left atrium is a risk factor for recurrent arrhythmia after catheter ablation for atrial fibrillation; however, data are sparse regarding the role of functional left atrial remodeling in predicting procedural outcomes. We evaluated whether left atrial transport function could be used to predict recurrent atrial fibrillation. From July 2008 through August 2010, we enrolled 202 consecutive patients who underwent catheter ablation for atrial fibrillation (paroxysmal=120, persistent=82). Left atrial volumes (LAVs) were measured by means of multislice computed tomography at every 10% of the R-R interval, and measurements were adjusted for body surface area to yield the LAV index (LAVI) at baseline. The left atrial emptying fraction (LAEF) was calculated according to LAV differences. During the mean follow-up period of 10 ± 4 months after a single ablation procedure, atrial fibrillation recurred in 59 patients (paroxysmal=19, persistent=40). Multivariate analysis revealed that persistent atrial fibrillation, early mitral inflow velocity, LAVImax, LAVImin, LAEF, LAVImax/LAEF, and LAVImin/LAEF were all independent predictors of atrial fibrillation, but the best predictor was LAVImin/LAEF (β=1.329, P=0.001). The cutoff value was 1.61 (mL/m2)/%, and the sensitivity and specificity were 74.6% and 62.2%, respectively (area under the curve=0.761). Our study shows that adjusted left atrial emptying fraction with use of multislice computed tomography might be a useful, noninvasive method to select patients for ablation. PMID:26175632

  18. Korean Atrial Fibrillation (AF) Network: Genetic Variants for AF Do Not Predict Ablation Success

    PubMed Central

    Choi, Eue-Keun; Park, Jae Hyung; Lee, Ji-Young; Nam, Chung Mo; Hwang, Min Ki; Uhm, Jae-Sun; Joung, Boyoung; Ko, Young-Guk; Lee, Moon-Hyoung; Lubitz, Steven A; Ellinor, Patrick T; Pak, Hui-Nam

    2015-01-01

    Background Genomewide association studies have identified several loci associated with atrial fibrillation (AF) and have been reportedly associated with response to catheter ablation for AF in patients of European ancestry; however, associations between top susceptibility loci and AF recurrence after ablation have not been examined in Asian populations. We examined whether the top single nucleotide polymorphisms (SNPs) at chromosomes 4q25 (PITX2), 16q22 (ZFHX3), and 1q21 (KCNN3) were associated with AF in a Korean population and whether these SNPs were associated with clinical outcomes after catheter ablation for AF. Methods and Results We determined the association between 4 SNPs and AF in 1068 AF patients who underwent catheter ablation (74.6% male, aged 57.5±10.9 years, 67.9% paroxysmal AF) and 1068 age- and sex-matched controls. The SNPs at the PITX2 and ZFHX3 loci, but not the KCNN3 locus, were significantly associated with AF (PITX2/rs6843082_G: odds ratio 3.41, 95% CI 2.55 to 4.55, P=1.32×10−16; PITX2/rs2200733_T: odds ratio 2.05, 95% CI 1.66 to 2.53, P=2.20×10−11; ZFHX3/rs2106261_A: odds ratio 2.33, 95% CI 1.87 to 2.91, P=3.75×10−14; KCNN3/rs13376333_T: odds ratio 1.74, 95% CI 0.93 to 3.25, P=0.085). Among those patients who underwent catheter ablation for AF, none of the top AF-associated SNPs were associated with long-term clinical recurrence of AF after catheter ablation. Conclusions SNPs at the PITX2 and ZFHX3 loci were strongly associated with AF in Korean patients. In contrast to prior reports, none of the 4 top AF-susceptibility SNPs predicted clinical recurrence after catheter ablation. PMID:26272656

  19. Effectiveness of impedance monitoring during radiofrequency ablation for predicting popping

    PubMed Central

    Iida, Hiroya; Aihara, Tsukasa; Ikuta, Shinichi; Yamanaka, Naoki

    2012-01-01

    AIM: To retrospectively evaluate the effectiveness of impedance monitoring for predicting popping during radiofrequency ablation (RFA) using internally cooled electrodes. METHODS: We reviewed 140 patients (94 males, 46 females; age range 73.0 ± 11.1 year) who underwent RFA between February 2006 and November 2008 with a modified protocol using a limited power delivery rather than a conventional one to avoid popping. All the patients provided their written informed consent, and the study was approved by the institutional review board. Intraprocedural impedances were measured for the study subjects, and the tumors were classified into three types according to the characteristics of their impedance curves: increasing, flat, or decreasing. The tumors were further sorted into seven subtypes (A-G) depending on the curvature of the impedance curve’s increase or decrease. Relative popping rates were determined for the three types and seven subtypes. A chi-square test was performed to estimate statistical significance. RESULTS: A total of 148 nodules treated by RFA were analyzed. The study samples included 132 nodules of hepatocellular carcinoma, 14 nodules of metastatic liver cancer, and two nodules of intrahepatic cholangiocarcinoma. The numbers of nodules with each impedance curve type were as follows: 37 increasing-type nodules, 43 flat-type nodules, and 68 decreasing-type nodules. Popping occurrence rates were 24.3%, 46.5% and 64.7%, respectively. Flat-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules (P = 0.039). Decreasing-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules (P < 0.0001). Notably, nodules that showed a sharp decrease in impedance in the latter ablation period (subtype E) exhibited a significantly higher rate of popping compared to other subtypes. CONCLUSION: Intraprocedural impedance monitoring can be a useful tool to predict the occurrence of popping

  20. Outcome Prediction in Clinical Treatment Processes.

    PubMed

    Huang, Zhengxing; Dong, Wei; Ji, Lei; Duan, Huilong

    2016-01-01

    Clinical outcome prediction, as strong implications for health service delivery of clinical treatment processes (CTPs), is important for both patients and healthcare providers. Prior studies typically use a priori knowledge, such as demographics or patient physical factors, to estimate clinical outcomes at early stages of CTPs (e.g., admission). They lack the ability to deal with temporal evolution of CTPs. In addition, most of the existing studies employ data mining or machine learning methods to generate a prediction model for a specific type of clinical outcome, however, a mathematical model that predicts multiple clinical outcomes simultaneously, has not yet been established. In this study, a hybrid approach is proposed to provide a continuous predictive monitoring service on multiple clinical outcomes. More specifically, a probabilistic topic model is applied to discover underlying treatment patterns of CTPs from electronic medical records. Then, the learned treatment patterns, as low-dimensional features of CTPs, are exploited for clinical outcome prediction across various stages of CTPs based on multi-label classification. The proposal is evaluated to predict three typical classes of clinical outcomes, i.e., length of stay, readmission time, and the type of discharge, using 3492 pieces of patients' medical records of the unstable angina CTP, extracted from a Chinese hospital. The stable model was characterized by 84.9% accuracy and 6.4% hamming-loss with 3 latent treatment patterns discovered from data, which outperforms the benchmark multi-label classification algorithms for clinical outcome prediction. Our study indicates the proposed approach can potentially improve the quality of clinical outcome prediction, and assist physicians to understand the patient conditions, treatment inventions, and clinical outcomes in an integrated view. PMID:26573645

  1. Outcomes of Catheter Ablation of Ventricular Tachycardia in the Setting of Structural Heart Disease.

    PubMed

    Betensky, B P; Marchlinski, F E

    2016-07-01

    Sustained ventricular tachycardias are common in the setting of structural heart disease, either due to prior myocardial infarction or a variety of non-ischemic etiologies, including idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Over the past two decades, percutaneous catheter ablation has evolved dramatically and has become an effective tool for the control of ventricular arrhythmias. Single and multicenter observational studies as well as several prospective randomized trials have begun to investigate long-term outcomes after catheter ablation procedures. These studies encompass a wide range of mapping and ablation techniques, including conventional activation mapping/entrainment criteria, substrate modification guided by pacemapping, late potential and abnormal electrogram ablation, scar de-channeling, and core isolation. While large-scale, multicenter prospective randomized clinical trials are somewhat limited, the published data demonstrate favorable outcomes with respect to a reduction in overall ventricular tachycardia (VT) burden, reduction of implantable cardioverter defibrillator (ICD) shocks, and discontinuation of anti-arrhythmic medications across varying disease subtypes and convincingly support the use of catheter ablation as the standard of care for many patients with VT in the setting of structural heart disease. PMID:27234813

  2. Outcome after Radiofrequency Ablation of Sarcoma Lung Metastases

    SciTech Connect

    Koelblinger, Claus; Strauss, Sandra; Gillams, Alice

    2013-05-14

    PurposeResection is the mainstay of management in patients with sarcoma lung metastases, but there is a limit to how many resections can be performed. Some patients with inoperable disease have small-volume lung metastases that are amenable to thermal ablation. We report our results after radiofrequency ablation (RFA).MethodsThis is a retrospective study of patients treated from 2007 to 2012 in whom the intention was to treat all sites of disease and who had a minimum CT follow-up of 4 months. Treatment was performed under general anesthesia/conscious sedation using cool-tip RFA. Follow-up CT scans were analyzed for local control. Primary tumor type, location, grade, disease-free interval, prior resection/chemotherapy, number and size of lung tumors, uni- or bilateral disease, complications, and overall and progression-free survival were recorded.ResultsTwenty-two patients [15 women; median age 48 (range 10–78) years] with 55 lung metastases were treated in 30 sessions. Mean and median tumor size and initial number were 0.9 cm and 0.7 (range 0.5–2) cm, and 2.5 and 1 (1–7) respectively. Median CT and clinical follow-up were 12 (4–54) and 20 (8–63) months, respectively. Primary local control rate was 52 of 55 (95 %). There were 2 of 30 (6.6 %) Common Terminology Criteria grade 3 complications with no long-term sequelae. Mean (median not reached) and 2- and 3-year overall survival were 51 months, and 94 and 85 %. Median and 1- and 2-year progression-free survival were 12 months, and 53 and 23 %. Prior disease-free interval was the only significant factor to affect overall survival.ConclusionRFA is a safe and effective treatment for patients with small-volume sarcoma metastases.

  3. Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease

    PubMed Central

    Liang, Jackson J; Santangeli, Pasquale; Callans, David J

    2015-01-01

    Ventricular tachycardia (VT) often occurs in the setting of structural heart disease and can affect patients with ischaemic or nonischaemic cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) provide mortality benefit and are therefore indicated for secondary prevention in patients with sustained VT, but they do not reduce arrhythmia burden. ICD shocks are associated with increased morbidity and mortality, and antiarrhythmic medications are often used to prevent recurrent episodes. Catheter ablation is an effective treatment option for patients with VT in the setting of structural heart disease and, when successful, can reduce the number of ICD shocks. However, whether VT ablation results in a mortality benefit remains unclear. We aim to review the long-term outcomes in patients with different types of structural heart disease treated with VT ablation. PMID:26835122

  4. Predictive value of various Doppler-derived parameters of atrial conduction time for successful atrial fibrillation ablation

    PubMed Central

    Valtuille, Lucas; Choy, Jonathan B; Becher, Harald

    2015-01-01

    Various Doppler-derived parameters of left atrial electrical remodeling have been demonstrated to predict recurrence of atrial fibrillation (AF) after AF ablation. The aim of this study was to compare three Doppler-derived measures of atrial conduction time in patients undergoing AF ablation, and to investigate their predictive value for successful procedure. In 32 prospectively enrolled patients undergoing the first AF ablation, atrial conduction time was estimated by measuring the time delay between the onset of P-wave on the surface ECG to the peak of the a′-wave on the pulsed-wave Doppler and color-coded tissue Doppler imaging of the left atrial lateral wall, and to the peak of the A-wave on the pulsed-wave Doppler of the mitral inflow. There was a significant difference in the baseline atrial conduction time measured by different echocardiographic techniques. Most (88%) patients had normal or only mildly dilated left atrium. At 6 months, 12 patients (38%) had recurrent AF/atrial tachycardia. The duration of history of AF was the only predictor of AF/atrial tachycardia recurrence following the first AF ablation (P=0.024; OR 1.023, CI 1.003–1.044). A combination of normal left atrial volume and history of paroxysmal AF of ≤48 months was associated with the best outcome. Predictive value of the Doppler derived parameters of atrial conduction time may be reduced in the early stages of left atrial remodeling. Future studies may determine which echocardiographic parameter correlates best with the extent of left atrial remodeling and is most predictive of successful AF ablation. PMID:26795694

  5. Material properties of lithium fluoride for predicting XUV laser ablation rate and threshold fluence

    NASA Astrophysics Data System (ADS)

    Blejchař, Tomáś; Nevrlý, Václav; Vašinek, Michal; Dostál, Michal; Pečínka, Lukáś; Dlabka, Jakub; Stachoň, Martin; Juha, Libor; Bitala, Petr; Zelinger, Zdeněk.; Pira, Peter; Wild, Jan

    2015-05-01

    This paper deals with prediction of extreme ultraviolet (XUV) laser ablation of lithium fluoride at nanosecond timescales. Material properties of lithium fluoride were determined based on bibliographic survey. These data are necessary for theoretical estimation of surface removal rate in relevance to XUV laser desorption/ablation process. Parameters of XUV radiation pulses generated by the Prague capillary-discharge laser (CDL) desktop system were assumed in this context. Prediction of ablation curve and threshold laser fluence for lithium fluoride was performed employing XUV-ABLATOR code. Quasi-random sampling approach was used for evaluating its predictive capabilities in the means of variance and stability of model outputs in expected range of uncertainties. These results were compared to experimental data observed previously.

  6. Early Adolescent Affect Predicts Later Life Outcomes

    PubMed Central

    Kansky, Jessica; Allen, Joseph P.; Diener, Ed

    2016-01-01

    Background Subjective well-being as a predictor for later behavior and health has highlighted its relationship to health, work performance, and social relationships. However, the majority of such studies neglect the developmental nature of well-being in contributing to important changes across the transition to adulthood. Methods To examine the potential role of subjective well-being as a long-term predictor of critical life outcomes, we examined indicators of positive and negative affect at age 14 as a predictor of relationship, adjustment, self worth, and career outcomes a decade later at ages 23 to 25, controlling for family income and gender. We utilized multi-informant methods including reports from the target participant, close friends, and romantic partners in a demographically diverse community sample of 184 participants. Results Early adolescent positive affect predicted less relationship problems (less self-reported and partner-reported conflict, greater friendship attachment as rated by close peers), healthy adjustment to adulthood (lower levels of depression, anxiety, and loneliness). It also predicted positive work functioning (higher levels of career satisfaction and job competence) and increased self-worth. Negative affect did not significantly predict any of these important life outcomes. In addition to predicting desirable mean levels of later outcomes, early positive affect predicted beneficial changes across time in many outcomes. Conclusions The findings extend early research on the beneficial outcomes of subjective well-being by having an earlier assessment of well-being, including informant reports in measuring a large variety of outcome variables, and by extending the findings to a lower socioeconomic group of a diverse and younger sample. The results highlight the importance of considering positive affect as an important component of subjective well-being distinct from negative affect. PMID:27075545

  7. Initial Independent Outcomes from Focal Impulse and Rotor Modulation Ablation for Atrial Fibrillation: Multicenter FIRM Registry

    PubMed Central

    MILLER, JOHN M.; KOWAL, ROBERT C.; SWARUP, VIJAY; DAUBERT, JAMES P.; DAOUD, EMILE G.; DAY, JOHN D.; ELLENBOGEN, KENNETH A.; HUMMEL, JOHN D.; BAYKANER, TINA; KRUMMEN, DAVID E.; NARAYAN, SANJIV M.; REDDY, VIVEK Y.; SHIVKUMAR, KALYANAM; STEINBERG, JONATHAN S.; WHEELAN, KEVIN R.

    2014-01-01

    Introduction The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers. Methods We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm View™; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI. Results Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ≥1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145–354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89). Conclusions Elimination of patient-specific AF rotors/focal sources produced freedom-from-AF of ≈80% at 1 year at centers new to FIRM. FIRM-guided ablation has a rapid learning curve, yielding similar results to original FIRM reports in each center’s first cases. PMID:24948520

  8. Outcomes after ablation for typical atrial flutter (from the Loire Valley Atrial Fibrillation Project).

    PubMed

    Clementy, Nicolas; Desprets, Laurent; Pierre, Bertrand; Lallemand, Bénédicte; Simeon, Edouard; Brunet-Bernard, Anne; Babuty, Dominique; Fauchier, Laurent

    2014-11-01

    Similar predisposing factors are found in most types of atrial arrhythmias. The incidence of atrial fibrillation (AF) among patients with atrial flutter is high, suggesting similar outcomes in patients with those arrhythmias. We sought to investigate the long-term outcomes and prognostic factors of patients with AF and/or atrial flutter with contemporary management using radiofrequency ablation. In an academic institution, we retrospectively examined the clinical course of 8,962 consecutive patients admitted to our department with a diagnosis of AF and/or atrial flutter. After a median follow-up of 934 ± 1,134 days, 1,155 deaths and 715 stroke and/thromboembolic (TE) events were recorded. Patients with atrial flutter undergoing cavotricuspid isthmus ablation (n = 875, 37% with a history of AF) had a better survival rate than other patients (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.25 to 0.49, p <0.0001). Using Cox proportional hazards model and propensity score model, after adjustment for main other confounders, ablation for atrial flutter was significantly associated with a lower risk of all-cause mortality (HR 0.55, 95% CI 0.36 to 0.84, p = 0.006) and stroke and/or TE events (HR 0.53, 95% CI 0.30 to 0.92, p = 0.02). After ablation, there was no significant difference in the risk of TE between patients with a history of AF and those with atrial flutter alone (HR 0.83, 95% CI 0.41 to 1.67, p = 0.59). In conclusion, in patients with atrial tachyarrhythmias, those with atrial flutter with contemporary management who undergo cavotricuspid isthmus radiofrequency ablation independently have a lower risk of stroke and/or TE events and death of any cause, whether a history of AF is present or not. PMID:25200340

  9. Expectations predict chronic pain treatment outcomes.

    PubMed

    Cormier, Stéphanie; Lavigne, Geneviève L; Choinière, Manon; Rainville, Pierre

    2016-02-01

    Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment. PMID:26447703

  10. Predicting math outcomes: reading predictors and comorbidity.

    PubMed

    Fletcher, Jack M

    2005-01-01

    This commentary addresses issues concerning (a) the measurement of numbers, letters, and words versus cognitive processes in early screening batteries, and (b) comorbid associations of reading, math, and attention disorders. Based on reading prediction studies, assessments that include numbers should be most predictive of math outcomes. However, given the comorbid association of reading, math, and attention disorders, measures sensitive to reading and attention difficulties may be necessary in early screening batteries for math disabilities. PMID:16122061

  11. Patient reported outcome measures for cardiac ablation procedures: a multicentre pilot to develop a new questionnaire

    PubMed Central

    Withers, Kathleen L.; White, Judith; Carolan-Rees, Grace; Patrick, Hannah; O'Callaghan, Peter; Murray, Stephen; Cunningham, David; Wood, Kathryn A.; Lencioni, Mauro; Griffith, Michael

    2014-01-01

    Aim To assess the feasibility of administering Patient Reported Outcomes Measures (PROMs) in patients treated with ablation for cardiac arrhythmias, and to conduct the first stage of development and testing of a new PROM tool. Methods and results A new tool was developed by a multidisciplinary team and tested alongside an adaptation of the patient perception of arrhythmia questionnaire (PPAQ) and EQ-5D-5L in a multicentre retrospective audit involving 791 consecutive cardiac arrhythmia patients treated with catheter ablation at three UK centres over 13 months. Data were recorded in the National Cardiac Rhythm Management Database, part of the National Institute for Cardiovascular Outcomes Research. The response rate was 71.9% (n = 569). Patients reported significant improvements across all outcomes and impacts, with reductions in symptoms of 51.7% (heart racing), 33.9% (fatigue) 31.8% (heart flutters), 43.5% (dizziness), 38.6% (breathlessness), 44.2% (chest pressure), 33.1% (trouble concentrating), 15.9% (headache), 28.3% (neck pressure), and 23.4% (fainting) (P < 0.001). The mean number of social days affected reduced by 7.49 days/month (P < 0.001); mean work/school days affected/month reduced by 6.26 (P < 0.001); mean GP/hospital visits reduced by 1.36 days/month (P < 0.001). The procedure met patient expectations in 72% of responders. Conclusions The high response rate suggests that the use of PROMs in this patient group is feasible, with rates equalling those of the National PROMs Programme. The results showed that patients experienced significant improvements in their quality of life following ablation, while feedback allowed the tools to be improved. Further work is required to validate these tools; however, the findings suggest that PROMs could be useful in the audit of ablation techniques. PMID:24627541

  12. Predicting Language Outcomes for Internationally Adopted Children

    ERIC Educational Resources Information Center

    Glennen, Sharon L.

    2007-01-01

    Purpose: Language and speech are difficult to assess in newly arrived internationally adopted children. The purpose of this study was to determine if assessments completed when toddlers were first adopted could predict language outcomes at age 2. Local norms were used to develop early intervention guidelines that were evaluated against age 2…

  13. Prediction of processing tomato peeling outcomes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Peeling outcomes of processing tomatoes were predicted using multivariate analysis of Magnetic Resonance (MR) images. Tomatoes were obtained from a whole-peel production line. Each fruit was imaged using a 7 Tesla MR system, and a multivariate data set was created from 28 different images. After ...

  14. Improving Outcomes with Surgical Resection and Other Ablative Therapies in HCC

    PubMed Central

    Deshpande, Rahul; O'Reilly, Derek; Sherlock, David

    2011-01-01

    With rising incidence and emergence of effective treatment options, the management of hepatocellular carcinoma (HCC) is a complex multidisciplinary process. There is still little consensus and uniformity about clinicopathological staging systems. Resection and liver transplantation have been the cornerstone of curative surgical treatments with recent emergence of ablative techniques. Improvements in diagnostics, surgical techniques, and postoperative care have lead to dramatically improved results over the years. The most appropriate treatment plan has to be individualised and depends on a variety of patient and tumour-related factors. Very small HCCs discovered on surveillance have the best outcomes. Patients with advanced cirrhosis and tumours within Milan criteria should be offered transplantation. Resection is best for small solitary tumours with preserved liver function. Ablative techniques are suitable for low volume tumours in patients unfit for either resection or transplantation. The role of downstaging and bridging therapy is not clearly established. PMID:21994867

  15. Comparison of Ablation Predictions for Carbonaceous Materials Using CEA and JANAF-Based Species Thermodynamics

    NASA Technical Reports Server (NTRS)

    Milos, Frank S.

    2011-01-01

    In most previous work at NASA Ames Research Center, ablation predictions for carbonaceous materials were obtained using a species thermodynamics database developed by Aerotherm Corporation. This database is derived mostly from the JANAF thermochemical tables. However, the CEA thermodynamics database, also used by NASA, is considered more up to date. In this work, the FIAT code was modified to use CEA-based curve fits for species thermodynamics, then analyses using both the JANAF and CEA thermodynamics were performed for carbon and carbon phenolic materials over a range of test conditions. The ablation predictions are comparable at lower heat fluxes where the dominant mechanism is carbon oxidation. However, the predictions begin to diverge in the sublimation regime, with the CEA model predicting lower recession. The disagreement is more significant for carbon phenolic than for carbon, and this difference is attributed to hydrocarbon species that may contribute to the ablation rate.

  16. Predicting Alcohol Treatment Outcome: Using Expectancy to Enhance Prediction.

    ERIC Educational Resources Information Center

    Brown, Sandra A.; Berger, Barry

    Research in the field of alcohol abuse evidences a long history of attempts to predict outcome from alcohol treatment programs using situational and intrapsychic factors. To investigate whether alcohol reinforcement expectancies are related to drinking behavior, 42 male veteran graduates of an inpatient alcohol treatment program were interviewed 1…

  17. Scalp EEG does not predict hemispherectomy outcome

    PubMed Central

    Greiner, Hansel M.; Park, Yong D.; Holland, Katherine; Horn, Paul S.; Byars, Anna W.; Mangano, Francesco T.; Smith, Joseph R.; Lee, Mark R.; Lee, Ki-Hyeong

    2012-01-01

    Background Functional hemispherectomy is effective in carefully selected patients, resulting in a reduction of seizure burden up to complete resolution, improvement of intellectual development, and developmental benefit despite possible additional neurological deficit. Despite apparent hemispheric pathology on brain magnetic resonance imaging (MRI) or other imaging tests, scalp electroencephalography (EEG) could be suggestive of bilateral ictal onset or even ictal onset contralateral to the dominant imaging abnormality. We aimed to investigate the role of scalp EEG lateralization pre-operatively in predicting outcome. Methods We retrospectively reviewed 54 patients who underwent hemispherectomy between 1991 and 2009 at Medical College of Georgia (1991–2006) and Cincinnati Children’s Hospital Medical Center (2006–2009) and had at least one year post-operative follow-up. All preoperative EEGs were reviewed, and classified as either lateralizing or nonlateralizing, for both ictal and interictal EEG recordings. Results Of 54 patients, 42 (78%) became seizure free. Twenty-four (44%) of 54 had a nonlateralizing ictal or interictal EEG. Further analysis was based on etiology of epilepsy, including malformation of cortical development (MCD), Rasmussen syndrome (RS), and stroke (CVA). EEG nonlateralization did not predict poor outcome in any of the etiology groups evaluated. Conclusion Scalp EEG abnormalities in contralateral or bilateral hemispheres do not, in isolation, predict a poor outcome from hemispherectomy. Results of other non-invasive and invasive evaluations should be used to determine candidacy. PMID:21813300

  18. Predicting Clinical Outcomes Using Molecular Biomarkers

    PubMed Central

    Burke, Harry B.

    2016-01-01

    Over the past 20 years, there has been an exponential increase in the number of biomarkers. At the last count, there were 768,259 papers indexed in PubMed.gov directly related to biomarkers. Although many of these papers claim to report clinically useful molecular biomarkers, embarrassingly few are currently in clinical use. It is suggested that a failure to properly understand, clinically assess, and utilize molecular biomarkers has prevented their widespread adoption in treatment, in comparative benefit analyses, and their integration into individualized patient outcome predictions for clinical decision-making and therapy. A straightforward, general approach to understanding how to predict clinical outcomes using risk, diagnostic, and prognostic molecular biomarkers is presented. In the future, molecular biomarkers will drive advances in risk, diagnosis, and prognosis, they will be the targets of powerful molecular therapies, and they will individualize and optimize therapy. Furthermore, clinical predictions based on molecular biomarkers will be displayed on the clinician’s screen during the physician–patient interaction, they will be an integral part of physician–patient-shared decision-making, and they will improve clinical care and patient outcomes. PMID:27279751

  19. Predicting performance of annual safety outcomes.

    PubMed

    Guria, J; Mara, K

    2001-05-01

    A control chart system was developed in an earlier paper to identify the occurrence of actual risk changes or deviation from the expected levels of road crash fatalities during the course of a year. This paper discusses the development of a prediction method for estimating number of fatalities during a year. The method then provides a mechanism for estimating the likelihood of meeting a pre-set target or any other outcome. At any point of time in a year, the attainability of a target for the year, depends not only on safety outcomes during the remainder of the year but also on outcomes up to that point in the year. High week to week variability would indicate that it can be difficult to achieve the intended maximum goal. The control charts developed earlier, indicate if the current trend differs from the expected trend or that required to achieve the target. This paper determines the probability of achieving the target given the past outcomes of the year. It also determines the level of outcome for the year based on the past trend and in the absence of any special programmes. The paper discusses the New Zealand application as an example. PMID:11235800

  20. Impact of Free Thyroxine on the Outcomes of Left Atrial Ablation Procedures.

    PubMed

    Sousa, Pedro A; Providência, Rui; Albenque, Jean-Paul; Khoueiry, Ziad; Combes, Nicolas; Combes, Stéphane; Boveda, Serge

    2015-12-15

    The prevalence of atrial fibrillation (AF) is increased in hyperthyroidism. The degree to which thyroid hormones affect the outcomes of left atrial (LA) ablation is still unclear. From September 2010 to September 2013, 1,095 patients who underwent LA ablation (59.7% paroxysmal AF, 32.3% persistent AF, and 8.0% LA tachycardia) had their serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels measured in the 48 hours before the procedure. Patients were followed until they presented the first AF relapse after a blanking period of 3 months. TSH and FT4 were assessed as predictors of arrhythmia relapse and were adjusted for possible confounders. During a mean follow-up of 12.5 ± 7.9 months, 28.9% of patients presented an atrial arrhythmia relapse. TSH was not a predictor of relapse. In contrast, after adjustment, FT4 (median = 11.8 ng/L and interquartile range 10.6 to 14.6 ng/L) remained a predictor of relapse with 15% increase per quartile (hazard ratio 1.15, 95% confidence interval 1.03 to 1.29, p = 0.014). In conclusion, FT4 levels influence the success rate of LA ablation procedures, even when in the normal range. PMID:26514301

  1. Re-ablation I-131 activity does not predict treatment success in low- and intermediate-risk patients with differentiated thyroid carcinoma.

    PubMed

    Prpic, Marin; Kruljac, Ivan; Kust, Davor; Kirigin, Lora S; Jukic, Tomislav; Dabelic, Nina; Bolanca, Ante; Kusic, Zvonko

    2016-06-01

    The aim of this study was to evaluate the efficacy of different radioactive iodine (I-131) activities used for re-ablation, to compare various combinations of treatment activities, and to identify predictors of re-ablation failure in low- and intermediate-risk differentiated thyroid carcinoma (DTC) patients. The study included 128 consecutive low- and intermediate-risk patients with DTC with ablation failure after total thyroidectomy. Patient characteristics, T status, tumor size, lymph node involvement, postoperative remnant size on whole-body scintigraphy, serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), anti-Tg antibody (TgAb), and Tg/TSH ratio were analyzed as potential predictors of the re-ablation success. Re-ablation was successful in 113 out of 128 patients (88.3 %). Mean first I-131 activity was 2868 ± 914 MBq (77.5 ± 24.7 mCi) and mean second I-131 activity 3004 ± 699 MBq (81.2 ± 18.9 mCi). There was no association between the first, second, and cumulative activity with re-ablation treatment outcome. Treatment failure was associated with higher Tg levels prior to re-ablation (Tg2) (OR 1.16, 95 % CI 1.05-1.29, P = 0.003) and N1a status (OR 3.89, 95 % CI 1.13-13.41, P = 0.032). After excluding patients with positive-to-negative TgAb conversion, Tg2 level of 3.7 ng/mL predicted treatment failure with a sensitivity of 75.0 %, specificity of 80.5 %, and a negative predictive value of 97.1 %. Patients with positive-to-negative TgAb conversion had higher failure rates (OR 2.96, 95 % CI 0.94-9.29). Re-ablation success was high in all subgroups of patients and I-131 activity did not influence treatment outcome. Tg may serve as a good predictor of re-ablation failure. Patients with positive-to-negative TgAb conversion represent a specific group, in whom Tg level should not be used as a predictive marker of treatment outcome. PMID:26732041

  2. Incidence and predictive factors of atrial fibrillation after ablation of typical atrial flutter.

    PubMed

    Laurent, Valérie; Fauchier, Laurent; Pierre, Bertrand; Grimard, Caroline; Babuty, Dominique

    2009-03-01

    Although cavotricuspid isthmus radiofrequency catheter ablation is considered curative therapy for typical atrial flutter, many patients develop an atrial fibrillation after ablation. The purpose of our study was to determine the incidence and the predictive factors of post-ablation atrial fibrillation. One hundred and forty eight consecutive patients underwent cavotricuspid isthmus ablation for the treatment of typical atrial flutter between January 2004 and December 2005 in our electrophysiological department. Complete cavotricuspid isthmus block was successfully obtained in 96.6% of the patients. At the end of the electrophysiological study a sustained atrial fibrillation was inducible in 20 patients (13.5%). During an average follow-up of 21.3 +/- 8.2 months, atrial fibrillation occurred in 27% of the patients. Univariate analysis identified four parameters correlated with post-ablation atrial fibrillation among the 21 parameters tested: the young age of the patients, a prior history of atrial fibrillation, an inducible atrial fibrillation, and a paroxysmal atrial flutter. Only inducible atrial fibrillation and paroxysmal atrial flutter were independent factors linked to atrial fibrillation after ablation. In our study the incidence of atrial fibrillation after cavotricuspid isthmus radiofrequency catheter ablation is 152 per 1,000 patient-years, i.e. 25 times higher than the incidence of atrial fibrillation in the general population of the same age. Twenty five percent of the patients who had neither prior history of atrial fibrillation nor structural heart disease suffered from atrial fibrillation during a mean follow-up of 21.3 +/- 8.2 months. All these results suggest that atrial flutter and fibrillation could be manifestations of a more general electrophysiologic disease. They emphasize the need for all these patients to benefit from regular, long-term cardiological follow-up after cavotricuspid isthmus ablation because of the high incidence of atrial

  3. Novel P Wave Indices to Predict Atrial Fibrillation Recurrence After Radiofrequency Ablation for Paroxysmal Atrial Fibrillation.

    PubMed

    Hu, Xiaoliang; Jiang, Jingzhou; Ma, Yuedong; Tang, Anli

    2016-01-01

    BACKGROUND Circumferential pulmonary vein isolation (CPVI) is a widely used treatment for paroxysmal atrial fibrillation (AF). Several P wave duration (PWD) parameters have been suggested to predict post-ablation recurrence, but their use remains controversial. This study aimed to identify novel P wave indices that predict post-ablation AF recurrence. MATERIAL AND METHODS We selected 171 consecutive patients undergoing CPVI for paroxysmal AF. Electrocardiography (ECG) recordings were obtained at the beginning and the end of ablation. PWD was measured in all 12 leads. The PWD variation was calculated by subtracting the pre-ablation PWD from the post-ablation PWD. RESULTS PWD was significantly shortened in leads II, III, aVF, and V1 after ablation. During a mean follow-up of 19.96±4.32 months, AF recurrence occurred in 32 (18.7%) patients. No significant differences in baseline characteristics or pre- or post-ablation PWD were observed between the AF recurrence and non-recurrence groups. Patients with AF recurrence exhibited a smaller PWD variation in leads II (1.21(-0.56, 2.40) vs. -5.77(-9.10, -4.06) ms, P<0.001), III (-5.92(-9.87, 3.27) vs. -9.44(-11.89, -5.57) ms, P=0.001) and V1 (-4.43(-6.64, -3.13) vs. -6.33(-8.19,-4.59) ms, P=0.003). Multivariable logistic regression analysis demonstrated that smaller PWD variations in lead II and III were independent risk factors for AF recurrence. PWD variation ≥-2.21 ms in lead II displayed the highest combined sensitivity and specificity (85.29% and 83.94%, respectively) for predicting post-ablation AF recurrence. A PWD variation ≥0 ms displayed the best practical value in predicting AF recurrence. CONCLUSIONS PWD variation in lead II is an effective predictor of post-ablation AF recurrence. PMID:27450644

  4. Novel P Wave Indices to Predict Atrial Fibrillation Recurrence After Radiofrequency Ablation for Paroxysmal Atrial Fibrillation

    PubMed Central

    Hu, Xiaoliang; Jiang, Jingzhou; Ma, Yuedong; Tang, Anli

    2016-01-01

    Background Circumferential pulmonary vein isolation (CPVI) is a widely used treatment for paroxysmal atrial fibrillation (AF). Several P wave duration (PWD) parameters have been suggested to predict post-ablation recurrence, but their use remains controversial. This study aimed to identify novel P wave indices that predict post-ablation AF recurrence. Material/Methods We selected 171 consecutive patients undergoing CPVI for paroxysmal AF. Electrocardiography (ECG) recordings were obtained at the beginning and the end of ablation. PWD was measured in all 12 leads. The PWD variation was calculated by subtracting the pre-ablation PWD from the post-ablation PWD. Results PWD was significantly shortened in leads II, III, aVF, and V1 after ablation. During a mean follow-up of 19.96±4.32 months, AF recurrence occurred in 32 (18.7%) patients. No significant differences in baseline characteristics or pre- or post-ablation PWD were observed between the AF recurrence and non-recurrence groups. Patients with AF recurrence exhibited a smaller PWD variation in leads II (1.21(−0.56, 2.40) vs. −5.77(−9.10, −4.06) ms, P<0.001), III (−5.92(−9.87, 3.27) vs. −9.44(−11.89, −5.57) ms, P=0.001) and V1 (−4.43(−6.64, −3.13) vs. −6.33(−8.19,−4.59) ms, P=0.003). Multivariable logistic regression analysis demonstrated that smaller PWD variations in lead II and III were independent risk factors for AF recurrence. PWD variation ≥−2.21 ms in lead II displayed the highest combined sensitivity and specificity (85.29% and 83.94%, respectively) for predicting post-ablation AF recurrence. A PWD variation ≥0 ms displayed the best practical value in predicting AF recurrence. Conclusions PWD variation in lead II is an effective predictor of post-ablation AF recurrence. PMID:27450644

  5. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome.

    PubMed

    Bohlmann, M K; Hoellen, F; Hunold, P; David, M

    2014-02-01

    Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk. PMID:24741124

  6. Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

    PubMed Central

    Mikhaylov, Evgeny N.; Lebedev, Dmitry S.; Pokushalov, Evgeny A.; Davtyan, Karapet V.; Ivanitskii, Eduard A.; Nechepurenko, Anatoly A.; Kosonogov, Alexey Ya.; Kolunin, Grigory V.; Morozov, Igor A.; Termosesov, Sergey A.; Maykov, Evgeny B.; Khomutinin, Dmitry N.; Eremin, Sergey A.; Mayorov, Igor M.; Romanov, Alexander B.; Shabanov, Vitaliy V.; Shatakhtsyan, Victoria; Tsivkovskii, Viktor; Revishvili, Amiran Sh.; Shlyakhto, Evgeny V.

    2015-01-01

    Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres. PMID:26640789

  7. Personality and the prediction of consequential outcomes.

    PubMed

    Ozer, Daniel J; Benet-Martínez, Verónica

    2006-01-01

    Personality has consequences. Measures of personality have contemporaneous and predictive relations to a variety of important outcomes. Using the Big Five factors as heuristics for organizing the research literature, numerous consequential relations are identified. Personality dispositions are associated with happiness, physical and psychological health, spirituality, and identity at an individual level; associated with the quality of relationships with peers, family, and romantic others at an interpersonal level; and associated with occupational choice, satisfaction, and performance, as well as community involvement, criminal activity, and political ideology at a social institutional level. PMID:16318601

  8. Endometrial ablation

    MedlinePlus

    Hysteroscopy-endometrial ablation; Laser thermal ablation; Endometrial ablation-radiofrequency; Endometrial ablation-thermal balloon ablation; Rollerball ablation; Hydrothermal ablation; Novasure ablation

  9. Predicting radiotherapy outcomes using statistical learning techniques*

    PubMed Central

    El Naqa, Issam; Bradley, Jeffrey D; Lindsay, Patricia E; Hope, Andrew J; Deasy, Joseph O

    2013-01-01

    Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for ‘generalizabilty’ validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among model

  10. Predicting radiotherapy outcomes using statistical learning techniques

    NASA Astrophysics Data System (ADS)

    El Naqa, Issam; Bradley, Jeffrey D.; Lindsay, Patricia E.; Hope, Andrew J.; Deasy, Joseph O.

    2009-09-01

    Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for 'generalizabilty' validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among model

  11. Predicting outcome after traumatic brain injury.

    PubMed

    Maas, Andrew I R; Lingsma, Hester F; Roozenbeek, Bob

    2015-01-01

    Developing insight into which factors determine prognosis after traumatic brain injury (TBI) is useful for clinical practice, research, and policy making. Several steps can be identified in prediction research: univariate analysis, multivariable analysis, and the development of prediction models. For each step, several methodological issues should be considered, such as selection/coding of predictors and dealing with missing data. "Traditional" predictors include demographic factors (age), type of injury, clinical severity, second insults, and the presence of structural abnormalities on neuroimaging. In combination, these predictors can explain approximately 35% of the variance in outcome in populations with severe and moderate TBI. Novel and emerging predictors include genetic constitution, biomarkers, and advanced magnetic resonance (MR) imaging. To estimate prognosis for individual patients reliably, multiple predictors need to be considered jointly in prognostic models. Two prognostic models for use in TBI, developed upon large patient numbers, have been extensively validated externally: the IMPACT and CRASH prediction models. Both models showed good performance in validations across a wide range of settings. Importantly, these models were developed not only for mortality but also for functional outcome. Prognostic models can be used for providing information to relatives of individual patients, for resource allocation, and to support decisions on treatment. At the group level, prognostic models aid in the characterization of patient populations, are important to clinical trial design and analysis, and importantly, can serve as benchmarks for assessing quality of care. Continued development, refinement, and validation of prognostic models for TBI is required and this should become an ongoing process. PMID:25701901

  12. Image-guided percutaneous microwave ablation of small renal tumours: short- and mid-term outcomes

    PubMed Central

    Genson, Pierre-Yves; Mourey, Eric; Moulin, Morgan; Favelier, Sylvain; Di Marco, Lucy; Chevallier, Olivier; Cercueil, Jean-Pierre; Krausé, Denis; Cormier, Luc

    2015-01-01

    Background The purpose is to assess the short- and mid-term outcomes of microwave ablation (MWA) of small renal tumours in selected patients. Methods From August 2012 to February 2015, 29 renal tumours in 23 patients (17 male, 6 female, mean age 75 years) were treated by percutaneous MWA under imaging guidance. The tumours were 1-4.7 cm in diameter (mean size, 2.7 cm). Therapeutic effects were assessed at follow-up with magnetic resonance imaging (MRI). All patients were followed up for 2-25 months (mean, 12.2 months) to observe the therapeutic effects and complications. Changes in renal function at day 1 after treatment were statistically analyzed using the Student paired t-test or the paired Wilcoxon test. Results Technical success was achieved in all cases. One severe bleeding complication post-procedure occurred leading to death. No other unexpected side effects were observed after the MWA procedures. Clinical effectiveness was 100%. None of the patients showed recurrence on MRI imaging follow-up. No significant changes in renal function were noted after treatment (P=0.57). Conclusions Our preliminary study demonstrates that the use of MWA for the treatment of small renal tumours can be applied as safely and efficiently as other ablative techniques in selected patients not eligible for surgery. PMID:26682134

  13. Prediction of Ablation Rates from Solid Surfaces Exposed to High Temperature Gas Flow

    NASA Technical Reports Server (NTRS)

    Akyuzlu, Kazim M.; Coote, David

    2013-01-01

    ablation. Two different ablation models are proposed to determine the heat loss from the solid surface due to the ablation of the solid material. Both of them are physics based. Various numerical simulations were carried out using both models to predict the temperature distribution in the solid and in the gas flow, and then predict the ablation rates at a typical NTR motor hydrogen gas temperature and pressure. Solid mass loss rate per foot of a pipe was also calculated from these predictions. The results are presented for fully developed turbulent flow conditions in a sample SS pipe with a 6 inch diameter.

  14. Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease.

    PubMed

    Anguera, Ignasi; Dallaglio, Paolo; Macías, Rosa; Jiménez-Candil, Javier; Peinado, Rafael; García-Seara, Javier; Arcocha, Mari Fe; Herreros, Benito; Quesada, Aurelio; Hernández-Madrid, Antonio; Alvarez, Miguel; Filgueiras, David; Matía, Roberto; Cequier, Angel; Sabaté, Xavier

    2015-06-15

    Atrial myopathy, atriotomies, and fibrotic scars are the pathophysiological substrate of lines of conduction block, promoting atrial macroreentry. The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for right atrial tachyarrhythmia (AT) in adults after cardiac surgery for congenital heart disease (CHD) and acquired heart disease (AHD) and predictors of these outcomes. Clinical records of adults after surgery for heart disease undergoing RFCA of right-sided AT were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors predicting acute and long-term outcomes. A total of 372 patients (69% men; age 61 ± 15 years) after surgical repair of CHD (n = 111) or AHD (n = 261) were studied. Cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) was observed in 300 patients and non-CTI-AFL in 72 patients. Ablation was successful in 349 cases (94%). During a mean follow-up of 51 ± 30 months, recurrences were observed in 24.5% of patients. Multivariate analysis showed that non-CTI-AFL (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.1 to 2.9) and CHD (HR 1.75, 95% CI 1.07 to 2.9) were independent predictors of long-term recurrences. Multivariate analysis showed that female gender (HR 2.29, 95% CI 1.6 to 3.3), surgery for AHD (HR 95% 2.31, 95% CI 1.5 to 3.7), and left atrial dilatation (HR 2.1, 95% CI 1.3 to 3.2) were independent predictors of long-term atrial fibrillation. In conclusion, RFCA of right-sided AT after cardiac surgery is associated with high acute success rates and significant long-term recurrences. Non-CTI-dependent AFL and surgery for CHD are at higher risk of recurrence. Atrial fibrillation is common during follow-up, particularly in patients with AHD and enlarged left atrium. PMID:25896151

  15. Predicting outcomes for children with neuroblastoma.

    PubMed

    Vermeulen, Joëlle; De Preter, Katleen; Mestdagh, Pieter; Laureys, Geneviève; Speleman, Frank; Vandesompele, Jo

    2010-07-01

    One of the main challenges in clinical cancer research remains to be accurate outcome prediction at the time of diagnosis. Although not frequent in absolute terms, neuroblastoma represents an important clinical challenge, as it is fatal in almost half of the patients despite advances in multimodal anti-cancer therapies. Four major risk stratification systems for neuroblastoma patients are currently being used in various parts of the world. Systems are based on a combination of various clinical, histopathological, and biological factors. Accordingly, different therapeutic schemes exist ranging from wait-and-see approaches to intensive multimodal therapies. Clinical experience with the currently used risk stratification systems suggests that the stratification of patients for treatment is useful, but patients with the same clinico-pathological parameters, receiving the same treatment, can have markedly different clinical courses. Therefore, the challenge remains to identify additional tumor-specific and sensitive prognostic markers for improved risk estimation at the time of diagnosis and to improve the choice of risk-related therapy. Various studies have put forward new prognostic markers, including copy number aberrations, gene expression signatures, and epigenetic markers. PMID:20670596

  16. A novel parameter for predicting arterial fusion and ablation in finite element models

    NASA Astrophysics Data System (ADS)

    Fankell, Douglas; Kramer, Eric; Taylor, Kenneth; Ferguson, Virginia; Rentschler, Mark E.

    2015-03-01

    Tissue fusion devices apply heat and pressure to ligate or ablate blood vessels during surgery. Although this process is widely used, a predictive finite element (FE) model incorporating both structural mechanics and heat transfer has not been developed, limiting improvements to empirical evidence. This work presents the development of a novel damage parameter, which incorporates stress, water content and temperature, and demonstrates its application in a FE model. A FE model, using the Holzapfel-Gasser-Ogden strain energy function to represent the structural mechanics and equations developed by Cezo to model water content and heat transfer, was created to simulate the fusion or ablation of a porcine splenic artery. Using state variables, the stresses, temperature and water content are recorded and combined to create a single parameter at each integration point. The parameter is then compared to a critical value (determined through experiments). If the critical value is reached, the element loses all strength. If the value is not reached, no change occurs. Little experimental data exists for validation, but the resulting stresses, temperatures and water content fall within ranges predicted by prior work. Due to the lack of published data, additional experimental studies are being conducted to rigorously validate and accurately determine the critical value. Ultimately, a novel method for demonstrating tissue damage and fusion in a FE model is presented, providing the first step towards in-depth FE models simulating fusion and ablation of arteries.

  17. Differences between real and predicted corneal shapes after aspherical corneal ablation.

    PubMed

    Anera, Rosario G; Villa, César; Jiménez, José R; Gutiérrez, Ramón; del Barco, Luis Jiménez

    2005-07-20

    We study the differences between real and expected corneal shapes, using an aspherical ablation algorithm with a known equation and avoiding the limitation imposed by most studies of refractive surgery in which the ablation equations are not known. We have calculated the theoretical corneal shape predicted by this algorithm, comparing this shape with the real corneal topography. The results indicate that the deviations that appear in the corneal shape are significant for visual performance and for the correction of eye aberrations. If we include in this analysis the effect of reflection losses and nonnormal incidence on the cornea, we can reduce corneal differences, but they will remain significant. These results confirm that it is essential to minimize corneal differences to achieve effective correction in refractive surgery. PMID:16047903

  18. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    PubMed

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. PMID:27089522

  19. Clinical outcomes between optical path difference custom aspheric treatment and optimized prolate ablation photorefractive keratectomy in myopia exceeding 8 diopters

    PubMed Central

    Choi, B J; Park, Y M; Lee, J S

    2015-01-01

    Purpose Comparison of visual acuity, refractive, and wavefront outcomes associated with optimized prolate ablation (OPA) and optical path difference custom aspheric treatment (OPDCAT) algorithms for correction of myopia exceeding 8 diopters (D). Patients and Methods Patients were randomly assigned to have photorefractive keratectomy (PRK) with OPA (n=32) or OPDCAT (n=21) algorithms. Visual acuity, manifest refraction, ocular and corneal higher-order aberrations, corneal asphericity, modulated-transfer function, and point-spread function were compared 1, 3, and 6 months postoperatively. Results Mean manifest-refraction spherical equivalents at 6 months were −0.24 D in both groups. All patients in both groups had an uncorrected-distance visual acuity of 20/20 or better. Predictability (±1 D from intended refraction) at 6 months was 94% in the OPA group, and in the OPDCAT group it was 86%. The OPA group had less induced corneal and ocular spherical aberrations (SAs) than the OPDCAT group. Postoperative corneal asphericity change was lowest in the OPA group. Both the groups exhibited significantly-improved AreaRatio-Total value and insignificantly deteriorated AreaRatio-HO value throughout the postoperative period. The OPA group had significantly-higher AreaRatio-Total compared with OPDCAT group at both 1 and 6 months after the operation. Six months after surgery, the Strehl ratio had decreased in both groups, and there was no significant difference between the groups. Conclusion The OPA algorithms yielded higher-objective visual quality and predictability, induced less corneal and ocular SAs, and preserved more preoperative-corneal asphericity than the OPDCAT algorithms. PMID:25397788

  20. Predictable surface ablation of dielectrics with few-cycle laser pulse even beyond air ionization

    NASA Astrophysics Data System (ADS)

    Pasquier, C.; Sentis, M.; Utéza, O.; Sanner, N.

    2016-08-01

    We study surface ablation of dielectrics with single-shot few-cycle optical pulse (˜10 fs) in air, at intensities below and above the onset of air ionization. We perform 3D analysis and careful calibration of the fluence distribution at the laser focus, spanning from linear- to nonlinear- focusing regimes, enabling to thoroughly characterize the severe limitation of the fluence delivered onto the sample surface upon increase of incident pulse energy. Despite significant beam reshaping taking place at high fluence, we demonstrate that it is nevertheless possible to confidently predict the resulting crater profiles on fused silica surface, even in the regime of filamentation.

  1. Does Television Viewership Predict Presidential Election Outcomes?

    PubMed Central

    Barfar, Arash; Padmanabhan, Balaji

    2015-01-01

    Abstract The days of surprise about actual election outcomes in the big data world are likely to be fewer in the years ahead, at least to those who may have access to such data. In this paper we highlight the potential for forecasting the Unites States presidential election outcomes at the state and county levels based solely on the data about viewership of television programs. A key consideration for relevance is that given the infrequent nature of elections, such models are useful only if they can be trained using recent data on viewership. However, the target variable (election outcome) is usually not known until the election is over. Related to this, we show here that such models may be trained with the television viewership data in the “safe” states (the ones where the outcome can be assumed even in the days preceding elections) to potentially forecast the outcomes in the swing states. In addition to their potential to forecast, these models could also help campaigns target programs for advertisements. Nearly two billion dollars were spent on television advertising in the 2012 presidential race, suggesting potential for big data–driven optimization of campaign spending. PMID:26487986

  2. Predicting School Referenda Outcomes: Answers from Illinois.

    ERIC Educational Resources Information Center

    Lentz, Corliss

    1999-01-01

    Uses ordinary least-squares multivariate regression analysis to determine if jurisdictional types vary in their willingness to increase taxation for schools, employing 892 education fund referenda conducted in Illinois from 1981 to 1989. Outcomes do differ by jurisdiction type. The strongest predictor is willingness to pay for higher taxes. (29…

  3. FBG Sensor for Contact Level Monitoring and Prediction of Perforation in Cardiac Ablation

    PubMed Central

    Ho, Siu Chun Michael; Razavi, Mehdi; Nazeri, Alireza; Song, Gangbing

    2012-01-01

    Atrial fibrillation (AF) is the most common type of arrhythmia, and is characterized by a disordered contractile activity of the atria (top chambers of the heart). A popular treatment for AF is radiofrequency (RF) ablation. In about 2.4% of cardiac RF ablation procedures, the catheter is accidently pushed through the heart wall due to the application of excessive force. Despite the various capabilities of currently available technology, there has yet to be any data establishing how cardiac perforation can be reliably predicted. Thus, two new FBG based sensor prototypes were developed to monitor contact levels and predict perforation. Two live sheep were utilized during the study. It was observed during operation that peaks appeared in rhythm with the heart rate whenever firm contact was made between the sensor and the endocardial wall. The magnitude of these peaks varied with pressure applied by the operator. Lastly, transmural perforation of the left atrial wall was characterized by a visible loading phase and a rapid signal drop-off correlating to perforation. A possible pre-perforation signal was observed for the epoxy-based sensor in the form of a slight signal reversal (12–26% of loading phase magnitude) prior to perforation (occurring over 8 s). PMID:22368507

  4. FBG sensor for contact level monitoring and prediction of perforation in cardiac ablation.

    PubMed

    Ho, Siu Chun Michael; Razavi, Mehdi; Nazeri, Alireza; Song, Gangbing

    2012-01-01

    Atrial fibrillation (AF) is the most common type of arrhythmia, and is characterized by a disordered contractile activity of the atria (top chambers of the heart). A popular treatment for AF is radiofrequency (RF) ablation. In about 2.4% of cardiac RF ablation procedures, the catheter is accidently pushed through the heart wall due to the application of excessive force. Despite the various capabilities of currently available technology, there has yet to be any data establishing how cardiac perforation can be reliably predicted. Thus, two new FBG based sensor prototypes were developed to monitor contact levels and predict perforation. Two live sheep were utilized during the study. It was observed during operation that peaks appeared in rhythm with the heart rate whenever firm contact was made between the sensor and the endocardial wall. The magnitude of these peaks varied with pressure applied by the operator. Lastly, transmural perforation of the left atrial wall was characterized by a visible loading phase and a rapid signal drop-off correlating to perforation. A possible pre-perforation signal was observed for the epoxy-based sensor in the form of a slight signal reversal (12-26% of loading phase magnitude) prior to perforation (occurring over 8 s). PMID:22368507

  5. Long-term Therapeutic Outcomes of Radiofrequency Ablation for Subcapsular versus Nonsubcapsular Hepatocellular Carcinoma: A Propensity Score Matched Study.

    PubMed

    Kang, Tae Wook; Lim, Hyo Keun; Lee, Min Woo; Kim, Young-Sun; Rhim, Hyunchul; Lee, Won Jae; Paik, Yong Han; Kim, Min Ji; Ahn, Joong Hyun

    2016-07-01

    Purpose To compare the long-term therapeutic outcomes of radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) in subcapsular versus nonsubcapsular locations by using propensity score matching. Materials and Methods RF ablation for subcapsular HCC is controversial because of a high risk of incomplete ablation or major complications. This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between April 2006 and December 2011, 508 consecutive patients (396 men, 112 women; age range, 30-80 years) with a single HCC (Barcelona Clinic Liver Cancer stage 0 or A) underwent ultrasonography-guided percutaneous RF ablation as a first-line treatment. The patients were divided into two groups according to tumor location: subcapsular (n = 227) and nonsubcapsular (n = 281). Subcapsular HCC was defined as an index tumor located within 0.1 cm of the liver capsule. The association of subcapsular location and therapeutic outcomes of RF ablation was evaluated, including (a) local tumor progression (LTP) by using a competing risk regression model and (b) overall survival (OS) by using a Cox proportional hazards model according to propensity score matched data. The major complication rates from both overall data and matched data were assessed. Results Matching yielded 163 matched pairs of patients. In the two matched groups, cumulative LTP rates were 18.8% and 20.9% at 3 and 5 years, respectively, in the subcapsular group and 13.2% and 16.0% in the nonsubcapsular group. Corresponding OS rates were 90.7% for 3 years and 83.2% for 5 years in the subcapsular group and 91.4% and 79.1%, respectively, in the nonsubcapsular group. Hazard ratios (HRs) for LTP (HR = 1.37, P = .244) and OS (HR = 0.86, P = .604) were not significantly different between the two matched groups. Additionally, differences in major complication rates were not significant between groups for the two sets of data (P > .05). Conclusion The

  6. Protein-Based Urine Test Predicts Kidney Transplant Outcomes

    MedlinePlus

    ... News Releases News Release Thursday, August 22, 2013 Protein-based urine test predicts kidney transplant outcomes NIH- ... supporting development of noninvasive tests. Levels of a protein in the urine of kidney transplant recipients can ...

  7. Sense of Coherence Predicts Employment Outcomes after Job Loss

    ERIC Educational Resources Information Center

    Vastamaki, Jaana; Paul, Karsten I.; Moser, Klaus

    2011-01-01

    This study investigated sense of coherence (SOC) as a potential predictor of employment outcomes of unemployed job seekers. Ninety-eight unemployed persons were surveyed at 2 measurement points 6 months apart. The findings showed that strong SOC at baseline predicted positive outcomes (reemployment or being a student) 6 months later. SOC evidently…

  8. Alcohol-Outcome Expectancies: Predicting Interest in Violence and Erotica.

    ERIC Educational Resources Information Center

    George, William H.; Marlatt, G. Alan

    Although research has examined the content of alcohol-outcome expectancies and also the role of alcohol use in aggressive and sexual behaviors, few studies have linked the two lines of inquiry. To examine the efficacy of outcome expectancies for predicting actual behavior, 64 male social drinkers, aged 21 to 25 years, completed questionnaires and,…

  9. Nephrolithometric Scoring Systems to Predict Outcomes of Percutaneous Nephrolithotomy

    PubMed Central

    Vernez, Simone L; Okhunov, Zhamshid; Motamedinia, Piruz; Bird, Vincent; Okeke, Zeph; Smith, Arthur

    2016-01-01

    Currently, there is no single agreement upon an ideal predictive model that characterizes the complexity of renal stones and predicts surgical outcomes following percutaneous nephrolithotomy (PCNL). New predictive tools have recently emerged to systematically and quantitatively assess kidney stone complexity to predict outcomes following PCNL: the Guy’s Stone Score, the CROES nomogram, S.T.O.N.E. nephrolithometry, and S-ReSC score. An ideal scoring system should include variables that both influence surgical planning and are predictive of postoperative outcomes. This review discusses the strengths, weaknesses, and commonalities of each of the above scoring systems. Additionally, we propose future directions for the development and analysis of surgical treatment for stone disease, namely, the importance of assessing radiation exposure and patient quality of life when counseling patients on treatment options. PMID:27162508

  10. Macaques can predict social outcomes from facial expressions.

    PubMed

    Waller, Bridget M; Whitehouse, Jamie; Micheletta, Jérôme

    2016-09-01

    There is widespread acceptance that facial expressions are useful in social interactions, but empirical demonstration of their adaptive function has remained elusive. Here, we investigated whether macaques can use the facial expressions of others to predict the future outcomes of social interaction. Crested macaques (Macaca nigra) were shown an approach between two unknown individuals on a touchscreen and were required to choose between one of two potential social outcomes. The facial expressions of the actors were manipulated in the last frame of the video. One subject reached the experimental stage and accurately predicted different social outcomes depending on which facial expressions the actors displayed. The bared-teeth display (homologue of the human smile) was most strongly associated with predicted friendly outcomes. Contrary to our predictions, screams and threat faces were not associated more with conflict outcomes. Overall, therefore, the presence of any facial expression (compared to neutral) caused the subject to choose friendly outcomes more than negative outcomes. Facial expression in general, therefore, indicated a reduced likelihood of social conflict. The findings dispute traditional theories that view expressions only as indicators of present emotion and instead suggest that expressions form part of complex social interactions where individuals think beyond the present. PMID:27155662

  11. Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors

    PubMed Central

    Akhan, Okan; Güler, Ezgi; Akıncı, Devrim; Çiftçi, Türkmen; Köse, Ilgaz Çağatay

    2016-01-01

    PURPOSE We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODS Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTS Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. CONCLUSION RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors. PMID:26611111

  12. Outcomes of Stereotactic Ablative Radiotherapy in Patients With Potentially Operable Stage I Non-Small Cell Lung Cancer

    SciTech Connect

    Lagerwaard, Frank J.; Verstegen, Naomi E.; Haasbeek, Cornelis J.A.; Slotman, Ben J.; Paul, Marinus A.; Smit, Egbert F.; Senan, Suresh

    2012-05-01

    Background: Approximately two-thirds of patients with early-stage non-small-cell lung cancer (NSCLC) in The Netherlands currently undergo surgical resection. As an increasing number of fit patients have elected to undergo stereotactic ablative radiotherapy (SABR) in recent years, we studied outcomes after SABR in patients with potentially operable stage I NSCLC. Methods and Materials: In an institutional prospective database collected since 2003, 25% of lung SABR cases (n = 177 patients) were found to be potentially operable when the following patients were excluded: those with (1) synchronous lung tumors or other malignancy, (2) prior high-dose radiotherapy/pneumonectomy, (3) chronic obstructive pulmonary disease with a severity score of 3-4 according to the Global initiative for Obstructive Lung Disease classification. (4) a performance score of {>=}3, and (5) other comorbidity precluding surgery. Study patients included 101 males and 76 females, with a median age of 76 years old, 60% of whom were staged as T1 and 40% of whom were T2. Median Charlson comorbidity score was 2 (range, 0-5). A SABR dose of 60 Gy was delivered using a risk-adapted scheme in 3, 5, or 8 fractions, depending on tumor size and location. Follow-up chest computed tomography scans were obtained at 3, 6, and 12 months and yearly thereafter. Results: Median follow-up was 31.5 months; and median overall survival (OS) was 61.5 months, with 1- and 3-year survival rates of 94.7% and 84.7%, respectively. OS rates at 3 years in patients with (n = 59) and without (n = 118) histological diagnosis did not differ significantly (96% versus 81%, respectively, p = 0.39). Post-SABR 30-day mortality was 0%, while predicted 30-day mortality for a lobectomy, derived using the Thoracoscore predictive model (Falcoz PE et al. J Thorac Cardiovasc Surg 2007;133:325-332), would have been 2.6%. Local control rates at 1 and 3 years were 98% and 93%, respectively. Regional and distant failure rates at 3 years were each

  13. Microwave ablation of hepatocellular carcinoma as first-line treatment: long term outcomes and prognostic factors in 221 patients.

    PubMed

    Wang, Tao; Lu, Xiao-Jie; Chi, Jia-Chang; Ding, Min; Zhang, Yuan; Tang, Xiao-Yin; Li, Ping; Zhang, Li; Zhang, Xiao-Yu; Zhai, Bo

    2016-01-01

    This retrospective study aimed at evaluating the long-term outcomes and prognostic factors of microwave ablation (MWA) as a first-line treatment for hepatocellular carcinoma (HCC). 221 consecutive patients receiving MWA in our center between October 11, 2010 and December 31, 2013 were enrolled. Technique effectiveness was evaluated one month post-ablation. Initial complete ablation (CA1(st)) was gained in 201 (90.95%) patients, secondary CA (CA2(nd)) in 8 (3.62%) patients and the remaining 12 (5.43%) patients suffered from incomplete ablation (IA2(nd)) after two sessions of MWA. Patients with tumor size >5 cm were less likely to gain CA1(st). Procedure-related complications were recorded and no procedure-related death occurred. 22 (10.4%) complications occurred with 8 (3.8%) being major ones. Tumor characteristics (size, number, location) do not significantly influence complication rates. After a median follow-up of 41.0 (ranging 25.0-63.5) months, the median RFS and OS was 14.0 months (95% CI: 9.254-18.746) and 41.0 months (95% CI: 33.741-48.259) respectively. Multivariate analysis identified two significant prognosticators (levels of alpha fetal protein [AFP] and gamma-glutamyl transpeptidase [GGT]) of RFS and five significant prognosticators (tumor number, tumor size, AFP, GGT and recurrence type) of OS. In conclusion, MWA provides high technique effectiveness rate and is well tolerated in patients with HCC as a first-line treatment. PMID:27620527

  14. Vitamin D Deficiency Predicts Prostate Biopsy Outcomes

    PubMed Central

    Murphy, Adam B.; Nyame, Yaw; Martin, Iman K.; Catalona, William J.; Hollowell, Courtney M.P.; Nadler, Robert B.; Kozlowski, James M.; Perry, Kent T.; Kajdacsy-Balla, Andre; Kittles, Rick A.

    2014-01-01

    Purpose The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with abnormal PSA and/or digital rectal examination. Experimental Design Serum 25-hydroxyvitamin D (25-OH D) was obtained from 667 men, age 40-79, prospectively enrolled from Chicago urology clinics undergoing first prostate biopsy. Logistic regression was used to evaluate the associations between 25-OH D status and incident prostate cancer (PCa), Gleason score, and tumor stage. Results Among European American (EA) men, there was an association of 25-OH D < 12 ng/ml with higher Gleason score ≥ 4+4 (OR = 3.66 [1.41, 9.50], p = 0.008) and tumor stage (stage ≥ cT2b vs. ≤ cT2a, OR = 2.42 [1.14, 5.10], p = 0.008). In African American (AA) men, we find increased odds of PCa diagnosis on biopsy with 25-OH D < 20 ng/ml (OR = 2.43 [1.20, 4.94], p = 0.01). AA men demonstrated an association between 25-OH D < 12ng/ml and Gleason ≥ 4+4 (OR = 4.89 [1.59, 15.07]; p = 0.006). There was an association with tumor stage ≥ cT2b vs. ≤ cT2a (OR: 4.22, [1.52 – 11.74], p = 0.003). Conclusions In AA men, vitamin D deficiency was associated with increased odds of PCa diagnosis on biopsy. In both EA and AA men, severe deficiency was positively associated with higher Gleason grade and tumor stage. PMID:24789033

  15. Action-outcome learning and prediction shape the window of simultaneity of audiovisual outcomes.

    PubMed

    Desantis, Andrea; Haggard, Patrick

    2016-08-01

    To form a coherent representation of the objects around us, the brain must group the different sensory features composing these objects. Here, we investigated whether actions contribute in this grouping process. In particular, we assessed whether action-outcome learning and prediction contribute to audiovisual temporal binding. Participants were presented with two audiovisual pairs: one pair was triggered by a left action, and the other by a right action. In a later test phase, the audio and visual components of these pairs were presented at different onset times. Participants judged whether they were simultaneous or not. To assess the role of action-outcome prediction on audiovisual simultaneity, each action triggered either the same audiovisual pair as in the learning phase ('predicted' pair), or the pair that had previously been associated with the other action ('unpredicted' pair). We found the time window within which auditory and visual events appeared simultaneous increased for predicted compared to unpredicted pairs. However, no change in audiovisual simultaneity was observed when audiovisual pairs followed visual cues, rather than voluntary actions. This suggests that only action-outcome learning promotes temporal grouping of audio and visual effects. In a second experiment we observed that changes in audiovisual simultaneity do not only depend on our ability to predict what outcomes our actions generate, but also on learning the delay between the action and the multisensory outcome. When participants learned that the delay between action and audiovisual pair was variable, the window of audiovisual simultaneity for predicted pairs increased, relative to a fixed action-outcome pair delay. This suggests that participants learn action-based predictions of audiovisual outcome, and adapt their temporal perception of outcome events based on such predictions. PMID:27131076

  16. Perioperative and long-term operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation

    PubMed Central

    Jellish, W Scott; Benedict, William; Owen, Kevin; Anderson, Douglas; Fluder, Elaine; Shea, John F

    2008-01-01

    Objectives Numerous medical and surgical therapies have been utilized to treat the symptoms of trigeminal neuralgia (TN). This retrospective study compares patients undergoing either microvascular decompression or balloon ablation of the trigeminal ganglion and determines which produces the best long-term outcomes. Methods A 10-year retrospective chart review was performed on patients who underwent microvascular decompression (MVD) or percutaneous balloon ablation (BA) surgery for TN. Demographic data, intraoperative variables, length of hospitalization and symptom improvement were assessed along with complications and recurrences of symptoms after surgery. Appropriate statistical comparisons were utilized to assess differences between the two surgical techniques. Results MVD patients were younger but were otherwise similar to BA patients. Intraoperatively, twice as many BA patients developed bradycardia compared to MVD patients. 75% of BA patients with bradycardia had an improvement of symptoms. Hospital stay was shorter in BA patients but overall improvement of symptoms was better with MVD. Postoperative complication rates were similar (21% vs 26%) between the BA and MVD groups. Discussion MVD produced better overall outcomes compared to BA and may be the procedure of choice for surgery to treat TN. PMID:18597696

  17. High-Intensity Focused Ultrasound Ablation of Uterine Fibroids – Potential Impact on Fertility and Pregnancy Outcome

    PubMed Central

    Bohlmann, M. K.; Hoellen, F.; Hunold, P.; David, M.

    2014-01-01

    Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk. PMID:24741124

  18. Predictive Modeling for Comfortable Death Outcome Using Electronic Health Records

    PubMed Central

    Lodhi, Muhammad Kamran; Ansari, Rashid; Yao, Yingwei; Keenan, Gail M.; Wilkie, Diana J.; Khokhar, Ashfaq A.

    2016-01-01

    Electronic health record (EHR) systems are used in healthcare industry to observe the progress of patients. With fast growth of the data, EHR data analysis has become a big data problem. Most EHRs are sparse and multi-dimensional datasets and mining them is a challenging task due to a number of reasons. In this paper, we have used a nursing EHR system to build predictive models to determine what factors impact death anxiety, a significant problem for the dying patients. Different existing modeling techniques have been used to develop coarse-grained as well as fine-grained models to predict patient outcomes. The coarse-grained models help in predicting the outcome at the end of each hospitalization, whereas fine-grained models help in predicting the outcome at the end of each shift, therefore providing a trajectory of predicted outcomes. Based on different modeling techniques, our results show significantly accurate predictions, due to relatively noise-free data. These models can help in determining effective treatments, lowering healthcare costs, and improving the quality of end-of-life (EOL) care.

  19. Prediction of engine performance and wall erosion due to film cooling for the 'fast track' ablative thrust chamber

    NASA Technical Reports Server (NTRS)

    Trinh, Huu P.

    1994-01-01

    Efforts have been made at the Propulsion Laboratory (MSFC) to design and develop new liquid rocket engines for small-class launch vehicles. Emphasis of the efforts is to reduce the engine development time with the use of conventional designs while meeting engine reliability criteria. Consequently, the engine cost should be reduced. A demonstrative ablative thrust chamber, called 'fast-track', has been built. To support the design of the 'fast-track' thrust chamber, predictions of the wall temperature and ablation erosion rate of the 'fast-track' thrust chamber have been performed using the computational fluid dynamics program REFLEQS (Reactive Flow Equation Solver). The analysis is intended to assess the amount of fuel to be used for film cooling so that the erosion rate of the chamber ablation does not exceed its allowable limit. In addition, the thrust chamber performance loss due to an increase of the film cooling is examined.

  20. Comparison of Physician-Predicted to Measured Low Vision Outcomes

    PubMed Central

    Chan, Tiffany L.; Goldstein, Judith E.; Massof, Robert W.

    2013-01-01

    Purpose To compare low vision rehabilitation (LVR) physicians’ predictions of the probability of success of LVR to patients’ self-reported outcomes after provision of usual outpatient LVR services; and to determine if patients’ traits influence physician ratings. Methods The Activity Inventory (AI), a self-report visual function questionnaire, was administered pre and post-LVR to 316 low vision patients served by 28 LVR centers that participated in a collaborative observational study. The physical component of the Short Form-36, Geriatric Depression Scale, and Telephone Interview for Cognitive Status were also administered pre-LVR to measure physical capability, depression and cognitive status. Following patient evaluation, 38 LVR physicians estimated the probability of outcome success (POS), using their own criteria. The POS ratings and change in functional ability were used to assess the effects of patients’ baseline traits on predicted outcomes. Results A regression analysis with a hierarchical random effects model showed no relationship between LVR physician POS estimates and AI-based outcomes. In another analysis, Kappa statistics were calculated to determine the probability of agreement between POS and AI-based outcomes for different outcome criteria. Across all comparisons, none of the kappa values were significantly different from 0, which indicates the rate of agreement is equivalent to chance. In an exploratory analysis, hierarchical mixed effects regression models show that POS ratings are associated with information about the patient’s cognitive functioning and the combination of visual acuity and functional ability, as opposed to visual acuity or functional ability alone. Conclusions Physicians’ predictions of LVR outcomes appear to be influenced by knowledge of patients’ cognitive functioning and the combination of visual acuity and functional ability - information physicians acquire from the patient’s history and examination. However

  1. Long-term outcomes after ablation of persistent atrial fibrillation: an observational study over 6 years

    PubMed Central

    El-Kadri, Moutaz; Haq, Iram; Das, Moloy; Modi, Simon; Snowdon, Richard; Hall, Mark; Waktare, Johan EP; Todd, Derick M; Gupta, Dhiraj

    2016-01-01

    Objectives To address the limited long-term outcome data for catheter ablation (CA) of persistent atrial fibrillation (PeAF), we analysed consecutive ablations performed at our centre from 1 January 2008 to 31 December 2010 and followed patients prospectively until January 2014. Methods Both arrhythmia recurrence and symptom relief were assessed. Follow-up data were collected from hospital records, supplemented by data from general practitioners and referring hospitals. At the end of the follow-up period, all patients were contacted by phone to determine their up-to-date clinical condition. Results 188 consecutive patients with PeAF (157 male, mean age 57.3±9.7 years, 20% with long-standing PeAF) underwent a mean of 1.75 procedures (range 1–4). Telephone follow-up was achieved for 77% of surviving patients. Over a mean follow-up of 46±16 months (range 4–72), 139 (75%) patients experienced arrhythmia recurrence after a single procedure and 90 (48%) after their final procedure. Median time to first recurrence was 210 days (range 91–1850). 71% of recurrences were within the first year following ablation and 91% within 2 years. At final follow-up, 82% of patients reported symptomatic improvement. 7 (2.3%) major complications occurred, and there was no procedure-related death or stroke. Conclusions CA for PeAF is safe with a low rate of complications. Over a follow-up period of up to 6 years, a large majority of patients experience significant symptomatic improvement but recurrence after the initial procedure is the norm rather than the exception. 2 years' follow-up is sufficient to observe 90% of AF recurrences, but recurrence can occur even after 5 years' remission. PMID:27547426

  2. Potential biomarkers for predicting outcomes in CABG cardiothoracic surgeries

    PubMed Central

    2013-01-01

    The variations in recovery time, complications, and survival among cardiac patients who have undergone coronary artery bypass graft (CABG) procedures are vast. Many formulas and theories are used to predict clinical outcome and recovery time, and current prognostic predictions are based on medical and family history, lifestyle, co-morbidities, and performance status. The identification of biomarkers that provide concrete evidence supporting clinical outcome has greatly affected the field of medicine, helping clinicians in many medicine sub-specialties to forecast clinical course. Recent studies have discovered biomarkers that may be used as predictors of cardiac patients’ status post-cardiothoracic surgery, and the applications are numerous. In this review, we assess currently available cardiac biomarkers as predictors of clinical outcome for post-operative CABG patients. Data were collected from various studies in which cardiac biomarkers were measured in pre-operative and post-operative CABG patients. PMID:23866777

  3. Looking for Students' Personal Characteristics Predicting Study Outcome

    ERIC Educational Resources Information Center

    Van Bragt, Cyrille A. C.; Bakx, Anouke W. E. A.; Bergen, Theo C. M.; Croon, Marcel A.

    2011-01-01

    The central goal of this study is to clarify to what degree former education and students' personal characteristics (the "Big Five personality characteristics", personal orientations on learning and students' study approach) may predict study outcome (required credits and study continuance). Analysis of the data gathered through questionnaires of…

  4. Individual Factors Predicting Mental Health Court Diversion Outcome

    ERIC Educational Resources Information Center

    Verhaaff, Ashley; Scott, Hannah

    2015-01-01

    Objective: This study examined which individual factors predict mental health court diversion outcome among a sample of persons with mental illness participating in a postcharge diversion program. Method: The study employed secondary analysis of existing program records for 419 persons with mental illness in a court diversion program. Results:…

  5. Adherence indicators predict changes in health outcomes: HUB City Steps

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Participant adherence is a major threat to intervention effectiveness. Most researchers have reported effects of a single adherence measure on health outcomes. The objective of this analysis was to evaluate two adherence measures, separately and in combination, for predicting changes in health out...

  6. Learning Approaches, Demographic Factors to Predict Academic Outcomes

    ERIC Educational Resources Information Center

    Nguyen, Tuan Minh

    2016-01-01

    Purpose: The purpose of this paper is to predict academic outcome in math and math-related subjects using learning approaches and demographic factors. Design/Methodology/Approach: ASSIST was used as the instrumentation to measure learning approaches. The study was conducted in the International University of Vietnam with 616 participants. An…

  7. Mapping Genes that Predict Treatment Outcome in Admixed Populations

    PubMed Central

    Baye, Tesfaye M.; Wilke, Russell A.

    2010-01-01

    There is great interest in characterizing the genetic architecture underlying drug response. For many drugs, gene-based dosing models explain a considerable amount of the overall variation in treatment outcome. As such, prescription drug labels are increasingly being modified to contain pharmacogenetic information. Genetic data must, however, be interpreted within the context of relevant clinical covariates. Even the most predictive models improve with the addition of data related to biogeographical ancestry. The current review explores analytical strategies that leverage population structure to more fully characterize genetic determinants of outcome in large clinical practice-based cohorts. The success of this approach will depend upon several key factors: (1) the availability of outcome data from groups of admixed individuals (i.e., populations recombined over multiple generations), (2) a measurable difference in treatment outcome (i.e., efficacy and toxicity endpoints), and (3) a measurable difference in allele frequency between the ancestral populations. PMID:20921971

  8. Renal Function Outcomes for Multifocal Renal Neoplasms Managed by Radiofrequency Ablation

    SciTech Connect

    Gupta, Pushpender Allen, Brian C. Chen, Michael Y. Childs, David D. Kota, Gopi Zagoria, Ronald J.

    2013-10-15

    Purpose: To evaluate renal function changes related to radiofrequency ablation (RFA) for the treatment of multifocal renal neoplasms. Methods: This is an institutional review board-approved, Health Insurance Portability and Accountability Act compliant retrospective study of all patients treated with computed tomography guided RFA for multifocal renal neoplasms at one institution. Fifty-seven subjects, mean age 70 (range 37-88) years, underwent RFA of 169 renal neoplasms (average size 2.0 cm). Subjects had between 2 and 8 (mean 2.96) neoplasms ablated. Estimated glomerular filtration rate (eGFR) was measured before and after RFA. Complications related to RFA were recorded. Results: eGFR decreased on average of 4.4 % per tumor treated and 6.7 % per ablation session (average 1.76 tumors treated per session). For subjects with the largest neoplasm measuring >3 cm, eGFR decreased an average of 14.5 % during the course of their treatment. If the largest neoplasm measured 2-3 cm, eGFR decreased an average of 7.7 %, and if the largest neoplasm measured <2 cm, eGFR decreased an average of 3.8 %. Subjects with reduced baseline renal function were more likely to have a greater decline in eGFR after RFA. There was a minor complication rate of 6.3 % (6 of 96 sessions), none of which required treatment, and a major complication rate of 4.2 % (4 of 96 sessions). Conclusion: RFA for the treatment of multifocal renal neoplasms results in mild decline of renal function.

  9. Initial outcome following invasive cardiac electrophysiologic studies and radiofrequency ablation of atrial fibrillation

    PubMed Central

    Uwanuruochi, Kelechukwu; Saravanan, Sabari; Ganasekar, Anita; Solomon, Benjamin S; Murugesan, Ravikumar; Shah, Ruchit A; Krishnamoorthy, Jaishankar; Pandurangi, Ulhas M

    2016-01-01

    Background: Cardiac electrophysiologic study and radiofrequency ablation (RFA) have become an established mode of treatment for patients with refractory arrhythmias. These procedures are carried out regularly at the cardiac catheterization laboratory of Madras Medical Mission India. Objective: The purpose of this study was to evaluate our experience with cardiac electrophysiologic studies (EPS) and RFA catheter of atrial fibrillation (AF). Materials and Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. All cases diagnosed to have AF following cardiac EPS between January 2010 and April 2014 was selected for the study. The records, which were obtained from the Cardiac Electrophysiology Clinical Research Office of Madras Medical Mission, were reviewed. Forty-nine cases were chosen for analysis, using SPSS statistical software version 15. Results: There were 49 patients, 23 males and 26 females. The mean age was 57.53 years. Commonly associated diseases were diabetes mellitus 8 (16.3%), hypertension 18 (36.7%), and coronary heart disease 14 (28.5%). The ventricular rate was rapid most cases (91.2%). AF was diagnosed as being paroxysmal in 40 (81.6%), persistent in 5 (10.2%), chronic in 3 (6.1%), and lone in 1 (2.0%). Ablation was carried out in 28 (57.1%), the success rate being 90% for pulmonary vein isolation, and 90.9% for atrioventricular node ablation. Complication rate was 2.04%. Conclusions: Treatment of AF by RFA is highly effective and safe. PMID:27127736

  10. Prediction of Functional Outcome in Axonal Guillain-Barre Syndrome

    PubMed Central

    2016-01-01

    Objective To identify the factors that could predict the functional outcome in patients with the axonal type of Guillain-Barre syndrome (GBS). Methods Two hundred and two GBS patients admitted to our university hospital between 2003 and 2014 were reviewed retrospectively. We defined a good outcome as being "able to walk independently at 1 month after onset" and a poor outcome as being "unable to walk independently at 1 month after onset". We evaluated the factors that differed between the good and poor outcome groups. Results Twenty-four patients were classified into the acute motor axonal neuropathy type. There was a statistically significant difference between the good and poor outcome groups in terms of the GBS disability score at admission, and GBS disability score and Medical Research Council sum score at 1 month after admission. In an electrophysiologic analysis, the good outcome group showed greater amplitude of median, ulnar, deep peroneal, and posterior tibial nerve compound muscle action potentials (CMAP) and greater amplitude of median, ulnar, and superficial peroneal sensory nerve action potentials (SNAP) than the poor outcome group. Conclusion A lower GBS disability score at admission, high amplitude of median, ulnar, deep peroneal, and posterior tibial CMAPs, and high amplitude of median, ulnar, and superficial peroneal SNAPs were associated with being able to walk at 1 month in patients with axonal GBS. PMID:27446785

  11. Probabilistic Prediction of the Outcome of Bone-Marrow Transplantation

    PubMed Central

    Suermondt, H. Jacques; Amylon, Michael D.

    1989-01-01

    Bone-marrow transplantation is considered the treatment of choice for pediatric patients with recurring acute lymphoblastic leukemia, provided that a suitable donor is available. Many prognostic factors are known that help to predict the likely outcome of transplantation. We have implemented a system that applies probabilistic reasoning to the available data about individual patients to help determine the risk of recurrence and morbidity after transplantation, and to predict life expectancy. The resulting predictions can be used to decide whether marrow transplantation is the most desirable treatment modality for the patient.

  12. Estimation of brain network ictogenicity predicts outcome from epilepsy surgery

    PubMed Central

    Goodfellow, M.; Rummel, C.; Abela, E.; Richardson, M. P.; Schindler, K.; Terry, J. R.

    2016-01-01

    Surgery is a valuable option for pharmacologically intractable epilepsy. However, significant post-operative improvements are not always attained. This is due in part to our incomplete understanding of the seizure generating (ictogenic) capabilities of brain networks. Here we introduce an in silico, model-based framework to study the effects of surgery within ictogenic brain networks. We find that factors conventionally determining the region of tissue to resect, such as the location of focal brain lesions or the presence of epileptiform rhythms, do not necessarily predict the best resection strategy. We validate our framework by analysing electrocorticogram (ECoG) recordings from patients who have undergone epilepsy surgery. We find that when post-operative outcome is good, model predictions for optimal strategies align better with the actual surgery undertaken than when post-operative outcome is poor. Crucially, this allows the prediction of optimal surgical strategies and the provision of quantitative prognoses for patients undergoing epilepsy surgery. PMID:27384316

  13. Estimation of brain network ictogenicity predicts outcome from epilepsy surgery.

    PubMed

    Goodfellow, M; Rummel, C; Abela, E; Richardson, M P; Schindler, K; Terry, J R

    2016-01-01

    Surgery is a valuable option for pharmacologically intractable epilepsy. However, significant post-operative improvements are not always attained. This is due in part to our incomplete understanding of the seizure generating (ictogenic) capabilities of brain networks. Here we introduce an in silico, model-based framework to study the effects of surgery within ictogenic brain networks. We find that factors conventionally determining the region of tissue to resect, such as the location of focal brain lesions or the presence of epileptiform rhythms, do not necessarily predict the best resection strategy. We validate our framework by analysing electrocorticogram (ECoG) recordings from patients who have undergone epilepsy surgery. We find that when post-operative outcome is good, model predictions for optimal strategies align better with the actual surgery undertaken than when post-operative outcome is poor. Crucially, this allows the prediction of optimal surgical strategies and the provision of quantitative prognoses for patients undergoing epilepsy surgery. PMID:27384316

  14. Unexpected but Incidental Positive Outcomes Predict Real-World Gambling.

    PubMed

    Otto, A Ross; Fleming, Stephen M; Glimcher, Paul W

    2016-03-01

    Positive mood can affect a person's tendency to gamble, possibly because positive mood fosters unrealistic optimism. At the same time, unexpected positive outcomes, often called prediction errors, influence mood. However, a linkage between positive prediction errors-the difference between expected and obtained outcomes-and consequent risk taking has yet to be demonstrated. Using a large data set of New York City lottery gambling and a model inspired by computational accounts of reward learning, we found that people gamble more when incidental outcomes in the environment (e.g., local sporting events and sunshine) are better than expected. When local sports teams performed better than expected, or a sunny day followed a streak of cloudy days, residents gambled more. The observed relationship between prediction errors and gambling was ubiquitous across the city's socioeconomically diverse neighborhoods and was specific to sports and weather events occurring locally in New York City. Our results suggest that unexpected but incidental positive outcomes influence risk taking. PMID:26796614

  15. Predictable Outcomes with Porcelain Laminate Veneers: A Clinical Report.

    PubMed

    Pimentel, Welson; Teixeira, Marcelo Lucchesi; Costa, Priscila Paganini; Jorge, Mônica Zacharias; Tiossi, Rodrigo

    2016-06-01

    This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock-ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome. PMID:26633080

  16. Scoring Systems for Outcome Prediction of Patients with Perforation Peritonitis

    PubMed Central

    Litake, Manjusha Madhusudhan

    2016-01-01

    Introduction Peritonitis continues to be one of the major infectious problems confronting a surgeon. Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for en Umeration of Mortality (POSSUM) and Morbidity and sepsis score of Stoner and Elebute have been devised for risk assessment and for prediction of postoperative outcome. Aim The aim of this study was to find the accuracy of these scores in predicting outcome in terms of mortality in patients undergoing exploratory laprotomy for perforation peritonitis. Materials and Methods The prospective study was carried out in 100 diagnosed cases of perforation at our centre in a single unit over a period of 21 months from December 2012 to August 2014. Study was conducted on all cases of peritonitis albeit primary, tertiary, iatrogenic and those with age less than 12 years were excluded from the study. All the relevant data were collected and three scores were computed from one set of data from the patient. The main outcome measure was survival of the patient. The Receiver Operator Characteristics (ROC) curves were obtained for the three scores. Area Under the Curves (AUC) was calculated. Sensitivity and specificity were calculated at a cut off point obtained from the ROC curves. Results POSSUM had an AUC of 0.99, sepsis score had an AUC of 0.98 and MPI had an AUC of 0.95. The cut off point score of 51 for POSSUM had an accuracy of 93.8 and positive predictive value of 70.5, the score of 29 for MPI had an accuracy of 82.8 and positive predictive value of 46 and the score of 22 for sepsis score had an accuracy of 95.9 and positive predictive value of 86.67. Conclusion POSSUM score was found to be superior in prediction of mortality as compared to sepsis score of Stoner and Elebute and MPI. POSSUM and MPI over predicted mortality in some cases. None of these scores are strictly preoperative. PMID:27134924

  17. Noninvasive Fibrosis Marker Can Predict Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

    PubMed Central

    Chung, Hyun Ah; Kim, Jeong-Han; Hwang, Young; Choi, Hong Seok; Ko, Soon Young; Choe, Won Hyeok; Kwon, So Young

    2016-01-01

    Background/Aims: Tumor recurrence after curative therapy is common for patients with hepatocellular carcinoma (HCC). As fibrosis and chronic inflammation contribute to the progression of HCC, we aimed to identify the predictive value of inflammatory and fibrosis markers for HCC recurrence after curative therapy using radiofrequency ablation (RFA). Materials and Methods: We retrospectively reviewed the records of patients with HCC treated with RFA between October 2005 and September 2013. The median duration of follow-up was 40 months (4–95 months). Inflammatory and fibrosis markers and demographic and clinical data were analyzed by Cox proportional hazards model using univariate and multivariate analyses and longitudinal analysis. Results: A total of 98 patients were included for analysis. There were 54 cases of HCC recurrence (55.1%). The aspartate aminotransferase-to-platelet ratio index (APRI; 2.3 ± 1.8 vs. 1.3 ± 1.4, P = 0.018) was significantly higher in the recurrence group than in the recurrence-free group. In multivariate analysis, APRI (hazard ratio, 2.64; confidence interval, 1.488–4.714; P = 0.001) was an independent risk factor for tumor recurrence. In particular, patients with APRI >1.38 showed a higher recurrence rate than patients with APRI ≤1.38 (P < 0.001). Longitudinal analysis showed persistently higher APRI values when assessed 12 months after RFA in patients who developed recurrence during follow-up than those who remained recurrence-free. Conclusions: These findings show that a high APRI value is associated with HCC recurrence after RFA. Therefore, APRI could play an important role in predicting HCC recurrence after RFA. PMID:26831608

  18. Repression predicts outcome following multidisciplinary treatment of chronic pain.

    PubMed

    Burns, J W

    2000-01-01

    This study examined whether repression predicts outcome following multidisciplinary treatment for chronic pain and whether links between anxiety and outcome are obscured by repressors. Ninety-three chronic pain patients completed a 4-week pain program. Lifting capacity, walking endurance, depression, pain severity, and activity were measured at pre- and posttreatment. Low-anxious, repressor, high-anxious, and defensive/high-anxious groups were formed from median splits of Anxiety Content (ACS) and Lie scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Significant ACS x Lie interactions were found for lifting capacity, depression, and pain severity changes. Planned comparisons showed that both repressors and high-anxious patients performed poorly on lifting capacity; repressors alone recovered poorly on depression and pain severity. Results imply that repression may interfere with the process and outcome of pain programs. PMID:10711590

  19. Visual outcome after correcting the refractive error of large pupil patients with wavefront-guided ablation

    PubMed Central

    Khalifa, Mounir A; Allam, Waleed A; Shaheen, Mohamed S

    2012-01-01

    Purpose To investigate the efficacy and predictability of wavefront-guided laser in situ keratomileusis (LASIK) treatments using the iris registration (IR) technology for the correction of refractive errors in patients with large pupils. Setting Horus Vision Correction Center, Alexandria, Egypt. Methods Prospective noncomparative study including a total of 52 eyes of 30 consecutive laser refractive correction candidates with large mesopic pupil diameters and myopia or myopic astigmatism. Wavefront-guided LASIK was performed in all cases using the VISX STAR S4 IR excimer laser platform. Visual, refractive, aberrometric and mesopic contrast sensitivity (CS) outcomes were evaluated during a 6-month follow-up. Results Mean mesopic pupil diameter ranged from 8.0 mm to 9.4 mm. A significant improvement in uncorrected distance visual acuity (UCDVA) (P < 0.01) was found postoperatively, which was consistent with a significant refractive correction (P < 0.01). No significant change was detected in corrected distance visual acuity (CDVA) (P = 0.11). Efficacy index (the ratio of postoperative UCDVA to preoperative CDVA) and safety index (the ratio of postoperative CDVA to preoperative CDVA) were calculated. Mean efficacy and safety indices were 1.06 ± 0.33 and 1.05 ± 0.18, respectively, and 92.31% of eyes had a postoperative spherical equivalent within ±0.50 diopters (D). Manifest refractive spherical equivalent improved significantly (P < 0.05) from a preoperative level of −3.1 ± 1.6 D (range −6.6 to 0 D) to −0.1 ± 0.2 D (range −1.3 to 0.1 D) at 6 months postoperative. No significant changes were found in mesopic CS (P ≥ 0.08), except CS for three cycles/degree, which improved significantly (P = 0.02). Magnitudes of primary coma and trefoil did not change significantly (P ≥ 0.34), with a small but statistically significant increase in primary spherical aberration. Conclusion Wavefront-guided LASIK provides an effective correction of low to moderate myopia or

  20. Predicting outcome from subacute unresponsive wakefulness syndrome or vegetative state.

    PubMed

    Bodart, Olivier; Laureys, Steven

    2014-01-01

    Predicting recovery of consciousness in patients who survive their coma but evolve to a vegetative state (recently coined unresponsive wakefulness syndrome) remains a challenge. Most previous prognostic studies have focused on the acute coma phase. A novel outcome scale (combining behavioural, aetiology, electroencephalographic, sleep electroencephalographic and somatosensory evoked potential data) has been proposed for patients in subacute unresponsive wakefulness syndrome. The scale's clinical application awaits validation in a larger population. PMID:25029668

  1. Predicting outcome from subacute unresponsive wakefulness syndrome or vegetative state

    PubMed Central

    2014-01-01

    Predicting recovery of consciousness in patients who survive their coma but evolve to a vegetative state (recently coined unresponsive wakefulness syndrome) remains a challenge. Most previous prognostic studies have focused on the acute coma phase. A novel outcome scale (combining behavioural, aetiology, electroencephalographic, sleep electroencephalographic and somatosensory evoked potential data) has been proposed for patients in subacute unresponsive wakefulness syndrome. The scale’s clinical application awaits validation in a larger population. PMID:25029668

  2. Predicting visual outcomes for macular disease using optical coherence tomography

    PubMed Central

    Keane, Pearse A.; Sadda, Srinivas R.

    2011-01-01

    In recent years, the management of macular disease has undergone radical changes, in part because of new therapeutic approaches, but also due to the introduction of a new imaging modality – optical coherence tomography (OCT). The application of OCT imaging has clarified many aspects of chorioretinal disease pathophysiology and elucidated many hitherto unrecognized disease characteristics. From an early stage in its development, OCT has also been revolutionary in attempting to extract clinically useful measurements from image data in an automated fashion. As a result, OCT-derived measurements of retinal thickness have been rapidly embraced in clinical and research settings. However, as knowledge of OCT image analysis has developed, it has become increasingly clear that even accurate measurements of retinal thickness may fail to predict visual outcomes for many diseases. As a result, the focus of much current clinical imaging research is on the identification of other OCT-derived anatomic biomarkers predictive of visual outcomes – such biomarkers could serve as surrogate endpoints in clinical trials and provide prognostic information in clinical practice. In this review, we begin by highlighting the importance of accurate visual function assessment and describing the fundamentals of OCT image evaluation, before describing the current state-of-the-art with regard to predicting visual outcomes, for a variety of macular diseases, using OCT. PMID:23960916

  3. Frequency of and Predictive Factors for Vascular Invasion after Radiofrequency Ablation for Hepatocellular Carcinoma

    PubMed Central

    Asaoka, Yoshinari; Tateishi, Ryosuke; Nakagomi, Ryo; Kondo, Mayuko; Fujiwara, Naoto; Minami, Tatsuya; Sato, Masaya; Uchino, Koji; Enooku, Kenichiro; Nakagawa, Hayato; Kondo, Yuji; Shiina, Shuichiro; Yoshida, Haruhiko; Koike, Kazuhiko

    2014-01-01

    Background Vascular invasion in patients with hepatocellular carcinoma (HCC) is representative of advanced disease with an extremely poor prognosis. The detailed course of its development has not been fully elucidated. Methods We enrolled 1057 consecutive patients with HCC who had been treated with curative intent by radiofrequency ablation (RFA) as an initial therapy from 1999 to 2008 at our department. We analyzed the incidence rate of and predictive factors for vascular invasion. The survival rate after detection of vascular invasion was also analyzed. Results During a mean follow-up period of 4.5 years, 6075 nodules including primary and recurrent lesions were treated by RFA. Vascular invasion was observed in 97 patients. The rate of vascular invasion associated with site of original RFA procedure was 0.66% on a nodule basis. The incidence rates of vascular invasion on a patient basis at 1, 3, and 5 years were 1.1%, 5.9%, and 10.4%, respectively. Univariate analysis revealed that tumor size, tumor number, alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein were significant risk predictors of vascular invasion. In multivariate analysis, DCP was the most significant predictor for vascular invasion (compared with a DCP of ≤100 mAu/mL, the hazard ratio was 1.95 when DCP was 101–200 mAu/mL and 3.22 when DCP was >200 mAu/mL). The median survival time after development of vascular invasion was only 6 months. Conclusion Vascular invasion occurs during the clinical course of patients initially treated with curative intent. High-risk patients may be identified using tumor markers. PMID:25397677

  4. Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

    PubMed Central

    Kosmidou, Ioanna; Wooden, Shannnon; Jones, Brian; Deering, Thomas; Wickliffe, Andrew; Dan, Dan

    2013-01-01

    Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion. Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible. We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training. Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast. PMID:23485956

  5. Direct pressure monitoring accurately predicts pulmonary vein occlusion during cryoballoon ablation.

    PubMed

    Kosmidou, Ioanna; Wooden, Shannnon; Jones, Brian; Deering, Thomas; Wickliffe, Andrew; Dan, Dan

    2013-01-01

    Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion. Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible. We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training. Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast. PMID:23485956

  6. Gambling severity predicts midbrain response to near-miss outcomes

    PubMed Central

    Chase, Henry W.; Clark, Luke

    2010-01-01

    Gambling is a common recreational activity that becomes dysfunctional in a subset of individuals, with DSM ‘pathological gambling’ regarded as the most severe form. During gambling, players experience a range of cognitive distortions that promote an over-estimation of the chances of winning. Near-miss outcomes are thought to fuel these distortions. We observed previously that near-misses recruited overlapping circuitry to monetary wins in a study in healthy volunteers (Clark et al. 2009). The present study sought to extend these observations in regular gamblers and relate brain responses to an index of gambling severity. Twenty regular gamblers, who varied in their involvement from recreational players to probable pathological gamblers, were scanned whilst performing a simplified slot-machine task that delivered occasional monetary wins, as well as near-miss and full-miss non-win outcomes. In the overall group, near-miss outcomes were associated with a significant response in the ventral striatum, which was also recruited by monetary wins. Gambling severity, measured with the South Oaks Gambling Screen, predicted a greater response in the dopaminergic midbrain to near-miss outcomes. This effect survived controlling for clinical co-morbidities that were present in the regular gamblers. Gambling severity did not predict win-related responses in the midbrain or elsewhere. These results demonstrate that near-miss events during gambling recruit reward-related brain circuitry in regular players. An association with gambling severity in the midbrain suggests that near-miss outcomes may enhance dopamine transmission in disordered gambling, which extends neurobiological similarities between pathological gambling and drug addiction. PMID:20445043

  7. Predicting the outcome of competition when fitness inequality is variable

    PubMed Central

    Pedruski, Michael T.; Fussmann, Gregor F.; Gonzalez, Andrew

    2015-01-01

    Traditional niche theory predicts that when species compete for one limiting resource in simple ecological settings the more fit competitor should exclude the less fit competitor. Since the advent of neutral theory ecologists have increasingly become interested both in how the magnitude of fitness inequality between competitors and stochasticity may affect this prediction. We used numerical simulations to investigate the outcome of two-species resource competition along gradients of fitness inequality (inequality in R*) and initial population size in the presence of demographic stochasticity. We found that the deterministic prediction of more fit competitors excluding less fit competitors was often unobserved when fitness inequalities were low or stochasticity was strong, and unexpected outcomes such as dominance by the less fit competitor, long-term co-persistence of both competitors or the extinction of both competitors could be common. By examining the interaction between fitness inequality and stochasticity our results mark the range of parameter space in which the predictions of niche theory break down most severely, and suggest that questions about whether competitive dynamics are driven by neutral or niche processes may be locally contingent. PMID:26361557

  8. Efficacy and predictability of soft tissue ablation using a prototype Raman-shifted alexandrite laser

    NASA Astrophysics Data System (ADS)

    Kozub, John A.; Shen, Jin-H.; Joos, Karen M.; Prasad, Ratna; Shane Hutson, M.

    2015-10-01

    Previous research showed that mid-infrared free-electron lasers could reproducibly ablate soft tissue with little collateral damage. The potential for surgical applications motivated searches for alternative tabletop lasers providing thermally confined pulses in the 6- to-7-μm wavelength range with sufficient pulse energy, stability, and reliability. Here, we evaluate a prototype Raman-shifted alexandrite laser. We measure ablation thresholds, etch rates, and collateral damage in gelatin and cornea as a function of laser wavelength (6.09, 6.27, or 6.43 μm), pulse energy (up to 3 mJ/pulse), and spot diameter (100 to 600 μm). We find modest wavelength dependence for ablation thresholds and collateral damage, with the lowest thresholds and least damage for 6.09 μm. We find a strong spot-size dependence for all metrics. When the beam is tightly focused (˜100-μm diameter), ablation requires more energy, is highly variable and less efficient, and can yield large zones of mechanical damage (for pulse energies >1 mJ). When the beam is softly focused (˜300-μm diameter), ablation proceeded at surgically relevant etch rates, with reasonable reproducibility (5% to 12% within a single sample), and little collateral damage. With improvements in pulse-energy stability, this prototype laser may have significant potential for soft-tissue surgical applications.

  9. Efficacy and predictability of soft tissue ablation using a prototype Raman-shifted alexandrite laser.

    PubMed

    Kozub, John A; Shen, Jin-H; Joos, Karen M; Prasad, Ratna; Hutson, M Shane

    2015-10-01

    Previous research showed that mid-infrared free-electron lasers could reproducibly ablate soft tissue with little collateral damage. The potential for surgical applications motivated searches for alternative tabletop lasers providing thermally confined pulses in the 6- to-7-µm wavelength range with sufficient pulse energy, stability, and reliability. Here, we evaluate a prototype Raman-shifted alexandrite laser. We measure ablation thresholds, etch rates, and collateral damage in gelatin and cornea as a function of laser wavelength (6.09, 6.27, or 6.43 µm), pulse energy (up to 3 mJ/pulse), and spot diameter (100 to 600 µm). We find modest wavelength dependence for ablation thresholds and collateral damage, with the lowest thresholds and least damage for 6.09 µm. We find a strong spot-size dependence for all metrics. When the beam is tightly focused (~100-µm diameter), ablation requires more energy, is highly variable and less efficient, and can yield large zones of mechanical damage (for pulse energies>1 mJ). When the beam is softly focused (~300-µm diameter), ablation proceeded at surgically relevant etch rates, with reasonable reproducibility (5% to 12% within a single sample), and little collateral damage. With improvements in pulse-energy stability, this prototype laser may have significant potential for soft-tissue surgical applications. PMID:26456553

  10. Lymphocyte-to-monocyte ratio predicts survival after radiofrequency ablation for colorectal liver metastases

    PubMed Central

    Facciorusso, Antonio; Del Prete, Valentina; Crucinio, Nicola; Serviddio, Gaetano; Vendemiale, Gianluigi; Muscatiello, Nicola

    2016-01-01

    AIM: To test the correlation between lymphocyte-to-monocyte ratio (LMR) and survival after radiofrequency ablation (RFA) for colorectal liver metastasis (CLMs). METHODS: From July 2003 to Feb 2012, 127 consecutive patients with 193 histologically-proven unresectable CLMs were treated with percutaneous RFA at the University of Foggia. All patients had undergone primary colorectal tumor resection before RFA and received systemic chemotherapy. LMR was calculated by dividing lymphocyte count by monocyte count assessed at baseline. Treatment-related toxicity was defined as any adverse events occurred within 4 wk after the procedure. Overall survival (OS) and time to recurrence (TTR) were estimated from the date of RFA by Kaplan-Meier with plots and median (95%CI). The inferential analysis for time to event data was conducted using the Cox univariate and multivariate regression model to estimate hazard ratios (HR) and 95%CI. Statistically significant variables from the univariate Cox analysis were considered for the multivariate models. RESULTS: Median age was 66 years (range 38-88) and patients were prevalently male (69.2%). Median LMR was 4.38% (0.79-88) whereas median number of nodules was 2 (1-3) with a median maximum diameter of 27 mm (10-45). Median OS was 38 mo (34-53) and survival rate (SR) was 89.4%, 40.4% and 33.3% at 1, 4 and 5 years respectively in the whole cohort. Running log-rank test analysis found 3.96% as the most significant prognostic cut-off point for LMR and stratifying the study population by this LMR value median OS resulted 55 mo (37-69) in patients with LMR > 3.96% and 34 (26-39) mo in patients with LMR ≤ 3.96% (HR = 0.53, 0.34-0.85, P = 0.007). Nodule size and LMR were the only significant predictors for OS in multivariate analysis. Median TTR was 29 mo (22-35) with a recurrence-free survival (RFS) rate of 72.6%, 32.1% and 21.8% at 1, 4 and 5 years, respectively in the whole study group. Nodule size and LMR were confirmed as significant

  11. Novel gene expression model for outcome prediction in paediatric medulloblastoma.

    PubMed

    Zakrzewska, Magdalena; Grešner, Sylwia M; Zakrzewski, Krzysztof; Zalewska-Szewczyk, Beata; Liberski, Pawel P

    2013-10-01

    Medulloblastoma is the most frequent type of embryonal tumour in the paediatric population. The disease progression in patients with this tumour may be connected with the presence of stem/tumour-initiating cells, but the precise source and characteristics of such cells is still a subject of debate. Thus, we tried to analyse biomarkers for which a connection with the presence of stem/tumour-initiating cells was suggested. We evaluated the transcriptional level of the ATOH1, FUT4, NGFR, OTX1, OTX2, PROM1 and SOX1 genes in 48 samples of medulloblastoma and analysed their usefulness in the prediction of disease outcome. The analyses showed a strong correlation of PROM1, ATOH1 and OTX1 gene expression levels with the outcome (p ≤ 0.2). On the basis of the multivariate Cox regression analysis, we propose a three-gene model predicting risk of the disease, calculated as follows: RS(risk score) =( 0:81 x PROM1) + (0:18 x OTX1) + (0:02 x ATOH1). Survival analysis revealed a better outcome among standard-risk patients, with a 5-year survival rate of 65 %, compared to the 40 % rate observed among high-risk patients. The most promising advantage of such molecular analysis consists in the identification of molecular markers influencing clinical behaviour, which may in turn be useful in therapy optimization. PMID:23649504

  12. Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome.

    PubMed

    Maiti, Tanmoy K; Bir, Shyamal C; Patra, Devi Prasad; Kalakoti, Piyush; Guthikonda, Bharat; Nanda, Anil

    2016-08-01

    OBJECTIVE Spinal meningiomas are benign tumors with a wide spectrum of clinical and radiological features at presentation. The authors analyzed multiple clinicoradiological factors to predict recurrence and functional outcome in a cohort with a mean follow-up of more than 4 years. The authors also discuss the results of clinical studies regarding spinal meningiomas in the last 15 years. METHODS The authors retrospectively reviewed the clinical and radiological details of patients who underwent surgery for spinal tumors between 2001 and 2015 that were histopathologically confirmed as meningiomas. Demographic parameters, such as age, sex, race, and association with neurofibromatosis Type 2, were considered. Radiological parameters, such as tumor size, signal changes of spinal cord, spinal level, number of levels, location of tumor attachment, shape of tumor, and presence of dural tail/calcification, were noted. These factors were analyzed to predict recurrence and functional outcome. Furthermore, a pooled analysis was performed from 13 reports of spinal meningiomas in the last 15 years. RESULTS A total of 38 patients were included in this study. Male sex and tumors with radiological evidence of a dural tail were associated with an increased risk of recurrence at a mean follow-up of 51.2 months. Ventral or ventrolateral location, large tumors, T2 cord signal changes, and poor preoperative functional status were associated with poor functional outcome at 1-year follow-up. CONCLUSIONS Spine surgeons must be aware of the natural history and risk factors of spinal meningiomas to establish a prognosis for their patients. PMID:27476848

  13. Predicting outcomes after liver transplantation. A connectionist approach.

    PubMed Central

    Doyle, H R; Dvorchik, I; Mitchell, S; Marino, I R; Ebert, F H; McMichael, J; Fung, J J

    1994-01-01

    OBJECTIVE: The authors sought to train an artificial neural network to predict early outcomes after orthotopic liver transplantation. SUMMARY BACKGROUND DATA: Reliable prediction of outcomes early after liver transplantation would help improve organ use and could have an impact on patient survival, but remains an elusive goal. Traditional multivariate models have failed to attain the sensitivity and specificity required for practical clinical use. Alternate approaches that can help us model clinical phenomena must be explored. One such approach is the use of artificial neural networks, or connectionist models. These are computation systems that process information in parallel, using large numbers of simple units, and excel in tasks involving pattern recognition. They are capable of adaptive learning and self-organization, and exhibit a high degree of fault tolerance. METHODS: Ten feed-forward, back-propagation neural networks were trained to predict graft outcomes, using data from 155 adult liver transplants. The data included information that was available by the second postoperative day. Ten separate training and testing data subsets were prepared, using random sampling, and the ability of the different networks to predict outcomes successfully was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Four of the networks showed perfect discrimination, with an area under the ROC curve (Az) of 1.0. Two other networks also had excellent performance, with an Az of 0.95. The sensitivity and specificity of the combined networks was 60% and 100%, respectively, when using an output neuron activation of 0.6 as the cutoff point to decide class membership. Lowering the cutoff point to 0.14 increased the sensitivity to 77%, and lowered the specificity to 96%. CONCLUSIONS: These results are encouraging, especially when compared to the performance of more traditional multivariate models on the same data set. The robustness of neural networks, when

  14. Computed tomography in the prediction of outcome in head injury

    SciTech Connect

    Lipper, M.H.; Kishore, P.R.S.; Enas, G.G.; Domingues da Silva, A.A.; Choi, S.C.; Becker, D.P.

    1985-03-01

    To determine the prognostic significance of computed tomographic (CT) findings in head injury, retrospective analysis was performed in 128 randomly selected severe head-injury patients managed with a standardized protocol. The minimal criterion for entry into this study was that the patients were unable to obey simple commands or utter formed words. Serial CT was performed on admission and 3-5 days, 2 weeks, 3 months, and 1 year after injury. A scale of severity of abnormalities was devised taking into account the size of the traumatic lesions on CT. The CT findings using the proposed scale were correlated with the clincial outcome and analyzed using linear logistic regression. The correct prediction rate of outcome using the proposed scale for CT findings alone was found to be 69.7%. When CT findings were combined with the Glasgow Coma Scale score this rate was increased to 75.8%.

  15. Predicting stroke outcome using DCE-CT measured blood velocity

    NASA Astrophysics Data System (ADS)

    Oosterbroek, Jaap; Bennink, Edwin; Dankbaar, Jan Willem; Horsch, Alexander D.; Viergever, Max A.; Velthuis, Birgitta K.; de Jong, Hugo W. A. M.

    2015-03-01

    CT plays an important role in the diagnosis of acute stroke patients. Dynamic contrast enhanced CT (DCE-CT) can estimate local tissue perfusion and extent of ischemia. However, hemodynamic information of the large intracranial vessels may also be obtained from DCE-CT data and may contain valuable diagnostic information. We describe a novel method to estimate intravascular blood velocity (IBV) in large cerebral vessels using DCE-CT data, which may be useful to help predict stroke outcome. DCE-CT scans from 34 patients with isolated M1 occlusions were included from a large prospective multi-center cohort study of patients with acute ischemic stroke. Gaussians fitted to the intravascular data yielded the time-to-peak (TTP) and cerebral-blood-volume (CBV). IBV was computed by taking the inverse of the TTP gradient magnitude. Voxels with a CBV of at least 10% of the CBV found in the arterial input function were considered part of a vessel. Mid-sagittal planes were drawn manually and averages of the IBV over all vessel-voxels (arterial and venous) were computed for each hemisphere. Mean-hemisphere IBV differences, mean-hemisphere TTP differences, and hemisphere vessel volume differences were used to differentiate between patients with good and bad outcome (modified Rankin Scale score <3 versus ≥3 at 90 days) using ROC analysis. AUCs from the ROC for IBV, TTP, and vessel volume were 0.80, 0.67 and 0.62 respectively. In conclusion, IBV was found to be a better predictor of patient outcome than the parameters used to compute it and may be a promising new parameter for stroke outcome prediction.

  16. The ability of adolescents to predict future outcome. Part II: Therapeutic enhancement of predictive skills.

    PubMed

    Trad, P V

    1993-01-01

    The assertion of autonomy, a developmental challenge of adolescence, helps predict the teenager's attitude toward pregnancy and parenthood. Significantly, the ability to predict the future relationship with the infant has direct implications for the achievement of an adaptive outcome. Indeed, the interpersonal outcome of the parent-infant relationship may be predicted by the adolescent's behaviors with her infant. A prospective orientation may offer an important vantage point for improving this relationship. For example, the ability to predict future outcome helps identify potential conflict, such as abuse. When applying a prospective approach during the prenatal period, the adolescent's past relationship with her own mother and her motivations for becoming a parent will be explored in order to predict the future dyadic relationship. For adolescents who are already parents, an assessment of the dyad's contemporaneous interaction may further predict future interpersonal exchange. Moreover, orienting the adolescent parent toward the future may identify areas of potential conflict, as well as foster more adaptive dyadic exchange. PMID:8266833

  17. Predicting outcome in clinically isolated syndrome using machine learning

    PubMed Central

    Wottschel, V.; Alexander, D.C.; Kwok, P.P.; Chard, D.T.; Stromillo, M.L.; De Stefano, N.; Thompson, A.J.; Miller, D.H.; Ciccarelli, O.

    2014-01-01

    We aim to determine if machine learning techniques, such as support vector machines (SVMs), can predict the occurrence of a second clinical attack, which leads to the diagnosis of clinically-definite Multiple Sclerosis (CDMS) in patients with a clinically isolated syndrome (CIS), on the basis of single patient's lesion features and clinical/demographic characteristics. Seventy-four patients at onset of CIS were scanned and clinically reviewed after one and three years. CDMS was used as the gold standard against which SVM classification accuracy was tested. Radiological features related to lesional characteristics on conventional MRI were defined a priori and used in combination with clinical/demographic features in an SVM. Forward recursive feature elimination with 100 bootstraps and a leave-one-out cross-validation was used to find the most predictive feature combinations. 30 % and 44 % of patients developed CDMS within one and three years, respectively. The SVMs correctly predicted the presence (or the absence) of CDMS in 71.4 % of patients (sensitivity/specificity: 77 %/66 %) at 1 year, and in 68 % (60 %/76 %) at 3 years on average over all bootstraps. Combinations of features consistently gave a higher accuracy in predicting outcome than any single feature. Machine-learning-based classifications can be used to provide an “individualised” prediction of conversion to MS from subjects' baseline scans and clinical characteristics, with potential to be incorporated into routine clinical practice. PMID:25610791

  18. Distal end of the atrioventricular nodal artery predicts the risk of atrioventricular block during slow pathway catheter ablation of atrioventricular nodal re-entrant tachycardia

    PubMed Central

    Lin, J; Huang, S; Lai, L; Lin, L; Chen, J; Tseng, Y; Lien, W

    2000-01-01

    OBJECTIVE—To search for a reliable anatomical landmark within Koch's triangle to predict the risk of atrioventricular (AV) block during radiofrequency slow pathway catheter ablation of AV nodal re-entrant tachycardia (AVNRT).
PATIENTS AND METHODS—To test the hypothesis that the distal end of the AV nodal artery represents the anatomical location of the AV node, and thus could be a useful landmark for predicting the risk of AV block, 128 consecutive patients with AVNRT receiving slow pathway catheter ablation were prospectively studied in two phases. In phase I (77 patients), angiographic demonstration of the AV nodal artery and its ending was performed at the end of the ablation procedure, whereas in the subsequent phase II study (51 patients), the angiography was performed immediately before catheter ablation to assess the value of identifying this new landmark in reducing the risk of AV block. Multiple electrophysiologic and anatomical parameters were analysed. The former included the atrial activation sequence between the His bundle recording site (HBE) and the coronary sinus orifice or the catheter ablation site, either during AVNRT or during sinus rhythm. The latter included the spatial distances between the distal end of the AV nodal artery and the HBE and the final catheter ablation site, and the distance between the HBE and the tricuspid border at the coronary sinus orifice floor.
RESULTS—In phase I, nine of the 77 patients had complications of transient (seven patients) or permanent (two patients) complete AV block during stepwise, anatomy guided slow pathway catheter ablation. These nine patients had a wider distance between the HBE and the distal end of the AV nodal artery, and a closer approximation of the catheter ablation site to the distal end of the AV nodal artery, which independently predicted the risk of AV block. In contrast, none of the available electrophysiologic parameters were shown to be reliable. When the distance between

  19. Predicting outcome of group counseling with severely disabled patients.

    PubMed

    Evans, R L; Kleinman, L; Halar, E M; Herzer, K

    1985-02-01

    Client characteristics associated with outcome of group counseling were identified in a sample of physically disabled persons using standardized self report inventories. Thirty-eight subjects were tested before and after an 8 week treatment interval for signs of emotional disorder, inactivity, and social problems related to being severely disabled. Treatment consisted of group conference phone calls using self determined task assignments as a focus for discussion. Change in report of life satisfaction was predicted reliably from pretest data. Loneliness accounted for 73% of the variance in posttreatment life satisfaction scores. Other significant predictors included signs of depression, alcohol use, and constructs related to social support. Using regression analysis, persons with adjustment problems could be identified and prognosis for treatment predicted with acceptable reliability. PMID:3155916

  20. Network measures predict neuropsychological outcome after brain injury

    PubMed Central

    Warren, David E.; Power, Jonathan D.; Bruss, Joel; Denburg, Natalie L.; Waldron, Eric J.; Sun, Haoxin; Petersen, Steven E.; Tranel, Daniel

    2014-01-01

    Hubs are network components that hold positions of high importance for network function. Previous research has identified hubs in human brain networks derived from neuroimaging data; however, there is little consensus on the localization of such hubs. Moreover, direct evidence regarding the role of various proposed hubs in network function (e.g., cognition) is scarce. Regions of the default mode network (DMN) have been frequently identified as “cortical hubs” of brain networks. On theoretical grounds, we have argued against some of the methods used to identify these hubs and have advocated alternative approaches that identify different regions of cortex as hubs. Our framework predicts that our proposed hub locations may play influential roles in multiple aspects of cognition, and, in contrast, that hubs identified via other methods (including salient regions in the DMN) might not exert such broad influence. Here we used a neuropsychological approach to directly test these predictions by studying long-term cognitive and behavioral outcomes in 30 patients, 19 with focal lesions to six “target” hubs identified by our approaches (high system density and participation coefficient) and 11 with focal lesions to two “control” hubs (high degree centrality). In support of our predictions, we found that damage to target locations produced severe and widespread cognitive deficits, whereas damage to control locations produced more circumscribed deficits. These findings support our interpretation of how neuroimaging-derived network measures relate to cognition and augment classic neuroanatomically based predictions about cognitive and behavioral outcomes after focal brain injury. PMID:25225403

  1. Developing an open platform for evidence-based microwave ablation treatment planning and validation

    NASA Astrophysics Data System (ADS)

    Deshazer, Garron; Dupuy, Damian E.; Walsh, Edward; Prakash, Punit; Fairchild, Dillon; Glidden, David; Collins, Scott A.; Cook, Madeleine L.; Ryan, Thomas P.; Merck, Derek

    2015-03-01

    The clinical utility of current thermal ablation planning tools is severely limited by treatment variability. We discuss the development of an open platform for evidence-based thermal ablation treatment planning and validation. Improved predictive treatment modeling and consistent outcome analysis are crucial components for useful planning and guidance tools.

  2. The Role of Sexual Orientation in Predicting Outcome Value and Communication Behaviors.

    ERIC Educational Resources Information Center

    Mottet, Timothy P.

    The purpose of this study was to first, examine the role of sexual orientation in determining positive or negative predicted outcome value during initial interactions and second, to test predicted-outcome-value (POV) theory which posits that predicted outcome values are related to future communication behaviors. Participants, 284 students enrolled…

  3. Predicting Language Outcome and Recovery After Stroke (PLORAS)

    PubMed Central

    Price, CJ; Seghier, ML; Leff, AP

    2013-01-01

    The ability of comprehend and produce speech after stroke depends on whether the areas of the brain that support language have been damaged. Here we review two different ways to predict language outcome after stroke. The first depends on understanding the neural circuits that support language. This model-based approach is a challenging endeavor because language is a complex cognitive function that involves the interaction of many different brain areas. The second approach does not require an understanding of why a lesion impairs language, instead, predictions are made on the basis of how previous patients with the same lesion recovered. This requires a database storing the speech and language abilities of a large population of patients who have, between them, incurred a comprehensive range of focal brain damage. In addition it requires a system that converts an MRI scan from a new patient into a 3D description of the lesion and then compares this lesion to all others on the database. The outputs of this system are the longitudinal language outcomes of corresponding patients in the database. This will provide a new patient, their carers and the clinician team managing them the range of likely recovery patterns over a variety of language measures. PMID:20212513

  4. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    PubMed

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety. PMID:21369388

  5. Predicting academic outcomes in an Australian graduate entry medical programme

    PubMed Central

    2014-01-01

    Background Predictive validity studies for selection criteria into graduate entry courses in Australia have been inconsistent in their outcomes. One of the reasons for this inconsistency may have been failure to have adequately considered background disciplines of the graduates as well as other potential confounding socio-demographic variables that may influence academic performance. Methods Graduate entrants into the MBBS at The University of Western Australia between 2005 and 2012 were studied (N = 421). They undertook a 6-month bridging course, before joining the undergraduate-entry students for Years 3 through 6 of the medical course. Students were selected using their undergraduate Grade Point Average (GPA), Graduate Australian Medical School Admissions Test scores (GAMSAT) and a score from a standardised interview. Students could apply from any background discipline and could also be selected through an alternative rural entry pathway again utilising these 3 entry scores. Entry scores, together with age, gender, discipline background, rural entry status and a socioeconomic indicator were entered into linear regression models to determine the relative influence of each predictor on subsequent academic performance in the course. Results Background discipline, age, gender and selection through the rural pathway were variously related to each of the 3 entry criteria. Their subsequent inclusion in linear regression models identified GPA at entry, being from a health/allied health background and total GAMSAT score as consistent independent predictors of stronger academic performance as measured by the weighted average mark for the core units completed throughout the course. The Interview score only weakly predicted performance later in the course and mainly in clinically-based units. The association of total GAMSAT score with academic performance was predominantly dictated by the score in GAMSAT Section 3 (Reasoning in the biological and physical sciences) with

  6. Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center

    PubMed Central

    Schulz, Anselm; Drolsum, Anders; Guren, Marianne Grønlie; Kløw, Nils Einar; Bjørnbeth, Bjørn Atle

    2015-01-01

    Background Radiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM). Purpose To evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade. Material and Methods Hospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001–2006: n = 26) and period II (2007–2011: n = 26). Results Concomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% (P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% (P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence (n = 11): subcapsular localization (n = 4), tumor size >3 cm and subcapsular localization (n = 2), and perivascular localization (portal veins/hepatic veins) (n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively (P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II (P = 0.017). Conclusion RFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy. PMID:26346740

  7. Numerical predictions of railgun performance including the effects of ablation and arc drag

    SciTech Connect

    Schnurr, N.M.; Kerrisk, J.F.; Parker, J.V.

    1986-11-01

    Thermal radiation from plasma armatures in railguns may cause vaporization and partial ionization of the rail and insulator materials. This causes an increase in mass of the arc, which has an adverse effect on projectile velocity. Viscous drag on the arc also has a deleterious effect, particularly at high velocities. Simulations were performed and numerical results were compared with experimental data for a wide range of test performed at the Los Alamos and Lawrence Livermore National Laboratories, the Ling Temco Vought Aerospace and Defense Company, and the Center for Electromechanics at the University of Texas at Austin. The effects of ablation and arc drag on railgun performance are discussed. Some strategies for reducing the effects of ablation are proposed.

  8. Numerical predictions of railgun performance including the effects of ablation and arc drag

    SciTech Connect

    Schnurr, N.M.; Kerrisk, J.F.; Parker, J.V.

    1986-01-01

    Thermal radiation from plasma armatures in railguns may cause vaporization and partial ionization of the rail and insulator materials. This causes an increase in mass of the arc, which has an adverse effect on projectile velocity. Viscous drag on the arc also has a deleterious effect, particularly at high velocities. These loss mechanisms are modeled in the Los Alamos Railgun Estimator code. Simulations were performed and numerical results were compared with experimental data for a wide range of tests performed at the Los Alamos and Lawrence Livermore National Laboratories, the Ling Temco Vought Aerospace and Defense Company, and the Center for Electromechanics at the University of Texas at Austin. The effects of ablation and arc drag on railgun performance are discussed. Parametric studies illustrate the effects of some design parameters on projectile velocity and launcher efficiency. Some strategies for reducing the effects of ablation are proposed.

  9. Numerical predictions of railgun performance including the effects of ablation and arc drag

    NASA Astrophysics Data System (ADS)

    Schnurr, N. M.; Kerrisk, J. F.; Parker, J. V.

    Thermal radiation from plasma armatures in railguns may cause vaporization and partial ionization of the rail and insulator materials. This causes an increase in mass of the arc, which has an adverse effect on projectile velocity. Viscous drag on the arc also has a deleterious effect, particularly at high velocities. These loss mechanisms are modeled in the Los Alamos Railgun Estimator code. Simulations were performed and numerical results were compared with experimental data for a wide range of tests performed at the Los Alamos and Lawrence Livermore National Laboratories, the Ling Temco Vought Aerospace and Defense Company, and the Center for Electromechanics at the University of Texas at Austin. The effects of ablation and arc drag on railgun performance are discussed. Parametric studies illustrate the effects of some design parameters on projectile velocity and launcher efficiency. Some strategies for reducing the effects of ablation are proposed.

  10. Frailty score on admission predicts outcomes in elderly burn injury.

    PubMed

    Romanowski, Kathleen S; Barsun, Alura; Pamlieri, Tina L; Greenhalgh, David G; Sen, Soman

    2015-01-01

    With longer life expectancy, the number of burn injuries in the elderly continues to increase. Prediction of outcomes for the elderly is complicated by preinjury physical fitness and comorbid illness. The authors hypothesize that admission frailty assessment would be predictive of outcomes in the elderly burn population. Our primary aim was to determine if higher frailty scores were associated with higher risk of mortality for elderly burn patients. The secondary aims were to assess if higher frailty scores were associated with increased length of stay, increased needs for mechanical ventilation and poor discharge disposition. A 2-year retrospective chart review was performed of all admitted acute burn patients 65 years or older. Data collected included: age, gender, %TBSA of burn injury, presence of inhalation injury, in hospital mortality, hospital length of stay, ventilator days, ICU length of stay, surgical procedures, insurance status, and discharge disposition. Frailty scores were assessed from admission data and calculated using the Canadian Study of Health and Aging clinical frailty scale. A total of 89 patients met entry criteria. Mean age was 75.3 ± 8.1 years and consisted of 62 men and 27 women. Mean %TBSA was 9.6 ± 9.1% and mean frailty score (FS) was 4.5 ± 1.2. Eighty patients survived to discharge and nine died. Nonsurvivors had significantly higher FS compared to survivors (5.2 ± 1.2 vs 4.4 ± 1.2). FS were also significantly higher in patients discharged to skilled nursing facilities (SNF) (5.34 ± 0.9) compared to those who were discharged home (4.1 ± 1.2) or to physical rehabilitation facilities (4 ± 1.5). Multivariate linear regression analysis revealed that age (B = 0.04) and discharge to SNF (B = 1.2) are independently associated with higher FS. However, survivors were independently associated with a significantly lower FS (B = -1.3). Multivariate logistic regression analysis revealed high admission FS independently increased the risk of

  11. Genomic approaches to outcome prediction in prostate cancer.

    PubMed

    Febbo, Phillip G

    2009-07-01

    Prostate cancer remains a common cause of cancer death in men. Applications of emerging genomic technologies to high-quality prostate cancer models and patient samples in multiple contexts have made significant contributions to our molecular understanding of the development and progression of prostate cancer. Genomic analysis of DNA, RNA, and protein alterations allows for the global assessment of this disease and provides the molecular framework to improve risk classification, outcome prediction, and development of targeted therapies. In this review, the author focused on highlighting recent work in genomics and its role in evaluating molecular modifiers of prostate cancer risk and behavior and the development of predictive models that anticipate the risk of developing prostate cancer, prostate cancer progression, and the response of prostate cancer to therapy. This framework has the exciting potential to be predictive and to provide personalized and individual treatment to the large number of men diagnosed with prostate cancer each year. Cancer 2009;115(13 suppl):3046-57. (c) 2009 American Cancer Society. PMID:19544546

  12. Planning and predictability of clinical outcomes in esthetic rehabilitation.

    PubMed

    Kurbad, A

    2015-01-01

    In esthetic rehabilitation, it is a challenge to meet the needs of patients with growing expectations. Creating predictable results is the key to success. This can be accomplished by performing a comprehensive esthetic diagnosis, elaborating treatment proposals that satisfy today's esthetic standards, and using modern computer-assisted methods. The diagnostic wax-up and mock-up are effective tools that allow patients to visualize treatment proposals without invasive procedures. Once the patient has approved the proposals, they provide the basis for the fabrication of the final restoration. The use of modern ceramic materials makes it possible to achieve a good esthetic outcome, even in restorations with extremely thin layer thicknesses. Esthetic cementation is the final step of restorative treatment. PMID:25911830

  13. Genetic polymorphisms predicting the outcome of bone marrow transplants.

    PubMed

    Dickinson, Anne M; Middleton, Peter G; Rocha, Vanderson; Gluckman, Eliane; Holler, Ernst

    2004-12-01

    Analysis of non-histocompatibility leucocyte antigen (HLA) functional genomics, together with conventional risk factors in haematopoietic stem cell transplantation (HSCT) can lead to predicting outcome in HLA-matched sibling transplant recipients. Polymorphisms of cytokine genes including tumour necrosis factor alpha, interleukin-10, interferon gamma and interleukin (IL)-6, associate with more severe acute graft-versus-host disease (aGvHD). Donor genotype for IL-1 receptor antagonist (IL-1Ra) has been associated with reduced aGvHD severity. Other genotypes (patient IL-1Ra, IL-6 and donor IL-1 alpha) have been associated with chronic GvHD, or overall survival (Vitamin D receptor and oestrogen receptor). Polymorphisms within genes associated with host defence/inflammatory responses (mannose binding lectin genes, myeloperoxidase genes and the FC gamma receptors) have been associated with infections. Polymorphisms of pharmacogenes, such as methylenetetrahydrofolate-reductase, have been associated with aGvHD and other post-transplant complications. The NOD2 gene polymorphism, associated with Crohn's disease, has been shown to be associated with risk of gut GvHD. The majority of the studies have been carried out in single centre HLA-matched sibling cohorts and in relatively few matched unrelated donor transplants. This review gives an overall perspective of the current field of non-HLA genetics with regard to HSCT outcome, clinical relevance and potential application of the results to clinical management of HSCT. PMID:15566351

  14. Delay Discounting Predicts Adolescent Substance Abuse Treatment Outcome

    PubMed Central

    Stanger, Catherine; Ryan, Stacy R.; Fu, Hongyun; Landes, Reid D.; Jones, Bryan A.; Bickel, Warren K.; Budney, Alan J.

    2014-01-01

    The purpose of the current study was to identify predictors of delay discounting among adolescents receiving treatment for marijuana abuse or dependence, and to test delay discounting as a predictor of treatment outcome. Participants for this study were 165 adolescents (88% male) between the ages of 12 and 18 (M =15.8; SD = 1.3) who enrolled in a clinical trial comparing three behavioral treatments for adolescent marijuana abuse or dependence. Participants completed a delay discounting task at treatment onset for $100 and $1,000 of hypothetical money and marijuana. Overall, smaller magnitude rewards were discounted more than larger magnitude rewards. Delay discounting rates were concurrently related to demographic variables (SES, race). Delay discounting of $1,000 of money predicted during treatment abstinence outcomes among adolescent marijuana abusers, over and above the effects of type of treatment received. Teens who show higher levels of discounting of the future may be an important subgroup to identify at treatment onset. Youth with a greater tendency to discount the future may require different intervention strategies that address their impulsivity (e.g., targeting executive function or inhibitory control) and/or different schedules of reinforcement to address their degree of preference for immediate rewards. PMID:22182419

  15. Delay discounting predicts adolescent substance abuse treatment outcome.

    PubMed

    Stanger, Catherine; Ryan, Stacy R; Fu, Hongyun; Landes, Reid D; Jones, Bryan A; Bickel, Warren K; Budney, Alan J

    2012-06-01

    The purpose of the current study was to identify predictors of delay discounting among adolescents receiving treatment for marijuana abuse or dependence, and to test delay discounting as a predictor of treatment outcome. Participants for this study were 165 adolescents (88% male) between the ages of 12 and 18 (mean age = 15.8 years; standard deviation = 1.3 years) who enrolled in a clinical trial comparing three behavioral treatments for adolescent marijuana abuse or dependence. Participants completed a delay discounting task at treatment onset for $100 and $1,000 of hypothetical money and marijuana. Overall, smaller magnitude rewards were discounted more than larger magnitude rewards. Delay discounting rates were concurrently related to demographic variables (socioeconomic status, race). Delay discounting of $1,000 of money predicted during treatment abstinence outcomes among adolescent marijuana abusers, over and above the effects of type of treatment received. Teens who show higher levels of discounting of the future may be an important subgroup to identify at treatment onset. Youth with a greater tendency to discount the future may require different intervention strategies that address their impulsivity (e.g., targeting executive function or inhibitory control) and/or different schedules of reinforcement to address their degree of preference for immediate rewards. PMID:22182419

  16. Predicting Dental Caries Outcomes in Children: A "Risky" Concept.

    PubMed

    Divaris, K

    2016-03-01

    In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as "precision medicine" and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)-a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and "precision dentistry" at the

  17. Model to predict the melting and ablation of reactive metal shrapnel in a high Weber number environment

    SciTech Connect

    Connell, L.W.

    1984-05-01

    Aerothermoballistic behavior of pyrophoric metal shrapnel ejected at supersonic speeds has been numerically simulated. The theoretical model predicts aerodynamic and chemical heat-transfer rates and particle thermal response, including time and position of melt initiation. Because of the high Weber number environment, the melting particle undergoes liquid layer stripping. The model, incorporated in the PLUTO computer code, predicts the liquid mass loss rate, characteristic liquid droplet diameter, temperature rise across the liquid film, and the coupled particle trajectory. The aeroheating, thermal, and ballistic sections of the PLUTO code have been validated by comparison with independent calculations and qualitative experimental data concerning the melting and ablation of gold microspheres. The model still needs to be field tested against reactive metal particles in high Weber number flows.

  18. CT-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma in Korea: Mid-Term Outcomes

    PubMed Central

    Kim, Hae Jin; Park, Jung Jae; Kim, Chan Kyo

    2016-01-01

    Objective To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Materials and Methods Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0–3.9 cm) and 26 months (4–60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Results Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m2 (14.2–142.7 mL/min/1.73 m2) and 72.0 mL/min/1.73 m2 (7.2–112.6 mL/min/1.73 m2), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. Conclusion CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes. PMID:27587966

  19. Predictive Models of Cognitive Outcomes of Developmental Insults

    NASA Astrophysics Data System (ADS)

    Chan, Yupo; Bouaynaya, Nidhal; Chowdhury, Parimal; Leszczynska, Danuta; Patterson, Tucker A.; Tarasenko, Olga

    2010-04-01

    Representatives of Arkansas medical, research and educational institutions have gathered over the past four years to discuss the relationship between functional developmental perturbations and their neurological consequences. We wish to track the effect on the nervous system by developmental perturbations over time and across species. Except for perturbations, the sequence of events that occur during neural development was found to be remarkably conserved across mammalian species. The tracking includes consequences on anatomical regions and behavioral changes. The ultimate goal is to develop a predictive model of long-term genotypic and phenotypic outcomes that includes developmental insults. Such a model can subsequently be fostered into an educated intervention for therapeutic purposes. Several datasets were identified to test plausible hypotheses, ranging from evoked potential datasets to sleep-disorder datasets. An initial model may be mathematical and conceptual. However, we expect to see rapid progress as large-scale gene expression studies in the mammalian brain permit genome-wide searches to discover genes that are uniquely expressed in brain circuits and regions. These genes ultimately control behavior. By using a validated model we endeavor to make useful predictions.

  20. Cast index in predicting outcome of proximal pediatric forearm fractures

    PubMed Central

    Sheikh, Hassaan Qaiser; Malhotra, Karan; Wright, Phil

    2015-01-01

    Background: Many pediatric forearm fractures can be treated in plaster following closed reduction. The cast index (CI, a ratio of anteroposterior to lateral internal diameters of the cast at the fracture site) is a simple, reliable marker of quality of molding and a CI of >0.8 correlates with increased risk of redisplacement. Previously, CI has been applied to all forearm fractures. We hypothesize that an acceptable CI is more difficult to achieve and does not predict outcome in fractures of the proximal forearm. Materials and Methods: Seventynine cases of pediatric forearm fractures initially treated by manipulation alone over a year were included in this retrospective radiographic analysis. The CI was calculated from the post manipulation radiographs. All fractures were divided as either proximal or distal half forearm based on the location of the radius fracture. Subsequent radiographs were reviewed to assess redisplacement and reoperation. Results: The mean CI was 0.77. Remanipulation was required in five cases (6%), all distal half fractures – mean CI 0.79. CI was higher in proximal half forearm fractures (0.83 vs. 0.76, P = 0.006), nonetheless these fractures did not re-displace more than distal fractures. Conclusion: Cast index is useful in predicting redisplacement of manipulated distal forearm fractures. We found that in proximal half forearm fractures it is difficult to achieve a CI of <0.8, but increased CI does not predict loss of position in these fractures. We therefore discourage the use of CI in proximal half forearm fractures. PMID:26229159

  1. Pretransplant renal dysfunction predicts poorer outcome in liver transplantation.

    PubMed

    Lafayette, R A; Paré, G; Schmid, C H; King, A J; Rohrer, R J; Nasraway, S A

    1997-09-01

    The postoperative courses of 115 liver transplant recipients were reviewed to monitor for outcomes of acute renal failure and mortality. An analysis of baseline (preoperative) variables with particular attention to baseline renal function was accomplished to establish predictive variables for a complicated postoperative course. Acute renal failure requiring dialysis occurred in 27 cases (23%) and was associated with a prolonged ICU stay, greater infectious complications, greater hospital charges and a high mortality rate (46 +/- 11% vs. 9 +/- 3%) as compared to patients who did not experience acute renal failure. Death occurred in 20 patients (17%) overall prior to discharge. In order to assess the contribution of renal function, the population was divided arbitrarily into two groups based on preoperative serum creatinine. Group 1 (n = 50) had a preoperative serum creatinine < 1.0 mg/dl (mean +/- SD = 2.2 +/- 0.2 mg/dl) and Group 2 (n = 65) had a preoperative serum creatinine < or = 1.0 mg/dl (0.7 +/- 0.1 mg/dl). The groups experienced similar operative courses. Group 1 patients experienced significantly longer ICU stays (18 +/- 3 vs. 10 +/- 2 days), higher rates of acute renal failure requiring dialysis (52 +/- 7 vs. 5 +/- 2%), higher hospital charges (231,454 +/- 17,088 vs. 178,755 +/- 14,744 $, US) and a greatly increased mortality rate (32 +/- 1 vs. 6 +/- 1%), as compared to Group 2 patients. A multifactorial regression analysis demonstrated that of all pretransplant factors analyzed, elevation in the serum creatinine was significantly associated and was the strongest predictor of both outcomes: acute renal failure requiring dialysis (ROC = 0.89) and death (ROC = 0.83). The presence or absence of hepatorenal syndrome did not influence the results of this analysis. This study demonstrates that cirrhotic patients with renal dysfunction, as indicated by an elevated serum creatinine, experience a poor surgical outcome following liver transplantation. These patients

  2. MRI of the left atrium: predicting clinical outcomes in patients with atrial fibrillation.

    PubMed

    Daccarett, Marcos; McGann, Chris J; Akoum, Nazem W; MacLeod, Rob S; Marrouche, Nassir F

    2011-01-01

    Atrial fibrillation is a significant public health burden, with clinically, epidemiologically and economically significant repercussions. In the last decade, catheter ablation has provided an improvement in morbidity and quality of life, significantly reducing long-term healthcare costs and avoiding recurrences compared with drug therapy. Despite recent progress in techniques, current catheter ablation success rates fall short of expectations. Late gadolinium-enhancement cardiovascular MRI is a well-established tool to image the myocardium and, most specifically, the left atrium. Unique imaging protocols allow for left atrial structural remodeling and fibrosis assessment, which has been demonstrated to correlate with clinical outcomes after catheter ablation, assessment of the individual's risks of thromboembolic events, and effective imaging of patients with left atrial appendage thrombus. Late gadolinium-enhancement MRI aids in the individualized treatment of atrial fibrillation, stratifying recurrence risk and guiding specific ablation strategies. Real-time MRI offers significant safety and effectiveness profiles that would optimize the invasive treatment of atrial fibrillation. PMID:21166532

  3. Radiofrequency Ablation of Colorectal Liver Metastases: Small Size Favorably Predicts Technique Effectiveness and Survival

    SciTech Connect

    Veltri, Andrea Sacchetto, Paola; Tosetti, Irene; Pagano, Eva; Fava, Cesare; Gandini, Giovanni

    2008-09-15

    The objective of this study was to analyze long-term results of radiofrequency thermal ablation (RFA) for colorectal metastases (MTS), in order to evaluate predictors for adverse events, technique effectiveness, and survival. One hundred ninety-nine nonresectable MTS (0.5-8 cm; mean, 2.9 cm) in 122 patients underwent a total of 166 RFA sessions, percutaneously or during surgery. The technique was 'simple' or 'combined' with vascular occlusion. The mean follow-up time was 24.2 months. Complications, technique effectiveness, and survival rates were statistically analyzed. Adverse events occurred in 8.1% of lesions (major complication rate: 1.1%), 7.1% with simple and 16.7% with combined technique (p = 0.15). Early complete response was obtained in 151 lesions (81.2%), but 49 lesions (26.3%) recurred locally after a mean of 10.4 months. Sustained complete ablation was achieved in 66.7% of lesions {<=}3 cm versus 33.3% of lesions >3 cm (p < 0.0001). Survival rates at 1, 3, and 5 years were 91%, 54%, and 33%, respectively, from the diagnosis of MTS and 79%, 38%, and 22%, respectively, from RFA. Mean survival time from RFA was 31.5 months, 36.2 in patients with main MTS {<=}3 cm and 23.2 in those with at least one lesion >3 cm (p = 0.006). We conclude that 'simple' RFA is safe and successful for MTS {<=}3 cm, contributing to prolong survival when patients can be completely treated.

  4. Does Bronchoscopic Evaluation of Inhalation Injury Severity Predict Outcome?

    PubMed

    Spano, Stefania; Hanna, Steven; Li, Zeyu; Wood, Donna; Cartotto, Robert

    2016-01-01

    Although fiber-optic bronchoscopy is essential in the diagnosis of smoke inhalation injury (INH), controversy still exists over whether or not the visualized severity of the mucosal injury predicts clinically meaningful outcomes. The purpose of this study was to assess whether the grade of mucosal INH severity was associated with various outcomes among adult burn patients. We conducted a retrospective review of all patients requiring greater than or equal to 48 hours of mechanical ventilation who were admitted between January 1, 2007 and June 1, 2014 to an adult regional American Burn Association-verified burn center. Bronchoscopy was performed on all subjects at burn center admission and grading of severity was documented using the grades 0 to 4 abbreviated injury score (AIS). Subjects with grade 1 or 2 injury formed the low-grade INH group, whereas those with grade 3 or 4 injury formed the high-grade INH group. Values are shown as the median (first to third quartiles). A P value less than .05 was considered significant. The study population consisted of 160 subjects (age, 48 [35-60] years; %TBSA burn, 28 [19-39.9]; % full thickness burn, 12.8 [0-30]; and 61% with INH). There were no significant differences in age, %TBSA burn, or % full thickness burn between subjects with different individual INH severity grades. Oxygenation on the day of injury worsened significantly as the severity of INH increased, but otherwise there were no significant differences in 24 and 48-hour fluid requirements, duration of ventilation, ventilator free days, incidence of acute respiratory distress syndrome, or mortality between subjects with different individual grades of INH severity. Subjects with high-grade INH showed statistically insignificant trends toward larger 48-hour fluid volumes (P = .07), poorer oxygenation over the first 3 post burn days (P = .055), longer duration of ventilation (P = .08), and fewer ventilator free days (P = .047) than low-grade INH. High-grade and low

  5. Artificial neural networks in laboratory medicine and medical outcome prediction.

    PubMed

    Tafeit, E; Reibnegger, G

    1999-09-01

    Since the early nineties the number of scientific papers reporting on artificial neural network (ANN) applications in medicine has been quickly increasing. In the present paper, we describe in some detail the architecture of network types used most frequently in ANN applications in the broad field of laboratory medicine and clinical chemistry, present a technique-structured review about the recent ANN applications in the field, and give information about the improvements of available ANN software packages. ANN applications are divided into two main classes: supervised and unsupervised methods. Most of the described supervised applications belong to the fields of medical diagnosis (n = 7) and outcome prediction (n = 9). Laboratory and clinical data are presented to multilayer feed-forward ANNs which are trained by the back propagation algorithm. Results are often better than those of traditional techniques such as linear discriminant analysis, classification and regression trees (CART), Cox regression analysis, logistic regression, clinical judgement or expert systems. Unsupervised ANN applications provide the ability of reducing the dimensionality of a dataset. Low-dimensional plots can be generated and visually understood and compared. Results are very similar to that of cluster analysis and factor analysis. The ability of Kohonen's self-organizing maps to generate 2D maps of molecule surface properties was successfully applied in drug design. PMID:10596951

  6. Low inhibitory control and restrictive feeding practices predict weight outcomes

    PubMed Central

    Anzman, Stephanie L.; Birch, Leann L.

    2009-01-01

    Objective A priority for research is to identify individuals early in development who are particularly susceptible to weight gain in the current, obesogenic environment. This longitudinal study investigated whether early individual differences in inhibitory control, an aspect of temperament, predicted weight outcomes and whether parents’ restrictive feeding practices moderated this relation. Study design Participants included 197 non-Hispanic White girls and their parents; families were assessed when girls were 5, 7, 9, 11, 13, and 15 years old. Measures included mothers’ reports of girls’ inhibitory control levels, girls’ reports of parental restriction in feeding, girls’ body mass indexes (BMIs), and parents’ BMIs, education, and income. Results Girls with lower inhibitory control at age 7 had higher concurrent BMIs, greater weight gain, higher BMIs at all subsequent time points, and were 1.95 times more likely to be overweight at age 15. Girls who perceived higher parental restriction exhibited the strongest inverse relation between inhibitory control and weight status. Conclusion Variability in inhibitory control could help identify individuals who are predisposed to obesity risk; the current findings also highlight the importance of parenting practices as potentially modifiable factors which exacerbate or attenuate this risk. PMID:19595373

  7. Nonequilibrium Ablation of Phenolic Impregnated Carbon Ablator

    NASA Technical Reports Server (NTRS)

    Milos, Frank S.; Chen, Yih K.; Gokcen, Tahir

    2012-01-01

    In previous work, an equilibrium ablation and thermal response model for Phenolic Impregnated Carbon Ablator was developed. In general, over a wide range of test conditions, model predictions compared well with arcjet data for surface recession, surface temperature, in-depth temperature at multiple thermocouples, and char depth. In this work, additional arcjet tests were conducted at stagnation conditions down to 40 W/sq cm and 1.6 kPa. The new data suggest that nonequilibrium effects become important for ablation predictions at heat flux or pressure below about 80 W/sq cm or 10 kPa, respectively. Modifications to the ablation model to account for nonequilibrium effects are investigated. Predictions of the equilibrium and nonequilibrium models are compared with the arcjet data.

  8. Predicting postoperative visual outcomes in cataract patients with maculopathy

    PubMed Central

    Macky, Tamer A; Mohamed, Abdel Moniem Hasaballah; Emarah, Ahmed M; Osman, Amr Abdellatif; Gado, Ahmed S

    2015-01-01

    Purpose: To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. Study Design: Prospective interventional clinical trial. Patients and Methods: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25–0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60–70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error. Results: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1–0.5). The mean PAM score was 0.442 ± 0.24 (0.1–1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17–1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively). Conclusion: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies. PMID:26655002

  9. Developing demographic toxicity data: optimizing effort for predicting population outcomes

    PubMed Central

    Stark, John D.

    2016-01-01

    Mounting evidence suggests that population endpoints in risk assessment are far more accurate than static assessments. Complete demographic toxicity data based on full life tables are eminently useful in predicting population outcomes in many applications because they capture both lethal and sublethal effects; however, developing these life tables is extremely costly. In this study we investigated the efficiency of partial life cycle tests as a substitute for full life cycles in parameterizing population models. Life table data were developed for three species of Daphniids, Ceriodaphnia dubia, Daphnia magna, and D. pulex, weekly throughout the life span of these species. Population growth rates (λ) and a series of other demographic parameters generated from the complete life cycle were compared to those calculated from cumulative weeks of the life cycle in order to determine the minimum number of weeks needed to generate an accurate population projection. Results showed that for C. dubia and D. pulex, λ values developed at >4 weeks (44.4% of the life cycle) were not significantly different from λ developed for the full life cycle (9 weeks) of each species. For D. magna, λ values developed at >7 weeks (70% of the life cycle) were not significantly different from λ developed for the full life cycle (10 weeks). Furthermore, these cutoff points for λ were not the same for other demographic parameters, with no clear pattern emerging. Our results indicate that for C. dubia, D. magna, and D. pulex, partial life tables can be used to generate population growth rates in lieu of full life tables. However, the implications of differences in cutoff points for different demographic parameters need to be investigated further. PMID:27257546

  10. Developing demographic toxicity data: optimizing effort for predicting population outcomes.

    PubMed

    Stark, John D; Banks, John E

    2016-01-01

    Mounting evidence suggests that population endpoints in risk assessment are far more accurate than static assessments. Complete demographic toxicity data based on full life tables are eminently useful in predicting population outcomes in many applications because they capture both lethal and sublethal effects; however, developing these life tables is extremely costly. In this study we investigated the efficiency of partial life cycle tests as a substitute for full life cycles in parameterizing population models. Life table data were developed for three species of Daphniids, Ceriodaphnia dubia, Daphnia magna, and D. pulex, weekly throughout the life span of these species. Population growth rates (λ) and a series of other demographic parameters generated from the complete life cycle were compared to those calculated from cumulative weeks of the life cycle in order to determine the minimum number of weeks needed to generate an accurate population projection. Results showed that for C. dubia and D. pulex, λ values developed at >4 weeks (44.4% of the life cycle) were not significantly different from λ developed for the full life cycle (9 weeks) of each species. For D. magna, λ values developed at >7 weeks (70% of the life cycle) were not significantly different from λ developed for the full life cycle (10 weeks). Furthermore, these cutoff points for λ were not the same for other demographic parameters, with no clear pattern emerging. Our results indicate that for C. dubia, D. magna, and D. pulex, partial life tables can be used to generate population growth rates in lieu of full life tables. However, the implications of differences in cutoff points for different demographic parameters need to be investigated further. PMID:27257546

  11. Hazards of Hospitalization: Residence Prior to Admission Predicts Outcomes

    ERIC Educational Resources Information Center

    Friedman, Susan M.; Mendelson, Daniel A.; Bingham, Karilee W.; McCann, Robert M.

    2008-01-01

    Purpose: Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during…

  12. Role of Subdural Electrocorticography in Prediction of Long-Term Seizure Outcome in Epilepsy Surgery

    ERIC Educational Resources Information Center

    Asano, Eishi; Juhasz, Csaba; Shah, Aashit; Sood, Sandeep; Chugani, Harry T.

    2009-01-01

    Since prediction of long-term seizure outcome using preoperative diagnostic modalities remains suboptimal in epilepsy surgery, we evaluated whether interictal spike frequency measures obtained from extraoperative subdural electrocorticography (ECoG) recording could predict long-term seizure outcome. This study included 61 young patients (age…

  13. Predicting Adolescent Drug Abuse Treatment Outcome with the Personal Experience Inventory (PEI)

    ERIC Educational Resources Information Center

    Stinchfield, Randy; Winters, Ken C.

    2004-01-01

    The purposes of this study were to examine the clinical utility of the Personal Experience Inventory (PEI) Psychosocial scales to predict adolescent drug abuse treatment outcome. The role of psychosocial risk factors in predicting treatment outcome also has theoretical interest given that such factors have been associated with the development of…

  14. Longitudinal Prediction of Child Outcomes from Differing Measures of Parenting in a Low-Income Sample

    ERIC Educational Resources Information Center

    Zaslow, Martha J.; Weinfield, Nancy S.; Gallagher, Megan; Hair, Elizabeth C.; Ogawa, John R.; Egeland, Byron; Tabors, Patton O.; De Temple, Jeanne M.

    2006-01-01

    This study examined predictions from preschool parenting measures to middle childhood cognitive and socioemotional child outcomes to explore whether parenting assessment methodologies that require more time, training, and expense yield better predictions of child outcomes than less intensive methodologies. Mother-child dyads (N=278) in low-income…

  15. Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children

    PubMed Central

    Temiz, Abdulkerim; Oguzkurt, Pelin; Ezer, Semire Serin; Ince, Emine; Hicsonmez, Akgun

    2012-01-01

    AIM: To assess the necessity of esophagogastroduodenoscopy (EGD) to predict the outcome of caustic ingestion in children. METHODS: The study included 206 children who underwent EGD because of ingestion of caustic substances between January 2005 and August 2010. Retrospective analysis of data of the patients was performed. RESULTS: The male/female ratio was 1.6 and mean age was 38.1 ± 28.8 mo. The caustic substances were acidic in 72 (34.9%) cases, alkaline in 56 (27.2%), liquid household bleach in 62 (30.1%), and unknown in 16 (7.8%). Fifty-seven (27.7%) patients were symptom-free. Significant clinical findings were observed in 149 (72.3%) patients. Upper gastrointestinal endoscopy findings of esophageal injury were grade 0 in 86 (41.7%) patients, grade 1 in 49 (23.8%), grade 2a in 42 (20.4%), grade 2b in 28 (13.6%), and grade 3a in 1 (0.5%) patient. 35 patients with grade 2a, 2b, and 3a injuries underwent esophageal dilation at second week of ingestion. Esophageal stricture, which necessitated a regular dilation program developed in 13 of the aforementioned 35 patients. There is no statistically significant difference in the rate of development of esophageal stricture between the patients who ingested acidic (15.3%) and alkaline (8.9%) substances (P = 0.32). Severe gastric injury was detected in 38 (18.5%) patients. The rate of development of gastric injury was significantly higher in the acidic group (14%) than in the alkaline group (2.9%) (P = 0.001). Out of 149 patients with clinical findings, 49 (32.9%) patients had no esophageal injury and 117 (78.5%) patients had no gastric lesion. Esophageal and severe gastric injuries were detected in 20 (35.1%) and 8 (14%) of patients with no clinical findings respectively. Pyloric stenosis developed in 6 patients. Pyloric obstruction improved with balloon dilation in 2 patients. Mean hospitalization time were 1.2 ± 0.5 d for grade 0 and 2.3 ± 5 d for grade 1 and 6.3 ± 6.2 d for grade 2a and 15.8 ± 18.6 d for grade 2

  16. Predictability influences whether outcomes are processed in terms of original or relative values.

    PubMed

    Zeng, Jianmin; Cao, Zhipeng; Huang, Jiajin; Hitchman, Glenn; Zhang, Qinglin

    2014-10-01

    Previous studies have provided insights into the representations of original and relative values and the influence of predictability on decision making. However, whether the predictability of outcomes can influence the processing manner of outcomes (i.e. whether the outcomes are processed in terms of original or relative values) is still unknown. To investigate this issue, we had participants perform a monetary decision task which resulted in two outcomes with the same relative values but different original values in either a predictable or unpredictable condition, while recording event-related potentials (ERP). ERP results showed that the outcome processing in the unpredictable condition elicited more positive deflections in the time window of 300-500ms (P300) than did those in the predictable condition. More importantly, the outcome with high original value elicited a greater P300 component than did that with low original value in the unpredictable condition even though these two outcomes had the same relative values, while in the predictable condition no significant difference was observed between ERPs elicited by the two outcomes even though their original values were different. These results suggest that the outcomes might be processed in terms of relative values in the predictable condition but original values in the unpredictable condition. PMID:24905428

  17. Outcome of radiofrequency ablation over partial nephrectomy for small renal mass (<4 cm): a systematic review and meta-analysis

    PubMed Central

    Yang, Yue; Chen, Shouzhen; Chen, Fan; Zhu, Kejia; Deng, Qiming; Luo, Li; Shi, Benkang

    2015-01-01

    Objective: A meta-analysis was undertaken to provide evidence-based clinical trials comparing radiofrequency ablation with partial nephrectomy for small renal mass. Methods: We searched through the major medical databases such as Pub Med, EMBASE, Medline, Science Citation Index, Web of Science and CNKI (Chinese National Knowledge Infrastructure Database) and Wangfang (Database of Chinese Ministry of Science & Technology) for all published studies without any limit on language from May 2007 until May 2015. The following search terms wereused: partial nephrectomy, radiofrequency ablation, renal cell carcinoma, small renal tumor or mass. Furthermore, additional related studies were manually searched in the reference lists of all published reviews and retrieved articles. Results: We found there were no statistical differences between groups in 5y-DFS, recurrence rates, complications, but a less percentage decease rate of GFR than PN, and RFA may be a better application for SRM (<4 cm). PMID:26884989

  18. Ablation of kidney tumors.

    PubMed

    Karam, Jose A; Ahrar, Kamran; Matin, Surena F

    2011-04-01

    While surgical excision remains the gold standard for curative treatment of small renal cell carcinomas, ablative therapy has a place as a minimally invasive, kidney function-preserving therapy in carefully selected patients who are poor candidates for surgery. Although laparoscopic cryoablation and percutaneous radiofrequency ablation (RFA) are commonly performed, percutaneous cryoablation and laparoscopic RFA are reportedly being performed with increasing frequency. The renal function and complication profiles following ablative therapy are favorable, while oncologic outcomes lag behind those of surgery, thus reinforcing the need for careful patient selection. PMID:21377587

  19. Predicting outcomes for youth transferred to adult court.

    PubMed

    Schubert, Carol A; Mulvey, Edward P; Loughran, Thomas A; Fagan, Jeffrey; Chassin, Laurie A; Piquero, Alex R; Losoya, Sandra H; Steinberg, Laurence; Cauffman, Elizabeth

    2010-12-01

    Extant research regarding juvenile transfer has focused primarily on the negative effects of current policies, with little consistent and rigorous work on the variation among the adolescents transferred to adult court and their later adjustment in the community. Using a sample of 193 transferred youth from Arizona, we consider how certain individual characteristics are related to four post-release outcomes (antisocial activity, re-arrest, re-institutionalization, and gainful activity). We find considerable variability in outcomes, with adjustment significantly and consistently related to certain legal and risk-need factors. These results indicate that some transferred youth may experience negative outcomes, and that refinements to transfer policy may benefit from consideration of these factors in determining which serious adolescent offenders are most appropriate for transfer. PMID:20204478

  20. NAP1 Strain Type Predicts Outcomes from Clostridium difficile Infection

    PubMed Central

    See, Isaac; Mu, Yi; Cohen, Jessica; Beldavs, Zintars G.; Winston, Lisa G.; Dumyati, Ghinwa; Holzbauer, Stacy; Dunn, John; Farley, Monica M.; Lyons, Carol; Johnston, Helen; Phipps, Erin; Perlmutter, Rebecca; Anderson, Lydia; Gerding, Dale N.; Lessa, Fernanda C.

    2015-01-01

    Background Studies conflict regarding the importance of the fluoroquinolone-resistant North American pulsed-field gel electrophoresis type 1 (NAP1) strain in Clostridium difficile infection (CDI) outcome. We describe strain types causing CDI and evaluate their association with patient outcomes. Methods CDI cases were identified from population-based surveillance. Multivariate regression models were used to evaluate the associations of strain type with severe disease (ileus, toxic megacolon, or pseudomembranous colitis within 5 days; or white blood cell count ≥15,000/mm3 within one day of positive test), severe outcome (intensive care unit admission after positive test, colectomy for C. difficile infection, or death within 30 days of positive test), and death within 14 days of positive test. Results Strain typing results were available for 2,057 cases. Severe disease occurred in 363 (17.7%) cases, severe outcome in 100 (4.9%), and death within 14 days in 56 (2.7%). The most common strain types were NAP1 (28.4%), NAP4 (10.2%) and NAP11 (9.1%). In unadjusted analysis, NAP1 was associated with greater odds of severe disease than other strains. After controlling for patient risk factors, healthcare exposure, and antibiotic use, NAP1 was associated with severe disease (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI], 1.36–2.22), severe outcome (aOR 1.66, 95% CI, 1.09–2.54), and death within 14 days (aOR 2.12, 95% CI, 1.22–3.68). Conclusion NAP1 was the most prevalent strain and a predictor of severe disease, severe outcome, and death. Strategies to reduce NAP1 prevalence, such as antibiotic stewardship to reduce fluoroquinolone use, might reduce CDI morbidity. PMID:24604900

  1. Caregiving and Dementia: Predicting Negative and Positive Outcomes for Caregivers.

    ERIC Educational Resources Information Center

    Gold, Dolores Pushkar; And Others

    1995-01-01

    Interviewed a sample of 118 caregivers maintaining relatives with dementia at home, who completed questionnaires at initial and follow-up assessment 6 months later. All dependents received a cognitive assessment. Results of data analysis supported a model of caregiving in which negative outcomes of burden and impaired health reduced positive…

  2. Predicting Child Outcomes from Preschool Quality in Portugal

    ERIC Educational Resources Information Center

    Abreu-Lima, Isabel M. P.; Leal, Teresa B.; Cadima, Joana; Gamelas, Ana Madalena

    2013-01-01

    The main purpose of this study is to analyze whether quality of preschool classrooms relates to 4- and 5-year-old children developmental outcomes. The study was conducted in 60 classrooms in Porto Metropolitan Area, Portugal. Children (N = 215) were evaluated in the literacy, math, and behavior domains. Preschool quality was assessed through…

  3. Predicting Outcome in Behavioral Parent Training: Expected and Unexpected Results

    ERIC Educational Resources Information Center

    MacKenzie, Elizabeth P.; Fite, Paula J.; Bates, John E.

    2004-01-01

    This study examined the relationships among clinical utility and treatment outcome variables in Behavioral Parent Training (BPT). The sample included 21 mothers with 3-8 year-old children with significant externalizing behavior problems who received treatment for Oppositional Defiant Disorder. The primary aim was to relate two treatment…

  4. Relatively Random: Context Effects on Perceived Randomness and Predicted Outcomes

    ERIC Educational Resources Information Center

    Matthews, William J.

    2013-01-01

    This article concerns the effect of context on people's judgments about sequences of chance outcomes. In Experiment 1, participants judged whether sequences were produced by random, mechanical processes (such as a roulette wheel) or skilled human action (such as basketball shots). Sequences with lower alternation rates were judged more likely to…

  5. Professor-Student Rapport Scale: Six Items Predict Student Outcomes

    ERIC Educational Resources Information Center

    Wilson, Janie H.; Ryan, Rebecca G.

    2013-01-01

    Rapport between students and teachers leads to numerous positive student outcomes, including attitudes toward the teacher and course, student motivation, and perceived learning. The recent development of a Professor-Student Rapport scale offers assessment of this construct. However, a Cronbach's [alpha] of 0.96 indicated item redundancy, and the…

  6. Incidence and Factors Predicting Skin Burns at the Site of Indifferent Electrode during Radiofrequency Catheter Ablation of Cardiac Arrhythmias

    PubMed Central

    Ibrahim, Hussain; Finta, Bohuslav; Rind, Jubran

    2016-01-01

    Radiofrequency catheter ablation (RFA) has become a mainstay for treatment of cardiac arrhythmias. Skin burns at the site of an indifferent electrode patch have been a rare, serious, and likely an underreported complication of RFA. The purpose of this study was to determine the incidence of skin burns in cardiac RFA procedures performed at one institution. Also, we wanted to determine the factors predicting skin burns after cardiac RFA procedures at the indifferent electrode skin pad site. Methods. A retrospective case control study was performed to compare the characteristics in patients who developed skin burns in a 2-year period. Results. Incidence of significant skin burns after RFA was 0.28% (6/2167). Four of the six patients were female and all were Caucasians. Four controls for every case were age and sex matched. Burn patients had significantly higher BMI, procedure time, and postprocedure pain, relative to control subjects (p < 0.05, one-tailed testing). No one in either group had evidence of dispersive pad malattachment. Conclusions. Our results indicate that burn patients had higher BMI and longer procedure times compared to control subjects. These findings warrant further larger studies on this topic. PMID:27213077

  7. Prediction of cardiovascular outcomes by imaging coronary atherosclerosis

    PubMed Central

    Pathan, Faraz

    2016-01-01

    Over the last two decades, several invasive and non-invasive coronary atherosclerosis imaging modalities have emerged as predictors of cardiovascular outcomes in at-risk population. These modalities have demonstrated independent or incremental prognostic information over existing/standard risk stratification schemes, such as the Framingham risk score (FRS), by identifying characteristics of coronary artery diseases (CADs). In this review, we begin with discussing the importance of pre-test probability and quality of outcome measure, followed by specific findings of each modality in relation to prognosis. We focused on both short and long term prognostic aspects of coronary computed tomography (CT) (including coronary calcium score and coronary angiography) and magnetic resonance imaging as non-invasive tools, as well as invasive modalities including intravascular ultrasound (IVUS), optical coherence tomography (OCT), near infrared spectroscopy and Angioscopy. PMID:27500091

  8. Arthroscopic wafer resection for ulnar impaction syndrome: prediction of outcomes.

    PubMed

    Meftah, Morteza; Keefer, Eric P; Panagopoulos, Georgia; Yang, S Steven

    2010-01-01

    Twenty-six patients with mean age of 38.5 (range 18-59), from 1998 to 2005, with ulnar impaction syndrome who failed nonoperative treatments were included in our study. Patients' age, history of previous wrist fracture, presence of MRI signs and ulnar variance were recorded as variables. Also, patients' postoperative strength (compared to the contralateral wrist) and pain relief were collected as outcome measurements. Twenty-two patients (84.6%) had either good or excellent pain relief (median 4, range 1-4). Significant correlation was found between MRI findings and postop pain relief (r = 0.53, p < or = 0.01). History of previous distal radius fractures was negatively correlated with pain relief (r = -0.50, p < or = 0.01). No correlation was found between postop strength and any of the variables. Presence of MRI signs of UIS is a predictor of good outcome in arthroscopic wafer resection. PMID:20672395

  9. Using conversation topics for predicting therapy outcomes in schizophrenia.

    PubMed

    Howes, Christine; Purver, Matthew; McCabe, Rose

    2013-01-01

    Previous research shows that aspects of doctor-patient communication in therapy can predict patient symptoms, satisfaction and future adherence to treatment (a significant problem with conditions such as schizophrenia). However, automatic prediction has so far shown success only when based on low-level lexical features, and it is unclear how well these can generalize to new data, or whether their effectiveness is due to their capturing aspects of style, structure or content. Here, we examine the use of topic as a higher-level measure of content, more likely to generalize and to have more explanatory power. Investigations show that while topics predict some important factors such as patient satisfaction and ratings of therapy quality, they lack the full predictive power of lower-level features. For some factors, unsupervised methods produce models comparable to manual annotation. PMID:23943658

  10. Revolutionizing Toxicity Testing For Predicting Developmental Outcomes (DNT4)

    EPA Science Inventory

    Characterizing risk from environmental chemical exposure currently requires extensive animal testing; however, alternative approaches are being researched to increase throughput of chemicals screened, decrease reliance on animal testing, and improve accuracy in predicting adverse...

  11. Using Conversation Topics for Predicting Therapy Outcomes in Schizophrenia

    PubMed Central

    Howes, Christine; Purver, Matthew; McCabe, Rose

    2013-01-01

    Previous research shows that aspects of doctor-patient communication in therapy can predict patient symptoms, satisfaction and future adherence to treatment (a significant problem with conditions such as schizophrenia). However, automatic prediction has so far shown success only when based on low-level lexical features, and it is unclear how well these can generalize to new data, or whether their effectiveness is due to their capturing aspects of style, structure or content. Here, we examine the use of topic as a higher-level measure of content, more likely to generalize and to have more explanatory power. Investigations show that while topics predict some important factors such as patient satisfaction and ratings of therapy quality, they lack the full predictive power of lower-level features. For some factors, unsupervised methods produce models comparable to manual annotation. PMID:23943658

  12. Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes.

    PubMed

    Chang, Lawrence; Frame, David; Braun, Thomas; Gatza, Erin; Hanauer, David A; Zhao, Shuang; Magenau, John M; Schultz, Kathryn; Tokala, Hemasri; Ferrara, James L M; Levine, John E; Reddy, Pavan; Paczesny, Sophie; Choi, Sung Won

    2014-09-01

    Engraftment syndrome (ES), characterized by fever, rash, pulmonary edema, weight gain, liver and renal dysfunction, and/or encephalopathy, occurs at the time of neutrophil recovery after hematopoietic cell transplantation (HCT). In this study, we evaluated the incidence, clinical features, risk factors, and outcomes of ES in children and adults undergoing first-time allogeneic HCT. Among 927 patients, 119 (13%) developed ES at a median of 10 days (interquartile range 9 to 12) after HCT. ES patients experienced significantly higher cumulative incidence of grade 2 to 4 acute GVHD at day 100 (75% versus 34%, P < .001) and higher nonrelapse mortality at 2 years (38% versus 19%, P < .001) compared with non-ES patients, resulting in lower overall survival at 2 years (38% versus 54%, P < .001). There was no significant difference in relapse at 2 years (26% versus 31%, P = .772). Suppression of tumorigenicity 2, interleukin 2 receptor alpha, and tumor necrosis factor receptor 1 plasma biomarker levels were significantly elevated in ES patients. Our results illustrate the clinical significance and prognostic impact of ES on allogeneic HCT outcomes. Despite early recognition of the syndrome and prompt institution of corticosteroid therapy, outcomes in ES patients were uniformly poor. This study suggests the need for a prospective approach of collecting clinical features combined with correlative laboratory analyses to better characterize ES. PMID:24892262

  13. Early prediction of tumor recurrence based on CT texture changes after stereotactic ablative radiotherapy (SABR) for lung cancer

    SciTech Connect

    Mattonen, Sarah A.; Palma, David A.; Haasbeek, Cornelis J. A.; Senan, Suresh; Ward, Aaron D.

    2014-03-15

    Purpose: Benign computed tomography (CT) changes due to radiation induced lung injury (RILI) are common following stereotactic ablative radiotherapy (SABR) and can be difficult to differentiate from tumor recurrence. The authors measured the ability of CT image texture analysis, compared to more traditional measures of response, to predict eventual cancer recurrence based on CT images acquired within 5 months of treatment. Methods: A total of 24 lesions from 22 patients treated with SABR were selected for this study: 13 with moderate to severe benign RILI, and 11 with recurrence. Three-dimensional (3D) consolidative and ground-glass opacity (GGO) changes were manually delineated on all follow-up CT scans. Two size measures of the consolidation regions (longest axial diameter and 3D volume) and nine appearance features of the GGO were calculated: 2 first-order features [mean density and standard deviation of density (first-order texture)], and 7 second-order texture features [energy, entropy, correlation, inverse difference moment (IDM), inertia, cluster shade, and cluster prominence]. For comparison, the corresponding response evaluation criteria in solid tumors measures were also taken for the consolidation regions. Prediction accuracy was determined using the area under the receiver operating characteristic curve (AUC) and two-fold cross validation (CV). Results: For this analysis, 46 diagnostic CT scans scheduled for approximately 3 and 6 months post-treatment were binned based on their recorded scan dates into 2–5 month and 5–8 month follow-up time ranges. At 2–5 months post-treatment, first-order texture, energy, and entropy provided AUCs of 0.79–0.81 using a linear classifier. On two-fold CV, first-order texture yielded 73% accuracy versus 76%–77% with the second-order features. The size measures of the consolidative region, longest axial diameter and 3D volume, gave two-fold CV accuracies of 60% and 57%, and AUCs of 0.72 and 0.65, respectively

  14. Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score

    PubMed Central

    Aggarwal, Rishi Anil; Srivastava, Sudhir Kumar; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings, following

  15. Connectivity-Based Predictions of Hand Motor Outcome for Patients at the Subacute Stage After Stroke

    PubMed Central

    Lindow, Julia; Domin, Martin; Grothe, Matthias; Horn, Ulrike; Eickhoff, Simon B.; Lotze, Martin

    2016-01-01

    Background: Connectivity-based predictions of hand motor outcome have been proposed to be useful in stroke patients. We intended to assess the prognostic value of different imaging methods on short-term (3 months) and long-term (6 months) motor outcome after stroke. Methods: We measured resting state functional connectivity (rsFC), diffusion weighted imaging (DWI) and grip strength in 19 stroke patients within the first days (5–9 days) after stroke. Outcome measurements for short-term (3 months) and long-term (6 months) motor function was assessed by the Motricity Index (MI) of the upper limb and the box and block test (BB). Patients were predominantly mildly affected since signed consent was necessary at inclusion. We performed a multiple stepwise regression analysis to compare the predictive value of rsFC, DWI and clinical measurements. Results: Patients showed relevant improvement in both motor outcome tests. As expected grip strength at inclusion was a predictor for short- and long-term motor outcome as assessed by MI. Diffusion-based tract volume (DTV) of the tracts between ipsilesional primary motor cortex and contralesional anterior cerebellar hemisphere showed a strong trend (p = 0.05) for a predictive power for long-term motor outcome as measured by MI. DTV of the interhemispheric tracts between both primary motor cortices was predictive for both short- and long-term motor outcome in BB. rsFC was not associated with motor outcome. Conclusions: Grip strength is a good predictor of hand motor outcome concerning strength-related measurements (MI) for mildly affected subacute patients. Therefore additional connectivity measurements seem to be redundant in this group. Using more complex movement recruiting bilateral motor areas as an outcome parameter, DTV and in particular interhemispheric pathways might enhance predictive value of hand motor outcome. PMID:27014032

  16. Predicting Outcome of Community-Based Early Intensive Behavioral Intervention for Children with Autism.

    PubMed

    Smith, Tristram; Klorman, Rafael; Mruzek, Daniel W

    2015-10-01

    We examined predictors of outcome (IQ, adaptive behavior, and ASD severity) after 12 and 24 months of early intensive behavioral intervention (EIBI) in 71, 20-59 months old children with autism spectrum disorder (ASD) who were enrolled in publicly-funded, community-based agencies. Predictors included social engagement (combining variables loading onto a single factor: social approach, joint attention, and imitation) and sensorimotor rituals. Younger age and higher IQ at intake predicted favorable outcomes at both 12 and 24 months. Adjusting for age, IQ, baseline predictor scores, EIBI hours, treatment site, and sensorimotor rituals, social engagement predicted superior later IQ and adaptive behavior. In contrast, sensorimotor rituals did not predict outcome. Although limited by the absence of a control group, the study indicates social engagement predicts some EIBI outcomes. PMID:25778537

  17. Predicting Residential Treatment Outcomes for Emotionally and Behaviorally Disordered Youth: The Role of Pretreatment Factors

    ERIC Educational Resources Information Center

    den Dunnen, Wendy; St. Pierre, Jeff; Stewart, Shannon L.; Johnson, Andrew; Cook, Steven; Leschied, Alan W.

    2012-01-01

    This study examined outcomes with 170 children and youth admitted to residential treatment with complex mental health problems. Overall, outcomes at 2 years post-treatment was predicted by children and youth's behavioral pretreatment status reflected in lower internalizing and externalizing behavior at admission. These findings recognize a cluster…

  18. Context-Outcome Associations Mediate Context-Switch Effects in a Human Predictive Learning Task

    ERIC Educational Resources Information Center

    Leon, Samuel P.; Abad, Maria J. F.; Rosas, Juan M.

    2011-01-01

    Four experiments explored the role of contexts in information retrieval after different levels of acquisition training in human predictive learning. Participants were trained where cue (X) was followed by an outcome in context A while a different cue (Y) was followed by the absence of the outcome in context B. When 4 training trials with each cue…

  19. Predicting Young Adult Outcome among More and Less Cognitively Able Individuals with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Anderson, Deborah K.; Liang, Jessie W.; Lord, Catherine

    2014-01-01

    Background: The range of outcomes for young adults with Autism Spectrum Disorders (ASD) and the early childhood factors associated with this diversity have implications for clinicians and scientists. Methods: This prospective study provided a unique opportunity to predict outcome 17 years later for a relatively large sample of children diagnosed…

  20. Factors of Learner-Instructor Interaction Which Predict Perceived Learning Outcomes in Online Learning Environment

    ERIC Educational Resources Information Center

    Kang, M.; Im, T.

    2013-01-01

    Interaction in the online learning environment has been regarded as one of the most critical elements that affect learning outcomes. This study examined what factors in learner-instructor interaction can predict the learner's outcomes in the online learning environment. Learners in K Online University participated by answering the survey, and data…

  1. Interspecific interactions through 2 million years: are competitive outcomes predictable?

    PubMed Central

    Di Martino, Emanuela; Rust, Seabourne

    2016-01-01

    Ecological interactions affect the survival and reproduction of individuals. However, ecological interactions are notoriously difficult to measure in extinct populations, hindering our understanding of how the outcomes of interactions such as competition vary in time and influence long-term evolutionary changes. Here, the outcomes of spatial competition in a temporally continuous community over evolutionary timescales are presented for the first time. Our research domain is encrusting cheilostome bryozoans from the Wanganui Basin of New Zealand over a ca 2 Myr time period (Pleistocene to Recent). We find that a subset of species can be identified as consistent winners, and others as consistent losers, in the sense that they win or lose interspecific competitive encounters statistically more often than the null hypothesis of 50%. Most species do not improve or worsen in their competitive abilities through the 2 Myr period, but a minority of species are winners in some intervals and losers in others. We found that conspecifics tend to cluster spatially and interact more often than expected under a null hypothesis: most of these are stand-off interactions where the two colonies involved stopped growing at edges of encounter. Counterintuitively, competitive ability has no bearing on ecological dominance. PMID:27581885

  2. Interspecific interactions through 2 million years: are competitive outcomes predictable?

    PubMed

    Liow, Lee Hsiang; Di Martino, Emanuela; Voje, Kjetil Lysne; Rust, Seabourne; Taylor, Paul D

    2016-08-31

    Ecological interactions affect the survival and reproduction of individuals. However, ecological interactions are notoriously difficult to measure in extinct populations, hindering our understanding of how the outcomes of interactions such as competition vary in time and influence long-term evolutionary changes. Here, the outcomes of spatial competition in a temporally continuous community over evolutionary timescales are presented for the first time. Our research domain is encrusting cheilostome bryozoans from the Wanganui Basin of New Zealand over a ca 2 Myr time period (Pleistocene to Recent). We find that a subset of species can be identified as consistent winners, and others as consistent losers, in the sense that they win or lose interspecific competitive encounters statistically more often than the null hypothesis of 50%. Most species do not improve or worsen in their competitive abilities through the 2 Myr period, but a minority of species are winners in some intervals and losers in others. We found that conspecifics tend to cluster spatially and interact more often than expected under a null hypothesis: most of these are stand-off interactions where the two colonies involved stopped growing at edges of encounter. Counterintuitively, competitive ability has no bearing on ecological dominance. PMID:27581885

  3. Predicting Radiation Pneumonitis After Stereotactic Ablative Radiation Therapy in Patients Previously Treated With Conventional Thoracic Radiation Therapy

    SciTech Connect

    Liu Hui; Zhang Xu; Vinogradskiy, Yevgeniy Y.; Swisher, Stephen G.; Komaki, Ritsuko; Chang, Joe Y.

    2012-11-15

    Purpose: To determine the incidence of and risk factors for radiation pneumonitis (RP) after stereotactic ablative radiation therapy (SABR) to the lung in patients who had previously undergone conventional thoracic radiation therapy. Methods and Materials: Seventy-two patients who had previously received conventionally fractionated radiation therapy to the thorax were treated with SABR (50 Gy in 4 fractions) for recurrent disease or secondary parenchymal lung cancer (T <4 cm, N0, M0, or Mx). Severe (grade {>=}3) RP and potential predictive factors were analyzed by univariate and multivariate logistic regression analyses. A scoring system was established to predict the risk of RP. Results: At a median follow-up time of 16 months after SABR (range, 4-56 months), 15 patients had severe RP (14 [18.9%] grade 3 and 1 [1.4%] grade 5) and 1 patient (1.4%) had a local recurrence. In univariate analyses, Eastern Cooperative Oncology Group performance status (ECOG PS) before SABR, forced expiratory volume in 1 second (FEV1), and previous planning target volume (PTV) location were associated with the incidence of severe RP. The V{sub 10} and mean lung dose (MLD) of the previous plan and the V{sub 10}-V{sub 40} and MLD of the composite plan were also related to RP. Multivariate analysis revealed that ECOG PS scores of 2-3 before SABR (P=.009), FEV1 {<=}65% before SABR (P=.012), V{sub 20} {>=}30% of the composite plan (P=.021), and an initial PTV in the bilateral mediastinum (P=.025) were all associated with RP. Conclusions: We found that severe RP was relatively common, occurring in 20.8% of patients, and could be predicted by an ECOG PS score of 2-3, an FEV1 {<=}65%, a previous PTV spanning the bilateral mediastinum, and V{sub 20} {>=}30% on composite (previous RT+SABR) plans. Prospective studies are needed to validate these predictors and the scoring system on which they are based.

  4. Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery

    NASA Technical Reports Server (NTRS)

    Qin, J. X.; Shiota, T.; Lever, H. M.; Kapadia, S. R.; Sitges, M.; Rubin, D. N.; Bauer, F.; Greenberg, N. L.; Agler, D. A.; Drinko, J. K.; Martin, M.; Tuzcu, E. M.; Smedira, N. G.; Lytle, B.; Thomas, J. D.

    2001-01-01

    OBJECTIVES: This study was conducted to evaluate follow-up results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy. BACKGROUND: Controversy exists with regard to these two forms of treatment for patients with HOCM. METHODS: Of 51 patients with HOCM treated, 25 were treated by PTSMA and 26 patients via myectomy. Two-dimensional echocardiograms were performed before both procedures, immediately afterwards and at a three-month follow-up. The New York Heart Association (NYHA) functional class was obtained before the procedures and at follow-up. RESULTS: Interventricular septal thickness was significantly reduced at follow-up in both groups (2.3 +/- 0.4 cm vs. 1.9 +/- 0.4 cm for septal ablation and 2.4 +/- 0.6 cm vs. 1.7 +/- 0.2 cm for myectomy, both p < 0.001). Estimated by continuous-wave Doppler, the resting pressure gradient (PG) across the left ventricular outflow tract (LVOT) significantly decreased immediately after the procedures in both groups (64 +/- 39 mm Hg vs. 28 +/- 29 mm Hg for PTSMA, 62 +/- 43 mm Hg vs. 7 +/- 7 mm Hg for myectomy, both p < 0.0001). At three-month follow-up, the resting PG remained lower in the PTSMA and myectomy groups (24 +/- 19 mm Hg and 11 +/- 6 mm Hg, respectively, vs. those before procedures, both p < 0.0001). The NYHA functional class was also significantly improved in both groups (3.5 +/- 0.5 vs. 1.9 +/- 0.7 for PTSMA, 3.3 +/- 0.5 vs. 1.5 +/- 0.7 for myectomy, both p < 0.0001). CONCLUSIONS: Both myectomy and PTSMA reduce LVOT obstruction and significantly improve NYHA functional class in patients with HOCM. However, there are benefits and drawbacks for each therapeutic method that must be counterbalanced when deciding on treatment for LVOT obstruction.

  5. Ablative skin resurfacing.

    PubMed

    Agrawal, Nidhi; Smith, Greg; Heffelfinger, Ryan

    2014-02-01

    Ablative laser resurfacing has evolved as a safe and effective treatment for skin rejuvenation. Although traditional lasers were associated with significant thermal damage and lengthy recovery, advances in laser technology have improved safety profiles and reduced social downtime. CO2 lasers remain the gold standard of treatment, and fractional ablative devices capable of achieving remarkable clinical improvement with fewer side effects and shorter recovery times have made it a more practical option for patients. Although ablative resurfacing has become safer, careful patient selection and choice of suitable laser parameters are essential to minimize complications and optimize outcomes. This article describes the current modalities used in ablative laser skin resurfacing and examines their efficacy, indications, and possible side effects. PMID:24488638

  6. Treatment Outcome in Depressed Latinos Predicted by Concomitant Psychosislike Symptoms.

    PubMed

    Cassano, Paolo; Trinh, Nhi-Ha; Chang, Trina; Cusin, Cristina; Fisher, Lauren; Pedrelli, Paola; Nyer, Maren; Kim, Daniel Ju Hyung; Alpert, Jonathan; Mischoulon, David

    2015-10-01

    We compared treatment response (≥50 decrease in Nine-Item Patient Health Questionnaire total score) among 24 Latinos with major depressive disorder, presenting with and without specific psychosislike symptoms: A, hearing noises or house sounds, B, hearing voices calling one's name, C, seeing fleeting visions such as shadows, and D, symptoms more likely to be truly psychotic (e.g., poorly defined and short-lasting voices [other than B], fleeting paranoid ideation, or fleeting ideas of reference). 18 subjects (75%) endorsed symptoms of cluster A, 12 (50%) of cluster B, 10 (31%) of cluster C, and 12 (50%) of cluster D. Only subjects who reported symptoms from the D cluster exhibited significantly unfavorable depressive outcomes (compared to those with absence of D symptoms). The authors propose a phenomenological differentiation between benign psychosislike symptoms (clusters A-C) and the expression of the psychotic continuum (cluster D) in depressed Latinos. PMID:26356091

  7. Early Axonal Area Measurement Predicts Early Nerve Regeneration Outcomes.

    PubMed

    Neilson, Michael; Yan, Yuhui; Zhang, Lin-Ling; Wang, Ziyi; Agresti, Michael; Matloub, Hani; Yan, Ji-Gheng

    2016-03-01

    Background Study of peripheral nerve injury and regeneration in laboratory animals can be time consuming and expensive. This study determines if it is possible to reduce time and cost for a peripheral nerve regeneration study. Purpose The purpose of this study was to determine if nerve axonal area (NXA) or nerve fiber counting (NFC) correlates with compound muscle action potential (CMAP) recovery which is known to predict functional muscular recovery in the early stage of nerve regeneration. Methods In this study, six rats had a crush injury of the sciatic nerve without treatment. These rats were evaluated at 4 weeks of recovery with the following assessments: CMAP readings from the extensor digitorum longus, NXA measurement, and NFC. Results NXA correlated with CMAP; NFC did not correlate with CMAP. Conclusion NFC is not a reliable method for predicting muscular recovery in the early stages. NXA is a dependable assessment for muscular recovery in the early stages of nerve regeneration. Using NXA measurement can predict later electrophysiological and functional recovery. Using NXA with CMAP measurement for nerve injury, repair, and treatment in the animal study can save cost and time. PMID:26636887

  8. Biomarkers in Coronary Artery Bypass Surgery: Ready for Prime Time and Outcome Prediction?

    PubMed Central

    Parolari, Alessandro; Poggio, Paolo; Myasoedova, Veronika; Songia, Paola; Bonalumi, Giorgia; Pilozzi, Alberto; Pacini, Davide; Alamanni, Francesco; Tremoli, Elena

    2016-01-01

    Coronary artery bypass surgery (CABG) is still one of the most frequently performed surgical procedures all over the world. The results of this procedure have been constantly improved over the years with low perioperative mortality rates, with relatively low complication rates. To further improve these outstanding results, the clinicians focused their attention at biomarkers as outcome predictors. Although biological testing for disease prediction has already been discussed many times, the role of biomarkers in outcome prediction after CABG is still controversial. In this article, we reviewed the current knowledge regarding the role of genetic and dynamic biomarkers and their possible association with the occurrence of adverse clinical outcomes after CABG. We also took into consideration that the molecular pathway activation and the possible imbalance may affect hard outcomes and graft patency. We analyzed biomarkers classified in two different categories depending on their possibility to change over time: genetic markers and dynamic markers. Moreover, we evaluated these markers by dividing them, into sub-categories, such as inflammation, hemostasis, renin–angiotensin, endothelial function, and other pathways. We showed that biomarkers might be associated with unfavorable outcomes after surgery, and in some cases improved outcome prediction. However, the identification of a specific panel of biomarkers or of some algorithms including biomarkers is still in an early developmental phase. Finally, larger studies are needed to analyze broad panel of biomarkers with the specific aim to evaluate the prediction of hard outcomes and graft patency. PMID:26779491

  9. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

    PubMed Central

    Wiltink, Jörg; Hoyer, Jürgen; Beutel, Manfred E.; Ruckes, Christian; Herpertz, Stephan; Joraschky, Peter; Koranyi, Susan; Michal, Matthias; Nolting, Björn; Pöhlmann, Karin; Salzer, Simone; Strauss, Bernhard

    2016-01-01

    Objectives Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. Research Design and Methods In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Results Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. Conclusions We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Trial Registration Controlled-trials.com/ISRCTN53517394 PMID:26785255

  10. Role of Abnormal Sperm Morphology in Predicting Pregnancy Outcomes.

    PubMed

    Shabtaie, Samuel A; Gerkowicz, Sabrina A; Kohn, Taylor P; Ramasamy, Ranjith

    2016-09-01

    The evaluation of strict morphology for predicting successful pregnancy has been controversial, nevertheless remains an essential component of semen analysis. Patients with teratozoospermia (abnormal strict morphology) have traditionally been counseled to undergo assisted reproduction. However, recent studies suggest that patients with abnormal sperm morphology alone should not be precluded from attempting natural conception before undergoing assisted reproduction. The goal of this review is to provide an update on the evaluation of sperm morphology for prognosis in assisted reproductive techniques such as intrauterine insemination and in vitro fertilization with or without intracytoplasmic sperm injection. Additionally, we propose a logical approach to the evaluation of a patient with teratozoospermia seeking fertility treatment. PMID:27469478

  11. Utility of the MMPI Pain Assessment Index in Predicting Outcome After Lumbar Surgery.

    ERIC Educational Resources Information Center

    Turner, Judith; And Others

    1986-01-01

    Examined the ability of the Pain Assesment Index, determined from presurgery Minnesota Multiphasic Personality Inventory scores, to predict outcome subsequent to lumbar laminectomy and discectomy. The PAI was found to have good ability to identify patients who were doing well after surgery, but low power in predicting which patients would have…

  12. Early Seizure Frequency and Aetiology Predict Long-Term Medical Outcome in Childhood-Onset Epilepsy

    ERIC Educational Resources Information Center

    Sillanpaa, Matti; Schmidt, Dieter

    2009-01-01

    In clinical practice, it is important to predict as soon as possible after diagnosis and starting treatment, which children are destined to develop medically intractable seizures and be at risk of increased mortality. In this study, we determined factors predictive of long-term seizure and mortality outcome in a population-based cohort of 102…

  13. The Role of Teachers' Support in Predicting Students' Motivation and Achievement Outcomes in Physical Education

    ERIC Educational Resources Information Center

    Zhang, Tao; Solmon, Melinda A.; Gu, Xiangli

    2012-01-01

    Examining how teachers' beliefs and behaviors predict students' motivation and achievement outcomes in physical education is an area of increasing research interest. Guided by the expectancy-value model and self-determination theory, the major purpose of this study was to examine the predictive strength of teachers' autonomy, competence, and…

  14. Prediction and diagnosis of clinical outcomes affecting restoration margins.

    PubMed

    Dennison, J B; Sarrett, D C

    2012-04-01

    The longevity of dental restorations is largely dependent on the continuity at the interface between the restorative material and adjacent tooth structure (the restoration margin). Clinical decisions on restoration repair or replacement are usually based upon the weakest point along that margin interface. Physical properties of a restorative material, such as polymerisation shrinkage, water sorption, solubility, elastic modulus and shear strength, all have an effect on stress distribution and can significantly affect margin integrity. This review will focus on two aspects of margin deterioration in the oral environment: the in vitro testing of margin seal using emersion techniques to simulate the oral environment and to predict clinical margin failure and the relationship between clinically observable microleakage and secondary caries. The many variables associated with in vitro testing of marginal leakage and the interpretation of the data are presented in detail. The most recent studies of marginal leakage mirror earlier methodology and lack validity and reliability. The lack of standardised testing procedures makes it impossible to compare studies or to predict the clinical performance of adhesive materials. Continual repeated in vitro studies contribute little to the science in this area. Clinical evidence is cited to refute earlier conclusions that clinical microleakage (penetrating margin discoloration) leads to caries development and is an indication for restoration replacement. Margin defects, without visible evidence of soft dentin on the wall or base of the defect, should be monitored, repaired or resealed, in lieu of total restoration replacement. PMID:22066463

  15. Mothers' labeling responses to infants' gestures predict vocabulary outcomes.

    PubMed

    Olson, Janet; Masur, Elise Frank

    2015-11-01

    Twenty-nine infants aged 1;1 and their mothers were videotaped while interacting with toys for 18 minutes. Six experimental stimuli were presented to elicit infant communicative bids in two communicative intent contexts - proto-declarative and proto-imperative. Mothers' verbal responses to infants' gestural and non-gestural communicative bids were coded for object and action labels. Relations between maternal labeling responses and infants' vocabularies at 1;1 and 1;5 were examined. Mothers' labeling responses to infants' gestural communicative bids were concurrently and predictively related to infants' vocabularies, whereas responses to non-gestural communicative bids were not. Mothers' object labeling following gestures in the proto-declarative context mediated the association from infants' gesturing in the proto-declarative context to concurrent noun lexicons and was the strongest predictor of subsequent noun lexicons. Mothers' action labeling after infants' gestural bids in the proto-imperative context predicted infants' acquisition of action words at 1;5. Findings show that mothers' responsive labeling explain specific relations between infants' gestures and their vocabulary development. PMID:25643656

  16. Human experts' and a fuzzy model's predictions of outcomes of scoliosis treatment: a comparative analysis.

    PubMed

    Chalmers, Eric; Pedrycz, Witold; Lou, Edmond

    2015-03-01

    Brace treatment is the most commonly used nonsurgical treatment for adolescents with idiopathic scoliosis. However, brace treatment is not always successful and the factors influencing its success are not completely clear. This makes treatment outcome difficult to predict. A computer model which can accurately predict treatment outcomes could potentially provide valuable treatment recommendations. This paper describes a fuzzy system that includes a prediction model and a decision support engine. The model was constructed using conditional fuzzy c-means clustering to discover patterns in retrospective patient data. The model's ability to predict treatment outcome was compared to the ability of eight Scoliosis experts. The model and experts each predicted treatment outcome retrospectively for 28 braced patients, and these predictions were compared to the actual outcomes. The model outperformed all but one expert individually and performed similarly to the experts as a group. These results suggest that the fuzzy model is capable of providing meaningful treatment recommendations. This study offers the first model for this application whose performance has been shown to be at or above the human expert level. PMID:25494498

  17. Using General Outcome Measures to Predict Student Performance on State-Mandated Assessments: An Applied Approach for Establishing Predictive Cutscores

    ERIC Educational Resources Information Center

    Leblanc, Michael; Dufore, Emily; McDougal, James

    2012-01-01

    Cutscores for reading and math (general outcome measures) to predict passage on New York state-mandated assessments were created by using a freely available Excel workbook. The authors used linear regression to create the cutscores and diagnostic indicators were provided. A rationale and procedure for using this method is outlined. This method…

  18. Time to First Cigarette Predicts Cessation Outcomes in Adolescent Smokers

    PubMed Central

    Branstetter, Steven A.; Muscat, Joshua E.; Horn, Kimberly A.

    2013-01-01

    Introduction: This study examined the relationship between the time to the first cigarette (TTFC) of the morning with quit status among adolescent smokers at the completion of a school-based smoking cessation program. Among those who did not quit, the relationship of TTFC with changes in cigarettes/day (CPD) was also examined. Methods: A total of 1,167 adolescent smokers (1,024 nonquitters and 143 quitters) from 4 states participating in efficacy and effectiveness studies of the Not-On-Tobacco (N-O-T) cessation program were assessed prior to entry into the program and again 3 months later at the end of treatment. Linear and logistic regression analyses determined the influence of treatment condition, age, gender, motivation to quit, confidence in quitting ability, baseline CPD, and TTFC on quit status and end-of-treatment CPD. Results: Adolescents with a TTFC of >30min of waking were twice as likely to quit at end of treatment. Additionally, among those who did not quit at end of treatment (n = 700 for TTFC ≤30min and n = 324 for TTFC for >30min), those with a TTFC within 30min of waking smoked a greater number of CPD. The relationships of TTFC with both of these outcomes remained when controlling for all other predictor variables. Conclusions: Identifying adolescent smokers who smoke their first cigarette of the day within the first 30min of waking prior to a quit attempt may help to classify those individuals as having a greater risk for cessation failure. Thus, TTFC may be a behavioral indicator of nicotine dependence in adolescents. PMID:23811009

  19. Ablation algorithms and corneal asphericity in myopic correction with excimer lasers

    NASA Astrophysics Data System (ADS)

    Iroshnikov, Nikita G.; Larichev, Andrey V.; Yablokov, Michail G.

    2007-06-01

    The purpose of this work is studying a corneal asphericity change after a myopic refractive correction by mean of excimer lasers. As the ablation profile shape plays a key role in the post-op corneal asphericity, ablation profiles of recent lasers should be studied. The other task of this research was to analyze operation (LASIK) outcomes of one of the lasers with generic spherical ablation profile and to compare an asphericity change with theoretical predictions. The several correction methods, like custom generated aspherical profiles, may be utilized for mitigation of unwanted effects of asphericity change. Here we also present preliminary results of such correction for one of the excimer lasers.

  20. Predicting reading outcomes with progress monitoring slopes among middle grade students.

    PubMed

    Tolar, Tammy D; Barth, Amy E; Fletcher, Jack M; Francis, David J; Vaughn, Sharon

    2014-02-01

    Effective implementation of response-to-intervention (RTI) frameworks depends on efficient tools for monitoring progress. Evaluations of growth (i.e., slope) may be less efficient than evaluations of status at a single time point, especially if slopes do not add to predictions of outcomes over status. We examined progress monitoring slope validity for predicting reading outcomes among middle school students by evaluating latent growth models for different progress monitoring measure-outcome combinations. We used multi-group modeling to evaluate the effects of reading ability, reading intervention, and progress monitoring administration condition on slope validity. Slope validity was greatest when progress monitoring was aligned with the outcome (i.e., word reading fluency slope was used to predict fluency outcomes in contrast to comprehension outcomes), but effects varied across administration conditions (viz., repeated reading of familiar vs. novel passages). Unless the progress monitoring measure is highly aligned with outcome, slope may be an inefficient method for evaluating progress in an RTI context. PMID:24659899

  1. Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness

    PubMed Central

    Kang, Dong Hoon; Lee, Myoung Jin; Lee, Kyu-Yup; Lee, Sang Heun; Jang, Jeong Hun

    2016-01-01

    Objectives. To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children. Methods. Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared. Results. Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046). Conclusion. This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates. PMID:27337951

  2. Migration Phenotype of Brain-Cancer Cells Predicts Patient Outcomes.

    PubMed

    Smith, Chris L; Kilic, Onur; Schiapparelli, Paula; Guerrero-Cazares, Hugo; Kim, Deok-Ho; Sedora-Roman, Neda I; Gupta, Saksham; O'Donnell, Thomas; Chaichana, Kaisorn L; Rodriguez, Fausto J; Abbadi, Sara; Park, JinSeok; Quiñones-Hinojosa, Alfredo; Levchenko, Andre

    2016-06-21

    Glioblastoma multiforme is a heterogeneous and infiltrative cancer with dismal prognosis. Studying the migratory behavior of tumor-derived cell populations can be informative, but it places a high premium on the precision of in vitro methods and the relevance of in vivo conditions. In particular, the analysis of 2D cell migration may not reflect invasion into 3D extracellular matrices in vivo. Here, we describe a method that allows time-resolved studies of primary cell migration with single-cell resolution on a fibrillar surface that closely mimics in vivo 3D migration. We used this platform to screen 14 patient-derived glioblastoma samples. We observed that the migratory phenotype of a subset of cells in response to platelet-derived growth factor was highly predictive of tumor location and recurrence in the clinic. Therefore, migratory phenotypic classifiers analyzed at the single-cell level in a patient-specific way can provide high diagnostic and prognostic value for invasive cancers. PMID:27292647

  3. Optimized Prediction of Extreme Treatment Outcomes in Ovarian Cancer

    PubMed Central

    Misganaw, Burook; Ahsen, Eren; Singh, Nitin; Baggerly, Keith A.; Unruh, Anna; White, Michael A.; Vidyasagar, M.

    2015-01-01

    Ovarian cancer is the fifth leading cause of death among female cancers. Front-line therapy for ovarian cancer is platinum-based chemotherapy. However, the response of patients is highly nonuniform. The TCGA database of serous ovarian carcinomas shows that ~10% of patients respond poorly to platinum-based chemotherapy, with tumors relapsing in seven months or less. Another 10% or so enjoy disease-free survival of three years or more. The objective of the present research is to identify a small number of highly predictive biomarkers that can distinguish between the two extreme responders and then extrapolate to all patients. This is achieved using the lone star algorithm that is specifically developed for biological applications. Using this algorithm, we are able to identify biomarker panels of 25 genes (of 12,000 genes) that can be used to classify patients into one of the three groups: super responders, medium responders, and nonresponders. We are also able to determine a discriminant function that can divide the entire patient population into two classes, such that one group has a clear survival advantage over the other. These biomarkers are developed using the TCGA Agilent platform data and cross-validated on the TCGA Affymetrix platform data, as well as entirely independent data from Tothill et al. The P-values on the training data are extremely small, sometimes below machine zero, while the P-values on cross-validation are well below the widely accepted threshold of 0.05. PMID:27034613

  4. CT Imaging Biomarkers Predict Clinical Outcomes After Pancreatic Cancer Surgery

    PubMed Central

    Zhu, Liang; Shi, Xiaohua; Xue, Huadan; Wu, Huanwen; Chen, Ge; Sun, Hao; He, Yonglan; Jin, Zhengyu; Liang, Zhiyong; Zhang, Zhuoli

    2016-01-01

    Abstract This study aimed to determine whether changes in contrast-enhanced computed tomography (CT) parameters could predict postsurgery overall and progression-free survival (PFS) in pancreatic cancer patients. Seventy-nine patients with a final pathological diagnosis of pancreatic adenocarcinoma were included in this study from June 2008 to August 2012. Dynamic contrast-enhanced (DCE) CT of tumors was obtained before curative-intent surgery. Absolute enhancement change (AEC) and relative enhancement change (REC) were evaluated on DCE-CT. PFS and overall survival (OS) were compared based on CT enhancement patterns. The markers of fibrogenic alpha-smooth muscle antigen (α-SMA) and periostin in tumor specimens were evaluated by immunohistochemical staining. The χ2 test was performed to determine whether CT enhancement patterns were associated with α-SMA-periostin expression levels (recorded as positive or negative). Lower REC (<0.9) was associated with shorter PFS (HR 0.51, 95% CI: 0.31–0.89) and OS (HR 0.44, 95% CI: 0.25–0.78). The α-SMA and periostin expression level were negatively correlated with REC (both P = 0). Among several CT enhancement parameters, REC was the best predictor of patient postsurgery survival. Low REC was associated with a short progression-free time and poor survival. The pathological studies suggested that REC might be a reflection of cancer fibrogenic potential. PMID:26844495

  5. Predicting the Match Outcome in One Day International Cricket Matches, while the Game is in Progress

    PubMed Central

    Bailey, Michael; Clarke, Stephen R.

    2006-01-01

    Millions of dollars are wagered on the outcome of one day international (ODI) cricket matches, with a large percentage of bets occurring after the game has commenced. Using match information gathered from all 2200 ODI matches played prior to January 2005, a range of variables that could independently explain statistically significant proportions of variation associated with the predicted run totals and match outcomes were created. Such variables include home ground advantage, past performances, match experience, performance at the specific venue, performance against the specific opposition, experience at the specific venue and current form. Using a multiple linear regression model, prediction variables were numerically weighted according to statistical significance and used to predict the match outcome. With the use of the Duckworth-Lewis method to determine resources remaining, at the end of each completed over, the predicted run total of the batting team could be updated to provide a more accurate prediction of the match outcome. By applying this prediction approach to a holdout sample of matches, the efficiency of the “in the run ”wagering market could be assessed. Preliminary results suggest that the market is prone to overreact to events occurring throughout the course of the match, thus creating brief inefficiencies in the wagering market. Key Points In excess of 80% of monies wagered on the outcome of ODI matches are placed after the match has commenced. Using all past data from ODI matches, multiple linear regression models are constructed to predict team totals and margin of victory. By combining match information with prediction models, an ‘in the run’ prediction process is created for ODI matches. PMID:24357940

  6. Predicting MCI outcome with clinically available MRI and CSF biomarkers

    PubMed Central

    Heister, D.; Brewer, J.B.; Magda, S.; Blennow, K.

    2011-01-01

    Objective: To determine the ability of clinically available volumetric MRI (vMRI) and CSF biomarkers, alone or in combination with a quantitative learning measure, to predict conversion to Alzheimer disease (AD) in patients with mild cognitive impairment (MCI). Methods: We stratified 192 MCI participants into positive and negative risk groups on the basis of 1) degree of learning impairment on the Rey Auditory Verbal Learning Test; 2) medial temporal atrophy, quantified from Food and Drug Administration–approved software for automated vMRI analysis; and 3) CSF biomarker levels. We also stratified participants based on combinations of risk factors. We computed Cox proportional hazards models, controlling for age, to assess 3-year risk of converting to AD as a function of risk group and used Kaplan-Meier analyses to determine median survival times. Results: When risk factors were examined separately, individuals testing positive showed significantly higher risk of converting to AD than individuals testing negative (hazard ratios [HR] 1.8–4.1). The joint presence of any 2 risk factors substantially increased risk, with the combination of greater learning impairment and increased atrophy associated with highest risk (HR 29.0): 85% of patients with both risk factors converted to AD within 3 years, vs 5% of those with neither. The presence of medial temporal atrophy was associated with shortest median dementia-free survival (15 months). Conclusions: Incorporating quantitative assessment of learning ability along with vMRI or CSF biomarkers in the clinical workup of MCI can provide critical information on risk of imminent conversion to AD. PMID:21998317

  7. Prediction of concurrent chemoradiotherapy outcome in advanced oropharyngeal cancer

    PubMed Central

    HASEGAWA, MASAHIRO; MAEDA, HIROYUKI; DENG, ZEYI; KIYUNA, ASANORI; GANAHA, AKIRA; YAMASHITA, YUKASHI; MATAYOSHI, SEN; AGENA, SHINYA; TOITA, TAKAFUMI; UEHARA, TAKAYUKI; SUZUKI, MIKIO

    2014-01-01

    The aim of this study was to investigate human papillomavirus (HPV) infection as a predictor of concurrent chemoradiotherapy (CCRT) response and indicator of planned neck dissection (PND) for patients with advanced oropharyngeal squamous cell carcinoma (OPSCC; stage III/IV). Overall, 39 OPSCC patients (32 men, 7 women; median age 61 years, range 39–79 years) were enrolled. The primary lesion and whole neck were irradiated up to 50.4 Gy, and subsequently the primary site and metastatic lymph nodes were boosted with a further 16.2 Gy. Although several chemotherapy regimens were employed, 82.1% of OPSCC patients received the combination of nedaplatin and 5-fluorouracil. HPV-related OPSCC (16 cases) was defined as both HPV DNA-positive status by polymerase chain reaction and p16INK4a overexpression by immunohistochemistry. Patients with N2 and N3 disease received PND 2–3 months after CCRT completion. Compared to non-responders, CCRT responders showed significantly lower nodal stage (N0 to N2b) and HPV-positive status in univariate analysis. Patients with HPV-related OPSCC had longer time to treatment failure (TTF) than those with HPV-unrelated OPSCC (p=0.040). Three-year TTF was 81.3 and 47.8% in the HPV-related and HPV-unrelated groups, respectively. There were also significant differences in disease-free survival (DFS) between the two OPSCC patient groups (p=0.042). Three-year DFS was 93.8 and 66.7% in patients with HPV-related and HPV-unrelated OPSCC, respectively. Multivariate logistic analysis showed a lower risk of TTF event occurrence in HPV-related OPSCC (p=0.041) than in HPV-unrelated OPSCC. Thus, HPV testing in addition to nodal stage was useful for predicting CCRT response, especially in advanced OPSCC. Because patients who received PND showed moderate locoregional control, PND is an effective surgical procedure for controlling neck lesions in patients with advanced HPV-unrelated disease. PMID:24969413

  8. DISPARATE EVOLUTION OF RIGHT AND LEFT ATRIAL RATE DURING ABLATION OF LONG-LASTING PERSISTENT ATRIAL FIBRILLATION

    PubMed Central

    Hocini, Mélèze; Nault, Isabelle; Wright, Matthew; Veenhuyzen, George; Narayan, Sanjiv M.; Jaïs, Pierre; Lim, Kang-Teng; Knecht, Sébastien; Matsuo, Seiichiro; Forclaz, Andrei; Miyazaki, Shinsuke; Jadidi, Amir; O’Neill, Mark D.; Sacher, Frédéric; Clémenty, Jacques; Haïssaguerre, Michel

    2010-01-01

    Objectives To assess whether additional ablation in the right atrium(RA) improves termination rate in long-lasting persistent atrial fibrillation(PsAF). Background Prolongation of atrial fibrillation(AF) cycle length(CL) measured from the left atrial appendage predicts favorable outcome during catheter ablation of PsAF. However, in some patients despite prolongation of AFCL in the left atrium(LA) with ablation, AF persists. We hypothesized that this is due to RA drivers and these patients may benefit from RA ablation. Methods 148 consecutive patients undergoing catheter ablation of PsAF(duration 25±32 months) were studied. AFCL was monitored in both atria during stepwise ablation commencing in the LA. Ablation was performed in the RA when all LA sources in AF had been ablated and a RA-LA gradient existed. The procedural endpoint was AF termination. Results Two distinct patterns of AFCL change emerged during LA ablation. In 104patients(70%), there was parallel increase of AFCL in LA and RA culminating in AF termination (baseline: LA 153ms[140,170], RA 155ms[143,171]; after ablation: LA 181ms[170,200], RA 186ms[175,202]). In 24 patients(19%), RA AFCL did not prolong, creating a right-to-left frequency gradient, (baseline: LA 142ms[143,153], RA 145 ms[139,162]; after ablation: LA 177 ms[165–185], RA 152ms[147,175]). These patients had a longer AF history (23versus12 months, p=0.001), and larger RA diameter (42versus39mm, p=0.005) and RA ablation terminated AF in 55%. In the remaining 20 patients, biatrial ablation failed to terminate AF. Conclusions A divergent pattern of AFCL prolongation after LA ablation resulting in a right-to-left gradient demonstrating that the right atrium is driving AF in about 20 % of PsAF. PMID:20202517

  9. Predictive Modeling for End-of-Life Pain Outcome using Electronic Health Records

    PubMed Central

    Lodhi, Muhammad K.; Stifter, Janet; Yao, Yingwei; Ansari, Rashid; Kee-nan, Gail M.; Wilkie, Diana J.; Khokhar, Ashfaq A.

    2016-01-01

    Electronic health record (EHR) systems are being widely used in the healthcare industry nowadays, mostly for monitoring the progress of the patients. EHR data analysis has become a big data problem as data is growing rapidly. Using a nursing EHR system, we built predictive models for determining what factors influence pain in end-of-life (EOL) patients. Utilizing different modeling techniques, we developed coarse-grained and fine-grained models to predict patient pain outcomes. The coarse-grained models help predict the outcome at the end of each hospitalization, whereas fine-grained models help predict the outcome at the end of each shift, thus providing a trajectory of predicted outcomes over the entire hospitalization. These models can help in determining effective treatments for individuals and groups of patients and support standardization of care where appropriate. Using these models may also lower the cost and increase the quality of end-of-life care. Results from these techniques show significantly accurate predictions. PMID:27500287

  10. Predicting Outcome in Comatose Patients: The Role of EEG Reactivity to Quantifiable Electrical Stimuli

    PubMed Central

    Liu, Gang; Su, Yingying; Liu, Yifei; Jiang, Mengdi; Zhang, Yan; Zhang, Yunzhou; Gao, Daiquan

    2016-01-01

    Objective. To test the value of quantifiable electrical stimuli as a reliable method to assess electroencephalogram reactivity (EEG-R) for the early prognostication of outcome in comatose patients. Methods. EEG was recorded in consecutive adults in coma after cardiopulmonary resuscitation (CPR) or stroke. EEG-R to standard electrical stimuli was tested. Each patient received a 3-month follow-up by the Glasgow-Pittsburgh cerebral performance categories (CPC) or modified Rankin scale (mRS) score. Results. Twenty-two patients met the inclusion criteria. In the CPR group, 6 of 7 patients with EEG-R had good outcomes (positive predictive value (PPV), 85.7%) and 4 of 5 patients without EEG-R had poor outcomes (negative predictive value (NPV), 80%). The sensitivity and specificity were 85.7% and 80%, respectively. In the stroke group, 6 of 7 patients with EEG-R had good outcomes (PPV, 85.7%); all of the 3 patients without EEG-R had poor outcomes (NPV, 100%). The sensitivity and specificity were 100% and 75%, respectively. Of all patients, the presence of EEG-R showed 92.3% sensitivity, 77.7% specificity, 85.7% PPV, and 87.5% NPV. Conclusion. EEG-R to quantifiable electrical stimuli might be a good positive predictive factor for the prognosis of outcome in comatose patients after CPR or stroke. PMID:27127529

  11. Ablative system

    NASA Technical Reports Server (NTRS)

    Gray, V. H. (Inventor)

    1973-01-01

    A carrier liquid containing ablative material bodies is connected to a plenum chamber wall with openings to a high temperature environment. The liquid and bodies pass through the openings of the wall to form a self replacing ablative surface. The wall is composed of honeycomb layers, spheres containing ablative whiskers or wads, and a hardening catalyst for the carrier liquid. The wall also has woven wicks of ablative material fibers that extend through the wall openings and into plenum chamber which contains the liquid.

  12. Clinical Neurochemistry of Subarachnoid Hemorrhage: Toward Predicting Individual Outcomes via Biomarkers of Brain Energy Metabolism.

    PubMed

    Tholance, Yannick; Barcelos, Gleicy; Dailler, Frederic; Perret-Liaudet, Armand; Renaud, Bernard

    2015-12-16

    The functional outcome of patients with subarachnoid hemorrhage is difficult to predict at the individual level. The monitoring of brain energy metabolism has proven to be useful in improving the pathophysiological understanding of subarachnoid hemorrhage. Nonetheless, brain energy monitoring has not yet clearly been included in official guidelines for the management of subarachnoid hemorrhage patients, likely because previous studies compared only biological data between two groups of patients (unfavorable vs favorable outcomes) and did not determine decision thresholds that could be useful in clinical practice. Therefore, this Viewpoint discusses recent findings suggesting that monitoring biomarkers of brain energy metabolism at the level of individuals can be used to predict the outcomes of subarachnoid hemorrhage patients. Indeed, by taking into account specific neurochemical patterns obtained by local or global monitoring of brain energy metabolism, it may become possible to predict routinely, and with sufficient sensitivity and specificity, the individual outcomes of subarachnoid hemorrhage patients. Moreover, combining both local and global monitoring improves the overall performance of individual outcome prediction. Such a combined neurochemical monitoring approach may become, after prospective clinical validation, an important component in the management of subarachnoid hemorrhage patients to adapt individualized therapeutic interventions. PMID:26595414

  13. Sustain talk predicts poorer outcomes among mandated college student drinkers receiving a brief motivational intervention.

    PubMed

    Apodaca, Timothy R; Borsari, Brian; Jackson, Kristina M; Magill, Molly; Longabaugh, Richard; Mastroleo, Nadine R; Barnett, Nancy P

    2014-09-01

    Within-session client language that represents a movement toward behavior change (change talk) has been linked to better treatment outcomes in the literature on motivational interviewing (MI). There has been somewhat less study of the impact of client language against change (sustain talk) on outcomes following an MI session. This study examined the role of both client change talk and sustain talk, as well as therapist language, occurring during a brief motivational intervention (BMI) session with college students who had violated college alcohol policy (N = 92). Audiotapes of these sessions were coded using a therapy process coding system. A series of hierarchical regressions were used to examine the relationships among therapist MI-consistent and MI-inconsistent language, client change talk and sustain talk, as well as global measures of relational variables, and drinking outcomes. Contrary to prior research, sustain talk, but not change talk, predicted poorer alcohol use outcomes following the BMI at 3- and 12-month follow-up assessments. Higher levels of client self-exploration during the session also predicted improved drinking outcomes. Therapist measures of MI-consistent and MI-inconsistent language, and global measures of therapist acceptance and MI spirit were unrelated to client drinking outcomes. Results suggest that client sustain talk and self-exploration during the session play an important role in determining drinking outcomes among mandated college students receiving a BMI addressing alcohol use. PMID:25222170

  14. Genomic Copy Number Variations in the Genomes of Leukocytes Predict Prostate Cancer Clinical Outcomes

    PubMed Central

    Huo, Zhiguang; Martin, Amantha; Nelson, Joel B.; Tseng, George C.; Luo, Jian-Hua

    2015-01-01

    Accurate prediction of prostate cancer clinical courses remains elusive. In this study, we performed whole genome copy number analysis on leukocytes of 273 prostate cancer patients using Affymetrix SNP6.0 chip. Copy number variations (CNV) were found across all chromosomes of the human genome. An average of 152 CNV fragments per genome was identified in the leukocytes from prostate cancer patients. The size distributions of CNV in the genome of leukocytes were highly correlative with prostate cancer aggressiveness. A prostate cancer outcome prediction model was developed based on large size ratio of CNV from the leukocyte genomes. This prediction model generated an average prediction rate of 75.2%, with sensitivity of 77.3% and specificity of 69.0% for prostate cancer recurrence. When combined with Nomogram and the status of fusion transcripts, the average prediction rate was improved to 82.5% with sensitivity of 84.8% and specificity of 78.2%. In addition, the leukocyte prediction model was 62.6% accurate in predicting short prostate specific antigen doubling time. When combined with Gleason’s grade, Nomogram and the status of fusion transcripts, the prediction model generated a correct prediction rate of 77.5% with 73.7% sensitivity and 80.1% specificity. To our knowledge, this is the first study showing that CNVs in leukocyte genomes are predictive of clinical outcomes of a human malignancy. PMID:26295840

  15. Do Physical Symptoms Predict the Outcome of Surgical Fusion in Patients with Discogenic Low Back Pain?

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa

    2016-01-01

    Study Design Retrospective case series. Purpose To determine whether symptoms predict surgical outcomes for patients with discogenic low back pain (DLBP). Overview of Literature Specific diagnosis of DLBP remains difficult. Worsening of pain on flexion is a reported symptom of DLBP. This study sought to determine whether symptoms predict surgical outcomes for patients with DLBP. Methods We investigated 127 patients with low back pain (LBP) and no dominant radicular pain. Magnetic resonance imaging was used to select patients with disc degeneration at only one level. If pain was provoked during discography, we performed fusion surgery (87 patients). Visual analogue scale score and responses to a questionnaire regarding symptoms including worsening of pain on flexion or extension were assessed. Symptom sites before surgery were categorized into LBP alone, or LBP plus referred inguinal or leg pain. We followed 77 patients (average 3.0 years) and compared symptoms before surgery with surgical outcome. Results Sixty-three patients with a good outcome showed postsurgical pain relief (≥60% pain relief) and 14 patients with a poor outcome did not (<60% pain relief). In patients with good outcomes, worsening of LBP was evident in 65% of cases on flexion and in 35% on extension. However, these findings were not significantly different from those in patients with poor outcomes. The percentage of patients with LBP alone was significantly lower and the percentage of patients with LBP plus referred inguinal or leg pain was significantly higher in the group with good surgical outcome compared with patients in the group with poor surgical outcome (p<0.05). Conclusions Worsening of pain on extension may be a symptom of DLBP. Surgical outcomes were superior in patients with both LBP and either referred inguinal or leg pain compared with those having LBP alone. PMID:27340531

  16. Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting

    PubMed Central

    Ayaru, Lakshmana; Ypsilantis, Petros-Pavlos; Nanapragasam, Abigail; Choi, Ryan Chang-Ho; Thillanathan, Anish; Min-Ho, Lee; Montana, Giovanni

    2015-01-01

    Background There are no widely used models in clinical care to predict outcome in acute lower gastro-intestinal bleeding (ALGIB). If available these could help triage patients at presentation to appropriate levels of care/intervention and improve medical resource utilisation. We aimed to apply a state-of-the-art machine learning classifier, gradient boosting (GB), to predict outcome in ALGIB using non-endoscopic measurements as predictors. Methods Non-endoscopic variables from patients with ALGIB attending the emergency departments of two teaching hospitals were analysed retrospectively for training/internal validation (n=170) and external validation (n=130) of the GB model. The performance of the GB algorithm in predicting recurrent bleeding, clinical intervention and severe bleeding was compared to a multiple logic regression (MLR) model and two published MLR-based prediction algorithms (BLEED and Strate prediction rule). Results The GB algorithm had the best negative predictive values for the chosen outcomes (>88%). On internal validation the accuracy of the GB algorithm for predicting recurrent bleeding, therapeutic intervention and severe bleeding were (88%, 88% and 78% respectively) and superior to the BLEED classification (64%, 68% and 63%), Strate prediction rule (78%, 78%, 67%) and conventional MLR (74%, 74% 62%). On external validation the accuracy was similar to conventional MLR for recurrent bleeding (88% vs. 83%) and therapeutic intervention (91% vs. 87%) but superior for severe bleeding (83% vs. 71%). Conclusion The gradient boosting algorithm accurately predicts outcome in patients with acute lower gastrointestinal bleeding and outperforms multiple logistic regression based models. These may be useful for risk stratification of patients on presentation to the emergency department. PMID:26172121

  17. A Prediction Model for Functional Outcomes in Spinal Cord Disorder Patients Using Gaussian Process Regression.

    PubMed

    Lee, Sunghoon Ivan; Mortazavi, Bobak; Hoffman, Haydn A; Lu, Derek S; Li, Charles; Paak, Brian H; Garst, Jordan H; Razaghy, Mehrdad; Espinal, Marie; Park, Eunjeong; Lu, Daniel C; Sarrafzadeh, Majid

    2016-01-01

    Predicting the functional outcomes of spinal cord disorder patients after medical treatments, such as a surgical operation, has always been of great interest. Accurate posttreatment prediction is especially beneficial for clinicians, patients, care givers, and therapists. This paper introduces a prediction method for postoperative functional outcomes by a novel use of Gaussian process regression. The proposed method specifically considers the restricted value range of the target variables by modeling the Gaussian process based on a truncated Normal distribution, which significantly improves the prediction results. The prediction has been made in assistance with target tracking examinations using a highly portable and inexpensive handgrip device, which greatly contributes to the prediction performance. The proposed method has been validated through a dataset collected from a clinical cohort pilot involving 15 patients with cervical spinal cord disorder. The results show that the proposed method can accurately predict postoperative functional outcomes, Oswestry disability index and target tracking scores, based on the patient's preoperative information with a mean absolute error of 0.079 and 0.014 (out of 1.0), respectively. PMID:25423659

  18. Development of a Screening Tool for Predicting Adverse Outcomes of Gestational Diabetes Mellitus

    PubMed Central

    Park, Jee Soo; Kim, Deok Won; Kwon, Ja-Young; Park, Yong Won; Kim, Young Han; Cho, Hee Young

    2016-01-01

    Abstract Gestational diabetes mellitus (GDM) is a common disease in pregnancy causing maternal and fetal complications. To prevent these adverse outcomes, optimal screening and diagnostic criteria must be adequate, timely, and efficient. This study suggests a novel approach that is practical, efficient, and patient- and clinician-friendly in predicting adverse outcomes of GDM. The authors conducted a retrospective cohort study via medical record review of patients admitted between March 2001 and April 2013 at the Severance Hospital, Seoul, South Korea. Patients diagnosed by a conventional 2-step method were evaluated according to the presence of adverse outcomes (neonatal hypoglycemia, hyperbilirubinemia, and hyperinsulinemia; admission to the neonatal intensive care unit; large for gestational age; gestational insulin therapy; and gestational hypertension). Of 802 women who had an abnormal 50-g, 1-hour glucose challenge test, 306 were diagnosed with GDM and 496 did not have GDM (false-positive group). In the GDM group, 218 women (71.2%) had adverse outcomes. In contrast, 240 women (48.4%) in the false-positive group had adverse outcomes. Women with adverse outcomes had a significantly higher body mass index (BMI) at entry (P = 0.03) and fasting blood glucose (FBG) (P = 0.03). Our logistic regression model derived from 2 variables, BMI at entry and FBG, predicted GDM adverse outcome with an area under the curve of 0.642, accuracy of 61.3%, sensitivity of 57.2%, and specificity of 66.9% compared with the conventional 2-step method with an area under the curve of 0.610, accuracy of 59.1%, sensitivity of 47.6%, and specificity of 74.4%. Our model performed better in predicting GDM adverse outcomes than the conventional 2-step method using only BMI at entry and FBG. Moreover, our model represents a practical, inexpensive, efficient, reproducible, easy, and patient- and clinician-friendly approach. PMID:26735528

  19. Why Is It Difficult to Predict Language Impairment and Outcome in Patients with Aphasia after Stroke?

    PubMed Central

    Kasselimis, Dimitrios; Varkanitsa, Maria; Selai, Caroline; Potagas, Constantin; Evdokimidis, Ioannis

    2014-01-01

    One of the most devastating consequences of stroke is aphasia. Communication problems after stroke can severely impair the patient's quality of life and make even simple everyday tasks challenging. Despite intense research in the field of aphasiology, the type of language impairment has not yet been localized and correlated with brain damage, making it difficult to predict the language outcome for stroke patients with aphasia. Our primary objective is to present the available evidence that highlights the difficulties of predicting language impairment after stroke. The different levels of complexity involved in predicting the lesion site from language impairment and ultimately predicting the long-term outcome in stroke patients with aphasia were explored. Future directions and potential implications for research and clinical practice are highlighted. PMID:24829592

  20. A genome-wide association study points to multiple loci predicting antidepressant treatment outcome in depression

    PubMed Central

    Binder, Elisabeth B.; Bettecken, Thomas; Uhr, Manfred; Ripke, Stephan; Kohli, Martin A.; Hennings, Johannes M.; Horstmann, Sonja; Kloiber, Stefan; Menke, Andreas; Bondy, Brigitta; Rupprecht, Rainer; Domschke, Katharina; Baune, Bernhard T.; Arolt, Volker; Rush, A. John; Holsboer, Florian; Müller-Myhsok, Bertram

    2015-01-01

    Context Efficacy of antidepressant treatment in depression is unsatisfactory as one in three patients does not fully recover even after several treatment trials. Genetic factors and clinical characteristics contribute to the failure of a favorable treatment outcome. Objective To identify genetic and clinical determinants of antidepressant treatment outcome in depression. Design Genome-wide pharmacogenetic association study with two independent replication samples. Setting We performed a genome-wide association (GWA) study in patients from the Munich-Antidepressant-Response-Signature (MARS) project and in pooled DNA from an independent German replication sample. A set of 328 single nucleotide polymorphisms (SNPs) highly related to outcome in both GWA studies was genotyped in a sample of the Sequenced-Treatment-Alternatives-to-Relieve-Depression (STAR*D) study. Participants 339 inpatients suffering from a depressive episode (MARS sample), further 361 depressed inpatients (German replication sample), and 832 outpatients with major depression (STAR*D sample). Main Outcome Measures We generated a multi-locus genetic variable describing the individual number of alleles of the selected SNPs associated with beneficial treatment outcome in the MARS sample (“response” alleles) to evaluate additive genetic effects on antidepressant treatment outcome. Results Multi-locus analysis revealed a significant contribution of a binary variable categorizing patients as carriers of a high vs. low number of response alleles in predicting antidepressant treatment outcome in both samples, MARS and STAR*D. In addition, we observed that patients with a comorbid anxiety disorder in combination with a low number of response alleles showed the least favorable outcome. Conclusion Our results demonstrate the importance of multiple genetic factors in combination with clinical features to predict antidepressant treatment outcome underscoring the multifactorial nature of this trait. PMID

  1. Mechanism-anchored profiling derived from epigenetic networks predicts outcome in acute lymphoblastic leukemia

    PubMed Central

    Yang, Xinan; Huang, Yong; Chen, James L; Xie, Jianming; Sun, Xiao; Lussier, Yves A

    2009-01-01

    Background Current outcome predictors based on "molecular profiling" rely on gene lists selected without consideration for their molecular mechanisms. This study was designed to demonstrate that we could learn about genes related to a specific mechanism and further use this knowledge to predict outcome in patients – a paradigm shift towards accurate "mechanism-anchored profiling". We propose a novel algorithm, PGnet, which predicts a tripartite mechanism-anchored network associated to epigenetic regulation consisting of phenotypes, genes and mechanisms. Genes termed as GEMs in this network meet all of the following criteria: (i) they are co-expressed with genes known to be involved in the biological mechanism of interest, (ii) they are also differentially expressed between distinct phenotypes relevant to the study, and (iii) as a biomodule, genes correlate with both the mechanism and the phenotype. Results This proof-of-concept study, which focuses on epigenetic mechanisms, was conducted in a well-studied set of 132 acute lymphoblastic leukemia (ALL) microarrays annotated with nine distinct phenotypes and three measures of response to therapy. We used established parametric and non parametric statistics to derive the PGnet tripartite network that consisted of 10 phenotypes and 33 significant clusters of GEMs comprising 535 distinct genes. The significance of PGnet was estimated from empirical p-values, and a robust subnetwork derived from ALL outcome data was produced by repeated random sampling. The evaluation of derived robust network to predict outcome (relapse of ALL) was significant (p = 3%), using one hundred three-fold cross-validations and the shrunken centroids classifier. Conclusion To our knowledge, this is the first method predicting co-expression networks of genes associated with epigenetic mechanisms and to demonstrate its inherent capability to predict therapeutic outcome. This PGnet approach can be applied to any regulatory mechanisms including

  2. Usefulness of an early neurofunctional assessment in predicting neurodevelopmental outcome in very low birthweight infants

    PubMed Central

    Picciolini, O; Giannì, M L; Vegni, C; Fumagalli, M; Mosca, F

    2006-01-01

    Objective To evaluate whether early neurofunctional assessment may be useful in predicting neurodevelopmental outcome in children of very low birth weight (VLBW). Design Observational longitudinal study. Settings Northern Italy. Patients A total of 250 VLBW children (129 boys, 121 girls) born consecutively 1996–1999. Main outcome measures Neurodevelopment at 36 months of chronological age, classified in accordance with the classification of Tardieu and the International classification of functioning. Results Of the infants exhibiting normal neurodevelopment (n  =  183) or major dysfunction (n  =  17) at 3 months of corrected age, 72% and 94% respectively did not change their score during the study. Minor dysfunctions at 3 months of corrected age were transient in 17 (34%) children. After adjustment for neonatal variables, neurodevelopment at 3 months of corrected age remained predictive of dysfunction at 36 months (odds ratio  =  4.33, 95% confidence interval 2.05 to 9.12). If the results for the normal and minor dysfunction groups were pooled, the predictive qualities of the 3 month neurofunctional assessment were: sensitivity 0.5, specificity 0.99, positive predictive value 0.94, negative predictive value 0.93. Conclusion Early neurofunctional evaluation may be useful in predicting later neurodevelopmental outcome in VLBW children. PMID:16492947

  3. Predicting Outcome for Intracerebral Hemorrhage Patients: Current Tools and Their Limitations.

    PubMed

    Chu, Stacy Y; Hwang, David Y

    2016-06-01

    Accurate outcome prognostication is critical to the management of patients with primary or spontaneous intracerebral hemorrhage (ICH). Prognostication may guide the decision to pursue aggressive acute management or to plan proper goals of care for patients who will likely suffer long-term severe disability. In particular, early predictions of poor outcome for ICH patients routinely influence discussions with surrogate decision makers to pursue do-not-resuscitate orders or comfort care, practices that may often be appropriate, but that are at risk for self-fulfilling prophecies. The authors review the literature pertaining to these concepts. Currently available baseline severity scores, with a focus on the ICH Score, are summarized and compared, with a discussion of the limitations and biases of such clinical scales derived from observational cohorts. New research on the accuracy of the subjective early clinical judgment of physicians and nurses for predicting ICH functional outcome as it compares to that of baseline severity scores, is also summarized. PMID:27214700

  4. The Violence Proneness Scale of the DUSI-R predicts adverse outcomes associated with substance abuse.

    PubMed

    Kirisci, Levent; Tarter, Ralph; Reynolds, Maureen

    2009-01-01

    Accuracy of the Violence Proneness Scale (VPS) of the Drug Use Screening Inventory (DUSI-R) was evaluated in 328 boys for predicting use of illegal drugs, DUI, selling drugs, sexually transmitted disease, car accident while under acute effects of drugs/alcohol, trading drugs for sex, injuries from a fight, and traumatic head injury. Boys were prospectively tracked from age 16 to 19 at which time these outcomes were documented in the interim period. The results demonstrated that the VPS score is a significant predictor of all outcomes. Prediction accuracy ranged between 62%-83%. These findings suggest that the VPS may be useful for identifying youths who are at high risk for using illicit drugs and commonly associated adverse outcomes. PMID:19283571

  5. General and Religious Coping Predict Drinking Outcomes for Alcohol Dependent Adults in Treatment

    PubMed Central

    Martin, Rosemarie A.; Ellingsen, Victor J.; Tzilos, Golfo K.; Rohsenow, Damaris J.

    2015-01-01

    Background Religiosity is associated with improved treatment outcomes among adults with alcohol dependence; however, it is unknown whether religious coping predicts drinking outcomes above and beyond the effects of coping in general, and whether gender differences exist. Methods We assessed 116 alcohol-dependent adults (53% women; mean age = 37, SD = 8.6) for use of religious coping, general coping and alcohol use within two weeks of entering outpatient treatment, and again 6 months after treatment. Results Religious coping at 6 months predicted fewer heavy alcohol use days and fewer drinks per day. This relationship was no longer significant after controlling for general coping at 6 months. Conclusion The relationship between the use of religious coping strategies and drinking outcomes is not independent of general coping. Coping skills training that includes religious coping skills, as one of several coping methods, may be useful for a subset of adults early in recovery. PMID:25662479

  6. Validity of the Medical College Admission Test for Predicting MD-PhD Student Outcomes

    ERIC Educational Resources Information Center

    Bills, James L.; VanHouten, Jacob; Grundy, Michelle M.; Chalkley, Roger; Dermody, Terence S.

    2016-01-01

    The Medical College Admission Test (MCAT) is a quantitative metric used by MD and MD-PhD programs to evaluate applicants for admission. This study assessed the validity of the MCAT in predicting training performance measures and career outcomes for MD-PhD students at a single institution. The study population consisted of 153 graduates of the…

  7. Associations between Young Children's Emotion Attributions and Prediction of Outcome in Differing Social Situations

    ERIC Educational Resources Information Center

    Eivers, Areana R.; Brendgen, Mara; Borge, Anne I. H.

    2010-01-01

    Associations between young children's attributions of emotion at different points in a story, and with regard to their own prediction about the story's outcome, were investigated using two hypothetical scenarios of social and emotional challenge (social entry and negative event). First grade children (N = 250) showed an understanding that emotions…

  8. Predicting Outcomes of Children Referred for Autism Using the MacArthur-Bates Communicative Development Inventory

    ERIC Educational Resources Information Center

    Luyster, Rhiannon; Qiu, Shanping; Lopez, Kristina; Lord, Catherine

    2007-01-01

    Purpose: Autism spectrum disorders (ASD) are characterized by early impairments in language and related social communication skills. This investigation explored whether scores on the MacArthur-Bates Communicative Development Inventory (CDI) at ages 2 and 3 years predict outcome at age 9 years in children with ASD and developmental delay (DD).…

  9. Can Assessment Reactivity Predict Treatment Outcome among Adolescents with Alcohol and Other Substance Use Disorders?

    ERIC Educational Resources Information Center

    Kaminer, Yifrah; Burleson, Joseph A.; Burke, Rebecca H.

    2008-01-01

    The objectives of this paper are two-fold: to examine first, if the change from positive to negative alcohol and any other substance use status from baseline assessment to the onset of the first session (i.e., pre-treatment phase) occurs in adolescents, that is, Assessment Reactivity (AR); second, whether AR predicts treatment outcome.…

  10. Are Career Centers Worthwhile?: Predicting Unique Variance in Career Outcomes through Career Center Usage

    ERIC Educational Resources Information Center

    Brotheridge, Celeste M.; Power, Jacqueline L.

    2008-01-01

    Purpose: This study seeks to examine the extent to which the use of career center services results in the significant incremental prediction of career outcomes beyond its established predictors. Design/methodology/approach: The authors survey the clients of a public agency's career center and use hierarchical multiple regressions in order to…

  11. EEG Estimates of Cognitive Workload and Engagement Predict Math Problem Solving Outcomes

    ERIC Educational Resources Information Center

    Beal, Carole R.; Galan, Federico Cirett

    2012-01-01

    In the present study, the authors focused on the use of electroencephalography (EEG) data about cognitive workload and sustained attention to predict math problem solving outcomes. EEG data were recorded as students solved a series of easy and difficult math problems. Sequences of attention and cognitive workload estimates derived from the EEG…

  12. How action structures time: About the perceived temporal order of action and predicted outcomes.

    PubMed

    Desantis, Andrea; Waszak, Florian; Moutsopoulou, Karolina; Haggard, Patrick

    2016-01-01

    Few ideas are as inexorable as the arrow of causation: causes must precede their effects. Explicit or implicit knowledge about this causal order permits humans and other animals to predict and control events in order to produce desired outcomes. The sense of agency is deeply linked with representation of causation, since it involves the experience of a self-capable of acting on the world. Since causes must precede effects, the perceived temporal order of our actions and subsequent events should be relevant to the sense of agency. The present study investigated whether the ability to predict the outcome of an action would impose the classical cause-precedes-outcome pattern on temporal order judgements. Participants indicated whether a visual stimulus (dots moving upward or downward) was presented either before or after voluntary actions of the left or right hand. Crucially, the dot motion could be either congruent or incongruent with an operant association between hand and motion direction learned in a previous learning phase. When the visual outcome of voluntary action was congruent with previous learning, the motion onset was more often perceived as occurring after the action, compared to when the outcome was incongruent. This suggests that the prediction of specific sensory outcomes restructures our perception of timing of action and sensory events, inducing the experience that congruent effects occur after participants' actions. Interestingly, this bias to perceive events according to the temporal order of cause and outcome disappeared when participants knew that motion directions were automatically generated by the computer. This suggests that the reorganisation of time perception imposed by associative learning depends on participants' causal beliefs. PMID:26409246

  13. Individual prediction of treatment outcome in patients with temporomandibular disorders. A quality improvement model.

    PubMed

    Sundqvist, Bertil

    2007-01-01

    The general aim of this thesis was to create and evaluate a quality improvement model for prediction of treatment outcome in patients diagnosed with Temporomandibular Disorders (TMD) of either Muscle or Mainly TMJ (Temporomandibular Joint) origin, treated with interocclusal appliances and/or occlusal adjustment. The model was assumed to generate negative predictors of treatment outcome through evaluating all patients predicted Good reaching an objective treatment goal but not having an improvement of 50% or more. The model was created and evaluated by one TMD specialist. The questions were: (I) Was it possible for the TMD specialist to predict treatment outcome individually in patients diagnosed with TMD and, from the results, create a quality improvement model? (II) Was it possible for eight TMD-trained general dental practitioners, under the supervision of the TMD specialist, to treat TMD patients with similar results to the TMD specialist if the TMD specialist had examined, treatment planned, and individually predicted the treatment outcome? (III) Was it possible for the TMD specialist to improve the possibility to predict individual treatment outcome overtime? (IV) Was it possible for one TMD-trained general dental practitioner to copy the clinical part of the model and achieve the same results as the TMD specialist, in patients selected by the TMD specialist? Out of 5165 patients subjected to a functional examination of the masticatory system, 3602 were diagnosed with TMD and subgrouped as either Muscle or Mainly TMJ symptoms. The patients were predicted to have a Good, Dubious, or Poor possibility to have an improvement of 50% or more after treatment. Patients predicted Poor were not offered any treatment. A correct prediction of actual treatment outcome Good was defined as an improvement of 50% or more for muscle and/or TMJ symptoms. A total of 2625 patients began treatment at the specialist clinic for TMD and 2128 completed the full course of treatment. The

  14. Can Machine Learning Methods Predict Extubation Outcome in Premature Infants as well as Clinicians?

    PubMed Central

    Mueller, Martina; Almeida, Jonas S.; Stanislaus, Romesh; Wagner, Carol L.

    2014-01-01

    Rationale Though treatment of the prematurely born infant breathing with assistance of a mechanical ventilator has much advanced in the past decades, predicting extubation outcome at a given point in time remains challenging. Numerous studies have been conducted to identify predictors for extubation outcome; however, the rate of infants failing extubation attempts has not declined. Objective To develop a decision-support tool for the prediction of extubation outcome in premature infants using a set of machine learning algorithms Methods A dataset assembled from 486 premature infants on mechanical ventilation was used to develop predictive models using machine learning algorithms such as artificial neural networks (ANN), support vector machine (SVM), naïve Bayesian classifier (NBC), boosted decision trees (BDT), and multivariable logistic regression (MLR). Performance of all models was evaluated using area under the curve (AUC). Results For some of the models (ANN, MLR and NBC) results were satisfactory (AUC: 0.63–0.76); however, two algorithms (SVM and BDT) showed poor performance with AUCs of ~0.5. Conclusion Clinician's predictions still outperform machine learning due to the complexity of the data and contextual information that may not be captured in clinical data used as input for the development of the machine learning algorithms. Inclusion of preprocessing steps in future studies may improve the performance of prediction models. PMID:25419493

  15. Machine learning approach for the outcome prediction of temporal lobe epilepsy surgery.

    PubMed

    Armañanzas, Rubén; Alonso-Nanclares, Lidia; Defelipe-Oroquieta, Jesús; Kastanauskaite, Asta; de Sola, Rafael G; Defelipe, Javier; Bielza, Concha; Larrañaga, Pedro

    2013-01-01

    Epilepsy surgery is effective in reducing both the number and frequency of seizures, particularly in temporal lobe epilepsy (TLE). Nevertheless, a significant proportion of these patients continue suffering seizures after surgery. Here we used a machine learning approach to predict the outcome of epilepsy surgery based on supervised classification data mining taking into account not only the common clinical variables, but also pathological and neuropsychological evaluations. We have generated models capable of predicting whether a patient with TLE secondary to hippocampal sclerosis will fully recover from epilepsy or not. The machine learning analysis revealed that outcome could be predicted with an estimated accuracy of almost 90% using some clinical and neuropsychological features. Importantly, not all the features were needed to perform the prediction; some of them proved to be irrelevant to the prognosis. Personality style was found to be one of the key features to predict the outcome. Although we examined relatively few cases, findings were verified across all data, showing that the machine learning approach described in the present study may be a powerful method. Since neuropsychological assessment of epileptic patients is a standard protocol in the pre-surgical evaluation, we propose to include these specific psychological tests and machine learning tools to improve the selection of candidates for epilepsy surgery. PMID:23646148

  16. Machine Learning Approach for the Outcome Prediction of Temporal Lobe Epilepsy Surgery

    PubMed Central

    DeFelipe-Oroquieta, Jesús; Kastanauskaite, Asta; de Sola, Rafael G.; DeFelipe, Javier; Bielza, Concha; Larrañaga, Pedro

    2013-01-01

    Epilepsy surgery is effective in reducing both the number and frequency of seizures, particularly in temporal lobe epilepsy (TLE). Nevertheless, a significant proportion of these patients continue suffering seizures after surgery. Here we used a machine learning approach to predict the outcome of epilepsy surgery based on supervised classification data mining taking into account not only the common clinical variables, but also pathological and neuropsychological evaluations. We have generated models capable of predicting whether a patient with TLE secondary to hippocampal sclerosis will fully recover from epilepsy or not. The machine learning analysis revealed that outcome could be predicted with an estimated accuracy of almost 90% using some clinical and neuropsychological features. Importantly, not all the features were needed to perform the prediction; some of them proved to be irrelevant to the prognosis. Personality style was found to be one of the key features to predict the outcome. Although we examined relatively few cases, findings were verified across all data, showing that the machine learning approach described in the present study may be a powerful method. Since neuropsychological assessment of epileptic patients is a standard protocol in the pre-surgical evaluation, we propose to include these specific psychological tests and machine learning tools to improve the selection of candidates for epilepsy surgery. PMID:23646148

  17. The Temporal Stability and Predictive Ability of the Gambling Outcome Expectancies Scale (GOES): A Prospective Study.

    PubMed

    Flack, Mal; Morris, Mary

    2016-09-01

    Previous research using the Gambling Outcome Expectancies Scale (GOES; Flack and Morris in J Gambl Stud, 2015. doi: 10.1007/s10899-014-9484-z ) revealed the instrument has excellent psychometric properties and differentially predicts gambling frequency and problem gambling scores. However, like the existing gambling motivation scales, the GOES psychometric properties and predictive utility have not been tested outside of cross sectional studies. The current study used a prospective survey design to redress this issue. Eight hundred and ninety-three participants, drawn from the general community, completed the second wave of the gambling survey. Temporal invariance testing revealed the GOES was reliable. Furthermore, the ability of the GOES to predict gambling behaviour using baseline and concurrent measures of gambling outcome expectancies was demonstrated. Specifically, consistent with the Wave 1 results, the gambling outcome expectancies that reflect diverse reasons for gambling (e.g., social, escape, and money) preferentially predicted gambling frequency whereas the narrower range of emotion focused reasons (e.g., excitement, escape, and ego enhancement) predicted gambling problems. Considered in light of the Wave 1 findings, these results underscore the need for gambling harm minimisation initiatives to take into account the emotion-oriented reasons for gambling. PMID:26518686

  18. Outcome Prediction of Consciousness Disorders in the Acute Stage Based on a Complementary Motor Behavioural Tool

    PubMed Central

    Jöhr, Jane; Gilart de Keranflec'h, Charlotte; Van De Ville, Dimitri; Preti, Maria Giulia; Meskaldji, Djalel E.; Hömberg, Volker; Laureys, Steven; Draganski, Bogdan; Frackowiak, Richard; Diserens, Karin

    2016-01-01

    Introduction Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. Methods From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. Results Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation

  19. Prediction of Outcome after Traumatic Brain Injury: Comparison of Disease State Index and IMPACT Calculator.

    PubMed

    Liedes, Hilkka; Mattila, Jussi; Lingsma, Hester; Lötjönen, Jyrki; Menon, David; Tenovuo, Olli; van Gils, Mark

    2016-01-01

    Traumatic brain injury (TBI) is a major cause of death and disability, especially in young adults. A reliable prediction of outcome after TBI is of great importance in clinical practice and research. We aimed to compare performance of the well-established IMPACT calculator and an alternative method, Disease State Index (DSI), in the prediction of six-month outcome after TBI. Performance of the models was evaluated using 2036 patients with moderate or severe TBI from the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) database. Prediction performance of both models was similar. The models with more variables provided better performance than the simpler models. This study showed that the DSI is a valid tool with efficient visualizations that can help clinicians with their decision making process in clinical practice. PMID:27225575

  20. Revision of the Predictive Method Improves Precision in the Prediction of Stroke Outcomes for Patients Admitted to Rehabilitation Hospitals

    PubMed Central

    Matsugi, Akiyoshi; Tani, Keisuke; Mitani, Yasuhiro; Oku, Kosuke; Tamaru, Yoshiki; Nagano, Kiyoshi

    2014-01-01

    [Purpose] The purpose of this study was to confirm the accuracy of a revised method for predicting the Functional Independence Measure (FIM) at discharge when stroke patients are first admitted to a rehabilitation hospital. [Subjects and Methods] The predictive equation with logarithmic trend line was calculated based on the total score of the FIM at admission and discharge in 93 patients with cerebral infarction (CI) and 60 patients with intracerebral hemorrhage (ICH). In other patients with CI or ICH (validation group), the differences between the actual FIM and the predicted FIM at discharge calculated by the CI or ICH equation and the combined (CI + ICH) equation, as well as by the CI or ICH equation and combined equation used in a previous study, were calculated. [Results] The multiple correlation coefficients of the CI equation, ICH equation, and combined equation were 0.87, 0.71, and 0.8. The residual of the actual FIM and predicted FIM at discharge calculated by the CI equation was the smallest in the CI validation group. In the ICH validation group, the residual calculated for ICH patients alone was smaller than that calculated by the previous ICH equation. [Conclusion] This easy-to-use method using a new equation for prediction was more precise than the previous equation. Therefore, we should revise the equation for predicting stroke patient outcome strata according to data from within the governing medical administration system. PMID:25276029

  1. Evolving technology in bipolar perfused radiofrequency ablation: assessment of efficacy, predictability and safety in a pig liver model.

    PubMed

    Burdío, Fernando; Navarro, Ana; Sousa, Ramón; Burdío, José M; Güemes, Antonio; Gonzalez, Ana; Cruz, Ignacio; Castiella, Tomás; Lozano, Ricardo; Berjano, Enrique; Figueras, Joan; de Gregorio, Miguel A

    2006-08-01

    Bipolar radiofrequency (RF) ablation, especially with perfusion of saline, has been shown to increase volume over monopolar conventional methods. The aims of this study are to study whether this method is linked to too flattened thermal lesions and premature rise of impedance and to elucidate some safety concerns. Eighteen RF ablations were performed using a 1.8-mm-diameter bipolar applicator in the liver of nine healthy pigs through laparotomy with or without temporary vascular occlusion [the Pringle maneuver (PGM)]: group A (n=9), without PGM; group B (n=9), with PGM. Hypertonic saline solutions (3% and 20 %) were injected through the applicator at a rate of 400 ml/h during the procedure. The pigs were followed up and they were euthanased on the 15th day. Impedance, current, power output, energy output, temperatures, diameters of thermal lesion, volume, sphericity ratio of thermal lesion were correlated among groups. Impedance at the end of the procedure (50.00 Omega+/-28.39 and 52.88 Omega+/-26.77, for groups A and B, respectively) was very similar to the starting impedance (50 Omega). In a median of 1 (range, 0-6) time per RF ablation procedure a reduction of 30 W from the selected power supply was observed during the RF ablation procedure linked to a slight increase of impedance. Volume and short diameter of thermal lesion were 21.28 cm3+/-11.78 and 2.85 cm+/-0.87 for group A, 87.51 cm3+/-25.20 and 4.31 cm+/-0.65 for group B. Continuous thermal between both electrodes were described with a global sphericity ratio of 1.91. One major complication (thermal injury to the stomach) was encountered in a case of cross-sectional necrosis of the targeted liver and attributed to heat diffusion after the procedure. This method has been shown to determine: (1) the relative control of impedance during the procedure; (2) ovoid and relatively large thermal lesions with less dependence upon closest vessels. PMID:16541228

  2. BIOMARKERS S100B AND NSE PREDICT OUTCOME IN HYPOTHERMIA-TREATED ENCEPHALOPATHIC NEWBORNS

    PubMed Central

    Massaro, An N.; Chang, Taeun; Baumgart, Stephen; McCarter, Robert; Nelson, Karin B.; Glass, Penny

    2014-01-01

    Objective To evaluate if serum S100B protein and neuron specific enolase (NSE) measured during therapeutic hypothermia are predictive of neurodevelopmental outcome at 15 months in children with neonatal encephalopathy (NE). Design Prospective longitudinal cohort study Setting A level IV neonatal intensive care unit in a free-standing children’s hospital. Patients Term newborns with moderate to severe NE referred for therapeutic hypothermia during the study period. Interventions Serum NSE and S100B were measured at 0, 12, 24 and 72 hrs of hypothermia. Measurements and Main Reseults Of the 83 infants were enrolled, fifteen (18%) died in the newborn period. Survivors were evaluated by the Bayley Scales of Infant Development (BSID-II) at 15 months of age. Outcomes were assessed in 49/68 (72%) survivors at a mean age of 15.2±2.7 months. Neurodevelopmental outcome was classified by BSID-II Mental (MDI) and Psychomotor (PDI) Developmental Index scores, reflecting cognitive and motor outcomes respectively. Four-level outcome classifications were defined a priori: normal= MDI/PDI within 1SD (>85), mild= MDI/PDI <1SD (70–85), moderate/severe= MDI/PDI <2SD (<70), or died. Elevated serum S100B and NSE levels measured during hypothermia were associated with increasing outcome severity after controlling for baseline and soceioeconomic characteristics in ordinal regression models. Adjusted odds ratios for cognitive outcome were: S100B 2.5 (95% CI 1.3–4.8) and NSE 2.1 (1.2–3.6); for motor outcome: S100B 2.6 (1.2–5.6) and NSE 2.1 (1.2–3.6). Conclusions Serum S100B and NSE levels in babies with NE are associated with neurodevelopmental outcome at 15 months. These putative biomarkers of brain injury may help direct care during therapeutic hypothermia. PMID:24777302

  3. Predicting 3-year outcomes of early-identified children with hearing impairment

    PubMed Central

    Ching, T.Y.C.; Day, J.; Seeto, M.; Dillon, H.; Marnane, V.; Street, L.

    2013-01-01

    Problem/Objectives Permanent childhood hearing loss has major negative impacts on children’s health and development. To improve outcomes, universal newborn hearing screening (UNHS) has been implemented widely. However, high-quality evidence on its efficacy was lacking. To address this evidence gap, we conducted the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study to directly compare outcomes of early- and late-identified children. This paper investigates whether early performance measured shortly after initial amplification predicts language development at 3 years of age. Methodology This is a prospective, population-based study. We assessed outcomes at 6- and 12-months after amplification, and then at 3 and 5 years of age. Main outcome measures included directly-assessed language, receptive vocabulary, speech production; and parent-reported functional performance in everyday life. A range of demographic and audiological information was also collected at evaluation intervals. Results About 450 children participated, and 3-year outcomes scores were available for 356 participants. Multiple regression analysis revealed that early language scores or functional performance ratings were significant predictors of 3-year outcomes. Other significant predictors included the presence or absence of additional disabilities, severity of hearing loss, and age at cochlear implant activation. Conclusions Early performance, either directly-assessed language ability (PLS-4) or parent-reported functional ratings (PEACH), were significant predictors of 3-year outcomes; along with presence or absence of additional disabilities, severity of hearing loss, and age at CI activation. Earlier implantation is possible with early detection of hearing loss via UNHS. Monitoring performance after initial amplification allows preventive strategies to be implemented early to improve outcomes. PMID:24383228

  4. Severe hypoxaemia can predict unfavourable clinical outcomes in individuals with pulmonary embolism aged over 40 years

    PubMed Central

    Souza, Caio Simoes; Resende, Fernanda Simoes Seabra; Rodrigues, Marcelo Palmeira

    2014-01-01

    INTRODUCTION Acute pulmonary embolism (APE) is an urgent clinical condition that can progress in a wide variety of ways. Therefore, we sought to develop an easy-to-apply algorithm, to be based on readily available clinical indicators, effective in predicting unfavourable outcomes. METHODS This was a retrospective cohort study based on systematically collected data in a database. The study included 102 patients with APE who were admitted to a tertiary care hospital. The following outcomes were defined as unfavourable shock, the need for mechanical ventilation, the use of thrombolytics, and death. Logistic regression analysis was used to explore variables significantly associated with outcome and to calculate post-test probabilities. RESULTS The prevalence of unfavourable outcomes was 25.5% (26 of the 102 patients with APE). The risk of an unfavourable outcome was reduced to 7.0% for patients with APE who were aged ≤ 40 years. In patients with APE who were aged > 40 years, the presence of hypoxaemia (i.e. peripheral oxygen saturation < 90%) alone increased the risk of an unfavourable outcome to 57.0%. A recent history of trauma and the presence of pre-existing lung or heart disease were significantly associated with unfavourable outcomes. The inclusion of those variables in the logistic regression model increased the post-test risk of an unfavourable outcome to 65.0%–86.0%. CONCLUSION Advanced age (i.e. > 40 years), the presence of hypoxaemia, a recent history of trauma and the presence of pre-existing lung or heart disease are risk factors for unfavourable outcome in patients with APE. PMID:25273933

  5. Predicting the psychosocial outcome of epilepsy surgery: A longitudinal perspective on the 'burden of normality'.

    PubMed

    Kemp, Steven; Garlovsky, Jack; Reynders, Hazel; Caswell, Helen; Baker, Gus; Shah, Emily

    2016-07-01

    Good seizure outcomes and good psychosocial outcomes following epilepsy surgery do not necessarily follow one from the other. This study explored the relationship between several presurgical psychosocial characteristics and postsurgical quality-of-life outcomes. The study aimed to develop the concept of 'the burden of normality' and identify risk factors for a poor psychosocial outcome that could be targeted with ameliorative presurgery cognitive behavioral techniques. Data were collected from 77 epilepsy surgery patients from three UK epilepsy centers and presurgery and postsurgery follow-up data were obtained from 30-34 patients, depending on the measure. Measures were self-report. Postsurgery intervals were determined by the epilepsy surgery care pathway at individual centers. Presurgery poor levels of mental health, poor social functioning, increased belief in illness chronicity, and associating epilepsy with social role limitations were all associated with poor postsurgical quality of life. Adopting an accepting coping strategy presurgery was associated with good postoperative quality of life. Regression analysis showed that a good postsurgical quality of life was positively predicted by a presurgical coping style of being able to make the best of a situation and see challenges in a positive light (i.e., positive reinterpretation and growth from the COPE scale) and negatively predicted by presurgical levels of anxiety. These data are presented as an important step in identifying psychological red flags for an adverse psychosocial outcome to epilepsy surgery, as exemplified by the concept of the 'burden of normality' and specifying targets for preoperative ameliorative psychological advice. PMID:27206234

  6. Radiological predictive factors for the outcome of surgically treated calcaneus fractures.

    PubMed

    Baptista, Mário; Pinto, Rui; Torres, João

    2015-06-01

    Calcaneus fractures are fairly common and clinically relevant due to their poor outcome. Thus, solving the controversy regarding treatment and outcome prediction should be a target. This study intends to evaluate the predictive ability of common radiologic tools for the surgical outcome of calcaneus fractures, regardless of treatment modality. 44 patients' records, with operated calcaneus fractures between 2008 and 2013, were retrospectively assessed and imagiology was blindly evaluated. Patients were submitted to percutaneous or open lateral approach. No relevant correlations were found between the measurements on the plain lateral radiograph and the outcome. Fractures were also graded according to the Sanders classification. Type 4 fractures predicted the occurrence of any hazard, such as skin or pain related complications and need for secondary surgery (p=0.051, odds=14.00 [CI=1.30-150.89]). However, it's still not possible to accurately target patients with high risk of postoperative complications. Until then, follow-up protocols should be maintained indiscriminately. PMID:26280959

  7. Using a Machine Learning Approach to Predict Outcomes after Radiosurgery for Cerebral Arteriovenous Malformations

    PubMed Central

    Oermann, Eric Karl; Rubinsteyn, Alex; Ding, Dale; Mascitelli, Justin; Starke, Robert M.; Bederson, Joshua B.; Kano, Hideyuki; Lunsford, L. Dade; Sheehan, Jason P.; Hammerbacher, Jeffrey; Kondziolka, Douglas

    2016-01-01

    Predictions of patient outcomes after a given therapy are fundamental to medical practice. We employ a machine learning approach towards predicting the outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations (AVMs). Using three prospective databases, a machine learning approach of feature engineering and model optimization was implemented to create the most accurate predictor of AVM outcomes. Existing prognostic systems were scored for purposes of comparison. The final predictor was secondarily validated on an independent site’s dataset not utilized for initial construction. Out of 1,810 patients, 1,674 to 1,291 patients depending upon time threshold, with 23 features were included for analysis and divided into training and validation sets. The best predictor had an average area under the curve (AUC) of 0.71 compared to existing clinical systems of 0.63 across all time points. On the heldout dataset, the predictor had an accuracy of around 0.74 at across all time thresholds with a specificity and sensitivity of 62% and 85% respectively. This machine learning approach was able to provide the best possible predictions of AVM radiosurgery outcomes of any method to date, identify a novel radiobiological feature (3D surface dose), and demonstrate a paradigm for further development of prognostic tools in medical care. PMID:26856372

  8. Using a Machine Learning Approach to Predict Outcomes after Radiosurgery for Cerebral Arteriovenous Malformations.

    PubMed

    Oermann, Eric Karl; Rubinsteyn, Alex; Ding, Dale; Mascitelli, Justin; Starke, Robert M; Bederson, Joshua B; Kano, Hideyuki; Lunsford, L Dade; Sheehan, Jason P; Hammerbacher, Jeffrey; Kondziolka, Douglas

    2016-01-01

    Predictions of patient outcomes after a given therapy are fundamental to medical practice. We employ a machine learning approach towards predicting the outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations (AVMs). Using three prospective databases, a machine learning approach of feature engineering and model optimization was implemented to create the most accurate predictor of AVM outcomes. Existing prognostic systems were scored for purposes of comparison. The final predictor was secondarily validated on an independent site's dataset not utilized for initial construction. Out of 1,810 patients, 1,674 to 1,291 patients depending upon time threshold, with 23 features were included for analysis and divided into training and validation sets. The best predictor had an average area under the curve (AUC) of 0.71 compared to existing clinical systems of 0.63 across all time points. On the heldout dataset, the predictor had an accuracy of around 0.74 at across all time thresholds with a specificity and sensitivity of 62% and 85% respectively. This machine learning approach was able to provide the best possible predictions of AVM radiosurgery outcomes of any method to date, identify a novel radiobiological feature (3D surface dose), and demonstrate a paradigm for further development of prognostic tools in medical care. PMID:26856372

  9. Specific gyrA gene mutations predict poor treatment outcome in MDR-TB

    PubMed Central

    Rigouts, L.; Coeck, N.; Gumusboga, M.; de Rijk, W. B.; Aung, K. J. M.; Hossain, M. A.; Fissette, K.; Rieder, H. L.; Meehan, C. J.; de Jong, B. C.; Van Deun, A.

    2016-01-01

    Objectives Mutations in the gyrase genes cause fluoroquinolone resistance in Mycobacterium tuberculosis. However, the predictive value of these markers for clinical outcomes in patients with MDR-TB is unknown to date. The objective of this study was to determine molecular markers and breakpoints predicting second-line treatment outcomes in M. tuberculosis patients treated with fourth-generation fluoroquinolones. Methods We analysed treatment outcome data in relation to the gyrA and gyrB sequences and MICs of ofloxacin, gatifloxacin and moxifloxacin for pretreatment M. tuberculosis isolates from 181 MDR-TB patients in Bangladesh whose isolates were susceptible to injectable drugs. Results The gyrA 90Val, 94Gly and 94Ala mutations were most frequent, with the highest resistance levels for 94Gly mutants. Increased pretreatment resistance levels (>2 mg/L), related to specific mutations, were associated with lower cure percentages, with no cure in patients whose isolates were resistant to gatifloxacin at 4 mg/L. Any gyrA 94 mutation, except 94Ala, predicted a significantly lower proportion of cure compared with all other gyrA mutations taken together (all non-94 mutants + 94Ala) [OR = 4.3 (95% CI 1.4–13.0)]. The difference in treatment outcome was not explained by resistance to the other drugs. Conclusions Our study suggests that gyrA mutations at position 94, other than Ala, predict high-level resistance to gatifloxacin and moxifloxacin, as well as poor treatment outcome, in MDR-TB patients in whom an injectable agent is still effective. PMID:26604243

  10. Inflammation-driven malnutrition: a new screening tool predicts outcome in Crohn's disease.

    PubMed

    Jansen, Irene; Prager, Matthias; Valentini, Luzia; Büning, Carsten

    2016-09-01

    Malnutrition is a frequent feature in Crohn's disease (CD), affects patient outcome and must be recognised. For chronic inflammatory diseases, recent guidelines recommend the development of combined malnutrition and inflammation risk scores. We aimed to design and evaluate a new screening tool that combines both malnutrition and inflammation parameters that might help predict clinical outcome. In a prospective cohort study, we examined fifty-five patients with CD in remission (Crohn's disease activity index (CDAI) <200) at 0 and 6 months. We assessed disease activity (CDAI, Harvey-Bradshaw index), inflammation (C-reactive protein (CRP), faecal calprotectin (FC)), malnutrition (BMI, subjective global assessment (SGA), serum albumin, handgrip strength), body composition (bioelectrical impedance analysis) and administered the newly developed 'Malnutrition Inflammation Risk Tool' (MIRT; containing BMI, unintentional weight loss over 3 months and CRP). All parameters were evaluated regarding their ability to predict disease outcome prospectively at 6 months. At baseline, more than one-third of patients showed elevated inflammatory markers despite clinical remission (36·4 % CRP ≥5 mg/l, 41·5 % FC ≥100 µg/g). Prevalence of malnutrition at baseline according to BMI, SGA and serum albumin was 2-16 %. At 6 months, MIRT significantly predicted outcome in numerous nutritional and clinical parameters (SGA, CD-related flares, hospitalisations and surgeries). In contrast, SGA, handgrip strength, BMI, albumin and body composition had no influence on the clinical course. The newly developed MIRT was found to reliably predict clinical outcome in CD patients. This screening tool might be used to facilitate clinical decision making, including treatment of both inflammation and malnutrition in order to prevent complications. PMID:27546478

  11. Intrinsic Functional Connectivity Patterns Predict Consciousness Level and Recovery Outcome in Acquired Brain Injury

    PubMed Central

    Wu, Xuehai; Zou, Qihong; Hu, Jin; Tang, Weijun; Mao, Ying; Gao, Liang; Zhu, Jianhong; Jin, Yi; Wu, Xin; Lu, Lu; Zhang, Yaojun; Zhang, Yao; Dai, Zhengjia; Gao, Jia-Hong; Weng, Xuchu; Northoff, Georg; Giacino, Joseph T.; He, Yong

    2015-01-01

    For accurate diagnosis and prognostic prediction of acquired brain injury (ABI), it is crucial to understand the neurobiological mechanisms underlying loss of consciousness. However, there is no consensus on which regions and networks act as biomarkers for consciousness level and recovery outcome in ABI. Using resting-state fMRI, we assessed intrinsic functional connectivity strength (FCS) of whole-brain networks in a large sample of 99 ABI patients with varying degrees of consciousness loss (including fully preserved consciousness state, minimally conscious state, unresponsive wakefulness syndrome/vegetative state, and coma) and 34 healthy control subjects. Consciousness level was evaluated using the Glasgow Coma Scale and Coma Recovery Scale-Revised on the day of fMRI scanning; recovery outcome was assessed using the Glasgow Outcome Scale 3 months after the fMRI scanning. One-way ANOVA of FCS, Spearman correlation analyses between FCS and the consciousness level and recovery outcome, and FCS-based multivariate pattern analysis were performed. We found decreased FCS with loss of consciousness primarily distributed in the posterior cingulate cortex/precuneus (PCC/PCU), medial prefrontal cortex, and lateral parietal cortex. The FCS values of these regions were significantly correlated with consciousness level and recovery outcome. Multivariate support vector machine discrimination analysis revealed that the FCS patterns predicted whether patients with unresponsive wakefulness syndrome/vegetative state and coma would regain consciousness with an accuracy of 81.25%, and the most discriminative region was the PCC/PCU. These findings suggest that intrinsic functional connectivity patterns of the human posteromedial cortex could serve as a potential indicator for consciousness level and recovery outcome in individuals with ABI. SIGNIFICANCE STATEMENT Varying degrees of consciousness loss and recovery are commonly observed in acquired brain injury patients, yet the

  12. Use of a Cumulative Risk Scale to Predict Poor Intellectual and Academic Outcomes in Childhood Epilepsy.

    PubMed

    Kavanaugh, Brian C; Scarborough, Vanessa Ramos; Salorio, Cynthia F

    2016-06-01

    Discrete risk factors for poor outcomes in childhood epilepsy have been identified, but it is unclear whether the combined effect of several risk factors better predicts outcome. The Epilepsy Cumulative Risk Scale was developed to quantify cumulative risk for poor outcomes in childhood epilepsy. Participants included 156 clinic-referred children with epilepsy. The Epilepsy Cumulative Risk Scale was developed using variables previously associated with functional outcomes. Scale utility was examined through its association with intellectual and academic functioning. All Epilepsy Cumulative Risk Scale variables were significantly associated with functioning. The Total Score (ie, cumulative effect) was most strongly correlated with cognition and academic skills. A Total Score ≥ 5 had the best sensitivity and specificity for differentiating those at high risk for poor outcomes. The Epilepsy Cumulative Risk Scale shows promise as a practical, data-driven tool for quantification of cumulative risk for poor outcomes in childhood epilepsy and may be helpful in detecting those needing referral for additional services. PMID:26747083

  13. Advances in Atrial Fibrillation Ablation

    PubMed Central

    Darge, Alicia; Reynolds, Matthew R.; Germano, Joseph J.

    2009-01-01

    Atrial Fibrillation (AF) is an increasingly common and costly medical problem.1–3 Given the disappointing efficacy and side effects associated with pharmacological therapy for AF, new treatment options are needed. Over the last decade, advances in our understanding of the mechanisms of AF, coupled with iterative improvements in catheter ablation techniques, have spurred the evolution of catheter ablation for AF from an experimental procedure to an increasingly important treatment option.4 This paper will review recent advances in the approaches and outcomes of AF ablation. PMID:19411729

  14. On the feasibility of tilt test outcome early prediction using ECG and pressure parameters

    NASA Astrophysics Data System (ADS)

    Gimeno-Blanes, FJ; Rojo-Álvarez, JL; Caamaño, AJ; Flores-Yepes, JA; García-Alberola, A.

    2011-12-01

    The tilt test is a valuable clinical tool for vasovagal syncope (VVS) diagnostic, and its early prediction from simple ECG and blood pressure-based parameters has widely been studied in the literature. However, no practical system is currently used in the clinical setting for the early prediction of the tilt test outcome. The objectives of this study were (1) to benchmark the early prediction performance of all the previously proposed parameters, when nonlinearly combined; (2) to try to improve this performance with the inclusion of additional information and processing techniques. We analyzed a database of 727 consecutive cases of tilt test. Previously proposed features were measured from heart rate and systolic/diastolic pressure tachograms, in several representative signal segments. We aimed to improve the prediction performance: first, using new nonlinear features (detrended fluctuation analysis and sample entropy); second, using a multivariable nonlinear classifier (support vector machine); and finally, including additional physiological signals (stroke volume). The predictive performance of the nonlinearly combined previously proposed features was limited [area under receiver operating characteristic curve (ROC) 0.57 ± 0.12], especially at the beginning of the test, which is the most clinically relevant period. The improvement with additional available physiological information was limited too. We conclude that the use of a system for tilt test outcome prediction with current knowledge and processing should be considered with caution, and that further effort has to be devoted to understand the mechanisms of VVS.

  15. Ablative thermal protection systems

    NASA Technical Reports Server (NTRS)

    Vaniman, J.; Fisher, R.; Wojciechowski, C.; Dean, W.

    1983-01-01

    The procedures used to establish the TPS (thermal protection system) design of the SRB (solid rocket booster) element of the Space Shuttle vehicle are discussed. A final evaluation of the adequacy of this design will be made from data obtained from the first five Shuttle flights. Temperature sensors installed at selected locations on the SRB structure covered by the TPS give information as a function of time throughout the flight. Anomalies are to be investigated and computer design thermal models adjusted if required. In addition, the actual TPS ablator material loss is to be measured after each flight and compared with analytically determined losses. The analytical methods of predicting ablator performance are surveyed.

  16. Minimal Brain Dysfunction in Childhood: II. Late Outcome in Relation to Initial Presentation. III. Predictive Factors in Relation to Late Outcome.

    ERIC Educational Resources Information Center

    Milman, Doris H.

    Two studies explore the late outcome of minimal brain dysfunction in 73 patients in relation to their initial presentation and predictive factors. Both studies followed the patients for a period of 10 to 20 years. Findings from the first study of initial presentation in relation to adult outcome showed that there was a strong positive correlation…

  17. Endometrial ablation

    MedlinePlus

    ... can be seen on the video screen. Small tools can be used through the scope to remove abnormal growths or tissue for examination. Ablation uses heat, cold, or electricity to destroy the lining of the womb. The ...

  18. Long-Term Outcome of a Hepatocellular Carcinoma 71/2 Years After Surgery and Repeated Radiofrequency Ablation: Case Report and Review of the Literature

    SciTech Connect

    Thanos, L. Mylona, S.; Nikita, A.; Ptohis, N.; Kelekis, D.A.

    2007-04-15

    An interesting case is presented of a 78-year-old patient with cirrhosis who was managed with combined treatment (surgery and radiofrequency (RF) ablation) for hepatocellular carcinoma (HCC) and has survived for 71/2 years. Elevation of the {alpha}-FP (alpha-fetoprotein) levels was noted 2 years after surgery. CT demonstrated two lesions: one central at the remaining right liver lobe, and the other at the excision site. Biopsy of the lesions confirmed the diagnosis of HCC for both of them. RF ablation of these two lesions was performed in one session with technical success. Four and a half years after the first RF ablation a new recurrence was demonstrated at the CT follow-up control. RF ablation was again applied successfully. The imaging findings and the therapeutic percutaneous management of this patient along with the natural course of HCC and its recurrence are discussed, and the literature concerning risk factors is reviewed.

  19. Ablation article and method

    NASA Technical Reports Server (NTRS)

    Erickson, W. D.; Sullivan, E. M. (Inventor)

    1973-01-01

    An ablation article, such as a conical heat shield, having an ablating surface is provided with at least one discrete area of at least one seed material, such as aluminum. When subjected to ablation conditions, the seed material is ablated. Radiation emanating from the ablated seed material is detected to analyze ablation effects without disturbing the ablation surface. By providing different seed materials having different radiation characteristics, the ablating effects on various areas of the ablating surface can be analyzed under any prevailing ablation conditions. The ablating article can be provided with means for detecting the radiation characteristics of the ablated seed material to provide a self-contained analysis unit.

  20. Early functional magnetic resonance imaging activations predict language outcome after stroke.

    PubMed

    Saur, Dorothee; Ronneberger, Olaf; Kümmerer, Dorothee; Mader, Irina; Weiller, Cornelius; Klöppel, Stefan

    2010-04-01

    An accurate prediction of system-specific recovery after stroke is essential to provide rehabilitation therapy based on the individual needs. We explored the usefulness of functional magnetic resonance imaging scans from an auditory language comprehension experiment to predict individual language recovery in 21 aphasic stroke patients. Subjects with an at least moderate language impairment received extensive language testing 2 weeks and 6 months after left-hemispheric stroke. A multivariate machine learning technique was used to predict language outcome 6 months after stroke. In addition, we aimed to predict the degree of language improvement over 6 months. 76% of patients were correctly separated into those with good and bad language performance 6 months after stroke when based on functional magnetic resonance imaging data from language relevant areas. Accuracy further improved (86% correct assignments) when age and language score were entered alongside functional magnetic resonance imaging data into the fully automatic classifier. A similar accuracy was reached when predicting the degree of language improvement based on imaging, age and language performance. No prediction better than chance level was achieved when exploring the usefulness of diffusion weighted imaging as well as functional magnetic resonance imaging acquired two days after stroke. This study demonstrates the high potential of current machine learning techniques to predict system-specific clinical outcome even for a disease as heterogeneous as stroke. Best prediction of language recovery is achieved when the brain activation potential after system-specific stimulation is assessed in the second week post stroke. More intensive early rehabilitation could be provided for those with a predicted poor recovery and the extension to other systems, for example, motor and attention seems feasible. PMID:20299389

  1. Vagal Regulation of Heart Rate in the Prediction of Developmental Outcome for Very Low Birth Weight Preterm Infants.

    ERIC Educational Resources Information Center

    Doussard-Roosevelt, Jane A.; And Others

    1997-01-01

    Used heart rate and respiratory sinus arrhythmia (RSA) assessed at 33 to 35 weeks gestational age to predict developmental outcome at 3 years for very low birth weight infants. Found that RSA measures predicted developmental outcome beyond effects of birth weight, medical risk, and socioeconomic status. For infants < 1,000 grams, RSA maturation…

  2. Development and optimization of SPECT gated blood pool cluster analysis for the prediction of CRT outcome

    SciTech Connect

    Lalonde, Michel Wassenaar, Richard; Wells, R. Glenn; Birnie, David; Ruddy, Terrence D.

    2014-07-15

    Purpose: Phase analysis of single photon emission computed tomography (SPECT) radionuclide angiography (RNA) has been investigated for its potential to predict the outcome of cardiac resynchronization therapy (CRT). However, phase analysis may be limited in its potential at predicting CRT outcome as valuable information may be lost by assuming that time-activity curves (TAC) follow a simple sinusoidal shape. A new method, cluster analysis, is proposed which directly evaluates the TACs and may lead to a better understanding of dyssynchrony patterns and CRT outcome. Cluster analysis algorithms were developed and optimized to maximize their ability to predict CRT response. Methods: About 49 patients (N = 27 ischemic etiology) received a SPECT RNA scan as well as positron emission tomography (PET) perfusion and viability scans prior to undergoing CRT. A semiautomated algorithm sampled the left ventricle wall to produce 568 TACs from SPECT RNA data. The TACs were then subjected to two different cluster analysis techniques, K-means, and normal average, where several input metrics were also varied to determine the optimal settings for the prediction of CRT outcome. Each TAC was assigned to a cluster group based on the comparison criteria and global and segmental cluster size and scores were used as measures of dyssynchrony and used to predict response to CRT. A repeated random twofold cross-validation technique was used to train and validate the cluster algorithm. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC) and compare results to those obtained for SPECT RNA phase analysis and PET scar size analysis methods. Results: Using the normal average cluster analysis approach, the septal wall produced statistically significant results for predicting CRT results in the ischemic population (ROC AUC = 0.73;p < 0.05 vs. equal chance ROC AUC = 0.50) with an optimal operating point of 71% sensitivity and 60% specificity. Cluster

  3. Tumour ablation: technical aspects

    PubMed Central

    Bodner, Gerd; Bale, Reto

    2009-01-01

    Abstract Image-guided percutaneous radiofrequency ablation (RFA) is a minimally invasive, relatively low-risk procedure for tumour treatment. Local recurrence and survival rates depend on the rate of complete ablation of the entire tumour including a sufficient margin of surrounding healthy tissue. Currently a variety of different RFA devices are available. The interventionalist must be able to predict the configuration and extent of the resulting ablation necrosis. Accurate planning and execution of RFA according to the size and geometry of the tumour is essential. In order to minimize complications, individualized treatment strategies may be necessary for tumours close to vital structures. This review examines the state-of-the art of different device technologies, approaches, and treatment strategies for percutaneous RFA of liver tumours. PMID:19965296

  4. Prediction of post-surgical seizure outcome in left mesial temporal lobe epilepsy☆

    PubMed Central

    Feis, Delia-Lisa; Schoene-Bake, Jan-Christoph; Elger, Christian; Wagner, Jan; Tittgemeyer, Marc; Weber, Bernd

    2013-01-01

    Mesial temporal lobe epilepsy is the most common type of focal epilepsy and in its course often becomes refractory to anticonvulsant pharmacotherapy. A resection of the mesial temporal lobe structures is a promising option in these cases. However, approximately 30% of all patients remain with persistent seizures after surgery. In other words, reliable criteria for patients' outcome prediction are absent. To address this limitation, we investigated pre-surgical brain morphology of patients with unilateral left mesial temporal lobe epilepsy who underwent a selective amygdalohippocampectomy. Using support vector classification, we aimed to predict the post-surgical seizure outcome of each patient based on the pre-surgical T1-weighted structural brain images. Due to morphological gender differences and the evidence that men and women differ in onset, prevalence and symptomology in most neurological diseases, we investigated male and female patients separately. Thus, we benefitted from the capability to validate the reliability of our method in two independent samples. Notably, we were able to accurately predict the individual patients' outcome in the male (94% balanced accuracy) as well as in the female (96% balanced accuracy) group. In the male cohort relatively larger white matter volumes in the favorable as compared to the non-favorable outcome group were identified bilaterally in the cingulum bundle, fronto-occipital fasciculus and both caudate nuclei, whereas the left inferior longitudinal fasciculus showed relatively larger white matter volume in the non-favorable group. While relatively larger white matter volumes in the female cohort in the left inferior and right middle longitudinal fasciculus were associated with the favorable outcome, relatively larger white matter volumes in the non-favorable outcome group were identified bilaterally in the superior longitudinal fasciculi I and II. Here, we observed a clear lateralization and distinction of structures

  5. DTI measures track and predict motor function outcomes in stroke rehabilitation utilizing BCI technology

    PubMed Central

    Song, Jie; Nair, Veena A.; Young, Brittany M.; Walton, Leo M.; Nigogosyan, Zack; Remsik, Alexander; Tyler, Mitchell E.; Farrar-Edwards, Dorothy; Caldera, Kristin E.; Sattin, Justin A.; Williams, Justin C.; Prabhakaran, Vivek

    2015-01-01

    Tracking and predicting motor outcomes is important in determining effective stroke rehabilitation strategies. Diffusion tensor imaging (DTI) allows for evaluation of the underlying structural integrity of brain white matter tracts and may serve as a potential biomarker for tracking and predicting motor recovery. In this study, we examined the longitudinal relationship between DTI measures of the posterior limb of the internal capsule (PLIC) and upper-limb motor outcomes in 13 stroke patients (median 20-month post-stroke) who completed up to 15 sessions of intervention using brain–computer interface (BCI) technology. Patients’ upper-limb motor outcomes and PLIC DTI measures including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) were assessed longitudinally at four time points: pre-, mid-, immediately post- and 1-month-post intervention. DTI measures and ratios of each DTI measure comparing the ipsilesional and contralesional PLIC were correlated with patients’ motor outcomes to examine the relationship between structural integrity of the PLIC and patients’ motor recovery. We found that lower diffusivity and higher FA values of the ipsilesional PLIC were significantly correlated with better upper-limb motor function. Baseline DTI ratios were significantly correlated with motor outcomes measured immediately post and 1-month-post BCI interventions. A few patients achieved improvements in motor recovery meeting the minimum clinically important difference (MCID). These findings suggest that upper-limb motor recovery in stroke patients receiving BCI interventions relates to the microstructural status of the PLIC. Lower diffusivity and higher FA measures of the ipsilesional PLIC contribute toward better motor recovery in the stroke-affected upper-limb. DTI-derived measures may be a clinically useful biomarker in tracking and predicting motor recovery in stroke patients receiving BCI interventions. PMID

  6. DTI measures track and predict motor function outcomes in stroke rehabilitation utilizing BCI technology.

    PubMed

    Song, Jie; Nair, Veena A; Young, Brittany M; Walton, Leo M; Nigogosyan, Zack; Remsik, Alexander; Tyler, Mitchell E; Farrar-Edwards, Dorothy; Caldera, Kristin E; Sattin, Justin A; Williams, Justin C; Prabhakaran, Vivek

    2015-01-01

    Tracking and predicting motor outcomes is important in determining effective stroke rehabilitation strategies. Diffusion tensor imaging (DTI) allows for evaluation of the underlying structural integrity of brain white matter tracts and may serve as a potential biomarker for tracking and predicting motor recovery. In this study, we examined the longitudinal relationship between DTI measures of the posterior limb of the internal capsule (PLIC) and upper-limb motor outcomes in 13 stroke patients (median 20-month post-stroke) who completed up to 15 sessions of intervention using brain-computer interface (BCI) technology. Patients' upper-limb motor outcomes and PLIC DTI measures including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) were assessed longitudinally at four time points: pre-, mid-, immediately post- and 1-month-post intervention. DTI measures and ratios of each DTI measure comparing the ipsilesional and contralesional PLIC were correlated with patients' motor outcomes to examine the relationship between structural integrity of the PLIC and patients' motor recovery. We found that lower diffusivity and higher FA values of the ipsilesional PLIC were significantly correlated with better upper-limb motor function. Baseline DTI ratios were significantly correlated with motor outcomes measured immediately post and 1-month-post BCI interventions. A few patients achieved improvements in motor recovery meeting the minimum clinically important difference (MCID). These findings suggest that upper-limb motor recovery in stroke patients receiving BCI interventions relates to the microstructural status of the PLIC. Lower diffusivity and higher FA measures of the ipsilesional PLIC contribute toward better motor recovery in the stroke-affected upper-limb. DTI-derived measures may be a clinically useful biomarker in tracking and predicting motor recovery in stroke patients receiving BCI interventions. PMID:25964753

  7. Predicting Outcome after Pediatric Traumatic Brain Injury by Early Magnetic Resonance Imaging Lesion Location and Volume.

    PubMed

    Smitherman, Emily; Hernandez, Ana; Stavinoha, Peter L; Huang, Rong; Kernie, Steven G; Diaz-Arrastia, Ramon; Miles, Darryl K

    2016-01-01

    Brain lesions after traumatic brain injury (TBI) are heterogeneous, rendering outcome prognostication difficult. The aim of this study is to investigate whether early magnetic resonance imaging (MRI) of lesion location and lesion volume within discrete brain anatomical zones can accurately predict long-term neurological outcome in children post-TBI. Fluid-attenuated inversion recovery (FLAIR) MRI hyperintense lesions in 63 children obtained 6.2±5.6 days postinjury were correlated with the Glasgow Outcome Scale Extended-Pediatrics (GOS-E Peds) score at 13.5±8.6 months. FLAIR lesion volume was expressed as hyperintensity lesion volume index (HLVI)=(hyperintensity lesion volume / whole brain volume)×100 measured within three brain zones: zone A (cortical structures); zone B (basal ganglia, corpus callosum, internal capsule, and thalamus); and zone C (brainstem). HLVI-total and HLVI-zone C predicted good and poor outcome groups (p<0.05). GOS-E Peds correlated with HLVI-total (r=0.39; p=0.002) and HLVI in all three zones: zone A (r=0.31; p<0.02); zone B (r=0.35; p=0.004); and zone C (r=0.37; p=0.003). In adolescents ages 13-17 years, HLVI-total correlated best with outcome (r=0.5; p=0.007), whereas in younger children under the age of 13, HLVI-zone B correlated best (r=0.52; p=0.001). Compared to patients with lesions in zone A alone or in zones A and B, patients with lesions in all three zones had a significantly higher odds ratio (4.38; 95% confidence interval, 1.19-16.0) for developing an unfavorable outcome. PMID:25808802

  8. Patient factors predict functional outcomes after cruciate retaining TKA: a 2-year follow-up analysis.

    PubMed

    Roth, Justin S; Buehler, Knute C; Shen, Jianhua; Naughton, Marybeth

    2013-09-01

    We analyzed preoperative patient characteristics and postoperative functional outcomes to identify the most predictive preoperative characteristics of postoperative functional outcome for Cruciate Retaining (CR) TKA. In a prospective, multicenter study, 307 knees with minimum 2-year follow-up were first divided into groups based on 2-year functional performance. Logistic regression then determined SF-36 General Health Score (GHS) to be the most predictive preoperative patient characteristic. Subsequently, a second analysis was performed using preoperative SF-36 GHS to stratify patients into groups. Statistical significance was achieved in both analyses by gender, BMI and hypertension. Statistical significance was achieved in a single analysis by age, preoperative narcotic use, preoperative metabolic medication usage, preoperative pulmonary disease and preoperative use of medication for anxiety or depression. PMID:23523205

  9. Mental health predicts better academic outcomes: a longitudinal study of elementary school students in Chile.

    PubMed

    Murphy, J Michael; Guzmán, Javier; McCarthy, Alyssa E; Squicciarini, Ana María; George, Myriam; Canenguez, Katia M; Dunn, Erin C; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W; Jellinek, Michael S

    2015-04-01

    The world's largest school-based mental health program, Habilidades para la Vida [Skills for Life (SFL)], has been operating on a national scale in Chile for 15 years. SFL's activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL's data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students' academic outcomes. PMID:24771270

  10. Mental health predicts better academic outcomes: A longitudinal study of elementary school students in Chile

    PubMed Central

    Murphy, J. Michael; Guzmán, Javier; McCarthy, Alyssa; Squicciarini, Ana María; George, Myriam; Canenguez, Katia; Dunn, Erin C.; Baer, Lee; Simonsohn, Ariela; Smoller, Jordan W.; Jellinek, Michael

    2015-01-01

    The world’s largest school-based mental health program, Habilidades para la Vida [Skills for Life, SFL], has been operating at a national scale in Chile for fifteen years. SFL’s activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL’s data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students’ academic outcomes. PMID:24771270

  11. Comparing predicted and actual affective responses to process versus outcome: an emotion-as-feedback perspective.

    PubMed

    Kwong, Jessica Y Y; Wong, Kin Fai Ellick; Tang, Suki K Y

    2013-10-01

    One of the conjectures in affective forecasting literature is that people are advised to discount their anticipated emotions because their forecasts are often inaccurate. The present research distinguishes between emotional reactions to process versus those to outcome, and highlights an alternative view that affective misforecasts could indeed be adaptive to goal pursuit. Using an ultimatum game, Study 1 showed that people overpredicted how much they would regret and be disappointed by the amount of effort they exerted, should the outcomes turned out worse than expected; nonetheless, people could accurately predict their emotional responses to unfavorable outcomes per se. In a natural setting of a university examination, Study 2 demonstrated that actual regret and disappointment toward favorable outcomes were more intense than the level people expected, but this discrepancy was not observed in their emotional responses to efforts they had invested. These two distinct patterns of results substantiate the argument that the deviation between predicted and actual emotions is dependent on the referents of the emotional reactions. PMID:23831563

  12. Remote health monitoring: predicting outcome success based on contextual features for cardiovascular disease.

    PubMed

    Alshurafa, Nabil; Eastwood, Jo-Ann; Pourhomayoun, Mohammad; Liu, Jason J; Sarrafzadeh, Majid

    2014-01-01

    Current studies have produced a plethora of remote health monitoring (RHM) systems designed to enhance the care of patients with chronic diseases. Many RHM systems are designed to improve patient risk factors for cardiovascular disease, including physiological parameters such as body mass index (BMI) and waist circumference, and lipid profiles such as low density lipoprotein (LDL) and high density lipoprotein (HDL). There are several patient characteristics that could be determining factors for a patient's RHM outcome success, but these characteristics have been largely unidentified. In this paper, we analyze results from an RHM system deployed in a six month Women's Heart Health study of 90 patients, and apply advanced feature selection and machine learning algorithms to identify patients' key baseline contextual features and build effective prediction models that help determine RHM outcome success. We introduce Wanda-CVD, a smartphone-based RHM system designed to help participants with cardiovascular disease risk factors by motivating participants through wireless coaching using feedback and prompts as social support. We analyze key contextual features that secure positive patient outcomes in both physiological parameters and lipid profiles. Results from the Women's Heart Health study show that health threat of heart disease, quality of life, family history, stress factors, social support, and anxiety at baseline all help predict patient RHM outcome success. PMID:25570321

  13. Selecting radiomic features from FDG-PET images for cancer treatment outcome prediction.

    PubMed

    Lian, Chunfeng; Ruan, Su; Denœux, Thierry; Jardin, Fabrice; Vera, Pierre

    2016-08-01

    As a vital task in cancer therapy, accurately predicting the treatment outcome is valuable for tailoring and adapting a treatment planning. To this end, multi-sources of information (radiomics, clinical characteristics, genomic expressions, etc) gathered before and during treatment are potentially profitable. In this paper, we propose such a prediction system primarily using radiomic features (e.g., texture features) extracted from FDG-PET images. The proposed system includes a feature selection method based on Dempster-Shafer theory, a powerful tool to deal with uncertain and imprecise information. It aims to improve the prediction accuracy, and reduce the imprecision and overlaps between different classes (treatment outcomes) in a selected feature subspace. Considering that training samples are often small-sized and imbalanced in our applications, a data balancing procedure and specified prior knowledge are taken into account to improve the reliability of the selected feature subsets. Finally, the Evidential K-NN (EK-NN) classifier is used with selected features to output prediction results. Our prediction system has been evaluated by synthetic and clinical datasets, consistently showing good performance. PMID:27236221

  14. A novel embryonic plasticity gene signature that predicts metastatic competence and clinical outcome

    PubMed Central

    Soundararajan, Rama; Paranjape, Anurag N.; Barsan, Valentin; Chang, Jeffrey T.; Mani, Sendurai A.

    2015-01-01

    Currently, very few prognosticators accurately predict metastasis in cancer patients. In order to complete the metastatic cascade and successfully colonize distant sites, carcinoma cells undergo dynamic epithelial-mesenchymal-transition (EMT) and its reversal, mesenchymal-epithelial-transition (MET). While EMT-centric signatures correlate with response to therapy, they are unable to predict metastatic outcome. One reason is due to the wide range of transient phenotypes required for a tumor cell to disseminate and recreate a similar histology at distant sites. Since such dynamic cellular processes are also seen during embryo development (epithelial-like epiblast cells undergo transient EMT to generate the mesoderm, which eventually redifferentiates into epithelial tissues by MET), we sought to utilize this unique and highly conserved property of cellular plasticity to predict metastasis. Here we present the identification of a novel prognostic gene expression signature derived from mouse embryonic day 6.5 that is representative of extensive cellular plasticity, and predicts metastatic competence in human breast tumor cells. This signature may thus complement conventional clinical parameters to offer accurate prediction for outcome among multiple classes of breast cancer patients. PMID:26123483

  15. Structural connectome disruption at baseline predicts 6-months post-stroke outcome.

    PubMed

    Kuceyeski, Amy; Navi, Babak B; Kamel, Hooman; Raj, Ashish; Relkin, Norman; Toglia, Joan; Iadecola, Costantino; O'Dell, Michael

    2016-07-01

    In this study, models based on quantitative imaging biomarkers of post-stroke structural connectome disruption were used to predict six-month outcomes in various domains. Demographic information and clinical MRIs were collected from 40 ischemic stroke subjects (age: 68.1 ± 13.2 years, 17 female, NIHSS: 6.8 ± 5.6). Diffusion-weighted images were used to create lesion masks, which were uploaded to the Network Modification (NeMo) Tool. The NeMo Tool, using only clinical MRIs, allows estimation of connectome disruption at three levels: whole brain, individual gray matter regions and between pairs of gray matter regions. Partial Least Squares Regression models were constructed for each level of connectome disruption and for each of the three six-month outcomes: applied cognitive, basic mobility and daily activity. Models based on lesion volume were created for comparison. Cross-validation, bootstrapping and multiple comparisons corrections were implemented to minimize over-fitting and Type I errors. The regional disconnection model best predicted applied cognitive (R(2)  = 0.56) and basic mobility outcomes (R(2)  = 0.70), while the pairwise disconnection model best predicted the daily activity measure (R(2)  = 0.72). These results demonstrate that models based on connectome disruption metrics were more accurate than ones based on lesion volume and that increasing anatomical specificity of disconnection metrics does not always increase model accuracy, likely due to statistical adjustments for concomitant increases in data dimensionality. This work establishes that the NeMo Tool's measures of baseline connectome disruption, acquired using only routinely collected MRI scans, can predict 6-month post-stroke outcomes in various functional domains including cognition, motor function and daily activities. Hum Brain Mapp, 2016. © 2016 Wiley Periodicals, Inc. PMID:27016287

  16. Driving Errors in Parkinson’s Disease: Moving Closer to Predicting On-Road Outcomes

    PubMed Central

    Brumback, Babette; Monahan, Miriam; Malaty, Irene I.; Rodriguez, Ramon L.; Okun, Michael S.; McFarland, Nikolaus R.

    2014-01-01

    Age-related medical conditions such as Parkinson’s disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age = 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age = 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), χ2(1) = 35.54, HC N = 138, PD N = 99, p < .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R2 =.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t(61) = 7.004, p < .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so. PMID:24367958

  17. Cortical surface biomarkers for predicting cognitive outcomes using group l2,1 norm.

    PubMed

    Yan, Jingwen; Li, Taiyong; Wang, Hua; Huang, Heng; Wan, Jing; Nho, Kwangsik; Kim, Sungeun; Risacher, Shannon L; Saykin, Andrew J; Shen, Li

    2015-01-01

    Regression models have been widely studied to investigate the prediction power of neuroimaging measures as biomarkers for inferring cognitive outcomes in the Alzheimer's disease study. Most of these models ignore the interrelated structures either within neuroimaging measures or between cognitive outcomes, and thus may have limited power to yield optimal solutions. To address this issue, we propose to use a new sparse multitask learning model called Group-Sparse Multi-task Regression and Feature Selection (G-SMuRFS) and demonstrate its effectiveness by examining the predictive power of detailed cortical thickness measures toward 3 types of cognitive scores in a large cohort. G-SMuRFS proposes a group-level l2,1-norm strategy to group relevant features together in an anatomically meaningful manner and use this prior knowledge to guide the learning process. This approach also takes into account the correlation among cognitive outcomes for building a more appropriate predictive model. Compared with traditional methods, G-SMuRFS not only demonstrates a superior performance but also identifies a small set of surface markers that are biologically meaningful. PMID:25444599

  18. Early seizures in patients with acute stroke: Frequency, predictive factors, and effect on clinical outcome

    PubMed Central

    Alberti, Andrea; Paciaroni, Maurizio; Caso, Valeria; Venti, Michele; Palmerini, Francesco; Agnelli, Giancarlo

    2008-01-01

    Background Early seizure (ES) may complicate the clinical course of patients with acute stroke. The aim of this study was to assess the rate of and the predictive factors for ES as well the effects of ES on the clinical outcome at hospital discharge in patients with first-ever stroke. Patients and methods A total of 638 consecutive patients with first-ever stroke (543 ischemic, 95 hemorrhagic), admitted to our Stroke Unit, were included in this prospective study. ES were defined as seizures occurring within 7 days from acute stroke. Patients with history of epilepsy were excluded. Results Thirty-one patients (4.8%) had ES. Seizures were significantly more common in patients with cortical involvement, severe and large stroke, and in patient with cortical hemorrhagic transformation of ischemic stroke. ES was not associated with an increase in adverse outcome (mortality and disability). After multivariate analysis, hemorrhagic transformation resulted as an independent predictive factor for ES (OR = 6.5; 95% CI: 1.95–22.61; p = 0.003). Conclusion ES occur in about 5% of patients with acute stroke. In these patients hemorrhagic transformation is a predictive factor for ES. ES does not seem to be associated with an adverse outcome at hospital discharge after acute stroke. PMID:18827922

  19. Altruistic traits are predicted by neural responses to monetary outcomes for self vs charity.

    PubMed

    San Martín, René; Kwak, Youngbin; Pearson, John M; Woldorff, Marty G; Huettel, Scott A

    2016-06-01

    Human altruism is often expressed through charitable donation-supporting a cause that benefits others in society, at cost to oneself. The underlying mechanisms of this other-regarding behavior remain imperfectly understood. By recording event-related-potential (ERP) measures of brain activity from human participants during a social gambling task, we identified markers of differential responses to receipt of monetary outcomes for oneself vs for a charitable cause. We focused our ERP analyses on the frontocentral feedback-related negativity (FRN) and three subcomponents of the attention-related P300 (P3) brain wave: the frontocentral P2 and P3a and the parietal P3b. The FRN distinguished between gains and losses for both self and charity outcomes. Importantly, this effect of outcome valence was greater for self than charity for both groups and was independent of two altruism-related measures: participants' pre-declared intended donations and the actual donations resulting from their choices. In contrast, differences in P3 subcomponents for outcomes for self vs charity strongly predicted both of our laboratory measures of altruism-as well as self-reported engagement in real-life altruistic behaviors. These results indicate that individual differences in altruism are linked to individual differences in the relative deployment of attention (as indexed by the P3) toward outcomes affecting other people. PMID:27030510

  20. Does impulsivity predict outcome in treatment for binge eating disorder? A multimodal investigation.

    PubMed

    Manasse, Stephanie M; Espel, Hallie M; Schumacher, Leah M; Kerrigan, Stephanie G; Zhang, Fengqing; Forman, Evan M; Juarascio, Adrienne S

    2016-10-01

    Multiple dimensions of impulsivity (e.g., affect-driven impulsivity, impulsive inhibition - both general and food-specific, and impulsive decision-making) are associated with binge eating pathology cross-sectionally, yet the literature on whether impulsivity predicts treatment outcome is limited. The present pilot study explored impulsivity-related predictors of 20-week outcome in a small open trial (n = 17) of a novel treatment for binge eating disorder. Overall, dimensions of impulsivity related to emotions (i.e., negative urgency) and food cues emerged as predictors of treatment outcomes (i.e., binge eating frequency and global eating pathology as measured by the Eating Disorders Examination), while more general measures of impulsivity were statistically unrelated to global eating pathology or binge frequency. Specifically, those with higher levels of negative urgency at baseline experienced slower and less pronounced benefit from treatment, and those with higher food-specific impulsivity had more severe global eating pathology at baseline that was consistent at post-treatment and follow-up. These preliminary findings suggest that patients high in negative urgency and with poor response inhibition to food cues may benefit from augmentation of existing treatments to achieve optimal outcomes. Future research will benefit from replication with a larger sample, parsing out the role of different dimensions of impulsivity in treatment outcome for eating disorders, and identifying how treatment can be improved to accommodate higher levels of baseline impulsivity. PMID:27230611

  1. Microsimulation Model Predicts Survival Benefit of Radiofrequency Ablation and Stereotactic Body Radiotherapy Versus Radiotherapy for Treating Inoperable Stage I Non–Small Cell Lung Cancer

    PubMed Central

    Tramontano, Angela C.; Cipriano, Lauren E.; Kong, Chung Yin; Shepard, Jo-Anne O.; Lanuti, Michael; Gazelle, G. Scott; McMahon, Pamela M.

    2013-01-01

    OBJECTIVE A subset of patients with stage IA and IB non–small cell lung cancer (NSCLC) is ineligible for surgical resection and undergoes radiation therapy. Radiofrequency ablation (RFA) and stereotactic body radiotherapy are newer potentially attractive alternative therapies. MATERIALS AND METHODS We added RFA and stereotactic body radiotherapy treatment modules to a microsimulation model that simulates lung cancer’s natural history, detection, and treatment. Natural history parameters were previously estimated via calibration against tumor registry data and cohort studies; the model was validated with screening study and cohort data. RFA model parameters were calibrated against 2-year survival from the Radiofrequency Ablation of Pulmonary Tumor Response Evaluation (RAPTURE) study, and stereotactic body radiotherapy model parameters were calibrated against 3-year survival from a phase 2 prospective trial. We simulated lifetime histories of identical patients with early-stage NSCLC who were ineligible for resection, who were treated with radiation therapy, RFA, or stereotactic body radiotherapy under a range of scenarios. From 5,000,000 simulated individuals, we selected a cohort of patients with stage I medically inoperable cancer for analysis (n = 2056 per treatment scenario). Main outcomes were life expectancy gains. RESULTS RFA or stereotactic body radiotherapy treatment in patients with peripheral stage IA or IB NSCLC who were nonoperative candidates resulted in life expectancy gains of 1.71 and 1.46 life-years, respectively, compared with universal radiation therapy. A strategy where patients with central tumors underwent stereotactic body radiotherapy and those with peripheral tumors underwent RFA resulted in a gain of 2.02 life-years compared with universal radiation therapy. Findings were robust with respect to changes in model parameters. CONCLUSION Microsimulation modeling results suggest that RFA and stereotactic body radiotherapy could provide life

  2. Usefulness of Midregional Proadrenomedullin to Predict Poor Outcome in Patients with Community Acquired Pneumonia

    PubMed Central

    Gordo-Remartínez, Susana; Sevillano-Fernández, José A.; Álvarez-Sala, Luis A.; Andueza-Lillo, Juan A.; de Miguel-Yanes, José M.

    2015-01-01

    Background midregional proadrenomedullin (MR-proADM) is a prognostic biomarker in patients with community-acquired pneumonia (CAP). We sought to confirm whether MR-proADM added to Pneumonia Severity Index (PSI) improves the potential prognostic value of PSI alone, and tested to what extent this combination could be useful in predicting poor outcome of patients with CAP in an Emergency Department (ED). Methods Consecutive patients diagnosed with CAP were enrolled in this prospective, single-centre, observational study. We analyzed the ability of MR-proADM added to PSI to predict poor outcome using receiver operating characteristic (ROC) curves, logistic regression and risk reclassification and comparing it with the ability of PSI alone. The primary outcome was “poor outcome”, defined as the incidence of an adverse event (ICU admission, hospital readmission, or mortality at 30 days after CAP diagnosis). Results 226 patients were included; 33 patients (14.6%) reached primary outcome. To predict primary outcome the highest area under curve (AUC) was found for PSI (0.74 [0.64-0.85]), which was not significantly higher than for MR-proADM (AUC 0.72 [0.63-0.81, p > 0.05]). The combination of PSI and MR-proADM failed to improve the predictive potential of PSI alone (AUC 0.75 [0.65-0.85, p=0.56]). Ten patients were appropriately reclassified when the combined PSI and MR-proADM model was used as compared with the model of PSI alone. Net reclassification improvement (NRI) index was statistically significant (7.69%, p = 0.03) with an improvement percentage of 3.03% (p = 0.32) for adverse event, and 4.66% (P = 0.02) for no adverse event. Conclusion MR-proADM in combination with PSI may be helpful in individual risk stratification for short-term poor outcome of CAP patients, allowing a better reclassification of patients compared with PSI alone. PMID:26030588

  3. Prediction of Functional Outcome in Individuals at Clinical High Risk for Psychosis

    PubMed Central

    Carrión, Ricardo E.; McLaughlin, Danielle; Goldberg, Terry E.; Auther, Andrea M.; Olsen, Ruth H.; Olvet, Doreen M.; Correll, Christoph U.; Cornblatt, Barbara A.

    2014-01-01

    Importance A major public health concern associated with schizophrenia and psychotic disorders is the long-term disability that involves impaired cognition, lack of social support, and an inability to function independently in the community. A critical goal of early detection and intervention studies in psychosis is therefore to understand the factors leading to this often profound impairment. Objective To develop a predictive model of functional (social and role) outcome in a clinical high-risk sample for psychosis. Design Prospective, naturalistic, longitudinal 3- to 5-year follow-up study. Setting The Recognition and Prevention Program in New York, a research clinic located in the Zucker Hillside Hospital in New York. Participants One hundred one treatment-seeking patients at clinical high risk for psychosis. Ninety-two (91%) were followed up prospectively for a mean (SD) of 3 (1.6) years. Intervention Neurocognitive and clinical assessment. Main Outcomes and Measures The primary outcome variables were social and role functioning at the last follow-up visit. Results Poor social outcome was predicted by reduced processing speed (odds ratio [OR], 1.38; 95% CI, 1.050-1.823; P = .02), impaired social functioning at baseline (OR, 1.85; 95% CI, 1.258-2.732; P = .002), and total disorganized symptoms (OR, 5.06; 95% CI, 1.548-16.527; P = .007). Reduced performance on tests for verbal memory (OR, 1.74; 95% CI, 1.169-2.594; P = .006), role functioning at baseline (OR, 1.34; 95% CI, 1.053-1.711; P = .02), and motor disturbances (OR, 1.77; 95% CI, 1.060-2.969; P = .03) predicted role outcome. The areas under the curve for the social and role prediction models were 0.824 (95% CI, 0.736-0.913; P < .001) and 0.77 (95% CI, 0.68-0.87; P < .001), respectively, demonstrating a high discriminative ability. In addition, poor functional outcomes were not entirely dependent on the development of psychosis, because 40.3% and 45.5% of nonconverters at clinical high risk had poor social

  4. Prediction of insemination outcomes in Holstein dairy cattle using alternative machine learning algorithms.

    PubMed

    Shahinfar, Saleh; Page, David; Guenther, Jerry; Cabrera, Victor; Fricke, Paul; Weigel, Kent

    2014-02-01

    When making the decision about whether or not to breed a given cow, knowledge about the expected outcome would have an economic impact on profitability of the breeding program and net income of the farm. The outcome of each breeding can be affected by many management and physiological features that vary between farms and interact with each other. Hence, the ability of machine learning algorithms to accommodate complex relationships in the data and missing values for explanatory variables makes these algorithms well suited for investigation of reproduction performance in dairy cattle. The objective of this study was to develop a user-friendly and intuitive on-farm tool to help farmers make reproduction management decisions. Several different machine learning algorithms were applied to predict the insemination outcomes of individual cows based on phenotypic and genotypic data. Data from 26 dairy farms in the Alta Genetics (Watertown, WI) Advantage Progeny Testing Program were used, representing a 10-yr period from 2000 to 2010. Health, reproduction, and production data were extracted from on-farm dairy management software, and estimated breeding values were downloaded from the US Department of Agriculture Agricultural Research Service Animal Improvement Programs Laboratory (Beltsville, MD) database. The edited data set consisted of 129,245 breeding records from primiparous Holstein cows and 195,128 breeding records from multiparous Holstein cows. Each data point in the final data set included 23 and 25 explanatory variables and 1 binary outcome for of 0.756 ± 0.005 and 0.736 ± 0.005 for primiparous and multiparous cows, respectively. The naïve Bayes algorithm, Bayesian network, and decision tree algorithms showed somewhat poorer classification performance. An information-based variable selection procedure identified herd average conception rate, incidence of ketosis, number of previous (failed) inseminations, days in milk at breeding, and mastitis as the most

  5. Using predator-prey theory to predict outcomes of broadscale experiments to reduce apparent competition.

    PubMed

    Serrouya, Robert; Wittmann, Meike J; McLellan, Bruce N; Wittmer, Heiko U; Boutin, Stan

    2015-05-01

    Apparent competition is an important process influencing many ecological communities. We used predator-prey theory to predict outcomes of ecosystem experiments aimed at mitigating apparent competition by reducing primary prey. Simulations predicted declines in secondary prey following reductions in primary prey because predators consumed more secondary prey until predator numbers responded to reduced prey densities. Losses were exacerbated by a higher carrying capacity of primary prey and a longer lag time of the predator's numerical response, but a gradual reduction in primary prey was less detrimental to the secondary prey. We compared predictions against two field experiments where endangered woodland caribou (Rangifer tarandus caribou) were victims of apparent competition. First, when deer (Odocoileus sp.) declined suddenly following a severe winter, cougar (Puma concolor) declined with a 1-2-year lag, yet in the interim more caribou were killed by cougars, and caribou populations declined by 40%. Second, when moose (Alces alces) were gradually reduced using a management experiment, wolf (Canis lupus) populations declined but did not shift consumption to caribou, and the largest caribou subpopulation stabilized. The observed contrasting outcomes of sudden versus gradual declines in primary prey supported theoretical predictions. Combining theory with field studies clarified how to manage communities to mitigate endangerment caused by apparent competition that affects many taxa. PMID:25905509

  6. Time course of thrombocytes in burn patients and its predictive value for outcome.

    PubMed

    Marck, Roos Elisabeth; Montagne, Harriet Leonie; Tuinebreijer, Willem Eduard; Breederveld, Roelf Simon

    2013-06-01

    Thrombocytopenia is common in trauma and critically ill patients and is associated with a poor outcomes. The objective of this retrospective study was to investigate the course of thrombocyte concentration changes in burn patients, the influences of various factors on this course, and a possible predictive value of thrombocyte counts on outcome in 244 patients admitted to our burn centre. Their thrombocyte counts were obtained until 50 days after burn. Data on patient demographics, total percentage burned surface area (%TBSA), sepsis and mortality were collected. Multilevel multivariable analysis was performed to investigate the influence of the variables on the platelet course. Cox regression analysis was performed to analyse the predictive value of the variables for mortality. A distinct pattern of thrombocyte counts was observed, with a nadir at day 3 followed by a peak at day 15 and a temporary thrombocytosis. %TBSA and age (p<0.05) influence this course. The mean thrombocyte course of septic and non-surviving patients depicts a significant lower nadir. Furthermore, higher age, %TBSA and low thrombocyte counts at the peak are predictive for 50 day mortality (p<0.05). Platelets follow a distinct course after burn, influenced by %TBSA and age. These factors and a low thrombocyte peak count predict mortality. PMID:23490002

  7. Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis.

    PubMed

    Gillick, K; Elbeltagi, H; Bhattacharya, S

    2016-01-01

    Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients' general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann-Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of disease

  8. Predictive Factors Affecting Long-Term Outcome of Unilateral Lateral Rectus Recession

    PubMed Central

    Yang, Hee Kyung; Kim, Mi-Jin; Hwang, Jeong-Min

    2015-01-01

    Background There are few long-term outcome reports of unilateral lateral rectus (LR) recession for exotropia including a large number of subjects. Previous reports on unilateral LR recession commonly show extremely low rates of initial overcorrection and large exodrifts after surgery suggesting that the surgical dose may be increased. However, little is known of the long-term outcome of a large unilateral LR recession for exotropia. Objectives To determine long-term outcomes and predictive factors of recurrence after a large unilateral LR recession in patients with exotropia. Data Extraction Retrospective analysis was performed on 92 patients aged 3 to 17 years who underwent 10 mm unilateral LR recession for exotropia of ≤ 25 prism diopters (Δ) with prism and alternate cover testing and were followed up for more than 2 years after surgery. Final success rates within 10Δ of exophoria/tropia and 5Δ of esophoria/tropia at distance in the primary position, improvement in stereopsis and the predictive factors for recurrence were evaluated. Results At 24 months after surgery, 54% of patients had ocular alignment meeting the defined criteria of success, 45% had recurrence and 1% had overcorrection. After a mean follow-up of 39 months, 36% showed success, 63% showed recurrence and 1% resulted in overcorrection. The average time of recurrence was 23.4±14.7 months (range, 1–60 months) and the rate of recurrence per person-year was 23% after unilateral LR recession. Predictive factors of recurrence were a larger preoperative near angle of deviation (>16Δ) and larger initial postoperative exodeviation (>5Δ) at distance. Conclusions Long-term outcome of unilateral LR recession for exotropia showed low success rates with high recurrence, thus should be reserved for patients with a small preoperative near angle of exodeviation. PMID:26418819

  9. Automated prediction of tissue outcome after acute ischemic stroke in computed tomography perfusion images

    NASA Astrophysics Data System (ADS)

    Vos, Pieter C.; Bennink, Edwin; de Jong, Hugo; Velthuis, Birgitta K.; Viergever, Max A.; Dankbaar, Jan Willem

    2015-03-01

    Assessment of the extent of cerebral damage on admission in patients with acute ischemic stroke could play an important role in treatment decision making. Computed tomography perfusion (CTP) imaging can be used to determine the extent of damage. However, clinical application is hindered by differences among vendors and used methodology. As a result, threshold based methods and visual assessment of CTP images has not yet shown to be useful in treatment decision making and predicting clinical outcome. Preliminary results in MR studies have shown the benefit of using supervised classifiers for predicting tissue outcome, but this has not been demonstrated for CTP. We present a novel method for the automatic prediction of tissue outcome by combining multi-parametric CTP images into a tissue outcome probability map. A supervised classification scheme was developed to extract absolute and relative perfusion values from processed CTP images that are summarized by a trained classifier into a likelihood of infarction. Training was performed using follow-up CT scans of 20 acute stroke patients with complete recanalization of the vessel that was occluded on admission. Infarcted regions were annotated by expert neuroradiologists. Multiple classifiers were evaluated in a leave-one-patient-out strategy for their discriminating performance using receiver operating characteristic (ROC) statistics. Results showed that a RandomForest classifier performed optimally with an area under the ROC of 0.90 for discriminating infarct tissue. The obtained results are an improvement over existing thresholding methods and are in line with results found in literature where MR perfusion was used.

  10. Fragmentation and high entropy of neonatal experience predict adolescent emotional outcome.

    PubMed

    Molet, J; Heins, K; Zhuo, X; Mei, Y T; Regev, L; Baram, T Z; Stern, H

    2016-01-01

    Vulnerability to emotional disorders including depression derives from interactions between genes and environment, especially during sensitive developmental periods. Across evolution, maternal care is a key source of environmental sensory signals to the developing brain, and a vast body of work has linked quantitative and qualitative aspects of maternal care to emotional outcome in children and animals. However, the fundamental properties of maternal signals, that promote advantageous vs pathological outcomes in the offspring, are unknown and have been a topic of intense study. We studied emotional outcomes of adolescent rats reared under routine or impoverished environments, and used mathematical approaches to analyze the nurturing behaviors of the dams. Unexpectedly, whereas the quantity and typical qualities of maternal care behaviors were indistinguishable in the two environments, their patterns and rhythms differed drastically and influenced emotional outcomes. Specifically, unpredictable, fragmented maternal care patterns translated into high-entropy rates of sensory signals to the offspring in the impoverished cages. During adolescence, these offspring had significant reductions in sucrose preference and in peer-play, two independent measures of the ability to experience pleasure. This adolescent anhedonia, often a harbinger of later depression, was not accompanied by measures of anxiety or helplessness. Dopaminergic pleasure circuits underlying anhedonia are engaged by predictable sequences of events, and predictable sensory signals during neonatal periods may be critical for their maturation. Conversely, unpredictability maternal-derived signals may disrupt these developmental processes, provoking anhedonia. In sum, high-entropy and fragmented patterns of maternal-derived sensory input to the developing brain predicts, and might promote, the development of anhedonia in rodents, with potential clinical implications. PMID:26731439

  11. Ablative therapies in renal cell carcinoma.

    PubMed

    Chan, A A; Ahrar, K; Matin, S F

    2011-09-01

    We reviewed the use of ablative therapies in the management of renal cell carcinoma. We performed a PubMed search of the English language literature using the keywords "ablation" and "renal carcinoma." Pertinent articles specific to the technologic advancement of ablative therapy and clinical outcomes were selected for review. Intermediate-term oncologic outcomes of cryoablation and radiofrequency ablation are acceptable but are not quite as good as for surgical excision based nearly all on retrospective studies. No randomized studies have been performed comparing excisional and ablative therapies. Careful selection of patients and tumor characteristics results in improved outcomes. Diagnostic biopsy for tissue confirmation is mandatory and should even be considered post therapy after 6-12 months in patients with a concern about recurrence. Ablative therapies are associated with decreased morbidity, less severe complication rates, and excellent preservation of renal function in comparison with surgical excision. The majority of recurrences occur early, but long-term surveillance is required as delayed recurrences are also possible and the long-term oncologic efficacy is not yet established. Ablation can be delivered percutaneously or laparoscopically, and the superiority of one over the other remains controversial. The percutaneous approach is more cost effective and causes less perinephric desmoplasia. Nearly all data on ablation are retrospective and, with few exceptions, from single institutions. Ablative therapy is an appealing option for the management of small renal tumors shown to be renal cell carcinoma on biopsy in patients who are unsuitable candidates for surgical extirpation. PMID:21993322

  12. Validation of an immunohistochemical signature predictive of 8-year outcome for patients with breast carcinoma.

    PubMed

    Charpin, Colette; Tavassoli, Fattaneh; Secq, Véronique; Giusiano, Sophie; Villeret, Julia; Garcia, Stéphane; Birnbaum, Daniel; Bonnier, Pascal; Lavaut, Marie-Noëlle; Boubli, Léon; Carcopino, Xavier; Iovanna, Juan

    2012-08-01

    We recently reported that standardized quantitative immunohistochemical (IHC) assays allowed prediction of an adverse outcome among 572 node negative (N-) patients with breast carcinoma (BrCa). To further validate our prior findings, we repeated the IHC stains including a second series of BrCa diagnosed at Yale University. Tissue microarrays (TMAs) of two cohorts of patients with BrCa (418 Marseille University and 303 Yale University) were respectively investigated for IHC expression of 15 markers (HIF-1α, PI3K, pAKT, pmTOR, moesin, P21, 4(E) BP-1, P27, Ker5-6, pMAPKAPK-2, SHARP2, claudin-1, ALDH, AF6 and CD24). Quantitative measurements of immunoprecipitates densitometry assessed with an image analyzer were correlated with 8-year patients' outcome and compared in the two cohorts. The best predictive signature consisted of a combination of five markers that included HIF-1α, PI3K, claudin-1, AF6 and pAKT in N- BrCa. This combination permitted an accurate prediction of outcome in 92.34% (386/418) of N- patients in the first set (Marseille) and 89.8% (158/176) in the second set (Yale). The close results in both cohorts confirmed the validity of this original IHC signature predictive of prognosis in node negative BrCa. This validation suggests that in clinical practice, it would be possible with standardized kits (i) to identify patients with poor prognosis at diagnosis time, particularly in the N- BrCa subset, who would require more aggressive adjuvant therapy and (ii) to avoid useless expensive therapies and their side effects in N- patients with favorable prognosis. PMID:22120430

  13. Developing and Testing a Model to Predict Outcomes of Organizational Change

    PubMed Central

    Gustafson, David H; Sainfort, François; Eichler, Mary; Adams, Laura; Bisognano, Maureen; Steudel, Harold

    2003-01-01

    Objective To test the effectiveness of a Bayesian model employing subjective probability estimates for predicting success and failure of health care improvement projects. Data Sources Experts' subjective assessment data for model development and independent retrospective data on 221 healthcare improvement projects in the United States, Canada, and the Netherlands collected between 1996 and 2000 for validation. Methods A panel of theoretical and practical experts and literature in organizational change were used to identify factors predicting the outcome of improvement efforts. A Bayesian model was developed to estimate probability of successful change using subjective estimates of likelihood ratios and prior odds elicited from the panel of experts. A subsequent retrospective empirical analysis of change efforts in 198 health care organizations was performed to validate the model. Logistic regression and ROC analysis were used to evaluate the model's performance using three alternative definitions of success. Data Collection For the model development, experts' subjective assessments were elicited using an integrative group process. For the validation study, a staff person intimately involved in each improvement project responded to a written survey asking questions about model factors and project outcomes. Results Logistic regression chi-square statistics and areas under the ROC curve demonstrated a high level of model performance in predicting success. Chi-square statistics were significant at the 0.001 level and areas under the ROC curve were greater than 0.84. Conclusions A subjective Bayesian model was effective in predicting the outcome of actual improvement projects. Additional prospective evaluations as well as testing the impact of this model as an intervention are warranted. PMID:12785571

  14. Ex Vivo Apoptosis in CD8+ Lymphocytes Predicts Rectal Cancer Patient Outcome

    PubMed Central

    Haderlein, Marlen

    2016-01-01

    Background. Apoptotic rates in peripheral blood lymphocytes can predict radiation induced normal tissue toxicity. We studied whether apoptosis in lymphocytes has a prognostic value for therapy outcome. Methods. Lymphocytes of 87 rectal cancer patients were ex vivo irradiated with 2 Gy, 8 Gy, or a combination of 2 Gy ionizing radiation and Oxaliplatin. Cells were stained with Annexin V and 7-Aminoactinomycin D and apoptotic and necrotic rates were analyzed by multicolor flow cytometry. Results. After treatment, apoptotic and necrotic rates in CD8+ cells are consistently higher than in CD4+ cells, with lower corresponding necrotic rates. Apoptotic and necrotic rates of CD4+ cells and CD8+ cells correlated well within the 2 Gy, 8 Gy, and 2 Gy and Oxaliplatin arrangements (p ≤ 0.009). High apoptotic CD8+ rates after 2 Gy, 8 Gy, and 2 Gy + Oxaliplatin treatment were prognostically favorable for metastasis-free survival (p = 0.009, p = 0.038, and p = 0.009) and disease-free survival (p = 0.013, p = 0.098, and p = 0.013). Conclusions. Ex vivo CD8+ apoptotic rates are able to predict the patient outcome in regard to metastasis-free or disease-free survival. Patients with higher CD8+ apoptotic rates in the peripheral blood have a more favorable prognosis. In addition to the prediction of late-toxicity by utilization of CD4+ apoptotic rates, the therapy outcome can be predicted by CD8+ apoptotic rates. PMID:27340400

  15. Predicting motor outcome and death in term hypoxic-ischemic encephalopathy

    PubMed Central

    Martinez-Biarge, M.; Diez-Sebastian, J.; Kapellou, O.; Gindner, D.; Allsop, J.M.; Rutherford, M.A.

    2011-01-01

    Objectives: Central gray matter damage, the hallmark of term acute perinatal hypoxia-ischemia, frequently leads to severe cerebral palsy and sometimes death. The precision with which these outcomes can be determined from neonatal imaging has not been fully explored. We evaluated the accuracy of early brain MRI for predicting death, the presence and severity of motor impairment, and ability to walk at 2 years in term infants with hypoxic-ischemic encephalopathy (HIE) and basal ganglia–thalamic (BGT) lesions. Methods: From 1993 to 2007, 175 term infants with evidence of perinatal asphyxia, HIE, and BGT injury seen on early MRI scans were studied. BGT, white matter, posterior limb of the internal capsule (PLIC), and cortex and brainstem abnormality were classified by severity. Motor impairment was staged using the Gross Motor Function Classification System. Results: The severity of BGT lesions was strongly associated with the severity of motor impairment (Spearman rank correlation 0.77; p < 0.001). The association between white matter, cortical, and brainstem injury and motor impairment was less strong and only BGT injury correlated significantly in a logistic regression model. The predictive accuracy of severe BGT lesions for severe motor impairment was 0.89 (95% confidence interval 0.83–0.96). Abnormal PLIC signal intensity predicted the inability to walk independently by 2 years (sensitivity 0.92, specificity 0.77, positive predictive value 0.88, negative predictive value 0.85). Brainstem injury was the only factor with an independent association with death. Conclusion: We have shown that in term newborns with HIE and BGT injury, early MRI can be used to predict death and specific motor outcomes. PMID:21670434

  16. Adolescent Eating Disorders Predict Psychiatric, High-Risk Behaviors and Weight Outcomes in Young Adulthood

    PubMed Central

    Micali, Nadia; Solmi, Francesca; Horton, Nicholas J.; Crosby, Ross D.; Eddy, Kamryn T.; Calzo, Jerel P.; Sonneville, Kendrin R.; Swanson, Sonja A.; Field, Alison E.

    2015-01-01

    Objective To investigate whether anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED), including purging disorder (PD), subthreshold BN, and BED at ages 14 and 16, are prospectively associated with later depression, anxiety disorders, alcohol and substance use, and self-harm. Method Eating disorders were ascertained at 14 and 16 years of age in 6,140 youth at age 14 (58% of those eligible) and 5,069 at age 16 (52% of those eligible) as part of the prospective Avon Longitudinal Study of Parents and Children (ALSPAC). Outcomes (depression, anxiety disorders, binge drinking, drug use, deliberate self-harm, weight status) were measured using interviews and questionnaires about 2 years following predictors. Generalized estimating equation models adjusting for gender, socio-demographic variables, and prior outcome were used to examine prospective associations between eating disorders and each outcome. Results All eating disorders were predictive of later anxiety disorders. AN, BN, BED, PD, and OSFED were prospectively associated with depression (respectively AN: odds ratio [OR]=1.39 [95% CIs: 1.00-1.94]; BN: OR=3.39[1.25-9.20]; BED: OR=2.00 [1.06-3.75]; PD: OR=2.56 [1.38-4.74]). All eating disorders but AN predicted drug use and deliberate self-harm (BN: OR=5.72[2.22-14.72], PD: OR=4.88[2.78-8.57], subthreshold BN: OR=3.97[1.44-10.98], subthreshold BED: OR=2.32[1.43-3.75]). Whilst BED and BN predicted obesity (respectively OR=3.58 [1.06-12.14] and OR=6.42 [1.69-24.30]), AN was prospectively associated with underweight. Conclusions Adolescent eating disorders, including subthreshold presentations, predict negative outcomes, including mental health disorders, substance use, deliberate self-harm, and weight outcomes. This study highlights the high public health and clinical burden of eating disorders among adolescents. PMID:26210334

  17. Two Anatomically and Computationally Distinct Learning Signals Predict Changes to Stimulus-Outcome Associations in Hippocampus.

    PubMed

    Boorman, Erie D; Rajendran, Vani G; O'Reilly, Jill X; Behrens, Tim E

    2016-03-16

    Complex cognitive processes require sophisticated local processing but also interactions between distant brain regions. It is therefore critical to be able to study distant interactions between local computations and the neural representations they act on. Here we report two anatomically and computationally distinct learning signals in lateral orbitofrontal cortex (lOFC) and the dopaminergic ventral midbrain (VM) that predict trial-by-trial changes to a basic internal model in hippocampus. To measure local computations during learning and their interaction with neural representations, we coupled computational fMRI with trial-by-trial fMRI suppression. We find that suppression in a medial temporal lobe network changes trial-by-trial in proportion to stimulus-outcome associations. During interleaved choice trials, we identify learning signals that relate to outcome type in lOFC and to reward value in VM. These intervening choice feedback signals predicted the subsequent change to hippocampal suppression, suggesting a convergence of signals that update the flexible representation of stimulus-outcome associations. PMID:26948895

  18. Renal Resistive Index Predicts Postoperative Blood Pressure Outcome in Primary Aldosteronism.

    PubMed

    Iwakura, Yoshitsugu; Ito, Sadayoshi; Morimoto, Ryo; Kudo, Masataka; Ono, Yoshikiyo; Nezu, Masahiro; Takase, Kei; Seiji, Kazumasa; Ishidoya, Shigeto; Arai, Yoichi; Funamizu, Yasuharu; Miki, Takashi; Nakamura, Yasuhiro; Sasano, Hironobu; Satoh, Fumitoshi

    2016-03-01

    The renal resistive index (RI) calculated by Doppler ultrasonography has been reported to be correlated with renal structural changes and outcomes in patients with essential hypertension or renal disease. However, little is known about this index in primary aldosteronism. In this prospective study, we examined the utility of this index to predict blood pressure (BP) outcome after adrenalectomy in patients with primary aldosteronism. We studied 94 patients with histopathologically proven aldosteronoma who underwent surgery. Parameters on renal function, including renal flow indices, were examined and followed up for 12 months postoperatively. The renal RI of the main, hilum, and interlobar arteries was significantly higher in patients with aldosteronoma compared with 100 control patients. BP, estimated glomerular filtration rate, and urinary albumin excretion significantly decreased after adrenalectomy. The resistive indices of all compartment arteries were significantly reduced 1 month after adrenalectomy and remained stable for 12 months. Patients whose interlobar RI was in the highest tertile at baseline had higher systolic BP after adrenalectomy than those whose RI was in the lowest tertile. Logistic regression analysis demonstrated that the RI of the interlobar and hilum arteries could be an independent predictive marker for intractable hypertension (systolic BP ≥140 mm Hg, increased BP, taking ≥3 antihypertensive agents, or increased number of agents) even after adrenalectomy. Therefore, in patients with aldosteronoma, the renal RI indicates partially reversible renal hemodynamics and renal structural damages that would influence postoperative BP outcome. PMID:26865201

  19. Two Anatomically and Computationally Distinct Learning Signals Predict Changes to Stimulus-Outcome Associations in Hippocampus

    PubMed Central

    Boorman, Erie D.; Rajendran, Vani G.; O’Reilly, Jill X.; Behrens, Tim E.

    2016-01-01

    Summary Complex cognitive processes require sophisticated local processing but also interactions between distant brain regions. It is therefore critical to be able to study distant interactions between local computations and the neural representations they act on. Here we report two anatomically and computationally distinct learning signals in lateral orbitofrontal cortex (lOFC) and the dopaminergic ventral midbrain (VM) that predict trial-by-trial changes to a basic internal model in hippocampus. To measure local computations during learning and their interaction with neural representations, we coupled computational fMRI with trial-by-trial fMRI suppression. We find that suppression in a medial temporal lobe network changes trial-by-trial in proportion to stimulus-outcome associations. During interleaved choice trials, we identify learning signals that relate to outcome type in lOFC and to reward value in VM. These intervening choice feedback signals predicted the subsequent change to hippocampal suppression, suggesting a convergence of signals that update the flexible representation of stimulus-outcome associations. PMID:26948895

  20. SERPINB1 expression is predictive for sensitivity and outcome of cisplatin-based chemotherapy in melanoma

    PubMed Central

    Willmes, Christoph; Kumar, Rajiv; Becker, Jürgen C.; Fried, Isabella; Rachakonda, P. Sivaramakrishna; Poppe, Lidia M.; Hesbacher, Sonja; Schadendorf, Dirk; Sucker, Antje

    2016-01-01

    Despite of highly effective new therapeutic strategies, chemotherapy still is an important treatment option in metastatic melanoma. Since predictors of chemotherapy response are rare, drugs and regimens are currently chosen arbitrarily. The present study was aimed at the identification of molecular markers predicting the outcome of chemotherapy in melanoma. Tumor biopsies from metastatic lesions were collected from 203 stage IV melanoma patients prior to chemotherapy onset and used for gene expression profiling (n = 6; marker identification set), quantitative real-time PCR (n = 127; validation set 1), and immunohistochemistry on tissue microarrays (n = 70; validation set 2). The results were correlated to the tumors' in-vitro chemosensitivity and to the patients' in-vivo chemotherapy outcome. SERPINB1 was found to correlate to the in-vitro sensitivity to cisplatin-containing chemotherapy regimens (p = 0.005). High SERPINB1 gene expression was associated with favorable tumor response (p = 0.012) and prolonged survival (p = 0.081) under cisplatin-based chemotherapy. High SERPINB1 protein expression in tumor tissue from cisplatin-treated patients was associated with a favorable survival (p = 0.011), and proved as an independent predictor of survival (p = 0.008) by multivariate analysis. We conclude, that SERPINB1 expression, although not functionally involved, is predictive for the outcome of cisplatin-based chemotherapy in melanoma, and thus may be useful to personalize melanoma chemotherapy. PMID:26799424

  1. hENT1 expression is predictive of gemcitabine outcome in pancreatic cancer: a systematic review.

    PubMed

    Nordh, Stina; Ansari, Daniel; Andersson, Roland

    2014-07-14

    High human equilibrative nucleoside transporter 1 (hENT1)-expression has shown a survival benefit in pancreatic cancer patients treated with gemcitabine in several studies. The aim of this systematic review was to summarize the results and try to assess the predictive value of hENT1 for determining gemcitabine outcome in pancreatic cancer. Relevant articles were obtained from PubMed, Embase and Cochrane databases. Studies evaluating hENT1-expression in pancreatic tumor cells from patients treated with gemcitabine were selected. Outcome measures were overall survival, disease-free survival (DFS), toxicity and response rate. The database searches identified 10 studies that met the eligibility criteria, and a total of 855 patients were included. Nine of 10 studies showed a statistically significant longer overall survival in univariate analyses in patients with high hENT1-expression compared to those with low expression. In the 7 studies that reported DFS as an outcome measure, 6 had statistically longer DFS in the high hENT1 groups. Both toxicity and response rate were reported in only 2 articles and it was therefore hard to draw any major conclusions. This review provides evidence that hENT1 is a predictive marker for pancreatic cancer patients treated with gemcitabine. Some limitations of the review have to be taken into consideration, the majority of the included studies had a retrospective design, and there was no standardized scoring protocol for hENT1-expression. PMID:25024604

  2. Predictions of interplanetary shock arrivals at Earth: Dependence of forecast outcome on the input parameters

    NASA Astrophysics Data System (ADS)

    Smith, Z. K.; Steenburgh, R.; Fry, C. D.; Dryer, M.

    2009-12-01

    Predictions of interplanetary shock arrivals at Earth are important to space weather because they are often followed by geomagnetic disturbances that disrupt human technologies. The success of numerical simulation predictions depends on the codes and on the inputs obtained from solar observations. The inputs are usually divided into the more slowly varying background solar wind, onto which short-duration solar transient events are superposed. This paper examines the dependence of the prediction success on the range of values of the solar transient inputs. These input parameters are common to many 3-D MHD codes. The predictions of the Hakamada-Akasofu-Fry version 2 (HAFv2) model were used because its predictions of shock arrivals were tested, informally in the operational environment, from 1997 to 2006. The events list and HAFv2's performance were published in a series of three papers. The third event set is used to investigate the success and accuracy of the predictions in terms of the input parameter ranges (considered individually). By defining three thresholds for the input speed, duration, and X-ray class, it is possible to categorize the prediction outcomes by these input ranges. The X-ray class gives the most successful classification. Above the highest threshold, 89% of the predictions were successful while below the lowest threshold, only 40% were successful. The accuracy, measured in terms of the time differences between the observed and predicted shock arrivals, also shows largest improvement for the X-ray class. Guidelines are presented for space weather forecasters using the HAFv2 or other interplanetary simulation models.

  3. Ovarian Function, Not Age, Predicts the Benefit from Ovarian Suppression or Ablation for Premenopausal Women with Breast Cancer

    PubMed Central

    Cao, Ye; Wang, Shusen; Shi, Yanxia; An, Xin; Xu, Fei; Yuan, Zhongyu

    2016-01-01

    The role of adjuvant ovarian suppression or ablation (OS/OA) in premenopausal women with hormone receptor-positive breast cancer remains controversial. The purpose of our study was to examine which patients might benefit from the addition of OS/OA to tamoxifen. We analyzed the data of 2065 premenopausal patients with hormone receptor-positive invasive ductal carcinomas who were treated at Sun Yat-Sen University Cancer Center from 2000 to 2008. The five-year disease-free survival rate (DFSR) and overall survival rate (OSR) were compared by menstrual status and treatment. Compared with patients older than forty years of age, patients younger than forty years old had significant lower DFSRs and OSRs. The addition of OS/OA to tamoxifen increased the DFSR and OSR of patients with normal menstrual cycles after chemotherapy, regardless of their age at diagnosis. Patients with normal menstrual cycles after chemotherapy are the main beneficiaries of an adjuvant OS/OA. PMID:26866810

  4. Trajectories of physiological dysregulation predicts mortality and health outcomes in a consistent manner across three populations.

    PubMed

    Milot, Emmanuel; Morissette-Thomas, V; Li, Qing; Fried, Linda P; Ferrucci, Luigi; Cohen, Alan A

    2014-01-01

    Mechanistic and evolutionary perspectives both agree that aging involves multiple integrated biochemical networks in the organism. In particular, the homeostatic physiological dysregulation (PD) hypothesis contends that aging is caused by the progressive breakdown of key regulatory processes. However, nothing is yet known about the specifics of how PD changes with age and affects health. Using a recently validated measure of PD involving the calculation of a multivariate distance (DM) from biomarker data, we show that PD trajectories predict mortality, frailty, and chronic diseases (cancer, cardiovascular diseases, and diabetes). Specifically, relative risks of outcomes associated with individual slopes in (i.e. rate of) dysregulation range 1.20-1.40 per unit slope. We confirm the results by replicating the analysis using two suites of biomarkers selected with markedly different criteria and, for mortality, in three longitudinal cohort-based studies. Overall, the consistence of effect sizes (direction and magnitude) across data sets, biomarker suites and outcomes suggests that the positive relationship between DM and health outcomes is a general phenomenon found across human populations. Therefore, the study of dysregulation trajectories should allow important insights into aging physiology and provide clinically meaningful predictors of outcomes. PMID:25454986

  5. Detrended Fluctuation Analysis of Intracranial Pressure Predicts Outcome Following Traumatic Brain Injury

    PubMed Central

    Kirkness, Catherine J.; Mitchell, Pamela H.

    2009-01-01

    Detrended fluctuation analysis (DFA) is a recently developed technique suitable for describing scaling behavior of variability in physiological signals. The purpose of this study is to explore applicability of DFA methods to intracranial pressure (ICP) signals recorded in patients with traumatic brain injury (TBI). In addition to establishing the degree of fit of the power-law scaling model of detrended fluctuations of ICP in TBI patients, we also examined the relationship of DFA coefficients (scaling exponent and intercept) to: 1) measures of initial neurological functioning; 2) measures of functional outcome at six month follow-up; and 3) measures of outcome, controlling for patient characteristics, and initial neurological status. In a sample of 147 moderate-to-severely injured TBI patients, we found that a higher DFA scaling exponent is significantly associated with poorer initial neurological functioning, and that lower DFA intercept and higher DFA scaling exponent jointly predict poorer functional outcome at six month follow-up, even after statistical control for covariates reflecting initial neurological condition. DFA describes properties of ICP signal in TBI patients that are associated with both initial neurological condition and outcome at six months postinjury. PMID:18990620

  6. Prediction of adverse outcomes of acute coronary syndrome using intelligent fusion of triage information with HUMINT

    NASA Astrophysics Data System (ADS)

    McCullough, Claire L.; Novobilski, Andrew J.; Fesmire, Francis M.

    2006-04-01

    Faculty from the University of Tennessee at Chattanooga and the University of Tennessee College of Medicine, Chattanooga Unit, have used data mining techniques and neural networks to examine a set of fourteen features, data items, and HUMINT assessments for 2,148 emergency room patients with symptoms possibly indicative of Acute Coronary Syndrome. Specifically, the authors have generated Bayesian networks describing linkages and causality in the data, and have compared them with neural networks. The data includes objective information routinely collected during triage and the physician's initial case assessment, a HUMINT appraisal. Both the neural network and the Bayesian network were used to fuse the disparate types of information with the goal of forecasting thirty-day adverse patient outcome. This paper presents details of the methods of data fusion including both the data mining techniques and the neural network. Results are compared using Receiver Operating Characteristic curves describing the outcomes of both methods, both using only objective features and including the subjective physician's assessment. While preliminary, the results of this continuing study are significant both from the perspective of potential use of the intelligent fusion of biomedical informatics to aid the physician in prescribing treatment necessary to prevent serious adverse outcome from ACS and as a model of fusion of objective data with subjective HUMINT assessment. Possible future work includes extension of successfully demonstrated intelligent fusion methods to other medical applications, and use of decision level fusion to combine results from data mining and neural net approaches for even more accurate outcome prediction.

  7. Cognitive dysfunction at baseline predicts symptomatic 1-year outcome in first-episode schizophrenics.

    PubMed

    Moritz, S; Krausz, M; Gottwalz, E; Lambert, M; Perro, C; Ganzer, S; Naber, D

    2000-01-01

    The present study addresses the consequences of cognitive disturbances on symptomatic outcome. Fifty-three first-episode schizophrenics were reassessed (n = 32) 1 year after admission. Simple regression analyses revealed that several self-perceived cognitive deficits at baseline as measured with the Frankfurt Complaint Questionnaire significantly predicted increased Brief Psychiatric Rating Scale global scores at follow-up (p = 0.05 to p = 0.005). A stepwise regression analysis proved memory dysfunction to be the strongest predictor of symptomatic worsening (p = 0.005). It is suggested that the exploration and treatment of neuropsychological deficits in schizophrenia is of great clinical importance with regard to its impact on both functional and symptomatic outcome in schizophrenia. PMID:10601828

  8. Ferritin levels in the cerebrospinal fluid predict Alzheimer's disease outcomes and are regulated by APOE.

    PubMed

    Ayton, Scott; Faux, Noel G; Bush, Ashley I

    2015-01-01

    Brain iron elevation is implicated in Alzheimer's disease (AD) pathogenesis, but the impact of iron on disease outcomes has not been previously explored in a longitudinal study. Ferritin is the major iron storage protein of the body; by using cerebrospinal fluid (CSF) levels of ferritin as an index, we explored whether brain iron status impacts longitudinal outcomes in the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. We show that baseline CSF ferritin levels were negatively associated with cognitive performance over 7 years in 91 cognitively normal, 144 mild cognitive impairment (MCI) and 67 AD subjects, and predicted MCI conversion to AD. Ferritin was strongly associated with CSF apolipoprotein E levels and was elevated by the Alzheimer's risk allele, APOE-ɛ4. These findings reveal that elevated brain iron adversely impacts on AD progression, and introduce brain iron elevation as a possible mechanism for APOE-ɛ4 being the major genetic risk factor for AD. PMID:25988319

  9. The orbitofrontal oracle: cortical mechanisms for the prediction and evaluation of specific behavioral outcomes.

    PubMed

    Rudebeck, Peter H; Murray, Elisabeth A

    2014-12-17

    The orbitofrontal cortex (OFC) has long been associated with the flexible control of behavior and concepts such as behavioral inhibition, self-control, and emotional regulation. These ideas emphasize the suppression of behaviors and emotions, but OFC's affirmative functions have remained enigmatic. Here we review recent work that has advanced our understanding of this prefrontal area and how its functions are shaped through interaction with subcortical structures such as the amygdala. Recent findings have overturned theories emphasizing behavioral inhibition as OFC's fundamental function. Instead, new findings indicate that OFC provides predictions about specific outcomes associated with stimuli, choices, and actions, especially their moment-to-moment value based on current internal states. OFC function thereby encompasses a broad representation or model of an individual's sensory milieu and potential actions, along with their relationship to likely behavioral outcomes. PMID:25521376

  10. Ferritin levels in the cerebrospinal fluid predict Alzheimer's disease outcomes and are regulated by APOE

    PubMed Central

    Ayton, Scott; Faux, Noel G.; Bush, Ashley I.; Weiner, Michael W.; Aisen, Paul; Petersen, Ronald; Jack Jr., Clifford R.; Jagust, William; Trojanowki, John Q.; Toga, Arthur W.; Beckett, Laurel; Green, Robert C.; Saykin, Andrew J.; Morris, John; Shaw, Leslie M.; Khachaturian, Zaven; Sorensen, Greg; Kuller, Lew; Raichle, Marc; Paul, Steven; Davies, Peter; Fillit, Howard; Hefti, Franz; Holtzman, Davie; Marcel Mesulam, M.; Potter, William; Snyder, Peter; Schwartz, Adam; Montine, Tom; Thomas, Ronald G.; Donohue, Michael; Walter, Sarah; Gessert, Devon; Sather, Tamie; Jiminez, Gus; Harvey, Danielle; Bernstein, Matthew; Fox, Nick; Thompson, Paul; Schuff, Norbert; Borowski, Bret; Gunter, Jeff; Senjem, Matt; Vemuri, Prashanthi; Jones, David; Kantarci, Kejal; Ward, Chad; Koeppe, Robert A.; Foster, Norm; Reiman, Eric M.; Chen, Kewei; Mathis, Chet; Landau, Susan; Cairns, Nigel J.; Householder, Erin; Taylor-Reinwald, Lisa; Lee, Virginia; Korecka, Magdalena; Figurski, Michal; Crawford, Karen; Neu, Scott; Foroud, Tatiana M.; Potkin, Steven; Shen, Li; Faber, Kelley; Kim, Sungeun; Nho, Kwangsik; Thal, Leon; Buckholtz, Neil; Albert, Marylyn; Frank, Richard; Hsiao, John; Kaye, Jeffrey; Quinn, Joseph; Lind, Betty; Carter, Raina; Dolen, Sara; Schneider, Lon S.; Pawluczyk, Sonia; Beccera, Mauricio; Teodoro, Liberty; Spann, Bryan M.; Brewer, James; Vanderswag, Helen; Fleisher, Adam; Heidebrink, Judith L.; Lord, Joanne L.; Mason, Sara S.; Albers, Colleen S.; Knopman, David; Johnson, Kris; Doody, Rachelle S.; Villanueva-Meyer, Javier; Chowdhury, Munir; Rountree, Susan; Dang, Mimi; Stern, Yaakov; Honig, Lawrence S.; Bell, Karen L.; Ances, Beau; Carroll, Maria; Leon, Sue; Mintun, Mark A.; Schneider, Stacy; Oliver, Angela; Marson, Daniel; Griffith, Randall; Clark, David; Geldmacher, David; Brockington, John; Roberson, Erik; Grossman, Hillel; Mitsis, Effie; deToledo-Morrell, Leyla; Shah, Raj C.; Duara, Ranjan; Varon, Daniel; Greig, Maria T.; Roberts, Peggy; Albert, Marilyn; Onyike, Chiadi; D'Agostino II, Daniel; Kielb, Stephanie; Galvin, James E.; Cerbone, Brittany; Michel, Christina A.; Rusinek, Henry; de Leon, Mony J; Glodzik, Lidia; De Santi, Susan; Murali Doraiswamy, P.; Petrella, Jeffrey R.; Wong, Terence Z.; Arnold, Steven E.; Karlawish, Jason H.; Wolk, David; Smith, Charles D.; Jicha, Greg; Hardy, Peter; Sinha, Partha; Oates, Elizabeth; Conrad, Gary; Lopez, Oscar L.; Oakley, MaryAnn; Simpson, Donna M.; Porsteinsson, Anton P.; Goldstein, Bonnie S.; Martin, Kim; Makino, Kelly M.; Saleem Ismail, M.; Brand, Connie; Mulnard, Ruth A.; Thai, Gaby; Mc-Adams-Ortiz, Catherine; Womack, Kyle; Mathews, Dana; Quiceno, Mary; Diaz-Arrastia, Ramon; King, Richard; Weiner, Myron; Martin-Cook, Kristen; DeVous, Michael; Levey, Allan I.; Lah, James J.; Cellar, Janet S.; Burns, Jeffrey M.; Anderson, Heather S.; Swerdlow, Russell H.; Apostolova, Liana; Tingus, Kathleen; Woo, Ellen; Silverman, Daniel H.S.; Lu, Po H.; Bartzokis, George; Graff-Radford, Neill R; Parfitt, Francine; Kendall, Tracy; Johnson, Heather; Farlow, Martin R.; Hake, Ann Marie; Matthews, Brandy R.; Herring, Scott; Hunt, Cynthia; van Dyck, Christopher H.; Carson, Richard E.; MacAvoy, Martha G.; Chertkow, Howard; Bergman, Howard; Hosein, Chris; Black, Sandra; Stefanovic, Bojana; Caldwell, Curtis; Robin Hsiung, Ging-Yuek; Feldman, Howard; Mudge, Benita; Assaly, Michele; Kertesz, Andrew; Rogers, John; Bernick, Charles; Munic, Donna; Kerwin, Diana; Mesulam, Marek-Marsel; Lipowski, Kristine; Wu, Chuang-Kuo; Johnson, Nancy; Sadowsky, Carl; Martinez, Walter; Villena, Teresa; Scott Turner, Raymond; Johnson, Kathleen; Reynolds, Brigid; Sperling, Reisa A.; Johnson, Keith A.; Marshall, Gad; Frey, Meghan; Lane, Barton; Rosen, Allyson; Tinklenberg, Jared; Sabbagh, Marwan N.; Belden, Christine M.; Jacobson, Sandra A.; Sirrel, Sherye A.; Kowall, Neil; Killiany, Ronald; Budson, Andrew E.; Norbash, Alexander; Johnson, Patricia Lynn; Allard, Joanne; Lerner, Alan; Ogrocki, Paula; Hudson, Leon; Fletcher, Evan; Carmichael, Owen; Olichney, John; DeCarli, Charles; Kittur, Smita; Borrie, Michael; Lee, T-Y; Bartha, Rob; Johnson, Sterling; Asthana, Sanjay; Carlsson, Cynthia M.; Potkin, Steven G.; Preda, Adrian; Nguyen, Dana; Tariot, Pierre; Reeder, Stephanie; Bates, Vernice; Capote, Horacio; Rainka, Michelle; Scharre, Douglas W.; Kataki, Maria; Adeli, Anahita; Zimmerman, Earl A.; Celmins, Dzintra; Brown, Alice D.; Pearlson, Godfrey D.; Blank, Karen; Anderson, Karen; Santulli, Robert B.; Kitzmiller, Tamar J.; Schwartz, Eben S.; Sink, Kaycee M.; Williamson, Jeff D.; Garg, Pradeep; Watkins, Franklin; Ott, Brian R.; Querfurth, Henry; Tremont, Geoffrey; Salloway, Stephen; Malloy, Paul; Correia, Stephen; Rosen, Howard J.; Miller, Bruce L.; Mintzer, Jacobo; Spicer, Kenneth; Bachman, David; Finger, Elizabether; Pasternak, Stephen; Rachinsky, Irina; Drost, Dick; Pomara, Nunzio; Hernando, Raymundo; Sarrael, Antero; Schultz, Susan K.; Boles Ponto, Laura L.; Shim, Hyungsub; Elizabeth Smith, Karen; Relkin, Norman; Chaing, Gloria; Raudin, Lisa; Smith, Amanda; Fargher, Kristin; Ashok Raj, Balebail; Neylan, Thomas; Grafman, Jordan; Davis, Melissa; Morrison, Rosemary; Hayes, Jacqueline; Finley, Shannon; Friedl, Karl; Fleischman, Debra; Arfanakis, Konstantinos; James, Olga; Massoglia, Dino; Jay Fruehling, J.; Harding, Sandra; Peskind, Elaine R.; Petrie, Eric C.; Li, Gail; Yesavage, Jerome A.; Taylor, Joy L.; Furst, Ansgar J.

    2015-01-01

    Brain iron elevation is implicated in Alzheimer's disease (AD) pathogenesis, but the impact of iron on disease outcomes has not been previously explored in a longitudinal study. Ferritin is the major iron storage protein of the body; by using cerebrospinal fluid (CSF) levels of ferritin as an index, we explored whether brain iron status impacts longitudinal outcomes in the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. We show that baseline CSF ferritin levels were negatively associated with cognitive performance over 7 years in 91 cognitively normal, 144 mild cognitive impairment (MCI) and 67 AD subjects, and predicted MCI conversion to AD. Ferritin was strongly associated with CSF apolipoprotein E levels and was elevated by the Alzheimer's risk allele, APOE-ɛ4. These findings reveal that elevated brain iron adversely impacts on AD progression, and introduce brain iron elevation as a possible mechanism for APOE-ɛ4 being the major genetic risk factor for AD. PMID:25988319

  11. The orbitofrontal oracle: cortical mechanisms for the prediction and evaluation of specific behavioral outcomes

    PubMed Central

    Rudebeck, Peter H.; Murray, Elisabeth A.

    2014-01-01

    The orbitofrontal cortex (OFC) has long been associated with the flexible control of behavior and concepts such as behavioral inhibition, self-control and emotional regulation. These ideas emphasize the suppression of behaviors and emotions, but OFC’s affirmative functions have remained enigmatic. Here we review recent work that has advanced our understanding of this prefrontal area and how its functions are shaped through interaction with subcortical structures such as the amygdala. Recent findings have overturned theories emphasizing behavioral inhibition as OFC’s fundamental function. Instead, new findings indicate that OFC provides predictions about specific outcomes associated with stimuli, choices and actions, especially their moment-to-moment value based on current internal states. OFC function thereby encompasses a broad representation or model of an individual’s sensory milieu and potential actions, along with their relationship to likely behavioral outcomes. PMID:25521376

  12. Spirituality and religiousness as predictive factors of outcome in schizophrenia and schizo-affective disorders.

    PubMed

    Mohr, Sylvia; Perroud, Nader; Gillieron, Christiane; Brandt, Pierre-Yves; Rieben, Isabelle; Borras, Laurence; Huguelet, Philippe

    2011-04-30

    Spirituality and religiousness have been shown to be highly prevalent in patients with schizophrenia. This study assesses the predictive value of helpful vs. harmful use of religion to cope with schizophrenia or schizo-affective disorder at 3 years. From an initial cohort of 115 outpatients, 80% were reassessed for positive, negative and general symptoms, clinical global impression, social adaptation and quality of life. For patients with helpful religion at baseline, the importance of spirituality was predictive of fewer negative symptoms, better clinical global impression, social functioning and quality of life. The frequencies of religious practices in community and support from religious community had no effect on outcome. For patients with harmful religion at baseline, no relationships were elicited. This result may be due to sample size. Indeed, helpful spiritual/religious coping concerns 83% of patients, whereas harmful spiritual/religious coping concerns only 14% of patients. Our study shows that helpful use of spirituality is predictive of a better outcome. Spirituality may facilitate recovery by providing resources for coping with symptoms. In some cases, however, spirituality and religiousness are a source of suffering. Helpful vs. harmful spiritual/religious coping appears to be of clinical significance. PMID:20869123

  13. The utility of pulmonary function testing in predicting outcomes following liver transplantation.

    PubMed

    Kia, Leila; Cuttica, Michael J; Yang, Amy; Donnan, Erica N; Whitsett, Maureen; Singhvi, Ajay; Lemmer, Alexander; Levitsky, Josh

    2016-06-01

    Although pulmonary function tests (PFTs) are routinely performed in patients during the evaluation period before liver transplantation (LT), their utility in predicting post-LT mortality and morbidity outcomes is not known. The aim of this study was to determine the impact of obstructive and/or restrictive lung disease on post-LT outcomes. We conducted a retrospective analysis of patients who had pre-LT PFTs and underwent a subsequent LT (2007-2013). We used statistical analyses to determine independent associations between PFT parameters and outcomes (graft/patient survival, time on ventilator, and hospital/intensive care unit [ICU] length of stay [LOS]). A total of 415 LT recipients with available PFT data were included: 65% of patients had normal PFTs; 8% had obstructive lung disease; and 27% had restrictive lung disease. There was no difference in patient and graft survival between patients with normal, obstructive, and restrictive lung disease. However, restrictive lung disease was associated with longer post-LT time on ventilator and both ICU and hospital LOS (P < 0.05). More specific PFT parameters (diffusing capacity of the lungs for carbon monoxide, total lung capacity, and residual volume) were all significant predictors of ventilator time and both ICU and hospital LOS (P < 0.05). Although pre-LT PFT parameters may not predict post-LT mortality, restrictive abnormalities correlate with prolonged post-LT ventilation and LOS. Efforts to identify and minimize the impact of restrictive abnormalities on PFTs might improve such outcomes. Liver Transplantation 22 805-811 2016 AASLD. PMID:26929108

  14. Neurophysiological markers that predict and track treatment outcomes in childhood anxiety.

    PubMed

    Hum, Kathryn M; Manassis, Katharina; Lewis, Marc D

    2013-11-01

    The present study examined the cortical processes that mediate cognitive regulation in response to emotion-eliciting stimuli, before and after anxious children participated in a cognitive behavioral therapy program. Electroencephalographic activity was recorded from anxious children (n = 24, 8 males) and comparison children (n = 16, 7 males) at pre-and post-treatment sessions. The change in anxiety T-scores from pre- to post-treatment was used to signify clinical improvement among anxious children (Improvers: n = 11 vs. Non-improvers: n = 13). Event-related potential components were recorded while children performed a Go/No-go task using emotional facial expressions. For the P1 component, believed to reflect attention and/or arousal processes, Non-improvers had greater activation levels relative to Improver and comparison groups at both sessions. Greater P1 amplitudes at pre-treatment predicted non-improvement following treatment. For the frontal N2 component, thought to reflect cognitive control processing, Improvers recruited greater activation from pre- to post-treatment, a change in activation that was predictive of treatment outcome. Non-improvers showed increased cortical activation within the time window of the P1, whether at pre- or post-treatment. These data suggest that heightened perceptual vigilance may have led to poorer outcomes. Improvers showed increased prefrontal activation within the time window of the N2 from pre- to post-treatment. These data suggest that increased cognitive control may have led to improved treatment outcomes. In sum, P1 activation may serve as a predictor of treatment outcome, while N2 activation may serve as an indicator of treatment response. PMID:23690280

  15. Clinical elements that predict outcome after traumatic brain injury: a prospective multicenter recursive partitioning (decision-tree) analysis.

    PubMed

    Brown, Allen W; Malec, James F; McClelland, Robyn L; Diehl, Nancy N; Englander, Jeffrey; Cifu, David X

    2005-10-01

    Traumatic brain injury (TBI) often presents clinicians with a complex combination of clinical elements that can confound treatment and make outcome prediction challenging. Predictive models have commonly used acute physiological variables and gross clinical measures to predict mortality and basic outcome endpoints. The primary goal of this study was to consider all clinical elements available concerning a survivor of TBI admitted for inpatient rehabilitation, and identify those factors that predict disability, need for supervision, and productive activity one year after injury. The Traumatic Brain Injury Model Systems (TBIMS) database was used for decision tree analysis using recursive partitioning (n = 3463). Outcome measures included the Functional Independence Measure(), the Disability Rating Scale, the Supervision Rating Scale, and a measure of productive activity. Predictor variables included all physical examination elements, measures of injury severity (initial Glasgow Coma Scale score, duration of post-traumatic amnesia [PTA], length of coma, CT scan pathology), gender, age, and years of education. The duration of PTA, age, and most elements of the physical examination were predictive of early disability. The duration of PTA alone was selected to predict late disability and independent living. The duration of PTA, age, sitting balance, and limb strength were selected to predict productive activity at 1 year. The duration of PTA was the best predictor of outcome selected in this model for all endpoints and elements of the physical examination provided additional predictive value. Valid and reliable measures of PTA and physical impairment after TBI are important for accurate outcome prediction. PMID:16238482

  16. External lumbar drain: A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus

    PubMed Central

    Chotai, Silky; Medel, Ricky; Herial, Nabeel A.; Medhkour, Azedine

    2014-01-01

    Background: The consensus on most reliable supplemental test to predict the shunt responsiveness in patients with idiopathic normal pressure hydrocephalus (iNPH) is lacking. The aim of this study is to discuss the utility of external lumbar drain (ELD) in evaluation of shunt responsiveness for iNPH patients. Methods: A retrospective review of 66 patients with iNPH was conducted. All patients underwent 4-day ELD trial. ELD-positive patients were offered ventriculoperitoneal shunt (VPS) surgery. The primary outcome evaluation parameters were gait and mini mental status examination (MMSE) assessment. The family and patient perception of improvement was accounted for in the outcome evaluation. Results: There were 38 male and 28 female with mean age of 74 years (range 45-88 years). ELD trial was positive in 86% (57/66) of patients. No major complications were encountered with the ELD trial. A total of 60 patients (57 ELD-positive, 3 ELD-negative) underwent VPS insertion. The negative ELD trial (P = 0.006) was associated with poor outcomes following shunt insertion. The positive ELD trial predicted shunt responsiveness in 96% patients (P < 0.0001, OR = 96.2, CI = 11.6-795.3). A receiver operating characteristic (ROC) curve analysis revealed that the ELD trial is reasonably accurate in differentiating shunt responder from non-responder in iNPH patients (area under curve = 0.8 ± 0.14, P = 0.02, CI = 0.52-1.0). The mean follow-up period was 12-months (range 0.3-3 years). The significant overall improvement after VPS was seen in 92% (55/60). The improvement was sustained in 76% of patients at mean 3-year follow-up. The number of comorbid conditions (P = 0.034, OR = 4.15, CI = 1.2-9.04), and a history of cerebrovascular accident (CVA) (P = 0.035, OR = 4.4, CI = 1.9-14.6) were the predictors of poor outcome following shunt surgery. Conclusion: The positive ELD test predicted shunt responsiveness in 96% of patients. With adequate technique, maximal results with minimal

  17. Prediction of Patient-Reported Outcome After Single-Bundle ACL Reconstruction

    PubMed Central

    Kowalchuk, Deborah A.; Harner, Christopher D.; Fu, Freddie H.; Irrgang, James J.

    2010-01-01

    Purpose To identify pre-operative and intra-operative factors that predict patient-oriented outcome as measured by the IKDC Subjective Knee Form after ACL reconstruction. Methods We identified 402 subjects who had undergone primary single-bundle arthroscopic ACL reconstruction at a mean follow-up of 6.3 years (range 2-15 years). The International Knee Documentation Committee Subjective Knee Form (IKDC) was used to measure patient-reported outcome and was dichotomized as above or below the patient-specific age and gender matched population average. Potential predictor variables included subject demographics, activity level prior to surgery, previous meniscectomy, and surgical variables. Multivariate logistic regression analysis was performed to identify the best subset of predictors for determining the likelihood that the IKDC score was better than the age- and sex-matched population average. Results The dichotomized IKDC score was associated with BMI, smoking status, education, previous medial meniscectomy, and medial chondrosis at the time of ACL reconstruction. The multivariate model containing only factors known before surgery included BMI and smoking status. Subjects with a BMI > 30 had 0.35 times the odds of success than subjects with a normal BMI. Subjects who smoked had 0.36 times the odds of success as subjects who did not smoke. A model including medial chondrosis at the time of surgery had a slightly higher discriminatory power (area under the ROC curve 0.65 versus 0.61) and negative predictive value (71.4 versus 60.0), but similar positive predictive power (86.3 versus 85.9). Conclusions Lower patient-reported outcome following ACL reconstruction was strongly associated with obesity, smoking, and severe chondrosis at time of surgery. PMID:19409302

  18. Lipocalin-2 as an Infection-Related Biomarker to Predict Clinical Outcome in Ischemic Stroke

    PubMed Central

    Hochmeister, Sonja; Engel, Odilo; Adzemovic, Milena Z.; Pekar, Thomas; Kendlbacher, Paul; Zeitelhofer, Manuel; Haindl, Michaela; Meisel, Andreas; Fazekas, Franz; Seifert-Held, Thomas

    2016-01-01

    Objectives From previous data in animal models of cerebral ischemia, lipocalin-2 (LCN2), a protein related to neutrophil function and cellular iron homeostasis, is supposed to have a value as a biomarker in ischemic stroke patients. Therefore, we examined LCN2 expression in the ischemic brain in an animal model and measured plasma levels of LCN2 in ischemic stroke patients. Methods In the mouse model of transient middle cerebral artery occlusion (tMCAO), LCN2 expression in the brain was analyzed by immunohistochemistry and correlated to cellular nonheme iron deposition up to 42 days after tMCAO. In human stroke patients, plasma levels of LCN2 were determined one week after ischemic stroke. In addition to established predictive parameters such as age, National Institutes of Health Stroke Scale and thrombolytic therapy, LCN2 was included into linear logistic regression modeling to predict clinical outcome at 90 days after stroke. Results Immunohistochemistry revealed expression of LCN2 in the mouse brain already at one day following tMCAO, and the amount of LCN2 subsequently increased with a maximum at 2 weeks after tMCAO. Accumulation of cellular nonheme iron was detectable one week post tMCAO and continued to increase. In ischemic stroke patients, higher plasma levels of LCN2 were associated with a worse clinical outcome at 90 days and with the occurrence of post-stroke infections. Conclusions LCN2 is expressed in the ischemic brain after temporary experimental ischemia and paralleled by the accumulation of cellular nonheme iron. Plasma levels of LCN2 measured in patients one week after ischemic stroke contribute to the prediction of clinical outcome at 90 days and reflect the systemic response to post-stroke infections. PMID:27152948

  19. ARID1A immunohistochemistry improves outcome prediction in invasive urothelial carcinoma of urinary bladder.

    PubMed

    Faraj, Sheila F; Chaux, Alcides; Gonzalez-Roibon, Nilda; Munari, Enrico; Ellis, Carla; Driscoll, Tina; Schoenberg, Mark P; Bivalacqua, Trinity J; Shih, Ie-Ming; Netto, George J

    2014-11-01

    AT-rich interactive domain 1A (ARID1A) is tumor suppressor gene that interacts with BRG1 adenosine triphosphatase to form a SWI/SNF chromatin remodeling protein complex. Inactivation of ARID1A has been described in several neoplasms, including epithelial ovarian and endometrial carcinomas, and has been correlated with prognosis. In the current study, ARID1A expression in urothelial carcinoma (UC) of the bladder and its association with clinicopathological parameters and outcome are addressed. Five tissue microarrays were constructed from 136 cystectomy specimens performed for UC at our institution. Nuclear ARID1A staining was evaluated using immunohistochemistry. An H-score was calculated as the sum of the products of intensity (0-3) multiplied by extent of expression (0%-100%). Average H-score per case was used for statistical analysis. ARID1A expression was categorized in low and high using Youden index to define the cut point. ARID1A expression significantly increased from normal to noninvasive UC to invasive UC. For both tumor progression and cancer death, Youden index yielded an H-score of 288 as the optimal cut point for ARID1A expression. Low ARID1A expression showed a tendency for lower risk of tumor progression and cancer mortality. Adding ARID1A expression to pathologic features offers a better model for predicting outcome than pathologic features alone. Low ARID1A expression was more frequently seen in earlier stage disease. There was a tendency for low ARID1A expression to predict better outcome. More importantly, the findings indicate that adding ARID1A expression to pathologic features increases the goodness of fit of the predictive model. PMID:25175170

  20. Do infant vocabulary skills predict school-age language and literacy outcomes?

    PubMed Central

    Duff, Fiona J; Reen, Gurpreet; Plunkett, Kim; Nation, Kate

    2015-01-01

    Background Strong associations between infant vocabulary and school-age language and literacy skills would have important practical and theoretical implications: Preschool assessment of vocabulary skills could be used to identify children at risk of reading and language difficulties, and vocabulary could be viewed as a cognitive foundation for reading. However, evidence to date suggests predictive ability from infant vocabulary to later language and literacy is low. This study provides an investigation into, and interpretation of, the magnitude of such infant to school-age relationships. Methods Three hundred British infants whose vocabularies were assessed by parent report in the 2nd year of life (between 16 and 24 months) were followed up on average 5 years later (ages ranged from 4 to 9 years), when their vocabulary, phonological and reading skills were measured. Results Structural equation modelling of age-regressed scores was used to assess the strength of longitudinal relationships. Infant vocabulary (a latent factor of receptive and expressive vocabulary) was a statistically significant predictor of later vocabulary, phonological awareness, reading accuracy and reading comprehension (accounting for between 4% and 18% of variance). Family risk for language or literacy difficulties explained additional variance in reading (approximately 10%) but not language outcomes. Conclusions Significant longitudinal relationships between preliteracy vocabulary knowledge and subsequent reading support the theory that vocabulary is a cognitive foundation of both reading accuracy and reading comprehension. Importantly however, the stability of vocabulary skills from infancy to later childhood is too low to be sufficiently predictive of language outcomes at an individual level – a finding that fits well with the observation that the majority of ‘late talkers’ resolve their early language difficulties. For reading outcomes, prediction of future difficulties is likely to

  1. Prediction of post-treatment outcome after combined treatment with maxillary protraction and chincap appliances.

    PubMed

    Yoshida, Ikue; Yamaguchi, Nobuhito; Mizoguchi, Itaru

    2006-02-01

    The aims of this study were to identify differences in the initial skeletal morphology between successful and unsuccessful groups and to establish a novel method for predicting the final outcome of treatment with a maxillary protraction appliance (MPA) and chincap. The cephalograms used in this study were taken from 32 Japanese girls (mean age 10.2 years) with a Class III malocclusion at the beginning of treatment with an MPA and chincap (T1), at removal of the appliance (T2), and during the final post-treatment period (T3). The subjects were divided into two groups according to the treatment outcome at T3. Lower face height (ANS-Me), total face height (N-Me), ratio of face height (ANS-Me/N-ANS), maxillary position, mandibular plane and gonial angle at T1 were all significantly larger in the unsuccessful group, compared with the successful group. Discriminant analysis indicated that lower face height and gonial angle were significant determinants for distinguishing between the two groups at T1. From T1 to T2, while the anterior displacement of the maxilla was almost the same in the two groups, SNB decreased by 1.6 degrees in the successful group and 0.4 degrees in the unsuccessful group. After orthopaedic treatment, a second phase of treatment with a multibracket system was performed (T2 to T3). From T2 to T3, SNA increased by 0.4 degrees in the successful group and decreased by 0.7 degrees in the unsuccessful group. These results indicate that the vertical dimensions of the craniofacial skeleton are important for predicting the prognosis of skeletal Class III patients treated with a MPA and chincap and that the discriminant formula established in this study is effective in predicting the final treatment outcome. PMID:16113036

  2. Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study

    PubMed Central

    Mirza, Mahek; Caracciolo, Giuseppe; Khan, Uzma; Mori, Naoyo; Saha, Samir K.; Srivathsan, Komandoor; Altemose, Gregory; Scott, Luis; Sengupta, Partho

    2011-01-01

    Background Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA. Methods and Results Sixty-three patients (63±10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18±12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55±17% vs. 64±14%, p=0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11±7% vs. 20±14%, p=0.007) and SR (0.9±0.4 vs. 1.3±0.6 s−1, p=0.01). Multivariate analysis revealed lateral wall LS (odds ratio=1.15, 95% CI=1.02–1.28, p=0.01) as an independent predictor of AFR. Conclusions Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA. PMID:21424845

  3. Setting the vision: Applied patient reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness

    PubMed Central

    Wysham, Nicholas G.; Abernethy, Amy P.; Cox, Christopher E.

    2014-01-01

    Purpose of review Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision making quality in the ICU. Recent Findings Patient-reported outcomes (PROs) have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic PROs (ePRO) to optimize patient-centered care including critical care outcome prediction. Summary A learning health system infrastructure integrating ePROs may aid in the management of critical illness associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness. PMID:25159475

  4. Akt-Ser473 Phosphorylation as a Marker for Predicting Taxane Chemotherapy Outcome | NCI Technology Transfer Center | TTC

    Cancer.gov

    The National Institute of Health, National Cancer Institute is seeking statements of capability or interest from parties interested in collaborative research to further develop, evaluate, or commercialize a marker for predicting taxane chemotherapy outcome.

  5. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis

    PubMed Central

    Chin, Calvin W.L.; Messika-Zeitoun, David; Shah, Anoop S.V.; Lefevre, Guillaume; Bailleul, Sophie; Yeung, Emily N.W.; Koo, Maria; Mirsadraee, Saeed; Mathieu, Tiffany; Semple, Scott I.; Mills, Nicholas L.; Vahanian, Alec; Newby, David E.; Dweck, Marc R.

    2016-01-01

    Aims Midwall myocardial fibrosis on cardiovascular magnetic resonance (CMR) is a marker of early ventricular decompensation and adverse outcomes in aortic stenosis (AS). We aimed to develop and validate a novel clinical score using variables associated with midwall fibrosis. Methods and results One hundred forty-seven patients (peak aortic velocity (Vmax) 3.9 [3.2,4.4] m/s) underwent CMR to determine midwall fibrosis (CMR cohort). Routine clinical variables that demonstrated significant association with midwall fibrosis were included in a multivariate logistic score. We validated the prognostic value of the score in two separate outcome cohorts of asymptomatic patients (internal: n = 127, follow-up 10.3 [5.7,11.2] years; external: n = 289, follow-up 2.6 [1.6,4.5] years). Primary outcome was a composite of AS-related events (cardiovascular death, heart failure, and new angina, dyspnoea, or syncope). The final score consisted of age, sex, Vmax, high-sensitivity troponin I concentration, and electrocardiographic strain pattern [c-statistic 0.85 (95% confidence interval 0.78–0.91), P < 0.001; Hosmer–Lemeshow χ2 = 7.33, P = 0.50]. Patients in the outcome cohorts were classified according to the sensitivity and specificity of this score (both at 98%): low risk (probability score <7%), intermediate risk (7–57%), and high risk (>57%). In the internal outcome cohort, AS-related event rates were >10-fold higher in high-risk patients compared with those at low risk (23.9 vs. 2.1 events/100 patient-years, respectively; log rank P < 0.001). Similar findings were observed in the external outcome cohort (31.6 vs. 4.6 events/100 patient-years, respectively; log rank P < 0.001). Conclusion We propose a clinical score that predicts adverse outcomes in asymptomatic AS patients and potentially identifies high-risk patients who may benefit from early valve replacement. PMID:26491110

  6. CAPRA-S predicts outcome for adjuvant and salvage external beam radiotherapy after radical prostatectomy

    PubMed Central

    Zimmermann, Michel; Delouya, Guila; Alenizi, Abdullah M.; Rajih, Emad; Zorn, Kevin C.; Taussky, Daniel

    2016-01-01

    Introduction: We aimed to evaluate the predictive value of the Cancer of the Prostate Risk Assessment Postsurgical Score (CAPRA-S) for patients treated with radical prostatectomy followed by subsequent external beam radiotherapy (EBRT). Methods: A total of 373 patients treated with EBRT between January 2000 and June 2015 were identified in the institutional database. Followup and complete CAPRA-S score were available for 334 (89.5%) patients. CAPRA-S scores were sorted into previously defined categories of low- (score 0–2), intermediate- (3–5), and high-risk (6–12). Time to biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) >0.20 ng/mL after EBRT. Survival analyses were performed using the Kaplan-Meier method and comparisons were made using the log-rank test. Results: Overall median time from surgery to EBRT was 18 months (interquartile range [IQR] 8–36) and median followup since EBRT was 48 months (IQR 28–78). CAPRA-S predicted time to BCR (<0.001), time to palliative androgen-deprivation therapy (ADT) (p=0.017), and a trend for significantly predicting overall survival (OS, p=0.058). On multivariate analysis, the CAPRA-S was predictive of time to BCR only (low-risk vs. intermediate-risk; hazard ratio [HR] 0.14, 95% confidence interval [CI] 0.043–0.48, p=0.001). The last PSA measurement before EBRT as a continuous and grouped variable proved highly significant in predicting all outcomes tested, including OS (p≤0.002). Conclusions: CAPRA-S predicts time to BCR and freedom from palliative ADT, and is borderline significant for OS. Together with the PSA before EBRT, CAPRA-S is a useful, predictive tool. The main limitation of this study is its retrospective design. PMID:27217861

  7. Predicting High School Outcomes in the Baltimore City Public Schools. The Senior Urban Education Research Fellowship Series. Volume VII

    ERIC Educational Resources Information Center

    Mac Iver, Martha Abele; Messel, Matthew

    2012-01-01

    This study of high school outcomes in the Baltimore City Public Schools builds on substantial prior research on the early warning indicators of dropping out. It sought to investigate whether the same variables that predicted a non-graduation outcome in other urban districts--attendance, behavior problems, and course failure--were also significant…

  8. Evaluating a theory of stress and adjustment when predicting long-term psychosocial outcome after brain injury.

    PubMed

    Rutterford, Neil A; Wood, Rodger L

    2006-05-01

    Kendall and Terry (1996) include many psychosocial predictors in their theoretical model that explains individual differences in psychosocial adjustment (Lazarus & Folkman, 1984). The model depicts appraisal and coping variables as mediating relationships between situation factors, environmental and personal resources, and multidimensional outcome. The aim of this study was to explore these theoretical relationships at very late stages of recovery from traumatic brain injury. A total of 131 participants who were more than 10 years post-injury (mean = 15.31 years) completed several psychosocial measures relating to outcome dimensions comprising employment, community integration, life satisfaction, quality of life (QoL), and emotion. There was no evidence that appraisal and coping variables mediated relationships between psychosocial and any of the outcome variables. However, when appraisal and coping variables were combined with psychosocial variables as direct predictors of outcome, every outcome except employment status was reliably predicted, accounting for between 31 and 46% of the variance. Personality significantly influenced all predicted outcomes. Self-efficacy contributed to the prediction of all outcomes except QoL. Data did not support for the theory of stress and adjustment as a framework for explaining the nature of predictive relationships between psychosocial variables and very long-term, multidimensional outcome after brain injury. PMID:16903128

  9. Dynamic self-efficacy and outcome expectancies: prediction of smoking lapse and relapse.

    PubMed

    Gwaltney, Chad J; Shiffman, Saul; Balabanis, Mark H; Paty, Jean A

    2005-11-01

    According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process. PMID:16351387

  10. Predicted and experienced affective responses to the outcome of the 2008 U.S. presidential election.

    PubMed

    Kitchens, Michael B; Corser, Grant C; Gohm, Carol L; VonWaldner, Kristen L; Foreman, Elizabeth L

    2010-12-01

    People typically have intense feelings about politics. Therefore, it was no surprise that the campaign and eventual election of Barack Obama were highly anticipated and emotionally charged events, making it and the emotion experienced afterward a useful situation in which to replicate prior research showing that people typically overestimate the intensity and duration of their future affective states. Consequently, it was expected that Obama supporters and McCain supporters might overestimate the intensity of their affective responses to the outcome of the election. Data showed that while McCain supporters underestimated how happy they would be following the election, Obama supporters accurately predicted how happy they would be following the election. These data provide descriptive information on the accuracy of people's predicted reactions to the 2008 U.S. presidential election. The findings are discussed in the context of the broad literature and this specific and unique event. PMID:21323142

  11. Predicting Outcomes of Hospitalization for Heart Failure Using Logistic Regression and Knowledge Discovery Methods

    PubMed Central

    Phillips, Kirk T.; Street, W. Nick

    2005-01-01

    The purpose of this study is to determine the best prediction of heart failure outcomes, resulting from two methods -- standard epidemiologic analysis with logistic regression and knowledge discovery with supervised learning/data mining. Heart failure was chosen for this study as it exhibits higher prevalence and cost of treatment than most other hospitalized diseases. The prevalence of heart failure has exceeded 4 million cases in the U.S.. Findings of this study should be useful for the design of quality improvement initiatives, as particular aspects of patient comorbidity and treatment are found to be associated with mortality. This is also a proof of concept study, considering the feasibility of emerging health informatics methods of data mining in conjunction with or in lieu of traditional logistic regression methods of prediction. Findings may also support the design of decision support systems and quality improvement programming for other diseases. PMID:16779367

  12. Predictive value of symptoms of atypical depression for differential drug treatment outcome.

    PubMed

    McGrath, P J; Stewart, J W; Harrison, W M; Ocepek-Welikson, K; Rabkin, J G; Nunes, E N; Wager, S G; Tricamo, E; Quitkin, F M; Klein, D F

    1992-06-01

    Data for 401 depressed outpatients with mood reactivity who participated in a randomized trial comparing placebo, imipramine, and phenelzine were analyzed for predictors of differential response by stepwise multiple regression techniques. Features of the Columbia criteria for atypical depression including oversleeping, overeating, severe anergy, and pathologic rejection sensitivity were each predictive of a poorer response to imipramine than to phenelzine only when compared to those patients with none of the features. These features were not additive in their contribution to differential outcome. Lack of endogenous features was not predictive of a differential drug treatment response. Compared with patients who have no symptoms of atypical depression, patients with any of the four features had an inferior imipramine response rather than a superior phenelzine response. These analyses indicate that the clear differential responsivity to medication treatment in atypical depression is not simply related to any one defining symptom and that further correlates of this apparent biological heterogeneity need to be explored. PMID:1629387

  13. Predicting the outcome of the growth of binary solids far from equilibrium

    NASA Astrophysics Data System (ADS)

    Mannige, Ranjan V.; Whitelam, Stephen

    2016-04-01

    The growth of multicomponent structures in simulations and experiments often results in kinetically trapped, nonequilibrium objects. In such cases we have no general theoretical framework for predicting the outcome of the growth process. Here we use computer simulations to study the growth of two-component structures within a simple lattice model. We show that kinetic trapping happens for many choices of growth rate and intercomponent interaction energies, and that qualitatively distinct kinds of kinetic trapping are found in different regions of parameter space. In a region in which the low-energy structure is an "antiferromagnet" or "checkerboard," we show that the grown nonequilibrium structure displays a component-type stoichiometry that is different from the equilibrium one but is insensitive to growth rate and solution conditions. This robust nonequilibrium stoichiometry can be predicted via a mapping to the jammed random tiling of dimers studied by Flory, a finding that suggests a way of making defined nonequilibrium structures in experiment.

  14. Outcome measures based on classification performance fail to predict the intelligibility of binary-masked speech.

    PubMed

    Kressner, Abigail Anne; May, Tobias; Rozell, Christopher J

    2016-06-01

    To date, the most commonly used outcome measure for assessing ideal binary mask estimation algorithms is based on the difference between the hit rate and the false alarm rate (H-FA). Recently, the error distribution has been shown to substantially affect intelligibility. However, H-FA treats each mask unit independently and does not take into account how errors are distributed. Alternatively, algorithms can be evaluated with the short-time objective intelligibility (STOI) metric using the reconstructed speech. This study investigates the ability of H-FA and STOI to predict intelligibility for binary-masked speech using masks with different error distributions. The results demonstrate the inability of H-FA to predict the behavioral intelligibility and also illustrate the limitations of STOI. Since every estimation algorithm will make errors that are distributed in different ways, performance evaluations should not be made solely on the basis of these metrics. PMID:27369123

  15. Validation that Metabolic Tumor Volume Predicts Outcome in Head-and-Neck Cancer

    SciTech Connect

    Tang, Chad; Murphy, James D.; Khong, Brian; La, Trang H.; Kong, Christina; Fischbein, Nancy J.; Colevas, A. Dimitrios; Iagaru, Andrei H.; Graves, Edward E.; Loo, Billy W.; Le, Quynh-Thu

    2012-08-01

    Purpose: We have previously reported that metabolic tumor volume (MTV) obtained from pretreatment {sup 18}F-fluorodeoxydeglucose positron emission tomography (FDG PET)/ computed tomography (CT) predicted outcome in patients with head-and-neck cancer (HNC). The purpose of this study was to validate these results on an independent dataset, determine whether the primary tumor or nodal MTV drives this correlation, and explore the interaction with p16{sup INK4a} status as a surrogate marker for human papillomavirus (HPV). Methods and Materials: The validation dataset in this study included 83 patients with squamous cell HNC who had a FDG PET/CT scan before receiving definitive radiotherapy. MTV and maximum standardized uptake value (SUV{sub max}) were calculated for the primary tumor, the involved nodes, and the combination of both. The primary endpoint was to validate that MTV predicted progression-free survival and overall survival. Secondary analyses included determining the prognostic utility of primary tumor vs. nodal MTV. Results: Similarly to our prior findings, an increase in total MTV of 17 cm{sup 3} (difference between the 75th and 25th percentiles) was associated with a 2.1-fold increase in the risk of disease progression (p = 0.0002) and a 2.0-fold increase in the risk of death (p = 0.0048). SUV{sub max} was not associated with either outcome. Primary tumor MTV predicted progression-free (hazard ratio [HR] = 1.94; p < 0.0001) and overall (HR = 1.57; p < 0.0001) survival, whereas nodal MTV did not. In addition, MTV predicted progression-free (HR = 4.23; p < 0.0001) and overall (HR = 3.21; p = 0.0029) survival in patients with p16{sup INK4a}-positive oropharyngeal cancer. Conclusions: This study validates our previous findings that MTV independently predicts outcomes in HNC. MTV should be considered as a potential risk-stratifying biomarker in future studies of HNC.

  16. Predicting Outcome in Patients with Rhabdomyosarcoma: Role of [{sup 18}F]Fluorodeoxyglucose Positron Emission Tomography

    SciTech Connect

    Casey, Dana L.; Wexler, Leonard H.; Fox, Josef J.; Dharmarajan, Kavita V.; Schoder, Heiko; Price, Alison N.; Wolden, Suzanne L.

    2014-12-01

    Purpose: To evaluate whether [{sup 18}F]fluorodeoxyglucose positron emission tomography (FDG-PET) response of the primary tumor after induction chemotherapy predicts outcomes in rhabdomyosarcoma (RMS). Methods and Materials: After excluding those with initial tumor resection, 107 patients who underwent FDG-PET after induction chemotherapy at Memorial Sloan Kettering Cancer Center from 2002 to 2013 were reviewed. Local control (LC), progression-free survival (PFS), and overall survival (OS) were calculated according to FDG-PET response and maximum standardized uptake value (SUV) at baseline (PET1/SUV1), after induction chemotherapy (PET2/SUV2), and after local therapy (PET3/SUV3). Receiver operator characteristic curves were used to determine the optimal cutoff for dichotomization of SUV1 and SUV2 values. Results: The SUV1 (<9.5 vs ≥9.5) was predictive of PFS (P=.02) and OS (P=.02), but not LC. After 12 weeks (median) of induction chemotherapy, 45 patients had negative PET2 scans and 62 had positive scans: 3-year PFS was 72% versus 44%, respectively (P=.01). The SUV2 (<1.5 vs ≥1.5) was similarly predictive of PFS (P=.005) and was associated with LC (P=.02) and OS (P=.03). A positive PET3 scan was predictive of worse PFS (P=.0009), LC (P=.05), and OS (P=.03). Conclusions: [{sup 18}F]fluorodeoxyglucose positron emission tomography is an early indicator of outcomes in patients with RMS. Future prospective trials may incorporate FDG-PET response data for risk-adapted therapy and early assessment of new treatment regimens.

  17. FERAL: network-based classifier with application to breast cancer outcome prediction

    PubMed Central

    Allahyar, Amin; de Ridder, Jeroen

    2015-01-01

    Motivation: Breast cancer outcome prediction based on gene expression profiles is an important strategy for personalize patient care. To improve performance and consistency of discovered markers of the initial molecular classifiers, network-based outcome prediction methods (NOPs) have been proposed. In spite of the initial claims, recent studies revealed that neither performance nor consistency can be improved using these methods. NOPs typically rely on the construction of meta-genes by averaging the expression of several genes connected in a network that encodes protein interactions or pathway information. In this article, we expose several fundamental issues in NOPs that impede on the prediction power, consistency of discovered markers and obscures biological interpretation. Results: To overcome these issues, we propose FERAL, a network-based classifier that hinges upon the Sparse Group Lasso which performs simultaneous selection of marker genes and training of the prediction model. An important feature of FERAL, and a significant departure from existing NOPs, is that it uses multiple operators to summarize genes into meta-genes. This gives the classifier the opportunity to select the most relevant meta-gene for each gene set. Extensive evaluation revealed that the discovered markers are markedly more stable across independent datasets. Moreover, interpretation of the marker genes detected by FERAL reveals valuable mechanistic insight into the etiology of breast cancer. Availability and implementation: All code is available for download at: http://homepage.tudelft.nl/53a60/resources/FERAL/FERAL.zip. Contact: j.deridder@tudelft.nl Supplementary information: Supplementary data are available at Bioinformatics online. PMID:26072498

  18. Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease

    PubMed Central

    Pavlides, Michael; Banerjee, Rajarshi; Sellwood, Joanne; Kelly, Catherine J.; Robson, Matthew D.; Booth, Jonathan C.; Collier, Jane; Neubauer, Stefan; Barnes, Eleanor

    2016-01-01

    Background & Aims Multiparametric magnetic resonance (MR) imaging has been demonstrated to quantify hepatic fibrosis, iron, and steatosis. The aim of this study was to determine if MR can be used to predict negative clinical outcomes in liver disease patients. Methods Patients with chronic liver disease (n = 112) were recruited for MR imaging and data on the development of liver related clinical events were collected by medical records review. The median follow-up was 27 months. MR data were analysed blinded for the Liver Inflammation and Fibrosis score (LIF; <1, 1–1.99, 2–2.99, and ⩾3 representing normal, mild, moderate, and severe liver disease, respectively), T2∗ for liver iron content and proportion of liver fat. Baseline liver biopsy was performed in 102 patients. Results Liver disease aetiologies included non-alcoholic fatty liver disease (35%) and chronic viral hepatitis (30%). Histologically, fibrosis was mild in 54 (48%), moderate in 17 (15%), and severe in 31 (28%) patients. Overall mortality was 5%. Ten patients (11%) developed at least one liver related clinical event. The negative predictive value of LIF <2 was 100%. Two patients with LIF 2–2.99 and eight with LIF ⩾3 had a clinical event. Patients with LIF ⩾3 had a higher cumulative risk for developing clinical events, compared to those with LIF <1 (p = 0.02) and LIF 1–1.99 (p = 0.03). Cox regression analysis including all 3 variables (fat, iron, LIF) resulted in an enhanced LIF predictive value. Conclusions Non-invasive standardised multiparametric MR technology may be used to predict clinical outcomes in patients with chronic liver disease. PMID:26471505

  19. Clinical outcome prediction in aneurysmal subarachnoid hemorrhage – Alterations in brain–body interface

    PubMed Central

    Lo, Benjamin W. Y.; Fukuda, Hitoshi; Angle, Mark; Teitelbaum, Jeanne; Macdonald, R. Loch; Farrokhyar, Forough; Thabane, Lehana; Levine, Mitchell A. H.

    2016-01-01

    Background: Brain–body associations are essential in influencing outcome in patients with ruptured brain aneurysms. Thus far, there is scarce literature on such important relationships. Methods: The multicenter Tirilazad database (3551 patients) was used to create this clinical outcome prediction model in order to elucidate significant brain–body associations. Traditional binary logistic regression models were used. Results: Binary logistic regression main effects model included four statistically significant single prognostic variables, namely, neurological grade, age, stroke, and time to surgery. Logistic regression models demonstrated the significance of hypertension and liver disease in development of brain swelling, as well as the negative consequences of seizures in patients with a history of myocardial infarction and post-admission fever worsening neurological outcome. Conclusions: Using the aforementioned results generated from binary logistic regression models, we can identify potential patients who are in the high risk group of neurological deterioration. Specific therapies can be tailored to prevent these detriments, including treatment of hypertension, seizures, early detection and treatment of myocardial infarction, and prevention of hepatic encephalopathy. PMID:27583179

  20. Couples' agreement on presenting problems predicts engagement and outcomes in problem-focused couple therapy.

    PubMed

    Biesen, Judith N; Doss, Brian D

    2013-08-01

    This study investigated the impact of couples' agreement regarding relationship problems at therapy intake on subsequent treatment engagement and success. One hundred and 47 couples seeking marital therapy at one of two Veteran Administration Medical Centers completed questionnaires assessing relationship satisfaction and were asked to indicate their three biggest relationship concerns. Agreement on relationship concern was defined as one person's list containing the partner's top relationship problem. Pretreatment agreement on relationship problems was unrelated to treatment course or outcomes when the therapy was longer and more integrative in nature. However, when couples received a brief, problem-focused treatment, agreement predicted greater engagement in therapy process and more positive treatment outcomes. Specifically, couples who were in agreement were more likely to attend the minimum number of required sessions and were more likely to be assessed as having received a full course of therapy by their treatment provider. Additionally, partners who agreed with each other were more likely to experience clinically significant changes during treatment. Taken together, results suggest that therapists and researchers should consider assessing agreement on relationship problems at the beginning of treatment and potentially suggest that couples who perceive their relationship differently should receive more integrative treatment. Future research is needed to examine the most effective sequencing for addressing differing, presenting problems as well as the mechanisms through which disagreement on presenting problems impacts treatment course and outcomes. PMID:23772844

  1. Predicting Outcome of Childhood Bacterial Meningitis With a Single Measurement of C-Reactive Protein

    PubMed Central

    Peltola, Heikki; Roine, Irmeli; Cruzeiro, Manuel Leite; Bernardino, Luis

    2016-01-01

    Introduction: C-reactive protein (CRP), a marker of inflammation, shows high serum levels in invasive bacterial infections. We investigated the potential of a single CRP measurement at different phases of acute childhood bacterial meningitis to predict outcomes. Methods: Using whole-blood finger-prick samples with no centrifugation, CRP was measured quantitatively on arrival and on day 3 or 4 in children participating in 2 prospective, randomized, double-blind treatment studies conducted in Latin America or Angola. The results were compared with patient outcomes. Results: Although initial CRP values from 669 children gave useful prognostic information, the 3rd or 4th day measurements taken from 275 children associated significantly with seizures, slow recovery and low scores on the Glasgow Outcome Scale, with odds ratios for CRP values above the median (62 mg/L) ranging from 2 to 6, 2 to 5, and 3 to 5 (Latin America–Angola), respectively. Hearing impairment, although not full deafness, was 3 to 7 times more likely if CRP was above the median soon after hospitalization. Conclusions: Especially in resource-poor settings, clinicians have few simple-enough tools to identify the child with meningitis who requires maximum attention. CRP is a worthy addition. PMID:26986770

  2. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients

    PubMed Central

    2008-01-01

    Objective To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: “basic” model (demographic and clinical variables only) and “CT” model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting Medical Research Council (MRC) CRASH Trial. Subjects 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury. PMID:18270239

  3. Response to methotrexate predicts long-term patient-related outcomes in rheumatoid arthritis.

    PubMed

    Krause, Dietmar; Gabriel, Bernadette; Herborn, Gertraud; Braun, Juergen; Rau, Rolf

    2016-05-01

    This study was conducted to investigate the predictive value of the initial response to methotrexate (MTX) on long-term patient-related outcomes (PROs) in rheumatoid arthritis (RA). All RA patients starting MTX treatment between 1980 and 1987 in our department were enrolled in a prospective observational study. After an average of 18 years, patient-related outcomes were assessed in three dimensions according to the International Classification of Functioning, Disability and Health (ICF). Statistical analyses employed multivariable models with baseline values for age, gender, disease duration, rheumatoid factor positivity, disease activity, response to MTX after 1 year and continuous use of MTX as covariates. The 271 patients enrolled had a mean disease duration of 8.5 years, a mean number of swollen joints of 18 (out of 32), and a mean erythrocyte sedimentation rate of 55 mm/h. After 18 years, PRO was available in 89 patients (33 %). A clinical improvement of at least 20 % 1 year after the initiation of MTX was associated with a favourable outcome in all three dimensions of the ICF, independent of continuation of MTX (p < 0.05). The initial response to MTX is an independent predictor of PRO in RA as assessed after an average of 18 years. PMID:26920753

  4. Spiritual Awakening Predicts Improved Drinking Outcomes in a Polish Treatment Sample

    PubMed Central

    Strobbe, Stephen; Cranford, James A.; Wojnar, Marcin; Brower, Kirk J.

    2014-01-01

    Purpose This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)—attendance and spiritual awakening—and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), one month (T2), and 6 to 12 months post-baseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. AA meeting attendance and alcohol consumption were measured using the Timeline Followback (TLFB) interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement (AAI) scale. Results There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled. Conclusions Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample. PMID:24335767

  5. Percutaneous ablation of colorectal lung metastases

    PubMed Central

    Solomon, Stephen B.

    2015-01-01

    Lung metastasectomy can prolong survival in patients with metastatic colorectal carcinoma. Thermal ablation offers a potential solution with similar reported survival outcomes. It has minimal effect on pulmonary function, or quality of life, can be repeated, and may be considered more acceptable to patients because of the associated shorter hospital stay and recovery. This review describes the indications, technique, reported outcomes, complications and radiologic appearances after thermal ablation of colorectal lung metastases. PMID:26697202

  6. Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

    PubMed Central

    Paydar, Shahram; Moghaninasab, Abdoshahid; Asiaei, Elham; Sabetian Fard Jahromi, Golnar; Bolandparvaz, Shahram; Abbasi, Hamidreza

    2014-01-01

    Introduction: Emergency department thoracotomy (EDT) may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT) were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty-eight cases of EDT were enrolled (86.2% male). The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19%) were alive to be transported to OR (defined as ED survived). The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived) was 6.9% (4 cases). Only one case (1.7%) survived to discharge from hospital (mortality rate=98.3%). There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04). The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04) and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02) were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome. PMID:26495363

  7. Predicting physical activity and outcome expectations in cancer survivors: an application of Self-Determination Theory.

    PubMed

    Wilson, Philip M; Blanchard, Chris M; Nehl, Eric; Baker, Frank

    2006-07-01

    The purpose of this study was to examine the contributions of autonomous and controlled motives drawn from Self-Determination Theory (SDT; Intrinsic Motivation and Self-determination in Human Behavior. Plenum Press: New York, 1985; Handbook of Self-determination Research. University of Rochester Press: New York, 2002) towards predicting physical activity behaviours and outcome expectations in adult cancer survivors. Participants were cancer-survivors (N=220) and a non-cancer comparison cohort (N=220) who completed an adapted version of the Treatment Self-Regulation Questionnaire modified for physical activity behaviour (TSRQ-PA), an assessment of the number of minutes engaged in moderate-to-vigorous physical activity (MVPA) weekly, and the anticipated outcomes expected from regular physical activity (OE). Simultaneous multiple regression analyses indicated that autonomous motives was the dominant predictor of OEs across both cancer and non-cancer cohorts (R(2adj)=0.29-0.43), while MVPA was predicted by autonomous (beta's ranged from 0.21 to 0.34) and controlled (beta's ranged from -0.04 to -0.23) motives after controlling for demographic considerations. Cancer status (cancer versus no cancer) did not moderate the motivation-physical activity relationship. Collectively, these findings suggest that the distinction between autonomous and controlled motives is useful and compliments a growing body of evidence supporting SDT as a framework for understanding motivational processes in physical activity contexts with cancer survivors. PMID:16304621

  8. Multiscale modeling and distributed computing to predict cosmesis outcome after a lumpectomy

    NASA Astrophysics Data System (ADS)

    Garbey, M.; Salmon, R.; Thanoon, D.; Bass, B. L.

    2013-07-01

    Surgery for early stage breast carcinoma is either total mastectomy (complete breast removal) or surgical lumpectomy (only tumor removal). The lumpectomy or partial mastectomy is intended to preserve a breast that satisfies the woman's cosmetic, emotional and physical needs. But in a fairly large number of cases the cosmetic outcome is not satisfactory. Today, predicting that surgery outcome is essentially based on heuristic. Modeling such a complex process must encompass multiple scales, in space from cells to tissue, as well as in time, from minutes for the tissue mechanics to months for healing. The goal of this paper is to present a first step in multiscale modeling of the long time scale prediction of breast shape after tumor resection. This task requires coupling very different mechanical and biological models with very different computing needs. We provide a simple illustration of the application of heterogeneous distributed computing and modular software design to speed up the model development. Our computational framework serves currently to test hypothesis on breast tissue healing in a pilot study with women who have been elected to undergo BCT and are being treated at the Methodist Hospital in Houston, TX.

  9. Two pathways through adversity: Predicting well-being and housing outcomes among homeless service users.

    PubMed

    Walter, Zoe C; Jetten, Jolanda; Dingle, Genevieve A; Parsell, Cameron; Johnstone, Melissa

    2016-06-01

    People who experience homelessness face many challenges and disadvantages that negatively impact health and well-being and form barriers to achieving stable housing. Further, people who are homeless often have limited social connections and support. Building on previous research that has shown the beneficial effect of group identification on health and well-being, the current study explores the relationship between two social identity processes - multiple group memberships and service identification - and well-being and positive housing outcomes. Measures were collected from 76 participants while they were residing in a homeless accommodation service (T1) and again 2-4 weeks after leaving the service (or 3 months after T1 if participants had not left the service). Mediation analyses revealed that multiple group memberships and service identification at T1 independently predicted well-being at T2 indirectly, via social support. Further, both social identity processes also indirectly predicted housing outcomes via social support. The implications of these findings are twofold. First, while belonging to multiple social groups may provide a pathway to gaining social support and well-being, group belonging may not necessarily be beneficial to achieve stable housing. Second, fostering identification with homeless services may be particularly important as a source of support that contributes to well-being. PMID:26333919

  10. Mitral valve apparatus: echocardiographic features predicting the outcome of percutaneous mitral balloon valvotomy

    PubMed Central

    Du Toit, R; Brice, EAW; Van Niekerk, JD; Doubell, AF

    2007-01-01

    Summary Objectives To evaluate the significance of involvement of subvalvular apparatus in the outcome of percutaneous mitral balloon valvotomy (PMBV) in patients with mitral stenosis (MS) and to determine the predictive value of chordal length compared with current echocardiographic scores. Methods Patients with significant MS were selected according to the Massachusetts General Hospital score (MGHS). Chordal lengths were assessed as additional markers of disease. Standard percutaneous valvotomies were performed. Valve area was assessed post-procedure with follow-up over one year. Results Thirty-nine patients were prospectively studied. Valve area increased from a mean (SD) 0.97 (0.26) cm2 to 1.52 (0.38) cm2 with procedural success in 31 (79.5%) patients. There was no correlation (r = 0.09) between the MGHS and final valve area (FV A). There was a positive correlation between anterior chordal length and FV A (r = 0.66; p = 0.01). An FV A ≥ 1.5 cm2 was associated with higher mean chordal lengths (p = 0.01). A positive correlation was seen between valve area pre-procedure and FV A (r = 0.61; p < 0.01). Conclusions The MGHS is valuable in the selection of patients for PMBV, but fails to separate selected patients into prognostic groups. Assessment of chordal length provides useful additional information, predicting the outcome of PMBV more accurately. Our data may support the earlier use of PMBV (asymptomatic patients). PMID:17612747

  11. Parent-child math anxiety and math-gender stereotypes predict adolescents' math education outcomes

    PubMed Central

    Casad, Bettina J.; Hale, Patricia; Wachs, Faye L.

    2015-01-01

    Two studies examined social determinants of adolescents' math anxiety including parents' own math anxiety and children's endorsement of math-gender stereotypes. In Study 1, parent-child dyads were surveyed and the interaction between parent and child math anxiety was examined, with an eye to same- and other-gender dyads. Results indicate that parent's math anxiety interacts with daughters' and sons' anxiety to predict math self-efficacy, GPA, behavioral intentions, math attitudes, and math devaluing. Parents with lower math anxiety showed a positive relationship to children's math outcomes when children also had lower anxiety. The strongest relationships were found with same-gender dyads, particularly Mother-Daughter dyads. Study 2 showed that endorsement of math-gender stereotypes predicts math anxiety (and not vice versa) for performance beliefs and outcomes (self-efficacy and GPA). Further, math anxiety fully mediated the relationship between gender stereotypes and math self-efficacy for girls and boys, and for boys with GPA. These findings address gaps in the literature on the role of parents' math anxiety in the effects of children's math anxiety and math anxiety as a mechanism affecting performance. Results have implications for interventions on parents' math anxiety and dispelling gender stereotypes in math classrooms. PMID:26579000

  12. Parent-child math anxiety and math-gender stereotypes predict adolescents' math education outcomes.

    PubMed

    Casad, Bettina J; Hale, Patricia; Wachs, Faye L

    2015-01-01

    Two studies examined social determinants of adolescents' math anxiety including parents' own math anxiety and children's endorsement of math-gender stereotypes. In Study 1, parent-child dyads were surveyed and the interaction between parent and child math anxiety was examined, with an eye to same- and other-gender dyads. Results indicate that parent's math anxiety interacts with daughters' and sons' anxiety to predict math self-efficacy, GPA, behavioral intentions, math attitudes, and math devaluing. Parents with lower math anxiety showed a positive relationship to children's math outcomes when children also had lower anxiety. The strongest relationships were found with same-gender dyads, particularly Mother-Daughter dyads. Study 2 showed that endorsement of math-gender stereotypes predicts math anxiety (and not vice versa) for performance beliefs and outcomes (self-efficacy and GPA). Further, math anxiety fully mediated the relationship between gender stereotypes and math self-efficacy for girls and boys, and for boys with GPA. These findings address gaps in the literature on the role of parents' math anxiety in the effects of children's math anxiety and math anxiety as a mechanism affecting performance. Results have implications for interventions on parents' math anxiety and dispelling gender stereotypes in math classrooms. PMID:26579000

  13. Knee shape might predict clinical outcome after an anterior cruciate ligament rupture.

    PubMed

    Eggerding, V; van Kuijk, K S R; van Meer, B L; Bierma-Zeinstra, S M A; van Arkel, E R A; Reijman, M; Waarsing, J H; Meuffels, D E

    2014-06-01

    We have investigated whether shape of the knee can predict the clinical outcome of patients after an anterior cruciate ligament rupture. We used statistical shape modelling to measure the shape of the knee joint of 182 prospectively followed patients on lateral and Rosenberg view radiographs of the knee after a rupture of the anterior cruciate ligament. Subsequently, we associated knee shape with the International Knee Documentation Committee subjective score at two years follow-up. The mean age of patients was 31 years (21 to 51), the majority were male (n = 121) and treated operatively (n = 135). We found two modes (shape variations) that were significantly associated with the subjective score at two years: one for the operatively treated group (p = 0.002) and one for the non-operatively treated group (p = 0.003). Operatively treated patients who had higher subjective scores had a smaller intercondylar notch and a smaller width of the intercondylar eminence. Non-operatively treated patients who scored higher on the subjective score had a more pyramidal intercondylar notch as opposed to one that was more dome-shaped. We conclude that the shape of the femoral notch and the intercondylar eminence is predictive of clinical outcome two years after a rupture of the anterior cruciate ligament. PMID:24891572

  14. Microsatellite Instability Predicts Clinical Outcome in Radiation-Treated Endometrioid Endometrial Cancer

    SciTech Connect

    Bilbao, Cristina; Lara, Pedro Carlos; Ramirez, Raquel; Henriquez-Hernandez, Luis Alberto; Rodriguez, German; Falcon, Orlando; Leon, Laureano; Perucho, Manuel

    2010-01-15

    Purpose: To elucidate whether microsatellite instability (MSI) predicts clinical outcome in radiation-treated endometrioid endometrial cancer (EEC). Methods and Materials: A consecutive series of 93 patients with EEC treated with extrafascial hysterectomy and postoperative radiotherapy was studied. The median clinical follow-up of patients was 138 months, with a maximum of 232 months. Five quasimonomorphic mononucleotide markers (BAT-25, BAT-26, NR21, NR24, and NR27) were used for MSI classification. Results: Twenty-five patients (22%) were classified as MSI. Both in the whole series and in early stages (I and II), univariate analysis showed a significant association between MSI and poorer 10-year local disease-free survival, disease-free survival, and cancer-specific survival. In multivariate analysis, MSI was excluded from the final regression model in the whole series, but in early stages MSI provided additional significant predictive information independent of traditional prognostic and predictive factors (age, stage, grade, and vascular invasion) for disease-free survival (hazard ratio [HR] 3.25, 95% confidence interval [CI] 1.01-10.49; p = 0.048) and cancer-specific survival (HR 4.20, 95% CI 1.23-14.35; p = 0.022) and was marginally significant for local disease-free survival (HR 3.54, 95% CI 0.93-13.46; p = 0.064). Conclusions: These results suggest that MSI may predict radiotherapy response in early-stage EEC.

  15. The PLORAS Database: A data repository for Predicting Language Outcome and Recovery After Stroke☆

    PubMed Central

    Seghier, Mohamed L.; Patel, Elnas; Prejawa, Susan; Ramsden, Sue; Selmer, Andre; Lim, Louise; Browne, Rachel; Rae, Johanna; Haigh, Zula; Ezekiel, Deborah; Hope, Thomas M.H.; Leff, Alex P.; Price, Cathy J.

    2016-01-01

    The PLORAS Database is a relational repository of anatomical and functional imaging data that has primarily been acquired from stroke survivors, along with standardized scores on a wide range of sensory, motor and cognitive abilities, demographic details and medical history. As of January 2015, we have data from 750 patients with an expected accrual rate of 200 patients per year. Expansion will accelerate as we extend our collaborations. The main aim of the database is to Predict Language Outcome and Recovery After Stroke (PLORAS) on the basis of a single structural (anatomical) brain scan that indexes the stereotactic location and extent of brain damage. Predictions are made for individual patients by indicating how other patients with the most similar brain damage, cognitive abilities and demographic details recovered their language skills over time. Predictions are validated by longitudinal follow-ups of patients who initially presented with speech and language difficulties. The PLORAS Database can also be used to predict recovery of other cognitive abilities on the basis of anatomical brain scans. The functional imaging data can be used to understand the neural mechanisms that support recovery from brain damage; and all the data can be used to understand the main sources of inter-subject variability in structure–function mappings in the human brain. Data will be made available for sharing, subject to: funding, ethical approval and patient consent. PMID:25882753

  16. The PLORAS Database: A data repository for Predicting Language Outcome and Recovery After Stroke.

    PubMed

    Seghier, Mohamed L; Patel, Elnas; Prejawa, Susan; Ramsden, Sue; Selmer, Andre; Lim, Louise; Browne, Rachel; Rae, Johanna; Haigh, Zula; Ezekiel, Deborah; Hope, Thomas M H; Leff, Alex P; Price, Cathy J

    2016-01-01

    The PLORAS Database is a relational repository of anatomical and functional imaging data that has primarily been acquired from stroke survivors, along with standardized scores on a wide range of sensory, motor and cognitive abilities, demographic details and medical history. As of January 2015, we have data from 750 patients with an expected accrual rate of 200 patients per year. Expansion will accelerate as we extend our collaborations. The main aim of the database is to Predict Language Outcome and Recovery After Stroke (PLORAS) on the basis of a single structural (anatomical) brain scan that indexes the stereotactic location and extent of brain damage. Predictions are made for individual patients by indicating how other patients with the most similar brain damage, cognitive abilities and demographic details recovered their language skills over time. Predictions are validated by longitudinal follow-ups of patients who initially presented with speech and language difficulties. The PLORAS Database can also be used to predict recovery of other cognitive abilities on the basis of anatomical brain scans. The functional imaging data can be used to understand the neural mechanisms that support recovery from brain damage; and all the data can be used to understand the main sources of inter-subject variability in structure-function mappings in the human brain. Data will be made available for sharing, subject to: funding, ethical approval and patient consent. PMID:25882753

  17. A predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations

    PubMed Central

    Wang, Chun; Yu, Xiaobo; Shrestha, Sudeep; Qian, Cong; Wang, Lin; Chen, Gao

    2016-01-01

    Abstract To explore a predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations. This study was a retrospective review of consecutive patients with cerebral supratentorial cavernous malformations presenting with seizures. All patients underwent surgical resection of CCMs. Univariate and multivariate analyses were performed to determine the predictive value of the preoperative seizure frequency, seizure type, seizure duration, lesion location, lesion size, and the presence of residual hemosiderin. A total of 43 patients met the inclusion criteria. After a mean follow-up period of 40.95 months, 34 patients who were free from postoperative seizures were classified into Engel class I, and the remaining 9 patients were classified into Engel classes II–IV. A univariate analysis showed that the seizure frequency (χ2 = 13.440, P = 0.004) and seizure duration (χ2 = 5.145, P = 0.023) prior to surgery were associated with a worse postoperative seizure prognosis. Other covariates including age at onset, gender, a history of the medications taken, smoking status, family history, lesion characteristics, and the role of hemosiderin were not related to seizure outcomes. Logistic regression results demonstrated that the preoperative seizure frequency was an effective predictor (P = 0.004). The receiver operating characteristic curve indicated that area under the curve for the preoperative seizure frequency test was 0.833 (95% confidence interval 0.709–0.957, P = 0.002). The preoperative seizure frequency was a prognostic factor for postoperative seizure outcomes after surgical resection of supratentorial cavernous malformations. To obtain a favorable prognosis for CCM patients with preoperative seizures, early intervention might be a better choice. PMID:27368051

  18. Predicting major outcomes in type 1 diabetes: a model development and validation study

    PubMed Central

    Soedamah-Muthu, Sabita S.; Vergouwe, Yvonne; Costacou, Tina; Miller, Rachel G.; Zgibor, Janice; Chaturvedi, Nish; Snell-Bergeon, Janet K.; Maahs, David M.; Rewers, Marian; Forsblom, Carol; Harjutsalo, Valma; Groop, Per-Henrik; Fuller, John H.; Moons, Karel G.M.; Orchard, Trevor J.

    2015-01-01

    Aims/hypothesis Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicts these outcomes early in the disease process would be helpful in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts. Methods Data were analysed of 1,973 participants with type 1 diabetes who were followed for seven years in the EURODIAB Prospective Complications Study. Strong prognostic factors of major outcomes were combined in a Weibull regression model. The model performance was tested in three different prospective cohorts: Pittsburgh Epidemiology of Diabetes Complications study (EDC, n=554), Finnish Diabetic Nephropathy study (FinnDiane, n=2,999) and Coronary Artery Calcification in Type 1 Diabetes study (CACTI, n=580). Major outcomes included major coronary heart disease, stroke, end-stage renal failure, amputations, blindness and all-cause death. Results 95 EURODIAB patients with type 1 diabetes developed major outcomes during follow-up. Prognostic factors were age, glycated haemoglobin, waist-hip ratio, albumin/creatinine ratio, and HDL cholesterol. A high risk group could be identified with 15% risk after 3-years of follow-up, 24% after 5-years and 32% after 7-years. The discriminative ability of the model was adequate with a C-statistic of 0.74. Discrimination was similar or even better in the independent cohorts: EDC, C-statistic = 0.79; FinnDiane, 0.82; and CACTI, 0.73. Conclusions/Interpretation Our prognostic model that uses easily accessible clinical features can discriminate between type 1 diabetes patients with good and poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials. PMID:25186291

  19. Does the Quality of the Working Alliance Predict Treatment Outcome in Online Psychotherapy for Traumatized Patients?

    PubMed Central

    Maercker, Andreas

    2006-01-01

    Background The provision of online counseling and online therapy is steadily increasing. The results of a number of controlled trials investigating the efficacy of online approaches indicate that some of these new treatment alternatives might indeed be effective. Yet, little is known about how the therapeutic relationship (or working alliance) evolves over the Internet and whether it influences treatment outcome as it does in traditional face-to-face therapy. The working alliance has been defined as the extent to which a patient and a therapist work collaboratively and purposefully and connect emotionally. Objective The aim of the study was to investigate the quality and predictive relevance of the therapeutic alliance for patients receiving a short-term, Internet-based, cognitive-behavioral therapy program for posttraumatic stress reactions. Methods After rigorous screening for exclusion criteria of high dissociative tendencies, risk of psychosis, and suicidal tendencies, 48 patients, who had experienced a traumatic event in the past, were included in the online treatment study. The short form of the Working Alliance Inventory (WAI-S) was administered at the fourth treatment session. The relevance of the therapeutic relationship for treatment outcome was assessed in terms of residual gain from pretreatment assessment to the end of treatment. The revised Impact of Event Scale (IES-R) and the depression and anxiety subscales of the Brief Symptom Inventory (BSI) were used to assess treatment outcome. Results A total of 48 participants were included in the analysis. Overall, high alliance scores were found. In contrast to previous studies of conventional face-to-face therapy, there was only a low to modest association (.13 to .33) between the quality of the therapeutic relationship and treatment outcome. Conclusion High alliance scores indicate that it was possible to establish a stable and positive therapeutic relationship online. However, the therapeutic

  20. Diameter-Axial-Polar Nephrometry is Predictive of Surgical Outcomes Following Partial Nephrectomy.

    PubMed

    Li, Mingmin; Gao, Yi; Cheng, Jiwen; Qu, Le; Chen, Junming; Cai, Chen; Xu, Bing; Li, Peng; Bao, Yi; Xu, Zhipeng; Xu, Yifan; Wu, Dengshuang; Wu, Zhenjie; Wang, Linhui; Sun, Yinghao

    2015-07-01

    This study sought to evaluate the predictive value of the DAP (diameter-axial-polar) nephrometry system on surgical outcomes following partial nephrectomy (PN).This was a retrospective study of 237 patients who underwent open or minimally invasive PN for renal tumors at a single tertiary care center between 2009 and 2013. The primary outcomes included ischemia time >20 minutes and percentage of estimated glomerular filtration rate (eGFR) decline >10%. Statistical analysis was performed to study associations and predictions.The DAP sum score exhibited a statistically significant correlation with ischemia time, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and percent change in eGFR. The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379-2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529-13.011; P < 0.001) independently predicted an ischemia time >20 minutes. Similarly, the DAP sum score (OR: 1.297; 95% CI 1.051-1.602; P = 0.016), age-weighted Charlson comorbidity index (CCI) (OR: 4.730; 95% CI 1.463-15.291; P = 0.009), EBL (OR 2.433; 95% CI 1.095-5.407; P = 0.029), and ischemia time (OR 3.332; 95% CI 1.777-6.249; P < 0.001) were identified as independent predictors of eGFR decline >10%. Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001).We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN. The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes. PMID:26222856

  1. Diameter-Axial-Polar Nephrometry is Predictive of Surgical Outcomes Following Partial Nephrectomy

    PubMed Central

    Li, Mingmin; Gao, Yi; Cheng, Jiwen; Qu, Le; Chen, Junming; Cai, Chen; Xu, Bing; Li, Peng; Bao, Yi; Xu, Zhipeng; Xu, Yifan; Wu, Dengshuang; Wu, Zhenjie; Wang, Linhui; Sun, Yinghao

    2015-01-01

    Abstract This study sought to evaluate the predictive value of the DAP (diameter-axial-polar) nephrometry system on surgical outcomes following partial nephrectomy (PN). This was a retrospective study of 237 patients who underwent open or minimally invasive PN for renal tumors at a single tertiary care center between 2009 and 2013. The primary outcomes included ischemia time >20 minutes and percentage of estimated glomerular filtration rate (eGFR) decline >10%. Statistical analysis was performed to study associations and predictions. The DAP sum score exhibited a statistically significant correlation with ischemia time, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and percent change in eGFR. The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379–2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529–13.011; P < 0.001) independently predicted an ischemia time >20 minutes. Similarly, the DAP sum score (OR: 1.297; 95% CI 1.051–1.602; P = 0.016), age-weighted Charlson comorbidity index (CCI) (OR: 4.730; 95% CI 1.463–15.291; P = 0.009), EBL (OR 2.433; 95% CI 1.095–5.407; P = 0.029), and ischemia time (OR 3.332; 95% CI 1.777–6.249; P < 0.001) were identified as independent predictors of eGFR decline >10%. Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001). We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN. The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes. PMID:26222856

  2. Interrogating differences in expression of targeted gene sets to predict breast cancer outcome

    PubMed Central

    2013-01-01

    Background Genomics provides opportunities to develop precise tests for diagnostics, therapy selection and monitoring. From analyses of our studies and those of published results, 32 candidate genes were identified, whose expression appears related to clinical outcome of breast cancer. Expression of these genes was validated by qPCR and correlated with clinical follow-up to identify a gene subset for development of a prognostic test. Methods RNA was isolated from 225 frozen invasive ductal carcinomas,and qRT-PCR was performed. Univariate hazard ratios and 95% confidence intervals for breast cancer mortality and recurrence were calculated for each of the 32 candidate genes. A multivariable gene expression model for predicting each outcome was determined using the LASSO, with 1000 splits of the data into training and testing sets to determine predictive accuracy based on the C-index. Models with gene expression data were compared to models with standard clinical covariates and models with both gene expression and clinical covariates. Results Univariate analyses revealed over-expression of RABEP1, PGR, NAT1, PTP4A2, SLC39A6, ESR1, EVL, TBC1D9, FUT8, and SCUBE2 were all associated with reduced time to disease-related mortality (HR between 0.8 and 0.91, adjusted p < 0.05), while RABEP1, PGR, SLC39A6, and FUT8 were also associated with reduced recurrence times. Multivariable analyses using the LASSO revealed PGR, ESR1, NAT1, GABRP, TBC1D9, SLC39A6, and LRBA to be the most important predictors for both disease mortality and recurrence. Median C-indexes on test data sets for the gene expression, clinical, and combined models were 0.65, 0.63, and 0.65 for disease mortality and 0.64, 0.63, and 0.66 for disease recurrence, respectively. Conclusions Molecular signatures consisting of five genes (PGR, GABRP, TBC1D9, SLC39A6 and LRBA) for disease mortality and of six genes (PGR, ESR1, GABRP, TBC1D9, SLC39A6 and LRBA) for disease recurrence were identified. These signatures

  3. Prediction of Bladder Outcomes after Traumatic Spinal Cord Injury: A Longitudinal Cohort Study

    PubMed Central

    Pavese, Chiara; Schneider, Marc P.; Schubert, Martin; Curt, Armin; Scivoletto, Giorgio; Finazzi-Agrò, Enrico; Mehnert, Ulrich; Abel, Rainer; Röhrich, Frank; Weidner, Norbert; Rupp, Rüdiger; Kessels, Alfons G.; Bachmann, Lucas M.; Kessler, Thomas M.

    2016-01-01

    Background Neurogenic bladder dysfunction represents one of the most common and devastating sequelae of traumatic spinal cord injury (SCI). As early prediction of bladder outcomes is essential to counsel patients and to plan neurourological management, we aimed to develop and validate a model to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. Methods and Findings Using multivariate logistic regression analysis from the data of 1,250 patients with traumatic SCI included in the European Multicenter Spinal Cord Injury study, we developed two prediction models of urinary continence and complete bladder emptying 1 y after traumatic SCI and performed an external validation in 111 patients. As predictors, we evaluated age, gender, and all variables of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and of the Spinal Cord Independence Measure (SCIM). Urinary continence and complete bladder emptying 1 y after SCI were assessed through item 6 of SCIM. The full model relies on lower extremity motor score (LEMS), light-touch sensation in the S3 dermatome of ISNCSI, and SCIM subscale respiration and sphincter management: the area under the receiver operating characteristics curve (aROC) was 0.936 (95% confidence interval [CI]: 0.922–0.951). The simplified model is based on LEMS only: the aROC was 0.912 (95% CI: 0.895–0.930). External validation of the full and simplified models confirmed the excellent predictive power: the aROCs were 0.965 (95% CI: 0.934–0.996) and 0.972 (95% CI 0.943–0.999), respectively. This study is limited by the substantial number of patients with a missing 1-y outcome and by differences between derivation and validation cohort. Conclusions Our study provides two simple and reliable models to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. Early prediction of bladder function might optimize counselling and patient-tailored rehabilitative

  4. Same admissions tools, different outcomes: a critical perspective on predictive validity in three undergraduate medical schools

    PubMed Central

    2013-01-01

    Background Admission to medical school is one of the most highly competitive entry points in higher education. Considerable investment is made by universities to develop selection processes that aim to identify the most appropriate candidates for their medical programs. This paper explores data from three undergraduate medical schools to offer a critical perspective of predictive validity in medical admissions. Methods This study examined 650 undergraduate medical students from three Australian universities as they progressed through the initial years of medical school (accounting for approximately 25 per cent of all commencing undergraduate medical students in Australia in 2006 and 2007). Admissions criteria (aptitude test score based on UMAT, school result and interview score) were correlated with GPA over four years of study. Standard regression of each of the three admissions variables on GPA, for each institution at each year level was also conducted. Results Overall, the data found positive correlations between performance in medical school, school achievement and UMAT, but not interview. However, there were substantial differences between schools, across year levels, and within sections of UMAT exposed. Despite this, each admission variable was shown to add towards explaining course performance, net of other variables. Conclusion The findings suggest the strength of multiple admissions tools in predicting outcomes of medical students. However, they also highlight the large differences in outcomes achieved by different schools, thus emphasising the pitfalls of generalising results from predictive validity studies without recognising the diverse ways in which they are designed and the variation in the institutional contexts in which they are administered. The assumption that high-positive correlations are desirable (or even expected) in these studies is also problematised. PMID:24373207

  5. Mealtime problems predict outcome in clinical trial to improve nutrition in children with CF.

    PubMed

    Opipari-Arrigan, Lisa; Powers, Scott W; Quittner, Alexandra L; Stark, Lori J

    2010-01-01

    Better growth and nutritional status is strongly associated with better pulmonary function and survival in children with CF. Behavioral intervention is an efficacious treatment approach for improving calorie intake and weight gain in children with CF; and recently has been shown to facilitate maintenance of daily energy intake at 120% of the healthy population over a 2-year period. However, no study to date has examined factors that predict outcome with behavior intervention to promote weight gain in CF. The objectives of this study were to examine the influence of nutritional status, mealtime behavior problems, and maternal depressive symptoms on calorie intake and weight gain following participation in a randomized trial to improve nutritional status in cystic fibrosis. Sixty-seven children, aged 4-12 years with cystic fibrosis participated in a clinical trial targeting calorie and weight increases. Participants completed baseline measures of mealtime behavior problems, maternal depression, and fat absorption, and baseline and post-treatment caloric intake and weight. Assignment to behavioral group (R(2) change = 0.17), lower frequency of mealtime behavior problems (R(2) change = 0.11), and higher maternal depression (R(2) change = 0.06) predicted greater calorie increase baseline to post-treatment. Assignment to behavioral group (R(2) change = 0.09), higher baseline weight (R(2) change = 0.10), fat absorption (R(2) change = 0.02), and lower frequency of mealtime behavior problems (R(2) change = 0.06) predicted greater weight gain baseline to post-treatment. Less frequent mealtime behavior problems led to better calorie intake and weight gain in a 9-week clinical trial of behavior intervention and nutrition education to improve nutritional status in cystic fibrosis. The key implication from these findings is that early referral to behavioral intervention as soon as growth deficits become a concern will likely yield the best nutritional outcomes. PMID:19953660

  6. Role of ultrasonography in outcome prediction in subclinical hypothyroid patients treated with levothyroxine.

    PubMed

    Shin, Dong Yeob; Kim, Eun-Kyung; Lee, Eun Jig

    2010-01-01

    Progression to overt hypothyroidism and the associated adverse effects on lipid metabolism and the cardiovascular system are major concerns for patients diagnosed with subclinical hypothyroidism (SCH). No consensus regarding the clinical parameters associated with prognosis for this mild thyroid dysfunction has yet been established, although elevation of serum anti-thyroid peroxidase antibody (TPOAb) and decreased or heterogeneous echogenicity (diffuse thyroid disease, DT) on ultrasonography (US) are commonly observed. We investigated the value of ultrasonographic examination compared to the measurement of serum TPOAb and anti-thyroglobulin antibody (TgAb) for the evaluation of levothyroxine treatment on SCH. We analyzed 204 SCH patients who initially underwent thyroid ultrasonography and were given a low dose of levothyroxine for a mean of 6.94 months. Outcome was determined by the normalization or sustained elevation of serum TSH, and evaluated according to the presence of DT on subsequent US and serum TPOAb or TgAb. Sustained TSH elevation after levothyroxine replacement was more frequent in patients who initially showed DT on US, regardless of thyroid autoantibody level. Ultrasonographic morphology had a higher negative predictive value (81.8%) compared with the absence of TPOAb (73.9%) or TgAb (73.7%) and a similar positive predictive value (48.9%) to that of thyroid autoantibodies (46.8% for TPOAb and 50.0% for TgAb) in the outcome prediction of SCH. Thyroid US may provide valuable information on the course of SCH, and DT pattern can serve as a prognostic factor when combined with other known parameters. PMID:19823000

  7. Predictive factors of short term outcome after liver transplantation: A review.

    PubMed

    Bolondi, Giuliano; Mocchegiani, Federico; Montalti, Roberto; Nicolini, Daniele; Vivarelli, Marco; De Pietri, Lesley

    2016-07-14

    Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1(th) and the 5(th) day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients

  8. Predictive factors of short term outcome after liver transplantation: A review

    PubMed Central

    Bolondi, Giuliano; Mocchegiani, Federico; Montalti, Roberto; Nicolini, Daniele; Vivarelli, Marco; De Pietri, Lesley

    2016-01-01

    Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients

  9. Prognostic Value of Metabolic Tumor Volume and Velocity in Predicting Head-and-Neck Cancer Outcomes

    SciTech Connect

    Chu, Karen P.; Murphy, James D.; La, Trang H.; Krakow, Trevor E.; Iagaru, Andrei; Graves, Edward E.; Hsu, Annie; Maxim, Peter G.; Loo, Billy; Chang, Daniel T.; Le, Quynh-Thu

    2012-08-01

    Purpose: We previously showed that metabolic tumor volume (MTV) on positron emission tomography-computed tomography (PET-CT) predicts for disease recurrence and death in head-and-neck cancer (HNC). We hypothesized that increases in MTV over time would correlate with tumor growth and biology, and would predict outcome. We sought to examine tumor growth over time in serial pretreatment PET-CT scans. Methods and Materials: From 2006 to 2009, 51 patients had two PET-CT scans before receiving HNC treatment. MTV was defined as the tumor volume {>=}50% of maximum SUV (SUV{sub max}). MTV was calculated for the primary tumor, nodal disease, and composite (primary tumor + nodes). MTV and SUV velocity were defined as the change in MTV or SUV{sub max} over time, respectively. Cox regression analyses were used to examine correlations between SUV, MTV velocity, and outcome (disease progression and overall survival). Results: The median follow-up time was 17.5 months. The median time between PET-CT scans was 3 weeks. Unexpectedly, 51% of cases demonstrated a decrease in SUV{sub max} (average, -0.1 cc/week) and MTV (average, -0.3 cc/week) over time. Despite the variability in MTV, primary tumor MTV velocity predicted disease progression (hazard ratio 2.94; p = 0.01) and overall survival (hazard ratio 1.85; p = 0.03). Conclusions: Primary tumor MTV velocity appears to be a better prognostic indicator of disease progression and survival in comparison to nodal MTV velocity. However, substantial variability was found in PET-CT biomarkers between serial scans. Caution should be used when PET-CT biomarkers are integrated into clinical protocols for HNC.

  10. Derived neutrophil/lymphocyte ratio predicts gemcitabine therapy outcome in unresectable pancreatic cancer

    PubMed Central

    SUZUKI, REI; TAKAGI, TADAYUKI; HIKICHI, TAKUTO; KONNO, NAOKI; SUGIMOTO, MITSURU; WATANABE, KO; NAKAMURA, JUN; WARAGAI, YUICHI; KIKUCHI, HITOMI; TAKASUMI, MIKA; WATANABE, HIROSHI; OHIRA, HIROMASA

    2016-01-01

    As gemcitabine is a key anti-tumor agent for unresectable pancreatic ductal adenocarcinoma (PDAC), it is important to predict the outcomes of gemcitabine chemotherapy. The present study aimed to confirm whether the derived neutrophil-to-lymphocyte ratio (dNLR) is able to predict chemotherapy outcomes. To elucidate the role of dNLR in patients that underwent chemotherapy, the current study evaluated clinicopathological variables in 31 patients with unresectable PDAC treated with gemcitabine. The correlation between clinicopathological variables, and progression-free survival (PFS) and overall survival (OS) time were investigated. Univariate analysis revealed that there were no significant differences in PFS and OS as a function of age (<65 vs. ≥65 years), gender, tumor location (pancreas head vs. body/tail), tumor diameter (<23 vs. ≥23 mm) or serum carbohydrate antigen 19–9 concentration level (<3,800 vs. ≥3,800 U/ml). However, disease stage (locally advanced vs. metastatic) and the dNLR (<2.5 vs. ≥2.5) significantly affected PFS and OS. Multivariate analysis subsequently revealed that a dNLR of ≥2.5 was an independent prognostic factor for poor PFS (P=0.003) and OS (P=0.026). In conclusion, data from the present study suggests that the pre-treatment dNLR is an independent prognostic factor to predict PFS and OS in patients with unresectable PDAC treated with gemcitabine. This indicates that dNLR has a potential role in stratifying patients that may benefit from gemcitabine therapy. PMID:27123132

  11. Predicting the In-Hospital Responsiveness to Treatment of Alcoholics. Social Factors as Predictors of Outcome. Brain Damage as a Factor in Treatment Outcome of Chronic Alcoholic Patients.

    ERIC Educational Resources Information Center

    Mascia, George V.; And Others

    The authors attempt to locate predictor variables associated with the outcome of alcoholic treatment programs. Muscia's study focuses on the predictive potential of: (1) response to a GSR conditioning procedure; (2) several personality variables; and (3) age and IQ measures. Nine variables, reflecting diverse perspectives, were selected as a basis…

  12. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma

    PubMed Central

    Poulou, Loukia S; Botsa, Evanthia; Thanou, Ioanna; Ziakas, Panayiotis D; Thanos, Loukas

    2015-01-01

    Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival. PMID:26052394

  13. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma.

    PubMed

    Poulou, Loukia S; Botsa, Evanthia; Thanou, Ioanna; Ziakas, Panayiotis D; Thanos, Loukas

    2015-05-18

    Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival. PMID:26052394

  14. LUPUS ANTICOAGULANT, BUT NOT ANTICARDIOLIPIN ANTIBODY, PREDICTS ADVERSE PREGNANCY OUTCOME IN PATIENTS WITH ANTIPHOSPHOLIPID ANTIBODIES

    PubMed Central

    Lockshin, Michael D.; Kim, Mimi; Laskin, Carl A.; Guerra, Marta; Branch, D. Ware; Merrill, Joan; Petri, Michelle; Porter, Flint; Sammaritano, Lisa; Stephenson, Mary D.; Buyon, Jill; Salmon, Jane E.

    2012-01-01

    BACKGROUND Which serologic and clinical findings predict adverse pregnancy outcome (APO) in patients with antiphospholipid antibody (aPL) is controversial. METHODS PROMISSE is a multicenter, prospective observational study of risk factors for APO in patients with aPL (lupus anticoagulant [LAC], anticardiolipin antibody [aCL] and/or antibody to β2 glycoprotein I [anti-β2-GP-I]). We tested the hypothesis that a pattern of clinical and serological variables can identify women at highest risk for APO. RESULTS Between 2003 and 2011 we enrolled 144 pregnant patients, of whom 28 had APO. Thirty-nine percent of patients with LAC had APO, compared to 3% who did not have LAC (p < 0.0001). Only 8% of women with IgG aCL ≥40 u/mL but not LAC suffered APO, compared to 43% of those with LAC (p = 0.002). IgM aCL or IgG or IgM anti-β2-GP-I did not predict APO. In bivariate analysis, APO occurred in 52% of patients with and 13% of patients without prior thrombosis (p = 0.00005), and in 23% with SLE compared to 17% without SLE (not significant); SLE was a predictor in multivariate analysis. Prior pregnancy loss did not predict APO, nor did maternal race. Simultaneous aCL, anti-β2-GP-I, and LAC did not predict APO better than did LAC alone. CONCLUSIONS LAC is the primary predictor of APO after 12 weeks gestation in aPL-associated pregnancies. ACL and anti-β2-GP-I, if LAC is not also present, do not predict APO. PMID:22275304

  15. A Study of the Predictive Relationships between Faculty Engagement, Learner Satisfaction and Outcomes in Multiple Learning Delivery Modes

    ERIC Educational Resources Information Center

    Yen, Cherng-Jyh; Abdous, M'hammed

    2012-01-01

    This study assessed the predictive relationships between faculty engagement, learner satisfaction, and outcomes across multiple learning delivery modes (LDMs). Participants were enrolled in courses with the options of three learning delivery modes: face-to-face, satellite broadcasting, and live video-streaming. The predictive relationship between…

  16. Watching novice action degrades expert motor performance: causation between action production and outcome prediction of observed actions by humans.

    PubMed

    Ikegami, Tsuyoshi; Ganesh, Gowrishankar

    2014-01-01

    Our social skills are critically determined by our ability to understand and appropriately respond to actions performed by others. However despite its obvious importance, the mechanisms enabling action understanding in humans have remained largely unclear. A popular but controversial belief is that parts of the motor system contribute to our ability to understand observed actions. Here, using a novel behavioral paradigm, we investigated this belief by examining a causal relation between action production, and a component of action understanding--outcome prediction, the ability of a person to predict the outcome of observed actions. We asked dart experts to watch novice dart throwers and predict the outcome of their throws. We modulated the feedbacks provided to them, caused a specific improvement in the expert's ability to predict watched actions while controlling the other experimental factors, and exhibited that a change (improvement) in their outcome prediction ability results in a progressive and proportional deterioration in the expert's own darts performance. This causal relationship supports involvement of the motor system in outcome prediction by humans of actions observed in others. PMID:25384755

  17. Watching novice action degrades expert motor performance: Causation between action production and outcome prediction of observed actions by humans

    PubMed Central

    Ikegami, Tsuyoshi; Ganesh, Gowrishankar

    2014-01-01

    Our social skills are critically determined by our ability to understand and appropriately respond to actions performed by others. However despite its obvious importance, the mechanisms enabling action understanding in humans have remained largely unclear. A popular but controversial belief is that parts of the motor system contribute to our ability to understand observed actions. Here, using a novel behavioral paradigm, we investigated this belief by examining a causal relation between action production, and a component of action understanding - outcome prediction, the ability of a person to predict the outcome of observed actions. We asked dart experts to watch novice dart throwers and predict the outcome of their throws. We modulated the feedbacks provided to them, caused a specific improvement in the expert's ability to predict watched actions while controlling the other experimental factors, and exhibited that a change (improvement) in their outcome prediction ability results in a progressive and proportional deterioration in the expert's own darts performance. This causal relationship supports involvement of the motor system in outcome prediction by humans of actions observed in others. PMID:25384755

  18. Evaluation of machine learning algorithms for treatment outcome prediction in patients with epilepsy based on structural connectome data

    PubMed Central

    Munsell, Brent C.; Wee, Chong-Yaw; Keller, Simon S.; Weber, Bernd; Elger, Christian; da Silva, Laura Angelica Tomaz; Nesland, Travis; Styner, Martin; Shen, Dinggang; Bonilha, Leonardo

    2015-01-01

    The objective of this study is to evaluate machine learning algorithms aimed at predicting surgical treatment outcomes in groups of patients with temporal lobe epilepsy (TLE) using only the structural brain connectome. Specifically, the brain connectome is reconstructed using white matter fiber tracts from presurgical diffusion tensor imaging. To achieve our objective, a two-stage connectome-based prediction framework is developed that gradually selects a small number of abnormal network connections that contribute to the surgical treatment outcome, and in each stage a linear kernel operation is used to further improve the accuracy of the learned classifier. Using a 10-fold cross validation strategy, the first stage in the connectome-based framework is able to separate patients with TLE from normal controls with 80% accuracy, and second stage in the connectome-based framework is able to correctly predict the surgical treatment outcome of patients with TLE with 70% accuracy. Compared to existing state-of-the-art methods that use VBM data, the proposed two-stage connectome-based prediction framework is a suitable alternative with comparable prediction performance. Our results additionally show that machine learning algorithms that exclusively use structural connectome data can predict treatment outcomes in epilepsy with similar accuracy compared with “expert-based” clinical decision. In summary, using the unprecedented information provided in the brain connectome, machine learning algorithms may uncover pathological changes in brain network organization and improve outcome forecasting in the context of epilepsy. PMID:26054876

  19. Preschool speech intelligibility and vocabulary skills predict long-term speech and language outcomes following cochlear implantation in early childhood.

    PubMed

    Castellanos, Irina; Kronenberger, William G; Beer, Jessica; Henning, Shirley C; Colson, Bethany G; Pisoni, David B

    2014-07-01

    Speech and language measures during grade school predict adolescent speech-language outcomes in children who receive cochlear implants (CIs), but no research has examined whether speech and language functioning at even younger ages is predictive of long-term outcomes in this population. The purpose of this study was to examine whether early preschool measures of speech and language performance predict speech-language functioning in long-term users of CIs. Early measures of speech intelligibility and receptive vocabulary (obtained during preschool ages of 3-6 years) in a sample of 35 prelingually deaf, early-implanted children predicted speech perception, language, and verbal working memory skills up to 18 years later. Age of onset of deafness and age at implantation added additional variance to preschool speech intelligibility in predicting some long-term outcome scores, but the relationship between preschool speech-language skills and later speech-language outcomes was not significantly attenuated by the addition of these hearing history variables. These findings suggest that speech and language development during the preschool years is predictive of long-term speech and language functioning in early-implanted, prelingually deaf children. As a result, measures of speech-language functioning at preschool ages can be used to identify and adjust interventions for very young CI users who may be at long-term risk for suboptimal speech and language outcomes. PMID:23998347

  20. Preschool Speech Intelligibility and Vocabulary Skills Predict Long-Term Speech and Language Outcomes Following Cochlear Implantation in Early Childhood

    PubMed Central

    Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Henning, Shirley C.; Colson, Bethany G.; Pisoni, David B.

    2013-01-01

    Speech and language measures during grade school predict adolescent speech-language outcomes in children who receive cochlear implants, but no research has examined whether speech and language functioning at even younger ages is predictive of long-term outcomes in this population. The purpose of this study was to examine if early preschool measures of speech and language performance predict speech-language functioning in long-term users of cochlear implants. Early measures of speech intelligibility and receptive vocabulary (obtained during preschool ages of 3 – 6 years) in a sample of 35 prelingually deaf, early-implanted children predicted speech perception, language, and verbal working memory skills up to 18 years later. Age of onset of deafness and age at implantation added additional variance to preschool speech intelligibility in predicting some long-term outcome scores, but the relationship between preschool speech-language skills and later speech-language outcomes was not significantly attenuated by the addition of these hearing history variables. These findings suggest that speech and language development during the preschool years is predictive of long-term speech and language functioning in early-implanted, prelingually deaf children. As a result, measures of speech-language functioning at preschool ages can be used to identify and adjust interventions for very young CI users who may be at long-term risk for suboptimal speech and language outcomes. PMID:23998347

  1. Cytokine Profiles during Invasive Nontyphoidal Salmonella Disease Predict Outcome in African Children.

    PubMed

    Gilchrist, James J; Heath, Jennifer N; Msefula, Chisomo L; Gondwe, Esther N; Naranbhai, Vivek; Mandala, Wilson; MacLennan, Jenny M; Molyneux, Elizabeth M; Graham, Stephen M; Drayson, Mark T; Molyneux, Malcolm E; MacLennan, Calman A

    2016-07-01

    Nontyphoidal Salmonella is a leading cause of sepsis in African children. Cytokine responses are central to the pathophysiology of sepsis and predict sepsis outcome in other settings. In this study, we investigated cytokine responses to invasive nontyphoidal Salmonella (iNTS) disease in Malawian children. We determined serum concentrations of 48 cytokines with multiplexed immunoassays in Malawian children during acute iNTS disease (n = 111) and in convalescence (n = 77). Principal component analysis and logistic regression were used to identify cytokine signatures of acute iNTS disease. We further investigated whether these responses are altered by HIV coinfection or severe malnutrition and whether cytokine responses predict inpatient mortality. Cytokine changes in acute iNTS disease were associated with two distinct cytokine signatures. The first is characterized by increased concentrations of mediators known to be associated with macrophage function, and the second is characterized by raised pro- and anti-inflammatory cytokines typical of responses reported in sepsis secondary to diverse pathogens. These cytokine responses were largely unaltered by either severe malnutrition or HIV coinfection. Children with fatal disease had a distinctive cytokine profile, characterized by raised mediators known to be associated with neutrophil function. In conclusion, cytokine responses to acute iNTS infection in Malawian children are reflective of both the cytokine storm typical of sepsis secondary to diverse pathogens and the intramacrophage replicative niche of NTS. The cytokine profile predictive of fatal disease supports a key role of neutrophils in the pathogenesis of NTS sepsis. PMID:27170644

  2. Cytokine Profiles during Invasive Nontyphoidal Salmonella Disease Predict Outcome in African Children

    PubMed Central

    Gilchrist, James J.; Heath, Jennifer N.; Msefula, Chisomo L.; Gondwe, Esther N.; Naranbhai, Vivek; Mandala, Wilson; MacLennan, Jenny M.; Molyneux, Elizabeth M.; Graham, Stephen M.; Drayson, Mark T.; Molyneux, Malcolm E.

    2016-01-01

    Nontyphoidal Salmonella is a leading cause of sepsis in African children. Cytokine responses are central to the pathophysiology of sepsis and predict sepsis outcome in other settings. In this study, we investigated cytokine responses to invasive nontyphoidal Salmonella (iNTS) disease in Malawian children. We determined serum concentrations of 48 cytokines with multiplexed immunoassays in Malawian children during acute iNTS disease (n = 111) and in convalescence (n = 77). Principal component analysis and logistic regression were used to identify cytokine signatures of acute iNTS disease. We further investigated whether these responses are altered by HIV coinfection or severe malnutrition and whether cytokine responses predict inpatient mortality. Cytokine changes in acute iNTS disease were associated with two distinct cytokine signatures. The first is characterized by increased concentrations of mediators known to be associated with macrophage function, and the second is characterized by raised pro- and anti-inflammatory cytokines typical of responses reported in sepsis secondary to diverse pathogens. These cytokine responses were largely unaltered by either severe malnutrition or HIV coinfection. Children with fatal disease had a distinctive cytokine profile, characterized by raised mediators known to be associated with neutrophil function. In conclusion, cytokine responses to acute iNTS infection in Malawian children are reflective of both the cytokine storm typical of sepsis secondary to diverse pathogens and the intramacrophage replicative niche of NTS. The cytokine profile predictive of fatal disease supports a key role of neutrophils in the pathogenesis of NTS sepsis. PMID:27170644

  3. Spirituality factors in the prediction of outcomes of PTSD treatment for U.S. military veterans.

    PubMed

    Currier, Joseph M; Holland, Jason M; Drescher, Kent D

    2015-02-01

    Spirituality is a multifaceted construct that might affect veterans' recovery from posttraumatic stress disorder (PTSD) in adaptive and maladaptive ways. Using a cross-lagged panel design, this study examined longitudinal associations between spirituality and PTSD symptom severity among 532 U.S. veterans in a residential treatment program for combat-related PTSD. Results indicated that spirituality factors at the start of treatment were uniquely predictive of PTSD symptom severity at discharge, when accounting for combat exposure and both synchronous and autoregressive associations between the study variables, βs = .10 to .16. Specifically, veterans who scored higher on adaptive dimensions of spirituality (daily spiritual experiences, forgiveness, spiritual practices, positive religious coping, and organizational religiousness) at intake fared significantly better in this program. In addition, possible spiritual struggles (operationalized as negative religious coping) at baseline were predictive of poorer PTSD outcomes, β = .11. In contrast to these results, PTSD symptomatology at baseline did not predict any of the spirituality variables at posttreatment. In keeping with a spiritually integrative approach to treating combat-related PTSD, these results suggest that understanding the possible spiritual context of veterans' trauma-related concerns might add prognostic value and equip clinicians to alleviate PTSD symptomatology among those veterans who possess spiritual resources or are somehow struggling in this domain. PMID:25624135

  4. A Predictive Model for Diabetic Foot Ulcer Outcome: The Wound Healing Index

    PubMed Central

    Fife, Caroline E.; Horn, Susan D.; Smout, Randall J.; Barrett, Ryan S.; Thomson, Brett

    2016-01-01

    Objective: To develop a healing index for patients with diabetic foot ulcers (DFUs) for use in clinical practice, research analysis, and clinical trials. Approach: U.S. Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, etc.). Significant variables were identified with bivariate analyses. A multivariable logistic regression model was created based on significant factors (p < 0.05) and tested on a hold-out sample of data. Out of 13,266 DFUs from the original dataset, 6,440 were eligible for analysis. The logistic regression model included 5,239 ulcers, of which 3,462 healed (66.1%). The 10% validation sample utilized 555 ulcers, of which 377 healed (67.9%). Results: Variables that significantly predicted healing were as follows: wound age (duration in days), wound size, number of concurrent wounds of any etiology, evidence of bioburden/infection, patient age, Wagner grade, being nonambulatory, renal dialysis, renal transplant, peripheral vascular disease, and patient hospitalization for any reason. Innovation: We present a validated stratification system, previously described as the Wound Healing Index (WHI), which predicts healing likelihood of patients with DFUs, incorporating patient- and wound-specific variables. Conclusion: The DFU WHI is a comprehensive and user-friendly validated predictive model for DFU healing. It can risk stratify patients enrolled in clinical research trials, stratify patient data for quality reporting and benchmarking activities, and identify patients most likely to require costly therapy to heal. PMID:27366589

  5. Individualised headband simulation test for predicting outcome after percutaneous bone conductive implantation.

    PubMed

    Monini, S; Filippi, C; Atturo, F; Biagini, M; Lazzarino, A I; Barbara, M

    2015-10-01

    Trans-cutaneous bone conduction (BC) stimulators, when coupled to the HB (BC-HB), are generally used to predict the results that could be achieved after bone conductive implant (BCI) surgery, and their performance is generally considered inferior to that provided by the definitive percutaneous system. The aim of the present study was to compare the performances between BC-HB and BCI of the same typology, when the former's sound processor is fitted in accordance to the individual auditory situation. Twenty-two patients selected for surgical application of a BCI were evaluated and the same audiological protocol was used to select the candidate and assess the final outcome. The BC-HB was properly fitted based on individual hearing loss and personal auditory targets, and tested as primary step of the protocol to obtain the most reliable predictive value. The BAHA Divino and BP100 sound processors were applied in 12 patients with conductive/mixed hearing loss (CMHL) and in 10 subjects with single sided deafness (SSD). Audiometric evaluation included the pure tone average (PTA3) threshold between 250-1000 Hz; the PTA thresholds at 2000 and 4000 Hz; intelligibility scores as percentage of word recognition (WRS) in quiet and in noise; and subjective evaluation of perceived sound quality by a visual analogue scale (VAS). Statistical evaluation with a student's t test was used for assessment of efficacy of BC-HB and BCI compared with the unaided condition. Spearman's Rho coefficient was used to confirm the reliability of the BC-HB simulation test as a predictor of definitive outcome. The results showed that the mean PTA difference between BCI and BC-HB ranged from 2.54 to 8.27 decibels in the CMHL group and from 1.27 to 3.9 decibels in the SSD group. Compared with the BC-HB, BCI showed a better WRS both in CMHL (16% in quiet and 12% in noise) and in SSD (5% in quiet and a 1% in noise) groups. Spearman's Rho coefficient, calculated for PTA, WRS in quiet and in noise and VAS

  6. Accelerating Adverse Outcome Pathway (AOP) development via computationally predicted AOP networks

    EPA Science Inventory

    The Adverse Outcome Pathway (AOP) framework is increasingly being adopted as a tool for organizing and summarizing the mechanistic information connecting molecular perturbations by environmental stressors with adverse outcomes relevant for ecological and human health outcomes. Ho...

  7. Behavioral, Brain Imaging and Genomic Measures to Predict Functional Outcomes Post - Bed Rest and Spaceflight

    NASA Technical Reports Server (NTRS)

    Mulavara, A. P.; DeDios, Y. E.; Gadd, N. E.; Caldwell, E. E.; Batson, C. D.; Goel, R.; Seidler, R. D.; Oddsson, L.; Zanello, S.; Clarke, T.; Peters, B.; Cohen, H. S.; Reschke, M.; Wood, S.; Bloomberg, J. J.

    2016-01-01

    retrospective study, leveraging data already collected from relevant ongoing or completed bed rest and spaceflight studies. These data will be combined with predictor metrics that will be collected prospectively (as described for behavioral, brain imaging and genomic measures) from these returning subjects to build models for predicting post-mission (bed rest - non-astronauts or space flight - astronauts) adaptive capability as manifested in their outcome measures. To date we have completed a study on 15 normal subjects with all of the above measures. In this presentation we will discuss the optimized set of tests for predictive metrics to be used for evaluating post mission adaptive capability as manifested in their outcome measures. Comparisons of model performance will allow us to better design and implement sensorimotor adaptability training countermeasures against decrements in post-mission adaptive capability that are customized for each crewmember's sensory biases, adaptive capacity, brain structure and functional capacities, and genetic predispositions. The ability to customize adaptability training will allow more efficient use of crew time during training and will optimize training prescriptions for astronauts to ensure expected outcomes.

  8. Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model

    SciTech Connect

    Louie, Alexander V.; Haasbeek, Cornelis J.A.; Mokhles, Sahar; Rodrigues, George B.; Stephans, Kevin L.; Lagerwaard, Frank J.; Palma, David A.; Videtic, Gregory M.M.; Warner, Andrew; Takkenberg, Johanna J.M.; Reddy, Chandana A.; Maat, Alex P.W.M.; Woody, Neil M.; Slotman, Ben J.; Senan, Suresh

    2015-09-01

    Purpose: A prognostic model for 5-year overall survival (OS), consisting of recursive partitioning analysis (RPA) and a nomogram, was developed for patients with early-stage non-small cell lung cancer (ES-NSCLC) treated with stereotactic ablative radiation therapy (SABR). Methods and Materials: A primary dataset of 703 ES-NSCLC SABR patients was randomly divided into a training (67%) and an internal validation (33%) dataset. In the former group, 21 unique parameters consisting of patient, treatment, and tumor factors were entered into an RPA model to predict OS. Univariate and multivariate models were constructed for RPA-selected factors to evaluate their relationship with OS. A nomogram for OS was constructed based on factors significant in multivariate modeling and validated with calibration plots. Both the RPA and the nomogram were externally validated in independent surgical (n=193) and SABR (n=543) datasets. Results: RPA identified 2 distinct risk classes based on tumor diameter, age, World Health Organization performance status (PS) and Charlson comorbidity index. This RPA had moderate discrimination in SABR datasets (c-index range: 0.52-0.60) but was of limited value in the surgical validation cohort. The nomogram predicting OS included smoking history in addition to RPA-identified factors. In contrast to RPA, validation of the nomogram performed well in internal validation (r{sup 2}=0.97) and external SABR (r{sup 2}=0.79) and surgical cohorts (r{sup 2}=0.91). Conclusions: The Amsterdam prognostic model is the first externally validated prognostication tool for OS in ES-NSCLC treated with SABR available to individualize patient decision making. The nomogram retained strong performance across surgical and SABR external validation datasets. RPA performance was poor in surgical patients, suggesting that 2 different distinct patient populations are being treated with these 2 effective modalities.

  9. EU Framework 6 Project: Predictive Toxicology (PredTox)-overview and outcome

    SciTech Connect

    Suter, Laura; Schroeder, Susanne; Meyer, Kirstin; Gautier, Jean-Charles; Amberg, Alexander; Wendt, Maria; Gmuender, Hans; Mally, Angela; Boitier, Eric; Ellinger-Ziegelbauer, Heidrun; Matheis, Katja; Pfannkuch, Friedlieb

    2011-04-15

    In this publication, we report the outcome of the integrated EU Framework 6 Project: Predictive Toxicology (PredTox), including methodological aspects and overall conclusions. Specific details including data analysis and interpretation are reported in separate articles in this issue. The project, partly funded by the EU, was carried out by a consortium of 15 pharmaceutical companies, 2 SMEs, and 3 universities. The effects of 16 test compounds were characterized using conventional toxicological parameters and 'omics' technologies. The three major observed toxicities, liver hypertrophy, bile duct necrosis and/or cholestasis, and kidney proximal tubular damage were analyzed in detail. The combined approach of 'omics' and conventional toxicology proved a useful tool for mechanistic investigations and the identification of putative biomarkers. In our hands and in combination with histopathological assessment, target organ transcriptomics was the most prolific approach for the generation of mechanistic hypotheses. Proteomics approaches were relatively time-consuming and required careful standardization. NMR-based metabolomics detected metabolite changes accompanying histopathological findings, providing limited additional mechanistic information. Conversely, targeted metabolite profiling with LC/GC-MS was very useful for the investigation of bile duct necrosis/cholestasis. In general, both proteomics and metabolomics were supportive of other findings. Thus, the outcome of this program indicates that 'omics' technologies can help toxicologists to make better informed decisions during exploratory toxicological studies. The data support that hypothesis on mode of action and discovery of putative biomarkers are tangible outcomes of integrated 'omics' analysis. Qualification of biomarkers remains challenging, in particular in terms of identification, mechanistic anchoring, appropriate specificity, and sensitivity.

  10. Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes

    PubMed Central

    Shaheen, Aisha W.; Crandall, Marie L.; Nicolson, Norman G.; Smith-Singares, Eduardo; Merlotti, Gary J.; Jalundhwala, Yash; Issa, Nabil M.

    2016-01-01

    Context: Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality among trauma patients. Several clinical and laboratory findings have been suggested as markers for ACS, and these may point to different types of ACS and complications. Aims: This study aims to identify the strength of association of clinical and laboratory variables with specific adverse outcomes in trauma patients with ACS. Settings and Design: A 5-year retrospective chart review was conducted at three Level I Trauma Centers in the City of Chicago, IL, USA. Subjects and Methods: A complete set of demographic, pre-, intra- and post-operative variables were collected from 28 patient charts. Statistical Analysis: Pearson's correlation coefficient was used to determine the strength of association between 29 studied variables and eight end outcomes. Results: Thirty-day mortality was associated strongly with the finding of an initial intra-abdominal pressure >20 mmHg and moderately with blunt injury mechanism. A lactic acid >5 mmol/L on admission was moderately associated with increased blood transfusion requirements and with acute renal failure during the hospitalization. Developing ACS within 48 h of admission was moderately associated with increased length of stay in the Intensive Care Unit (ICU), more ventilator days, and longer hospital stay. Initial operative intervention lasting more than 2 h was moderately associated with risk of developing multi-organ failure. Hemoglobin level <10 g/dL on admission, ongoing mechanical ventilation, and ICU stay >7 days were moderately associated with a disposition to long-term support facility. Conclusions: Clinical and lab variables can predict specific adverse outcomes in trauma patients with ACS. These findings may be used to guide patient management, improve resource utilization, and build capacity within trauma centers. PMID:27162436

  11. Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures?

    PubMed Central

    Ravindran, Manipriya; Amborium, Prakash; Umamaheswari, B.; Ramani, Gokul; Ninan, Binu

    2015-01-01

    Background: Neonatal seizures are a common manifestation of brain dysfunction. Neonatal magnetic resonance imaging (MRI) has rapidly become the study of choice for the evaluation of central nervous systems disorders in newborns. According to a study conducted in Wilhelmina Children's Hospital, University Medical Center Utrecht, diffusion Restriction (DR) changes in the MRI is a good indicator of cell dysfunction (reversible or irreversible) within one week of insult. Objectives: The main aim of this study was to find the association of DR changes in MRI of brain for neonatal seizures with long term neurodevelopment outcome. Methods: This is a retrospective observational study conducted in Sri Ramachandra University. Retrospective data was collected for the time period of January 2010 to December 2011 from medical records department (MRD) for patient data, neonatal intensive care unit and reports from PACS for MRI images and the Karthikeyan child development unit for their developmental follow up reports. Results: Comparison of composite score for various domains with DR changes was done with a t-test and comparison of babies with developmental delay and DR changes with Chi-square test. MRI DR changes with developmental outcome in different domains namely cognition, language-receptive/expressive, fine and gross motor was studied. There is no statistical significance among those who have DR changes and with those who do not have DR changes. Conclusion: Though diffusion restriction changes in MRI may not predict adverse long term neuro developmental outcome, they can be of use with regards to individual etiological profile as in stroke. Larger group study and long term follow up is required to substantiate these findings. PMID:26962336

  12. Utility of Socioeconomic Status in Predicting 30-Day Outcomes After Heart Failure Hospitalization

    PubMed Central

    Eapen, Zubin J.; McCoy, Lisa A.; Fonarow, Gregg C.; Yancy, Clyde W.; Miranda, Marie Lynn; Peterson, Eric D.; Califf, Robert M.; Hernandez, Adrian F.

    2015-01-01

    Background An individual's socioeconomic status (SES) is associated with health outcomes and mortality, yet it is unknown whether accounting for SES can improve risk-adjustment models for 30-day outcomes among Centers for Medicare & Medicaid Services (CMS) beneficiaries hospitalized with heart failure (HF). Methods and Results We linked clinical data on hospitalized HF patients in the Get With The Guidelines®-HF™ database (01/2005–12/2011) with CMS claims and county-level SES data from the 2012 Area Health Resources Files. We compared the discriminatory capabilities of multivariable models that adjusted for SES, patient, and/or hospital characteristics to determine whether county-level SES data improved prediction or changed hospital rankings for 30-day all-cause mortality and rehospitalization. After adjusting for patient and hospital characteristics, median household income (per $5,000 increase) was inversely associated with odds of 30-day mortality (OR 0.97, 95% CI 0.95–1.00, p=0.032), and the percentage of persons with at least a high school diploma (per 5 unit increase) was associated with lower odds of 30-day rehospitalization (OR 0.95, 95% CI 0.91–0.99).After adjustment for county-level SES data, relative to whites, Hispanic ethnicity (OR 0.70, 95% CI 0.58, 0.83) and black race (OR 0.57, 95% CI: 0.50–0.65) remained significantly associated with lower 30-day mortality, but had similar 30-day rehospitalization. County-level SES did not improve risk adjustment or change hospital rankings for 30-day mortality or rehospitalization. Conclusions County-level SES data are modestly associated with 30-day outcomes for CMS beneficiaries hospitalized with HF, but do not improve risk adjustment models based on patient characteristics alone. PMID:25747700

  13. Integrating Publicly Available Data to Generate Computationally Predicted Adverse Outcome Pathways for Fatty Liver.

    PubMed

    Bell, Shannon M; Angrish, Michelle M; Wood, Charles E; Edwards, Stephen W

    2016-04-01

    Newin vitrotesting strategies make it possible to design testing batteries for large numbers of environmental chemicals. Full utilization of the results requires knowledge of the underlying biological networks and the adverse outcome pathways (AOPs) that describe the route from early molecular perturbations to an adverse outcome. Curation of a formal AOP is a time-intensive process and a rate-limiting step to designing these test batteries. Here, we describe a method for integrating publicly available data in order to generate computationally predicted AOP (cpAOP) scaffolds, which can be leveraged by domain experts to shorten the time for formal AOP development. A network-based workflow was used to facilitate the integration of multiple data types to generate cpAOPs. Edges between graph entities were identified through direct experimental or literature information, or computationally inferred using frequent itemset mining. Data from the TG-GATEs and ToxCast programs were used to channel large-scale toxicogenomics information into a cpAOP network (cpAOPnet) of over 20 000 relationships describing connections between chemical treatments, phenotypes, and perturbed pathways as measured by differential gene expression and high-throughput screening targets. The resulting fatty liver cpAOPnet is available as a resource to the community. Subnetworks of cpAOPs for a reference chemical (carbon tetrachloride, CCl4) and outcome (fatty liver) were compared with published mechanistic descriptions. In both cases, the computational approaches approximated the manually curated AOPs. The cpAOPnet can be used for accelerating expert-curated AOP development and to identify pathway targets that lack genomic markers or high-throughput screening tests. It can also facilitate identification of key events for designing test batteries and for classification and grouping of chemicals for follow up testing. PMID:26895641

  14. EU framework 6 project: predictive toxicology (PredTox)--overview and outcome.

    PubMed

    Suter, Laura; Schroeder, Susanne; Meyer, Kirstin; Gautier, Jean-Charles; Amberg, Alexander; Wendt, Maria; Gmuender, Hans; Mally, Angela; Boitier, Eric; Ellinger-Ziegelbauer, Heidrun; Matheis, Katja; Pfannkuch, Friedlieb

    2011-04-15

    In this publication, we report the outcome of the integrated EU Framework 6 PROJECT: Predictive Toxicology (PredTox), including methodological aspects and overall conclusions. Specific details including data analysis and interpretation are reported in separate articles in this issue. The project, partly funded by the EU, was carried out by a consortium of 15 pharmaceutical companies, 2 SMEs, and 3 universities. The effects of 16 test compounds were characterized using conventional toxicological parameters and "omics" technologies. The three major observed toxicities, liver hypertrophy, bile duct necrosis and/or cholestasis, and kidney proximal tubular damage were analyzed in detail. The combined approach of "omics" and conventional toxicology proved a useful tool for mechanistic investigations and the identification of putative biomarkers. In our hands and in combination with histopathological assessment, target organ transcriptomics was the most prolific approach for the generation of mechanistic hypotheses. Proteomics approaches were relatively time-consuming and required careful standardization. NMR-based metabolomics detected metabolite changes accompanying histopathological findings, providing limited additional mechanistic information. Conversely, targeted metabolite profiling with LC/GC-MS was very useful for the investigation of bile duct necrosis/cholestasis. In general, both proteomics and metabolomics were supportive of other findings. Thus, the outcome of this program indicates that "omics" technologies can help toxicologists to make better informed decisions during exploratory toxicological studies. The data support that hypothesis on mode of action and discovery of putative biomarkers are tangible outcomes of integrated "omics" analysis. Qualification of biomarkers remains challenging, in particular in terms of identification, mechanistic anchoring, appropriate specificity, and sensitivity. PMID:20955723

  15. Neural activation during processing of aversive faces predicts treatment outcome in alcoholism.

    PubMed

    Charlet, Katrin; Schlagenhauf, Florian; Richter, Anne; Naundorf, Karina; Dornhof, Lina; Weinfurtner, Christopher E J; König, Friederike; Walaszek, Bernadeta; Schubert, Florian; Müller, Christian A; Gutwinski, Stefan; Seissinger, Annette; Schmitz, Lioba; Walter, Henrik; Beck, Anne; Gallinat, Jürgen; Kiefer, Falk; Heinz, Andreas

    2014-05-01

    Neuropsychological studies reported decoding deficits of emotional facial expressions in alcohol-dependent patients, and imaging studies revealed reduced prefrontal and limbic activation during emotional face processing. However, it remains unclear whether this reduced neural activation is mediated by alcohol-associated volume reductions and whether it interacts with treatment outcome. We combined analyses of neural activation during an aversive face-cue-comparison task and local gray matter volumes (GM) using Biological Parametric Mapping in 33 detoxified alcohol-dependent patients and 33 matched healthy controls. Alcoholics displayed reduced activation toward aversive faces-neutral shapes in bilateral fusiform gyrus [FG; Brodmann areas (BA) 18/19], right middle frontal gyrus (BA46/47), right inferior parietal gyrus (BA7) and left cerebellum compared with controls, which were explained by GM differences (except for cerebellum). Enhanced functional activation in patients versus controls was found in left rostral anterior cingulate cortex (ACC) and medial frontal gyrus (BA10/11), even after GM reduction control. Increased ACC activation correlated significantly with less (previous) lifetime alcohol intake [Lifetime Drinking History (LDH)], longer abstinence and less subsequent binge drinking in patients. High LDH appear to impair treatment outcome via its neurotoxicity on ACC integrity. Thus, high activation of the rostral ACC elicited by affective faces appears to be a resilience factor predicting better treatment outcome. Although no group differences were found, increased FG activation correlated with patients' higher LDH. Because high LDH correlated with worse task performance for facial stimuli in patients, elevated activation in the fusiform 'face' area may reflect inefficient compensatory activation. Therapeutic interventions (e.g. emotion evaluation training) may enable patients to cope with social stress and to decrease relapses after detoxification. PMID

  16. Serum Gamma-Glutamyltransferase Levels Predict Clinical Outcomes in Hemodialysis Patients

    PubMed Central

    Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo; Kim, Yong Kyun

    2015-01-01

    Background Gamma-glutamyltransferase (GGT) is a biomarker of liver injury. GGT has also been reported to be a marker of oxidative stress and a predictor of mortality in the general population. Hemodialysis (HD) patients suffer from oxidative stress. The aim of our study was to investigate the relationship between serum GGT levels and clinical outcomes in HD patients. Methods A total of 1,634 HD patients were enrolled from the Clinical Research Center registry for end-stage renal disease, a prospective cohort in Korea. Patients were categorized into three groups by tertiles of serum GGT levels. The primary outcome was all-cause, cardiovascular, or infection-related mortality and hospitalization. Results During the median follow-up period of 30 months, the highest tertile of serum GGT levels had a significantly higher risk for all-cause mortality (hazard ratio (HR) 2.39, 95% confidence interval (CI), 1.55–3.69, P<0.001), cardiovascular mortality (HR 2.14, 95% CI, 1.07–4.26, P = 0.031) and infection-related mortality (HR 3.07, 95% CI, 1.30–7.25, P = 0.011) using tertile 1 as the reference group after adjusting for clinical variables including liver diseases. The highest tertile also had a significantly higher risk for first hospitalization (HR 1.22, 95% CI, 1.00–1.48, P = 0.048) and cardiovascular hospitalization (HR 1.42, 95% CI, 1.06–1.92, P = 0.028). Conclusions Our data demonstrate that high serum GGT levels were an independent risk factor for all-cause, cardiovascular, and infection-related mortality, as well as cardiovascular hospitalization in HD patients. These findings suggest that serum GGT levels might be a useful biomarker to predict clinical outcomes in HD patients. PMID:26376075

  17. Epigenetic landscape correlates with genetic subtype but does not predict outcome in childhood acute lymphoblastic leukemia.

    PubMed

    Gabriel, Alem S; Lafta, Fadhel M; Schwalbe, Edward C; Nakjang, Sirintra; Cockell, Simon J; Iliasova, Alice; Enshaei, Amir; Schwab, Claire; Rand, Vikki; Clifford, Steven C; Kinsey, Sally E; Mitchell, Chris D; Vora, Ajay; Harrison, Christine J; Moorman, Anthony V; Strathdee, Gordon

    2015-01-01

    Although children with acute lymphoblastic leukemia (ALL) generally have a good outcome, some patients do relapse and survival following relapse is poor. Altered DNA methylation is highly prevalent in ALL and raises the possibility that DNA methylation-based biomarkers could predict patient outcome. In this study, genome-wide methylation analysis, using the Illumina Infinium HumanMethylation450 BeadChip platform, was carried out on 52 diagnostic patient samples from 4 genetic subtypes [ETV6-RUNX1, high hyperdiploidy (HeH), TCF3-PBX1 and dic(9;20)(p11-13;q11)] in a 1:1 case-control design with patients who went on to relapse (as cases) and patients achieving long-term remission (as controls). Pyrosequencing assays for selected loci were used to confirm the array-generated data. Non-negative matrix factorization consensus clustering readily clustered samples according to genetic subgroups and gene enrichment pathway analysis suggested that this is in part driven by epigenetic disruption of subtype specific signaling pathways. Multiple bioinformatics approaches (including bump hunting and individual locus analysis) were used to identify CpG sites or regions associated with outcome. However, no associations with relapse were identified. Our data revealed that ETV6-RUNX1 and dic(9;20) subtypes were mostly associated with hypermethylation; conversely, TCF3-PBX1 and HeH were associated with hypomethylation. We observed significant enrichment of the neuroactive ligand-receptor interaction pathway in TCF3-PBX1 as well as an enrichment of genes involved in immunity and infection pathways in ETV6-RUNX1 subtype. Taken together, our results suggest that altered DNA methylation may have differential impacts in distinct ALL genetic subtypes. PMID:26237075

  18. Prediction of motor outcome by shoulder subluxation at early stage of stroke

    PubMed Central

    Jang, Sung Ho; Yi, Ji Hyun; Chang, Chul Hoon; Jung, Young Jin; Kim, Seong Ho; Lee, Jun; Seo, Jeong Pyo

    2016-01-01

    Abstract We attempted to determine whether shoulder subluxation at the early stage of stroke can predict motor outcome in relation to the corticospinal tract (CST) state on diffusion tensor tractography. Fifty-nine stroke patients with severe hemiparesis were recruited. The patients were classified according to the distance of shoulder subluxation (group A: ≥2 cm, group B: <2 cm) and the affected CST on diffusion tensor tractography at the first evaluation (CST type A—the CST was discontinued at the stroke lesion; CST type B—the integrity of the CST was preserved). Motor function of the patients was evaluated twice (first: beginning of rehabilitation—24.1 ± 16.6 days; second: discharge after first rehabilitation—58.5 ± 24.1 days) using the Medical Research Council score, Motricity Index, and Modified Brunnstrom Classification. Regarding the improvement of the Medical Research Council for the finger extensor and upper Motricity Index, the order in terms of better recovery was as follows: group B–type B, group A–type B, group B–type A, and group A–type A (P < 0.05). The distance of shoulder subluxation showed significant correlation with improvement of the finger extensor (moderate negative correlation, r = −0.37) and improvement of the Modified Brunnstrom Classification (weak negative correlation, r = −0.29) (P < 0.05). The presence of shoulder subluxation at the early stage of stroke can be a predictor of motor outcome of the affected upper extremity and the degree of shoulder subluxation can be a predictor of the motor function of the affected hand. Therefore, our results suggest that shoulder subluxation in relation to the affected CST state at the early stage of stroke can be a prognostic factor for motor outcome. PMID:27512873

  19. Motor cortex excitability changes within 8 hours after ischaemic stroke may predict the functional outcome.

    PubMed

    Di Lazzaro, V; Oliviero, A; Profice, P; Saturno, E; Pilato, F; Tonali, P

    1999-06-01

    Motor evoked potentials after magnetic transcranial stimulation and the excitability of the motor cortex to increasing magnetic stimulus intensities were evaluated in six patients with hemiparesis after ischaemic stroke within 8 hours after stroke. The latencies of motor evoked potentials were normal in all patients. After stimulation of the ischaemic hemisphere we obtained responses comparable with the contralateral ones in two patients (mean NIH score 2 (SD 0)) and this group was completely asymptomatic after 15 days (NIH score 0). In four patients the excitability of the motor cortex involved by the ischaemia was reduced and magnetic motor threshold was higher than that of the spared motor cortex. This finding was associated with a poor motor recovery and the NIH score after 15 days was unchanged (NIH score 1.75 (SD 1.5)). The present data suggest that the evaluation of the excitability of motor cortex may offer a mean of predicting functional outcome following stroke. PMID:10461555

  20. Purpose in Life Predicts Treatment Outcome Among Adult Cocaine Abusers in Treatment

    PubMed Central

    Martin, Rosemarie A.; MacKinnon, Selene; Johnson, Jennifer; Rohsenow, Damaris J.

    2010-01-01

    A sense of purpose in life has been positively associated with mental health and well-being and has been negatively associated with alcohol use in correlational and longitudinal studies, but has not been studied as a predictor of cocaine treatment outcome. This study examined pre-treatment purpose in life as a predictor of response to a 30-day residential substance use treatment program among 154 participants with cocaine dependence. Purpose in life was unrelated to cocaine or alcohol use during the 6 months pretreatment. After controlling for age, baseline use, and depressive symptoms, purpose in life significantly (p < .01) predicted relapse to any use of cocaine and to alcohol, and the number of days cocaine or alcohol was used in the six months after treatment. Findings suggest that increasing purpose in life may be an important aspect of treatment among cocaine dependent patients. PMID:21129893

  1. Intimate Partner Violence Exposure Predicts PTSD Treatment Engagement and Outcome in Cognitive Processing Therapy

    PubMed Central

    Iverson, Katherine M.; Resick, Patricia A.; Suvak, Michael K.; Walling, Sherry; Taft, Casey T.

    2012-01-01

    Intimate partner violence (IPV) exposure was examined as a predictor of treatment engagement (i.e., starting and completing therapy) and treatment outcome in 150 women taking part in a dismantling study of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD; Resick et al., 2008). Results indicate that women in a current intimate relationship with recent IPV (i.e., past year) were less likely to begin treatment relative to women who reported past IPV only or no history of IPV. For women who began treatment, IPV exposure was not predictive of whether or not they completed treatment. Among women who began treatment, the frequency of IPV was associated with treatment outcome such that women who experienced more frequent IPV exhibited larger reductions in PTSD and depression symptoms over the course of treatment, but experienced similar levels of PTSD and depression severity at the 6-month follow-up. Findings highlight the importance of targeting treatment engagement among women who report recent IPV and suggest that women who have experienced frequent IPV respond well to CPT treatment in spite of their IPV experiences. PMID:21496509

  2. Comorbidities, Alcohol Use Disorder, and Age Predict Outcomes after Autologous Hematopoietic Cell Transplantation for Lymphoma.

    PubMed

    Graf, Solomon A; Vaughn, Jennifer E; Chauncey, Thomas R; Storer, Barry E; Gopal, Ajay K; Holmberg, Leona A; McCune, Jeannine S; Bensinger, William I; Maloney, David G; Press, Oliver W; Storb, Rainer; Sorror, Mohamed L

    2016-09-01

    Autologous hematopoietic cell transplantation (HCT) is a treatment option for many patients diagnosed with lymphoma. The effects of patient-specific factors on outcomes after autologous HCT are not well characterized. Here, we studied a sequential cohort of 754 patients with lymphoma treated with autologous HCT between 2000 and 2010. In multivariate analysis, patient-specific factors that were statistically significantly associated with nonrelapse mortality (NRM) included HCT-specific comorbidity index (HCT-CI) scores  ≥ 3 (HR, 1.94; P = .05), a history of alcohol use disorder (AUD) (HR, 2.17; P = .004), and older age stratified by decade (HR, 1.29; P = .02). HCT-CI ≥ 3, a history of AUD, and age > 50 were combined into a composite risk model: NRM and overall mortality rates at 5 years increased from 6% to 30% and 32% to 58%, respectively, in patients with 0 versus all 3 risk factors. The HCT-CI is a valid tool in predicting mortality risks after autologous HCT for lymphoma. AUD and older age exert independent prognostic impact on outcomes. Whether AUD indicates additional organ dysfunction or sociobehavioral abnormality warrants further investigation. The composite model may improve risk stratification before autologous HCT. PMID:27311969

  3. Can blood or follicular fluid levels of presepsin predict reproductive outcomes in ART; a preliminary study.

    PubMed

    Ovayolu, Ali; Özdamar, Özkan; Gün, İsmet; Arslanbuga, Cansev Yılmaz; Sofuoğlu, Kenan; Tunalı, Gülden; Topuz, Samet

    2015-01-01

    Many stages of COH protocols are considered to potentiate a state of systemic inflammation. The limit beyond which inflammation has negative impacts on the formation of conception and the reproductive outcomes are compromised still remains unclear. Presepsin is a novel biomarker for diagnosing systemic inflammation and sepsis. We aimed to investigate whether plasma and follicular fluid presepsin values on oocyte pick-up (OPU) day, embryo transfer (ET) day and pregnancy test (PT) days could predict reproductive outcomes during IVF treatment in women with UEI. Patients were assigned to two groups according to pregnancy test results; pregnant (Group 1) and non-pregnant (Group 2). From all patients included in the study, 2 cc of venous blood was sampled on the three days and follicular fluid (FF) was collected during oocyte retrieval. Plasma presepsin, CRP and WBC values and FF presepsin values were measured and compared between the 2 groups. There was no significant difference between FF and plasma presepsin levels on the OPU day (298±797.4 ve 352.9±657.1; P=0.701, respectively). Plasma WBC, CRP and presepsin levels on the OPU, ET and PT days and FF presepsin levels on OPU day were not different between the 2 groups. Plasma presepsin course on the separate 3 days were different between the groups. PMID:26221358

  4. Early warning and clinical outcome prediction of acute-on-chronic hepatitis B liver failure

    PubMed Central

    Chen, En-Qiang; Zeng, Fan; Zhou, Ling-Yun; Tang, Hong

    2015-01-01

    Hepatitis B virus (HBV) associated acute-on-chronic liver failure (ACLF) is an increasingly recognized fatal liver disease encompassing a severe acute exacerbation of liver function in patients with chronic hepatitis B (CHB). Despite the introduction of an artificial liver support system and antiviral therapy, the short-term prognosis of HBV-ACLF is still extremely poor unless emergency liver transplantation is performed. In such a situation, stopping or slowing the progression of CHB to ACLF at an early stage is the most effective way of reducing the morbidity and mortality of HBV-ACLF. It is well-known that the occurrence and progression of HBV-ACLF is associated with many factors, and the outcomes of HBV-ACLF patients can be significantly improved if timely and appropriate interventions are provided. In this review, we highlight recent developments in early warning and clinical outcome prediction in patients with HBV-ACLF and provide an outlook for future research in this field. PMID:26576085

  5. T2 relaxation time post febrile status epilepticus predicts cognitive outcome.

    PubMed

    Barry, Jeremy M; Choy, ManKin; Dube, Celine; Robbins, Ashlee; Obenaus, Andre; Lenck-Santini, Pierre Pascal; Scott, Rod C; Baram, Tallie Z; Holmes, Gregory L

    2015-07-01

    Evidence from animal models and patient data indicates that febrile status epilepticus (FSE) in early development can result in permanently diminished cognitive abilities. To understand the variability in cognitive outcome following FSE, we used MRI to measure dynamic brain metabolic responses to the induction of FSE in juvenile rats. We then compared these measurements to the ability to learn an active avoidance spatial task weeks later. T2 relaxation times were significantly lower in FSE rats that were task learners in comparison to FSE non-learners. While T2 time in whole brain held the greatest predictive power, T2 in hippocampus and basolateral amygdala were also excellent predictors. These signal differences in response to FSE indicate that rats that fail to meet metabolic and oxygen demand are more likely to develop spatial cognition deficits. Place cells from FSE non-learners had significantly larger firing fields and higher in-field firing rate than FSE learners and control animals and imply increased excitability in the pyramidal cells of FSE non-learners. These findings suggest a mechanistic cause for the spatial memory deficits in active avoidance and are relevant to other acute neurological insults in early development where cognitive outcome is a concern. PMID:25939697

  6. Can blood or follicular fluid levels of presepsin predict reproductive outcomes in ART; a preliminary study

    PubMed Central

    Ovayolu, Ali; Özdamar, Özkan; Gün, İsmet; Arslanbuga, Cansev Yılmaz; Sofuoğlu, Kenan; Tunalı, Gülden; Topuz, Samet

    2015-01-01

    Many stages of COH protocols are considered to potentiate a state of systemic inflammation. The limit beyond which inflammation has negative impacts on the formation of conception and the reproductive outcomes are compromised still remains unclear. Presepsin is a novel biomarker for diagnosing systemic inflammation and sepsis. We aimed to investigate whether plasma and follicular fluid presepsin values on oocyte pick-up (OPU) day, embryo transfer (ET) day and pregnancy test (PT) days could predict reproductive outcomes during IVF treatment in women with UEI. Patients were assigned to two groups according to pregnancy test results; pregnant (Group 1) and non-pregnant (Group 2). From all patients included in the study, 2 cc of venous blood was sampled on the three days and follicular fluid (FF) was collected during oocyte retrieval. Plasma presepsin, CRP and WBC values and FF presepsin values were measured and compared between the 2 groups. There was no significant difference between FF and plasma presepsin levels on the OPU day (298±797.4 ve 352.9±657.1; P=0.701, respectively). Plasma WBC, CRP and presepsin levels on the OPU, ET and PT days and FF presepsin levels on OPU day were not different between the 2 groups. Plasma presepsin course on the separate 3 days were different between the groups. PMID:26221358

  7. Laboratory Diagnosis of Invasive Aspergillosis: From Diagnosis to Prediction of Outcome

    PubMed Central

    Barton, Richard C.

    2013-01-01

    Invasive aspergillosis (IA), an infection caused by fungi in the genus Aspergillus, is seen in patients with immunological deficits, particularly acute leukaemia and stem cell transplantation, and has been associated with high rates of mortality in previous years. Diagnosing IA has long been problematic owing to the inability to culture the main causal agent A. fumigatus from blood. Microscopic examination and culture of respiratory tract specimens have lacked sensitivity, and biopsy tissue for histopathological examination is rarely obtainable. Thus, for many years there has been a great interest in nonculture-based techniques such as the detection of galactomannan, β-D-glucan, and DNA by PCR-based methods. Recent meta-analyses suggest that these approaches have broadly similar performance parameters in terms of sensitivity and specificity to diagnose IA. Improvements have been made in our understanding of the limitations of antigen assays and the standardisation of PCR-based DNA detection. Thus, in more recent years, the debate has focussed on how these assays can be incorporated into diagnostic strategies to maximise improvements in outcome whilst limiting unnecessary use of antifungal therapy. Furthermore, there is a current interest in applying these tests to monitor the effectiveness of therapy after diagnosis and predict clinical outcomes. The search for improved markers for the early and sensitive diagnosis of IA continues to be a challenge. PMID:24278780

  8. The ratio of the neutrophil leucocytes to the lymphocytes predicts the outcome after cardiac resynchronization therapy

    PubMed Central

    Boros, András Mihály; Széplaki, Gábor; Perge, Péter; Jenei, Zsigmond; Bagyura, Zsolt; Zima, Endre; Molnár, Levente; Apor, Astrid; Becker, Dávid; Gellér, László; Prohászka, Zoltán; Merkely, Béla

    2016-01-01

    Aims The low lymphocyte counts and high neutrophil leucocyte fractions have been associated with poor prognosis in chronic heart failure. We hypothesized that the baseline ratio of the neutrophil leucocytes to the lymphocytes (NL ratio) would predict the outcome of chronic heart failure patients undergoing cardiac resynchronization therapy (CRT). Methods and results The qualitative blood counts and the serum levels of N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) of 122 chronic heart failure patients and 122 healthy controls were analysed prospectively in this observational study. The 2-year mortality was considered as primary endpoint and the 6-month reverse remodelling (≥15% decrease in the end-systolic volume) as secondary endpoint. Multivariable regression analyses were applied and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. The NL ratio was elevated in chronic heart failure patients when compared with the healthy controls [2.93 (2.12–4.05) vs. 2.21 (1.64–2.81), P < 0.0001]. The baseline NL ratio exceeding 2.95 predicted the lack of the 6-month reverse remodelling [n = 63, odds ratio = 0.38 (0.17–0.85), P = 0.01; NRI = 0.49 (0.14–0.83), P = 0.005; IDI = 0.04 (0.00–0.07), P = 0.02] and the 2-year mortality [n = 29, hazard ratio = 2.44 (1.04–5.71), P = 0.03; NRI = 0.63 (0.24–1.01), P = 0.001; IDI = 0.04 (0.00–0.08), P = 0.02] independently of the NT-proBNP levels or other factors. Conclusion The NL ratio is elevated in chronic heart failure and predicts outcome after CRT. According to the reclassification analysis, 4% of the patients would have been better categorized in the prediction models by combining the NT-proBNP with the NL ratio. Thus, a single blood count measurement could facilitate the optimal patient selection for the CRT. PMID:25972301

  9. An intronic variant in OPRD1 predicts treatment outcome for opioid dependence in African-Americans.

    PubMed

    Crist, Richard C; Clarke, Toni-Kim; Ang, Alfonso; Ambrose-Lanci, Lisa M; Lohoff, Falk W; Saxon, Andrew J; Ling, Walter; Hillhouse, Maureen P; Bruce, R Douglas; Woody, George; Berrettini, Wade H

    2013-09-01

    Although buprenorphine and methadone are both effective treatments for opioid dependence, their efficacy can vary significantly among patients. Genetic differences may explain some of the variability in treatment outcome. Understanding the interactions between genetic background and pharmacotherapy may result in more informed treatment decisions. This study is a pharmacogenetic analysis of the effects of genetic variants in OPRD1, the gene encoding the δ-opioid receptor, on the prevalence of opioid-positive urine tests in African-Americans (n=77) or European-Americans (n=566) undergoing treatment for opioid dependence. Patients were randomly assigned to treatment with either methadone or buprenorphine/naloxone (Suboxone) over a 24-week open-label clinical trial, in which illicit opioid use was measured by weekly urinalysis. In African-Americans, the intronic SNP rs678849 predicted treatment outcome for both medications. Methadone patients with the CC genotype were less likely to have opioid-positive urine tests than those in the combined CT and TT genotypes group (relative risk (RR)=0.52, 95% confidence interval (CI)=0.44-0.60, p=0.001). In the buprenorphine treatment group, however, individuals with the CC genotype were more likely to have positive opioid drug screens than individuals in the combined CT and TT genotypes group (RR=2.17, 95% CI=1.95-2.68, p=0.008). These findings indicate that the genotype at rs678849 predicts African-American patient response to two common treatments for opioid dependence, suggesting that matching patients to treatment type based on the genotype at this locus may improve overall treatment efficacy. This observation requires confirmation in an independent population. PMID:23612435

  10. Predictability of horizontal versus vertical muscle surgery outcomes in thyroid eye disease.

    PubMed

    Iordanous, Yiannis; Sharan, Sapna; Robitaille, Johanne; Walsh, Leah; LaRoche, G Robert

    2016-08-01

    Surgical repair of vertical muscles in thyroid eye disease (TED) is believed to yield more unpredictable results than horizontal muscle surgery. The purpose of this study is to determine if the short-term outcomes for strabismus surgery in TED are equally predictable for horizontal and vertical muscle surgery. We retrospectively reviewed the charts of 27 consecutive patients who underwent strabismus surgery for TED from a single surgeon's practice. Eligibility for inclusion in the study included biochemically stable thyroid disease for at least a year and stable orthoptic measurements for at least 6 months prior to surgery. Nine patients had surgery only on vertical rectus muscles, three only on horizontal, and fifteen on both vertical and horizontal rectus muscles. Mean follow-up was 2.4 ± 5.2 months. In primary gaze at 6 m, a mean horizontal deviation of 16.6 ± 22.3 PD, and a mean vertical deviation of 19.7 ± 14.1 PD were measured pre-operatively. Post-operatively, this measured 2.3 ± 8.4 PD horizontally and 2.1 ± 7.8 PD vertically (p = 0.933). There was no statistically significant difference between post-operative horizontal and vertical deviations in elevation, depression, adduction, and abduction. Nine patients required reoperation to attain satisfactory ocular alignment; seven of these cases involved repeat surgery on vertical muscles, while two cases required operation on both horizontal and vertical muscles. Results suggest that surgical outcomes of both horizontal and vertical muscle surgery are equally predictable in stable TED; however, reoperation rates were higher for vertical muscles compared to horizontal muscles. PMID:26559967

  11. Using electronic health records to predict costs and outcomes in stable coronary artery disease

    PubMed Central

    Asaria, Miqdad; Walker, Simon; Palmer, Stephen; Gale, Chris P; Shah, Anoop D; Abrams, Keith R; Crowther, Michael; Manca, Andrea; Timmis, Adam; Hemingway, Harry; Sculpher, Mark

    2016-01-01

    Objectives To use electronic health records (EHR) to predict lifetime costs and health outcomes of patients with stable coronary artery disease (stable-CAD) stratified by their risk of future cardiovascular events, and to evaluate the cost-effectiveness of treatments targeted at these populations. Methods The analysis was based on 94 966 patients with stable-CAD in England between 2001 and 2010, identified in four prospectively collected, linked EHR sources. Markov modelling was used to estimate lifetime costs and quality-adjusted life years (QALYs) stratified by baseline cardiovascular risk. Results For the lowest risk tenth of patients with stable-CAD, predicted discounted remaining lifetime healthcare costs and QALYs were £62 210 (95% CI £33 724 to £90 043) and 12.0 (95% CI 11.5 to 12.5) years, respectively. For the highest risk tenth of the population, the equivalent costs and QALYs were £35 549 (95% CI £31 679 to £39 615) and 2.9 (95% CI 2.6 to 3.1) years, respectively. A new treatment with a hazard reduction of 20% for myocardial infarction, stroke and cardiovascular disease death and no side-effects would be cost-effective if priced below £72 per year for the lowest risk patients and £646 per year for the highest risk patients. Conclusions Existing EHRs may be used to estimate lifetime healthcare costs and outcomes of patients with stable-CAD. The stable-CAD model developed in this study lends itself to informing decisions about commissioning, pricing and reimbursement. At current prices, to be cost-effective some established as well as future stable-CAD treatments may require stratification by patient risk. PMID:26864674

  12. Precise Classification of Cervical Carcinomas Combined with Somatic Mutation Profiling Contributes to Predicting Disease Outcome

    PubMed Central

    Spaans, Vivian M.; Trietsch, Marjolijn D.; Peters, Alexander A. W.; Osse, Michelle; ter Haar, Natalja; Fleuren, Gert J.; Jordanova, Ekaterina S.

    2015-01-01

    Introduction Squamous cell carcinoma (SCC), adenocarcinoma (AC), and adenosquamous carcinoma (ASC) are the most common histological subtypes of cervical cancer. Differences in the somatic mutation profiles of these subtypes have been suggested. We investigated the prevalence of somatic hot-spot mutations in three well-defined cohorts of SCC, AC, and ASC and determined the additional value of mutation profiling in predicting disease outcome relative to well-established prognostic parameters. Materials and Methods Clinicopathological data were collected for 301 cervical tumors classified as SCC (n=166), AC (n=55), or ASC (n=80). Mass spectrometry was used to analyze 171 somatic hot-spot mutations in 13 relevant genes. Results In 103 (34%) tumors, 123 mutations were detected (36% in SCC, 38% in AC, and 28% in ASC), mostly in PIK3CA (20%) and KRAS (7%). PIK3CA mutations occurred more frequently in SCC than AC (25% vs. 11%, P=0.025), whereas KRAS mutations occurred more frequently in AC than SCC (24% vs. 3%, P<0.001) and ASC (24% vs. 3%, P<0.001). A positive mutation status correlated with worse disease-free survival (HR 1.57, P=0.043). In multivariate analysis, tumor diameter, parametrial infiltration, and lymph node metastasis, but not the presence of a somatic mutation, were independent predictors of survival. Conclusion Potentially targetable somatic mutations occurred in 34% of cervical tumors with different distributions among histological subtypes. Precise classification of cervical carcinomas in combination with mutation profiling is valuable for predicting disease outcome and may guide the development and selection of tumor-specific treatment approaches. PMID:26197069

  13. An Intronic Variant in OPRD1 Predicts Treatment Outcome for Opioid Dependence in African-Americans

    PubMed Central

    Crist, Richard C; Clarke, Toni-Kim; Ang, Alfonso; Ambrose-Lanci, Lisa M; Lohoff, Falk W; Saxon, Andrew J; Ling, Walter; Hillhouse, Maureen P; Bruce, R Douglas; Woody, George; Berrettini, Wade H

    2013-01-01

    Although buprenorphine and methadone are both effective treatments for opioid dependence, their efficacy can vary significantly among patients. Genetic differences may explain some of the variability in treatment outcome. Understanding the interactions between genetic background and pharmacotherapy may result in more informed treatment decisions. This study is a pharmacogenetic analysis of the effects of genetic variants in OPRD1, the gene encoding the δ-opioid receptor, on the prevalence of opioid-positive urine tests in African-Americans (n=77) or European-Americans (n=566) undergoing treatment for opioid dependence. Patients were randomly assigned to treatment with either methadone or buprenorphine/naloxone (Suboxone) over a 24-week open-label clinical trial, in which illicit opioid use was measured by weekly urinalysis. In African-Americans, the intronic SNP rs678849 predicted treatment outcome for both medications. Methadone patients with the CC genotype were less likely to have opioid-positive urine tests than those in the combined CT and TT genotypes group (relative risk (RR)=0.52, 95% confidence interval (CI)=0.44–0.60, p=0.001). In the buprenorphine treatment group, however, individuals with the CC genotype were more likely to have positive opioid drug screens than individuals in the combined CT and TT genotypes group (RR=2.17, 95% CI=1.95–2.68, p=0.008). These findings indicate that the genotype at rs678849 predicts African-American patient response to two common treatments for opioid dependence, suggesting that matching patients to treatment type based on the genotype at this locus may improve overall treatment efficacy. This observation requires confirmation in an independent population. PMID:23612435

  14. Neuro-oncological patients admitted in intensive-care unit: predictive factors and functional outcome.

    PubMed

    Tabouret, E; Boucard, C; Devillier, R; Barrie, M; Boussen, S; Autran, D; Chinot, O; Bruder, N

    2016-03-01

    The prognosis of oncology patients admitted to the intensive care unit (ICU) is considered poor. Our objective was to analyze the characteristics and predictive factors of death in the ICU and functional outcome following ICU treatment for neuro-oncology patients. A retrospective study was conducted on all patients with primary brain tumor admitted to our institutional ICU for medical indications. Predictive impact on the risk of death in the ICU was analyzed as well as the functional status was evaluated prior and following ICU discharge. Seventy-one patients were admitted to the ICU. ICU admission indications were refractory seizures (41 %) and septic shock (17 %). On admission, 16 % had multi-organ failure. Ventilation was necessary for 41 % and catecholamines for 13 %. Twenty-two percent of patients died in the ICU. By multivariate analysis, predictive factors associated with an increased risk of ICU death were: non-neurological cause of admission [p = 0.045; odds ratio (OR) 5.405], multiple organ failure (p = 0.021; OR 8.027), respiratory failure (p = 0.006; OR 9.615), and hemodynamic failure (p = 0.008; OR 10.111). In contrast, tumor type (p = 0.678) and disease control status (p = 0.380) were not associated with an increased risk of ICU death. Among the 35 evaluable patients, 77 % presented with a stable or improved Karnofsky performance status following ICU hospitalization compared with the ongoing status before discharge. In patients with primary brain tumor admitted to the ICU, predictive factors of death appear to be similar to those described in non-oncology patients. ICU hospitalization is generally not associated with a subsequent decrease in the functional status. PMID:26608523

  15. Listening to injured workers: how recovery expectations predict outcomes — a prospective study

    PubMed Central

    Cole, Donald C.; Mondloch, Michael V.; Hogg-Johnson, Sheilah

    2002-01-01

    Background Rigorous evidence on factors affecting the prognosis of work-related soft-tissue injuries remains limited. Although shown to be important for a wide variety of clinical conditions, recovery expectations have rarely been assessed as prognostic factors for workers with soft-tissue injuries. We examined the predictive role of various measures of recovery expectations among workers with injuries resulting in time off work. Methods We identified a prospective cohort of 1566 injured workers shortly after they filed a claim for their injury with the Ontario Workers' Compensation Board (OWCB). They had soft-tissue injuries to the back or upper or lower extremities, had new, lost-time claims from May to November 1993 and were still off work at the time of the first interview. We interviewed participants by telephone within 3 weeks after the injury and measured their recovery expectations (perceptions regarding progress, expected change in condition, expected time until return to usual activities and expectations regarding return to usual job) along with other, potentially important prognostic factors. The primary outcome was total time receiving 100% wage-replacement benefits during the year following injury, obtained from OWCB administrative files. Self-reported measures of pain, health-related quality of life and functional status, obtained up to 4 times during the year following injury, were both independent predictors and secondary outcomes. Results The 4 measures of recovery expectations together explained one-sixth of the variation in time receiving benefits. All but expectations regarding return to usual job were individually predictive of time receiving benefits. Judging one's recovery as much better than expected resulted in a 30% (95% confidence interval [CI] 9%–46%) faster rate of stopping receiving benefits (and likely returning to work) compared with judging one's recovery as much worse than expected. Similarly, participants who expected to return

  16. The case against using the APACHE system to predict intensive care unit outcome in trauma patients.

    PubMed

    Vassar, M J; Holcroft, J W

    1994-01-01

    The use of outcome indices as a means of evaluating institutional performance for delivery of medical care is at the forefront of federal health policy reforms. Because an enormous number of clinical and financial data are generated by ICU patients, it is inevitable that integrated bedside computers will be necessary to supply the type of information that is being sought by governmental and private insurance agencies involved in assessment of hospital performance. The Health Care Financing Administration already has adopted the APACHE data collection protocols and predictive models for the severity of illness adjustments that were used in assessing the 1986 hospital-specific death rate for acute myocardial infarction, congestive heart failure, stroke, and pneumonia. In our opinion, however, it is unlikely that any single system will be developed that can accurately estimate more than 50% of ICU deaths. The intention of the APACHE III system to include 78 diagnostic categories seems unrealistic. Furthermore, the number of data needed to document outcomes for both low- and high-risk admissions is impractical. We are evaluating APACHE III to determine whether the revisions to the definition for head trauma will represent a significant improvement in predicting outcomes for trauma patients. In the interim, the financial investment in the APACHE III automated bedside data collection system cannot be justified for trauma patients. Neither should it be used in ICUs that admit a large number of trauma patients as a tool for monitoring unit efficiency, guiding triage decisions, allocating staff and ICU beds, identifying risks of iatrogenic or other potential complications, or assessing quality of life, in spite of marketing efforts by the APACHE Corporation. We believe that using any of the APACHE systems for these purposes, at best, is premature, and potentially misrepresents the trauma patient population. Standards for patient classification already are in place for use

  17. Image-Guided Percutaneous Ablation of Hepatic Malignancies

    PubMed Central

    Foltz, Gretchen

    2014-01-01

    The liver is a common site of primary and secondary malignancies, often resulting in significant morbidity and mortality. Evaluating these patients in a multidisciplinary setting allows for optimal utilization of all oncologic therapies including surgery, radiation, systemic chemotherapy, transarterial therapies, and ablation. While surgical intervention often provides the best outcomes when treating most hepatic tumors, many patients are not surgical candidates due to extensive tumor burden, underlying liver disease, or other comorbid conditions. The evolution of imaging and ablation devices has allowed for the increased utilization of percutaneous ablation as definitive and palliative treatment of primary and metastatic hepatic malignancies. Ablation induces tumor necrosis by injection of chemicals (chemical ablation) or temperature modification (thermal ablation). The goal of this review is to provide an overview of different ablation techniques commonly used for hepatic malignancies, discuss the oncologic outcomes of these interventions, and outline the current indications, contraindications, and reported complications of these therapies. PMID:25071304

  18. Population-Based Stroke Atlas for Outcome Prediction: Method and Preliminary Results for Ischemic Stroke from CT

    PubMed Central

    Nowinski, Wieslaw L.; Gupta, Varsha; Qian, Guoyu; Ambrosius, Wojciech; Kazmierski, Radoslaw

    2014-01-01

    Background and Purpose Knowledge of outcome prediction is important in stroke management. We propose a lesion size and location-driven method for stroke outcome prediction using a Population-based Stroke Atlas (PSA) linking neurological parameters with neuroimaging in population. The PSA aggregates data from previously treated patients and applies them to currently treated patients. The PSA parameter distribution in the infarct region of a treated patient enables prediction. We introduce a method for PSA calculation, quantify its performance, and use it to illustrate ischemic stroke outcome prediction of modified Rankin Scale (mRS) and Barthel Index (BI). Methods The preliminary PSA was constructed from 128 ischemic stroke cases calculated for 8 variants (various data aggregation schemes) and 3 case selection variables (infarct volume, NIHSS at admission, and NIHSS at day 7), each in 4 ranges. Outcome prediction for 9 parameters (mRS at 7th, and mRS and BI at 30th, 90th, 180th, 360th day) was studied using a leave-one-out approach, requiring 589,824 PSA maps to be analyzed. Results Outcomes predicted for different PSA variants are statistically equivalent, so the simplest and most efficient variant aiming at parameter averaging is employed. This variant allows the PSA to be pre-calculated before prediction. The PSA constrained by infarct volume and NIHSS reduces the average prediction error (absolute difference between the predicted and actual values) by a fraction of 0.796; the use of 3 patient-specific variables further lowers it by 0.538. The PSA-based prediction error for mild and severe outcomes (mRS = [2]–[5]) is (0.5–0.7). Prediction takes about 8 seconds. Conclusions PSA-based prediction of individual and group mRS and BI scores over time is feasible, fast and simple, but its clinical usefulness requires further studies. The case selection operation improves PSA predictability. A multiplicity of PSAs can be computed independently for different

  19. Prediction of functional outcome by motor capability after spinal cord injury.

    PubMed

    Lazar, R B; Yarkony, G M; Ortolano, D; Heinemann, A W; Perlow, E; Lovell, L; Meyer, P R

    1989-11-01

    The relationship between early motor status and functional outcome after spinal cord injury (SCI) was evaluated prospectively in 52 quadriplegic and 26 paraplegic patients. Motor status was measured within 72 hours of injury and quantified with the Motor Index Score (MIS). Functional status was evaluated with the Modified Barthel Index (MBI). A senior physical therapist completed the MIS and the MBI when each patient was admitted to the spinal cord intensive care unit and every 30 days during rehabilitation. Early motor function was correlated with average daily improvement in functional status including self-care and mobility (p = .001). The initial MIS strongly correlated with functional status of quadriplegics at admission (p = .001), at 60 days, and at rehabilitation discharge (p = .001). In paraplegics, the overall MBI at admission, after 60 days of rehabilitation, and at discharge was not correlated with early motor function. However, the MIS correlated significantly with the MBI self-care subscore at 60 days and at discharge (p = .01), but not with the mobility subscore. The initial MIS was also significantly correlated to functional status at discharge in patients with complete lesions (p = .001), but was not related to functional status at discharge in patients with incomplete lesions. The MIS appears to be a useful tool in predicting function during rehabilitation, although individual differences in ambulation, particularly for patients with paraplegia, limit the predictive utility of this index. PMID:2818153

  20. The predictive value of 2-year posttreatment biopsy after prostate cancer radiotherapy for eventual biochemical outcome

    SciTech Connect

    Vance, Waseet; Tucker, Susan L.; Crevoisier, Renaud de; Kuban, Deborah A.; Cheung, M. Rex . E-mail: mrcheung@mdanderson.org

    2007-03-01

    Purpose: To determine the value of a 2-year post-radiotherapy (RT) prostate biopsy for predicting eventual biochemical failure in patients who were treated for localized prostate cancer. Methods and Materials: This study comprised 164 patients who underwent a planned 2-year post-RT prostate biopsy. The independent prognostic value of the biopsy results for forecasting eventual biochemical outcome and overall survival was tested with other factors (the Gleason score, 1992 American Joint Committee on Cancer tumor stage, pretreatment prostate-specific antigen level, risk group, and RT dose) in a multivariate analysis. The current nadir + 2 (CN + 2) definition of biochemical failure was used. Patients with rising prostate-specific antigen (PSA) or suspicious digital rectal examination before the biopsy were excluded. Results: The biopsy results were normal in 78 patients, scant atypical and malignant cells in 30, carcinoma with treatment effect in 43, and carcinoma without treatment effect in 13. Using the CN + 2 definition, we found a significant association between biopsy results and eventual biochemical failure. We also found that the biopsy status provides predictive information independent of the PSA status at the time of biopsy. Conclusion: A 2-year post-RT prostate biopsy may be useful for forecasting CN + 2 biochemical failure. Posttreatment prostate biopsy may be useful for identifying patients for aggressive salvage therapy.

  1. Plasma genetic and genomic abnormalities predict treatment response and clinical outcome in advanced prostate cancer.

    PubMed

    Xia, Shu; Kohli, Manish; Du, Meijun; Dittmar, Rachel L; Lee, Adam; Nandy, Debashis; Yuan, Tiezheng; Guo, Yongchen; Wang, Yuan; Tschannen, Michael R; Worthey, Elizabeth; Jacob, Howard; See, William; Kilari, Deepak; Wang, Xuexia; Hovey, Raymond L; Huang, Chiang-Ching; Wang, Liang

    2015-06-30

    Liquid biopsies, examinations of tumor components in body fluids, have shown promise for predicting clinical outcomes. To evaluate tumor-associated genomic and genetic variations in plasma cell-free DNA (cfDNA) and their associations with treatment response and overall survival, we applied whole genome and targeted sequencing to examine the plasma cfDNAs derived from 20 patients with advanced prostate cancer. Sequencing-based genomic abnormality analysis revealed locus-specific gains or losses that were common in prostate cancer, such as 8q gains, AR amplifications, PTEN losses and TMPRSS2-ERG fusions. To estimate tumor burden in cfDNA, we developed a Plasma Genomic Abnormality (PGA) score by summing the most significant copy number variations. Cox regression analysis showed that PGA scores were significantly associated with overall survival (p < 0.04). After androgen deprivation therapy or chemotherapy, targeted sequencing showed significant mutational profile changes in genes involved in androgen biosynthesis, AR activation, DNA repair, and chemotherapy resistance. These changes may reflect the dynamic evolution of heterozygous tumor populations in response to these treatments. These results strongly support the feasibility of using non-invasive liquid biopsies as potential tools to study biological mechanisms underlying therapy-specific resistance and to predict disease progression in advanced prostate cancer. PMID:25915538

  2. Automated Physician Order Recommendations and Outcome Predictions by Data-Mining Electronic Medical Records

    PubMed Central

    Chen, Jonathan H.; Altman, Russ B.

    2014-01-01

    The meaningful use of electronic medical records (EMR) will come from effective clinical decision support (CDS) applied to physician orders, the concrete manifestation of clinical decision making. CDS development is currently limited by a top-down approach, requiring manual production and limited end-user awareness. A statistical data-mining alternative automatically extracts expertise as association statistics from structured EMR data (>5.4M data elements from >19K inpatient encounters). This powers an order recommendation system analogous to commercial systems (e.g., Amazon.com’s “Customers who bought this…”). Compared to a standard benchmark, the association method improves order prediction precision from 26% to 37% (p<0.01). Introducing an inverse frequency weighted recall metric demonstrates a quantifiable improvement from 3% to 17% (p<0.01) in recommending more specifically relevant orders. The system also predicts clinical outcomes, such as 30 day mortality and 1 week ICU intervention, with ROC AUC of 0.88 and 0.78 respectively, comparable to state-of-the-art prognosis scores. PMID:25717414

  3. Automated physician order recommendations and outcome predictions by data-mining electronic medical records.

    PubMed

    Chen, Jonathan H; Altman, Russ B

    2014-01-01

    The meaningful use of electronic medical records (EMR) will come from effective clinical decision support (CDS) applied to physician orders, the concrete manifestation of clinical decision making. CDS development is currently limited by a top-down approach, requiring manual production and limited end-user awareness. A statistical data-mining alternative automatically extracts expertise as association statistics from structured EMR data (>5.4M data elements from >19K inpatient encounters). This powers an order recommendation system analogous to commercial systems (e.g., Amazon.com's "Customers who bought this…"). Compared to a standard benchmark, the association method improves order prediction precision from 26% to 37% (p<0.01). Introducing an inverse frequency weighted recall metric demonstrates a quantifiable improvement from 3% to 17% (p<0.01) in recommending more specifically relevant orders. The system also predicts clinical outcomes, such as 30 day mortality and 1 week ICU intervention, with ROC AUC of 0.88 and 0.78 respectively, comparable to state-of-the-art prognosis scores. PMID:25717414

  4. A Prognostic Model Predicting Autologous Transplantation Outcomes in Children, Adolescents and Young Adults with Hodgkin Lymphoma

    PubMed Central

    Satwani, Prakash; Ahn, Kwang Woo; Carreras, Jeanette; Abdel-Azim, Hisham; Cairo, Mitchell S.; Cashen, Amanda; Chen, Andy I.; Cohen, Jonathon B.; Costa, Luciano J.; Dandoy, Christopher; Fenske, Timothy S.; Freytes, César O.; Ganguly, Siddhartha; Gale, Robert Peter; Ghosh, Nilanjan; Hertzberg, Mark S.; Hayashi, Robert J.; Kamble, Rummurti T.; Kanate, Abraham S.; Keating, Armand; Kharfan-Dabaja, Mohamed A.; Lazarus, Hillard M.; Marks, David I.; Nishihori, Taiga; Olsson, Richard F.; Prestidge, Tim D.; Rolon, Juliana Martinez; Savani, Bipin N.; Vose, Julie M.; Wood, William A.; Inwards, David J.; Bachanova, Veronika; Smith, Sonali M.; Maloney, David G.; Sureda, Anna; Hamadani, Mehdi

    2015-01-01

    Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pre-transplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995–2010. The probabilities of progression free survival (PFS) at 1, 5 and 10 years were 66% (95% CI: 62–70), 52% (95% CI: 48–57) and 47% (95% CI: 42–51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ≥90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low, intermediate and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64–80), 53% (95% CI: 47–59) and 23% (95% CI: 9–36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk for progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT. PMID:26237164

  5. A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma.

    PubMed

    Satwani, P; Ahn, K W; Carreras, J; Abdel-Azim, H; Cairo, M S; Cashen, A; Chen, A I; Cohen, J B; Costa, L J; Dandoy, C; Fenske, T S; Freytes, C O; Ganguly, S; Gale, R P; Ghosh, N; Hertzberg, M S; Hayashi, R J; Kamble, R T; Kanate, A S; Keating, A; Kharfan-Dabaja, M A; Lazarus, H M; Marks, D I; Nishihori, T; Olsson, R F; Prestidge, T D; Rolon, J M; Savani, B N; Vose, J M; Wood, W A; Inwards, D J; Bachanova, V; Smith, S M; Maloney, D G; Sureda, A; Hamadani, M

    2015-11-01

    Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pretransplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995 and 2010. The probabilities of PFS at 1, 5 and 10 years were 66% (95% confidence interval (CI): 62-70), 52% (95% CI: 48-57) and 47% (95% CI: 42-51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ⩾90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low-, intermediate- and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64-80), 53% (95% CI: 47-59) and 23% (95% CI: 9-36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk of progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT. PMID:26237164

  6. Platelet count recovery after intravenous immunoglobulin predicts a favorable outcome in children with immune thrombocytopenia

    PubMed Central

    Ji, Mi Hong; Kim, Sung Jin; Ahn, Hyo Seop

    2016-01-01

    Background Childhood immune thrombocytopenic purpura (ITP) is a common acquired bleeding disorder. Even though most children recover, either spontaneously or with therapy, 10-20% of newly diagnosed ITP cases have a chronic course beyond 12 months. This study evaluated whether clinical and laboratory findings can predict the response to intravenous immunoglobulin (IVIG) and progression to persistent or chronic ITP in children. Methods During the period between March 2003 and June 2015, we retrospectively analyzed 72 children, newly diagnosed with ITP, who received IVIG treatment. Peripheral blood counts were obtained at diagnosis and at 1, 3, 6, and 12 months after IVIG treatment. Results After 6 months of IVIG treatment, 14 of 72 patients (19.4%) had persistent ITP, and after 12 months, 7 of 40 patients (17.5%) had chronic ITP. Age at diagnosis, gender, history of viral infection, or vaccination before disease onset were not statistically correlated with platelet recovery at 6 and 12 months. However, a platelet count recovery of ≥100×103/µL at 1 and 3 months was significantly correlated with platelet recovery at 6 (P<0.001 and P<0.001, respectively) and 12 (P=0.007 and P=0.004, respectively) months. Conclusion This study demonstrated that early platelet count recovery, at 1 and 3 months after IVIG treatment, predicts a short disease duration and a favorable outcome in children with newly diagnosed ITP. Further investigation in a larger group of patients is warranted to validate these findings. PMID:27382553

  7. Acute megakaryoblastic leukemia, unlike acute erythroid leukemia, predicts an unfavorable outcome after allogeneic HSCT.

    PubMed

    Ishiyama, Ken; Yamaguchi, Takuhiro; Eto, Tetsuya; Ohashi, Kazuteru; Uchida, Naoyuki; Kanamori, Heiwa; Fukuda, Takahiro; Miyamura, Koichi; Inoue, Yoshiko; Taguchi, Jun; Mori, Takehiko; Iwato, Koji; Morishima, Yasuo; Nagamura-Inoue, Tokiko; Atsuta, Yoshiko; Sakamaki, Hisashi; Takami, Akiyoshi

    2016-08-01

    Acute erythroid leukemia (FAB-M6) and acute megakaryoblastic leukemia (FAB-M7) exhibit closely related properties in cells regarding morphology and the gene expression profile. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered the mainstay of the treatment for both subtypes of leukemia due to their refractoriness to chemotherapy and high rates of relapse, it remains unclear whether allo-HSCT is curative in such cases due to their scarcity. We retrospectively examined the impact of allo-HSCT in 382 patients with M6 and 108 patients with M7 using nationwide HSCT data and found the overall survival (OS) and relapse rates of the M6 patients to be significantly better than those of the M7 patients after adjusting for confounding factors and statistically comparable with those of the patients with M0/M1/M2/M4/M5 disease. Consequently, the factors of age, gender, performance status, karyotype, disease status at HSCT and development of graft-vs.-host disease predicted the OS for the M6 patients, while the performance status and disease status at HSCT were predictive of the OS for the M7 patients. These findings substantiate the importance of distinguishing between M6 and M7 in the HSCT setting and suggest that unknown mechanisms influence the HSCT outcomes of these closely related subtypes of leukemia. PMID:27244257

  8. Plasma genetic and genomic abnormalities predict treatment response and clinical outcome in advanced prostate cancer

    PubMed Central

    Du, Meijun; Dittmar, Rachel L.; Lee, Adam; Nandy, Debashis; Yuan, Tiezheng; Guo, Yongchen; Wang, Yuan; Tschannen, Michael R.; Worthey, Elizabeth; Jacob, Howard; See, William; Kilari, Deepak; Wang, Xuexia; Hovey, Raymond L.; Huang, Chiang-Ching; Wang, Liang

    2015-01-01

    Liquid biopsies, examinations of tumor components in body fluids, have shown promise for predicting clinical outcomes. To evaluate tumor-associated genomic and genetic variations in plasma cell-free DNA (cfDNA) and their associations with treatment response and overall survival, we applied whole genome and targeted sequencing to examine the plasma cfDNAs derived from 20 patients with advanced prostate cancer. Sequencing-based genomic abnormality analysis revealed locus-specific gains or losses that were common in prostate cancer, such as 8q gains, AR amplifications, PTEN losses and TMPRSS2-ERG fusions. To estimate tumor burden in cfDNA, we developed a Plasma Genomic Abnormality (PGA) score by summing the most significant copy number variations. Cox regression analysis showed that PGA scores were significantly associated with overall survival (p < 0.04). After androgen deprivation therapy or chemotherapy, targeted sequencing showed significant mutational profile changes in genes involved in androgen biosynthesis, AR activation, DNA repair, and chemotherapy resistance. These changes may reflect the dynamic evolution of heterozygous tumor populations in response to these treatments. These results strongly support the feasibility of using non-invasive liquid biopsies as potential tools to study biological mechanisms underlying therapy-specific resistance and to predict disease progression in advanced prostate cancer. PMID:25915538

  9. Multi-Marker Strategy in Heart Failure: Combination of ST2 and CRP Predicts Poor Outcome.

    PubMed

    Dupuy, Anne Marie; Curinier, Corentin; Kuster, Nils; Huet, Fabien; Leclercq, Florence; Davy, Jean Marc; Cristol, Jean Paul; Roubille, François

    2016-01-01

    Natriuretic peptides (BNP and NT-proBNP) are recognized as gold-standard predictive markers in Heart Failure (HF). However, currently ST2 (member of the interleukin 1 receptor family) has emerged as marker of inflammation, fibrosis and cardiac stress. We evaluated ST2 and CRP as prognostic markers in 178 patients with chronic heart failure in comparison with other classical markers such as clinical established parameters but also biological markers: NT-proBNP, hs-cTnT alone or in combination. In multivariate analysis, subsequent addition of ST2 led to age, CRP and ST2 as the only remaining predictors of all-cause mortality (HR 1.03, HR 1.61 and HR 2.75, respectively) as well as of cardiovascular mortality (HR 1.00, HR 2.27 and HR 3.78, respectively). The combined increase of ST2 and CRP was significant for predicting worsened outcomes leading to identify a high risk subgroup that individual assessment of either marker. The same analysis was performed with ST2 in combination with Barcelona score. Overall, our findings extend previous data demonstrating that ST2 in combination with CRP as a valuable tool for identifying patients at risk of death. PMID:27311068

  10. Prediction of outcome in breast cancer patients using test parameters from complete blood count

    PubMed Central

    ZHANG, PINGPING; ZONG, YULONG; LIU, MOHAN; TAI, YANHONG; CAO, YUAN; HU, CHENGIIN

    2016-01-01

    The aim of this study was to evaluate the prognostic effect of test parameters from pretreatment complete blood count (CBC) for predicting outcome in breast cancer patients. A total of 162 patients with breast cancer and a long follow-up were enrolled in this study. Red cell indices (RCIs) and neutrophil-lymphocyte ratio (NLR) from CBC prior to treatment, as well as related clinical data, were retrospectively collected. We evaluated the association of RCI and NLR with tumor size, clinical stage, histological grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status. We further performed survival analysis and Cox multivariate analysis, stratified by RCI and NLR median values, to evaluate their prognostic effects. In the disease-free survival (DFS) analysis, patients in the higher mean corpuscular hemoglobin (MCH) and NLR groups exhibited shorter DFS times compared with those in the lower MCH and NLR groups (P=0.017 for MCH and P=0.039 for NLR). The univariate analysis revealed that both MCH and NLR were significantly associated with DFS. The Cox multivariate analysis demonstrated that only MCH was an independent predictor associated with disease relapse (hazard ratio = 1.975, 95% confidence interval: 1.118–3.487, P=0.019), whereas no index was associated with overall survival. Our results suggest that MCH prior to treatment may be a predictive marker associated with DFS in breast cancer. PMID:27284423

  11. Validity of a simple Internet-based outcome-prediction tool in patients with total hip replacement: a pilot study.

    PubMed

    Stöckli, Cornel; Theiler, Robert; Sidelnikov, Eduard; Balsiger, Maria; Ferrari, Stephen M; Buchzig, Beatus; Uehlinger, Kurt; Riniker, Christoph; Bischoff-Ferrari, Heike A

    2014-04-01

    We developed a user-friendly Internet-based tool for patients undergoing total hip replacement (THR) due to osteoarthritis to predict their pain and function after surgery. In the first step, the key questions were identified by statistical modelling in a data set of 375 patients undergoing THR. Based on multiple regression, we identified the two most predictive WOMAC questions for pain and the three most predictive WOMAC questions for functional outcome, while controlling for comorbidity, body mass index, age, gender and specific comorbidities relevant to the outcome. In the second step, a pilot study was performed to validate the resulting tool against the full WOMAC questionnaire among 108 patients undergoing THR. The mean difference between observed (WOMAC) and model-predicted value was -1.1 points (95% confidence interval, CI -3.8, 1.5) for pain and -2.5 points (95% CI -5.3, 0.3) for function. The model-predicted value was within 20% of the observed value in 48% of cases for pain and in 57% of cases for function. The tool demonstrated moderate validity, but performed weakly for patients with extreme levels of pain and extreme functional limitations at 3 months post surgery. This may have been partly due to early complications after surgery. However, the outcome-prediction tool may be useful in helping patients to become better informed about the realistic outcome of their THR. PMID:24585892

  12. Predictive value of arterial ammonia for complications and outcome in acute liver failure

    PubMed Central

    Bhatia, V; Singh, R; Acharya, S K

    2006-01-01

    Background and aim In acute liver failure (ALF), the brain is exposed to high levels of ammonia. Human studies defining the clinical significance of ammonia in ALF are lacking. This prospective study evaluated the relationship of arterial ammonia levels at admission to complications and survival among patients with ALF. Methods Eighty consecutive ALF patients admitted from March 2001 to December 2003 were followed up until death or complete recovery. All had arterial ammonia estimation at admission (enzymatic method). Logistic regression analysis was performed to identify independent predictors of mortality. Results Forty two (52.5%) patients died. Non‐survivors had significantly higher median ammonia levels than survivors (174.7 v 105.0 μmol/l; p<0.001). An arterial ammonia level of ⩾ 124 μmol/l was found to predict mortality with 78.6% sensitivity and 76.3% specificity, and had 77.5% diagnostic accuracy. Patients with higher ammonia levels also developed more complications, including deeper encephalopathy (p = 0.055), cerebral oedema (p = 0.020), need for ventilation (p<0.001), and seizures (p = 0.006). Logistic regression analysis showed that pH, presence of cerebral oedema, and arterial ammonia at admission were independent predictors of mortality (odds ratios 6.6, 12.6, and 10.9, respectively). Incorporating these variables, a score predicting mortality risk at admission was derived: 2.53 + 2.91 ammonia + 2.41 oedema + 1.40 pH, where ammonia is scored as 0 (if <124 μmol/l) or 1 (if ⩾124 μmol/l); oedema is scored as 0 (absent) or 1(present); and pH is scored as 1 (if ⩽7.40) or 0 (if >7.40). Levels of partial pressure of ammonia were equally correlated with outcome. Conclusion Arterial ammonia at presentation is predictive of outcome and can be used for risk stratification. Ammonia lowering therapies in patients with ALF should be evaluated. PMID:16024550

  13. Protein phosphatase methylesterase-1 (PME-1) expression predicts a favorable clinical outcome in colorectal cancer.

    PubMed

    Kaur, Amanpreet; Elzagheid, Adam; Birkman, Eva-Maria; Avoranta, Tuulia; Kytölä, Ville; Korkeila, Eija; Syrjänen, Kari; Westermarck, Jukka; Sundström, Jari

    2015-12-01

    Colorectal cancer (CRC) accounts for high mortality. So far, there is lack of markers capable of predicting which patients are at risk of aggressive course of the disease. Protein phosphatase-2A (PP2A) inhibitor proteins have recently gained interest as markers of more aggressive disease in certain cancers. Here, we report the role of PP2A inhibitor PME-1 in CRC. PME-1 expression was assessed from a rectal cancer patient cohort by immunohistochemistry, and correlations were performed for various clinicopathological variables and patient survival. Rectal cancer patients with higher cytoplasmic PME-1 protein expression (above median) had less recurrences (P = 0.003, n = 195) and better disease-free survival (DFS) than the patients with low cytoplasmic PME-1 protein expression (below median). Analysis of PPME-1 mRNA expression from TCGA dataset of colon and rectal adenocarcinoma (COADREAD) patient cohort confirmed high PPME1 expression as an independent protective factor predicting favorable overall survival (OS) (P = 0.005, n = 396) compared to patients with low PPME1 expression. CRC cell lines were used to study the effect of PME-1 knockdown by siRNA on cell survival. Contrary to other cancer types, PME-1 inhibition in CRC cell lines did not reduce the viability of cells or the expression of active phosphorylated AKT and ERK proteins. In conclusion, PME-1 expression predicts for a favorable outcome of CRC patients. The unexpected role of PME-1 in CRC in contrast with the oncogenic role of PP2A inhibitor proteins in other malignancies warrants further studies of cancer-specific function for each of these proteins. PMID:26377365

  14. Predicting Outcome in Acute Organophosphorus Poisoning with a Poison Severity Score or the Glasgow Coma Scale

    PubMed Central

    Davies, James O. J.; Eddleston, Michael; Buckley, Nick A.

    2008-01-01

    Background: Organophosphorus pesticide poisoning kills around 200,000 people each year, principally due to self poisoning in the Asia-Pacific region. Aim: We wished to assess whether patients at high risk of death could be identified accurately using clinical parameters soon after hospital admission. Design: We evaluated the usefulness of the International Program on Chemical Safety Poison Severity Score (IPCS PSS) and the Glasgow Coma Score (GCS) prospectively for predicting death in patients poisoned by organophosphorus pesticides. Methods: Data were collected as part of a multicentre cohort study in Sri Lanka. Study doctors saw all patients on admission, collecting data on pulse, blood pressure, pupil size, need for intubation, and GCS. Results: 1365 patients with a history of acute organophosphorus poisoning were included. Receiver operating characteristic (ROC) curves were calculated for the IPCS PSS and GCS on admission. The IPCS PSS and GCS had similar ROC area under the curves (AUC) and best cut points as determined by Youden's index (AUC/sensitivity/specificity 0.81/0.78/0.79 for IPCS PSS ≥ grade 2 and 0.84/0.79/0.79 for GCS ≤13). The predictive value varied with the pesticide ingested, being more accurate for dimethoate poisoning and less accurate for fenthion poisoning (GCS AUC 0.91 compared to 0.69). Conclusions: GCS and the IPCS PSS were similarly effective at predicting outcome. Patients presenting with a GCS ≤ 13 need intensive monitoring and treatment. However, the identity of the organophosphate must be taken into account since the half of all patients who died from fenthion poisoning only had mild symptoms at presentation. PMID:18319295

  15. Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients

    PubMed Central

    Imura, Takeshi; Nagasawa, Yuki; Inagawa, Tetsuji; Imada, Naoki; Izumi, Hiroaki; Emoto, Katsuya; Tani, Itaru; Yamasaki, Hiroyuki; Ota, Yuichiro; Oki, Shuichi; Maeda, Tadanori; Araki, Osamu

    2015-01-01

    [Purpose] The efficacy of diffusion tensor imaging in the prediction of motor outcomes and activities of daily living function remains unclear. We evaluated the most appropriate diffusion tensor parameters and methodology to determine whether the region of interest- or tractography-based method was more useful for predicting motor outcomes and activities of daily living function in stroke patients. [Subjects and Methods] Diffusion tensor imaging data within 10 days after stroke onset were collected and analyzed for 25 patients. The corticospinal tract was analyzed. Fractional anisotropy, number of fibers, and apparent diffusion coefficient were used as diffusion tensor parameters. Motor outcomes and activities of daily living function were evaluated on the same day as diffusion tensor imaging and at 1 month post-onset. [Results] The fractional anisotropy value of the affected corticospinal tract significantly correlated with the motor outcome and activities of daily living function within 10 days post-onset and at 1 month post-onset. Tthere were no significant correlations between other diffusion tensor parameters and motor outcomes or activities of daily living function. [Conclusion] The fractional anisotropy value of the affected corticospinal tract obtained using the tractography-based method was useful for predicting motor outcomes and activities of daily living function in stroke patients. PMID:26157225

  16. Lung Cancer Ablation: Technologies and Techniques

    PubMed Central

    Alexander, Erica S.; Dupuy, Damian E.

    2013-01-01

    The incidence of lung cancers in 2012 is estimated to reach 226,160 new cases, with only a third of patients suitable surgical candidates. Tumor ablation has emerged as an important and efficacious treatment option for nonsurgical lung cancer patients. This localized minimally invasive therapy is best suited for small oligonodular lesions or favorably located metastatic tumors. Radiofrequency ablation has been in use for over a decade, and newer modalities including microwave ablation, cryoablation, and irreversible electroporation have emerged as additional treatment options for patients. Ablation therapies can offer patients and clinicians a repeatable and effective therapy for palliation and, in some cases, cure of thoracic malignancies. This article discusses the available technologies and techniques available for tumor ablation of thoracic malignancies including patient selection, basic aspects of procedure technique, imaging follow-up, treatment outcomes, and comparisons between various therapies. PMID:24436530

  17. Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients

    PubMed Central

    Schrutka, Lore; Goliasch, Georg; Meyer, Brigitte; Wurm, Raphael; Koller, Lorenz; Kriechbaumer, Lukas; Heinz, Gottfried; Pacher, Richard; Lang, Irene M

    2016-01-01

    Introduction Oxidative stress affects clinical outcome in critically ill patients. Although high-density lipoprotein (HDL) particles generally possess anti-oxidant capacities, deleterious properties of HDL have been described in acutely ill patients. The impact of anti-oxidant HDL capacities on clinical outcome in critically ill patients is unknown. We therefore analyzed the predictive value of anti-oxidant HDL function on mortality in an unselected cohort of critically ill patients. Method We prospectively enrolled 270 consecutive patients admitted to a university-affiliated intensive care unit (ICU) and determined anti-oxidant HDL function using the HDL oxidant index (HOI). Based on their HOI, the study population was stratified into patients with impaired anti-oxidant HDL function and the residual study population. Results During a median follow-up time of 9.8 years (IQR: 9.2 to 10.0), 69% of patients died. Cox regression analysis revealed a significant and independent association between impaired anti-oxidant HDL function and short-term mortality with an adjusted HR of 1.65 (95% CI 1.22–2.24; p = 0.001) as well as 10-year mortality with an adj. HR of 1.19 (95% CI 1.02–1.40; p = 0.032) when compared to the residual study population. Anti-oxidant HDL function correlated with the amount of oxidative stress as determined by Cu/Zn superoxide dismutase (r = 0.38; p<0.001). Conclusion Impaired anti-oxidant HDL function represents a strong and independent predictor of 30-day mortality as well as long-term mortality in critically ill patients. PMID:26978526

  18. PSA Decrease During Combined-Modality Radiotherapy Predicts for Treatment Outcome

    SciTech Connect

    Kubicek, Gregory J.; Naguib, Marco; Redfield, Sandy; Grayback, Nola; Olszanski, Arthur; Dawson, George; Brown, Sam I.

    2010-11-01

    Purpose: Prostate-specific antigen (PSA) is the well-used marker in the diagnosis, prognosis, and follow-up for prostate cancer patients. Although reports have focused on the importance of pretreatment PSA levels, doubling time, and posttreatment nadirs, there is little information on the value of PSA during the course of radiotherapy. Methods and Materials: Retrospective review of PSA values obtained midway through a course of radiotherapy treatment for prostate cancer. Patients had a PSA (midPSA) measured after a course of external beam radiation (EBRT) before planned transperineal low-dose-rate brachytherapy implant (LDR). Results: A total of 717 patients were analyzed with a median follow-up of 5.8 years, all censored patients had a minimum follow-up of 2 years. A total of 277 patients had low-risk disease, 267 patients had intermediate risk, and 173 patients had high-risk disease. Androgen blockade was used in 512 patients. A total of 653 patients had a midPSA decrease after EBRT, the median decrease was 6.2 ng/mL. Patients who had a midPSA decrease {>=}25% compared with pretreatment PSA had improved overall survival of 10.0 vs. 7.4 years (p < 0.0004) and improved disease-free survival of 9.8 vs. 7.3 years (p < 0.01). When stratified by use of androgen blockade, midPSA remained significant for both androgen and non-androgen patients. Conclusions: PSA response after EBRT before brachytherapy predicts for long-term outcome; this may allow for risk stratification and intervention with higher LDR doses to improve outcomes.

  19. Outcome and Predicting Factor Following Severe Traumatic Brain Injury: A Retrospective Cross-Sectional Study

    PubMed Central

    Khajavikhan, Javaher; Vasigh, Aminolah; Khani, Ali; Kokhazade, Taleb

    2016-01-01

    Introduction Severe traumatic brain injury (TBI) is a major and challenging problem in critical care medicine. Aim To assess the outcome and predicting factor following severe TBI. Materials and Methods This is a retrospective and cross-sectional study. Data were collected from two sections; one section consisting of a questionnaire answered by the patients and other section from the patient records. The instruments used included the Glasgow Outcome Scale (GOS), SF-36 and the Hospital Anxiety and Depression Scale (HAD). Results The mortality rate of the patients was 46.2%. The quality of life (QOL) of the patients in most dimension were impaired and (58%) of patients had unfavourable QOL. About (37.5%) of patients with anxiety and (27.5%) had a depression. A significant correlation was found between age, GCS arrival, length of ICU stay, mechanical ventilation, VAP & ARDS and pupil reactivity with QOL, GOS, HAD-A and HAD-D (p<0.05, p< 0.001). GCS arrival a predicate factor for QOL and GOS (p <0.001, OR: 1.75, 1.94 respectively); length of ICU stay a predicate factor for QOL and GOS (p <0.05, OR : 1.11, 1.28 respectively); mechanical ventilation a predicate factor for GOS (p <0.001, OR : 1.78); ventilation associated pneumonia (VAP) & acute respiratory distress syndrome (ARDS) and pupil reactivity a predicate factor for GOS (p <0.05, OR : 1.36; p<0.001, OR: 1.94 respectively). The GCS arrival and ICU stay a predicate factor for HAD-A (p<0.05, OR: 1.73, 1.38 respectively). Conclusion With respect to results advanced in pre hospital, medical and surgical care for the decrease in mortality rates of Head trauma (HT), the use of trauma triage tools and strict enforcement of traffic rules are necessary. PMID:27042518

  20. SPARC promotes leukemic cell growth and predicts acute myeloid leukemia outcome

    PubMed Central

    Alachkar, Houda; Santhanam, Ramasamy; Maharry, Kati; Metzeler, Klaus H.; Huang, Xiaomeng; Kohlschmidt, Jessica; Mendler, Jason H.; Benito, Juliana M.; Hickey, Christopher; Neviani, Paolo; Dorrance, Adrienne M.; Anghelina, Mirela; Khalife, Jihane; Tarighat, Somayeh S.; Volinia, Stefano; Whitman, Susan P.; Paschka, Peter; Hoellerbauer, Pia; Wu, Yue-Zhong; Han, Lina; Bolon, Brad N.; Blum, William; Mrózek, Krzysztof; Carroll, Andrew J.; Perrotti, Danilo; Andreeff, Michael; Caligiuri, Michael A.; Konopleva, Marina; Garzon, Ramiro; Bloomfield, Clara D.; Marcucci, Guido

    2014-01-01

    Aberrant expression of the secreted protein, acidic, cysteine-rich (osteonectin) (SPARC) gene, which encodes a matricellular protein that participates in normal tissue remodeling, is associated with a variety of diseases including cancer, but the contribution of SPARC to malignant growth remains controversial. We previously reported that SPARC was among the most upregulated genes in cytogenetically normal acute myeloid leukemia (CN-AML) patients with gene-expression profiles predictive of unfavorable outcome, such as mutations in isocitrate dehydrogenase 2 (IDH2-R172) and overexpression of the oncogenes brain and acute leukemia, cytoplasmic (BAALC) and v-ets erythroblastosis virus E26 oncogene homolog (ERG). In contrast, SPARC was downregulated in CN-AML patients harboring mutations in nucleophosmin (NPM1) that are associated with favorable prognosis. Based on these observations, we hypothesized that SPARC expression is clinically relevant in AML. Here, we found that SPARC overexpression is associated with adverse outcome in CN-AML patients and promotes aggressive leukemia growth in murine models of AML. In leukemia cells, SPARC expression was mediated by the SP1/NF-κB transactivation complex. Furthermore, secreted SPARC activated the integrin-linked kinase/AKT (ILK/AKT) pathway, likely via integrin interaction, and subsequent β-catenin signaling, which is involved in leukemia cell self-renewal. Pharmacologic inhibition of the SP1/NF-κB complex resulted in SPARC downregulation and leukemia growth inhibition. Together, our data indicate that evaluation of SPARC expression has prognosticative value and SPARC is a potential therapeutic target for AML. PMID:24590286

  1. Glomerular IgG deposition predicts renal outcome in patients with IgA nephropathy.

    PubMed

    Shin, Dong Ho; Lim, Beom Jin; Han, In Mi; Han, Seung Gyu; Kwon, Young Eun; Park, Kyoung Sook; Lee, Mi Jung; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Kang, Shin-Wook; Yoo, Tae-Hyun

    2016-07-01

    Glomerular IgG deposition is frequently observed in patients with IgA nephropathy. However, the association between glomerular IgG deposition and progression of IgA nephropathy is uncertain. Six hundred and twenty-seven patients with biopsy-proven IgA nephropathy were recruited. Histological variables of the Oxford classification (Oxford-MEST) and the presence of glomerular IgG deposits were assessed. Renal progression defined as end-stage renal disease or 50% reduction in estimated glomerular filtration rate was analyzed using Kaplan-Meier methods and Cox regression analysis. Of the study population, 200 patients (31.9%) had glomerular IgG deposition on immunofluorescence staining. During a mean follow-up of 56.8±37.5 months, the rate of renal progression was significantly higher in the IgA nephropathy patients with glomerular IgG deposition compared with the IgA nephropathy patients without glomerular IgG deposition (39.8 vs 12.3 per 1000 patient-years; P<0.001). Of patients with IgG deposition, 178 (28.3%), 20 (3.2%), and 2 (0.3%) patients had mild, moderate, and marked glomerular IgG deposits, receptively. Kaplan-Meier analysis revealed that cumulative renal survival was significantly lower in IgA nephropathy patients with the higher intensity of glomerular IgG deposits (P<0.001). In addition, Cox regression analysis revealed that moderate and marked glomerular IgG deposits significantly predicted renal outcome independent of Oxford-MEST and clinical variables (HR, 2.97; 95% CI, 1.01-8.77; P=0.04). This study showed that that glomerular IgG deposition was independently associated with poor renal outcome in patient with IgA nephropathy. PMID:27102346

  2. Using Post-Traumatic Amnesia To Predict Outcome after Traumatic Brain Injury.

    PubMed

    Ponsford, Jennie L; Spitz, Gershon; McKenzie, Dean

    2016-06-01

    Duration of post-traumatic amnesia (PTA) has emerged as a strong measure of injury severity after traumatic brain injury (TBI). Despite the growing international adoption of this measure, there remains a lack of consistency in the way in which PTA duration is used to classify severity of injury. This study aimed to establish the classification of PTA that would best predict functional or productivity outcomes. We conducted a cohort study of 1041 persons recruited from inpatient admissions to a TBI rehabilitation center between 1985 and 2013. Participants had a primary diagnosis of TBI, emerged from PTA before discharge from inpatient hospital, and engaged in productive activities before injury. Eight models that classify duration of PTA were evaluated-six that were based on the literature and two that were statistically driven. Models were assessed using area under the receiver operating characteristic curve (AUC) as well as model-based Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) statistics. All categorization models showed longer PTA to be associated with a greater likelihood of being nonproductive at 1 year after TBI. Classification systems with a greater number of categories performed better than two-category systems. The dimensional (continuous) form of PTA resulted in the greatest AUC, and lowest AIC as well as BIC, of the classification systems examined. This finding indicates that the greatest accuracy in prognosis is likely to be achieved using PTA as a continuous variable. This enables the probability of productive outcomes to be estimated with far greater precision than that possible using a classification system. Categorizing PTA to classify severity of injury may be reducing the precision with which clinicians can plan the treatment of patients after TBI. PMID:26234939

  3. Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

    PubMed Central

    Lim, Ki Hong; Jung, Jin-Hee; Kwon, Jae Hyun; Lee, Yong Seok; Bae, Jungbum; Cho, Min Chul; Lee, Kwang Soo

    2015-01-01

    Purpose The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. Materials and Methods A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. Results Mean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. Conclusions Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure. PMID:25598937

  4. High cystatin C levels predict undesirable outcome for diabetic foot ulcerations.

    PubMed

    Ai, Ligen; Hu, Yanyun; Zhang, Xiaoyan; Zeng, Hui; Zhao, Jun; Zhao, Jungong; Chai, Yimin; Lu, Junxi; Tang, Junling; Bao, Yuqian; Liu, Fang; Jia, Weiping

    2016-05-01

    We investigated the relationship between serum cystatin C levels and the prognosis of diabetic foot ulcerations (DFU). A population-based cohort study involving 1018 patients with type 2 diabetes was conducted. These patients recruited and divided into two groups: nondiabetic foot ulcer group (NDF, n = 865, 85.5%) and diabetic foot ulcer group (DFU, n = 147, 14.5%).After a 1-year-follow-up, DFUs were grouped into healing (n = 110, 74.8%) and nonhealing (n = 37, 25.2%) group based on the clinical prognosis. Compared with the healing group, the nonhealing group were older, had long diabetic duration and had significantly increased serum cystatin C concentrations in DFU (p < 0.01). After adjustments for age, diabetes duration, renal function and infection control, multiple logistical regression analysis revealed that cystatin C remained associated increased risk of undesirable DFU outcome (OR = 7.279, 95% CI: 1.299-40.784, p < 0.05). When divided into quartiles according to cystatin C levels, the healing rate of Quartile 4 was significantly lower (57.9%) compared with other groups (p < 0.01). The odd is ratio (OR) analysis showed that the risk of undesirable DFU outcome in Quartile 4 was significantly higher (OR = 4.554, 95% CI: 3.14-5.12, p < 0.05) compared with that in Quartile 1. We concluded that there was a strong and independent association between serum cystatin C and diabetic foot ulceration prognosis, cystatin C > 1.35 mg/L predicts more than sixfold increased risk of incurable foot ulceration. PMID:26864251

  5. Thermal ablation of stage I non-small cell lung carcinoma.

    PubMed

    Ridge, Carol A; Solomon, Stephen B; Thornton, Raymond H

    2014-06-01

    Ablation options for the treatment of localized non-small cell lung carcinoma (NSCLC) include radiofrequency ablation, microwave ablation, and cryotherapy. Irreversible electroporation is a novel ablation method with the potential of application to lung tumors in risky locations. This review article describes the established and novel ablation techniques used in the treatment of localized NSCLC, including mechanism of action, indications, potential complications, clinical outcomes, postablation surveillance, and use in combination with other therapies. PMID:25053863

  6. Predicting Outcome after Traumatic Brain Injury: Development of Prognostic Scores Based on the IMPACT and the APACHE II

    PubMed Central

    Siironen, Jari; Kivisaari, Riku; Hernesniemi, Juha; Skrifvars, Markus B.

    2014-01-01

    Abstract Prediction models are important tools for heterogeneity adjustment in clinical trials and for the evaluation of quality of delivered care to patients with traumatic brain injury (TBI). We sought to improve the predictive performance of the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials) prognostic model by combining it with the APACHE II (Acute Physiology and Chronic Health Evaluation II) for 6-month outcome prediction in patients with TBI treated in the intensive care unit. A total of 890 patients with TBI admitted to a large urban level 1 trauma center in 2009–2012 comprised the study population. The IMPACT and the APACHE II scores were combined using binary logistic regression. A randomized, split-sample technique with secondary bootstrapping was used for model development and internal validation. Model performance was assessed by discrimination (by area under the curve [AUC]), calibration, precision, and net reclassification improvement (NRI). Overall 6-month mortality was 22% and unfavorable neurological outcome 47%. The predictive power of the new combined IMPACT–APACHE II models was significantly superior, compared to the original IMPACT models (AUC, 0.81–0.82 vs. 0.84–0.85; p<0.05) for 6-month mortality prediction, but not for unfavorable outcome prediction (AUC, 0.81–0.82 vs. 0.83; p>0.05). However, NRI showed a significant improvement in risk stratification of patients with unfavorable outcome by the IMPACT–APACHE II models, compared to the original models (NRI, 5.4–23.2%; p<0.05). Internal validation using split-sample and resample bootstrap techniques yielded equivalent results, indicating low grade of overestimation. Our findings show that by combining the APACHE II with the IMPACT, improved 6-month outcome predictive performance is achieved. This may be applicable for heterogeneity adjustment in forthcoming TBI studies. PMID:24836936

  7. Sperm chromatin structure assay in prediction of in vitro fertilization outcome.

    PubMed

    Oleszczuk, K; Giwercman, A; Bungum, M

    2016-03-01

    Sperm DNA fragmentation index (DFI) assessed by sperm chromatin structure assay is a valuable tool for prediction of fertility in vivo. Previous studies on DFI as predictor of in vitro fertilization (IVF) outcome, based on relatively small materials, gave contradictory results. The present study examines, in a large cohort, the association between sperm DFI and the outcome of IVF/ICSI procedure. The study is based on 1633 IVF or ICSI cycles performed at the Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden, between May 2007 and March 2013. DFI values were categorized into four intervals: DFI ≤ 10% (reference group), 10% < DFI ≤ 20%, 20% < DFI ≤ 30%, DFI > 30%. For the three latter intervals, the following outcomes of IVF/ICSI procedures were analyzed in relation to the reference group: fertilization, good quality embryo, pregnancy, miscarriage, and live births. In the standard IVF group, a significant negative association between DFI and fertilization rate was found. When calculated per ovum pick-up (OPU) Odds Ratios (ORs) for at least one good quality embryo (GQE) were significantly lower in the standard IVF group if DFI > 20%. OR for live birth calculated per OPU was significantly lower in standard IVF group if DFI > 20% (OR 0.61; 95% CI: 0.38-0.97; p = 0.04). No such associations were seen in the ICSI group. OR for live birth by ICSI compared to IVF were statistically significantly higher for DFI > 20% (OR 1.7; 95% CI: 1.0-2.9; p = 0.05). OR for miscarriage was significantly increased for DFI > 40% (OR 3.8; 95% CI: 1.2-12; p = 0.02). The results suggest that ICSI might be a preferred method of in vitro treatment in cases with high DFI. Efforts should be made to find options for pharmacologically induced reduction of DFI. The study was based on retrospectively collected data and prospective studies confirming the superiority of ICSI in cases with high DFI are warranted. PMID:26757265

  8. Serum IL-10 Predicts Worse Outcome in Cancer Patients: A Meta-Analysis

    PubMed Central

    Wu, Pin; Wang, Zhen; Huang, Jian

    2015-01-01

    Background IL–10 is an important immunosuppressive cytokine which is frequently elevated in tumor microenvironment. Some studies have reported that overexpression of serous IL–10 is correlated with worse outcome in patients with malignant tumor. Here, we conducted a meta-analysis to assess the prognostic impact of serous IL–10 expression in cancer patients. Methods We searched PubMed and EBSCO for studies in evaluating the association of IL–10 expression—in serum and clinical outcome in cancer patients. Overall survival (OS) was the primary prognostic indicator and disease-free survival (DFS) was the secondary indicator. Extracted data were computed into odds ratios (ORs) and 95% confidence interval (CI) or a P value for survival at 1, 3 and 5 years. Pooled data were weighted using the Mantel–Haenszel Fixed-effect model. All statistical tests were two-sided. Results A total of 1788 patients with cancer from 21 published studies were incorporated into this meta-analysis. High level of serum IL–10 was significantly associated with worse OS at 1-year (OR = 3.70, 95% CI = 2.81 to 4.87, P < 0.00001), 3-year (OR = 3.33, 95% CI = 2.53 to 4.39, P < 0.0001) and 5-year (OR = 2.80, 95% CI = 1.90 to 4.10, P < 0.0001) of cancer. Subgroup analysis showed that the correlation between serous IL–10 expression and outcome of patients with solid tumors and hematological malignancies are consistent. The association of IL–10 with worse DFS at 1-year (OR = 3.34, 95% CI = 1.40 to 7.94, P = 0.006) and 2-year (OR = 3.91, 95% CI = 1.79 to 8.53, P = 0.0006) was also identified. Conclusions High expression of serous IL–10 leads to an adverse survival in most types of cancer. IL–10 is a valuable biomarker for prognostic prediction and targeting IL–10 treatment options for both solid tumors and hematological malignancies. PMID:26440936

  9. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

    PubMed Central

    Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus BM; Schmitz, Christoph

    2014-01-01

    Background Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient’s individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height. Methods Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast® device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5–4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires. Results The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient’s condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age. Conclusion Radial shock wave therapy is a safe and effective treatment option for cellulite. The

  10. Predicting the outcome of grade II glioma treated with temozolomide using proton magnetic resonance spectroscopy

    PubMed Central

    Guillevin, R; Menuel, C; Taillibert, S; Capelle, L; Costalat, R; Abud, L; Habas, C; De Marco, G; Hoang-Xuan, K; Chiras, J; Vallée, J-N

    2011-01-01

    predictive of tumour relapse with a significant cutoff of 0.046, a sensitivity of 60% and a specificity of 100% (P=0.004). Conclusions: The 1H-MRS profile changes more widely and rapidly than tumour volume during the response and relapse phases, and represents an early predictive factor of outcome over 14 months of follow-up. Thus, 1H-MRS may be a promising, non-invasive tool for predicting and monitoring the clinical response to TMZ. PMID:21610707

  11. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis.

    PubMed

    Peolsson, Anneli; Peolsson, Michael

    2008-03-01

    We conducted a prospective randomized study to investigate predictive factors for short- and long-term outcome of anterior cervical decompression and fusion (ACDF) as measured by current pain intensity on the Visual Analogue Scale (VAS) and by disability using the Neck Disability Index (NDI). Current understanding about how preoperative and short-term outcome data predict long-term outcome is sparse, and there are few studies involving analysis of short-term follow-up using multivariate approaches with quantification of the relative importance of each variable studied. A total of 95 patients were randomly allocated for ACDF with the cervical intervertebral fusion cage or the Cloward procedure. The mean follow-up time was 19 months (range 12-24) for short-term follow-up and 76 months (range 56-94 months) for long-term. Background factors, radiologically detected findings, physiological measurements, treatment type, pain, and disability were used as potential predictors. Multivariate statistical analysis by projection to latent structures was used to investigate predictors of importance for short- and long-term outcome of ACDF. A "preoperative" low disability and pain intensity, non-smoking status, male sex, good hand strength, and an active range of motion (AROM) in the neck were significant predictors for good short- and long-term outcomes. The short-term outcome data were better at predicting long-term outcome than were baseline data. Radiologically detected findings and surgical technique used were mainly insignificant as predictors. We suggest that the inclusion criteria for ACDF should be based on a bio-psycho-social model including NDI. NDI may also be regarded as an important outcome measurement in evaluation of ACDF. PMID:18084782

  12. Development of a Screening Tool for Predicting Adverse Outcomes of Gestational Diabetes Mellitus: A Retrospective Cohort Study.

    PubMed

    Park, Jee Soo; Kim, Deok Won; Kwon, Ja-Young; Park, Yong Won; Kim, Young Han; Cho, Hee Young

    2016-01-01

    Gestational diabetes mellitus (GDM) is a common disease in pregnancy causing maternal and fetal complications. To prevent these adverse outcomes, optimal screening and diagnostic criteria must be adequate, timely, and efficient. This study suggests a novel approach that is practical, efficient, and patient- and clinician-friendly in predicting adverse outcomes of GDM. The authors conducted a retrospective cohort study via medical record review of patients admitted between March 2001 and April 2013 at the Severance Hospital, Seoul, South Korea. Patients diagnosed by a conventional 2-step method were evaluated according to the presence of adverse outcomes (neonatal hypoglycemia, hyperbilirubinemia, and hyperinsulinemia; admission to the neonatal intensive care unit; large for gestational age; gestational insulin therapy; and gestational hypertension). Of 802 women who had an abnormal 50-g, 1-hour glucose challenge test, 306 were diagnosed with GDM and 496 did not have GDM (false-positive group). In the GDM group, 218 women (71.2%) had adverse outcomes. In contrast, 240 women (48.4%) in the false-positive group had adverse outcomes. Women with adverse outcomes had a significantly higher body mass index (BMI) at entry (P = 0.03) and fasting blood glucose (FBG) (P = 0.03). Our logistic regression model derived from 2 variables, BMI at entry and FBG, predicted GDM adverse outcome with an area under the curve of 0.642, accuracy of 61.3%, sensitivity of 57.2%, and specificity of 66.9% compared with the conventional 2-step method with an area under the curve of 0.610, accuracy of 59.1%, sensitivity of 47.6%, and specificity of 74.4%. Our model performed better in predicting GDM adverse outcomes than the conventional 2-step method using only BMI at entry and FBG. Moreover, our model represents a practical, inexpensive, efficient, reproducible, easy, and patient- and clinician-friendly approach. PMID:26735528

  13. Characterizing primary refractory neuroblastoma: prediction of outcome by microscopic image analysis

    NASA Astrophysics Data System (ADS)

    Niazi, M. Khalid Khan; Weiser, Daniel A.; Pawel, Bruce R.; Gurcan, Metin N.

    2015-03-01

    Neuroblastoma is a childhood cancer that starts in very early forms of nerve cells found in an embryo or fetus. It is a highly lethal cancer of sympathetic nervous system that commonly affects children of age five or younger. It accounts for a disproportionate number of childhood cancer deaths and remains a difficult cancer to eradicate despite intensive treatment that includes chemotherapy, surgery, hematopoietic stem cell transplantation, radiation therapy and immunotherapy. A poorly characterized group of patients are the 15% with primary refractory neuroblastoma (PRN) which is uniformly lethal due to de novo chemotherapy resistance. The lack of response to therapy is currently assessed after multiple months of cytotoxic therapy, driving the critical need to develop pretreatment clinic-biological biomarkers that can guide precise and effective therapeutic strategies. Therefore, our guiding hypothesis is that PRN has distinct biological features present at diagnosis that can be identified for prediction modeling. During a visual analysis of PRN slides, stained with hematoxylin and eosin, we observed that patients who survived for less than three years contained large eosin-stained structures as compared to those who survived for greater than three years. So, our hypothesis is that the size of eosin stained structures can be used as a differentiating feature to characterize recurrence in neuroblastoma. To test this hypothesis, we developed an image analysis method that performs stain separation, followed by the detection of large structures stained with Eosin. On a set of 21 PRN slides, stained with hematoxylin and eosin, our image analysis method predicted the outcome with 85.7% accuracy.

  14. Machine Learning Approaches for Predicting Radiation Therapy Outcomes: A Clinician's Perspective.

    PubMed

    Kang, John; Schwartz, Russell; Flickinger, John; Beriwal, Sushil

    2015-12-01

    Radiation oncology has always been deeply rooted in modeling, from the early days of isoeffect curves to the contemporary Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) initiative. In recent years, medical modeling for both prognostic and therapeutic purposes has exploded thanks to increasing availability of electronic data and genomics. One promising direction that medical modeling is moving toward is adopting the same machine learning methods used by companies such as Google and Facebook to combat disease. Broadly defined, machine learning is a branch of computer science that deals with making predictions from complex data through statistical models. These methods serve to uncover patterns in data and are actively used in areas such as speech recognition, handwriting recognition, face recognition, "spam" filtering (junk email), and targeted advertising. Although multiple radiation oncology research groups have shown the value of applied machine learning (ML), clinical adoption has been slow due to the high barrier to understanding these complex models by clinicians. Here, we present a review of the use of ML to predict radiation therapy outcomes from the clinician's point of view with the hope that it lowers the "barrier to entry" for those without formal training in ML. We begin by describing 7 principles that one should consider when evaluating (or creating) an ML model in radiation oncology. We next introduce 3 popular ML methods--logistic regression (LR), support vector machine (SVM), and artificial neural network (ANN)--and critique 3 seminal papers in the context of these principles. Although current studies are in exploratory stages, the overall methodology has progressively matured, and the field is ready for larger-scale further investigation. PMID:26581149

  15. The multimodal management of GH-secreting pituitary adenomas: predictive factors, strategies and outcomes.

    PubMed

    Buliman, A; Tataranu, L G; Ciubotaru, V; Cazac, T L; Dumitrache, C

    2016-01-01

    Object. The aim of this study was to analyze a series of 28 patients with acromegaly who underwent a multimodal surgical, medical and radiosurgical therapy, with a special attention to the advantages, complications, and predictive factors of a successful outcome. Methods. 28 consecutive cases of GH-secreting pituitary adenomas, who underwent transsphenoidal endoscopic or microscopic surgery, between 1 January 2014 and 31 December 2014 were retrospectively reviewed. Tumors were classified according to the diameter, measured on MRI, as micro- or macroadenomas, and parasellar (cavernous sinus) tumor extension was analyzed based on the Knosp grading score. The mean follow-up period was of 18.4 months. Criteria justifying the complete hormonal remission were preoperative basal serum GH < 2.5 μg/ L, preoperative nadirGH < 1 ng/ L after OGTT and normal preoperative IGF-I levels age and sex-matched. Results. An overall complete hormonal remission rate was achieved in 64.3% of the patients. The remission rate was higher in patients with microadenomas (77.8%) than in those with macroadenomas (57.9%). A number of predictive factors, which might have interfered with the hormonal remission rate from a statistical, clinical and paraclinical point of view, were identified: tumor size (r = 0.625), preoperative GH serum levels (r = -0.517), cavernous sinus extension was quantified according to Knosp grading score (r = 0.469) and the degree of tumor subtotal resection (r = 0.598). Conclusions. Favorable hormonal and visual remission rates can be achieved after transsphenoidal resection of GH-secreting pituitary adenomas; however, the management remains challenging, the increased surgical experience being important for higher cure rates. If a biochemical hormonal cure is not achieved postoperatively, adjuvant medical or radio surgical therapy can be recommended. PMID:27453753

  16. Mucosal Immune Responses Predict Clinical Outcomes during Influenza Infection Independently of Age and Viral Load

    PubMed Central

    Oshansky, Christine M.; Gartland, Andrew J.; Wong, Sook-San; Jeevan, Trushar; Wang, David; Roddam, Philippa L.; Caniza, Miguela A.; Hertz, Tomer; DeVincenzo, John P.; Webby, Richard J.

    2014-01-01

    Rationale: Children are an at-risk population for developing complications following influenza infection, but immunologic correlates of disease severity are not understood. We hypothesized that innate cellular immune responses at the site of infection would correlate with disease outcome. Objectives: To test the immunologic basis of severe illness during natural influenza virus infection of children and adults at the site of infection. Methods: An observational cohort study with longitudinal sampling of peripheral and mucosal sites in 84 naturally influenza-infected individuals, including infants. Cellular responses, viral loads, and cytokines were quantified from nasal lavages and blood, and correlated to clinical severity. Measurements and Main Results: We show for the first time that although viral loads in children and adults were similar, innate responses in the airways were stronger in children and varied considerably between plasma and site of infection. Adjusting for age and viral load, an innate immune profile characterized by increased nasal lavage monocyte chemotactic protein-3, IFN-α2, and plasma IL-10 levels at enrollment predicted progression to severe disease. Increased plasma IL-10, monocyte chemotactic protein-3, and IL-6 levels predicted hospitalization. This inflammatory cytokine production correlated significantly with monocyte localization from the blood to the site of infection, with conventional monocytes positively correlating with inflammation. Increased frequencies of CD14lo monocytes were in the airways of participants with lower inflammatory cytokine levels. Conclusions: An innate profile was identified that correlated with disease progression independent of viral dynamics and age. The airways and blood displayed dramatically different immune profiles emphasizing the importance of cellular migration and localized immune phenotypes. PMID:24308446

  17. Coexpression of atypical chemokine binders (ACBs) in breast cancer predicts better outcomes.

    PubMed

    Zeng, Xiao-Hua; Ou, Zhou-Luo; Yu, Ke-Da; Feng, Lan-Yun; Yin, Wen-Jing; Li, Jing; Shen, Zhen-Zhou; Shao, Zhi-Ming

    2011-02-01

    Some evidence suggests that atypical chemokine binders (ACBs) including DARC, D6, and CCX-CKR play an important role in inhibiting invasion and metastasis of cancer cells; however, their expressio