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Background: No reliable instruments exist to measure prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer.Methods: We developed the Prognostic Awareness Impact Scale (PAIS) using a qu...
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Background: No reliable instruments exist to measure prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer.Methods: We developed the Prognostic Awareness Impact Scale (PAIS) using a qualitative approach. During phase 1, we convened a working group with a transdisciplinary team of clinicians from oncology (n = 2), psychology (n = 2), psychiatry (n = 1), palliative care (n = 3), and survey development (n = 1) to identify key domains of PAIS. Using a consensus-driven process, the team generated an item bank for each domain. During phase 2, we conducted cognitive interviews with 39 patients with advanced cancer to assess the understandability of the PAIS.Results: The working group developed a conceptual framework for PAIS, identifying three domains: (1) cognitive understanding of prognosis (capacity to understand intellectually one's prognosis), (2) emotional coping (capacity to process prognostic uncertainty and terminal prognosis), and (3) adaptive response (capacity to use prognostic awareness to inform life decisions). Cognitive interviews revealed that patients had an accurate understanding of most PAIS items. Patients reported difficulty with binary response options for questions pertaining to emotional coping. They expressed difficulty answering numerous questions regarding their cognitive understanding of their prognosis. We revised the PAIS by (1) replacing binary response options with ordinal agreement scales; and (2) reducing the number of items focused on cognitive understanding of prognosis.Conclusion: We developed a conceptual framework to capture prognostic awareness and its psychological and behavioral impacts for patients with advanced cancer using the PAIS. Future work should focus on validating the PAIS by testing its psychometric properties.
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Background KRAS is the most frequently mutated gene in non-small cell lung cancer (NSCLC), however conflicting data are available on its role as a biomarker. Objective The aim of our work was to investigate the impact of KRAS muta...
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Background KRAS is the most frequently mutated gene in non-small cell lung cancer (NSCLC), however conflicting data are available on its role as a biomarker. Objective The aim of our work was to investigate the impact of KRAS mutations on response and survival outcomes in advanced non-squamous NSCLC patients treated with immune checkpoint inhibitors alone or in combination with chemotherapy. Patients and Methods We retrospectively identified 119 patients, most of whom (58%) were KRAS wild type. For each patient we evaluated overall survival (OS), progression-free survival (PFS), and disease control rate (DCR). An exploratory analysis was performed among KRAS mutated patients to investigate the impact of specific KRAS mutations on response and survival outcomes. Results After a median follow-up of 10.3 months, the median OS was 14.9 months (95% confidence interval [CI] 7.6-22.7) in wild-type KRAS patients versus 14.7 months (95% CI 8.0-19.5) in mutated KRAS patients (p = 0.529). No differences were detected between the two groups in terms of PFS and DCR. Patients with a KRAS G12C mutation reported survival and response outcomes that were not statistically different from those of patients with other KRAS mutations. Conclusion Our data confirmed that KRAS mutational status is not associated with survival and response outcomes in advanced non-squamous NSCLC patients treated with immunotherapy alone or combined with chemotherapy.
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Myelodysplastic neoplasm (MDS) represents a heterogeneous group of myeloid disorders that originate from the hematopoietic stem and progenitor cells that lead to the development of clonal hematopoiesis. MDS was characterized by an...
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Myelodysplastic neoplasm (MDS) represents a heterogeneous group of myeloid disorders that originate from the hematopoietic stem and progenitor cells that lead to the development of clonal hematopoiesis. MDS was characterized by an increased risk of transformation into acute myeloid leukemia (AML). In recent years, with the aid of next-generation sequencing (NGS), an increasing number of molecular aberrations were discovered, such as recurrent mutations in FLT3, NPM1, DNMT3A, TP53, NRAS, and RUNX1 genes. During MDS progression to leukemia, the order of gene mutation acquisition is not random and is important when considering the prognostic impact. Moreover, the co-occurrence of certain gene mutations is not random;some of the combinations of gene mutations seem to have a high frequency (ASXL1 and U2AF1), while the co-occurrence of mutations in splicing factor genes is rarely observed. Recent progress in the understanding of molecular events has led to MDS transformation into AML and unraveling the genetic signature has paved the way for developing novel targeted and personalized treatments. This article reviews the genetic abnormalities that increase the risk of MDS transformation to AML, and the impact of genetic changes on evolution. Selected therapies for MDS and MDS progression to AML are also discussed.
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The recently updated World Health Organization (WHO) Classification of myeloid neoplasms and leukemia reflects the fact that research in the underlying pathogenic mechanisms of acute myeloid leukemia (AML) has led to remarkable ad...
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The recently updated World Health Organization (WHO) Classification of myeloid neoplasms and leukemia reflects the fact that research in the underlying pathogenic mechanisms of acute myeloid leukemia (AML) has led to remarkable advances in our understanding of the disease. Gene mutations now allow us to explore the enormous diversity among cytogenetically defined subsets of AML, particularly the large subset of cytogenetically normal AML. Despite the progress in unraveling the tumor genome, only a small number of recurrent mutations have been incorporated into risk-stratification schemes and have been proven to be clinically relevant, targetable lesions. We here discuss the utility of molecular markers in AML in prognostication and treatment decision making, specifically highlighting the aberrations included in the current WHO classification.
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For decades, maintenance of facilities and equipment, as well as related activities (from fault detection to prognostics and health management), has a proven impact on efficiency of production systems and is thus still the subject...
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For decades, maintenance of facilities and equipment, as well as related activities (from fault detection to prognostics and health management), has a proven impact on efficiency of production systems and is thus still the subject of numerous developments (from corrective to proactive maintenance). These developments are supported by the increase in digital pervasiveness accompanying the Industry 4.0. concept, based in particular on the use of Cyber-Physical Systems. In addition, we are witnessing the growing interest of the political and academic world and public opinion with regard to the sustainable impact of human activity. For company decision-makers, triple bottom line accounting frameworks have been introduced at higher decision levels (strategic) based on economic, social, and environmental performance indicators. This triple preoccupation has not yet been integrated into studies on middle (tactical) and lower (operational) decision levels, and paradoxically, not into production facility health management either. In this paper, we propose the deployment of a framework helping decisions makers to be environmentally aware in the maintenance of cyber physical systems. This framework consists of three key elements: a new maintenance policy called Sustainable Condition-Based Maintenance (SCBM), which requires the assessment of the Remaining Sustainable Life (RSL) as a key indicator; an adaptation and extension of a generic prognostic business process initially proposed for traditional Conditions Based Maintenance (CBM); and an organization adapted to the prognosis of the environmental performance of systems, based on holonic structures. We present the implementation of such a framework on a real Cyber Physical Systems under development.
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Stress echocardiography is the combination of echocardiography with a physical, pharmacological, or electrical stress. The diagnostic endpoint for the detection of myocardial ischaemia is the induction of a transient worsening in ...
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Stress echocardiography is the combination of echocardiography with a physical, pharmacological, or electrical stress. The diagnostic endpoint for the detection of myocardial ischaemia is the induction of a transient worsening in regional function during stress. Stress echocardiography provides similar diagnostic and prognostic accuracy to radionuclide stress perfusion imaging, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician#
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? 2022 American Academy of Dermatology, Inc.Background: Evidence for the prognostic importance of tumor thickness in acral melanoma (AM) patients is limited. Objective: The objective of the study was to determine the prognostic im...
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? 2022 American Academy of Dermatology, Inc.Background: Evidence for the prognostic importance of tumor thickness in acral melanoma (AM) patients is limited. Objective: The objective of the study was to determine the prognostic impact of Breslow thickness in AM. Methods: This multicenter study enrolled patients diagnosed with localized AM between January 1, 2000 and December 31, 2017. Melanoma-specific survival (MSS) in different tumor thickness strata (T1-T4: ≤1, >1-2, >2-4, >4 mm, respectively) was estimated by the Kaplan-Meier method. Comparisons were performed by the log-rank test and multivariable Cox regression. Results: A total of 853 patients with clinical N0 (cN0) AM were included in the analysis. The median follow-up time was 60.1 months. The median MSS in patients with T1-T4 disease was not reached, 111.0, 92.8, and 67.1 months, respectively. MSS differed significantly among cN0 patients with T1-T3 AM (log-rank P = .004,. 012, <0.001 for T1 vs T2, T2 vs T3, and T1 vs T3, respectively); however, there was no significant difference between T3 and T4 AM (hazard ratio = 0.82, 95% CI, 0.62-1.09). Six-subgroup analyses confirmed that survival outcomes were similar between different subgroups with tumor thickness >2 mm. Limitations: The limitations were retrospective design and some missing variables. Conclusions: There was no association between tumor thickness and survival in AM patients with a Breslow thickness >2 mm.
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The purpose of the study was to investigate variables that may predict ureteral stone impaction and create a new model to predict more accurately stone impaction based on preoperative NCCT findings. Data of 238 patients who underw...
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The purpose of the study was to investigate variables that may predict ureteral stone impaction and create a new model to predict more accurately stone impaction based on preoperative NCCT findings. Data of 238 patients who underwent URS were analyzed. Stone size, stone location, Hounsfield unit (HU) value of the stone, ureteral wall thickness (UWT) and grade of hydronephrosis were recorded. HU values of the ureter which are measured proximal and distal to the stone were recorded. Subsequently, we determined the factors that could predict the stone impaction in univariate and multivariate logistic regression analysis. After the AUC analysis for these factors, we created a new model to predict more accurately stone impaction. The formula was named Impacted Stone Formula (ISF). Stone impaction verified endoscopically. Predictors of impacted stones were evaluated using univariate and multivariate logistic regression analyses. Diagnostic value for the prediction of stone impaction was analyzed with receiver operating characteristic (ROC) incline. Overall, there were 196 patients included in the study. Multivariate regression analysis revealed that the HU below/above ratio, UWT, and grade of hydronephrosis were the crucial predictors of stone impaction (OR 20.53,p < 0.001; OR 10.55,p < 0.001; OR 5.95,p = 0.004, respectively). The ROC analysis revealed a cutoff value of 15.15 (AUC 0.958,p < 0.001, sensitivity 91.0%, specificity 97.7%) for the ISF. In conclusion, ISF is the most precise preoperative predictor of impacted stones in patients with ureteral stones. ISF could be used by the urologists before treatment to help preoperative planning and perioperative clinical course.
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Objectives This study sought to determine the prognostic value of dobutamine stress echocardiography (DSE) over a 15-year follow-up for predicting cardiac events in adolescent Kawasaki disease (KD) patients with coronary artery le...
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Objectives This study sought to determine the prognostic value of dobutamine stress echocardiography (DSE) over a 15-year follow-up for predicting cardiac events in adolescent Kawasaki disease (KD) patients with coronary artery lesions (CALs). Background Although DSE is an established technique for the detection of coronary artery disease, its prognostic value to predict cardiac events in adolescent KD patients with CALs is unknown. Methods Fifty-eight adolescent KD patients, including 36 patients with CALs documented by coronary angiography, and 22 patients with normal coronary arteries documented by echocardiography who underwent DSE were reviewed at initial testing (mean age: 13.6 years) and at 15 years' follow-up. Follow-up events were tabulated as major adverse cardiac events (MACEs) that included cardiac death, nonfatal myocardial infarction, and revascularization. Results During a mean follow-up of 14.7 years, there were 16 patients with MACEs (acute myocardial infarction: n = 1; old myocardial infarction: n = 7; coronary artery bypass grafting: n = 4; percutaneous coronary intervention: n = 4). Significant coronary artery disease (CAD) (>70% coronary stenosis) was detected in 31.0% of patients at initial testing and 42.1% at follow-up. However, there were no significant differences in wall motion score indices (WMSI) at peak DSE between initial testing and follow-up (p = 0.762). Five of 6 patients (85%) with false-positive DSE results (WMSI: ≥1.25) at initial testing, who had giant aneurysms without CAD, developed CAD with MACEs during follow-up. Cumulative event-free survival rate to 15 years was 25.0% in patients with WMSI ≥1.25 and 91.7% in patients with WMSI <1.25. Cox regression analysis showed the grade of peak WMSI at initial testing to be the only independent predictor of MACEs (relative risk: 3.28; 95% confidence interval: 1.73 to 6.20). Conclusions DSE provided independent prognostic information up to 15 years in adolescent KD survivors.
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