Autosomal Dominant Polycystic Kidney Disease: Epidemiological, Clinical Aspects and Predictive Factors of Poor Renal Prognosis (About 300 Cases)

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a common, multisystemic, and progressive hereditary disease. It accounts for 6 to 8% of incident cases of end-stage chronic renal disease (ESRD) in developed countries. The aim of this study is to describe the predictive factors for the development of end-stage chronic kidney disease (CKD) in the course of this disease. Material and Methods: This is a retrospective, descriptive, and analytical study including 300 cases of ADPKD collected at the Nephrology Department of Ibn-Sina Hospital in Rabat over a period of 30 years (1993 to 2023). Included in the study are all patients with ADPKD meeting the ultrasound diagnostic criteria. The analysis focused on demographic, clinical, paraclinical, evolutionary data, as well as prognostic factors associated with renal function deterioration. Results: The mean age of patients at diagnosis is 51.53 +/− 17 years [16 - 93] with a male predominance. The median serum creatinine at diagnosis is 15.5 mg/l [10 - 34]. 21% of patients had ESRD (eGFR 300 mg/24h (21%). The most common cystic complication is hemorrhage (12.3%). 21.3% of patients had hepatorenal polycystic disease. In adjusted analysis, the predictive risk factors for the occurrence of ESRD were smoking (p = 0.019), anemia (p Conclusion: ADPKD can progress insidiously to ESRD. Identification and early treatment of predictive factors for poor renal prognosis could contribute to a better outcome for this disease.

Clinical Features and Prognostic Factors of Small Cell Lung Cancer:A Retrospective Study in 148 Patients

To better understand the outcomes of small cell lung cancer（SCLC）,we examined the clinical features and prognostic factors of SCLC in this study.A total of 148 patients who were diagnosed as having SCLC between January 2009 and December 2013 in Cancer Center of Union Hospital,Wuhan,China,were enrolled and their clinical features and prognostic factors were retrospectively analyzed.Log-rank test and Cox regression model were employed for analysis of prognostic factors.The 1-and 2-year overall survival（OS） rates were 59.7% and 25.7%,respectively,for limited disease（LD） patients whose median survival time（MST） was 16 months.The 1-and 2-year OS rates were 29.5% and 5.3%,respectively,for extensive disease（ED） patients whose MST was 10 months.The univariate analysis and multivariate analysis revealed that age,tumor stage,serum CEA and Ki-67 antigen were significantly correlated to the outcomes of SCLC,and they were significant prognostic factors for SCLC.

Prognostic factors affecting long-term outcomes in patients with brain metastasis from esophageal carcinoma

Objective: The incidence of brain metastasis from esophageal cancer(BMEC) has increased in recent years.Thus, it is necessary to identify factors that affect long-term outcomes for such patients.Methods: From January 1997 to July 2018, consecutive patients(10,043 patients, 31 with brain metastasis) with esophageal cancer(EC) treated at Zhejiang Cancer Hospital were recruited for retrospective analysis.Demographic, clinical, and pathological variables and the survival data were retrieved.Results: The median time from diagnosis of EC to diagnosis of brain metastases was 7.67(range, 0.43-55.20)months. The median survival time of BMEC patients from diagnosis of primary esophageal tumor was 16.7(range,2.33-163.30) months and the median survival time from the point of diagnosis of brain metastasis was 6.47(range,0.43-148.13) months. Univariate and multivariate analyses showed that the pathology type, EC without chemotherapy, and bone metastasis history were significantly associated with a shorter time interval between the first treatment of EC and brain metastasis. Chemotherapy history after brain metastasis, whole brain radiation therapy(WBRT) history, and surgery were significant predictors for better long-term survival outcomes.Conclusions: Our findings indicate that the use of surgery, WBRT, and chemotherapy can achieve the best therapeutic effects for BMEC patients.

Easily manageable prognostic factors in 152 Chinese elderly acute myeloid leukemia patients:a single-center retrospective study

We retrospectively investigated the prognostic factors of acute myeloid leukemia（AML） in 152 Chinese patients with de novo AML who were older than 60 years of age and who received treatment at our hospital.Log-rank test showed that 6 parameters including older age,higher white blood cell（WBC） counts,lactate dehydrogenase（LDH）and bone marrow（BM） blasts at diagnosis,unfavorable risk cytogenetics,and non-mutated CEBPα were significant adverse prognostic factors of overall survival（OS） for elderly AML patients（P = 0.0013,0.0358,0.0132,0.0242,0.0236 and 0.0130,respectively）.Moreover,older age and higher LDH were significant adverse predictors for relapse-free survival（RFS）（P = 0.0447 and 0.0470,respectively）.Univariate analysis revealed similar results for OS to those of the log-rank test and only higher LDH at diagnosis was a significant adverse predictor for RFS（P = 0.028,HR：1.979,95%CI：1.075-3.644）.In multivariate analysis,we identified 2 trends towards independent prognostic factors for OS,including BM blasts at diagnosis（P = 0.057,HR：1.676,95%CI：0.984-2.854）and mutation status of CEBPα（P = 0.064,HR：4.173,95%CI：0.918-18.966）.Our data indicated that older age,gender and a previous history of hematologic diseases resulted in lower complete remission rate（P = 0.012,0.051 and 0.086,respectively）.We further developed an easy scoring system for predicting prognosis and response to induction therapy in older AML patients.Patients who had lower scores showed significantly longer OS and RFS（P = 0.0006 and 0.1001,respectively） and higher CR rate（P = 0.014）.Our research is limited by its retrospective nature and the results from our study need to be further validated by prospective randomized clinical trials.

PROGNOSTIC FACTORS AFFECTING THE RESULTS OF SURGICAL TREATMENT OF CERVICAL CANCER

From October, 1963 to December, 1992, 1213 cases with cervical cancer were treated surgically in our hospital, among whom 922 cases, including 305 in stage 0,123 in stage IA, 212 in stage IB, 265 in stage IIA, 17 in stage IIB, were operated before February, 1990. Among the 617 available cases, excluding those in stage 0, the five-year survival rates 95.1 % in stage IA, 91.0% in stage IB, 83.1 % in stage IIA, and 59.0% in stage IIB, respectively. The results showed that cervical tumor greater than 4 cm in diameter, invasion in muscular layers, lower degree of differentiation and pelvic lymph nodes metastasis would lead to worse therapeutic effects. The method of pelvic lymphadenectomy, pathological types, and ages of the patients, however, did not at all correlate with the survival rates of the patients. For those who have risk factors mentioned above active adjutant treatments are indicated.

EXPRESSION OF BASIC FIBROBLAST GROWTH FACTOR,TRANSFORMING GROWTH FACTOR β_1 AND THEIRRECEPTORS IN OSTEOSARCOMA AND ITSRELATIONSHIP TO ANGIOGENESIS

Objective: To investigate the expression ofangiogenic factors, basic fibroblast growth factor (bFGF)and transforming growth factor (TGF)-β1 inosteosarcoma, its association with neovascularizationand prognosis. Methods: The expression of bFGF, TGFβ1 and their receptors, as well as intratumoralmicrovcssel count (MVD) were studied in 80osteosarcomas by immunohistochemical staining andmorphometry. The relationship between the angiogenicfactors expression and prognosis was evaluated by amultivariate analysis using Cox proportion hazardmodel. Results: Among 80 cases of osteosarcoma, 46cases were positive for bFGFlbFGFr (57.5%), and 31cases for TGF-β1/ TGF-β (RI)(38.8%) respectively. TheMVD and bFGF, TGF-β1, were important indicators topredict the prognosis of patients with osteosarconla bythe Cox proportion hazard model analysis. Conclusioll:The angiogenic factors bFGF and TGF-β1 are involvedin the angiogenesis of osteosarcoma, and theangiogenesis inf'luences the prognosis. Also they may beuseful in the evaluation of the prognosis of patients withosteosarcoma.

Prognostic scoring system for synchronous brain metastasis at diagnosis of colorectal cancer: A population-based study

BACKGROUND Brain metastasis(BM)from colorectal cancer(CRC)is rarely encountered clinically,and its prognosis has not been fully evaluated.AIM To construct a scoring system and accurately predict the survival of patients with synchronous BM at diagnosis of CRC.METHODS A retrospective study of 371 patients with synchronous BM from CRC was performed,using the data from 2010 to 2014 from the Surveillance,Epidemiology,and End Results database.Survival time and prognostic factors were statistically analyzed by the Kaplan-Meier method and Cox proportional hazards models,respectively.A scoring system was developed using the independent prognostic factors,and was used to measure the survival difference among different patients.RESULTS For the 371 patients,the median overall survival was 5 mo,survival rates were 27%at 1 year and 11.2%at 2 years.Prognostic analysis showed that age,carcinoembryonic antigen level and extracranial metastasis to the liver,lung or bone were independent prognostic factors.A scoring system based on these three prognostic factors classified the patients into three prognostic subgroups(scores of 0-1,2-3,and 4).The median survival of patients with scores of 0-1,2-3 and 4 was 14,5 and 2 mo,respectively(P<0.001).Subgroup analysis showed that there were significant differences in prognosis among the groups.Score 2-3 vs 0-1:hazard ratio(HR)=2.050,95%CI:1.363-3.083;P=0.001;score 4 vs 0-1:HR=3.721,95%CI:2.225-6.225;P<0.001;score 2-3 vs 4:HR=0.551,95%CI:0.374-0.812;P=0.003.CONCLUSION The scoring system effectively distinguishes long-term and short-term survivors with synchronous BM from CRC.These results are helpful in providing a reference for guiding therapy.

Sicca to Lymphoma:Sjogren Syndrome

Sjogren Syndrome (SS) is an autoimmune disease characterized by a lymphocytic infiltration of exocrine glands. This abnormality leads to the destruction of these glands with the clinical expression of the sicca syndrome (dry eyes and dry mouth). Usually Sjogren Syndrome follows a non-aggressive course, but patients suffering from this disease have a very high risk of developing malignant lymphoma (MALT). The evolution from benign lymphocytic infiltration characteristic of Sjogren Syndrome to malignant lymphoma (usually MALT subtype) is a multistep process [1-3]. We present the case of 35 years old woman admitted to “Sf. Maria” Clinical Hospital—Bucharest, Romania, in the Rheumatology Department in May 2011, representative for the diagnosis difficulties as well as for the unfortunate evolution. She was diagnosed with primary Sjogren Syndrome in 2004. The first symptoms of the disease, dry eyes and dry mouth, appeared in 2000 but they were undermined by some hematological disorders, as the patient had a low white blood cell count at the biological evaluation. Four years later, when the diagnosis of Sjogren Syndrome was set, she already had some negative prognosis factors. In the end, the disease had an unfavorable outcome, as the patient developed non-Hodgkin malignant lymphoma for an unfortunate evolution.

Comprehensive molecular characterization and identification of prognostic signature in stomach adenocarcinoma on the basis of energy-metabolism-related genes

BACKGROUND Stomach adenocarcinoma(STAD)is a leading cause of cancer deaths,but its molecular and prognostic characteristics has never been fully illustrated.AIM To describe a molecular evaluation of primary STAD and develop new therapies and identify promising prognostic signatures.METHODS We describe a comprehensive molecular evaluation of primary STAD based on comprehensive analysis of energy-metabolism-related gene(EMRG)expression profiles.RESULTS On the basis of 86 EMRGs that were significantly associated to patients’progression-free survival(PFS),we propose a molecular classification dividing gastric cancer into two subtypes:Cluster 1,most of which are young patients and display more immune and stromal cell components in tumor microenvironment and lower tumor priority;and Cluster 2,which show early stages and better PFS.Moreover,we construct a 6-gene signature that can classify the prognostic risk of patients after a three-phase training test and validation process.Compared with patients with low-risk score,patients with high-risk score had shorter overall survival.Furthermore,calibration and DCA analysis plots indicate the excellent predictive performance of the 6-gene signature,and which present higher robustness and clinical usability compared with three previous reported prognostic gene signatures.According to gene set enrichment analysis,gene sets related to the high-risk group were participated in the ECM receptor interaction and hedgehog signaling pathway.CONCLUSION Identification of the EMRG-based molecular subtypes and prognostic gene model provides a roadmap for patient stratification and trials of targeted therapies.

Risk factors and prognosis of neurological complications in patients with infective endocarditis

Objective To identify risk factors of neurological complications(NC)in left-sided infective endocarditis(IE)and to assess its impact on the outcome and cardiac surgery.Methods Clinical data,NC,treatment and outcome of patients with definite left-sided IE admitted to our hospital during 2001—2012 were retrospectively ana-