Franksrubin4701

Overexpression of bcl-2 and c-myc are defining features of double-expressor-lymphoma (DEL) but may also occur separately in patients with primary central nervous system lymphoma (PCNSL). Despite all progress in optimizing treatment regimen, there is lack of sufficient risk stratification models. Here, we first describe the relationship between DEL biology, the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI), treatment response, disease progression, and mortality in PCNSL. In this study, we determined c-myc and bcl-2 status immunohistochemically in samples of 48 patients with newly diagnosed PCNSL and followed these patients for a median interval of 6.2 years. Twelve, 18, and 17 patients harbored none, one, or both DEL features. Corresponding overall response rates after first-line therapy were strongly associated with DEL biology (100%, 42%, and 44% in patients with 0, 1, or 2 DEL features). Patients with one or both DEL features had a 5-fold and 13-fold higher 5-year risk of progression and/or death than patients without DEL features. These associations prevailed after adjusting for the NCCN-IPI. DEL improved the discriminatory capability of the NCCN-IPI (P = .0001). Furthermore, we could show that addition of DEL biology to the NCCN-IPI significantly improved the score's discriminatory potential both toward progression-free survival (increase in Harell's c = 0.15, P = .005) and overall survival (increase in Harell's c = 0.11, P = .029). In conclusion, DEL biology is a strong and simple-to-use predictor of adverse outcome in PCNSL. Addition of DEL to the NCCN-IPI improves its prognostic potential. Disease progression from PCNSL harboring both DEL features is invariably fatal. This defines a novel PCNSL patient subset with a great unmet need for improved therapy. © 2020 The Authors. Hematological Oncology published by John Wiley & Sons Ltd.AIM OF STUDY We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs). CLINICAL RATIONALE FOR STUDY The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA. MATERIALS AND METHODS 28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single-centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the riability of COA and its surrounding structures. CLINICAL IMPLICATIONS Currently, the role of 3D-CTA planning is restricted to educational purposes only.AIM AND CLINICAL RATIONALE FOR STUDY In Poland, it is widely believed that the outlook for ischaemic stroke patients is gradually improving due to the development of a network of stroke wards and other dedicated hospital units throughout the country. However, a study by Shah et al., reporting a significant increase in mortality from ischaemic stroke in several European countries including Poland, contradicts this belief. Therefore, the aim of this study was to determine the risk factors for death in patients with recent ischaemic stroke among a population of patients from Western Pomerania, a region in north-western Poland. MATERIALS AND METHODS This retrospective study involved 2,374 patients with recent ischaemic stroke. Mortality was defined as death within 30 days of admission to hospital. Patients who died in hospital during this period were defined as deceased, while those who survived beyond this time were classified as alive. RESULTS We found that compared to ischaemic stroke patients who survived, the group of ischaemic stroke patients who died included a higher number of patients who smoked cigarettes (OR = 6.08 in univariable model; OR = 6.22 in adjusted model), had hypertension (OR = 2.57; OR = 1.85), had a history of previous stroke (OR = 2.63; OR = 2.14), had coronary heart disease (OR = 1.78; OR=1.36), and were older (OR = 1.06; OR = 1.05). For all these factors, p-value was lower than 0.001. Females had a higher risk of death (OR = 1.48, p less then 0.001; OR = 1.35, p = 0.01). For dyslipidemia, only univariable model was statistically significant (OR = 1.38, p less then 0.001). CONCLUSION AND CLINICAL IMPLICATIONS Older age, female sex, dyslipidemia, hypertension, coronary heart disease, and smoking are not only recognised risk factors for ischaemic stroke, but also risk factors associated with an unfavourable prognosis following stroke.Polish neurology and neurosurgery owe a very great deal to Edward Flatau. He was a pioneer of these disciplines in Poland whose influence extends worldwide, and we recently celebrated the 150th anniversary of his birth. Edward Flatau's grandson, an outstanding physicist who has been living in San Diego in the USA for many years, has published a book 'Edward Flatau and his comet beginnings of Polish neurology'. Its promotion took place in the Flatau hometown of Płock in Poland. In 1894, Edward Flatau published his notable work 'Atlas of the human brain and the trajectory of fibres', the result of arduous work on brain sections and images that were captured with an especially designed camera. These photographs caused a publishing sensation at the end of the 19th century. The atlas was published in German and almost immediately translated into Polish, Russian, French and English. The most distinguished work of Edward Flatau was his great 1912 study of migraine headaches entitled 'Migraine', which has still not become out-of-date and is regularly quoted in international literature today.Ensuring happiness in older adults is critical for their mental health. The purpose of the current study was to identify strategies for creating happiness in Iranian older adults. A qualitative study was performed through content analysis and deep semi-structured interviews with 18 adults age 60 and older and one family member. Participants were selected through purposeful sampling, and data were encoded using MAXQDA. Data analyses revealed 187 codes, 23 subcategories, and four main categories (a) self-centered strategies, (b) inductive strategies, (c) passive strategies, and (d) unselfish strategies. Following the four categories of strategies may lead to happiness in Iranian older adults. Self-centered strategies seemed to achieve better results given that such strategies can be learned and require involvement of older adults themselves. [Research in Gerontological Nursing, xx(x), xx-xx.]. Copyright 2020, SLACK Incorporated.The objective of the current study was to investigate the variation in postoperative delirium in patients with dementia undergoing joint replacement in New South Wales (NSW) Australia public hospitals, identify factors related to its occurrence, and explore the volume-outcome relationship. The NSW Admitted Patient Data (July 2001 to June 2014) were used in this study and included patients with dementia undergoing joint replacement who were 65 or older with minor to severe comorbidities. Mixed-effect logistic models were applied to investigate hospital-level variation and factors associated with postoperative delirium. The between-hospital variability of postoperative delirium was 0.19% prior to 2008-2009 and 8.32% after 2008-2009. Hospital volume was not inversely associated with postoperative delirium rate. During 2001-2014, the incidence of postoperative delirium increased by 13% per annum (95% confidence interval [CI] 10% to 16%), while it increased by 15% per annum (95% CI 8% to 22%) after 2008-2009. An integrated approach addressing complex needs of patients with dementia may reduce the observed unwarranted variation and improve surgical outcomes. [Research in Gerontological Nursing, xx(x), xx-xx.]. Copyright 2020, SLACK Incorporated.Oral hygiene is difficult to achieve for frail older adults. Aging, chronic diseases, polypharmacy, mouth-washes, and crushed drugs can contribute to uncontrolled proliferation and microbial deposits in the mouth. Looking for avoidable risk factors, in vitro microbial survival or proliferation in thickened drinks and oral nutritional supplements (ONS) was investigated. The safest thickened drinks were ready-to-use products containing preservatives. Escherichia coli, Staphylococcus aureus, and Candida albicans proliferated in dairy ONS at room temperature. C. albicans also proliferated in juices. Oral anerobic bacteria were recovered from part eaten ONS. Thickened drinks and ONS could contribute to microbial proliferation, especially with patients who have swallowing alterations or cognitive troubles, who may keep these solutions longer than necessary in their mouth. These products can also constitute microbial reservoirs in the environment of frail older adults. It is important for health care workers and family members to respect hand hygiene and refrigeration procedures. [Research in Gerontological Nursing, xx(x), xx-xx.]. Copyright 2020, SLACK Incorporated.BACKGROUND While Acute kidney injury (AKI) is commonly reported following Hematopoietic stem cell transplant (HCT), the incidence and impact of AKI on mortality among patients undergoing HCT are not well described. We conducted this systematic review to assess the incidence and impact of AKI on mortality risk among patients undergoing HCT. METHODS Ovid MEDLINE, EMBASE, and the Cochrane Databases were searched from database inceptions through August 2019 to identify studies assessing the incidence of AKI and mortality risk among adult patients who developed AKI following HCT. Random-effects and generic inverse variance method of DerSimonian-Laird were used to combine the effect estimates obtained from individual studies. RESULTS We included thirty six cohort studies with a total of 5,144 patients undergoing HCT. Overall, the pooled estimated incidence of AKI and severe AKI (AKI stage III) were 55.1% (95%CI 46.6%-63.3%) and 8.3% (95%CI 6.0%-11.4%), respectively. The pooled estimated incidence of AKI using contemporary AKI definitions (RIFLE, AKIN, and KDIGO criteria) was 49.8% (95%CI 41.6%-58.1%). There was no significant correlation between study year and the incidence of AKI (p = 0.12) or severe AKI (p = 0.97). The pooled odds ratios (ORs) of 3-month mortality and 3-year mortality among patients undergoing HCT with AKI were 3.05 (95% CI, 2.07-4.49) and 2.23 (95% CI, 1.06-4.73), respectively. CONCLUSION The incidence of AKI among patients who undergo HCT remains high, and it has not changed over the years despite advances in medicine. AKI after HCT is associated with increased short- and long-term mortality. Pidnarulex © The Author(s) 2020. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email journals.permissions@oup.com.