PurposeTo report associations between disease- and treatment-related variables and rates of recurrence-free survival and ocular survival in eyes treated with ophthalmic artery chemosurgery (OAC) for retinoblastoma.DesignPre-post study.SubjectsAll eyes treated with OAC for retinoblastoma at Memorial Sloan Kettering Cancer Center between May 2006 and February 2017.MethodsThis retrospective review included 452 retinoblastoma eyes treated with OAC. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), progression-free survival (PFS) and ocular survival (OcS), and Cox regression was used to estimate hazard ratios. Eyes treated in the pre-intravitreous chemotherapy era were analyzed separately from eyes treated in the intravitreal era.Main outcome measuresRecurrence-free survival, ocular survival, associations with risk of recurrenceResultsDisease and treatment characteristics were recorded over a median 23.6 month follow-up. One-year OcS, PFS and RFS were 96% (95% CI 93–99%), 88% (95% CI 88–94%) and 74% (95% CI 67–81%) in the pre-intravitreal era and 96% (95% CI 94–99%), 93% (95% CI 89–96%) and 78% (95% CI 72–83%) in the intravitreal era, respectively. Presence of vitreous seeds was associated with increased risk of recurrence in the pre-intravitreal era but not in the intravitreal era. Longer time interval between OAC sessions was associated with increased risk of recurrence and majority OAC access via the ophthalmic artery was associated with decreased risk of recurrence in both eras.ConclusionsApproximately a quarter of eyes initially treated with ophthalmic artery chemosurgery develop recurrent disease, with the majority of recurrences within the first year following completion of OAC. Despite this, these eyes have a very good chance of salvage. In eyes with vitreous seeds at presentation, intravitreal injections are useful in minimizing future vitreous recurrence. Eyes that receive the majority of drug infusions via non-ophthalmic artery routes or greater interval between OAC are more likely to recur and might warrant closer monitoring.
Purpose: To assess the effectiveness of treatments for Morbihan disease. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was performed on April 1, 2018, using PubMed, Google Scholar, and Excerpta Medica dataBASE with terms used to describe Morbihan disease, including “Morbihan Disease,” “Morbihan Syndrome,” “lymphedema rosacea,” and “lymphedematous rosacea”. Case reports or case series were included if they fulfilled the following criteria: published in English, peer-reviewed, and reported Morbihan disease. Results: A total of 89 patients—87 patients from 49 articles and 2 cases from the authors’ institution—were included in the final analysis. The median age of patients was 51 years (range: 14–79), and 66 of 89 (74%) patients were men. Male gender correlated with lack of complete response to treatment (odds ratio: 0.25; 95% confidence interval: 0.06–0.97; p = 0.02), while presence of papules or pustules correlated with complete response to treatment (odds ratio: 4.07; 95% confidence interval: 1.04–17.68; p = 0.03). Longer antibiotic duration correlated with response to treatment (p = 0.03), favoring complete over partial response (p = 0.02). Mean antibiotic duration in patients who responded was 4.43 months (standard deviation: 3.49), with complete responders requiring 6.50 months (standard deviation: 4.57). Oral corticosteroids, isotretinoins, and combination therapies did not correlate with treatment response. Conclusions: The presence of papules and pustules correlates with a complete response to treatment, while male gender correlates with a partial response. Patients may benefit from 4- to 6-month duration of tetracycline-based antibiotics. Prospective studies are needed to assess the impact of antibiotic and isotretinoin dose and duration on treatment response.
Objective We address four outstanding empirical questions related to the ''law of crime concentration'' (Weisburd in Criminology 53:133-157, 2015): (1) Is the spatial concentration of crime stable over time? (2) Do the same places consistently rank among those with the highest crime counts? (3) How much crime concentration would be observed if crimes were distributed randomly over place? (4) To what degree does the spatial concentration of crime depend on places that are crime free?Methods The data are annual counts of violent and property crimes in St. Louis between 2000 and 2014. Temporal stability in the spatial inequality of crime is measured by computing the fraction of crimes that occur in the 5% of street segments with the highest crime frequencies each year. The spatial mobility of crime is measured by computing the number of years each street segment appears in the top 5% of street segments. Poisson simulations are used to estimate the fraction of crimes that could appear in the top 5% of street segments on the basis of chance alone. The impact of crime-free locales on the spatial concentration of crime is evaluated by comparing results from analyses that include and exclude crime-free street segments from the crime distributions. ResultsThe concentration of crime is highly unequal and stable over time. The specific street segments with the highest crime frequencies, however, change over time. Nontrivial fractions of street segments may appear among the 5% with the highest crime frequencies on the basis of chance. Spatial concentration of crime is reduced when crime-free street segments are excluded from the crime distributions.
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