PurposeClinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.MethodsIn our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT‐CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data‐driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.ResultsSuccessful angiographic reperfusion (OR 26.50; 95%‐CI 9.33–83.61) and good collaterals (OR 9.69; 95%‐CI 2.28–59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%‐CI 0.14–0.85), younger age (OR 0.88; 95%‐CI 0.83–0.92) and higher NCCT ASPECTS (OR 2.54; 95%‐CI 1.01–6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.Conclusions CTA‐collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA‐collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA‐collaterals.
Background: Peripheral T-cell lymphoma, unspecifi ed (PTCL-US) is one of the entities from the infrequent family of nodal mature T-cell lymphomas. The clinical course is aggressive, and despite multiagent chemotherapy, the median survival is about 2 years. Published data are limited to restrospective, mostly single-center studies or reviews and usually include more lymphoma subtypes.Aim: To evaluate the current treatment modalities, clinical outcome and prognostic factors in unselected, new diagnosed patients with PTCL-US in the population of the central european region (Czech Republic).Method: Czech Lymphoma Study Group is a national scientifi c organization which provides an on-line database registry which collects a data about almost all new diagnosed lymphoma patients since year 2000. All diagnostic biopsies were reviewed by a reference pathologist.Results: We analyzed 63 patients with new diagnosis of PTCL-US. The median age was 59 years (25-81), chemotherapy (CHT) was administered in 56 of the 63 patients: anthracyclin-based CHT in 51 %, intensive CHT in 21 % and non-anthracyclin regimen was applied in 13 % of the patients. The overall response rate was 74.4 %, (CR in 57.4 %). After a median follow-up of 19.6 months, 41 % of the patients were in CR, 3.4 % in PR or stable disease and 55 % of the patients died. The estimated survival probability in 3 years was 36 %. Clinical stage (IV) and CR achievement were found to be independent survival predictors in a multivariate analysis.Conclusions: Although the current treatment modalities are mostly ineff ective in PTCL-US, appropriate intesive treatment may lead to prolonged remission but not survival.
Abstract:The process of sedimentation and subsequent gravity compression of kaolin and water suspensions was investigated experimentally. 45 batch tests were carried out and the time dependence of the height of the suspension column was measured. The one-dimensional equations of Darcian mechanics of two-phase porous media are applied to formulate the studied process mathematically. A very natural assumption makes it possible to find a solution of the forward problem for a starting period of the process. Analysis of the theoretical function and the experimental data gives hydraulic conductivity as a function of the suspension concentration. The obtained results are presented and discussed.
2882 Absolute lymphocyte count (ALC) at time of diagnosis has been documented as an independent predictor of survival in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). The optimal cut-off values of ALC are still a matter of debate. An extensive analysis of the prognostic impact of ALC in the elderly population treated with rituximab has not yet been carried out. Thus, we assessed the prognostic significance of different ALCs in unselected, newly diagnosed elderly patients with DLBCL in the population of the Central European region (the Czech Lymphoma Project registry). We analyzed data of 651 patients with confirmed DLBCL older than 59 years. Those with CNS involvement were excluded. The median age at diagnosis was 69 years (range, 60–97); the Ann Arbor stages were as follows: I (16.5%), II (26.1%), III (15.9%), and IV (41.5%). The IPI scores were: low (L) 19.8%, low-intermediate (LI) 26.6%, intermediate-high (IH) 24.3%, and high (H) 29.3%. We analyzed the prognostic value of lymphopenia with 3 different cut-off values. Values of ALC < 1.0 × 109/L and ALC < 0.84 × 109/L were chosen according to the previously published data, the third value was the median ALC at diagnosis (ALC 1.35 × 109/L). ALC < 1.0 × 109/L was observed in 201 (31%) and ALC < 0.84 × 109/L in 159 (24%) patients. ALCs below predefined levels were associated with higher (IH, H) IPI scores: ALC < 0.84 × 109/L (78% vs 46%, p < 0.001), ALC < 1.0 × 109/L (77% vs 43%, p < 0.001), and ALC < 1.35 × 109/L (68% vs 38%, p < 0.001); advanced disease (stages III/IV): ALC < 0.84 × 109/L (72% vs 53%, p < 0.001), ALC < 1.0 × 109/L (72% vs 51%, p < 0.001), and ALC < 1.35 × 109/L (66% vs 48%, p < 0.001); and low performance status (ECOG ≥ 2): ALC < 0.84 × 109/L (52% vs 27%, p < 0.001), ALC < 1.0 × 109/L (50% vs 25%, p < 0.001), and ALC < 1.35 × 109/L (43% vs 22%, p < 0.001). In 85% of patients, treatment was initiated with an anthracycline-containing regimen (CHOP), i.e. only 15% of patients recieved a non-anthracycline-based regimen (COP). The median number of chemotherapy cycles was 6. Chemotherapy was combined with rituximab in all patients (a median of 6 doses). Generally, treatment response was assessed in 544 (83.6%) patients. Complete remission (CR) or unconfirmed CR was achieved in 79.8% and partial remission in 12.5% of patients, with 7.7% of patients being classified as having stable disease or disease progression. CR rates were significantly higher in patients with higher lymphocyte counts: ALC > 0.84 × 109/L (82% vs 71%, p = 0.006), ALC >1.0 × 109/L (83.1% vs 71.7%, p = 0.008), and ALC > 1.35 × 109/L (85% vs 75%, p = 0.027). The overall survival (OS) and event-free survival (EFS) rates were superior in all subgroups of patients with higher ALC levels. The 3-year OS rates stratified by lymphocyte count: ALC > 0.84 × 109/L (67% vs 51%, p = 0.0002), ALC > 1.0 × 109/L (67% vs 52%, p = 0.0017), and ALC > 1.35 × 109/L (71% vs 55%, p = 0.0001). The 3-year EFS rates stratified by lymphocyte count: ALC > 0.84 × 109/L (61% vs 44%, p = 0.0002), ALC > 1.0 × 109/L (62% vs 44%, p = 0.0002), and ALC > 1.35 × 109/L (66% vs 47%, p < 0.0001). Only ALC < 1.35 × 109/L was found to be an independent negative prognostic factor for the OS (RR = 1.53, p = 0.006) and EFS (RR = 1.43, p = 0.013) in a multivariate analysis when compared with the LDH level, clinical stage, performance status and age (above median). In summary, the data support the hypothesis that host innate immunity is critical in tumor growth control and is a limiting factor for the efficacy of immunochemotherapy in elderly patients with DLBCL. The optimal cut-off levels of ALC may be different in various populations. This fact should be taken into account when designing new ALC-based prognostic schemes. Disclosures: Prochazka: ROCHE: Honoraria. Pytlik:ROCHE: Honoraria.
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