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Journal of Periodontology Jul 1996The assignment of prognosis is one of the most important functions undertaken in clinical practice, yet there is little evidence to support the current decision-making... (Comparative Study)
Comparative Study
The assignment of prognosis is one of the most important functions undertaken in clinical practice, yet there is little evidence to support the current decision-making process which is based on an outdated model of disease etiology and progression. This study evaluated 100 treated periodontal patients (2,484 teeth) under maintenance care for 5 years, with 38 of these patients followed for 8 years, to determine the relationship of assigned prognoses to the clinical criteria commonly used in the development of prognosis. The method of generalized estimating equations (GEE) for correlated data was utilized to determine the relationship of each clinical factor to the assignment of initial prognosis, improvement in prognosis at 5 years, and worsening in prognosis at 5 years. A multiple linear regression model was constructed for predicting initial prognosis based on initial clinical data. Increased probing depth, more severe furcation involvement, greater mobility, unsatisfactory crown-to-root ratio, malpositioned teeth, and teeth used as fixed abutments resulted in worse initial prognoses. The coefficients from this model were able to predict accurately the 5-year and 8-year prognoses 81% of the time. When teeth with "good" prognoses were excluded, the predictive accuracy dropped approximately 50%. Multiple logistic regression models indicated that improvement in prognoses and worsening in prognoses were both strongly associated with initial probing depth, initial furcation involvement, initial tooth malposition, and smoking when adjusted for initial prognosis. In addition, good hygiene was found to increase the probability of improvement in prognosis while initial mobility was found to decrease the likelihood of improvement in prognosis. Neither of these factors was found to be significant in worsening of prognosis. Smoking decreased the likelihood of improvement by 60% and doubled the likelihood of worsening in prognosis at 5 years. The results of this study indicate that some clinical factors used in the assignment of prognoses are clearly associated with changes in clinical condition over time. The data also demonstrated that the traditional approach for assigning prognoses is ineffective for teeth with an initial prognosis of less than good. Since most periodontally involved teeth are compromised, further work should include the development of a more effective method for assigning prognoses that is based on clear, objective clinical criteria.
Topics: Age Factors; Decision Making; Dental Abutments; Disease Progression; Factor Analysis, Statistical; Family Health; Furcation Defects; Humans; Likelihood Functions; Linear Models; Logistic Models; Models, Statistical; Odds Ratio; Oral Hygiene; Periodontal Attachment Loss; Periodontal Index; Periodontitis; Prognosis; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Smoking; Tooth Loss; Tooth Mobility; Treatment Outcome
PubMed: 8832476
DOI: 10.1902/jop.1996.67.7.658 -
Clinical Cardiology Jun 2021Although anxiety is highly prevalent after myocardial infarction (MI), but the association between anxiety and MI is not well established. This study aimed to provide an... (Meta-Analysis)
Meta-Analysis Review
Although anxiety is highly prevalent after myocardial infarction (MI), but the association between anxiety and MI is not well established. This study aimed to provide an updated and comprehensive evaluation of the association between anxiety and short-term and long-term prognoses in patients with MI. Anxiety is associated with poor short-term and long-term prognoses in patients with MI. We performed a systematic search in the PubMed and Cochrane databases (January 2000-October 2020). The study endpoints were complications, all-cause mortality, cardiac mortality, and/or major adverse cardiac events (MACEs). Pooled data were synthesized using Stata SE12.0 and expressed as risk ratios (RRs) and 95% confidence intervals (CIs). We included 9373 patients with MI from 16 published studies. Pooled analyses indicated a correlation between high anxiety and poor clinical outcomes (RR: 1.19, 95% CI: 1.13-1.26, p < .001), poor short-term complications (RR: 1.23, 95% CI: 1.09-1.38, p = .001), and poor long-term prognosis (RR: 1.27, 95% CI: 1.13-1.44, p < .001). Anxiety was also specifically associated with long-term mortality (RR: 1.16, 95% CI: 1.01-1.33, p = .033) and long-term MACEs (RR: 1.54, 95% CI: 1.26-1.90, p < .001). This study provided strong evidence that increased anxiety was associated with poor prognosis in patients with MI. Further analysis revealed that MI patients with anxiety had a 23% increased risk of short-term complications and a 27% increased risk of adverse long-term prognosis compared to those without anxiety.
Topics: Anxiety; Humans; Myocardial Infarction; Prognosis
PubMed: 33960435
DOI: 10.1002/clc.23605 -
Asian Journal of Surgery Sep 2023Whether thymectomy (TM) or thymomectomy (TMM) is better for non-myasthenic patients with early-stage thymoma. We conducted a meta-analysis to compare the clinical... (Meta-Analysis)
Meta-Analysis Review
Whether thymectomy (TM) or thymomectomy (TMM) is better for non-myasthenic patients with early-stage thymoma. We conducted a meta-analysis to compare the clinical outcomes and prognoses of non-myasthenic patients with early-stage thymoma treated using thymectomy versus thymomectomy. PubMed, Embase, Cochrane Library and CNKI databases were systematically searched for relevant studies on the surgical treatment (TM and TMM) of non-myasthenic patients with early-stage thymoma published before March 2022. The Newcastle-Ottawa scale was used to evaluate the quality of the studies, and the data were analyzed using RevMan version 5.30. Fixed or random effect models were used for the meta-analysis depending on heterogeneity. Subgroup analyses were performed to compare short-term perioperative and long-term tumor outcomes. A total of 15 eligible studies, including 3023 patients, were identified in the electronic databases. Our analysis indicated that TMM patients might benefit from a shorter duration of surgery (p = 0.006), lower blood loss volume (p < 0.001), less postoperative drainage (p = 0.03), and a shorter hospital stay (p = 0.009). There were no significant differences in the overall survival rate (p = 0.47) or disease-free survival rate (p = 0.66) between the two surgery treatment groups. Likewise, TM and TMM were similar in the administration of adjuvant therapy (p = 0.29), resection completeness (p = 0.38), and postoperative thymoma recurrence (p = 0.99). Our study revealed that TMM might be a more appropriate option in treating non-myasthenic patients with early-stage thymoma.
Topics: Humans; Thymoma; Thymectomy; Neoplasm Staging; Retrospective Studies; Thymus Neoplasms; Prognosis; Disease-Free Survival
PubMed: 37005182
DOI: 10.1016/j.asjsur.2023.03.063 -
Semergen 2019The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes... (Review)
Review
The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes most psychological impact on the patient. Although, by nature, medical professionals are aware of this negative impact and take care to be as prudent and human as possible, recent studies have shown that the "psychological factors of the patient" are of direct relevance to the medical factors in cancer, over and above their importance on quality of life during the course of the disease. This direct relevance needs replies that go beyond purely medical knowledge, as well as a specific training as to their application. Interdisciplinary medical-psychological cooperation is probably required. Studies indicate that compliance with both requisites may bring an improvement to clinical results. In Europe, although less than in the United States of America, the necessary inclusion has been the recognition of psychological training in academic pre- and postgraduate training in communicating these cases.
Topics: Communication; Humans; Interdisciplinary Communication; Neoplasms; Professional-Patient Relations; Prognosis; Quality of Life
PubMed: 30638638
DOI: 10.1016/j.semerg.2018.11.007 -
The Lancet. Oncology Apr 2015Nomograms are widely used as prognostic devices in oncology and medicine. With the ability to generate an individual probability of a clinical event by integrating... (Review)
Review
Nomograms are widely used as prognostic devices in oncology and medicine. With the ability to generate an individual probability of a clinical event by integrating diverse prognostic and determinant variables, nomograms meet our desire for biologically and clinically integrated models and fulfill our drive towards personalised medicine. Rapid computation through user-friendly digital interfaces, together with increased accuracy, and more easily understood prognoses compared with conventional staging, allow for seamless incorporation of nomogram-derived prognosis to aid clinical decision making. This has led to the appearance of many nomograms on the internet and in medical journals, and an increase in nomogram use by patients and physicians alike. However, the statistical foundations of nomogram construction, their precise interpretation, and evidence supporting their use are generally misunderstood. This issue is leading to an under-appreciation of the inherent uncertainties regarding nomogram use. We provide a systematic, practical approach to evaluating and comprehending nomogram-derived prognoses, with particular emphasis on clarifying common misconceptions and highlighting limitations.
Topics: Disease-Free Survival; Humans; Neoplasms; Nomograms; Prognosis
PubMed: 25846097
DOI: 10.1016/S1470-2045(14)71116-7 -
The Medical Clinics of North America Mar 2023Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine... (Review)
Review
Ovarian, uterine, and vulvovaginal cancers affect approximately 96,000 women per year in the United States, resulting in approximately 29,000 deaths annually. Routine screening protocols do not detect these malignancies; thus, the recognition of risk factors and evaluation of worrisome symptoms are essential for early detection and improved prognoses. Treatment is managed by gynecologic oncologists, and often involves a combination of surgery, chemotherapy, and possible radiation treatments. Survivor care is managed by the primary-care clinician: expert attention to the mental, physical, and sexual health of each patient will ensure the best outcomes and quality of life.
Topics: Female; United States; Humans; Quality of Life; Early Detection of Cancer; Neoplasms; Prognosis; Risk Factors
PubMed: 36759101
DOI: 10.1016/j.mcna.2022.10.016 -
Critical Reviews in Oncology/hematology Nov 2021Pancreatic neuroendocrine tumors (PanNETs) are heterogeneous; thus, individual prognostic prediction is important. Clinicopathological features, like TNM stage, grade,... (Review)
Review
Pancreatic neuroendocrine tumors (PanNETs) are heterogeneous; thus, individual prognostic prediction is important. Clinicopathological features, like TNM stage, grade, and differentiation, are independent clinical predictors. However, single predictors are insufficient, as patients sharing similar clinicopathological features usually show distinct prognoses. Accordingly, novel nomograms and risk stratifications have been developed for more accurate PanNET prognostic prediction. Moreover, the exploration of molecular mechanisms has identified novel prognostic predictors for PanNET. Multi-analyte assays of molecular biomarkers provide a deeper understanding of PanNET features; however, the priority, and the optimal combination of classic and novel predictors for PanNET prognosis prediction remain unclear. In this review, we summarized the patterns and predictors of PanNET prognosis and discussed their clinical utility; we emphasized that PanNET at different stages have different superior predictor, and that multi-analyte assays are more sensitive than mono-analyte biomarkers. Therefore, combined biomarkers improve the accuracy of surveillance and optimize decision-making in clinical practice.
Topics: Biomarkers; Humans; Neuroendocrine Tumors; Pancreatic Neoplasms; Plant Leaves; Prognosis
PubMed: 34653597
DOI: 10.1016/j.critrevonc.2021.103493 -
Frontiers in Immunology 2023Lipid metabolic reprogramming is gaining attention as a hallmark of cancers. Recent mounting evidence indicates that the malignant behavior of breast cancer (BC) is...
INTRODUCTION
Lipid metabolic reprogramming is gaining attention as a hallmark of cancers. Recent mounting evidence indicates that the malignant behavior of breast cancer (BC) is closely related to lipid metabolism. Here, we focus on the estrogen receptor-positive (ER+) subtype, the most common subgroup of BC, to explore immunometabolism landscapes and prognostic significance according to lipid metabolism-related genes (LMRGs).
METHODS
Samples from The Cancer Genome Atlas (TCGA) database were used as training cohort, and samples from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC), Gene Expression Omnibus (GEO) datasets and our cohort were applied for external validation. The survival-related LMRG molecular pattern and signature were constructed by unsupervised consensus clustering and least absolute shrinkage and selection operator (LASSO) analysis. A lipid metabolism-related clinicopathologic nomogram was established. Gene enrichment and pathway analysis were performed to explore the underlying mechanism. Immune landscapes, immunotherapy and chemotherapy response were further explored. Moreover, the relationship between gene expression and clinicopathological features was assessed by immunohistochemistry.
RESULTS
Two LMRG molecular patterns were identified and associated with distinct prognoses and immune cell infiltration. Next, a prognostic signature based on nine survival-related LMRGs was established and validated. The signature was confirmed to be an independent prognostic factor and an optimal nomogram incorporating age and T stage (AUC of 5-year overall survival: 0.778). Pathway enrichment analysis revealed differences in immune activities, lipid biosynthesis and drug metabolism by comparing groups with low- and high-risk scores. Further exploration verified different immune microenvironment profiles, immune checkpoint expression, and sensitivity to immunotherapy and chemotherapy between the two groups. Finally, arachidonate 15-lipoxygenase (ALOX15) was selected as the most prominent differentially expressed gene between the two groups. Its expression was positively related to larger tumor size, more advanced tumor stage and vascular invasion in our cohort (n = 149).
DISCUSSION
This is the first lipid metabolism-based signature with value for prognosis prediction and immunotherapy or chemotherapy guidance for ER+ BC.
Topics: Humans; Female; Breast Neoplasms; Lipid Metabolism; Prognosis; Nomograms; Lipids; Tumor Microenvironment
PubMed: 37469520
DOI: 10.3389/fimmu.2023.1199465 -
The British Journal of Oral &... Dec 2019The choice of treatment for diacapitular condylar fractures remains in dispute among oral and maxillofacial surgeons. A multivariate retrospective study was designed to...
The choice of treatment for diacapitular condylar fractures remains in dispute among oral and maxillofacial surgeons. A multivariate retrospective study was designed to compare the prognosis after conservative treatment and surgery, and to explore further indications for management. From 1 July 2013 to 30 June 2017, 169 patients with diacapitular condylar fractures were included. Relevant preoperative data were collected, and the prognoses assessed. Three ordinal logistic regression models were constructed to study the factors that affected prognosis, and these showed that all patients treated by open reduction and internal fixation (ORIF) tended to have a better prognosis than those treated with conservative treatment (adult: odds ratio (OR)=6.166, p=0.000, and children: OR=12.195, p=0.029). Adult patients with lateral dislocation of the stump of the ramus out of the glenoid fossa tended to have the highest risk of a poor prognosis, followed by those with anteromedial displacement of the disc and loss of the height of the ramus of over 5mm. Only the type of treatment affected the prognosis for children. In conclusion, these findings suggest that ORIF is the preferred method of treatment for patients with diacapitular condylar fractures. The absolute indications for ORIF in adult patients with diacapitular condylar fractures include lateral dislocation of the stump of the ramus out of the glenoid fossa, anteromedial displacement of the disc, and loss of height of the ramus of over 5mm. There are no absolute indications for ORIF in children.
Topics: Adult; Child; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Multivariate Analysis; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 31521410
DOI: 10.1016/j.bjoms.2019.08.025 -
Anticancer Research May 2019In the new TNM classification (8th edition) of lung cancer, T category is defined based on the solid component size; therefore, part solid type (PST) with and solid type...
BACKGROUND/AIM
In the new TNM classification (8th edition) of lung cancer, T category is defined based on the solid component size; therefore, part solid type (PST) with and solid type (ST) without ground glass opacity (GGO) are categorized as same T value according to their solid component sizes. However, differences between these tumors have not been clarified. Patients and Methods The study included 274 pStage I lung adenocarcinoma patients who had undergone surgery at our Institution from 2003 to 2012. Their tumors were classified as pure GGO, PST, and ST. After propensity score matching for solid component size, we compared prognoses between PST and ST.
RESULTS
The same percentage was noted for PST and ST tumors (119/274; 43.4%). After propensity score matching, the disease-free survival (DFS) was significantly worse in ST than PST (5-year DFS: 69.2% versus 88.7%; p=0.0241).
CONCLUSION
Prognoses of PST and ST adenocarcinomas differ even when their solid component sizes are the same.
Topics: Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Disease-Free Survival; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pneumonectomy; Prognosis; Retrospective Studies
PubMed: 31092466
DOI: 10.21873/anticanres.13391