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PurposeCure rate models accounting for cured and uncured patients, provide additional insights into long and short term survival. We aim to better understand the prognostic value of histologic response and chemotherapy intensification on cure fraction and progression-free survival (PFS) for the uncured patients.MethodsA logistic model is assumed for the effect of histologic response and intensified chemotherapy on the cure status, while a Cox regression model is estimated only for the uncured patients on PFS. The mixture cure model is used to simultaneously study these two effects.ResultsHistologic response is a strong prognostic factor for the cure status (OR: 3.00 [1.75-5.17]), but it has no clear effect on PFS for the uncured patients (HR: 0.78 [0.53-1.16]). The cure fractions are 55% [46%-63%] and 29% [22%-35%] among patients with good histologic response (GR) and poor responders (PR) respectively. The intensified regimen was associated with higher cure fraction among PR (OR: 1.90 [0.93 – 3.89]), with no evidence of effect for GR (OR: 0.78 [0.38 – 1.59]).ConclusionsAccounting for cured patients is valuable in distinguishing the covariate effects on cure and PFS. Estimating cure chances based on these prognostic factors is relevant for counseling patients and can affect treatment decisions.

Item does not contain fulltext OBJECTIVE: In Parkinson disease (PD), the rate of clinical progression is highly variable. To date, there are conflicting findings concerning the prognostic factors influencing the rate of progression. Methodologic issues such as the use of selected patients from therapeutic trials, and short durations of follow-up probably underlie this problem. We therefore designed a prospective follow-up study of a cohort of newly diagnosed patients with PD. METHODS: A cohort of 129 patients with newly diagnosed PD was assessed at baseline, and 1, 2, 3, and 5 years later. The rate of progression and its prognostic factors on the level of motor impairments, disability, and quality of life were investigated using linear mixed-model analysis. RESULTS: Annual increase of motor impairments measured with the Unified Parkinson's Disease Rating Scale-Motor Examination was estimated to be 2.46 points (95% confidence interval: 2.05-2.88). The main determinants of faster increase of motor impairments were male sex and cognitive dysfunction at the time of diagnosis. The main determinants of faster increase of disability were higher age at onset, cognitive dysfunction, and the presence of levodopa-nonresponsive motor symptoms at the time of diagnosis. No clinically relevant determinants were found for the decrease in quality of life. CONCLUSION: This study shows the importance of nondopaminergic symptoms at the time of diagnosis, because these symptoms are the main determinants of increased disability in the first 5 years of the disease.

Objective: To determine progression and prognostic factors of progression rate of motor impairment, disability, and quality of life (QoL) in patients with newly diagnosed Parkinson's disease. Methods: A group of 126 patients with newly diagnosed PD recruited from outpatient clinics participated in this 3-year prospective cohort study. Motor impairment was rated with the Unified Parkinson Disease Rating Scale Motor-Examination. Disability was rated using the Schwab and England Activities of Daily Living Scale, the AMC Linear Disability Score. QoL was assessed with the Parkinson's Disease Quality of Life questionnaire. Linear mixed model analyses were conducted to identify determinants of progression rate of motor impairment, disability, and poor QoL. Results: Motor impairment progressed with 3 points per year. There was a slight progression of disability and QoL during 3 years of follow-up. Female sex was a prognostic factor for slower progression of motor impairment and QoL. Older age at onset showed to prognosticate faster progression of disability and impaired QoL. Furthermore, independent of follow-up time, older age at onset was associated with worse motor impairment; nondopaminergic reactive symptoms (Axial impairment) were associated with more disability and poorer QoL; comorbidity showed relation with disability and QoL but to a lesser extent; self-reported mood symptoms were associated with poorer QoL; and disease duration correlated with motor impairment. Conclusions: Motor impairment, disability, and QoL of newly diagnosed Parkinson patients show progression in the first 3 years. Older age at onset predicts worse progression rate of disability and impaired QoL over time. Female sex predicts slower progression of motor impairment and less decline of QoL. (C) 2011 Movement Disorder Society

Objectives We sought to obtain new insights into the pathophysiologic basis of Brugada syndrome (BrS) by studying changes in various electrocardiographic depolarization and/ or repolarization variables that occurred with the development of the signature type 1 BrS electrocardiogram (ECG) during ajmaline provocation testing. Background BrS is associated with sudden cardiac death. Its pathophysiologic basis, although unresolved, is believed to reside in abnormal cardiac depolarization or abnormal repolarization. Methods Ajmaline provocation was performed in 269 patients suspected of having BrS with simultaneous recording of ECGs, vectorcardiograms, and 62-lead body surface potential maps. Results A type 1 ECG was elicited in 91 patients (BrS patients), 162 patients had a negative test result (controls), and 16 patients had an abnormal test result. Depolarization abnormalities were more prominent in BrS patients and were mapped to the right ventricle (RV) by longer right precordial filtered QRS complex durations (142 +/- 23 ms vs. 125 +/- 14 ms, p < 0.01) and right terminal conduction delay (60 +/- 11 ms vs. 53 +/- 9 ms, p < 0.01). Repolarization abnormalities remained concordant with depolarization abnormalities as indicated by steady low nondipolar content (12 +/- 8% vs. 8 +/- 4%, p = NS), lower spatial QRS-T integrals (33 +/- 12 mV . ms vs. 40 +/- 16 mV . ms, p < 0.05), similar spatial QRS-T angles (92 +/- 39 degrees vs. 87 +/- 31 degrees, p = NS), similar T-peak-T-end interval (143 +/- 36 ms vs. 138 +/- 25 ms, p = NS), and similar Tpeak-Tend dispersion (47 +/- 37 ms vs. 45 +/- 27 ms, p = NS). Conclusions The type 1 BrS ECG is characterized predominantly by localized depolarization abnormalities, notably (terminal) conduction delay in the RV, as assessed with complementary noninvasive electrocardiographic techniques. We could not define a separate role for repolarization abnormalities but suggest that the typical signs of repolarization derangements seen on the ECG are secondary to these depolarization abnormalities. (J Am Coll Cardiol 2010; 55: 789-97) (C) 2010 by the American College of Cardiology Foundation