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Background: Undifferentiated pleomorphic sarcoma (UPS) encompasses rare neoplasms that can arise either in the dermis or in the subfascial soft tissue. The behavior of UPS ranges from indolent to aggressive, but data predicting outcomes are limited., Objective: Identify predictors of poor outcomes by analyzing a large collection of UPS cases., Methods: We evaluated all available cases of UPS (including those termed atypical fibroxanthoma, malignant fibrous histiocytoma, pleomorphic dermal sarcoma, and subfascial UPS) across 3 tertiary care centers., Results: Among the 319 patients, 45 experienced recurrence, 33 experienced metastasis, and 96 died of any cause. Risk factors for recurrence were clinical tumor size larger than 5 cm and invasion beyond subcutaneous fat. Risk factors for distant metastases were tumor site, tumor size larger than 2 cm, invasion beyond subcutaneous fat, and lymphovascular invasion. Risk factors for overall mortality were age, immunosuppression, tumor size larger than 2 cm, and lymphovascular invasion. History of skin cancer was associated with a lower risk of recurrence and metastasis., Limitations: This was a retrospective study., Conclusions: Using the unbiased approach of pooling all UPS cases regardless of terminology, we identified clinical and histologic factors predicting poor outcomes. We propose subcategorization of UPS (into superficial versus deep UPS), which is consistent with the American Joint Committee on Cancer staging of soft-tissue sarcoma., (Published by Elsevier Inc.)

Introduction: There are over twenty anti-seizure medications and anti-seizure devices available commercially in the United States. The multitude of treatment options for seizures can present a challenge to clinicians, especially those who are not subspecialists in the epilepsy field. Many clinical questions are not adequately answered in double-blind randomized controlled studies. In the presence of a knowledge gap, many clinicians consult a respected colleague with acknowledged expertise in the field. Our survey was designed to provide expert opinions on the treatment of epilepsy in adults and adolescents., Method: We surveyed a group of 42 physicians across the United States who are considered experts based on publication record in the field of epilepsy, or a leadership role in a National Association of Epilepsy Centers comprehensive epilepsy program. The survey consisted of 43 multiple-part patient scenario questions and was administered online using Redcap software. The experts provided their opinion on 1126 treatment options based on a modified Rand 9-point scale. The patient scenarios focused on genetically-mediated generalized epilepsy and focal epilepsy. The scenarios first focused on overall treatment strategy and then on specific pharmacotherapies. Other questions focused on treatment of specific patient populations (pregnancy, the elderly, patients with brain tumors, and post organ transplant patients), epilepsy patients with comorbidities (renal and hepatic disease, depression), and how to combine medications after failure of monotherapy. Statistical analysis of data used the expert consensus method., Results: Valproate was considered a drug of choice in all genetically-mediated generalized epilepsies, except in the population of women of child-bearing age. Ethosuximide was a drug of choice in patient with absence seizures, and levetiracetam was a drug of choice in patients with genetic generalized tonic-clonic seizures and myoclonic seizures. Lamotrigine, levetiracetam and oxcarbazepine were considered drugs of choice for initial treatment of focal seizures. Lamotrigine and levetiracetam were the drugs of choice for women of child-bearing age with either genetic generalized epilepsy or focal epilepsy. Lamotrigine and levetiracetam were the drugs of choice in the elderly population. Lamotrigine was preferred in patients with co-morbid depression. Levetiracetam was the drug of choice in treating patients with hepatic failure, or who have undergone organ transplantation. Compared to the 2005 and 2001 surveys, there was increased preference for the use of levetiracetam and lamotrigine, and decreased preference for the use of phenytoin, gabapentin, phenobarbital and carbamazepine., Discussion: The study presented here provides a "snapshot" of the clinical practices of experts in the treatment of epilepsy. The experts were very often in agreement, and reached consensus in 81% of the possible responses. However, expert opinion does not replace the medical literature; instead, it acts to supplement existing information. Using the study results is similar to requesting an expert consultation. Our findings suggest options that the clinician should consider to achieve best practice., (Published by Elsevier Inc.)

Background: Pre-orthotopic heart (OHT) serum creatinine correlates with post-OHT outcomes, but there is limited information on the relationship between pre-OHT estimated glomerular filtration rate (eGFR) and adjusted short- and long-term survival and renal outcomes post-OHT., Methods: Using the United Network of Organ Sharing (UNOS) database we estimated pre-OHT eGFR using the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in patients aged ≥18 years who underwent OHT between 1988 and 2013. Patients were stratified into 5 eGFR categories (≥90, 60 to 89, 45 to 59, 30 to 44 and <30 ml/min/1.73 m 2 ) using each equation. The primary outcome was to determine whether pre-OHT eGFR independently predicted post-OHT mortality., Results: A total of 30,090 patients were included in the study; of these, 46.1% and 39.9% had an eGFR <60 ml/min/1.73 m 2 by MDRD and CKD-EPI, respectively. Compared with eGFR ≥90 ml/min/1.73 m 2 , the adjusted hazard ratio of mortality was 1.09 (95% confidence interval [CI] 1.02 to 1.26) for eGFR 45 to 59 ml/min/1.73 m 2 , 1.22 (95% CI -1.23 to 1.31) for eGFR 30 to 44 ml/min/1.73 m 2 and 1.55 (95% CI 1.41 to 1.70) for eGFR <30 ml/min/1.73 m 2 by MDRD. There was no advantage for CKD-EPI over MDRD in determining post-OHT mortality. Pre-OHT eGFR by either equation was predictive of post-OHT end-stage renal disease (ESRD) and the need for kidney transplantation, with the highest risk in those with pre-OHT eGFR <30 ml/min/1.73 m 2 by either equation., Conclusions: Pre-OHT eGFR was independently associated with mortality, ESRD and kidney transplantation after OHT. There was no advantage of CKD-EPI over MDRD in determining post-OHT mortality or renal outcomes., (Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)