bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of an additive TEA on thiosulfate leaching of low sulfur gold concentrate
Authors: Zhao Hefei , Yang Hongying , Shi Wenge , Lu Liangshan , Ma Pengcheng , Li Hong , Chen Xi
Published: December 2019

The environmentally friendly and non-cyanide thiosulfate gold leaching technology was used to extract gold from a low-sulfur gold concentrate. The effect of TEA on leaching of pure gold under the condition of adding quartz indicated that TEA could significant increase the dissolution rates of gold and the mixed solution potentials and decrease the consumption of thiosulfate. Quartz has little effect on the gold leaching process. Moreover, the effect of additive Triethanolamine (TEA) on the gold extraction was further studied. The chemical analysis and process mineralogy analysis of the concentrate indicated that the concentrate contained 59 g/t Au, 64.49% SiO2, 19.55% Al and 5.76% Fe. The concentrate was composed of quartz, muscovite and chlorite as major minerals. Quartz was the main gold-bearing mineral in concentrate. The gold particles of less than 20 μm in the concentrate reached 50.56%. Traditional thiosulfate leaching technology was used to extract gold from the concentrate, and the gold leaching rate was only 44.49% after 48 hours. When 0.024 M (MTEA:Mcopper=2:1) TEA was added in the thiosulfate leaching gold system, the thiosulfate consumption significantly reduced by about 32% and the leaching rate of gold increased to 73.40%.
Structure and properties of the electromagnetic starter’s contacts with the electro-explosive CuO-Ag coating
Authors: Romanov D A , Moskovskii S V , Gromov V E , Ivanov Yu F , Filjakov A D
Published: December 2019

Phases and elemental composition of CJ20 electromagnetic starter’s contacts subjected to electro-explosive spraying of the CuO-Ag coating were studied by using transmission and scanning electron microscopy methods. Electro-explosive spraying CuO-Ag coating were carried out in mode providing contact’s premelting condition. Such mode managed to minimize energy cost. Produced coating has a homogeneous structure containing silver matrix and CuO inclusions located in the matrix. After electro-explosive spraying the structure of coating elements’ surface and their scale vary in a very wide range from thousands µm to tens of hundreds µm. The high-speed cellular crystallization’s structure is formed in the electro-explosive CuO-Ag coating regardless of distance to modifying surface. The cell’s size is ranged from 150 nm to 300 nm. The cells are separated by the second phase’s layers which thickness varies from 10 nm to 70 nm. The cell is volume formed by copper atoms; silver atoms are located in interlayers along the cell boundaries. Sprayed coatings were tested for wear resistance, friction coefficient, nanohardness and Young’s modulus. The formed coating shows an increase in 2.0 times nanohardness, in 3.3 times wear-resistance and in 1.4 times friction coefficient and decrease to 5.3 times Young’s modulus in comparison with the original copper electrical contact.
Research and control of network carbide in GCr15 bearing steel
Authors: Huo Xiangdong , Ning Yuliang , Li Liejun , Lv Zhiwei , Chen Songjun
Published: December 2019

Due to the small amount of transformation during the phase transformation process, it is difficult to determine the phase transition temperature of the proeutectoid cementite in the bearing steel by the expansion method. In this paper, the Gleeble3800 thermal simulator was used to study the phase transformation behavior of GCr15 bearing steel at different cooling rates. Firstly, the phase transformation temperature range of pearlite is about 550 °C ∼ 700 °C measured by expansion method. Based on this, the transformation temperature range of proeutectoid cementite is about 700 °C ∼ 900 °C studied by metallographic method; The precipitation curve of proeutectoid cementite was supplemented, and the complete continuous cooling phase transition curve (CCT curve) of bearing steel was drawn. On this basis, the scheme of inhibiting the formation of proeutectoid cementite by two-stage cooling process was proposed and discussed, and the finishing cooling temperature was studied, which provides a basis for controlling network carbide in field production.
LeukmiR: a database for miRNAs and their targets in acute lymphoblastic leukemia
Authors: Rawoof Abdul , Swaminathan Guruprasadh , Tiwari Shrish , Nair Rekha A , Dinesh Kumar Lekha
Published: December 2019

Acute lymphoblastic leukemia (ALL) is one of the most common hematological malignancies in children. Recent studies suggest the involvement of multiple microRNAs in the tumorigenesis of various leukemias. However, until now, no comprehensive database exists for miRNAs and their cognate target genes involved specifically in ALL. Therefore, we developed ‘LeukmiR’ a dynamic database comprising in silico predicted microRNAs, and experimentally validated miRNAs along with the target genes they regulate in mouse and human. LeukmiR is a user-friendly platform with search strings for ALL-associated microRNAs, their sequences, description of target genes, their location on the chromosomes and the corresponding deregulated signaling pathways. For the user query, different search modules exist where either quick search can be carried out using any fuzzy term or by providing exact terms in specific modules. All entries for both human and mouse genomes can be retrieved through multiple options such as miRNA ID, their accession number, sequence, target genes, Ensemble-ID or Entrez-ID. User can also access miRNA: mRNA interaction networks in different signaling pathways, the genomic location of the targeted regions such as 3′UTR, 5′UTR and exons with their gene ontology and disease ontology information in both human and mouse systems. Herein, we also report 51 novel microRNAs which are not described earlier for ALL. Thus, LeukmiR database will be a valuable source of information for researchers to understand and investigate miRNAs and their targets with diagnostic and therapeutic potential in ALL.

Database URL: http://tdb.ccmb.res.in/LeukmiR/
Can evidence-based decision support tools transform antibiotic management? A systematic review and meta-analyses
Authors: Laka Mah , Milazzo Adriana , Merlin Tracy
Published: December 2019

Objectives

To assess the effectiveness of clinical decision support systems (CDSSs) at reducing unnecessary and suboptimal antibiotic prescribing within different healthcare settings.

Methods

A systematic review of published studies was undertaken with seven databases from database inception to November 2018. A protocol was developed using the PRISMA-P checklist and study selection criteria were determined prior to performing the search. Critical appraisal of studies was undertaken using relevant tools. Meta-analyses were performed using a random-effects model to determine whether CDSS use affected optimal antibiotic management.

Results

Fifty-seven studies were identified that reported on CDSS effectiveness. Most were non-randomized studies with low methodological quality. However, randomized controlled trials of moderate methodological quality were available and assessed separately. The meta-analyses indicated that appropriate antibiotic therapy was twice as likely to occur following the implementation of CDSSs (OR 2.28, 95% CI 1.82–2.86, k = 20). The use of CDSSs was also associated with a relative decrease (18%) in mortality (OR 0.82, 95% CI 0.73–0.91, k = 18). CDSS implementation also decreased the overall volume of antibiotic use, length of hospital stay, duration and cost of therapy. The magnitude of the effect did vary by study design, but the direction of the effect was consistent in favouring CDSSs.

Conclusions

Decision support tools can be effective to improve antibiotic prescribing, although there is limited evidence available on use in primary care. Our findings suggest that a focus on system requirements and implementation processes would improve CDSS uptake and provide more definitive benefits for antibiotic stewardship.
Deep packet inspection for intelligent intrusion detection in software-defined industrial networks: A proof of concept
Authors: Sainz Markel , Garitano Iñaki , Iturbe Mikel , Zurutuza Urko
Published: December 2019

Specifically tailored industrial control systems (ICSs) attacks are becoming increasingly sophisticated, accentuating the need of ICS cyber security. The nature of these systems makes traditional IT security measures not suitable, requiring expressly developed security countermeasures. Within the past decades, research has been focused in network-based intrusion detection systems. With the appearance of software-defined networks (SDNs), new opportunities and challenges have shown up in the research community. This paper describes the potential benefits of using SDNs in industrial networks with security purposes and presents the set up and results of a pilot experiment carried out in a scaled physical implementation. The experimental set up consists in the detection of ICMP flood and packet payload alteration based on signature comparison. Results point to the potential viability of the technology for intrusion detection and the need of researching in architectural scalability.
Left Ventricular Assist Device Backup for Conventional Surgery
Authors: Garster Noelle C. , Mohammed Asim
Published: December 2019

Surgical revascularization plays a significant role in the management of patients with ischemic cardiomyopathy; however, fall patients have equivalent surgical risk, and in fact some are viewed as high-risk candidates due to severe systolic dysfunction or multiple medical comorbidities. The use of perioperative and intraoperative temporary mechanical circulatory support with a left ventricular assist device (LVAD) offers an option for potentially reducing surgical risk for these patients. This chapter highlights case examples from one institution in which temporary LVADs are utilized in order to optimize patients for conventional cardiac surgery including coronary artery bypass grafting (CABG). It briefly reviews the utility of preoperative viability assessment and proposes key factors for the identification of patients who may benefit from this novel strategy.
Preoperative Strategies for Optimizing Mechanical Circulatory Support
Authors: Klein Evan C. , Saltzberg Mitchell T.
Published: December 2019

Several validated risk models can help determine whether patients with advanced heart failure should be considered for mechanical circulatory support based on its potential survival advantage. Once a patient is a candidate for device therapy, an understanding of these risk models can help inform decisions about modifying risk factors to provide the best postsurgical outcomes. Specific preoperative factors that can be addressed include the adequacy of perfusion, volume status, and the status of non-cardiac organ systems (e.g., the pulmonary, infectious, hematologic, renal systems). Additionally, an understanding of preoperative right ventricular hemodynamics and function can help alert providers to patients with an increased need for postoperative right-ventricular support. The chapter reviews several risk-stratification models, as well as the approach used by the authors’ institution to optimize the preoperative treatment of patients before implementing mechanical circulatory support.
Device Selection for Short- and Long-Term Mechanical Circulatory Support
Authors: Asleh Rabea , Schettle Sarah
Published: December 2019

Mechanical circulatory support has expanded to meet the needs of a variety of patient populations requiring short-term and long-term applications and is utilized internationally. Short-term support devices offer treatment for cardiogenic shock and consist of varying support mechanisms, including univentricular and biventricular support options to improve hemodynamics and tissue perfusion. Investigational devices offer additional options to consider in device selection. Long-term support with ventricular assist devices or total artificial heart offers dischargeable options for lifelong support, recovery, or while patients await organ transplantation. Consideration of device availability, expenses and coverage, operator expertise, and technical challenges should be undertaken when determining patient support strategies. Reviewing patient comorbidities and time frame needed for support is imperative when considering device options to ensure appropriate device selection for each individual patient, thus mitigating risks and maximizing outcomes. Innovation will continue to drive progress in mechanical circulatory support with ongoing development of novel strategies to afford new options to optimize support of patients with heart failure.
The Abbott HeartMate 3™ Left Ventricular Assist System
Authors: Bourque Kevin , O’Connell John B.
Published: December 2019

Mechanical circulatory support devices are increasingly used to treat chronic, advanced heart failure. In the Abbott HeartMate 3™ left ventricular assist system (HM3), a new magnetic levitation pump improves hemocompatibility and thus addresses the prominent morbidities associated with these devices, such as pump thrombosis, stroke, and bleeding. In the multicenter MOMENTUM 3 clinical trial of 366 patients, the primary endpoint—survival without disabling stroke or pump replacement—was 77.9% in the HM3 group (n = 190) and 56.4% in the HeartMate II™ Left Ventricular Assist System group (HMII; n = 176; P <0.001). Suspected or confirmed pump thrombosis occurred in two patients (1.1%) in the HM3 group and in 27 patients (15.7%) in the HMII group (P <0.001). Also at 2 years, 22 strokes occurred in 19 patients (10.1%) with the HM3 and 43 strokes occurred in 33 patients (19.2%) with the HMII (P = 0.02), indicating that the HM3 provides important improvements in care.
The Medtronic Miniature Left Ventricular Assist Device (MVAD)™ System
Authors: Hiivala Nicholas , Vassiliades Thomas
Published: December 2019

The Medtronic Miniature Left Ventricular Assist Device (MVAD)TM System is a continuous-flow, left ventricular assist device used to treat end-stage systolic heart failure. The pump is implanted either through a median sternotomy or a lateral thoracotomy and pumps blood from the left ventricle to the arterial system. The pump is controlled by an external microprocessor connected transcutaneously through a thin, flexible driveline and is powered by lithium-ion batteries or AC/DC power. In 2015, a clinical trial of the system in Europe and Australia was stopped because of several incidents of pump thrombosis.
The Syncardia Total Artificial Heart
Authors: Langford Steven , Arabía Francisco A.
Published: December 2019

The 70-cc Syncardia TAH is the only device with FDA approval as a bridge to transplant in patients with biventricular failure, with a history that dates back to the earliest days of mechanical circulatory support. Clinical trials are currently underway to establish a destination therapy indication for the 70-cc device and a bridge to transplant indication for the 50-cc device. With the current heart allocation system in the United States, the TAH is the only dischargeable platform for patients who are listed as Status 2. Adverse events remain the primary limitation of these devices, and careful patient selection is critical for achieving excellent postoperative outcomes.
The Berlin Heart Ventricular Assist Devices
Authors: Durham Lucian A.
Published: December 2019

Pediatric Mechanical Circulatory Support has been utilized increasingly to support children awaiting heart transplantation. The Berlin Heart EXCOR® is currently the only viable option, other than veno-arterial ECMO, to provide short- to intermediate-term mechanical circulatory support to infants and children. The Berlin Heart EXCOR® was approved by the Food and Drug Administration in 2011 as a durable bridge to transplantation following a prospective Investigative Device Exemption (IDE) trial. Since its introduction in Europe in 2001, the Berlin Heart EXCOR® has totaled over 2,400 implants at 176 centers in 41 countries with a 76% success rate.
Echocardiography in Left Ventricular Assist Device Recipients
Authors: Topilsky Yan , Havakuk Ofer
Published: December 2019

Echocardiography is enormously useful in managing patients treated with left ventricular assist devices (LVADs), but its use in these patients is rarely addressed specifically. The combined functions of the LVAD and the native left and right ventricles create unique hemodynamic conditions, which must be considered in a comprehensive echocardiographic assessment of patients receiving LVADs. This chapter reviews the hemodynamic effects of LVADS, including the trade-off between pump output and flow pulsatility, left ventricular and left arterial unloading, and the effects of LVADs on the right heart. It then describes the preoperative use of echocardiography in patient selection, including how to assess right ventricular function, aortic and tricuspid regurgitation, and patent foramen ovale. It then considers the intraoperative assessment of the left heart, right ventricular function; tricuspid, aortic, and mitral regurgitation; the inflow and outflow cannulas, and pump flow and total cardiac output. Finally, the authors address the postoperative uses of echocardiography in surveillance, including assessing hypovolemia, postoperative tamponade, impeller thrombosis, and cannula kinking or obstruction, as well as how to optimize LVAD function and to troubleshoot LVAD malfunctions.
Anticoagulation Strategies for Patients on Mechanical Circulation Support
Authors: Nei Scott D.
Published: December 2019

Anticoagulation strategies for patients with mechanical circulatory support devices (MCSD) remain a daily challenge for clinicians. The balance between thrombosis and bleeding is delicate, with either extreme affecting patient morbidity and mortality. This chapter reviews the evidence for various anticoagulation strategies for patients with left ventricular assist devices (LVAD), extracorporeal membrane oxygenation (ECMO), and total artificial hearts (TAH). Clinical controversies related to tailoring anticoagulation strategies to individual patients addressed in this chapter include adjusting anticoagulation for gastrointestinal bleeding in patients with VADs and monitoring warfarin treatment with chromogenic factor X and with time in the therapeutic range. The direct use of thrombin inhibitors as primary anticoagulation for ECMO and the future of anticoagulation for MCSDs should help prepare clinicians for new research and changes in the field.
Acquired von Willebrand Syndrome with Mechanical Circulatory Support
Authors: Klein Evan C. , Kreuziger Lisa Baumann
Published: December 2019

Acquired von Willebrand syndrome occurs in the setting of mechanical circulatory support from device-associated sheer stress, which changes the quaternary structure of high-molecular-weight von Willebrand factor multimers, exposing the cleavage site for ADAMTS-13. Once cleaved, lower-molecular-weight multimers lose their affinity for binding platelets, increasing the susceptibility to bleeding complications. Acquired von Willebrand syndrome has been described in all the currently approved continuous-flow mechanical circulatory support devices. Although theoretically the risk of von Willebrand factor multimer degradation is increased at the higher rotational speeds of axial-flow pumps, disease severity does not differ greatly between axial- and centrifugal-flow devices. Disease-specific therapies for acquired von Willebrand syndrome have not been well studied in patients supported by mechanical circulatory devices. Case reports and case series have noted beneficial effects from octreotide, doxycycline, desmopressin, or Humate-P treatment for patients with recurrent severe bleeding.
Pump Thrombosis
Authors: Schroder Jacob N. , Milano Carmelo A.
Published: December 2019

This chapter reviews the mechanisms, diagnosis, and treatment strategies of left ventricular assist device (LVAD) thrombosis. Despite improving results, thrombosis continues to be an important postoperative complication of continuous-flow (CF) LVADs. When LVAD thrombosis is suspected, aggressive and timely evaluation and treatment is critical. This chapter also reviews data on newer generation LVADs which appear to be more hemocompatible, reducing the risk of thrombosis.
Modalities of Left Ventricular Assist Device Optimization
Authors: Narang Nikhil , Sayer Gabriel , Uriel Nir
Published: December 2019

Continuous flow left ventricular assist devices (LVADs) are a viable long-term option to the end-stage heart failure patient, with improvements in hemocompatibility seen with newer generation devices. The complex interplay of native myocardial contractility, state of the right ventricle, and presence of aortic insufficiency, among other factors, governs cardiac performance in addition to that from the pump. Deliberate speed adjustments by non-invasive and invasive methods can improve the LVAD hemodynamic profile in a manner tailored to the individual patient. Individualized adjustments in pump parameters by these methods may reduce the longitudinal burden of LVAD-related adverse events.
The CardioMEMS Heart Failure Monitoring System
Authors: Lampert Brent C. , Abraham William T.
Published: December 2019

The initial cause of worsening heart failure is increased intracardiac and pulmonary pressures. Traditional non-invasive heart failure monitoring strategies that follow surrogates of increased pressures have not reduced heart failure hospitalizations. Pulmonary artery pressure measurements using the implantable CardioMEMS system allow daily remote monitoring and earlier identification of heart failure decompensations. In the CHAMPION trial, remote monitoring with the CardioMEMS Heart Failure system significantly reduced hospitalizations for heart failure, even in patients with numerous comorbidities. For patients with refractory advanced heart failure, mechanical circulatory support can markedly improve the length and quality of life but can also have multiple complications. Implantable hemodynamic monitoring with CardioMEMS may provide clinicians with better information to guide the timing of left ventricular assist device implantation and to improve post-implant care.
Mechanical Circulatory Support as a Bridge to Recovery
Authors: Hanff Thomas C. , Wald Joyce , Rame J. Eduardo
Published: December 2019

LVAD therapy has traditionally been viewed as a bridge to transplant or destination therapy strategy. However, an exciting new area of research has reopened the door to using these devices as a bridge to recovery. The RESTAGE-HF trial was designed to evaluate the potential for a recovery protocol to achieve successful explantation of the device. The early results from this trial suggest that a protocol including optimal medical therapy in the setting of LVAD therapy may allow for explantation in many cases with durable recovery. This chapter outlines the concepts and data surrounding this important area of study.
Emerging adulthood: Millennials, work, and pain
Authors: Fisher Emma , Eccleston Christopher
Published: December 2019

Millennials, born from 1980 onwards, may differ in important ways from previous generations. Differences have been explored in personality and occupational psychology, but largely ignored in medical and clinical psychology. Chronic pain, which peaks in incidence during puberty, can have negative effects on adolescents socially, emotionally, and physically. If unresolved, it may persist into adulthood, limiting opportunities. This brings challenges in understanding what it means to have chronic pain as a millennial and how this impacts on expectations and actions. In this chapter, we explore what we know from research on the millennial generation, including how millennials engage with work and with health care, and how an understanding of millennial generational features can help us determine how young people cope with pain. Finally, we consider what it means to be a millennial health-care provider, all within a generational framework.
EUSOMA
Authors: Marotti Lorenza , Cataliotti Luigi , Mansel Robert
Published: December 2019

Abstract: The European Society of Breast Cancer Specialists (EUSOMA) is the only European multidisciplinary society dedicated to breast cancer. EUSOMA has defined the requirements for a Breast Centre. Basic requirements are: at least 150 new breast cancer cases per year, provision of all services necessary from genetics and prevention, through diagnosis and treatment of primary tumour, follow-up, care of advanced disease, and palliation. The Breast Centre must have a dedicated team of specialists who regularly meet in the multidisciplinary meeting. EUSOMA also defined a set of Quality Indicators (QIs) to allow standardized auditing and quality assurance. EUSOMA developed a voluntary certification process to evaluate Breast Centre compliance with EUSOMA requirements and QIs. This process has now become an accredited scheme run by a dedicated organization (www.breastcentrescertification.com). The Breast Centre certification scheme is focused on real data, essential clinical skills, structure, and procedure, aiming at improving the quality of care. Breast Centres undergoing certification send data to the EUSOMA data warehouse. The EUSOMA data centre performs an analysis and issues a report showing the performances of the selected EUSOMA QIs. Thanks to the availability of these data, Certified Breast Centres under the umbrella of EUSOMA collectively publish scientific papers on selected topics.
A View on Patient-Reported Outcome Measures
Authors: Duhoux François , Hazarika Rishi
Published: December 2019

Abstract: Patient-reported outcome measures (PROMs) are being implemented more frequently in the clinical setting to monitor health-related quality of life. The breast cancer standard set developed by the International Consortium for Health Outcomes Measurement (ICHOM) aims at reducing health care costs by preventing medical errors and unnecessary treatments, supporting informed decision-making, and improving health care quality by allowing physicians to compare their health outcomes data to other providers. It encompasses survival, cancer control, and disutility of care outcomes in addition to selected case-mix factors, which are to be collected at baseline, and a combination of multiple PROM tools to capture long-term degree of health outcomes. It can be used for both the early and the metastatic settings. Implementing PROMs is both complex and time-consuming. This or a similar process will likely become mandatory in developed nations, where value-based health care is becoming increasingly popular.
Breast Cancer Surgery
Authors: van Dam Peter A. , Kaufman Cary , Garcia-Etienne Carlos , Peeters Marie-Jeanne Vrancken , Mansel Robert
Published: December 2019

Abstract: The role of the surgeon managing breast diseases has been the subject of continuous evolution, moving from the cancer-extirpative surgeon to a deeply informed surgical leader, who interacts in a multidisciplinary setting also encompassing tasks for risk assessment, genetic counselling, and new diagnostic approaches. Surgical removal of the tumour remains the cornerstone in treating early stage breast cancer. During the last century, breast cancer surgery became less radical, breast-conserving treatment emerged, and the role of axillary lymphadenectomy changed from a therapeutic procedure into a staging procedure with prognostic implications. Later, the sentinel node concept reduced the need for complete axillary clearance in most cases. Nowadays, thanks to breast-conserving surgery, oncoplastic techniques, and reconstructive procedures, most breast cancer patients can overcome this disease without serious permanent physical mutilation. A multidisciplinary approach, benchmarking, and quality assurance have improved outcomes markedly.
Radiation Therapy
Authors: Poortmans Philip , Essers Marion , Hol Sandra , Marks Lawrence , Kaidar-Person Orit
Published: December 2019

Abstract: For the majority of patients with non-metastatic breast cancer, radiation therapy (RT) plays an integral role as part of breast-conserving therapy and in the post-mastectomy setting. RT reduces the risk of local and regional recurrence and, albeit to a lesser degree, distant recurrence and mortality. Improvements in RT-based planning/delivery technologies have improved the therapeutic ratio (i.e. increased effectiveness and/or reduced morbidity). These techniques are better able to restrict the therapeutic dose to the target tissues and evolving technologies may yield further improvements. Given the integral role of RT as part of the overall treatment approach, radiation oncologists should be part of the multidisciplinary team from the initial phase of the diagnostic–therapeutic pathway. The interaction between local–regional and systemic treatments is complex. Most of the benefit of RT on survival is expected for low-risk patients, who do not receive systemic treatment, and for high-risk patients, receiving effective systemic therapy.
Psycho-Oncological Care and Survivorship
Authors: Travado Luzia , Turner Jane , Rowland Julia , Bultz Barry , Jacobsen Paul
Published: December 2019

Abstract: Around 32–60% of breast cancer patients have high levels of distress related to the impact of their disease and treatment consequences on their lives. There is evidence that psychosocial care and interventions can reduce the emotional impact of cancer and improve the quality of life for women affected by breast cancer. Inequalities in cancer care across countries contribute to different outcomes for patients. Psychosocial morbidity associated with cancer adds to the cancer burden if left unaddressed. However, psycho-oncological services are irregularly provided across countries and regions and do not cover entire populations. To improve patient outcomes, it is necessary to integrate distress screening and psycho-oncological care into standard cancer care from diagnosis, across treatment through all phases of disease, and survivorship as a vital part of comprehensive high-quality cancer care. Psycho-oncology professionals are aware of the need and the evidence. Responsibility for improvements must rest with all health professionals, services, and administrators involved in cancer care. ‘Whole of patient care’ requires ‘whole of system’ response.
Improving Treatment Value Using Health Information Technology
Authors: Maguire Roma , Ponti Antonio , Suarez Fernando
Published: December 2019

Abstract: Advances in diagnostics and treatment are putting an unprecedented strain on care services across the globe. Technologies are constantly developing, advancing, and becoming smarter. All these advancements in the field of oncology are being enhanced by significant developments in the field of information, communications technology, and data analytics. Generation of insights using artificial intelligence and machine learning will be the driving force of healthcare now and in the future. ‘Big data’ comprise a challenging resource for improving treatment of breast cancer. However, it is not sufficient that large data-systems are integrated, but also that sound study designs, analytical methods, as well as transparency are applied. A stronger epidemiological foundation is needed to effectively study the health impact of new technologies.
Who Controls the Message?
Authors: Attai Deanna J. , Pas Johanna , Asante-Shongwe Kwanele , O'Riordan Liz , Benn Carol , Mercurio AnneMarie , Radford Diane M. , Schwitzer Gary , Wagstaff Anna
Published: December 2019

Abstract: The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. The increasing numbers of breast cancer survivors from newly diagnosed to metastatic requires more personalised management by the medical breast cancer community. Whereas oncology specialists provide useful information, patients may not hear it. An equal partnership between patients and their doctors is proposed. Patient involvement is more than patient surveys. Patients need appropriate information which they can understand and trust and is tailored to their specific needs at each step of the care pathway. Patients are facing difficulties navigating all the information and available options. Physicians need to understand that patients receive information from multiple sites. Many tools are available to help in shared decision-making.
Medicolegal Aspects
Authors: Mansel Robert
Published: December 2019

Abstract: Breast cancer is the leading cause of malpractice claims for radiologists. The usual civil charge of negligence (malpractice) will be discussed. The most common complaint is delay in diagnosis. In symptomatic patients, this means failure to carry out the appropriate imaging investigation including biopsy. In screening, it usually means failure to detect the early signs of breast cancer. Three important principles in the law of civil negligence are present. There is the duty of the doctor for the treatment of his patient and his responsibility for giving the correct treatment. The failure to do so is judged by peers and is called breach of duty. The task of the patient to prove harm in a measurable way is called causation. Major differences in judicial structures and frequency of negligence claims exist between countries.
Perspective from India
Authors: Pillarisetti Raghu Ram
Published: December 2019

Abstract: Each year in India, 75,000 women succumb to breast cancer. For every two women newly diagnosed, one dies. The disease is rising in young women, is presenting at advanced stage, and a higher incidence of triple-negative breast cancer is observed. India currently spends only 1.2% of its gross domestic product on publicly funded health care. There are few efforts directed to empowering people to realize early detection of breast cancer. Breast cancer care is merely a lottery in which some receive excellent care while most do not. South Asia’s first free-standing comprehensive Breast Health Centre was established in Hyderabad in 2007. There is a need for a paradigm shift in the management of breast cancer in India.
Conclusion
Authors: Verhoeven Didier , Kaufman Cary S. , Mansel Robert , Siesling Sabine
Published: December 2019

This book demonstrates the complexity of care surrounding breast cancer and the difficulty in choosing the ideal treatment, especially when local resource issues intrude on the desired choices. High-quality breast cancer care requires constant communication among the treatment team with ongoing monitoring of the level of care the team provides. Excellent communication with the patient throughout her journey is needed in addition to a well-organized programme providing the broad spectrum of care necessary for a patient to receive optimal treatment in today’s environment. Ten key messages were identified.
Cosmic ray interactions in the solar atmosphere
Authors: Hudson Hugh S , MacKinnon Alec , Szydlarski Mikolaj , Carlsson Mats
Published: December 2019

High-energy particles enter the solar atmosphere from Galactic or solar coronal sources, and produce ‘albedo’ emission from the quiet Sun that is now observable across a wide range of photon energies. The interaction of high-energy particles in a stellar atmosphere depends essentially upon the joint variation of the magnetic field and plasma density, which heretofore has been characterized parametrically as P ∝ Bα with P the gas pressure and B the magnitude of the magnetic field. We re-examine that parametrization by using a self-consistent 3D MHD model (Bifrost) and show that this relationship tends to P ∝ B3.5 ± 0.1 based on the visible portions of the sample of open-field flux tubes in such a model, but with large variations from point to point. This scatter corresponds to the strong meandering of the open-field flux tubes in the lower atmosphere, which will have a strong effect on the prediction of the emission anisotropy (limb brightening). The simulations show that much of the open flux in coronal holes originates in weak-field regions within the granular pattern of the convective motions seen in the simulations.
X-ray reverberation lags from the 1.5 Seyfert galaxy NGC 5273
Authors: Vincentelli F M , Mastroserio G , McHardy I , Ingram A , Pahari M
Published: December 2019

We present the results of X-ray spectral-timing analysis of a 90 ks XMM–Newton observation of the nearby, broad-line, early-type AGN NGC5273. The X-ray spectrum revealed the clear presence of a reflection component at high energies, with a clear signature of a narrow iron line at 6.4 keV, consistent with distant reflection. Applying a relativistic reflection model, we found only marginal evidence for a broader relativistic line component. However, cross-spectral analysis revealed that, between 4 and 6 × 10−4 Hz, the 5–8 keV band lagged the 2–3 keV band, implying reflection of the iron line from material close to the black hole. From the analysis of the lag-energy spectrum, we found a broad, but skewed line with a peak of ≈1000 s at 7.5 keV relative to the continuum, which we interpret as the iron line in the reverberation spectrum from an illuminated accretion disc. From the asymmetry in the shape of lag-energy spectrum, we also found that the source is consistent with having an inclination ≥45°.
Characterizing the companion AGBs using surface chemical composition of barium stars
Authors: Shejeelammal J , Goswami Aruna , Goswami Partha Pratim , Rathour Rajeev Singh , Masseron Thomas
Published: December 2019

Barium stars are one of the important probes to understand the origin and evolution of slow neutron-capture process elements in the Galaxy. These are extrinsic stars, where the observed s-process element abundances are believed to have an origin in the now invisible companions that produced these elements at their asymptotic giant branch (AGB) phase of evolution. We have attempted to understand the s-process nucleosynthesis, as well as the physical properties of the companion stars through a detailed comparison of observed elemental abundances of 10 barium stars with the predictions from AGB nucleosynthesis models, FRUITY. For these stars, we have presented estimates of abundances of several elements, C, N, O, Na, Al, α-elements, Fe-peak elements, and neutron-capture elements Rb, Sr, Y, Zr, Ba, La, Ce, Pr, Nd, Sm, and Eu. The abundance estimates are based on high resolution spectral analysis. Observations of Rb in four of these stars have allowed us to put a limit to the mass of the companion AGB stars. Our analysis clearly shows that the former companions responsible for the surface abundance peculiarities of these stars are low-mass AGB stars. Kinematic analysis has shown the stars to be members of Galactic disc population.
AS2-1 TREATMENT OF BENIGN INTRA-AXIAL BRAIN TUMORS IN CHILDREN ASSOCIATED WITH EPILEPSY
Authors: Matsuo Takeshi
Published: December 2019

Low grade neuro-epithelial tumors presenting early-onset epilepsy as the major neurological symptom have recently been categorized as low-grade epilepsy-associated neuro-epithelial tumors, LEAT. Ganglioglioma and dysembryoplastic neuroepithelial tumors consist up to 60% of LEAT. Common characteristics of LEAT being early onset seizure, younger than the age of 15, and temporal lobe localization, its criteria do not include histological or genetic features; LEAT is an independent classification, unrelated to WHO classification.

Treatment for epilepsy associated with LEAT includes medication and surgery. As for drug therapy, most tumor-related seizures are controlled well with anti-epileptic drugs for focal epilepsy such as sodium channel blocker. On the other hand, those who are drug-resistant are candidates for surgical therapy. Because epileptogenic zone mostly exists not in tumor itself but in the marginal brain tissue, pure tumor resection without resection of peripheral epileptogenic zone sometimes fails to achieve satisfactory seizure outcome. Concept of epilepsy surgery is indispensable in pre-operative evaluation and in planning surgical strategy. Related association fibers in addition to five zones, epileptogenic zone, seizure onset zone, irritative zone, symptomatogenic zone and functional deficit zone should be taken into consideration.

Long-term survival is expected in children who underwent total resection of benign tumors. Therefore, good seizure control is crucial in improving activities of daily lives.
GEN-13 FIREWORK PATTERN OF CANCER GENESIS FOR GLIOBLASTOMA, IDH-WILDTYPE
Authors: Yoon Seon-Jin , Park Junseong , Kim Hyun Jung , Lee Joo Ho , Hee Chang Jong , Ho Lee Jeong , Kang Seok-Gu
Published: December 2019

Treatment of Glioblastoma (GBM), IDH-wildtype is a history of sequential failure. The cure for this disease is a distant story, and it is really the emperor of cancer. We believe that GBM should not be considered one of several cancers, and GBM is a cancer that occurs in a special environment called the central nervous system (CNS). What is the biggest difference between other cancers and cancers of the nervous system? It is thought to be neurogenesis. This presentation will review GBM genesis based on neurogensis of CNS. It also explains what the cell of origin is, what somatic mutations occur at the cell of origin, and why these somatic mutations occur. Human glioblastoma (GBM) occurs in a place without cancer tissue, that is, in the subventricular zone and have introduced the name of the firework pattern of cancer genesis, which is a metaphorical representation of the GBM genesis. So far, we have been trying to develop therapeutics focused on bulk tumors. However, in the case of GBM, IDH-wildtype, it has been found that the cell of origin is not in the tumor but is in normal SVZ, so it is now considered that the therapeutic target should also include the cell of origin.
TB-01 HUMAN IPS CELL-DERIVED BRAIN TUMOR MODEL UNCOVERS THE EMBRYONIC STEM CELL SIGNATURE AS A KEY DRIVER IN ATYPICAL TERATOID/RHABDOID TUMOR
Authors: Terada Yukinori , Jo Norihide , Arakawa Yoshiki , Mineharu Yohei , Yamada Yasuhiro , Miyamoto Susumu
Published: December 2019

Atypical teratoid/rhabdoid tumor (AT/RT), which harbors SMARCB1 mutation and exhibits a characteristic histology of rhabdoid cells, has a poor prognosis because of the lack of effective treatments. We established human SMARCB1-deficient pluripotent stem cells (hPSCs), which enabled investigation of the pathogenesis of AT/RT. SMARCB1-deficient hPSCs and neural progenitor-like cells (NPLCs) efficiently gave rise to brain tumors when transplanted into mouse brain. Notably, the emergence of typical rhabdoid cells was significantly enhanced in tumors from SMARCB1-deficient hPSCs. An embryonic stem cell (ESC)-like gene expression signature was more prominent in hPSC-derived tumors when compared with NPLCs-derived tumors. Moreover, mice transplanted with SMARCB1-deficient hPSCs showed poor survival than NPLC-transplanted mice. Activation of the ESC-like signature by the forced expression of reprogramming factors conferred a rhabdoid histology in SMARCB1-deficient NPLC-derived tumors, suggesting that acquisition of the ESC-like signature is responsible for the rhabdoid histology. Consistently, we found activation of the ESC-like gene expression signature and an ESC-like DNA methylation landscape in clinical specimens of AT/RT. Mechanistically, c-MYC expression was sufficient to acquire the ESC-like signature and the rhabdoid histology in SMARCB1-deficient NPLC-derived tumors, which resulted in poor survival. Together, SMARCB1-deficient hPSCs offer the first human model for AT/RT, which uncovered the unappreciated role of the activated ESC-like signature in the poor prognosis and unique histology. Finally, we performed a CRISPR/Cas9 knockout screening to inhibit activation of the ESC-like signature in AT/RT. Our effort identified candidate genes as therapeutic targets, including RAD21, which encodes a key component within the cohesin complex. Notably, chemical inhibition of HDAC8, which indirectly targets the function of cohesin, with simultaneous inhibition of EZH2 efficiently suppressed activation of the ESC-like signature and inhibited the growth of AT/RT cells. Collectively, we propose that the ESC-like signature could be a crucial therapeutic target for AT/RTs with rhabdoid histology.
ACT-13 RESPONSE TO SEIZURE AND TUMOR-PROGRESSION BY TREATMENT WITH PERAMPANEL IN PATIENTS WITH GLIOMAS
Authors: Izumoto Shuichi , Miyauchi Masaru , Watanabe Akira , Murakami Saori , Tsuyuguchi Naohiro , Kato Amami
Published: December 2019

BACKGROUND

Increased extracellular glutamate level activates AMPA type glutamate receptors (AMPA-receptor) and induces seizures. Antagonistic activation of AMPA-receptors inhibits epilepsy and glioma progression in vivo and in vitro studies.

PATIENTS AND METHODS

(1) We tested perampanel (PER), an AMPA-receptor antagonist, in fifteen glioma patients with uncontrolled epilepsy. Seizure response, PER concentration, and tumor volume were assessed. (2) We tested PER in thirteen glioma patients (gr 2- 3 cases, gr 3- 4 cases, and gr 4- 4cases) after the initial treatment of surgery and RT (and CT).

RESULTS

(1) An objective seizure response was observed in 13 analyzed patients (100%) with 8 cases (62%) of seizure-freedom. Median plasma concentration of PER was 232 ng/ml in patients with 4mg/day PER and 518 ng/ml in patients with 8mg/day PER. High intensity lesions of MRI-FLAIR images were assessed volumetrically to analyze the tumor size. The volume reduction was detected during the 6 months period in correlation with the plasma PER levels. (2) All the 13 cases treated with PER after the initial treatment was seizure free. Two cases of gr 4 were died at 18 and 20 months after the surgical treatment. Other 11 cases are survival-free.

CONCLUSION

PER treatment was effective in uncontrolled epilepsy with gliomas. MRI images showed the inhibition of tumor-progression. PER may effective for the inhibition of tumor progression.
ACT-18 SHOULD THE DOSE OF TEMOZOLOMIDE BE DECREASED FOR PATIENTS WITH HIGH-GRADE GLIOMAS WHO ARE ON HEMODIALYSIS?
Authors: Muto Jun , Matsutani Tomoo , Matsuda Ryosuke , Kinoshita Masashi , Oikawa Mitsuteru , Johan Pallud , Adachi Kazuhide , Hirose Yuichi , Sasaki Hikaru
Published: December 2019

BACKGROUND

The pharmacokinetics of temozolomide in patients with severe renal impairments (creatinine clearance less than 36 mL/min/m2) or in hemodialysis patients has not been investigated. Temozolomide and its metabolic products are mainly excreted in urine, as retention of these in the body may result in increased adverse events in hemodialysis patients harboring a high-grade glioma.

METHODS

Eight hemodialysis patients with high-grade gliomas from seven institutions were included in the study. Patient characteristics, treatment schedule, clinical course, pathological/molecular findings, and adverse events were evaluated.

RESULTS

The histopathological diagnoses were Isocitrate dehydrogenase (IDH) wild-type glioblastoma in four cases, Not other specified (NOS) glioblastoma in two cases and IDH-mutant anaplastic astrocytoma in one case. Five of the seven patients completed radiotherapy (48–60 Gy) with concomitant temozolomide (75 mg/m2) followed by adjuvant 5-day temozolomide (150 mg/m2) every 28 days. During the entire course of treatment with temozolomide, severe (Common Terminology Criteria for Adverse Events (CTCAE) more than grade 3) lymphocytopenia occurred in 57%(41.7–61%: non hemodialysis patients data, the same as below), neutropenia in 0%(1–15.4%) and thrombocytopenia in 14%(0–16.7%) of the patients. Generally, the frequency and degree of myelosuppression do not increase in hemodialysis patients with high-grade gliomas. Two of the seven (28.5%) patients died of infectious disease despite having no direct correlation to myelosuppression that is similar rate of 21.9% of the death results from infection in hemodialysis patients in Japan.

CONCLUSIONS

The high-grade glioma patients under study on hemodialysis did not require decreasing doses of Temozolomide during concomitant radiochemotherapy and maintenance therapy. However, careful clinical and hematological observation is required to avoid critical hematotoxicity and infection.