bluuebunny/crossref_metadata_2025 huggingface dataset:
ACT-22 CLINICAL RESULT AND CONSIDERATION OF 70 CASES OF INSULAR GLIOMA
Authors: Maruyama Takashi , Muragaki Yoshihiro , Sato Taiishi , Nitta Masayuki , Tsuzuki Shunsuke , Ikuta Soko , Nagahama Yasunori , Kawamata Takakazu
Published: December 2019

Our policy for insular glioma has achieved more than 90% removal. The policy influence grade 2 to postpone farther treatment and grade 3 to extend prognosis. In this study, we analyzed our clinical data to be sure how this policy effect to insular glioma. First-onset tumor since 2006 to 2015 were collected and following parameters were analyzed retrospectively, such as the tumor, extension, surgical removal rate, complications, pathological and genomic diagnosis. Of all 70 cases, the average age was 41 years old (24–76). The pathological diagnosis and number of patients were DAmt 20, DAwt 1, AAmt 8, AAwt 5, AO 5, O 18. PFS of each pathological grade(2,3,4) were 55,5m, 42,6m and 4,7m, OS were nr, nr, 32,8 months. 57 cases of IDHmt showed 60,2m of PFS and n.r of OS. 10 cases of IDHwt showed 19,9m PFS and 35,8m OS. The average and median removal rate were 91.4% and 95%. The number of complication case were mild 9 and moderate 2 at 3 months after surgery. The invasion pattern from temporal stem showed that frontal base invasion cases was resulted as poor prognosis comparing with temporal or parietal extension. Number of patients with IDHwt, Oligodedroglial tumor and GBM were relatively low. Surgical complications are mainly caused in the first half of the proficiency process, 15% had paralysis due to LSA infarction. Most of grade 2 cases were treated without post-operative treatment and the prognosis was almost same as grade 3 cases which were treated by chemo and radiation therapy such as 55m, 43m of PFS and n.r of OS. AA wt and GBM showed almost same OS of 32m.We have reconsidered a new classification based on temporal stem extension from surgical point of view. Insular glioma is somewhat different from the other location glioma.
PEDT-06 THERAPEUTIC STRATEGY FOR DISSEMINATED PILOCYTIC ASTROCYTOMAS
Authors: Suzuki Tomonari , Mizuno Rena , Uchida Eita , Shirahata Mitsuaki , Adachi Junichi , Mishima Kazuhiko , Fujimaki Takamitsu , Yanagisawa Takaaki , Nishikawa Ryo
Published: December 2019

BACKGROUND

Pilocytic astrocytoma is one of the common tumors found during childhood. However, the clinical course of disseminated pilocytic astrocytoma is not clearly known. Here, we present two cases with disseminated pilocytic astrocytoma and discuss the treatment strategy. Patients We treated a 7-year-old female (case 1) and 9-year-old male (case 2) with hypothalamic pilocytic astrocytomas. The results of magnetic resonance imaging showed diffuse spinal dissemination at diagnosis. Chemotherapy with vincristine and carboplatin was administered as the firstline therapy. The tumors showed some shrinkage, and symptoms improved. During chemotherapy, the patients developed allergies to carboplatin. Therefore, we changed the chemotherapy treatment to vincristine. Other adverse events were not observed. In Case 1, we observed an intratumoral hemorrhage and hydrocephalus due to occlusion of the foramen Monro. Endoscopic surgery was performed, and no clinical deficit was observed. Case 2 underwent ventricular peritoneal shunt procedure for communicating hydrocephalus and a reoperation for shunt malfunction because of dense cerebrospinal fluid with elevated protein levels. The patients have not undergone radiotherapy until now. They had no severe clinical symptoms and went to school for 5 and 10 years, respectively, after the diagnoses.

CONCLUSION

Chemotherapy for disseminated pilocytic astrocytoma is effective and may help in avoiding radiotherapy. Chemotherapy should be administered before radiotherapy, considering long-term complications.
IMT-02 VEGF RECEPTORS EXPRESSION AND REPORT OF CLINICAL TRIAL OF PEPTIDE VACCINE IN SKULL BASE CHORDOMA
Authors: Morimoto Yukina , Toda Masahiro , Tamura Ryota , Ohara Kentarou , Oishi Yumiko , Yoshida Kazunari
Published: December 2019

Chordoma is a rare refractory neoplasm that arises from the embryological remnants of the notochord. Vascular endothelial growth factor (VEGF) is a potent activator of angiogenesis that is associated with the tumor-immune microenvironment. To evaluate the characteristics of vascular and tumor cells in chordoma, we first analyzed the expression of VEGF receptor (VEGFR) 1, VEGFR2, CD34, and Brachyury in a cell line and 54 tumor tissues. Patients with primary skull base chordomas were divided into the two groups as per the tumor growth rate. The expressions of VEGF-A, VEGFR1, and VEGFR2 on tumor cells; tumor infiltrative immune cells, including regulatory T cells (Tregs) and tumor-associated macrophages (TAMs); and immune-checkpoint molecules (PD-1/PD-L1) were analyzed with the clinical courses. Both VEGFR1 and VEGFR2 were strongly expressed not only on vascular endothelial cells, but also on tumor cells. The recurrent cases showed significantly higher VEGFR1 expressions on tumor cells than the primary cases. The expression of VEGF-A, and the numbers of CD163+ TAMs and Foxp3+ Tregs were significantly higher in the patients with rapid progressive course than the patients with slow progressive course. Based on the present results, VEGFRs-targeted therapy may show efficacy in regulating growth of chordomas.
IMT-03 CLINICAL TRIAL FOR NEWLY DIAGNOSED MALIGNANT GLIOMA WITH WT1-W10 VACCINATION
Authors: Kawanishi Yu , Udaka Keiko , Yawata Toshio , Nakai Eiichi , Fukuda Hitoshi , Fukui Naoki , Ueba Tetsuya
Published: December 2019

OBJECT

Wilms’ tumor 1 (WT1) peptide vaccination is considered a potentially effective therapy against malignant glioma. We conducted a Phase I/II study to investigate the safety and feasibility of novel WT1 peptide (W10) vaccination therapy for patients with newly diagnosed malignant glioma.

METHODS

WT1 vaccination therapy was performed for patients with malignant glioma who have undergone concurrent radiotherapy and temozolomide therapy. A mixture of WT1 peptide with inactivated pertussis whole cell vaccine was injected intradermally once a week for at least 12 weeks.

RESULTS

Twenty-seven patients (12 men, 15 women; median 65 years) with the following tumors were enrolled: WHO grade IV (15), WHO grade III (12). PFS and OS of glioblastoma cases were 12.7 months 21.9 months, respectively. PFS of the MGMT unmethylated group was shorter than the methylated group. Interestingly enough, overall survival in the MGMT unmethylated group was not significantly different from the methylated group. Analysis of recurrent cases after immunotherapy showed decreased expression of WT1 antigen and increased Treg. They were suggested as a cause of treatment resistance. No serious adverse events were observed except for Grade 1 erythema at the injection sites.

CONCLUSIONS

This study of a novel WT1 vaccination therapy demonstrated safety and feasibility in the management of newly diagnosed malignant gliomas.
STMO-15 OUR THERAPEUTIC STRATEGIES FOR GLIOBLASTOMA: INTRAOPERATIVE SUPPORT SYSTEMS [INTRAOPERATIVE MRI, PET, 5-AMINOLEVULINIC ACID (5-ALA)] AND NEOADJUVANT CHEMOTHERAPY
Authors: Miyake Keisuke , Ogawa Tomoya , Fujimori Takeshi , Ogawa Daisuke , Okada Masaki , Hatakeyama Tetsuhiro , Tamiya Takashi
Published: December 2019

OBJECTIVE

Neuronavigation systems with MRI and multiple PET examinations (methionine [MET], fluorothymidine [FLT], and fluoromisonidazole [FMISO]) have become our standard techniques for glioma surgeries. Residual tumors are identified and removed using intraoperative MRI (IoMRI) to maximize tumor removal. This time, we performed tumor removal after Bevacizumab (Bev) therapy for glioblastoma with low KPS at admission and compared extraction rate and residual volume of MRI and PET examinations, and prognosis between with and without Bev therapy.

METHODS

We selected 12 glioblastoma patients with low KPS at admission and performed multiple PET examinations and IoMRI from January 2016 to July 2019. We divided them into the pre-Bev group that performed tumor removal after neoadjuvant Bev therapy and the non-Bev group that did not use Bev. We compared the extraction rate and residual volume of MRI and PET examinations, and prognosis between the pre-Bev group and the non-Bev group.

RESULTS

The pre-Bev group was 6 cases and the non-Bev group was 6 cases. The number of KPS for the pre-Bev group just before surgery was (90; 3 cases, 80; 2 cases, 70; 1 case) and (50; 2 cases, 40; 4 cases) for the non-Bev group. For comparison between the pre Bev group and the non-Bev group, the extraction rate (%) was T1-Gd (97.6, 91.5), MET (95.4, 99.9), FLT (96.2, 90.2), FMISO (97, 92), residual volume (ml) was T1-Gd (0.6, 1.7), MET (1.2, 2.9), FLT (1.0, 2.1), FMISO (0.5, 1.1), and for prognosis, median PFS (month) is (10.1, 4.9) and median OS (months) was (15.7, 13.3).

CONCLUSIONS

For glioblastoma patients with low KPS at admission, the neoadjuvant Bev therapy improved KPS just before surgery. The neoadjuvant Bev therapy improved the extraction rate and reduced residual volume of MRI and PET examinations and leads to the prolonged prognosis of PFS and OS.
RT-01 TREATMENT RESULTS OF SALVAGE GAMMA KNIFE STEREOTACTIC RADIOSURGERY AND BEVACIZUMAB (AVAGAMMA THERAPY) FOR RECURRENT GLIOBLASTOMA
Authors: Sato Kenichi , Takanashi Masami , Ozaki Yoshimaru , Asanome Taku , Sugio Hironori , Ishida Yuuki , Nakamura Hirohiko
Published: December 2019

PURPOSE

We report the treatment results of AVAgamma therapy combining gamma knife (GK) and bevacizumab for recurrent glioblastoma.

SUBJECTS

From August 2013 to April 2018, 42 patients (183 lesions) with recurrent glioblastoma treated with AVAgamma therapy as salvage therapy at the time of relapse after initial treatment. The average age is 61.1 years, with 25 men and 17 women. The tumor volume is 100 ml or less, and KPS is 40% or more as the indication of AVAgamma therapy. When the irradiation volume of GK is 15 ml or less, a single irradiation with a boundary dose of 20 Gy was performed, and when the irradiation volume was 15 ml or more, a single irradiation boundary dose was divided into two divided irradiations of 12 to 15 Gy. The mean therapeutic borderline dose was 24 Gy. Bevacizumab was administered 10 mg / kg or 15 mg / kg 1 to 10 times after GK.

METHODS

Median progression-free survival (mPFS), 6-month progression-free survival (PFS-6m), 6-month survival (OS-6m), median survival (mOS) from treatment with AVAgamma Considered mOS from initial treatment. [Results]: The mPFS from AVAgamma therapy was 5 months, PFS-6m was 37%, OS-6m was 84%, and mOS was 9 months. The mOS from initial treatment were 25 months. In relapsing glioma RPA classification, NABTT CNC class 5 mOS is 5.6 months, class 6 mOS is 6.4 months, but mOS from AVAgamma therapy is 9 months in class 5, 9 months in class 6. The survival time has been extended.

DISCUSSION

By AVAgamma therapy, it was thought that recurrent lesions were locally controlled and life prognosis was prolonged.

CONCLUSION

AVAgamma therapy is thought to prolong the survival of recurrent glioblastoma and play an important role as salvage treatment.
MPC-02 REVIEW OF MEDULLOBLASTOMA FOR THE ASSESSMENT OF CONSENSUS IN PATHOLOGICAL DIAGNOSIS USING JPMNG CASES
Authors: Sasaki Atsushi , Hirato Jyunko , Inoue Takeshi , Kanemura Yonehiro , Kodama Yoshinori , Ichimura Koichi , Sakamoto Hiroaki , Nishikawa Ryo
Published: December 2019

Medulloblastoma (MB) is now classified by WHO 2016 classification as “genetically defined” and “histologically defined” variants. The aim of this study is to search for consensus on pathological diagnosis and assess the correlation between the central pathological diagnosis and the molecular subgrouping. We performed the pathological and molecular analyses in a total of 176 JPMNG (The Japan Pediatric Molecular Neuro-Oncology Group) cases. The diagnosis of MB was made by three expert neuropathologists (AS, JH, and TH) without knowledge of the molecular data. Subgroup affiliation was determined by expression profiling of 22 medulloblastoma subgroup-specific genes using the nanoString nCounter system. Histologically, classic MBL accounted for approximately 80% of all MB cases. Genetic analyses of 176 cases revealed four distinct molecular subgroups: WNT (14%), SHH (27%), group 3 (16%), and group 4 (43%). The central review reached a diagnosis of AT/RT for 3 cases that had been diagnosed as MB by the local pathologists. Immunohistochemically, WNT MBs showed nuclear accumulation of β-catenin protein, but the immunoreactivity was patchy in approximately one-quarter of WNT cases. GAB1 often exhibited little or no reactivity in the SHH subgroup. No reliable staining was observed for YAP1. All D/N MBL (16 cases) or MBEN (6 cases) were defined as SHH tumors. All MBEN cases were in infants (<3 years of age), and genetically subdivided into SHH-TP53 wild-type tumors. Variable degrees of anaplasia, including LC/A MB, occur across the genetic subgroups, and the LC/A MB WNT type was rare (2/24=8.3%) among WNT subgroups. This study demonstrated that the combination of morphological and molecular analyses can precisely diagnose MB. More robust, surrogate markers should be developed as ancillary diagnostic testing for subgroup classification. Further exploration of the clinical significance of the variable degree of LC/A histology and some subtypes (i.e. LC/A, WNT) will be necessary for risk stratification.
NI-03 USEFULNESS OF IMP-SPECT IN PREOPERATIVE GRADE EVALUATION OF INTRAORBITAL TUMOR
Authors: Okonogi Shinichi , Kubota Shuuhei , Sakaeyama Yuuki , Ueda Keita , Nemoto Masaaki , Nagao Tateki , Sugo Nobuo
Published: December 2019

INTRODUCTION

The frequency of intraorbital tumors is small as 0.9% of all brain tumors, but its pathological type is diverse. Among them, the diagnosis of whether particularly malignant tumor scan clinically, is extremely important. Nuclear medical testing is essential for non-invasive differential diagnosis in brain tumors. SPECT, good malignancy differentiation, evaluation of malignancy, usefulness such as differentiation of non-tumorous lesions have been reported many. However, there are few reports that SPECT was useful in preoperative differential diagnosis of orbital tumors. Since 123IMP-SPECT was useful in preoperative differential diagnosis of intraorbital tumors, we report some literature considerations.

METHOD

Among the 27 cases of intraorbital tumors that were operated on in our clinic between August 2005 and August 2016, 14 cases of SPECT prior to surgery were examined for the usefulness of preoperative differential diagnosis. Breakdown of cases, as the malignant tumor, two cases of malignant lymphoma, MALT lymphoma 2 cases, adenoid cystic carcinoma 1 case, in one case plasma cytoma, as a benign tumor, false tumors 4 cases, three hemangioma cases, neurocytoma 1 case it was.

RESULTS

In IMP early image, accumulation of clear IMP was observed in all six cases of malignant tumors. In benign tumors, there is no accumulation in hemangioma and neurosheath, there is a strong accumulation in one of the four cases in false tumors, it was observed mild accumulation in the remaining two cases. Tumor to normal ratio of IMP early image was an average of 2.39 in six malignant tumors and 1.52 in 8 benign tumors.

CONCLUSION

This time, we examined the usefulness of 123IMP-SPECT in preoperative differential diagnosis of intraorbital tumors. The T/N ratio of intraorbital malignant tumors is higher than benign tumors, and it was thought to help to evaluate preoperative malignancy of intraorbital tumors.
NI-07 VALIDATION OF MACHINE LEARNING BASED HIGH GRADE GLIOMA MR SEGMENTATION VIA METHIONINE PET
Authors: Kinoshita Manabu , Ozaki Tomohiko , Arita Hideyuki , Kagawa Naoki , Kanemura Yonehiro , Fujimoto Yasunori , Sakai Mio , Watanabe Yoshiyuki , Nakanishi Katsuyuki , Shimosegawa Eku , Hatazawa Jun , Kishima Haruhiko
Published: December 2019

Treatment planning and lesion-follow up are generally conducted by contrast-enhanced MRI in glioma patient care. On the other hand, there are, however, substantial concerns whether MRI actually reflects the extension or activity of this neoplasm, which information should be fundamentally important at every step when treating this disease. As a matter of fact, the authors of this investigation have already shown that there is no difference in tumor cell density within areas with and without contrast enhancement (J Neurosurg. 2016,125(5):1136–1142.) and furthermore that the geometry of MRI based-radiation treatment planning is significantly altered when methionine PET is integrated for this purpose (J Neurosurg. 2018 published on-line). Regardless of these concerns, there is great interest in the research community to construct a machine learning based fully automated brain tumor segmentation tool specific for gliomas using MRI. The authors attempted to validate this method by comparing MRI-based automated brain tumor segmentation and methionine PET. Consecutively collected 45 high-grade gliomas (GBM-26, grade3-19) were analyzed. BraTumIA, an automated brain tumor segmentation tool, was used for machine learning based lesion segmentation. At the same time, lesions were segmented using various thresholds on methionine PET. The authors observed 40% of pseudo-positive and 90% of pseudo-negative error on BraTumIA based lesion segmentation when methionine PET was considered as ground truth with a cut-off of 1.3 in T/N ratio. Pseudo-negative error was as high as 60% even if the threshold was elevated to 2.0. Although machine learning based glioma segmentation is expected to expand in both research and clinical use, the observed results caution the use of MRI as ground truth of spatial extension of glioma and researchers should be reminded that this imaging modality may obscure the true behavior of the disease within the patient in some cases.
NI-20 IS GLIOMATOSIS CEREBRI DIAGNOSED AS GRADEII IN NEUROIMAGING A POTENTIALLY GRADEII GLIOMA?
Authors: Owashi Etsuko , Takei Hiroaki , Ikegame Yuka , Asano Yoshitaka , Miwa Kazuhiro , Ito Takeshi , Yokoyama Kazutoshi , Shinoda Jun , Maruyama Takashi , Muragaki Yoshihiro , Yano Hirohito , Iwama Toru
Published: December 2019

The 2007 World Health Organization (WHO) classification defined gliomatosis cerebri (GC) as a rare entity and an extensively infiltrating diffuse glioma involving three or more cerebral lobes. Although the revised 2016 WHO classification removed GC as a separate glioma entity due to the common histopathological findings shared with other gliomas, GC exhibits a distinct growth pattern and worse prognosis compared with other grade-matched gliomas. We retrospectively reviewed five patients with GC and five patients with insulo-opercular diffuse astrocytoma (IODA) who underwent both proton magnetic resonance spectroscopy (MRS) and [11C]-methionine positron emission tomography (MET-PET).

The patients were diagnosed with GC or IODA by T2-weighted magnetic resonance imaging /fluid-attenuated inversion recovery from April 2014 to August 2019 at our institution. The locations of lesions where single-voxel MRS to measure the N-acetylaspartate (NAA)/choline (Cho) ratio and MET-PET to measure the tumor/normal (T/N) ratio were performed were the same in every patient.

The mean age of all patients was 46.3±13.7 years. The mean ages of the GC (three males and two females) and IODA (two males and three females) groups were 54.0±14.0 and 38.6±8.7 years, respectively. The mean NAA/Cho ratios in the GC and IODA groups were 1.010±0.441 and 0.594±0.449, respectively. The mean T/N ratios in the GC and IODA groups were 1.201±0.050 and 1.169±0.009, respectively.

The higher NAA/Cho ratio in the GC lesions may reflect the abundance of normal neural tissue in GC compared with IODA. Nonetheless, the T/N ratios of the two groups were comparable. The discrepancy suggests that GC cells have higher tumor metabolic activity than IODA cells. Therefore, when GC is simply classified as grade II glioma based on neuroimaging diagnosis, the possibility of underestimating its malignant potential at the single-cell level should be considered.
ML-03 RECONSIDERATION OF TREATMENT FOR ELDERLY PATIENTS WITH PRIMARY CENTRAL NERVE SYSTEM LYMPHOMAS
Authors: Shinojima Naoki , Fujimoto Kenji , Makino Keishi , Yamamoto Takahiro , Kuroda Jun-ichiro , Ohta Kazutaka , Takezaki Tatsuya , Oda Kazutaka , Nakamura Kazumi , Jono Hiroshi , Mikami Yoshiki , Mukasa Akitake
Published: December 2019

BACKGROUND

The therapeutic response to high-dose methotrexate therapy (HD-MTX) for primary central nervous system lymphoma (PCNSL) varies. Polyglutamylation (PG) is a reversible protein modification, tumor cells show frequent occurrence of PG. Intracellularly polyglutamylated MTX is not subject to competitive inhibition by leucovorin (LV). Tumor cells with high PG levels are selectively killed, whereas normal cells with lower PG are rescued by LV. We previously reported that PG is a predictor of therapeutic response to HD-MTX in PCNSL. However, PG did not affect overall survival (OS) in the elderly unlike the young patients, suggesting that there are other significant predictors in the elderly. The aim of this study is to identify the prognostic factors in aged PCNSL.

METHODS

The prognostic factors were investigated in 48 patients (M/F=23/25) aged 65 and older undergoing HD-MTX in our institute with data of area under the concentration-time curve of MTX, AUCMTX (μmol/L/h).

RESULTS

The median OS of elderly PCNSL was 937days. In the AUCMTX high group (median 1706.3 or more, n=24) and the low group (median below, n=24), OS was significantly shortened in the high group compared with the low group (median 728 vs 1290days, p=0.032). Even in multivariate analysis, AUC was the only independent poor prognostic factor of OS (p=0.031). On the other hand, AUC was not a prognostic factor for OS in PCNSL younger than 65 years. AUCMTX of aged PCNSL was significantly higher compared with younger patients (p<0.01). These results suggested that PG may be a good prognostic factor of OS when AUCMTX is low.

CONCLUSION

In the aged PCNSL, OS was shortened when AUCMTX was high. With the results of the previous research, it is suggested that if PG levels is high in elderly PCNSL, the OS prolongation can be expected if the MTX dose is reduced.
MNG-08 VOLUMETRIC STUDIES IN ASYMPTOMATIC MENINGIOMAS: SLOWDOWN CASES AND GROWTH ARREST CASES
Authors: Hirayama Ryuichi , Nakagawa Tomoyoshi , Umehara Toru , Yokota Chisato , Kijima Noriyuki , Kinoshita Manabu , Kagawa Naoki , Kishima Haruhiko
Published: December 2019

BACKGROUND

The opportunity to follow up for asymptomatic meningiomas has increased. We have reported the risk of volume increase by individual continuous volume measurement of asymptomatic meningiomas. However, We have not reached fully understanding about natural history of meningiomas. Among cases are followed up over time, there are some cases that the volume increase rates slows down or almost stops are observed.

METHODS

We enrolled consecutive adult patients of asymptomatic meningiomas who follow-up for 2 years or more and 3 or more MRI scans. We performed sequential volumetric measurements on 95 patients (105 lesions) who met the criteria. We classified these transient volume curve of each lesion into three groups “Growing”, “Slowdown”, and “Growth arrest” for analysis.

RESULTS

The average age at the first visit was 62.8 years, the average follow-up period was 61.8 months, and the male-female ratio was 20:75 (male: female). There were 67 cases (73 lesions: 70.9%) that were in increasing trend, and 19 cases of those were received resection. Eleven cases (12 lesions: 11.7%) showed a tendency of “slow down” the increase rate, and one patient who became symptomatic led to surgical excision. In 18 cases (18 lesions: 17.4%) in which almost no volume change was observed during the observation period, no cases resulted in surgical treatment.

CONCLUSIONS

Among the meningiomas cases that have been followed for a long time, there are not a few those increase rate of tumor volume slows or does not change. Furthermore, most of these cases did not result in surgical treatment. The presence of these “Slowdown” and “Growth arrest” cases at a certain rate may have suggested the possibility of a Gompertz curve model as the natural course of meningiomas.
BT-03 A CASE OF ADULT-ONSET MEDULLOBLASTOMA PRESENTING WITH ATYPICAL CLINICAL COURSE AND MAGNETIC RESONANCE IMAGING
Authors: Ohue Shiro , Watanabe Masashi , Kusakabe Kousuke , Shinohara Tomoki , Fujiwara Satoshi , Ichikawa Haruhisa , Iwata Shinji , Okamoto Kensho , Ishida Yasushi
Published: December 2019

An 18-year-old woman gradually developed speech and gait disturbance for seven months. On admission, she presented with cerebellar ataxia and tetraparesis. Magnetic resonance images showed diffuse hyperintense lesions around the fourth ventricle in FLAIR, in addition to lesions of nodular diffusion restriction with enhancement. Heavily T2-weighted images revealed small cystic appearance within this lesion. We diagnosed her as classical medulloblastoma by open brain biopsy. We should consider medulloblastoma as a differential diagnosis of these characteristics around the fourth ventricle, even if magnetic resonance findings are atypical in point of no mass effect and heterogeneous enhancement.
CS-07 A CYSTIC LONG-SEGMENT CERVICAL SCHWANNOMA: A CASE REPORT
Authors: Takeshima Yuki , Takezaki Tatsuya , Hamasaki Tadashi , Tajiri Seiji , Mukasa Akitake
Published: December 2019

Schwannomas are the most common intradural extramedullary spinal tumors. However, they are usually solid tumors, and totally cystic changes are rare. Herein, we report a case of a 46-year-old male presenting with numbness of right limbs, right hemiplegia, and posterior neck pain for one year. MRI revealed a well-defined cystic long-segment, from C1 to C6, intradural extramedullary mass. The lesion showed hypointense on T1WI, hyperintense on T2WI, hyperintense on DWI, and it was marginally enhanced on the contrast image with Gd-DTPA. C1 laminectomy and hemi-laminectomy from C2 to C6 was performed for tumor resection. The tumor was found to be totally cystic and tensed with a jelly-like content. It was completely resected with the attachment of the C3 dorsal root. Histopathological examination confirmed it to be a schwannoma. The mechanism of cyst formation in schwannoma is considered as results of ischemic necrosis associated with tumor growth, or cystosis due to degeneration of Antoni-type B region. The long-segment, totally cystic intradural cervical schwannoma is rare, but it should be included in the differential diagnosis of a cystic mass in the spinal region. It can be difficult to distinguish cystic spinal schwannomas from other cystic lesions like arachnoid cyst, epidermoid cyst, and neurenteric cyst. Contrast enhanced MRI is useful by enhancing the margin of the tumor.
COT-04 FAMILY SUPPORT FOR PATIENTS WITH PRIMARY MALIGNANT BRAIN TUMORS BY PATIENT SUPPORT GROUP IN NATIONAL CANCER CENTER
Authors: Horikawa Mayumi , Kishi Tatsuya , Ishii Kazumi , Mori Ayako , Narita Yoshitaka , Miyakita Yasuji , Ohno Makoto , Takahashi Masamichi
Published: December 2019

BACKGROUND

A family support group for patients with primary malignant brain tumors in our hospital is called “Brain Tumor Family Table.” We conduct regular meetings, such as 30 minutes of medical lectures and 60 minutes of healthcare discussions, between participants and medical staff which is supervised by a nurse. To provide more effective family support, we report our activities.

METHOD

A total of 96 family members participated in 11 meetings from July 2015 to March 2019 and answered anonymous questionnaires about their participation. This survey evaluated their motivation for participation and the level of satisfaction toward the lectures and discussions by three-level scores and free description.

RESULT

Regarding the reason of their participation, 28.1% of the participants answered, “I want to talk to someone who is in the same condition.” We found that 83.3% of them were satisfied with the lectures, and 89.6% of them were satisfied with the discussions and conversations. The reasons for their satisfaction were: “I was happy to hear the story of other patients” (19.0%), “I feel positive toward patient care” (19.0%), and “I realized I was not alone” (17.2%). Moreover, 92.7% answered “I would like to participate in the next meeting.” Among them, 26.1% answered “I want to talk again,” 14.2% answered “I feel stable,” and 14.2% answered “I can get information.” There were other opinions, like “Sharing feelings is important” and “I would like to help others next time,” as well.

DISCUSSION

Malignant brain tumors are orphan cancers, and patients and their families lack the information about the disease and the chance to share their experiences. Hence, participants were quite satisfied with this meeting. We will improve our facilitating skills as an organizing body so that participants can share their experiences and feelings to reduce their loneliness and finally feel positive toward patient care.
COT-19 TREATMENT EXPERIENCE OF AND TIPS FOR ADMINISTRATING NOVO TTF
Authors: Shimada Daisuke , Kobayashi Keiichi , Saito Kuniaki , Matsumoto Yoshie , Shiokawa Yoshiaki , Nagane Motoo
Published: December 2019

BACKGROUNDS

Current standard of care for glioblastoma, consists of postoperative temozolomide (TMZ) concomitant with radiotherapy, followed by adjuvant TMZ monotherapy. Recently, an international phase 3 trial (EF-14) demonstrated that addition of tumor-treating fields (TTF) to adjuvant TMZ after completion of chemoradiotherapy extended median progression-free survival and overall survival by 2.7 months and 4.8 months, respectively, compared with TMZ alone in patients with newly diagnosed glioblastoma. TTF is now considered as a part of its initial treatment in the guideline in Japan (recommendation grade B). However,distinct from anticancer drugs,little is known or experienced using TTF as a therapeutic device so far, especially in management and handling.

METHODS

First six patients with newly diagnosed glioblastoma who underwent TTF were analyzed with special interest in medical and social supports to execute TTF at home.

RESULTS

TTF was first introduced in our institution in May 2016, but no patients were treated because of no coverage by medical insurance until December 2017. We further needed to wait to initiate TTF treatment until January 2019 when the contract to use TTF systems was finally made between the company and institution. Since then six patients were registered in five months. For its introduction to clinical practice,it is essential to establish new in-house environment with medical professions division in the facility including documentations of calculating instruction fees and usage guidance for home care application of TTF. It is also important to initiate providing information of TTF such as timing of visit by specific practitioners and potential medical and psychologic burdens to patients and their families during and after chemoradiotherapy to better understand this new modality leading to the consent acquisition.

CONCLUSIONS

Introducing TTF into clinical practice should accompany improvement of management in not only medical equipment and documentations but also patient care in hospital and home.
COT-21 EFFECT OF BEVACIZUMAB FOR PEDIATRIC HIGH GRADE GLIOMA
Authors: Tsukamoto Yoshihiro , Natsumeda Manabu , Okada Masayasu , Eda Takeyoshi , Yoshimura Junichi , Okamoto Kouichirou , Oishi Makoto , Fujii Yukihiko
Published: December 2019

INTRODUCTION

Bevacizumab (BEV) therapy has been used for pediatric high grade glioma,however the evidence and effectiveness are not understood yet.

METHODS

We report 7 cases (age 2 to 10 years old) of pediatric high grade glioma treated with BEV. One case is thalamic diffuse midline glioma H3K27 mutant (DMGH3K27M),one case is brain stem DMGH3K27M,one case is cerebellar high grade glioma,and 4 cases are diffuse intrinsic pontine glioma (DIPG) diagnosed clinically without biopsy. 5 cases were treated with BEV when diagnosed as recurrence after chemo-radiotherapy. One case was treated for rapid tumor progression during radiotherapy. One case was started on BEV therapy with radiation and concomitant temozolomide therapy.

RESULT

The number of times of BEV was 2 to 13 times (median 7 times). The period of BEV was 1 to 9 months (median 4 months). One case which was treated with BEV at rapid progression during radiation showed good response on imaging and improvement of symptoms. 4 of 5 cases who were treated at recurrence clinically showed mild symptomatic improvement. One case treated with BEV and radiotherapy initially was not evaluated. The adverse effects of BEV included wound complication of tracheostomy and rash.

CONCLUSION

BEV showed good response for rapid progression during radiotherapy,and mild response for recurrence cases. BEV is thought to be an effective therapeutic agent for pediatric HGG at recurrence and rapid tumor progression during radiotherapy.
Prevalence of systemic lupus erythematosus in Spain: higher than previously reported in other countries?
Authors: Cortés Verdú Raúl , Pego-Reigosa José M , Seoane-Mato Daniel , Morcillo Valle Mercedes , Palma Sánchez Deseada , Moreno Martínez María J , Mayor González Marta , Atxotegi Sáenz de Buruaga Joana , Urionagüena Onaindia Irati , Blanco Cáceres Boris A , Silva-Fernández Lucía , Sivera Francisca , Blanco Francisco J , Sánchez-Piedra Carlos , Díaz-González Federico , Bustabad Sagrario ,   for the Working Group Proyecto EPISER2016
Published: December 2019

Objectives

Prevalence of SLE varies among studies, being influenced by study design, geographical area and ethnicity. Data about the prevalence of SLE in Spain are scarce. In the EPISER2016 study, promoted by the Spanish Society of Rheumatology, the prevalence estimate of SLE in the general adult population in Spain has been updated and its association with sociodemographic, anthropometric and lifestyle variables has been explored.

Methods

Population-based multicentre cross-sectional study, with multistage stratified and cluster random sampling. Participants were contacted by telephone to carry out a questionnaire for the screening of SLE. Investigating rheumatologists evaluated positive results (review of medical records and/or telephone interview, with medical visit if needed) to confirm the diagnosis. To calculate the prevalence and its 95% CI, the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. Multivariate logistic regression models were defined to analyse which sociodemographic, anthropometric and lifestyle variables included in the telephone questionnaire were associated with the presence of SLE.

Results

4916 subjects aged 20 years or over were included. 16.52% (812/4916) had a positive screening result for SLE. 12 cases of SLE were detected. The estimated prevalence was 0.21% (95% CI: 0.11, 0.40). SLE was more prevalent in the rural municipalities, with an odds ratio (OR) = 4.041 (95% CI: 1.216, 13.424).

Conclusion

The estimated prevalence of SLE in Spain is higher than that described in most international epidemiological studies, but lower than that observed in ethnic minorities in the United States or the United Kingdom.
Facilitating Recovery of Daily Functioning in People With a Severe Mental Illness Who Need Longer-Term Intensive Psychiatric Services: Results From a Cluster Randomized Controlled Trial on Cognitive Adaptation Training Delivered by Nurses
Authors: Stiekema Annemarie P M , van Dam Michelle T , Bruggeman Richard , Redmeijer Jeroen E , Swart Marte , Dethmers Marian , Rietberg Kees , Wekking Ellie M , Velligan Dawn I , Timmerman Marieke E , Aleman André , Castelein Stynke , van Weeghel Jaap , Pijnenborg Gerdina M H , van der Meer Lisette
Published: December 2019

Background

Feasible and effective interventions to improve daily functioning in people with a severe mental illness (SMI), such as schizophrenia, in need of longer-term rehabilitation are scarce.

Aims

We assessed the effectiveness of Cognitive Adaptation Training (CAT), a compensatory intervention to improve daily functioning, modified into a nursing intervention.

Method

In this cluster randomized controlled trial, 12 nursing teams were randomized to CAT in addition to treatment as usual (CAT; n = 42) or TAU (n = 47). Daily functioning (primary outcome) was assessed every 3 months for 1 year. Additional follow-up assessments were performed for the CAT group in the second year. Secondary outcomes were assessed every 6 months. Data were analyzed using multilevel modeling.

Results

CAT participants improved significantly on daily functioning, executive functioning, and visual attention after 12 months compared to TAU. Improvements were maintained after 24 months. Improved executive functioning was related to improved daily functioning. Other secondary outcomes (quality of life, empowerment, negative symptoms) showed no significant effects.

Conclusions

As a nursing intervention, CAT leads to maintained improvements in daily functioning, and may improve executive functioning and visual attention in people with SMI in need of longer-term intensive psychiatric care. Given the paucity of evidence-based interventions in this population, CAT can become a valuable addition to recovery-oriented care.
Draft Genome Sequence of ‘Candidatus Phytoplasma pini’-Related Strain MDPP: A Resource for Comparative Genomics of Gymnosperm-Infecting Phytoplasmas
Authors: Cai Weili , Shao Jonathan , Zhao Yan , Davis Robert E. , Costanzo Stefano
Published: December 2019

‘Candidatus Phytoplasma pini’-related strain MDPP, the reference strain of subgroup 16SrXXI-B, is a pathogen associated with witches’ broom disease of Pinus spp. in North America. Here, we report the first draft genome sequence of ‘Ca. Phytoplasma pini’ strain MDPP, which consists of 474,136 bases, with a G + C content of 22.22%. This information will facilitate comparative genomics of gymnosperm-infecting phytoplasmas.
Metabolic control of T cells in autoimmunity
Authors: Kono Michihito , Yoshida Nobuya , Tsokos George C.
Published: December 2019

Purpose of review

Th1, Th17, and Treg cells play distinct roles in autoimmune diseases, including systemic lupus erythematosus, multiple sclerosis, and rheumatoid arthritis. During the last 5 years we have learned that T-cell metabolism affects cell survival, differentiation and fate of T cells.

Recent findings

We highlight recent studies which have reported on T-cell metabolism in autoimmune diseases, differences in cellular metabolisms in T-cell subsets among various diseases and transcription factors which control the expression and function of central metabolic enzymes.

Distinct metabolic processes control the function of T-cell subsets in autoimmune disease and known transcription factors control the activity of metabolic enzymes. The revealed insights into the metabolic events of immune cells offer opportunities for new therapeutic approaches.
Pilon Fractures in Patients Older Than 60 Years of Age: Should We Be Fixing These?
Authors: Haller Justin M. , Githens Michael , Rothberg David , Higgins Thomas , Nork Sean , Barei David
Published: December 2019

Objectives:

To compare complications after operatively treated pilon fracture between elderly patients (≥60 years) and younger patients (<60 years).

Design:

Retrospective comparative study.

Setting:

Two Level-1 academic trauma.

Patients/Participants:

Of the 740 tibial plafond fractures (OTA/AO 43-B & 43-C) treated January 2006 through December 2016, 538 patients had a minimum of 1 year follow up.

Intervention:

Open reduction–internal fixation (ORIF).

Main Outcome Measurement:

Treatment failure defined as either nonunion or arthrosis.

Results:

A total of 72 patients comprised the elderly group (mean age 66 years) and 466 patients comprised the younger group (mean age 44 years) (P < 0.001). Besides significantly more tobacco use in the younger group, patient demographics and fracture characteristics did not differ. Locking plates were used significantly more in elderly patients (47% vs. 32%, P = 0.01). Using chi-square analysis, we were unable to detect a difference in treatment failure (elderly 43% vs. young 37%, P = 0.33), infection (elderly 10% vs. young 13%, P = 0.4), or malunion (elderly 3% vs. young 4%, P = 1.0). Using regression analysis, age >60 was not associated with treatment failure [odds ratio (OR) 1.2 (0.7–2.1), P = 0.52]. Bone loss (OR 2.7 [1.8–4.1], P < 0.001), open fracture (OR 1.6 [1–2.5], P = 0.03), and malreduction (OR 4.2 [2.5–7.3], P < 0.001) were associated with failure.

Conclusions:

Age >60 years is not an independent predictor of surgical treatment failure of pilon fractures as defined by nonunion or arthrosis. This is the largest cohort of pilon fracture in elderly patients and indicates that we should continue to treat elderly patients similar to their younger counterparts using ORIF.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life
Authors: Telli Hilal , Hüner Berrin , Kuru Ömer
Published: December 2019

Study Design.

A prospective cross-sectional study.

Objective.

To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination.

Summary of Background Data.

Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain.

Methods.

Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale.

Results.

63.2% of patients were female and 36.8% were male. Mean age was 46.72 ± 11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02).

Conclusion.

Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments.

Level of Evidence: 2
Targeting the Mevalonate Pathway for Treating Lung Cancer
Authors: Fatehi Hassanabad Ali , Mina Fady
Published: December 2019

The mevalonate (MVA) pathway is a key metabolic pathway involved in various important cellular functions. Its downstream products are critical for cell-signaling, cell membrane integrity, protein synthesis, and cellular respiration. The rate-limiting enzyme of this pathway is targeted by statins, a class of medications best known for their lipid-lowering effects. Many studies have shown that a variety of cancerous cells have a dysregulated MVA pathway. Lung cancer is responsible for a third of all cancer-related deaths worldwide. As our understanding of the molecular mechanisms driving the pathogenesis of lung cancer improves, newer therapeutics have been proposed. However, these medications have not had the expected benefits for all subtypes of lung cancer. Therefore, there exists a significant role in identifying medications with safe profiles, which can potentially be used in managing various types of lung cancer. Herein, we review whether there is a role in utilizing statins to target the MVA pathway in treating lung cancer.
Single Bolus Rosuvastatin Accelerates Calcium Uptake and Attenuates Conduction Inhomogeneity in Failing Rabbit Hearts With Regional Ischemia–Reperfusion Injury
Authors: Chou Chung-Chuan , Lee Hui-Ling , Huang Yu-Chang , Wo Hung-Ta , Wen Ming-Shien , Chu Yen , Chang Po-Cheng
Published: December 2019

Acute statin therapy reduces myocardial ischemia/reperfusion (IR) injury–induced ventricular fibrillation (VF), but the underlying electrophysiological mechanisms remain unclear. This study sought to investigate the antiarrhythmic effects of a single bolus rosuvastatin injection in failing rabbit hearts with IR injury and to unveil the underlying molecular mechanisms. Rabbits were divided into rosuvastatin, rosuvastatin + l-NAME, control, and l-NAME groups. Intravenous bolus rosuvastatin (0.5 mg/kg) and/or l-NAME (10 mg/kg) injections were administered 1 hour and 15 minutes before surgery, respectively. Heart failure was induced using rapid ventricular pacing. Under general anesthesia with isoflurane, an IR model was created by coronary artery ligation for 30 minutes, followed by reperfusion for 15 minutes. Plasma NO end product levels were measured during IR. Then, hearts were excised and Langendorff-perfused for optical mapping studies. Cardiac tissues were sampled for Western blot analysis. Rosuvastatin increased plasma NO levels during IR, which was abrogated by l-NAME. Spontaneous VF during IR was suppressed by rosuvastatin (P < 0.001). Intracellular calcium (Cai) decay and conduction velocity were significantly slower in the IR zone. Rosuvastatin accelerated Cai decay, ameliorated conduction inhomogeneity, and reduced the inducibility of spatially discordant alternans and VF significantly. Western blots revealed significantly higher expression of enhancing endothelial NO-synthase and phosphorylated enhancing endothelial NO-synthase proteins in the Rosuvastatin group. Furthermore, SERCA2a, phosphorylated connexin43, and phosphorylated phospholamban were downregulated in the IR zone, which was attenuated or reversed by rosuvastatin. Acute rosuvastatin therapy before ischemia reduced IR-induced VF by improving SERCA2a function and ameliorating conduction disturbance in the IR zone.