bluuebunny/crossref_metadata_2025 huggingface dataset:
MPC-08 CLINICOPATHOLOGICAL ANALYSIS OF 12P GAIN IN INTRACRANIAL GERM CELL TUMORS
Authors: Satomi Kaishi , Takami Hirokazu , Fukushima Shintaro , Nakazato Yoichi , Tanaka Shota , Saito Nobuhito , Kanamori Masayuki , Kumabe Toshihiro , Kobayashi Keiichi , Nagane Motoo , Iuchi Toshihiko , Yoshimoto Koji , Tamura Kaoru , Maehara Taketoshi , Sakai Keiichi , Sugiyama Kazuhiko , Yokogami Kiyotaka , Takeshima Hideo , Nonaka Masahiro , Asai Akio , Nishikawa Ryo , Matsutani Masao , Ichimura Koichi
Published: December 2019

BACKGROUND

Gain of short arm of chromosome 12 (12p) is commonly observed in testicular germ cell tumors (tGCTs). 12p gain is also frequently seen in intracranial GCTs (iGCTs). However, little is known about the clinical significance of 12p gain in iGCTs.

MATERIALS AND METHODS

We have collected over 200 fresh frozen tissue samples of iGCTs through the Intracranial Germ Cell Tumor Genome Analysis Consortium in Japan. Firstly, we analyzed DNA methylation status in 83 iGCTs, 3 seminomas and 6 normal control samples using Infinium Human Methylation 450K BeadChip array (Illumina, CA). Idat files were processed using R (Version 3.5.3) and minfi package (1.30.0) to generate copy number variations. Compared with average genome-wide copy number level, 12p gain was determined. Then, 58 iGCTs with clinicopathological information were analyzed for progression-free survival (PFS) and overall survival (OS). Those tumors that consist of only either germinoma and/or mature teratoma components were classified as Favorable Histology (FH) and all the others that contains malignant histological components were classified as Unfavorable Histology (UFH).

RESULT

12p gain was observed in 100% (3/3) of seminoma, 13.6% (3/22) of germinoma, 16.7% (1/6) of mature teratoma, 25% (1/4) of immature teratoma, 55% (11/20) of mixed germ cell tumor, 100% (4/4) of yolk sac tumor, 100% (1/1) of embryonal carcinoma, and 100% (1/1) of choriocarcinoma. In total, 44.6% (37/83) of iGCT showed 12p gain. Regarding histological classification, the 12p gain rate in UFH (72%, 18/25) was significantly higher than that in FH (12.1%, 4/33, P<0.01). Both PFS and OS were significantly worse in iGCTs with 12p gain (PFS: P=0.027, OS: P=0.0012).

DISCUSSION

12p gain can be a molecular marker to predict prognosis and histological malignancy in iGCTs.
MPC-15 FEASIBILITY OF GLIOMA SPECIFIC ONCOPANEL IN THE DIAGNOSIS OF GLIOMA
Authors: Yoshimoto Koji , Higa Nayuta , Akahane Toshiaki , Yonezawa Hajime , Uchida Hiroyuki , Tanimoto Akihide
Published: December 2019

AIM

Molecular classification of glioma is a mandatory in the diagnosis of glioma according to the WHO 2016 classification of tumors of the central nervous system. However, WHO does not indicate the molecular methodology to be integrated, and the versatility and cost-effectiveness of molecular diagnosis is a concern. In this study, we evaluate the feasibility of a glioma specific tailored NGS panel where driver gene mutation and 1p/19q codeletion can be analyzed in a single platform.

MATERIALS AND METHODS

We developed a glioma specific tailored NGS panel consisting of 48 key driver genes including IDH1/2, TP53, PTEN, EGFR, PDGFR, NF1, RB1, CDKN2A, and the TERT promoter. DNA was extracted from FFPE tumor tissues histologically identified by a pathologist, and from patient derived blood to serve as a control. In this system, gene mutations and copy number alterations can be precisely characterized, thus 1p/19q co-deletion can also be evaluated. We have analyzed 106 glioma patients (Grade II: 19 cases, Grade III: 23 cases, Grade IV: 64 cases) using this system.

RESULTS

From these 106 cases, IDH1 and TERT promoter mutations were detected in 33 cases (28%) and 55 cases (52%), respectively. 1p/19q co-deletion was detected in 19 cases (18%), with IDH1 mutations in all cases. In 57 Grade IV cases, TP53, PTEN, RB1, NF1, PDGFRA mutations were detected in 25 cases (43%), 24 cases (41%), 10 cases (17%), 8 cases (14%) and 6 cases (10%). Although EGFR mutation frequency was low (3%), amplification was detected in 14 cases (24%). As for deletion, PTEN and CDKN2A loci were deleted in 36 cases (62%) and 30 cases (52%), respectively. To note, MET alterations were detected in 2 cases. The cases in which histopathological diagnosis is difficult to make have a tendency to show atypical genetic alterations.

CONCLUSION

Diagnosis of glioma patients with this glioma-specific tailored NGS panel is feasible.
MPC-18 CATEGORIZATION OF LOWER GRADE GLIOMA USING ONCOPANEL
Authors: Uchida Hiroyuki , Akahane Toshiaki , Higa Nayuta , Kirishima Mari , Hiraki Tsubasa , Yonezawa Hajime , Tanimoto Akihide , Yoshimoto Koji
Published: December 2019

PURPOSE

We are developing a 48-gene OncoPanel (Kagoshima Brain Tumor 48 OncoPanel) specializing in glioma diagnosis. Clinical application of genetic diagnosis derived from genetic alterations detected by OncoPanel, including IDH mutation, 1p/19q-codeletion, and other gene mutations in lower-grade glioma was verified.

METHODS

The 48 genes consist of 24 genes related to glioma and 24 genes on chromosomes 1 and 19. DNA was extracted from tumor FFPE samples and blood samples, and then single nucleotide variants and copy number variants were detected using next-generation sequencer.

RESULTS

Among the 99 diffuse glioma cases that had undergone OncoPanel analysis by July 2019, 40 cases diagnosed histologically as WHO grade 2 or 3 diffuse glioma were included. The integrated diagnosis by conventional gene analysis were Diffuse astrocytoma 10 cases, anaplastic astrocytoma 11 cases, oligodendroglioma 10 cases, anaplastic oligodendroglioma 9 cases. IDH1 mutation was detected in 30 cases, of which in 19 cases 1p/19q-codeletion was detected, all with TERT mutation. Among 11 cases with 1p/19q-non-codeletion, ATRX mutation was detected in 10 cases and was almost mutually exclusive with TERT mutation. In 10 cases without IDH mutation, EGFR amplification or mutation was detected in 6 cases, of which 4 cases were accompanied by TERT mutation.

DISCUSSION

KBT48 can detect TERT and ATRX mutations in a mutually exclusive manner and can improve the classification accuracy of oligodendroglioma and astrocytoma. Groups with gene profiles similar to glioblastoma with EGFR amplification/mutation and TERT mutation can also be classified.

CONCLUSIONS

In the diagnostic classification of lower-grade glioma, KBT48 can well classify into oligodendroglioma group, astrocytoma group and glioblastoma-like group, and is considered to be applicable in clinical practice.
NI-01 CONTRAST-ENHANCED MRI AND POSITRON EMISSION TOMOGRAPHY FOR DISTINGUISHING THE GRADE OF GLIOMA
Authors: Takei Hiroaki , Ohwashi Etsuko , Ikegame Yuka , Asano Yoshitaka , Shinoda Jun , Miwa Kazuhiro , Ito Takeshi , Yokoyama Kazutoshi , Nakayama Noriyuki , Yano Hirohito , Ikuta Sohko , Maruyama Takashi , Muragaki Yoshihiro , Iwama Toru
Published: December 2019

OBJECTIVE

Grading of glioma according to the WHO classification plays an important role in the treatment of patients with glioma. It is widely recognized that malignant gliomas exhibit contrast enhancement on MRI, whereas low-grade gliomas do not exhibit contrast enhancement. However, we sometimes encounter malignant gliomas without contrast enhancement on MRI. In this study, we evaluated the diagnostic accuracy of contrast-enhanced MRI and PET for distinguishing the WHO grade of glioma.

METHODS

A total of 105 patients with newly diagnosed cerebral glioma were included in the study. All patients underwent 11C-Methionine (MET), 11C-Choline (CHO), 18F-Fluorodeoxyglucose (FDG) PET and MRI. The specificity and sensitivity of MRI contrast enhancement and mean T/N ratios of these three tracers for each WHO grade were analyzed.

RESULTS

Contrast enhancement was observed in 35 patients (33%) of the total. Contrast enhancement was observed in 1/30 (3%) in grade 2, 8/43 (19%) in grade 3, and 26/30 (87%) in grade 4. The sensitivity and specificity of MRI for differentiating grade 2 from grade 3 was 11.1% and 54.7%, respectively. In contrast, the cutoff value, sensitivity, and specificity of each tracer for differentiating grade 2 from grade 3 were: 1.70, 66.7%, and 58.1% for MET; 2.15, 76.7%, and 51.2% for CHO; and 0.64, 80.0%, and 32.6% for FDG, respectively. DISCUSSION: A correlation between contrast enhancement of MRI and WHO grade was observed to some extent; however, only 19% grade 3 gliomas showed contrast enhancement. The sensitivity and specificity of PET for differentiating between grade 2 and 3 was relatively higher than that of MRI; however, it was not suitable for clinical use.

CONCLUSION

Contrast-enhanced MRI may not be reliable for determining the WHO grade for glioma, in particular differentiating between grade 2 and 3. Comprehensive evaluation with MRI and PET can provide more accurate diagnosis.
NI-05 CLINICOPATHOLOGICAL ANALYSIS AND METHIONINE PET ANALYSIS IN PATIENTS WITH GLIOMATOSIS CEREBRI
Authors: Yano Hirohito , Nakayama Noriyuki , Ohe Naoyuki , Miyai Masafumi , Yamada Tetsuya , Miwa Kazuhiro , Shinoda Jun , Iwama Toru
Published: December 2019

OBJECTIVE

Gliomatosis cerebri (GC) was defined as the tumor infiltrating into more than three lobes in WHO2007, but was deleted in WHO2016 because they include genetically heterogeneous tissues. However, we often encounter the cases with strongly invasive glioma. Then, we clinically analyzed the cases of GC.

PATIENTS AND METHODS

Seven cases (five men, median age: 57 years (23-89y)) diagnosed as GC in our hospital were included. Data of methionine-positron emission tomography (Met-PET), IDH and p53 mutation, MIB1-labeling index (LI) by immunohistochemistry were searched. We compared the accumulation areas of the Met-PET with the hyperintensity area (T2/FLAIR-high) and gadolinium-enhanced area on the MRI. We also examined a biopsy method, sites and a treatment regimen and analyzed overall survival (OS) and progression-free survival (PFS).

RESULTS

The primary symptoms were disorientation in five, epileptic seizure and abnormal vision were two, respectively. The largest lesion area with the image was T2/FLAIR-high, followed by Met-PET and Gd in all. The surgical methods were stereotactic biopsy (2), navigation-guided biopsy (2), endoscopic biopsy (1), and craniotomy (2), The average of tumor/normal ratio in Met-PET was 2.92 (1.97–5.0). The pathological grade was diagnosed as Grade III in 4 and Grade II in 3. IDH1R132H was negative in all, p53 was positive in 5, and an average of MIB-1LI was 12% (2–35). The radiotherapy was performed in 6 cases, and, temozolomide was given to all, and bevacizumab was in 3. Six patients died of a tumor. Median PFS and OS were 8mos and 16.5mos, respectively.

CONCLUSION

Because the GC cannot expect improvement by surgery, it is necessary to obtain the pathological diagnosis by a quick and correct biopsy, and the neurologic deterioration by the biopsy technique should be avoided. The Met-PET suggesting the highest grade site was useful for the plan of the biopsy site.
NI-15 THE USEFULNESS OF PET IMAGING IN MOLECULAR DIAGNOSIS OF GLIOMA
Authors: Ogawa Tomoya , Miyake Keisuke , Fujimori Takeshi , Ogawa Daisuke , Okada Masaki , Hatakeyama Tetsuhiro , Okauchi Masanobu , Shindo Atsushi , Kawanishi Masahiko , Tamiya Takashi
Published: December 2019

OBJECTIVE

After WHO 2016 Classification of Tumors of the Central Nervous System have published, molecular diagnosis became part of the diagnostic criteria. In this study, we investigated the correlation between PET images and molecular diagnosis of glioma.

METHODS

We performed retrospective review of newly diagnosed supratentorial glioma patients who preoperatively underwent all four PET examinations (18F-FDG, 11C-MET, 18F-FLT and 18F-FMISO) from April 2009 to March 2019. The standardized uptake value (SUV) from the accumulation of each PET tracers, TNR (tumor to contralateral normal tissue ratio) of 18F-FDG,11C-MET and 18F-FLT, TBR (tumor to blood values ratio) of 18F-FMISO were measured. We investigated the correlation between these PET images and molecular diagnosis of glioma.

RESULTS

Data from total of 79 patients which were 42 cases of IDH wild type glioblastoma, 2 cases of IDH mutated glioblastoma, 9 cases of IDH wild type astrocytoma, 13 cases of IDH mutated astrocytoma and 13 cases of IDH mutated and 1p/19q co-deleted oligodendroglioma were included in this study. Both TNR of 11C-MET(p<0.01) and 18F-FLT(p<0.01), and also TBR of 18F-FMISO(p<0.01) in IDH wild type gliomas showed significantly higher than IDH mutated gliomas. In WHO Gr2-3 gliomas, only TNR of 18F-FLT showed a significant difference between IDH wild type gliomas and IDH mutated gliomas(p<0.01). TNR of 18F-FLT(p<0.01) and TBR of 18F-FMISO(p<0.01) in 1p/19q co-deleted gliomas were significantly lower than gliomas without 1p/19q co-deletion, but there were no significant differences in WHO Gr2-3 gliomas. Among IDH mutated gliomas, TNR of 11C-MET in 1p/19q co-deleted gliomas showed significantly higher uptake than gliomas without 1p/19q co-deletion(p<0.05).

CONCLUSION

Preoperative PET evaluation of each PET tracers may be useful for the molecular diagnosis of glioma.
NQPC-01 CURRENT STATUS AND PROBLEMS OF ADVANCE CARE PLANNING AND PALLIATIVE CARE FOR MALIGNANT BRAIN TUMOR
Authors: Aoki Tomokazu , Narita Yoshitaka , Mishima Kazuhiko , Matsutani Masao
Published: December 2019

Purpose Genomic medicine is in progress, but the median survival of glioblastoma is 14–16 months. It seems to have the same life prognosis as stage 4 like unresectable pancreatic cancer, lung cancer and colon cancer. Palliative care including Advance care planning (ACP) at first diagnosis of glioblastoma is important We conducted a questionnaire survey to understand the current status of Japanese oncologists. Method In July 2018, a questionnaire of 37 items was sent by e-mail to 767 members of Japanese Society of Neuro Oncology, and in August replies were received from 154 persons (20%). The same 22-item questionnaire in 2012–2013 was compared internationally with a report (Walbert T., et al., 2015) by Society of NeuroOncology and the European Association of NeuroOncology. In addition, we compared domestically with a 30-item questionnaire (Narita et al. 2009) in 2007. The Nonparametric Mann-Whitney’s U test was mainly used. Result 1 Characteristics of Japan in comparison with Western countries(p<0.01): 1. The number of doctors in charge is overwhelmingly male. 2. The specialty is predominantly neurosurgeons. 3. Aging of NeuroOncologists. 4, medical treatment place: the proportion of university is low. 5, frequent regular examination of the patient. Result 2Changes compared with domestic(Japan) data 11 years ago(p<0.01): 1 Explaining the condition in more detail. 2. Explaining to not only the family but also the patient. 3. Continuing chemotherapy more aggressively. 4. The place of death: decreasing at hospitals and increasing at home. 5, Frequency with a respirator decreased. 6, About 70% at the end of the period, nasal injection and gastrostomy are applied. Conclusion In the treatment of malignant brain tumors in Japan, a male neurosurgeon who has over 15 years of experience actively continues chemotherapy and appears to see it with nasal injection.
NQPC-12 SHORT-TIME INTENSIVE REHABILITATION FOR PATIENTS WITH NEWLY DIAGNOSED MALIGNANT GLIOMAS WITH SPECIAL REFERENCE TO MEDICAL COOPERATION TEAM
Authors: Maeda Takeshi , Matsutani Masao , Kato Momoka , Okamura Daijiro , Muraya Syoichi
Published: December 2019

PURPOSE

Many reports presented that patients with GBM had stable HRQoL during their remission time. However, there are few reports on the situation of ADL that is the basis of QOL. This prospective study was designed to evaluate the effectiveness of intensive rehabilitation for physically disabled patients with GBM after the initial treatment.

PATIENTS and METHOD

Twelve patients with newly-diagnosed glioblastoma presenting with severe physical disabilities were registered after the completion of postsurgical radiation therapy combined with TMZ. All patients were evaluated by means of a core set of clinical scales of Functional Independence Measure (FIM), Sitting Balance score, Standing Balance score, and Mini-mental State Examination (MMSE). Patients were evaluated before the beginning and at the end of rehabilitation treatment. The daily rehabilitation program consisted of individual 180-min. sessions of treatment, seven days a week, for four to six consecutive weeks. Speech therapy was included when aphasia was diagnosed.

RESULTS

Ten of 12 patients presented with mean increased FIM score of 26.6 points that reached the individual maximum point within 10 to 56 days.

CONCLUSION

A short-time intensive rehabilitation (4 to 6seeks) is effective for GBM patients during TMZ withdrawal period after the postoperative radiation therapy. This effective program requires close teamwork with the medical cooperation teams in the medical and rehabilitation hospitals: explanation to patients of the significance of the short-term rehabilitation, which is different from stroke rehabilitation, adjustment of hospitalization date considering radiotherapy and chemotherapy schedule, and adjustment of MRI imaging or bevacizumab administration schedule during rehabilitation.
NQPC-14 COMPARISON OF QOL SCALES IN PATIENTS WITH BRAIN TUMORS
Authors: Satomi Natsuko Tsushita , Miyahara Ruriko , Omura Takaki , Takahashi Masamichi , Ohno Makoto , Miyakita Yasuji , Narita Yoshitaka
Published: December 2019

PURPOSE

Measurement of quality of life (QOL) of patients with brain tumors is a challenge, because parameters of the established QOL scales for cancer patients are easily affected by the focal neurological deficits. Thus, simpler QOL scales which are feasible for evaluation of QOL with severe neurological deficits are required. We compared the results of four QOL scales in patients with brain tumors.

METHODS

From 2015 to 2018, we prospectively performed EORTC QLQ-C30/BN20 (C30/BN20), KPS, EQ-5D and “Distress and Impact Thermometer (DIT)” every three months.

RESULTS

2150 QOL evaluations from 710 patients were analyzed. The median age was 54 years (range 14–97). 319 glioma, 93 meningioma, 165 brain metastases and 133 other brain tumors were included. Global health status of C30/BN20 strongly correlated with QOL scores calculated by EQ-5D and DIT; it also showed correlation with KPS (correlation coefficients: 0.632, -0.675, -0.622, 0.412, respectively (p<0.001)). Most items of C30/BN20 showed relatively strong correlation with QOL scores, whereas KPS strongly correlated to physical activities and DIT strongly correlated to items related to psychological status. Seizures did not corelate with any other QOL scales. In patients with KPS≤60, wide dispersion of QOL scores and DIT were observed. In these patients, KPS correlated only with items 1–3 of EQ-5D and DIT with item 5. When time course of QOL scores in malignant glioma was evaluated, it was maintained until first remission, and significantly impaired at recurrence, compared to onset (p=0.014).

CONCLUSION

QOL scores can be used as an alternative for C30/BN20, and QOL time course of glioma can be adequately evaluated with it. KPS and DIT can also be alternative scales. These two scales should desirably be used in combination in patients with low KPS. Evaluations of feasibility and validity of these QOL scales in patients who cannot answer C30/BN20 are warranted.
NQPC-15 COGNITIVE FUNCTION AND ACTIVITY OF DAILY LIFE AFTER TUMOR REMOVAL FOR PATIENTS WITH BIFRONTAL GLIOBLASTOMA
Authors: Kakuta Akiko , Nitta Masayuki , Maruyama Takashi , Muragaki Yoshihiro , Ikai Tetsuo
Published: December 2019

INTRODUCTION

Glioblastomas often grow in a butterfly shape in the bifrontal lobes. The aggressive removal of these contrast-enhanced lesions may cause serious cognitive dysfunction. In this study, we have analyzed changes of cognitive function, effects on ADL, as well as rehabilitation methods for patients with bifrontal glioblastoma before and after tumor removal.

SUBJECTS

In this study, 6 patients including 2 males and 4 females with a mean age of 39.8 were reviewed. All patients exhibited bifrontal glioblastoma that was surgically removed. The primary tumor location was lower-left frontal gyrus for four of the patients, the right preSMA-SMA region for one patient, and the lower-right frontal gyrus for the remaining patient.

METHOD

Patients’cognitive function and ADL evaluated after the tumor removal and at the end of postoperative chemoradiotherapy, were retrospectively analyzed. We compared and verified the features and EOR. An evaluation was performed using MMSE-J, FAB, TMT, RCPM, RBMT, BADS, and FIM.

RESULT

After completion of chemoradiotherapy, 3 patients returned home, 2 were transferred to the hospital, and 1 returned to work. MMSE score was worsen in two patients, and their tumor were located in the lower-right frontal gyrus and the lower-left frontal gyrus. Two cases in the right frontal lobe and two cases in the lower left frontal gyrus scored lower average on the TMT. In our final evaluation, ADL was not worsening after surgery.

DISCUSSION

Many patients with bifrontal glioblastoma exhibited disturbance of consciousness due to strong edema before surgery, but they recovered in about two months after the tumor removal and many of them considered back to work. Involvement of prefrontal cortex may be related to severe cognitive dysfunction. Active rehabilitation should be started as soon as possible after surgery to acquire a compensation functions for the cognitive disorders and simulation for social life and work.
BT-10 A RARE CASE OF RADIATION-INDUCED GLIOBLASTOMA 29 YEARS AFTER TREATMENTS OF GERMINOMA
Authors: Matsuo Ayaka , Kawahara Ichiro , Hiu Takeshi , Haraguchi Wataru , Ono Tomonori , Ushijima Ryujiro , Tsutsumi Keisuke
Published: December 2019

BACKGROUND

Germinoma is one of the most radiosensitive tumors. Although radiotherapy (RT) can lead to long term-survival, it has the possibility to cause adverse effects. One of the more serious side effects include radiation-induced tumors that can contribute to a life-long prognosis.

Case presentation

A 40-year-old man was diagnosed with left basal ganglia germinoma at the age of 11 years old. Postoperatively, he received whole-brain radiotherapy 40Gy, focal radiotherapy 9.26Gy, and craniospinal irradiation. After these treatments, he was free from tumor recurrence or a secondary tumor during the long-term follow up. However, after 29 years, he began experiencing aphasia. A Magnetic Resonance Imaging (MRI) showed a developing 4.5cm round mass in the left parietal lobe with marked surrounding edema. He underwent surgical resection of the tumor at the left partial lobe. Pathological examination showed the tumor to consist of unclear pleomorphism, and the diffuse proliferation of heterocyst. Therefore, the pathologic diagnoses concluded as glioblastoma (Ki-67 labeling index was 50%). Conclusion: The tumor developed in the previously irradiated field, and it was not present prior to the RT. He did not suffer from pathologies favoring the development of the tumor. The interval between the radiation exposure and the onset of the second tumor was approximately 29 years, and the histotype of the tumor differed from the original tumor. Considering these clinical features, we diagnosed the glioblastoma as a radiation-induced tumor. Radiation-induced malignant glioma occurs frequently in patients after the treatment for acute lymphoblastic leukemia. Therefore, the radiation-induced malignant glioma after the treatment for germinoma is rare. Regardless of age, histology, and RT dosages, the patient has the possibility to develop radiation-induced malignant glioma. In conclusion, it is necessary to have careful monitoring even after 20–30 years of RT.
CS-03 LARGE CYSTIC INTRADURAL SCHWANNOMA IN CERVICAL REGION: 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, bit 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.
CS-06 A CASE OF GLIOBLASTOMA METASTATIC TO THE LUMBAR VERTEBRA
Authors: Matsuhashi Ako , Tanaka Shota , Nomura Masashi , Ikemura Masako , Sakai Yu , Karasawa Yasuaki , Takayanagi Shunsaku , Saito Nobuhito
Published: December 2019

BACKGROUND

Most cases of glioblastoma recur within one year even under the standard treatment of surgical resection, radiation therapy and chemotherapy. 60–70% of recurrences are local, and in rare cases of metastasis, most are within the CNS. Extradural metastasis is considered exceedingly rare.

CASE REPORT

We present a 21-year-old man post total resection of right parietal lobe glioblastoma, diagnosed with lumber metastasis. He originally presented with impaired consciousness and left hemiplegia at the age of 20 and underwent gross total resection of the tumor. Pathology was IDH wild type, H3F3A K34R/V wild-type glioblastoma. Radiotherapy and adjuvant temozolomide per the Stupp regimen as well as infusion of bevacizumab were conducted. 6 months after the resection of tumor, the patient presented with severe back pain. Radiographic studies showed an osteolytic mass on the first lumbar vertebrae, and needle biopsy was consistent with glioblastoma. Posterior spinal fusion, internal decompression and radiotherapy were conducted to relieve the pain. At 3 months after the diagnosis of lumbar metastasis, he is currently treated with temozolomide and bevacizumab, without the enlarging of the tumor.

DISCUSSION

As far as we investigated, there has been 30 cases of vertebral metastasis of glioblastoma reported in literature. Considering the biological obstacles that prevent glioblastomas from infiltrating outside of the CNS, it can be speculated that deposition of tumor cells into the blood stream or excision of the dura due to surgical interventions may attribute to extracranial metastasis. Due to the improvement of overall survival of glioblastoma, vertebral metastasis is suspected to be more common. Therefore, investigation of its risk factors and standardization of its treatment is necessary.

CONCLUSION

We reported a case of lumbar metastasis of glioblastoma. Extradural metastasis of glioblastoma must be included in differential diagnoses in treating patients with glioblastoma.
COT-05 A CASE OF NEPALESE IN JAPAN SUSPECTED OF NEUROCYSTICERCOSIS
Authors: Mikai Masataka , Matsuzaki Ryo , Matsuura Chie , Terazono Sayaka , Ando Shumpei , Harada Masashi , Masuda Hiroyuki , Kondo Kosuke , Harada Naoyuki , Sugo Nobuo
Published: December 2019

INTRODUCTION

Cystosis is the most common parasitic disease of the central nervous system. Especially in developing countries, it is one of the differential diagnosis of diseases that cause seizures. We report a case of a foreigner suspected of having neurocysticercosis.

CASE

A 36-year-old Nepalese visiting Japan for 2 years. Two days ago, she lost consciousness for a few seconds and was transferred to our hospital complaint of convulsions for about 1 minute. Head Computed Tomography (CT) revealed a mass lesion with a ring enhancement effect of about 10 mm in the right frontal lobe, with edema around it. Magnetic Resonance Imaging (MRI) shows T1WI low signal, T2WI high signal, and diffusion-weighted image with a light high signal. The ring-shaped enhancement effect was exhibited. Whole body CT showed no obvious lesions and blood tumor markers were negative. Various infections were negative, and cerebrospinal fluid cytology and culture were negative.

POSTOPERATIVE COURSE

From the surgical findings, brain abscesses such as cerebral tuberculoma were suspected, but various tests were negative. As a pathological result, the tumor had a capsule, and the inside showed necrotic tissue and fibrous granulation tissue reaction. There were no insects, and no obvious cells were identified by special staining. From the origin area, symptoms, and pathological findings, neurocysticercosis was most suspected.

CONCLUSION

We experienced a case of suspected neurocysticercosis that was difficult to diagnose from images and pathological findings. In neurocysticercosis, when the worm body dies, contrast-enhanced MRI shows a ring-like enhancement effect, and it is accompanied by surrounding edema, which may require differentiation from brain tumors.
COT-11 EFFECT OF PHYSICIAN SUPPORTS ON QUALITY CONTROL AND QUALITY ASSURANCE IN CLINICAL BRAIN TUMOR RESEARCH
Authors: Furukawa Keiko , Arakawa Yoshiki , Mineharu Yohei , Tanji Masahiro , Takaori Akifumi , Miyamoto Susumu
Published: December 2019

BACKGROUND

Clinical physicians have difficulties in conducting investigator-initiated-trials because of increasing clinical duties in Japan. Therefore, physician support can be one of the important factors for quality control and quality assurance. In Kyoto University Hospital, clinical research professional’s support for physician had started at November 2012. In this study, we evaluate effect of physician supports on quality control and quality assurance in clinical brain tumor research.

METHODS

Our department of Neurosurgery has been a member of Brain Tumor Study Group in Japan Clinical Oncology Group (JCOG) since 2007. The number of registered patients, the status of periodic monitoring, the occurrence of inquiries per case, and details of physicians’ support (items, frequency, methods, etc.) in each clinical trial were investigated. The factors affecting the audit results conducted by JCOG Audit Committee on January 2013 and February 2019 are examined.

RESULTS

There are seven trials have been ongoing on or started since November 2012. There are fifty patients registered in the clinical studies until July 2019. Periodic monitoring has been carried out in 214 patients of cumulative total number since 2012. Physicians’ support mainly involved the preparation of ethical review documents, CRF documentation, responses to data queries, preparation of SAE reports, study schedule check and monitoring of observation items. The audit results of site visit were acceptable, total evaluation score 68.80 on January 2013 and excellent, total evaluation score 99.9 on February 2019.

CONCLUSION

Clinical Trials Act has been implemented, and further improvement in the quality of clinical trials has been demanded. As the results of this study, we clarified the necessity for physician support and the contribution to quality improvement.
COT-22 TIMING OF SURGERY AND BEVACIZUMAB THERAPY FOR MALIGNANT GLIOMAS
Authors: Matsubara Toshio , Mouri Genshin , Ishigaki Tomoki , Ikezawa Munenari , Suzuki Hidenori
Published: December 2019

BACKGROUND

The drug manufacturer recommends postponing initiation of bevacizumab for malignant gliomas at least 4 weeks later postoperatively. Malignant glioma patients with significant neurological deficits due to postoperative residual tumors are preferably needed earlier bevacizumab therapy that expecting improvement of neurological state and brain edema. There is a literature review indicating that the timing for administration of postoperative bevacizumab was at least 2 weeks. The authors assessed the safety,tolerability,efficacy for bevacizumab therapy less than 4 weeks later postoperatively.

METHODS

Six patients of malignant gliomas with residual tumors and neurological deficits were treated by bevacizumab (10mg /kg every 2 weeks) therapy 2–3 weeks later postoperatively with chemoradiotherapy. Patients included 31-year-old female with thalamic-midbrain glioblastoma (initial),11-year-old female with anaplastic ependymoma (recurrent),71-year-old female with initial cervical cord anaplastic astrocytoma (initial),88-year-old female bilateral frontal glioblastoma (initial),27-year-old female with thalamic midbrain glioblastoma (initial) and 3-year-old female with brain stem glioblastoma (initial).

RESULTS

All the patients did not experienced hemorrhage and impair wound healing. Every patient neurological state and perifocal brain edema following bevacizumab therapy demonstrated early improvement. Earlier bevacizumab therapy did not delay and cease postoperative chemoradiotherapy.

CONCLUSIONS

Initiation of bevacizumab therapy 2–3 weeks later postoperatively seems to be safe and effective for malignant glioma patients with worse neurological state due to residual tumor and perifocal edema. The optimal interval which balances the risk of complications and the risk of tumor progression should be considered.
Integrating an Adapted, Low-Intensity Program to Promote Early Childhood Development in Routine Health Visits in Rural India: A Feasibility Study
Authors: Shah Reshma , Gustafson Erika , Dhaded Sangappa , Herekar Veena , Metgud Deepa , Mastiholi Spoorthi , Kim Hajwa , Goudar Shivaprasad , Atkins Marc
Published: December 2019

Objective:

More than 200 million children younger than the age of 5 years fail to reach their full developmental potential in low- and middle-income countries (LMICs). The purpose of this study was to describe the feasibility of integrating a brief program to promote early childhood development within a health care setting serving a predominantly rural population in India.

Methods:

We conducted a prospective, noncomparative, mixed-methods study. An adapted parent-directed program was administered to caregivers of 2- to 6-month-old children while waiting for their health care provider. Caregivers completed baseline and 4-week follow-up surveys. Thematic analyses and generalized equation estimates were used for analyses in the following feasibility indicators: acceptability, demand, implementation and practicality, and limited efficacy testing.

Results:

Forty-seven caregivers were recruited; most were women (98%) and had equal to or less than 12 years of schooling (61%). Forty-six of 47 participants completed the follow-up at 1 month. Three administrators were trained to deliver the program over the course of 2 days. Caregivers perceived a need for the program and found the content and structure of the program useful. However, there were important suggestions for improvement, including greater visual content and dissemination to nonparental caregivers and fathers. Significant increases were seen on self-reported parenting behaviors regarding a child's caregiving environment.

Conclusion:

Our findings support the feasibility of integrating an adapted, low-intensity program in a primary care setting in India, but important adaptations and considerations will need to be addressed before effectiveness testing on a wider scale. We discussed implications for offering sustainable population-level interventions to promote early childhood development in LMICs.
Maximizing Panfacial Aesthetic Outcomes: Findings and Recommendations From the HARMONY Study
Authors: Kaminer Michael S. , Cohen Joel L. , Shamban Ava , Werschler William Philip , Shumate Garrett T. , Drinkwater Adrienne , Gallagher Conor J.
Published: December 2019

BACKGROUND

Aesthetic medicine has evolved from targeting individual treatment areas to a global approach of panfacial rejuvenation. HARMONY was the first clinical study to systematically demonstrate positive physical and psychosocial impacts of panfacial treatment.

OBJECTIVE

Provide evidence-based guidance on treatment strategies to help maximize outcomes in patients seeking panfacial rejuvenation.

MATERIALS AND METHODS

Study sites with the lowest (n = 2) and highest (n = 2) improvements based on FACE-Q Satisfaction with Face Overall scores were analyzed to understand differences in treatment strategy that may contribute to incrementally greater patient satisfaction.

RESULTS

The highest scoring sites exhibited greater improvement in all patient-reported outcomes and investigator-assessed measures related to dermal filler treatment compared with the lowest scoring sites. The highest sites favored lateral malar augmentation and used less volume medially versus the lowest sites. In the lower face, the highest sites used greater volumes and more HYC-24L than HYC-24L+. Initial treatment volumes were more conservative at highest than lowest sites; greater volumes were used by highest sites in touch-up treatments.

CONCLUSION

Product usage trends common to the highest scoring sites (including injection volume, injection sites, and product selection) may provide guidance on best practices for a panfacial approach to aesthetic treatment to maximize patient satisfaction.
Atrial fibrillation as presenting sign of primary aldosteronism: results of the Prospective Appraisal on the Prevalence of Primary Aldosteronism in Hypertensive (PAPPHY) Study
Authors: Seccia Teresa M. , Letizia Claudio , Muiesan Maria L. , Lerco Silvia , Cesari Maurizio , Bisogni Valeria , Petramala Luigi , Maiolino Giuseppe , Volpin Roberta , Rossi Gian Paolo
Published: December 2019

Background:

Despite hyperaldosteronism being suggested as predisposing to arrhythmias, the relationship between atrial fibrillation and primary aldosteronism remains uncertain. Therefore, we tested the hypothesis that atrial fibrillation is a presentation of primary aldosteronism in hypertensive patients with unexplained atrial fibrillation.

Design and methods:

The Prospective Appraisal on the Prevalence of Primary Aldosteronism in Hypertensive (PAPPHY) Study recruited consecutive patients with atrial fibrillation and an unambiguous diagnosis of arterial hypertension at three referral centers for hypertension.

Results:

In a cohort entailing 411 atrial fibrillation patients, we identified 18% (age 61 ± 11 years; 32% women), who showed no known cause of the arrhythmia. A thorough diagnostic work-up allowed us to identify primary aldosteronism in 73 of these patients, i.e. 42% [95% confidence interval (CI) 31.8–53.9]. Subtyping of primary aldosteronism demonstrated that surgically curable forms of primary aldosteronism accounted for 48% of the cases (95% CI 31.9–65.2). The high prevalence of primary aldosteronism was confirmed at sensitivity analyses.

Conclusion:

These results provided compelling evidence that primary aldosteronism is highly prevalent in hypertensive patients with unexplained atrial fibrillation. Accordingly, they suggest that patients with no identifiable cause of the arrhythmia should be screened for primary aldosteronism to identify those who can be cured or markedly improved with target treatment.

Clinical Trial Registration: :

https://clinicaltrials.gov, Identifier: NCT01267747.
Regulatory T-cell subset distribution in children with primary hypertension is associated with hypertension severity and hypertensive target organ damage
Authors: Gackowska Lidia , Michalkiewicz Jacek , Helmin-Basa Anna , Klosowski Maciej , Niemirska Anna , Obrycki Lukasz , Kubiszewska Izabela , Wierzbicka Aldona , Litwin Mieczyslaw
Published: December 2019

Background:

The relationship between circulating regulatory T-cell (Tregs) subset distribution and hypertension severity in children with primary hypertension is not known. We aimed to find out if target organ damage (TOD) in children with primary hypertension is related to defects in Tregs distribution reflected by their phenotype characteristics.

Methods:

The study constituted 33 nontreated hypertensive children and 35 sex-matched and age-matched controls. Using multicolor flow cytometry technique, we assessed a distribution of the total Tregs (CD4+CD25highCD127low/−) and their subsets (CD45RA+-naive Tregs, CD45RA− memory/activated Tregs, CD45RA+CD31+ recent thymic emigrants Tregs and mature naive CD45RA+CD31− Tregs) in the whole blood.

Results:

Hypertensive children showed decreased percentage of the total Tregs, the CD45RA+-naive Tregs, the total CD31+ Tregs and the recent thymic emigrants Tregs but elevation of the CD45RA− memory/activated Treg and mature naive CD45RA+CD31− Tregs. Decreased frequency of the total Tregs, naive Tregs and CD31+-bearing Treg cell subsets (CD31+ total Tregs, CD45RA+CD31+ recent thymic emigrants Tregs) negatively correlated to TOD markers, arterial stiffness and blood pressure elevation. In contrast, increased percentage of memory Tregs and CD31− Tregs subsets positively correlated to organ damage markers, arterial stiffness and blood pressure values. These changes were independent of BMI, age, sex and hsCRP.

Conclusion:

Both diagnosis of hypertension, TOD and arterial stiffness in hypertensive children were associated with decreased population of total CD4+ Tregs, limited output of recent thymic emigrants Tregs, and increased pool of activated/memory Tregs. Hypertension was an independent predictor of the circulating Treg subsets distribution irrespective of hsCRP.
ROBOT-ASSISTED VITREORETINAL SURGERY IMPROVES SURGICAL ACCURACY COMPARED WITH MANUAL SURGERY
Authors: Forslund Jacobsen Mads , Konge Lars , Alberti Mark , la Cour Morten , Park Yoon Soo , Thomsen Ann Sofia Skou
Published: December 2019

Purpose:

To compare manual and robot-assisted vitreoretinal surgery using a virtual-reality surgical simulator.

Methods:

Randomized controlled crossover study. Ten experienced vitreoretinal surgeons and 10 novice ophthalmic surgeons were included. The participants were randomized to start with either manual or robot-assisted surgery. Participants completed a test session consisting of three vitreoretinal modules on the Eyesi virtual-reality simulator. The automated metrics of performance supplied by the Eyesi simulator were used as outcome measures. Primary outcome measures were time with instruments inserted (seconds), instrument movement (mm), and tissue treatment (mm2).

Results:

Robot-assisted surgery was slower than manual surgery for both novices and vitreoretinal surgeons, 0.24 SD units (P = 0.024) and 0.73 SD units (P < 0.001), respectively. Robot-assisted surgery allowed for greater precision in novices and vitreoretinal surgeons, −0.96 SD units (P < 0.001) and −0.47 SD units (P < 0.001), respectively. Finally, novices using robot-assisted surgery inflicted less tissue damage when compared with that using manual surgery, −0.59 SD units (P = 0.009).

Conclusion:

At the cost of time, robot-assisted vitreoretinal surgery seems to improve precision and limit tissue damage compared with that of manual surgery. In particular, the performance of novice surgeons is enhanced with robot-assisted vitreoretinal surgery.
The Experience of Land and Water Birth Within the American Association of Birth Centers Perinatal Data Registry, 2012-2017
Authors: Snapp Carol , Stapleton Susan Rutledge , Wright Jennifer , Niemczyk Nancy A. , Jolles Diana
Published: December 2019

Consumer demand for water birth has grown within an environment of professional controversy. Access to nonpharmacologic pain relief through water immersion is limited within hospital settings across the United States due to concerns over safety. The study is a secondary analysis of prospective observational Perinatal Data Registry (PDR) used by American Association of Birth Center members (AABC PDR). All births occurring between 2012 and 2017 in the community setting (home and birth center) were included in the analysis. Descriptive, correlational, and relative risk statistics were used to compare maternal and neonatal outcomes. Of 26 684 women, those giving birth in water had more favorable outcomes including fewer prolonged first- or second-stage labors, fetal heart rate abnormalities, shoulder dystocias, genital lacerations, episiotomies, hemorrhage, or postpartum transfers. Cord avulsion occurred rarely, but it was more common among water births. Newborns born in water were less likely to require transfer to a higher level of care, be admitted to a neonatal intensive care unit, or experience respiratory complication. Among childbearing women of low medical risk, personal preference should drive utilization of nonpharmacologic care practices including water birth. Both land and water births have similar good outcomes within the community setting.
Force Myography across Socket Material
Authors: Curcio Brittney C. , Cirillo Nicholas V. , Wininger Michael
Published: December 2019

Introduction

Force myography (FMG) sensors were tested for responsiveness in application to prosthetic detection when the skin's surface is obscured by socket lining materials.

Materials and Methods

FMG data were collected from 30 healthy volunteers performing repeated tasks with the upper limb (fist clench, wrist flexion) while wearing a one-ply stockinet (“Sock”), a gel prosthetic liner (“Gel”), and without material (“Null”; comparator control). Two sensors recorded activity of the flexor digitorum profundus: one sensor making contact with the skin (“Near” sensor) and the other sensor placed immediately on top of the material (“Far” sensor). In the null condition, the sensors rested on top of one another.

Results

The signal from the Near sensor was 20% to 40% more intense than that of the Far sensor; however, the waveform shape was highly concordant (ρ > 0.985 in all conditions), capturing many of the same nuances in muscle shape change. Exploratory analysis of grasp classification revealed a less than 5% false-positive rate in recognition of grasp activity.

Conclusions

We conclude that FMG shows promise as an approach for prosthetic detection in a wider variety of settings than previously thought.
Adherence to Global Initiative for Chronic Obstructive Lung Disease guidelines in the real world: current understanding, barriers, and solutions
Authors: Albitar Hasan Ahmad Hasan , Iyer Vivek N.
Published: December 2019

Purpose of review

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides a comprehensive review and guidance for clinicians managing patients with chronic obstructive pulmonary disease (COPD). However, adherence to GOLD guidelines has been suboptimal over the years. The current review summarizes the current body of literature addressing the multitude of reasons for the lack of adherence to GOLD guidelines in clinical practice.

Recent findings

There continue to be several reasons for suboptimal adoption of GOLD guidelines in clinical practice. A primary and recurrent theme appears to be both delayed as well as missed diagnosis of COPD. There are several reasons for this including lack of awareness about current COPD guidelines, lack of availability as well as utilization of office spirometry and improper symptom assessment. Other issues include improper selection of proper pharmacotherapy options, misdiagnosis/mislabeling of COPD phenotypes, lack of smoking cessation counselling as well as enrollment in pulmonary rehabilitation. Potential solutions include adoption of clinical decision support systems, self-care models and careful phenotyping of COPD patients.

There are currently several barriers for the adoption of GOLD guidelines into routine clinical practice. These barriers are all amenable to systematic solutions that will increase adherence to current GOLD guidelines.