bluuebunny/crossref_metadata_2025_split huggingface dataset:
NURS-07. STAFF EDUCATION THROUGH NURSING AND PHARMACY COLLABORATION
Authors: Hancock Lauren , Pittman Whitney 
Published: December 2020

Abstract
Even within the focused field of pediatric oncology, there are healthcare providers who lack education regarding the specialized population of children with brain tumors. In order to improve staff knowledge of pediatric neuro-oncology, nursing and pharmacy developed a collaborative Lunch and Learn program to provide additional education. An eight week brain tumor curriculum was developed, and informal sessions grouped by diagnosis were held over lunch between the neuro-oncology nursing team (nurse practitioners and nurse coordinator) and a clinical pharmacy resident. A nurse practitioner provided academic literature and the pharmacy resident did further research and developed an outline for discussion. During these sessions, nursing was able to contribute academic knowledge and clinical experience, while pharmacy presented an overview of each tumor and provided education about medications. After each session, the pharmacy resident presented the information from the Lunch and Learn to all staff oncology pharmacists, which then increased their working knowledge of neuro-oncology as a whole, helping them feel better able to manage this population within their scope of practice. Because this innovative collaboration was so successful in heightening knowledge and awareness of the care and management of pediatric neuro-oncology patients for all those involved, the team now has future plans to utilize a similar model to provide neuro-oncology education to clinic and inpatient RNs.
NURS-08. A CASE REPORT OF RARE AND PROFOUND ANTEROGRADE AMNESIA IN A PAEDIATRIC SURVIVOR OF A BIFOCAL NON GERMINOMATOUS GERM CELL TUMOUR AND DIABETES INSIPIDUS
Authors: Bland Elizabeth 
Published: December 2020

Abstract
We present the case of a 12yo female who presented to the emergency department with increasing agitation, confusion, fluctuating GCS, hydrocephalus, and deranged electrolytes. MRI revealed tumour in pineal region and filling the third ventricle. Biopsy and tumour markers confirmed the diagnosis of bifocal Non Germinomatous Germ Cell Tumour (NGGCT). The diagnosis was complicated with the secondary diagnoses of diabetes insipidus and profound permanent anterograde amnesia. Whilst DI is common in NGGT in pineal region, anterograde amnesia is a very rare condition in paediatrics. Thus there is paucity of literature available to the clinicians to know how much improvement to expect or how to target rehabilitation whilst undergoing curative therapy, chemotherapy and craniospinal irradiation; however the importance of a consistent and coordinated nursing and allied health team approach with structure and errorless learning must be initiated from the beginning if independence is to be achieved.
NURS-09. INTRODUCTION OF A WELLNESS PROGRAM FOR PEDIATRIC NEURO-ONCOLOGY PROVIDERS
Authors: Waters Kaaren , Morgan Helene , Rangan Kasey , Bira Kim , Davidson Tom , Robison Nathan , Margol Ashley 
Published: December 2020

Abstract

INTRODUCTION
Pediatric oncology providers have unique and rewarding careers. The medical and psychosocial complexity of caring for pediatric oncology patients and their family units is simultaneously inspiring and challenging. In addition, the complex demands of the healthcare system can lead to chronic stress, burnout, and disruption to the healthcare professional’s individual well-being. Time constraints, lack of resources, and limited access to wellness interventions serve as barriers for providers to address adaptive coping within themselves. Identifying gaps to achieving wellness and implementing interventions may lead to improved equanimity for pediatric oncology providers in their personal lives as well as their medical practice.

METHODS
An interdisciplinary team of nurse practitioners and physicians in a large pediatric neuro-oncology program at an academic institution completed anonymized wellness self-assessments regarding the areas of emotional, environmental, intellectual, occupational, physical, social, spiritual, coping, and professional role wellness. The results were analyzed and barriers to provider health and well-being were identified. Tailored and regularly scheduled wellness interventions were implemented for the study participants addressing the identified wellness barriers. Participants will each complete post-intervention wellness self-assessments to evaluate the effectiveness of the program.

CONCLUSION
The introduction of a provider wellness program exemplifies a feasible approach to identify barriers and evaluate efficacy of wellness interventions in achieving multi-factorial provider wellness. Secondary aims include dissemination of findings, with the intention of cultivating improvement in provider quality of life throughout the healthcare profession, and the ultimate goal of improving care to patients and families.
NURS-11. MARIJUANA, HEMP, AND THE CHILD WITH CANCER: PATIENT, PARENT, AND CLINICIAN EDUCATION
Authors: Hemenway Molly 
Published: December 2020

Abstract
Many pediatric oncology patients report medical marijuana (MMJ) and hemp-based CBD use. Eleven states and Washington, DC have legalized marijuana for recreational use for adults greater than 21. Medical marijuana is legalized in 33 states. Additionally, due to the bipartisan Farm Bill passed in December of 2018, hemp is federally legal. Marijuana has medical legalization in 23 countries worldwide. Clinical trials in adults have examined MMJ for cancer-related symptoms. New research is emerging on MMJ in anticancer therapy, MMJ receptors on tumor cells, and the potential role for MMJ as an immunomodulator. Few pediatric oncology studies have evaluated MMJ. We describe the initial findings of a prospective observational study of MMJ on the quality of life (QOL) in pediatric brain tumor patients. Specific aims included (1) MMJ’s association with symptoms (nausea, anxiety, pain, fatigue, and cognitive problems) and (2) MMJ’s impact on family dynamics. The legality of hemp plus the increasing use of MMJ raises concerns with pharmacological interactions with CBD and the medications routinely administered to children with cancer. Nurses are the frontline for discussions with patients about MMJ and must be aware of the emerging field of MMJ in pediatric cancer. Additionally, nurses can influence patient care protocols and processes for alternative therapy administration enabling an open dialogue between providers, parents, and patients regarding treatments, symptoms, adverse effects, and drug interactions. Education about how to have conversations about important facets to cover and consider is crucial to patient safety and increased quality of life.
OTHR-02. MULTIMODALITY TREATMENT FOR CHILDREN WITH CENTRAL NERVOUS SYSTEM (CNS) TUMOR IN OUR INSTITUTE
Authors: Sasano Mari , Sumi Koichiro , Moro Nobuhiro , Oshima Hideki , Hirai Maiko , Yagasaki Hiroshi , Yoshino Atsuo 
Published: December 2020

Abstract

BACKGROUND
The brain tumor has a highest mortality rate among childhood malignant tumors. Development of peripheral blood stem cell transplant combined chemotherapy and radiation therapy improved the survival rate of patients with pediatric brain tumor drastically late years. Because of its complicated treatment plan, neurosurgeons cannot readily manage these aggressive therapies which require minute whole body control including prevention of lethal infection due to bone marrow suppression. Even if such treatment is effective and patient survives, the aftereffects may reduce patient’s QOL.

PURPOSE
We report outcomes of the patients with CNS tumor after multimodality treatment. In addition, we introduce the activity contents by the in-hospital children brain tumor multi-disciplinary medical treatment team organized in March 2016.

METHODS
We retrospectively reviewed 29 patients (under 15 years old) diagnosed as CNS tumors with total of 43 tumor surgeries between January 2001 and December 2019.

RESULTS
The histopathological diagnoses were 7 germ cell tumor, 7 astrocytic tumor, 4 ependymal tumor, 4 medulloblastoma, 2 craniopharyngioma, 2 AT/RT and 3 others. The mean age at first surgery was 7.4 y.o. (range: 0.3–14.8). Both chemotherapy and radiation therapy were performed in 22 cases out of 29. There were 15 survivors (11 ambulant, 3 W/C, 1 bedridden), 12 deaths, 2 lost follow-ups. Mean follow-up period was 66 months (range: 1–206).

CONCLUSION
To improve outcomes, we hold on a regular basis of team meeting, discuss treatment plan, and share information. Recently, we also care issues of the patients, such as fertility and palliative medicine.
OTHR-07. CHRONIC ENCEPHALOPATHY DUE TO METHOTREXATE NEUROTOXICITY AS A RARE COMPLICATION IN A CHILD WITH LEUKEMIA: A CASE REPORT
Authors: Rafli Achmad , Adiprabowo Srisadono Fauzi , Rahmartani Ludi Dhyani , Handryastuti Setyo 
Published: December 2020

Abstract
Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both intravenous (IV) and most commonly intrathecal (IT) routes of MTX have been complicated in acute, subacute, and chronic neurotoxicity syndromes. A 9-year-old girl had been diagnosed with standard risk ALL since 2011 with first chemotherapy protocol was Indonesian protocol standard risk ALL 2006 and remission in 2012. On July 2015, patient was diagnosed as relapse ALL and underwent Indonesian protocol high risk ALL 2013. The last chemotherapy protocol of patient was Indonesian protocol high risk ALL 2013 maintenance phase 89th weeks with total dosage of MTX was 336 mg (IT), 6000 mg/m2 (IV), and 2500 mg/m2 orally. Her presenting symptom was progressive decrease of consciousness since 3 months before hospital admission. First brain computed tomography (CT-Scan) and magnetic resonance imaging (MRI) revealed brain atrophy. One month later she had abnormality in behavior and functional ability with second brain CT-Scan revealed brain atrophy and lacunar infarct in left pons. This case can be in accordance with chronic encephalopathy due to MTX. It is important to recognize early complications taking the form of subclinical or symptomatic CNS damage (e.g. headache, dizziness, tremor, ataxia, aphasia, dysarthria, emotional instabilities, seizures, hemiparesis, encephalopathy) that can occur in the course of chemotherapy especially MTX. Determination of the cause of encephalopathy is associated with considerable difficulty despite the use of various diagnostic methods and also treatment of MTX neurotoxicity is mainly supportive and recovery is usually complete. Keywords: imaging, methotrexate, neurotoxicity, leukemia
OTHR-14. DIENCEPHALIC SYNDROME SECONDARY TO PITUITARY STALK THICKENING
Authors: Almeida Carlos , Mançano Bruna Minniti , Eugui Gilda D’Agostino , Matsushita Marcus , Alvarenga Gabrielle , Lourenço Lucas Dias 
Published: December 2020

Abstract

BACKGROUND
Diencephalic syndrome (DS) is a rare condition associated with neoplastic lesions of the sellar-suprasellar region, whose pathophysiological mechanisms are still unclear. DS occurs in &lt;10% of hypothalamic gliomas and has also been described in suprasellar germinomas, craniopharyngiomas, epidermoid cysts, rarely with non-suprasellar lesions such as brainstem gliomas. DS has not been associated with isolated pituitary stalk thickening. Isolated pituitary stalk thickening (IPST) presents a diagnostic challenge, ranging from benign (craniopharyngioma) to malignant lesions (germinoma, metastasis, histiocytoses of the Langerhans group). The coexistence of diabetes insipidus (DI) with anterior pituitary dysfunction and IPST implies more risk to harbor neoplasia. CASE REPORT: A 6-year old girl presented with DI and inadequate weight gain (despite regular caloric intake) and preservation of linear growth. Neurological examination showed no abnormalities. However, physical examination revealed a malnourished patient (both weight-for-age value and body-mass-index below the third percentile). Blood tests and negative IgA anti-endomysial antibodies excluded malabsorption as a cause of her malnutrition; endocrine work-up excluded thyroid dysfunction, growth hormone deficiency, and adrenal insufficiency. Magnetic resonance imaging (MRI) showed thickening of the pituitary stalk with a transverse diameter of 7 mm. The patient underwent a biopsy through a supraorbital eyebrow approach. Histopathological examination revealed lymphocytic hypophysitis, with tissue markers all negative for germinoma. The girl is currently under follow up with serial MRI every three months.

CONCLUSION
DS should be considered as a differential diagnosis in any child with failure to thrive, and imaging studies should be performed even if there are no additional neurological symptoms.
OTHR-16. CONCURRENT USE OF APREPITANT AND IFOSFAMIDE IN PEDIATRIC CANCER PATIENTS
Authors: Winzent Shelby , Dahl Nathan , Hemenway Molly , Lovria Rachel , Dorris Kathleen 
Published: December 2020

Abstract

BACKGROUND
Aprepitant, a selective neurokinin-1 receptor antagonist, is commonly used for prevention of chemotherapy-induced nausea and vomiting. Its use with ifosfamide is controversial due to the putative risk of potentiating neurotoxicity via inhibition of cytochrome P450 3A4 (CYP3A4). The current literature examining this interaction is inconclusive, and little data exists in pediatrics. We seek to describe a single-institution experience with concurrent aprepitant and ifosfamide administration.

METHODS
A retrospective review of patients treated with ifosfamide and aprepitant from 2009–2018 was conducted. Data collected included demographics, tumor type, number of days of concurrent therapy, dosing, and documented of neurotoxicity.

RESULTS
Twenty patients aged 7–21 years (median 17 years) were identified. Diagnoses included thirteen sarcomas and seven CNS tumors (6 germ cell tumors; 1 intracranial sarcoma). Five patients received high dose ifosfamide (&gt;2,000mg/m2/day). The number of concurrent ifosfamide and aprepitant doses ranged from 2–18 (median, 8.5). Only one patient (5%) developed ifosfamide-induced neurotoxicity: a 7-year-old female with a nongerminomatous germ cell tumor who presented with seizures and somnolence. She received methylene blue and returned to her neurologic baseline. She completed her ifosfamide course without incident. She was the only patient to require weight-based aprepitant dosing and to receive the liquid formulation.

CONCLUSIONS
Aprepitant should be used with caution when administered concurrently with ifosfamide due to the risk of neurotoxicity. However, the incidence of neurotoxicity in this retrospective pediatric cohort was low. This interaction may be more significant in younger patients due to age-related differences in hepatic metabolism, but further study is required.
PATH-03. HIGH-GRADE NEUROEPITHELIAL TUMOR SHOWING BCOR IMMUNOPOSITIVITY WITHOUT EXON 15 INTERNAL TANDEM DUPLICATIONS IN A FIVE-YEAR-OLD BOY: A CASE REPORT
Authors: Wakita Shogo , Matsutani Tomoo , Watanabe Yosuke , Hirono Seiichiro , Higuchi Yoshinori , Iwadate Yasuo , Ikeda Zyunichiro , Yokoo Hideaki 
Published: December 2020

Abstract
Recent DNA methylation profiling clarified several rare entities of pediatric CNS tumors from institutionally-diagnosed primitive neuroectodermal tumors (PNETs). One of which is CNS high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR), and it carries in-frame internal tandem duplications (ITD) of the BCL6 corepressor (BCOR) in exon 15. In the report, we describe a case of immunohistologically-diagnosed CNS HGNET-BCOR, which lacks exon 15 ITD of BCOR. A five-year-old boy visited a local hospital complaining uncontrolled vomiting for two months, and magnetic resonance imaging (MRI) showed a large well-circumscribed mass in his left cerebellum with ventricular dilatation. He referred to our hospital, and an additional MRI revealed diffuse and weak enhancement of gadolinium and low ADC values in mass. Immediately, he underwent total removal of the tumor and ventricular drainage, and his consciousness recovered soon after surgery. The tumor presented high BCOR expression by IHC, but target PCR did not identify exon 15 ITD of BCOR. As the previously-reported clinical and imaging features of CNS HGNET-BCOR resembled our case, we clinically diagnosed it as a similar phenotype of CNS HGNET-BCOR without exon 15 ITD. He received 60 Gy of extended-local irradiation with concomitant temozolomide and discharged without any neurological deficits. Since BCOR alterations, including ITD, gene fusions, and mutations, play an oncogenic role in several cancers, the present case might harbor another gene aberration of BCOR.
PATH-06. IMAGE-BASED MACHINE LEARNING CLASSIFIER FOR PEDIATRIC POSTERIOR FOSSA TUMOR HISTOPATHOLOGY
Authors: Tam Lydia , Bala Wasif , Lavezo Jonathan , Lummus Seth , Vogel Hannes , Yeom Kristen 
Published: December 2020

Abstract

BACKGROUND
Pediatric posterior fossa (PF) tumors can include astrocytomas, ependymomas, and medulloblastomas, all of which demonstrate unique histopathology. Whole slide image analyses can be time consuming and difficult. Therefore, we used machine learning to create a screenshot-based histopathology image classifier that can distinguish between types of pediatric PF tumors.

METHODS
We took 179 histopathology slides from Stanford University, dated from 2008–2019: 87 astrocytomas, 42 ependymomas, and 50 medulloblastomas, per pathology report. Each slide was viewed under a microscope at 20x. Then, a screenshot was taken of the region of interest representative of principal slide pathology, confirmed by a trained neuropathologist. These screenshots were used to train Resnet-18 models pre-trained on the ImageNet dataset and modified to predict three classes. Various models with different hyperparameters were trained using a random hyperparameter search method. Trained models were evaluated using 5-fold cross-validation, assigning 20% of the dataset for validation with each evaluation. Qualitative analysis of model performance was assessed by creating Class Activation Map (CAM) representations of image predictions.

RESULTS
The top performing Resnet-18 model achieved a cross-validation F1 of 0.967 on categorizing screenshots of tumor pathology into three types. Qualitative analysis using CAMs indicated the model was able to identify salient distinguishing features of each tumor type.

CONCLUSIONS
We present a PF lesion classifier capable of distinguishing between astrocytomas, ependymomas, and medulloblastomas based on a histopathology screenshot. Given its ease of use, this tool has potential as an educational tool in an academic setting.
PATH-07. QUALITY ASSURANCE IN CEREBROSPINAL FLUID CYTOLOGY ASSESSMENT FOR MEDULLOBLASTOMA STAGING LEADS TO POTENTIAL IMPROVED RISK-GROUP ASSESSMENT IN THE PROSPECTIVE MULTICENTER HIT-2000 TRIAL
Authors: Hagel Christian , Sloman Veronika , Mynarek Martin , Petrasch Katharina , Obrecht Denise , Deinlein Frank , Schmid Renate , von Bueren André O , Friedrich Carsten , Juhnke B Ole , Gerber Nicolas U , Kwiecien Robert , Girschick Hermann , Höller Alexandra , Zapf Antonia , von Hoff Katja , Rutkowski Stefan 
Published: December 2020

Abstract

BACKGROUND
Cerebrospinal fluid (CSF) dissemination of medulloblastoma (M1 stage) is a high-risk prognostic factor. However, because diagnostic criteria for M1 staging are missing we specified process-related and cytomorphological parameters influencing the predictive value of the CSF status.

PATIENTS AND METHODS
CSF samples and cytology reports from 405 medulloblastoma patients of the prospective multicenter trial HIT-2000 were reviewed and related to 5-year progression free survival (5y-PFS).

RESULTS
Tumor cells were detected in 237/1073 CSF cytospins. M1-patients and M2/3 patients with radiologically detected metastases showed a worse 5y-PFS than M0 patients (54% and 52% vs. 76%; p=0.01 and p&lt;0.001). Lumbar sampling was more sensitive than ventricular sampling. M0 diagnosed specimens containing &gt;50% lytic cells and/or less than 10 nucleated cells showed a decreased 5y-PFS (61%). Further investigation of cytological parameters revealed a poor outcome for cases harboring &gt; 3 tumor cell clusters and individual tumor cells (5y-PFS 33%) vs. cases with ≥ 2 individual tumor cells but no clusters (5y-PFS 61%). In bi-variable Cox-regression, ≥ 2 vs. 0 or 1 tumor cells were associated with a Hazard Ratio (HR) of 0.52 (95%-Confidence Interval (CI): 0.12, 2.30; p=0.39), whereas &gt; 3 vs. no tumor cell clusters were associated with a HR of 8.94 (95%-CI: 1.66, 48.22; p=0.01).

CONCLUSIONS
CSF staging in medulloblastoma should comprise lumbar specimens with &lt;50% lytic cells and a minimum of 10 nucleated cells. The predictive value of CSF cytology in M1 cases may predominantly depend on tumor cell clusters. The latter finding needs to be confirmed in prospective trials.
PATH-08. THE IMPORTANCE OF RE-DIAGNOSIS OF TUMORS PREVIOUSLY CLASSIFIED AS CENTRAL NERVOUS SYSTEM PRIMITIVE NEUROECTODERMAL TUMORS
Authors: Fujita Naohide , Akiyama Osamu , Kondo Akihide 
Published: December 2020

Abstract

BACKGROUND
The recent molecular analyses have revealed that central nervous system primitive neuroectodermal tumors (CNS PNETs) those having clusters of small round tumor cells are genetically different tumors. However, the concepts of CNS PNET are complicated, and it is difficult to diagnose them appropriately in clinical field. To overcome this difficulty, we reviewed previous studies associated with CNS PNETs, and carried out several approaches, those are relatively easy access to use in clinics, for our 8 samples of embryonal brain tumors diagnosed CNS PNETs in our institution, initially.

METHODS
We used in combination with immunohistochemistry (IHC), Sanger sequence, Pyrosequence, polymerase chain reaction (PCR), real time PCR and copy number analysis referring recent reports.

RESULTS
In terms of the diagnosis three out of 8 cases were changed based on the results in this study from previous diagnoses.

CONCLUSION
In this review, it seemed that either the histopathological evaluation or molecular analyses would be not enough to make accurate diagnosis of CNS embryonal brain tumors, and it is essential to combine both of them including recent comprehensive analysis methods.