bluuebunny/crossref_metadata_2025_split huggingface dataset:
OTHR-08. Efficacy of anti-epileptic drug prophylaxis on seizure prevention in patients with brain metastases: A systematic review and meta-analysis
Authors: Souders Leslie , Beg Usman , Svetly Conner , Dabrowski Michael , Hamidi Nima , Padmanaban Varun , Mansouri Alireza 
Published: August 2021

Abstract

Introduction
Seizures can occur in patients with brain metastasis and are often debilitating, leading to morbidity, mortality, and economic burden. Implementation of anti-epileptic drugs (AEDs) prophylaxis remains controversial, and provider dependent as current Level III guidelines recommend against their use. This systematic review gathers the current evidence on the effectiveness of AED prophylaxis on preventing new-onset seizures in patients with BM. Associated adverse effects of AED usage in this population are also reported.

Methods
Using PRISMA guidelines, a pertinent search was conducted on Embase, PubMed, and Web of Science to identify journal articles that reported AED prophylaxis as a variable to modify seizure frequency in adult patients with BM. Data of interest included AED agent, new-onset seizure frequency, and safety profile. A meta-analysis was performed to calculate odds ratio using Der-Simonian and Laird methods to compare AED group with control for new seizures. Heterogeneity was determined by Cochran Q test and I2.

Results
Our search returned 175 publications of which 5 retrospective cohort studies met inclusion criteria. A total of 1,292 patients (283 receiving AED prophylaxis, and 1,009 in control group) were included across the studies. AEDs used were phenobarbital, levetiracetam, phenytoin, and valproate. Meta-analysis showed no difference in seizure frequency between the AED and the control group (OR = 0.98; 95%-CI: 0.56–1.72). Heterogeneity: I2 = 7%. Adverse events were not reported in the publications.

Conclusion
Our meta-analysis suggests that there is no improvement in frequency of new seizures with AED prophylaxis in BM patients, supporting current guidelines. However, the evidence is based on a small patient population and retrospective studies. Additional studies are needed to determine efficacy of prophylaxis with newer AEDs and establish guidelines to target therapies for improving morbidity, mortality, and quality of life in patients with BM.
OTHR-12. The development of machine learning algorithms for the differentiation of glioma and brain metastases – a systematic review
Authors: Brim Waverly Rose , Jekel Leon , Petersen Gabriel Cassinelli , Subramanian Harry , Zeevi Tal , Payabvash Sam , Bousabarah Khaled , Lin MingDe , Cui Jin , Brackett Alexandria , Mahajan Ajay , Johnson Michele , Mahajan Amit , Aboian Mariam 
Published: August 2021

Abstract

Purpose
Medical staging, surgical planning, and therapeutic decisions are significantly different for brain metastases versus gliomas. Machine learning (ML) algorithms have been developed to differentiate these pathologies. We performed a systematic review to characterize ML methods and to evaluate their accuracy.

Methods
Studies on the application of machine learning in neuro-oncology were searched in Ovid Embase, Ovid MEDLINE, Cochrane trials (CENTRAL) and Web of science core-collection. A search strategy was designed in compliance with a clinical librarian and confirmed by a second librarian. The search strategy comprised of controlled vocabulary including artificial intelligence, machine learning, deep learning, magnetic resonance imaging, and glioma. The initial search was performed in October 2020 and then updated in February 2021. Candidate articles were screened in Covidence by at least two reviewers each. A bias analysis was conducted in agreement with TRIPOD, a bias assessment tool similar to CLAIM.

Results
Twenty-nine articles were used for data extraction. Four articles specified model development for solitary brain metastases. Classical ML (cML) algorithms represented 85% of models used, while deep learning (DL) accounted for 15%. cML algorithms performed with an average accuracy, sensitivity, and specificity of 82%, 78%, 88%, respectively; DL performed 84%, 79%, 81%. The support vector machine (SVM) algorithm was the most common used cML model in the literature and convolutional neural networks (CNN) were standard for DL models. We also found T1, T1 post-gadolinium and T2 sequences were most commonly used for feature extraction. Preliminary TRIPOD analysis yielded an average score of 14.25 (range 8–18).

Conclusion
ML algorithms that can accurately classify glioma from brain metastases have been developed. SVM and CNN are leading approaches with high accuracy. Standardized algorithm performance reporting is a clear limitation to be addressed in future studies.
RADI-01. Cystic brain metastases managed with reservoir placement and stereotactic radiosurgery
Authors: Park David , Schulder Michael 
Published: August 2021

Abstract

Background
Stereotactic radiosurgery (SRS) has become a mainstay of treatment for patients with metastatic brain tumors. However, metastatic tumors with a large cystic component often exceed the size limit for safe and effective SRS. In such cases, surgical resection may not be the preferred first method of treatment, due to tumor location, patient co-morbidities, and patient preference. In such cases volume reduction by cyst aspiration followed by SRS may be a preferred option.

Methods
Seven patients were treated with this method. We performed reservoir insertion for the aspiration of cystic component in each patient and followed that with outpatient SRS.

Results
Mean overall volume reduction from this treatment method was 80% (range 46.5–94.9). Mean volume reduction from the cyst aspiration alone was 60.7% (range 3.5–90.9), and after SRS a further 71.6% (range 34.6–94.4), accounting for some cyst reaccumulation between the time of surgery and SRS. The interval between those two procedures were 24 days on average (range 11–58 days). Repeat reservoir aspiration was done a total of 10 times in 5 patients.

Conclusion
Cyst aspiration with reservoir placement followed by SRS is a good option for patients with large cystic brain metastases. The reservoir allows for repeat aspiration if needed. Catheter placement at the center of the cyst, and SRS within 2–3 weeks of surgery, can maximize the likelihood of a successful outcome.
RADI-13. Systemic Therapy Type and Timing Effects on Radiation Necrosis Risk in HER2+ Breast Cancer Brain Metastases Patients Treated with Stereotactic Radiosurgery
Authors: Park Christine , Buckley Evan , Van Swearingen Amanda , Giles Will , Herndon James , Floyd Scott , Anders Carey 
Published: August 2021

Abstract

Background
Current standard of care options for HER2+ breast cancer brain metastasis (BCBrM) include radiation therapy, brain permeable systemic therapies, and in select cases, neurosurgical resection. There is a concern that HER2-directed systemic therapies when administered concurrently with stereotactic radiosurgery (SRS) may increase the risk of radiation necrosis (RN). This study explores the impact of timing and type of systemic therapies on the development of RN in patients treated with SRS for HER2+ BCBrM.

Methods
This was a single-institution, retrospective study including patients ≥18 years of age with HER2+ BCBrM who received SRS between 2013 and 2018 with at least 12-month post-SRS follow-up. Presence of RN was determined at one-year post-SRS. Demographics, radiotherapy parameters, and timing (“during” defined as four weeks before/after SRS) and type of systemic therapy were evaluated.

Results
Among 46 patients with HER2+ BCBrM who received SRS, 28 (60.9%) developed RN and 18 (39.1%) did not. Age (mean 53.3 vs 50.4 years, respectively), radiotherapy parameters (dose, fraction, CTV, GTV, CI, V12Gy, all p&gt;0.05), and receipt of any type of systemic therapy during SRS (60.7% vs 55.6%, p = 0.97) did not differ between patients who did or did not develop RN. However, patients who developed RN more commonly received more than one line of HER2-directed therapy independent of SRS timing compared to those who did not develop RN (75.0% vs 44.4%, p = 0.08). In fact, a significantly higher proportion of those who developed RN received more than one line of HER2-directed therapy during a given SRS treatment compared to those did not develop RN (35.7% vs 5.6%, p&lt;0.05).

Conclusions
Patients with HER2+ BCBrM who receive multiple lines of HER2-directed therapy during SRS for BCBrM may be at higher risk of RN. Collectively, this data supports a practice of holding HER2-directed therapy during treatment with SRS if medically acceptable.
RADI-17. Outcomes for patients with triple negative breast cancer treated with upfront stereotactic radiosurgery for brain metastases
Authors: An Ran , Wang Yan , Wang Fuchenchu , Raghavendra Akshara Singareeka , Gao Chao , Amaya Diana N , Ibrahim Nuhad K , Li Jing 
Published: August 2021

Abstract

Background
Triple-negative breast cancer (TNBC) is an aggressive subtype with high propensity of developing brain metastases (BM). Clinical outcomes and prognostic factors after stereotactic radiosurgery (SRS) for BM were not well defined.

Methods
We identified 57 consecutive TNBC patients (pts) treated with single fraction SRS for BM during 05/2008–04/2018. Overall survival (OS) from BM diagnosis and freedom from BM progression (FFBMP) after initial SRS were evaluated. BM progression was defined as local and/or distant brain failure (LBF, DBF) after SRS. Kaplan-Meier analyses and Cox proportional hazard regression were used to estimate survival outcomes and identify prognostic factors.

Results
The median time to BM development from TNBC diagnosis was 23.7 months (mo) (range 0.7‒271.1). Median OS was 13.1 mo (95%CI 8.0‒19.5). On univariate analysis, Karnofsky performance score (KPS) &gt;70 (p=0.03), number of BMs &lt;3 (p=0.016), and BM among the first metastatic sites (p=0.04) were associated with longer OS. On multivariate analysis, KPS ≤70 was associated with higher risk of death (HR 3.0, p=0.03). Of 46 pts with adequate imaging follow-up, 29 (63%) had intracranial progression with a median FFBMP of 7.4 mo (95% CI 5.7–12.7). At 12 mo the estimated cumulative DBF rate was 61.1% (95%CI 40.8%–74.4%) and LBF rate was 17.8% (95%CI 2%–31.1%). Number of BMs (≥3 vs &lt;3) was not associated with FFBMP (p=0.7). Of the 29 pts with BM progression, additional radiation therapy (RT) (vs. no RT) was associated with improved survival (21.7 vs. 7.0 mo, p&lt;0.0001).

Conclusions
TNBC pts with BM treated with SRS had an OS of 13.1 mo and FFBMP of 7.4 mo. Good KPS was an independent prognostic factor for OS. Further studies with more pts or conducted prospectively are needed to better understand and to improve treatment outcomes in this pt population.
SURG-03. The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes
Authors: Newman William , Goldberg Jacob , Guadix Sergio , Brown Samantha , Reiner Anne , Beal Kathryn , Brennan Cameron , Tabar Viviane , Young Robert , Moss Nelson 
Published: August 2021

Abstract

Objective
Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes.

Methods
A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003–2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups.

Results
Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (n=42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p&lt;0.05). EOR correlated with edema reduction at last follow-up, with significantly greater T2-FLAIR reduction with GTR versus subtotal resection (p&lt;0.05). There was a trend towards decreased steroid use, from 8mg daily dexamethasone-equivalent (range 2–36) preoperatively to 3mg 12-months postoperatively (range 1–8; p=0.063).

Conclusions
RN resection conferred both durable T2-FLAIR reduction, which correlated with EOR, and reduced steroid dependency.
Motherhood‐induced gene expression in the mouse medial amygdala: Changes induced by pregnancy and lactation but not by pup stimuli
Authors: Abellán‐Álvaro María , Ayala Guillermo , Barneo‐Muñoz Manuela , Martínez‐García Fernando , Agustín‐Pavón Carmen , Lanuza Enrique 
Published: August 2021

AbstractDuring lactation, adult female mice display aggressive responses toward male intruders, triggered by male‐derived chemosensory signals. This aggressive behavior is not shown by pup‐sensitized virgin females sharing pup care with dams. The genetic mechanisms underlying the switch from attraction to aggression are unknown. In this work, we investigate the differential gene expression in lactating females expressing maternal aggression compared to pup‐sensitized virgin females in the medial amygdala (Me), a key neural structure integrating chemosensory and hormonal information. The results showed 197 genes upregulated in dams, including genes encoding hormones such as prolactin, growth hormone, or follicle‐stimulating hormone, neuropeptides such as galanin, oxytocin, and pro‐opiomelanocortin, and genes related to catecholaminergic and cholinergic neurotransmission. In contrast, 99 genes were downregulated in dams, among which we find those encoding for inhibins and transcription factors of the Fos and early growth response families. The gene set analysis revealed numerous Gene Ontology functional groups with higher expression in dams than in pup‐sensitized virgin females, including those related with the regulation of the Jak/Stat cascade. Of note, a number of olfactory and vomeronasal receptor genes was expressed in the Me, although without differences between dams and virgins. For prolactin and growth hormone, a qPCR experiment comparing dams, pup‐sensitized, and pup‐naïve virgin females showed that dams expressed higher levels of both hormones than pup‐naïve virgins, with pup‐sensitized virgins showing intermediate levels. Altogether, the results show important gene expression changes in the Me, which may underlie some of the behavioral responses characterizing maternal behavior.
Ambulatory Neuromuscular Scoliosis Patients Have Superior Perioperative Results Than Nonambulatory Neuromuscular Scoliosis Patients and Can Approach Adolescent Idiopathic Scoliosis Outcomes After Posterior Spinal Fusion
Authors: Sarwahi Vishal , Atlas Aaron , Galina Jesse , Hasan Sayyida , Dimauro Jon-Paul , Katyal Chhavi , Djukic Aleksandra , Thornhill Beverly , Lo Yungtai , Amaral Terry D. , Moguilevich Marina 
Published: August 2021

Study Design.
Retrospective cohort study.

Objective.
This study aims to identify differences in perioperative outcomes between ambulatory patients with neuromuscular scoliosis (ANMS) and adolescent idiopathic scoliosis (AIS) following spinal fusion.

Summary of Background Data.
NMS patients have severe curves with more comorbidities and procedural complexity. These patients require extensive fusion levels, increased blood loss, and suffer increased periop complications. However, NMS patients have a variable severity spectrum, including ambulation status.

Methods.
Chart and radiographic review of NMS and AIS patients undergoing PSF from 2005 to 2018. NNMS included NMS patients who were completely dependent (GMFCS IV-V). ANMS consisted of community ambulators without significant reliance on wheeled assistive devices (GMFCS I-III). Subanalysis matched by age, sex, levels fused and preoperative Cobb angle was conducted as well. Wilcoxon Rank-Sum, Kruskal-Wallis, χ
2, and Fisher exact tests were performed.

Results.
There were 120 patients in the NNMS group, 54 in ANMS and 158 in the AIS group. EBL was significantly lower for ANMS and AIS patients (P < 0.001). Complications within 30 days were similar between ANMS and AIS (P = 1.0), but significantly higher for NNMS (P < 0.001). Two (1.3%) AIS patients, (1.7%) nonambulatory NMS patients, and one (1.9%) ANMS patient required revision surgery (P = 1.0). However, all NMS patients had increased fusion levels, fixation points, and surgery time (P < 0.05). NNMS had significantly longer ICU (P < 0.001), hospital stay (P < 0.001), intraoperative transfusions (P < 0.001), and fewer patients extubated in the OR (P < 0.001) than ANMS and AIS patients. In the subanalysis, ANMS had similar radiographic measurements, EBL, transfusion, surgery time, extubation rate, and complication rate (P > 0.05) to AIS.

Conclusion.
Our data show radiographic outcomes, infections, revisions, and overall complications for ANMS were similar to the AIS population. This suggests that NMS patients who ambulate primarily without assistance can expect surgical outcomes comparable to AIS patients with further room for improvement in length of ICU and hospital stay.

Level of Evidence: 4
Mother-to-child transmission of severe acute respiratory syndrome coronavirus 2: review of classification systems and systematic reviews
Authors: Ansari Kehkashan , Kew Tania , Allotey John , Thangaratinam Shakila 
Published: August 2021

Purpose of review
To review the various classification systems for mother-to-child transmission (MTCT) of SARS-CoV-2 and collate existing evidence on systematic reviews of MTCT of SARS-CoV-2.

Recent findings
To-date, there are three classification systems for MTCT of SARS-CoV-2, including the WHO classification developed by expert consensus, based on in-utero, intrapartum and postnatal exposure of the babies to the virus. The systems variously classify babies tested for suspected SARS-CoV-2 infection as confirmed, probable, possible, indeterminate and unlikely for MTCT. To-date, 68 systematic reviews have been published between December 2019 and March 2021 on SARS-CoV-2 MTCT. Most of the reviews included cases series and case reports in their pooling of data, and often used SARS-CoV-2 infection and test positivity interchangeably.

Summary
Several classification systems are available to assist in determining the timing of SARS-CoV-2 infection in new-borns. Existing reviews of MTCT are of poor quality and report variable rates of SARS-CoV-2 positivity. A high-quality systematic review is needed on the extent of confirmed vertical transmission of SARS-CoV-2, risk factors for MTCT of SARS-CoV-2, the prevalence and persistence of viral particles or immunological response in reported biological samples. Primary studies should categorize MTCT using classifications, such as WHO classification system that considers the strength of the timing of classification and persistence of positivity, taking into account the sterility of the collected samples.
Prosthetic Replacement of Ocular Surface Ecosystem Scleral Lens: Benefits of an In-Clinic Therapeutic Approach for Persistent Corneal Epithelial Defect
Authors: Paul Sona , Natarajan Radhika , Iqbal Asif 
Published: August 2021

Abstract:
This case report details the efficacy of in-clinic customized scleral lens trial with self-preserved antibiotic eye drop in the liquid reservoir, in promoting fast healing of persistent corneal epithelial defect (PED). A 57-year-old man with a PED following injury, not responding to conventional treatment, underwent an in-clinic therapeutic trial of prosthetic replacement of ocular surface ecosystem device, to promote epithelial healing. After device wear with antibiotic eye drop in the liquid reservoir for 8 hrs during the day on five consecutive days and pressure patching at night with antibiotic eye ointment, there was complete resolution of the PED. Prosthetic replacement of ocular surface ecosystem scleral lenses are an effective treatment modality for PED. In-clinic daytime lens wear with night time pressure patching is a cost-effective option. Expert supervision avoids patient learning curve issues. Corneal re-epithelization happens because of the moisture and protection of the fragile healing epithelium afforded by these high DK lenses.
Randomized Cross-over Trial of Endobronchial Ultrasound Transbronchial Needle Aspiration With or Without Suction in Suspected Malignant Lymphadenopathy
Authors: Chami Hassan A. , Abu Khouzam Rani , Makki Maha , Kahwaji Sandra , Hochaimi Nour , Tamim Hani , Shabb Nina S. 
Published: August 2021

Rationale:
The benefit from applying suction during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is unclear.

Background:
The purpose of this study was to evaluate the impact of applying suction during EBUS-TBNA of lymph nodes (LN) on the diagnostic yield and specimen quality of EBUS-TBNA smears and cellblocks.

Methods:
We conducted a randomized blinded cross-over trial comparing the diagnostic yield and quality of EBUS-TBNA samples obtained with suction (S+) and without suction (S−) from suspected malignant mediastinal LN. Each LN was aspirated 4 times in a randomly assigned alternating order: S+/S−/S+/S− or S−/S+/S−/S+, resulting in 2 matched S+/S− smears pairs and 1 matched S+/S− cellblocks pairs. Specimen were assessed by a blinded cytopathologist. The primary outcome was the diagnostic yield of EBUS-TBNA smears and cellblocks. Secondary analyses accounted for LN size (≤2 vs. >2 cm) and station (mediastinal vs. hilar).

Results:
Of 234 EBUS-TBNA smears and 114 cellblocks were obtained from 59 LN. The concordance of S+ and S− cellblocks diagnostic yield was low (43.8%; 95% confidence interval: 30.7-57.6) with a significantly higher diagnostic yield among S+ compared with S− cellblocks (56.1% vs. 10.5%, respectively, P<0.001), regardless of LN station and size. However, S+ and S− smears were moderately concordant (66.7%; 95% confidence interval: 57.4-75.1) with no overall difference in their respective diagnostic yield. Numerically higher diagnostic yield among S+ smears in LN≤2 cm or hilar LN was not statistically significant. Results were similar for specimen adequacy, sensitivity and diagnosis of malignancy.

Conclusion:
Applying suction during EBUS-TBNA of suspected malignant LN enhanced the diagnostic yield of cellblocks regardless of mediastinal LN station or size, but not of smears.