bluuebunny/crossref_metadata_2025_split huggingface dataset:
OCCUPATIONAL THERAPY PRE-ASSESSMENT OF LOW GRADE GLIOMA PATIENT WITH COMPLEX NEEDS ALMOST HALVES POST-OPERATIVE LENGTH OF STAY
Authors: Laycock Ms Claire , Sokhal Ms Sunita , Mathew Mr Ryan 
Published: October 2024

Abstract

AIMS
Due to tumour eloquence, patients with low grade gliomas (LGGs) often have complex Occupational Therapy (OT) needs post-operatively. This need can impact length of stay and OT resource. Limited studies have focused on pre-assessment for this patient group. To address these challenges, we aimed to identify the impact of a newly-introduced Occupational Therapy (OT) pre-surgical assessment service for low grade glioma patients.

METHOD
Patients (n=16, prospective, consecutive, Jan-Jul 2023) planned for LGG surgery at Leeds Teaching Hospitals NHS Trust were offered an OT pre-assessment. Mixed methods analysis. Assessments and data collected included existing needs and deﬁcits, length of stay, and OT sessions (number/contacts, time spent). Comparison was made to patients (n=16, retrospective, consecutive, Jun-Dec 2022) planned for LGG surgery who had not received this service. Complexity was deﬁned using standardised, clinically-accepted factors (social, cognitive and/or physical deﬁcits).

RESULTS
Patients with complex needs (4 in each group) beneﬁtted signiﬁcantly from OT pre-assessment with reductions in: length of stay (11.9 v 6.5 days, 45.4% decrease), median time spent (134 v 95 mins, 29.1% decrease), median number of contacts (5.4 v 3.4, 37.0% decrease). Patient, surgeon, CNS and other AHP feedback was overwhelm-ingly positive.

CONCLUSION
Patients with complex needs undergoing surgery for low grade gliomas signiﬁcantly beneﬁt from pre- assessment; reducing length of stay and liberating occupational therapy resource. This also reduces costs and increases productivity/eﬃciency. Further work in more LGG patients, other brain tumour patients, and the identiﬁcation of key pre-assessment variables and interventions will guide the development of the service.
SINGLE INSTITUTION RETROSPECTIVE ANALYSIS OF COMPLICATIONS ASSOCIATED WITH SURGICAL DEBULKING OF BRAIN METASTASIS
Authors: Liew Dr Yong Yie , Hazra Mr Abhijit , Kannan Mr Siddarth 
Published: October 2024

Abstract

AIMS
Surgical resection of brain metastasis is associated with complications, which worsen patient’s quality of life, results in oncological treatment delays and death. Surgical complication data aids decision making, leads to objective risk beneﬁt analysis and informed consent. The aim of this study is to quantify rates, types and risk factors for complications related to surgical debulking of brain metastasis.

METHOD
Retrospective analysis on adult patients with brain metastasis, who underwent surgical debulking between 2017 and 2023 at Royal Preston Hospital. Data collected included demographics, diagnosis, 30-days post-operative complications, 30-days mortality, 30-days post-operative palliation, primary tumour, Karnofsky-Performance Score (KPS), ﬁrst vs. repeat resection, use of drain and type of suture materials etc. Univariate analysis was carried out using Graphpad software.

RESULTS
Two-hundred and twenty-seven patients qualiﬁed. The most common primaries were lung (n=93, 41%), breast (n=43, 18.9%), and skin (n=31, 13.7%). The most common complications were Hospital-acquired pneumonia (HAP) (n=27, 11.9%), surgical site infection (SSI) (n=19, 8.4%), wound dehiscence (n=14, 6.2%), thromboembolic events (n=12, 5.3%) and CSF leak (n=8, 3.5%). Thirty days mortality and post-operative palliation (due to surgical complications) were both 3.5% each (n=8). Two-hundred and six (93.2%) had KPS ³70 whilst 15 (6.8%) had KPS &lt; 70 [range 30-60 pre-operatively (median 60)). KPS &lt; 70 was statistically signiﬁcant for post-operative palliation (p=0.01), HAP (0=0.02) and urine infection (p=0.002), but not for 30-day mortality. Twenty-ﬁve (11.1%) patients undergoing repeat resections, experienced higher wound infections (p=0.002).

CONCLUSION
Surgical debulking is associated with signiﬁcant post-operative complications, with 7% either dying or not receiving any further treatment, 18.1% percent developing serious wound complications (SSI, CSF leak, Wound dehiscence) and 19.4% experiencing signiﬁcant medical complications (HAP/UTI/Thromboembolism). Pre- operative KPS &lt; 70 and repeat resections are associated with statistically increased risk of complications.
RE-VISITING BIOPSIES FOR SUSPECTED CNS LYMPHOMAS: TO BIOPSY OR NOT TO BIOPSY?
Authors: Mathew Mr Mesi , Rajaraman Mr Chittoor , Achawal Mr Shailendra , Razak Mr Adam , O’Reilly Mr Gerry 
Published: October 2024

Abstract

AIMS
It is a common practice to get a histological diagnosis before treatment of suspected CNS (central nervous system) lymphoma. Should CNS lesions be routinely biopsied in patients with background systemic lymphoma?

METHOD
A 10-year retrospective review of biopsy-proven CNS lymphoma was conducted. Data was analyzed using SPSS for Windows, version 25 (SPSS, Inc., Chicago, Illinois, USA), and a p-value &lt; 0.05 was considered signiﬁcant for the appropriate test statistic.

RESULTS
Patients with background systemic lymphoma whose brain MRI appearances were in favour of lymphoma after MDT discussion all had histologically-proven lymphoma after brain biopsy. Pre-biopsy MDT diagnosis was congruent with post-biopsy histology in 87.6% of cranial lesions (p-value 0.003) and 40% of spinal lymphomas (p-value 0.002). Secondary CNS lymphoma was seen in 21.2%. Stereotactic brain biopsy was the most common biopsy technique for cranial lesions (79.8%). Histology was Diffuse B Cell Lymphoma in 93% of cases. The mean Ki67 percentage for cranial lymphomas was higher than that of spine (p-value 0.028) The complication rate for cranial biopsy was 8.9%. Transient motor deﬁcits (4.4%) and post-operative haematoma (2.2%) were the most common. The 24-hour post-brain biopsy mortality rate was 1.1%, while overall 30-day post-op mortality rate was 4.4%. The mean percentage of Ki67 was higher among patients who had complications (p-value 0.001).

CONCLUSION
In a setting of properly constituted neurooncology MDT, a sub-set of patients with suspected brain lymphoma and background systemic lymphoma might not require brain biopsy.

KEY WORDS
Lymphoma, Brain, Spine, Biopsy, Complication
EVALUATING GLIOMA PATIENT PERCEPTIONS TOWARDS REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR REHABILITATION
Authors: Ali Mr Ahmad , Aliaga-Arias Mr Jahard , Zakaria Mr Rasheed , Jenkinson Prof Michael , Pescador Ms Ana Mirallave , Vergani Mr Francesco , Lavrador Mr Jose 
Published: October 2024

Abstract

AIMS
Repetitive Transcranial Magnetic Stimulation (rTMS) is established for depression, chronic pain, and motor rehabilitation after stroke. It is an emerging tool for other purposes including cognitive rehabilitation. Recent evidence supports its use for motor rehabilitation after brain surgery. We sought to evaluate patient perceptions towards rTMS.

METHOD
Two studies were undertaken. Group 1 – patients who received seven days of rTMS for motor rehabilitation for post-operative weakness (MRC 0-1 in any limb) following resection of a glioma or other resective pathology were prospectively surveyed on the last day of their rTMS treatment, as well as their next of kin (NOK). Group 2 – patients who had previously been treated for a glioma but did not receive rTMS were retrospectively surveyed through two brain tumour charities, as well as their NOK.

RESULTS
Group1: 21 responses. 11 patients, 10 NOK. Commonest pathology was glioblastoma(n=3). Group2: 24 responses. 16 patients, 8 NOK. Commonest pathology was grade 2 glioma(n=7). Most Group1 respondents reported a positive experience with rTMS(n=15). Group1 patients experienced substantial subjective improvements in motor functioning(n=6), some improvements(n=3), or no change(n=2). None reported worsening. Experiencing adverse symptoms (e.g. headache) was associated with reduced likelihood of motor improvements(p=0.01). Most improvements were in gross rather than ﬁner motor domains. Patients in Group2 were accepting of longer and more frequent rTMS sessions than Group1(p=0.03 and p=0.01 respectively). The commonest concerns raised pertained to seizures, side effects, and geographic availability. The commonest hope raised pertained to cognitive or motor improvements.

CONCLUSION
rTMS is well-tolerated and patients and their NOK support its use. Respondents would ﬁnd longer and more sessions acceptable. Understandably, there is less tolerance for rTMS in the early post-operative period. However, enthusiasm for rTMS is substantial in the later stable post-operative phases. Our ﬁndings support the further development of rTMS as a tool for improving patient rehabilitation.
HAS THE INITIATION OF A FORMAL PATHWAY FOR TUMOUR TISSUE COLLECTION IN NEURO ONCOLOGY PATIENTS LED TO AN INCREASE IN PATIENT’S HAVING WHOLE GENOME SEQUENCING (WGS), AND HOW WILL THIS IMPACT ONCOLOGY MANAGEMENT IN THE FUTURE?
Authors: Suarez Mr Aeron , Hurwitz Mrs Victoria , Kostick Ms Ellie , Mullens Ms Laura , La Mrs Jessica , Robinson Mrs Charlotte , Hedges Mrs Sarah , Harding Ms Nicola , Sabido Ms Pat , Chia Ms Kazumi , Aliaga-Arias Mr Jahard , Laxton Mr Ross , Eggleton Ms Kelly , Al-Sarraj Prof Safa , Reisz Dr Zita , Bodi Mr Istvan 
Published: October 2024

Abstract

AIMS
To change the standard of care for collection of glial tumour tissue at a London teaching hospital. This would enable WGS on the tumour tissue, and give patients access to further clinical trials.

METHOD
The previous standard of care was for brain tumour pathology samples to be stored in paraﬃn. This was not suitable for WGS or for many clinical trials; the tumour samples needed to be sent to the lab as fresh tissue. The introduction of a genomics clinical nurse specialist meant that relationships were built between the surgical team, pathology teams and ward teams. There was a teaching by one of the neurosurgical team to the theatre staff. Genomics CNS led training for the nursing team. Adults started having WGS in May 2023 but many patient’s still had tissue incorrectly stored and could not have the sequencing performed. There was an introduction of a formal pathway in theatre created by one of the neurosurgeons in Dec 2023.

RESULTS
From May 2023 - November 2023, 58% adult glioma patients had WGS. Since December 2023 - current (March 2023) and the introduction of the formal pathways, 71% had WGS.

CONCLUSION
A formal pathway has now changed the standard of care for collecting tissue. There is still not 100% compliance, and this remains multifactorial. However the introduction of a formal pathway has now increased the percentage of eligible patients receiving WGS. This positive outcome has now led to discussions about freezing the fresh glioma tissue to allow glioma patient’s wider access to clinical trials which they would previously not have had access to.
THE UTILITY OF MULTIPARAMETRIC MRI IN REDUCING DIAGNOSTIC UNCERTAINTY FOR PRIMARY CNS LYMPHOMA
Authors: Goel Ms Aimee , Flintham Mr Robert , Pohl Dr Ute , Wykes Ms Victoria , Sawlani Dr Vijay 
Published: October 2024

Abstract

AIMS
A key limitation in the early treatment initiation in primary central nervous system lymphoma (PCNSL) is the diagnostic delay caused by lack of recognition of a lesion as a possible lymphoma, steroid initiation, and lesion involution, often resulting in inconclusive biopsy. We highlight the importance of multiparametric MRI (MPMRI), which incorporates diffusion weighted imaging (DWI), dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI) and proton magnetic resonance spectroscopy (1H-MRS) in addition to standard MRI sequences in resolving diagnostic uncertainty for PCNSL.

METHOD
We present a consecutive series of 10 patients at our centre with histology-proven PCNSL (speciﬁcally, diffuse large B-cell lymphoma of the CNS) who underwent multiparametric MRI. We retrospectively analyse the qualitative and semi-quantitative parameters and assess their radiological concordance for this diagnosis.

RESULTS
We note overall low apparent diffusion coeﬃcient on DWI (mean ADCmin of 0.74), high percentage signal recovery on perfusion weighted imaging (mean 170%), a high choline-creatine ratio and a high-grade lipid peak on MRS giving a “twin-tower” appearance. Nine of ten patients had MRMRI ﬁndings concordant for PCNSL, deﬁned as at least 3 of 4 parameters being consistent for PCNSL.

CONCLUSION
We propose that concordance between these imaging multiparametric modalities could be used as a radiological predictor of PCNSL, reducing diagnostic delays, providing a more accurate biopsy target, and resulting in quicker treatment initiation.
UNDERSTANDING THE MANAGEMENT OF MALIGNANT GLIOMAS DURING COVID-19 PANDEMIC IN A HIGH VOLUME TERTIARY GOVERNMENT HOSPITAL IN THE PHILIPPINES
Authors: Gatdula Dr Francis James 
Published: October 2024

Abstract

AIMS
Malignant glioma is a common primary brain tumor with a great burden of disease. When COVID-19 set in, it became a challenge to manage an already diﬃcult treatment process in low-resource-setting centers. Despite this, conventional recommendations and standard treatment protocols are followed. However, outcomes were perceived to deviate from the convention, hence the reason for this study which is to understand the nature of outcomes in the management of malignant gliomas during the COVID-19 pandemic in Southern Philippines Medical Center (SPMC), the largest government tertiary hospital in the Philippines.

METHOD
A retrospective chart review of nine clinically and histologically diagnosed cases of malignant gliomas admitted in SPMC between April 2020 to September 2021 was performed. The clinical presentations, image correlation, and outcomes were listed. Then, classiﬁed as desirable, undesirable but acceptable, or unacceptable based on factors identiﬁed. Qualitative analysis by deduction including outcomes determining possible modiﬁcations in treatment of future cases was done.

RESULTS
Of the nine cases, one was listed as desirable, one with unacceptable outcome due to management complications, and the rest were labeled as undesirable but acceptable either because of advanced disease or poor KPS score. Three major factors were determined: the roles of pre-hospital and initial treatment delays, the decision for surgical treatment, and the COVID-19 pandemic.

CONCLUSION
The shift in the outcomes of malignant gliomas during COVID-19 shows the management challenge in low resource centers. There is an increase in highly malignant cases with guarded prognosis due to lack of education, support, and resources in terms of early diagnosis, treatment, and post-surgical care. This was aggravated by the restrictions imposed by the pandemic and ﬁnancial crisis, especially for patients below the poverty line. Delays in management show a signiﬁcant inﬂuence on prognosis regardless of treatment. As such, possible modiﬁcations in the current treatment algorithm are hereby recommended.
MULTI-AGENCY DEVELOPMENT OF A NEW INFORMATION RESOURCE FOR PATIENTS WITH BRAIN METASTASES
Authors: Watson Ms Rhona , Austin Ms Gemma , Bulbeck Dr Helen 
Published: October 2024

Abstract

AIMS
Based in a large neuro-oncology centre which provides specialist care for hundreds of patients with BM per year, the authors identiﬁed a need for relevant, non-disease speciﬁc, technically accurate and holistically focussed patient information material. This project aimed to develop a comprehensive and patient-focussed information resource for patients with BM.

METHOD
A scoping exercise of twenty UK-based cancer charity websites was carried out. Generic cancer charity sites and sites of charities supporting the four main primary cancer groups which metastasize to the brain were targeted. Information pertaining to BM was collated and reviewed by a multidisciplinary group to assess for scope and quality of information provided. Particular attention was paid to identifying information which was technically accurate and speciﬁcally addressed the holistic needs of this patient group.

RESULTS
Information found was primary disease-speciﬁc, technically inaccurate and did not acknowledge the holistic needs of the patient. This exercise highlighted the need for comprehensive and relevant patient-focussed information material. A working group consisting of health professionals and BrainsTrust charity staff was formed to create an effective patient information resource. Existing BrainsTrust information templates were used to structure the new resource. Evidence-based clinical information was provided by the healthcare professionals involved and holistic information was created collaboratively with charity input. A patient reviewer was enlisted to provide feedback on draft versions.

CONCLUSION
This project resulted in production of a patient-focussed and comprehensive information resource on BM. Patient and healthcare professional feedback to date has been positive.
The HAT1 transcription factor regulates photomorphogenesis and skotomorphogenesis via phytohormone levels
Authors: Zhao Yuqing , Han Qing , Kang Xinke , Tan Wenrong , Yao Xiuhong , Zhang Yang , Shi Haoyu , Xia Ran , Wu Xuemei , Lin Honghui , Zhang Dawei 
Published: October 2024

Abstract
Plants dynamically modulate their growth and development to acclimate to the fluctuating light environment via a complex phytohormone network. However, the dynamic molecular regulatory mechanisms underlying how plants regulate phytohormones during skotomorphogenesis and photomorphogenesis are largely unknown. Here, we identified a HD-ZIP II transcription factor, HOMEODOMAIN ARABIDOPSIS THALIANA1 (HAT1), as a key node that modulates the dose effects of brassinosteroids (BRs) and auxin on hypocotyl growth during skotomorphogenesis and photomorphogenesis. Compared with the wild-type (Col-0), both HAT1 loss of function and its overexpression led to disrupted photomorphogenic and skotomorphogenic hypocotyl growth. HAT1 overexpression (HAT1OX) plants displayed longer hypocotyls in the light but shorter hypocotyls in darkness, whereas the triple mutant hat1hat2hat3 showed the opposite phenotype. Furthermore, we found that CONSTITUTIVE PHOTOMORPHOGENIC 1 (COP1) interacted with dephosphorylated HAT1 and facilitated the degradation of HAT1 by ubiquitination in darkness, while HAT1 was phosphorylated and stabilized by BRASSINOSTEROID INSENSITIVE2 (BIN2) in the light. Interestingly, we observed distinct dose-dependent effects of BR and auxin on hypocotyl elongation under varying light conditions and that HAT1 functioned as a key node in this process. The shorter hypocotyl of HAT1OX in darkness was due to the inhibition of BR biosynthetic gene BRASSINOSTEROID-6-OXIDASE2 (BR6OX2) expression to reduce BRs content, while brassinolide (BL) treatment alleviated this growth repression. In the light, HAT1 inhibited BR biosynthesis but enhanced auxin signaling by directly repressing IAA3/SHORT HYPOCOTYL 2 (SHY2) expression. Our findings uncover a dual function of HAT1 in regulating BR biosynthesis and auxin signaling that is crucial for ensuring proper skotomorphogenic and photomorphogenic growth.
NLRP3 deficiency improves bone healing of tooth extraction sockets through SMAD2/3-RUNX2-mediated osteoblast differentiation
Authors: Geng Ying , Bao Chen , Chen Yue , Yan Ziwei , Miao Fen , Wang Ting , Li Yingyi , Li Lu , Sun Wen , Xu Yan 
Published: October 2024

Abstract
Impaired bone healing following tooth extraction poses a significant challenge for implantation. As a crucial component of the natural immune system, the NLRP3 inflammasome is one of the most extensively studied pattern-recognition receptors, and is involved in multiple diseases. Yet, the role of NLRP3 in bone healing remains to be clarified. Here, to investigate the effect of NLRP3 on bone healing, we established a maxillary first molar extraction model in wild-type and NLRP3KO mice using minimally invasive techniques. We observed that NLRP3 was activated during the bone repair phase, and its depletion enhanced socket bone formation and osteoblast differentiation. Moreover, NLRP3 inflammasome activation was found to inhibit osteogenic differentiation in alveolar bone-derived mesenchymal stem cells (aBMSCs), an effect mitigated by NLRP3 deficiency. Mechanistically, we established that the SMAD2/3-RUNX2 signaling pathway is a downstream target of NLRP3 inflammasome activation, and SMAD2/3 knockdown partially reversed the significant decrease in expression of RUNX2, OSX, and ALP induced by NLRP3. Thus, our findings demonstrate that NLRP3 negatively modulates alveolar socket bone healing and contributes to the understanding of the NLRP3-induced signaling pathways involved in osteogenesis regulation.
Epidemiology and management of congenital anomalies in neonates in a hospital in Northern India
Authors: Verma Akanksha , Verma Manoj K , Priyanka Vallepu L , Naranje Kirti , Singh Anita , Roy Abhijeet , Paul Abhishek , Phadke Shubha , Kumar Basant 
Published: October 2024

Abstract
Recent evidence shows a shift in neonatal mortality causes, with an increasing proportion due to birth defects. This study aimed to determine the prevalence and treatment outcomes of congenital anomalies (CAs) at a tertiary referral center in Northern India. This retrospective observational study was conducted over 7 years (May 2014–December 2021) and included all inborn and outborn neonates admitted with a diagnosis of CA as per ICD-10 classification in a level 3 NICU in North India. The prevalence of CAs was 8.9% (332 out of 3734 neonates). The most commonly affected systems were cardiovascular (33.4%), gastrointestinal (19.8%), and genitourinary (19.8%). While 57.5% of these defects could potentially be addressed through pediatric and cardiovascular surgery, only a small proportion of eligible neonates received timely surgical intervention due to delayed referrals and financial constraints. The mortality rate was 16.8%. This study highlights the significant burden of CAs in Northern India, emphasizing the need for enhanced capacity building, better facilities, and increased awareness for timely referrals. The findings underscore the importance of multidisciplinary collaborations and upgraded healthcare services to inspire further research and preventive strategies to mitigate birth defects. Given the context of a low- and middle-income country, this study’s insights into the prevalence, challenges, and outcomes of CAs are particularly relevant, highlighting the necessity of accessible and affordable healthcare solutions in such settings.
Assessing the potential of native copepods in Guatemala for Aedes vector control
Authors: Dambach Peter , Louis Valérie R , Duarte Silvia , Monzón Vivian , García-Gallardo Edgar Orlando , Reyes-Ramirez Miguel Angel , Felipe-Díaz Juan Pablo , Montenegro-Quiñonez Carlos Alberto 
Published: October 2024

Abstract

Background
In this study we examine the feeding efficiency of copepods locally found in Guatemala on first instar Aedes aegypti larvae. Copepods are a potential tool for Aedes vector control that has shown promising results in the laboratory and in community-based field trials.

Methods
Four different copepod species from different habitat types were included in the laboratory assays of this study.

Results
All four tested copepod species decreased the number of the first instar Aedes larvae that were inserted into the glass vessels compared with controls. However, average predation rates between the tested species were highly different, with Thermocyclops crassus and Mesocyclops longisetus achieving the highest, with 31.0% (standard deviation [SD] 18.9) and 28. 9% (SD 11.2), respectively.

Conclusions
The copepod species with identified high predation rates are potential candidates for planned and other future field trials for community-based Aedes vector control with copepods in the region.