tbuckley/cabot-search huggingface dataset:
Imaging of acute abdominal pain in the third trimester of pregnancy
Authors: J Shur, C Bottomley, K Walton, JH Patel
Journal: BMJ (2018)

### What you need to know

A 25 year old woman at 29 weeks’ gestation in her first pregnancy presents to her local hospital with a 12 hour history of constant abdominal pain and vomiting. She has no relevant medical or surgical history, and the pregnancy has been uncomplicated. She reports normal fetal movements and no vaginal fluid or blood loss. On examination, she has a tachycardia of 100 beats/min, blood pressure 108/70 mmHg and a temperature of 37.9°C. Abdominal examination finds generalised abdominal tenderness without peritonism. On vaginal speculum examination, the cervix appears long and closed. Urinalysis is negative for blood, protein, leucocytes, and nitrites but shows ketonuria. Cardiotocography is performed, which confirms a normal fetal heart rate pattern with no evidence of uterine activity. Initial full blood count, electrolytes, renal, and liver function are normal, except for an elevated white cell count of 15.0×109/L and C reactive protein of 11.5 mg/L. 

Abdominal pain at all stages of pregnancy is a common presentation in both primary and secondary care. More serious causes of abdominal pain, such as appendicitis, can be associated with serious morbidity and mortality to both fetus and mother. Diagnosis and investigation of abdominal pain during pregnancy present specific challenges, particularly in the third trimester, where the large gravid uterus makes clinical and imaging assessment of abdominal pain more complex.

In this article, we present …
Impact of spliceosome mutations on RNA splicing in myelodysplasia: dysregulated genes/pathways and clinical associations
Authors: Andrea Pellagatti, Richard N. Armstrong, Violetta Steeples, Eshita Sharma, Emmanouela Repapi, Shalini Singh, Andrea Sanchi, Aleksandar Radujkovic, Patrick Horn, Hamid Dolatshad, Swagata Roy, John Broxholme, Helen Lockstone, Stephen Taylor, Aristoteles Giagounidis, Paresh Vyas, Anna Schuh, Angela Hamblin, Elli Papaemmanuil, Sally Killick, Luca Malcovati, Marco L. Hennrich, Anne-Claude Gavin, Anthony D. Ho, Thomas Luft, Eva Hellström-Lindberg, Mario Cazzola, Christopher W. J. Smith, Stephen Smith, Jacqueline Boultwood
Journal: Blood (2018)
The feasibility study of short hydration with oral rehydration therapy in chemotherapy with cisplatin plus gemcitabine for biliary tract cancer (KHBO-1302)
Authors: T. Ioka, D. Sakai, H. Wada, H. Eguchi, K. Yanagihara, H. Satake, J. Shimizu, M. Kanai, K. Hashimoto, T. Ajiki, M. Nakamura, Y. Takeda, K. Yoshimura, E. Hatano, H. Nagano
Journal: Annals of Oncology (2018)

Introduction: Gemcitabine plus cisplatin (GemCis) is a standard chemotherapy for advanced biliary tract cancer. It needs to take long time for hydration to prevent renal toxicity due to cisplatin. This prospective study evaluated the feasibility of short hydration regimen of GemCis with oral rehydration solution in patients with advanced biliary tract cancer. Methods: The major eligibility criteria included patients with biliary tract cancer for whom a cisplatin-gemcitabine combined chemotherapy was indicated and adequate organ function. For the patients in oral rehydration treatment (ORT) group, cisplatin and gemcitabine were administered via infusion as follows; 500 ml of 0.9% saline including cisplatin (25 mg/m2) over 1 hour followed by 250 ml of 0.9% saline including gemcitabine over 30 minutes. Before and after the infusion, each 500ml bottle of oral rehydration solution (OS-1 ®) will be taken respectively. Primary endpoint was completion rate during the 12 weeks. Results: From July 2013 to January 2016, 71 patients were enrolled from 11institusions in Japan, and 50 were allocated to oral rehydration group. The complete rate in ORT group was 65.4% (95% CI: 50.9 - 78.0) (n = 34/53). Progression free survival and overall survival in ORT group were 6.0 (95% C.I.: 4.4-8.3) and 15.1 (95% C.I.: 10.8-18.2) months, respectively. The proportion of Creatinine increased were 14% in ORT arm (grade 1 14%), and 26% in CHT arm (grade 1 21%, grade 2 5%), respectively. Conclusion: The short hydration regimen with oral rehydration solution for cisplatin regimen for the patient with BTC is as safe as the conventional hydration regimen.
RONC-03. STEREOTACTIC RADIOSURGERY PROVIDES EFFECTIVE LOCAL CONTROL FOR RADIORESISTANT BRAIN METASTASES IN PEDIATRIC PATIENTS
Authors: Tommy Sheu, Acsa M Zavala, Tina M Briere, Andrew J Bishop, Mary Frances McAleer
Journal: Neuro-Oncology (2018)

To characterize outcomes for pediatric patients treated with stereotactic radiosurgery (SRS) for radioresistant primary or metastatic tumors of the brain and/or base of skull. We retrospectively reviewed 12 patients with melanoma (n=5) or sarcoma (n=7) primary tumors who were treated with frame-based SRS for a total of 41 lesions or sites. Median age was 17 years (range, 13 – 20). Four patients (15 lesions) had previously received radiation to the SRS-treated lesion. Four (10%) treatment sites were resection cavities. Four patients were treated under general anesthesia, which was well-tolerated. A median dose of 20 Gy (range, 6 – 22) was prescribed to a mean lesion volume of 1.34 cc (range, 0.02 – 22.0). After SRS, median follow-up time was 8.6 months (range, 1.6 – 91.7), median OS was 6.2 months, and median PFS was 7.7 months. Median time to intracranial progression was 5.9 months; 83% of events were attributable to new intracranial metastases. SRS response rate was 68% (complete 44%, partial 24%); 10% of treated lesions progressed after SRS. The 6-month actuarial LC rate was 91% and was significantly better for lesions <1.5 cc (100% vs. 80%, P=0.03). Prior RT was not associated with poorer LC (P=0.64). There was one grade 5 toxicity at 1.6 months post-SRS, and one patient required surgical intervention for symptomatic perilesional edema. SRS is an important local therapy for pediatric patients with radioresistant metastases. SRS may provide more durable LC if used earlier and/or when tumors are small.
Lessons learnt from the National Confidential Enquiry into Patient Outcome and Death: Acute non-invasive ventilation
Authors: Michael G Davies, Mark C Juniper
Journal: Thorax (2018)

The British Thoracic Society (BTS) first produced a guideline on acute non-invasive ventilation (NIV) in 2002. 1 Earlier studies had established a survival benefit and reduced hospital stay for selected patients with chronic obstructive pulmonary disease (COPD). 2 3 Patients with milder acute hypercapnic respiratory failure (AHRF) due to COPD (pH 7.30-7.35)could be treated in a ward setting.No benefit was found when ward-based NIV was used for patients with pH<7.30. 3 Initially, there was limited availability of NIV in clinical practice, 4 though new services developed as the evidence base grew.In 2004, the National Institute for Health and Clinical Excellence (NICE) recommended that NIV should be available in all hospitals admitting patients with COPD. 5 The 2002 BTS NIV guideline defined the indications for NIV, described the optimal delivery of NIV and set standards of care.It comprised 41 recommendations (2 at grade A).Key recommendations are shown in table 1.The 2002 guideline also recommended regular audit of acute NIV services.National audits were emerging and a collaboration between the Royal College of Physicians of London (RCP) and BTS led to a series of national audits of acute hospital COPD care.The 2003 COPD audit showed that NIV was available in 89% of hospitals. 6However, only 31% of patients who presented with AHRF received NIV. 7An updated NIV guideline was produced in 2008, focused on the use of acute NIV to manage patients with AHRF due to COPD. 8 Its remit included patient selection, NIV set-up, monitoring and treatment escalation.It provided 28 recommendations (11 at grade A).The 2008 COPD audit placed a greater emphasis on NIV outcomes and highlighted numerous concerns. 9Some patients did not receive NIV despite meeting evidence-based criteria, whereas others did receive NIV when it was not indicated.There was a lack of sufficient trained staff, insufficient ventilators to provide NIV to all who needed it and fewer than half of patients with AHRF received NIV within 3 hours of presentation.The BTS established a national acute NIV audit and provided its first report in 2010 with further annual audits until 2013. 10While COPD was the indication for NIV for the majority of patients, BTS audits provided outcome data for all patients treated with NIV.All audit cycles raised important questions about the quality of NIV care and the organisation of NIV services in the UK.
Outcome and prognostic factors of gastric cancer in Tunisia
Authors: S. Karrit, I. Belaid, F. Ezzairi, A. El Ghali, A. Bedioui, N. Bouzid, M. Ben Mabrouk, F. Bouzaiene, Y. Ben Cheikh, I. Chabchoub, M. Hochlaf, L. Ben Fatma, S. Ben Ahmed
Journal: Annals of Oncology (2018)

Introduction: The aim of this retrospective study was to evaluate the influence of clinicopathological factors and treatment modalities on overall survival (OS) and progression free survival (PFS) of patients treated for gastric cancer. Methods: A single-center series of 115 patients treated between 2010 and 2017 in a department of Medical Oncology in Tunisia was retrospectively investigated. Results: A male predominance was noted (56.5%). Median age was 55 years old [26-89]. CA19-9 and ACE rates were increased in 34.8% of cases. Majority of patients were metastatic (43.9%) and 27% developed metachronous metastases. 62% of the metastases occurred in the peritoneum. 62.6% of the patients had surgery with a curative intent in 70.4%. 73.9% of patients received chemotherapy. Only 13.2% received radiotherapy. The median OS was 8 months. In univariate analysis, poor initial performance status, weight loss, elevated tumor markers, stages III and IV and a lymph node ratio of 0.5 were significantly (p < 0.0001) associated with a poor prognosis (OS and PFS). OS and PFS were significantly better in patients undergoing curative surgery, receiving chemotherapy and radiotherapy (p<0.001). In multivariate analysis, only pN3 stage was an independent prognostic factor for OS (p = 0.02). Conclusion: Gastric carcinoma is still diagnosed in an advanced stage in relatively young patients. Many factors are correlated with survival. Lymph node metastasis (pN3 stage) is the most important indicator to determine the prognosis of patients with resected gastric cancer. More aggressive treatments should be considered in patients with poor prognostic factors.
MBCL-50. SAFETY AND EFFICACY OF CHEMOTHERAPY INTENSIFICATION WITH AUTOLOGOUS HEMATOPOIETIC STEM CELL RESCUE, WITHOUT RADIATION, FOR CHILDREN WITH CNS EMBRYONAL TUMORS
Authors: Abhishek Bavle, Naina Gross, Theresa Gavula, Michael Confer, Jo Elle Peterson, Kar-Ming Fung, Laura Rooms, David Crawford, Rene McNall-Knapp
Journal: Neuro-Oncology (2018)

Survival for children with central nervous system (CNS) embryonal tumors has improved significantly with craniospinal irradiation, but at the cost of long-term adverse effects including second malignancies and significant neurocognitive deficits. One strategy to achieve cure, while avoiding radiation, is intensification of chemotherapy. We report our experience with this approach in 9 patients with embryonal tumors, whose parents declined radiation therapy. Four patients with medulloblastoma (MB) (median age 2.6 years; 2 classic/M0, 1 anaplastic/M1, 1 desmoplastic-nodular/M0/SHH; 3 non-WNT, non-SHH; none MYCN amplified) and 5 patients with localized non-MB embryonal tumors (median age 3.7 years; 4 ETMR, 1 NOS) were treated per ACNS0334 (3 cycles of vincristine, cyclophosphamide, cisplatin, etoposide, then consolidation with 3 cycles of carboplatin, thiotepa with autologous hematopoietic stem cell rescue). Three of 4 patients with MB are alive a median of 3 years (1.5 - 4.5y) off-therapy; one patient is deceased secondary to congenital heart disease (germline NAA10 mutation) 1.4 years off-therapy. Of 5 non-MB patients, 3 are alive - 1 without radiation 3.4 years off-therapy; 2 after focal radiation for local progression. Median time to progression for 4 patients was 5 months. Grade 3 adverse events for all patients included mucositis, pancytopenia and fever/neutropenia (median 5 episodes), with no therapy-related deaths. Intensified chemotherapy is a promising strategy to treat select MB patients without radiation, but appears less effective for non-MB embryonal tumors. Evaluation of the efficacy and safety of this approach for MB, with prospective trials informed by tumor biology, is warranted.
QOL-46. VISUAL REHABILITATION: INTEGRAL FOR AFFECTED BRAIN TUMOR PATIENTS
Authors: Himika Gupta, Yash Gala, Varun Sarvodaya, Purna Kurkure, Rakesh Jalali, Tejpal Gupta, Aliasgar Moiyadi, Aadil Chagla, Rahul Krishnatry
Journal: Neuro-Oncology (2018)

The eye is one of the most important senses for the overall development of a person, personality and self-esteem. We reviewed records of all patients referred from various centers across the city with visual impairment due to various non-ocular causes from March 2016-December 2017. The demographics, disease and treatment protocols, ophthalmic evaluation comprising of Visual Function Questionnaire 25(VFQ25) NEVI version 2000, functional visual assessment, perimetry, visually evoked potential(VEP), contrast sensitivity test(CST), retinal nerve fibre layer(RNFL) and Macula ocular computed tomography(OCT) were reviewed at baseline and at 6 months’ post-intervention. Of total fifty patients, 32 (64%) were with the brain tumor (commonest Optic pathway glioma: 62%). Twenty four(75%) were <21years at diagnosis. Mean age of presentation to us being 10.7 (1.5-22) years. Of these, 21 were students. Visual impairment ranged from bilateral no perception of light (blindness) to 20/20 (none). Average best-corrected visual acuity(BCVA) of the better eye:20/80 (moderate impairment) and of the worst eye: 20/175(severe impairment). Twenty patients (83%) underwent visual rehabilitation. Eight patients were prescribed optical enhancement devices and 11 visual stimulation exercises. Surgical intervention was done for 4 patients of which two were orneo-protective and two restorative procedures for unsightly appearance of the blind eye. Average VFQ score improved from 92.9 at presentation to 76.5 at 6 months. This review provides important insight into the baseline spectrum of visual morbidity in brain tumors and supports the benefit of routine integration of such services in the management of these patients.
Gemcitabine plus nab-paclitaxel versus modified FOLFIRINOX as first line chemotherapy in metastatic pancreatic cancer: A comparison of toxicity and survival
Authors: V. Pacheco-Barcia, T. France, G. Zogopoulos, N. Bouganim, O. Donnay, T. Alcindor, R. Mondéjar Solís, K. Guo, E. Martin, R. Colomer, J. Asselah
Journal: Annals of Oncology (2018)

Introduction: Gemcitabine plus nab-paclitaxel and modified FOLFIRINOX have been established as first line chemotherapy in metastatic pancreatic cancer, but there is no conclusive data on their comparison. The aim of our study is to evaluate survival and toxicity profile of metastatic pancreatic cancer patients treated with these therapies. Methods: Retrospective review of 85 metastatic PC diagnosed between January 2014 and January 2018 at two tertiary hospitals. Differences in treatment-related toxicity were assessed by the Chi-square test, progression-free survival (PFS) and overall survival (OS) with the log-rank test. Results: 46 patients were included: 25 Gemcitabine plus Nab-Paclitaxel and 21 received modified FOLFIRINOX. Median age was 63 years. Demographic and baseline characteristics were similar as follows (gemcitabine plus nab-paclitaxel/mFOLFIRINOX): Gender (male): 72%/71%, comorbidities: 16%/14%, liver metastasis: 72%/63%, jaundice that required stent insertion: 32%/48% and thromboembolic events: 56%/62%. The population of elderly patients (> 70y) was similar between both cohorts (36% vs. 42%, p = 0.2) but, 48% of patients treated with gemcitabine plus nab-paclitaxel showed ECOG PS > 1 compared to 4% of patients treated with mFOLFIRINOX (p = 0.01). Similar toxicity profile between both treatments was observed (36% vs 28%, p = 0.67). Incidence of grade 4 neutropenia was similar in both cohorts (12% vs 10%, p = 0.7), probably due to an increased use of G-CSF in patients receiving mFOLFIRINOX. Also, peripheral neuropathy (5% vs 7%, p = 0.8) and diarrhea (3% vs 2.1%, p = 0.6) were similar between groups. No differences were observed in median PFS of mFOLFIRINOX compared to gemcitabine plus nab-paclitaxel (8 months vs 4 months, p = 0.26). However, median OS was significantly longer in patients treated with mFOLFIRINOX (14 months vs 7 months, p = 0.02). Conclusion: Metastatic pancreatic cancer patients treated with mFOLFIRINOX showed increased survival compared to gemcitabine plus nab-paclitaxel, with a similar toxicity profile. These results raise the issue of appropriately selecting patients with poor ECOG PS who can benefit from gemcitabine plus nab-paclitaxel for an adequate control of disease.
HGG-21. IMAGING AND IMMUNOHISTOCHEMICAL CHARACTERISTICS OF H3 G34R-MUTANT GLIOMAS -A REPORT OF TWO CASES
Authors: Shumpei Onishi, Vega Karlowee, Yoshiko Nakano, Manish Kolakshyapati, Takeshi Takayasu, Motoki Takano, Vishwa Jeet Amatya, Yukio Takeshima, Koichi Ichimura, Kazuhiko Sugiyama, Kaoru Kurisu, Fumiyuki Yamasaki
Journal: Neuro-Oncology (2018)

Missense somatic mutations affecting histone H3.1 and H3.3 proteins are common in diffuse intrinsic pontine and thalamic gliomas and in a subset of cerebral hemispheric gliomas. The K27M mutation in histone H3.3 (H3F3A) and H3.1 (HIST1H3B/C) are defined as a new entity and named “diffuse midline glioma, H3 K27M-mutant” in WHO 2016 update. The G34 mutations, on the other hand, are found predominantly in supratentorial non-midline tumors and are not categorized as a new entity yet. We report the immunohistochemical and imaging characteristics of this rare tumor. Case 1: A 13-year-old boy presented with progressive right hemiparesis. MRI showed non-enhancing left frontal tumor with intratumoral hemorrhage and was hyper-intense on diffusion-weighted imaging (DWI). The tumor was excised in toto and was histologically diagnosed as glioblastoma. Case 2: A 19-year-old female was referred to our institute with complaints of dysesthesia and generalized convulsion. MRI revealed a right parietal tumor with partial enhancement and slight hyper-intensity on DWI. The tumor was completely excised and was histologically diagnosed as anaplastic astrocytoma. In both cases, the tumor cells were immunoreactive to H3 G34R-mutant and p53 antibodies, and non-reactive to H3 K27M-mutant, IDH1-R132H, ATRX, and olig2. Mutations of H3 G34R were confirmed by sequencing in both tumors. Immunohistochemical characteristics are valuable for predicting the mutation of H3 G34R in pediatric, adolescents and young adult gliomas. Negativity to olig2 may be the characteristic of H3 G34R-mutant gliomas. DWI hyper-intensity reflects the tumor cellularity and may be associated with malignant grade of H3 G34R-mutant gliomas.
Immunocytochemical method for diagnosis of metastases of signet ring cell carcinoma of the stomach
Authors: S. Lukmonov, O. Usmanov, M. Ismailov, K. Madatov, U. Kurbankulov, U. Allazarov
Journal: Annals of Oncology (2018)

Introduction: Evaluation of the informative value of the cytological method in the diagnosis of metastasis of cricoid-cell carcinoma of the stomach in ascites and pleural fluid. Methods: The results of cytological diagnostics of patients with cricoid carcinoma of the stomach of 24 patients in ascitic fluid and of 10 patients in pleural fluid were evaluated. They were treated on the basis of the Department of Oncology and Radiology of the Tashkent Medical Academy. A method of light microscopy with staining of Pappenheim drugs and an immunocytochemical method using a liquid preparation method were used, using standard techniques carrying out immunocytochemical reactions. The results of the study were evaluated and compared with the final diagnosis. Results: The patients' age was 48.5 ± 6.9 years, there were 16 men, 18 women. In 25 patients operated on for stomach cancer, ascites and pleurisy appeared 1-9 years. In the ascitic fluid of 9 patients, malignant tumor cells were detected during a primary examination. Without additional techniques, cricoid carcinoma in the fluid by the cytological method was established in 9 patients (26.5%). In the preparations, tumor cells with eccentrically located nuclei were noted, the individual cells took the form of a ring with a deformed nucleus and a vacuole with a mucus occupying almost the entire cellular body. Expression of EMA expression in the cytoplasm of tumor cells was noted in 61.5% (positive cases (in all cases, 8/13), Ber-EP4 in 100% (17/17), Claudin in 100% (4/4), CDX-2 in 35.3% (6/17), p53 in 100% (5/5), Ki-67 in 100% (3/3). Expression of cytokeratins was as follows: SC AE1/AE3 (13/13, 100%), SC MNF116 (13/13, 100%), CK5/6 (1/13, 7.7%), CK7 (15/17, 88, 2%), CK18 (17/17, 100%) and CK20 (8/17, 47.1%). In differential diagnosis of tumor cells and histiocytes, studies on CEAmono and CEApoly, which were 100% (15/15), were most significant, staining was pronounced. A positive reaction was noted in cells that were perceived as lightning microscopy as histiocytes. In histiocytes and leukocytes present in the liquid, a positive reaction to CD45 and CD68 was observed in the immunocytochemical study. Conclusion: 1) the possibility of light microscopy for diagnosis of metastasis of cricoid carcinoma in ascites and pleural fluid was 26.5%, which dictates the need to use additional refinement techniques; 2) the immunocytochemical method allows to confirm the histogenesis of tumor cells, however, antibodies specific for cricoid-cell carcinoma were not detected; 3) the problem of differential diagnosis of histiocytes, cellular mesothelium cells and cellular tumor cells is easily solved using an immunocytochemical reaction to cancer embryonic and epithelial antigens, which allows affirmatively determining the affiliation of cells to the cricoid-cell carcinoma.