tbuckley/cabot-search huggingface dataset:
Functional respiratory imaging provides novel insights into the long-term respiratory sequelae of bronchopulmonary dysplasia
Authors: Kristien Vanhaverbeke, Monique Slaats, Mohammed Al-Nejar, Niek Everaars, Annemiek Snoeckx, Maarten Spinhoven, Haroun El Addouli, Eline Lauwers, Annelies Van Eyck, Benedicte Y. De Winter, Kim Van Hoorenbeeck, Jozef De Dooy, Ludo Mahieu, Benjamin Mignot, Jan De Backer, Antonius Mulder, Stijn Verhulst
Journal: European Respiratory Journal (2020)

Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional respiratory imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD using FRI and to correlate these findings with the clinical presentation.We included 37 adolescents with a history of preterm birth (22 BPD cases and 15 preterm controls). The study protocol included a detailed history, lung function testing and computed tomography (CT) (at total lung capacity (TLC) and functional residual capacity (FRC)) with FRI. CT images were also assessed using the Aukland scoring system.BPD patients had lower forced expiratory volume in 1 s to forced vital capacity ratio (p=0.02) and impaired diffusion capacity (p=0.02). Aukland CT scores were not different between the two groups. FRI analysis showed higher lobar volumes in BPD patients at FRC (p<0.01), but not at TLC. Airway resistance was significantly higher in the BPD group, especially in the distal airways. Additionally, FRI showed more air trapping in BPD patients, in contrast to findings on conventional CT images.This study is the first to use FRI in research for BPD. FRI analysis showed higher lobar volumes in BPD patients, indicating air trapping and reduced inspiratory capacity. In contrast to Aukland CT scores, FRI showed more air trapping in the BPD group, suggesting that FRI might be a more sensitive detection method. Importantly, we also showed increased distal airway resistance in BPD patients. By combining structural and functional assessment, FRI may help to better understand the long-term sequelae of BPD.
Effectiveness of Molecular Testing Techniques for Diagnosis of Indeterminate Thyroid Nodules
Authors: Masha J. Livhits, Catherine Y. Zhu, Eric J. Kuo, Dalena T. Nguyen, Jiyoon Kim, Chi-Hong Tseng, Angela M. Leung, Jianyu Rao, Mary Levin, Michael L. Douek, Katrina R. Beckett, Dianne S. Cheung, Yaroslav A. Gofnung, Stephanie Smooke-Praw, Michael W. Yeh
Journal: JAMA Oncology (2020)

Approximately 20% of thyroid nodules display indeterminate cytology. Molecular testing can refine the risk of malignancy and reduce the need for diagnostic hemithyroidectomy.To compare the diagnostic performance between an RNA test (Afirma genomic sequencing classifier) and DNA-RNA test (ThyroSeq v3 multigene genomic classifier).This parallel randomized clinical trial of monthly block randomization included patients in the UCLA Health system who underwent thyroid biopsy from August 2017 to January 2020 with indeterminate cytology (Bethesda System for Reporting Thyroid Cytopathology category III or IV).Molecular testing with the RNA test or DNA-RNA test.Diagnostic test performance of the RNA test compared with the DNA-RNA test. The secondary outcome was comparison of test performance with prior versions of the molecular tests.Of 2368 patients, 397 were eligible for inclusion based on indeterminate cytology, and 346 (median [interquartile range] age, 55 [44-67] years; 266 [76.9%] women) were randomized to 1 of the 2 tests. In the total cohort assessed for eligibility, 3140 thyroid nodules were assessed, and 427 (13.6%) nodules were cytologically indeterminate. The prevalence of malignancy was 20% among indeterminate nodules. The benign call rate was 53% (95% CI, 47%-61%) for the RNA test and 61% (95% CI, 53%-68%) for the DNA-RNA test. The specificities of the RNA test and DNA-RNA test were 80% (95% CI, 72%-86%) and 85% (95% CI, 77%-91%), respectively (P = .33); the positive predictive values (PPV) of the RNA test and DNA-RNA test were 53% (95% CI, 40%-67%) and 63% (95% CI, 48%-77%), respectively (P = .33). The RNA test exhibited a higher PPV compared with the prior test version (Afirma gene expression classifier) (54% [95% CI, 40%-67%] vs 38% [95% CI, 27%-48%]; P = .01). The DNA-RNA test had no statistically significant difference in PPV compared with its prior version (ThyroSeq v2 next-generation sequencing) (63% [95% CI, 48%-77%] vs 58% [95% CI, 43%-73%]; P = .75). Diagnostic thyroidectomy was avoided in 87 (51%) patients tested with the RNA test and 83 (49%) patients tested with the DNA-RNA test. Surveillance ultrasonography was available for 90 nodules, of which 85 (94%) remained stable over a median of 12 months follow-up.Both the RNA test and DNA-RNA test displayed high specificity and allowed 49% of patients with indeterminate nodules to avoid diagnostic surgery. Although previous trials demonstrated that the prior version of the DNA-RNA test was more specific than the prior version of the RNA test, the current molecular test techniques have no statistically significant difference in performance.ClinicalTrials.gov Identifier: NCT02681328.
FRI0178 PREDICTIVE FACTORS FOR POOR SLEEP QUALITY IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: R. Magro, L. Camilleri, A. Borg
Journal: Annals of the Rheumatic Diseases (2020)

Background: Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month. 1 Objectives: The aim of this study was to analyse the relationship of sleep quality with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE. Methods: A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee. Results: 92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI &gt;5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R=0.254, p=0.014), VAS pain (R=0.515, p&lt;0.001), HADS-D (R=0.605, p&lt;0.001), HADS-A (R=0.375, p&lt;0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p=0.044), FSS (R=0.551, p&lt;0.001) and mHAQ (R=0.559, p&lt;0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p&lt;0.001), HADS-D (p&lt;0.001) and eGFR (p=0.003). Conclusion: Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing. References: [1]Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28: 193 – 213. Disclosure of Interests: None declared
NIMG-02. 18F-FLUCICLOVINE PET/CT TO DISTINGUISH RADIATION NECROSIS FROM TUMOR PROGRESSION IN BRAIN METASTASES TREATED WITH STEREOTACTIC RADIOSURGERY
Authors: Martin Tom, Frank DiFilippo, Stephen Jones, John Suh, Erin Murphy, Jennifer Yu, Alireza Mohammadi, Gene Barnett, Steve Huang, Guiyun Wu, Nancy Obuchowski, Manmeet Ahluwalia, David Peereboom, Glen Stevens, Samuel Chao
Journal: Neuro-Oncology (2020)

Abstract PURPOSE/OBJECTIVE(S) To report descriptive updates of an ongoing pilot trial assessing whether 18F-Fluciclovine PET/CT, a widely available amino-acid radiotracer, is useful to distinguish radiation necrosis (RN) from tumor progression (TP) among patients with brain metastases. MATERIALS/METHODS The primary objective is to estimate the accuracy of 18F-Fluciclovine PET/CT in distinguishing RN from TP. We included adults with brain metastases who underwent prior stereotactic radiosurgery and presented with a follow-up MRI brain (with DSC-MR perfusion) which was equivocal for RN versus TP. Within 30 days of equivocal MRI, patients underwent 18F-Fluciclovine PET/CT on a Siemens Biograph mCT scanner with a 10 mCi bolus dose immediately prior to PET. PET data were collected in list-mode for 25 mins post-injection and were reconstructed as a static image of data 10-25 mins post-injection, and as a dynamic series of four 5-min frames between 5-25 mins post-injection. Quantitative metrics for each lesion were documented. Lesion to normal brain ratios were calculated. The reference standard was clinical follow-up with MRI brain (with DSC-MR perfusion) every 2-4 months until multidisciplinary consensus (or tissue confirmation) for diagnosis of RN versus TP. RESULTS From 7/2019-6/2020, 12 of 16 planned subjects with 17 lesions underwent 18F-Fluciclovine PET/CT. Primary histology was non-small cell lung cancer in 5 patients, breast in 4, melanoma in 2, and endometrial in 1. Among all 17 lesions, ranges of quantitative metrics were: SUVmax, 2.18-12.10; SUVmean, 1.16-7.37; SUVpeak, 1.06-4.45; normal brain SUVmean, 0.19-0.44; SUVmax/normal ratio, 7.50-45.40; SUVmean/normal ratio, 4.20-26.30; and SUVpeak/normal ratio, 3.90-26.40. Follow-up was completed for 5 patients (6 lesions). No adverse events have occurred. CONCLUSION In this population, 18F-Fluciclovine produces a wide range of lesion quantitative metric values and uniformly low uptake in normal brain, which may allow accurate discrimination. Ongoing additional accrual and follow up is required.
EPCO-03. REPORT OF NTRK FUSION IN A PEDIATRIC PATIENT WITH SPINAL GANGLIOCYTOMA
Authors: Avanti Gupte, Stephanie Toll, Neena Marupudi, Hamza Gorsi
Journal: Neuro-Oncology (2020)

Abstract BACKGROUND Gangliocytomas are rare WHO grade 1 central nervous system tumors of neuronal/ mixed neuronal-glial classification that most commonly occur in the cerebrum, favoring the temporal lobe. They are also reported in cerebellum in the setting of Lhermite-Duclos disease. Spinal gangliocytomas are exceedingly rare, constituting 3–10% of reported pediatric cases. Maximal safe surgical resection is the mainstay of therapy, as response to irradiation or traditional chemotherapy is variable. Given the rarity of these tumors, little is known about the molecular makeup or the role of targeted therapy in this population. CASE Our patient presented as a 7-year-old male with thorocolumbar scoliosis. A magnetic resonance imaging (MRI) of his spine incidentally demonstrated a heterogeneously enhancing, expansile solid and cystic intramedullary thoracic mass from T6 through T11. MRI brain did not show any intracranial mass. He subsequently underwent a laminectomy with laminoplasty for the intramedullary mass. Histopathologic analysis confirmed a WHO grade I gangliocytoma with moderately cellular abnormal central neural tissue composed of irregular clusters and cords of mature-appearing neurons in a coarse neuropil background. Because of the unusual location and presentation of his disease, molecular analysis including DNA and RNA sequencing was performed which revealed a somatic BCR-NTRK2 fusion. DISCUSSION NTRK gene fusions are known oncogenic drivers, reported with varying frequency in many pediatric and adult tumors. They are reported in &amp;lt; 1% of adult head and neck cancers but greater than 90% of congenital infantile fibrosarcomas. NTRK fusions are seen in pediatric brain tumors like infantile high grade gliomas, however they have not been previously reported in gangliocytoma. As TRK inhibitors are efficacious in treating a number of NTRK-rearranged malignancies, this novel finding provides a therapeutic option for NTRK fusion positive gangliocytoma where complete surgical resection is not safely possible.
SURG-11. NEOADJUVANT CHEMOTHERAPY FOR DIFFUSE GLIOMAS: A FEASIBLE OPTION?
Authors: Aline Campos Paiva, João Luiz Vitorino Araujo, Guilherme Brasileiro de Aguiar, Gabriel Rezende Batistella, Marcos Maldaum, José Esteves veiga
Journal: Neuro-Oncology (2020)

Abstract BACKGROUND Diffuse gliomas are slow-growing tumors with predilection for deep and eloquent structures such as supplementary motor area and insula. They can reach huge dimensions which is a surgical challenging. OBJECTIVE Describe indications and limitations of neoadjuvant chemotherapy for diffuse gliomas. METHODS Systematic review was performed in November/2019 using Pubmed, Bireme and Cochrane databases. The following combinations were used: “Chemotherapy” AND “neoadjuvant” AND “diffuse glioma”, “Chemotherapy” AND “neoadjuvant” AND “low grade glioma”, “Chemotherapy” AND “preoperative” AND “diffuse glioma”, “Neoadjuvant” AND “Chemotherapy” AND “temozolomide” AND “diffuse glioma”. RESULTS After carefully analysis, 7 papers were selected. They had mixed surgical interventions and used different drugs. In general, it was observed that neoadjuvant Temozolomide for Oligodendrogliomas 1p19q codeleted with MGMT methylation had better response than other molecular groups. Tumor reduction was significant. CONCLUSIONS Quality of life is a main goal in neurooncology. Tumor reduction using chemotherapy is a promising therapeutic. Surgery, especially in eloquent areas, could remove more tumors with less morbidity. Recent publications are using this approach with good outcomes, however further studies with more patients and uniformization are required to stablish this approach.
LINC-07. PREVALENCE AND SPECTRUM OF EARLY ENDOCRINE DISORDERS IN SURVIVORS OF PEDIATRIC EMBRYONAL BRAIN TUMORS (PEBT): EXPERIENCE FROM INDIA
Authors: Maya Prasad, Kalasekhar Vijayasekharan Nair, Rahul Krishnatry, Girish Chinnaswamy, Tejpal Gupta, Sudha Rao
Journal: Neuro-Oncology (2020)

Abstract BACKGROUND Survivors of pediatric brain tumors are at high risk of developing endocrine disorders, potentially impacting growth,development and quality of life. METHODS etrospective audit of 2-year survivors of PEBT(3-18years at diagnosis)viz. medulloblastoma(MB),Central nervous system Primitive neuro-ectodermal tumors(CNS-PNET) and atypical teratoid/rhabdoid tumor(ATRT) treated January 2006-December 2017 at Tata Memorial Centre,Mumbai, with surgery, cranio-spinal irradiation(CSI; 35Gy in high-risk MB,CNS-PNET,ATRT and 23.4Gy in average-risk MB with tumor boost 19.8Gy)and six cycles of adjuvant chemotherapy(cyclophosphamide,cisplatin and vincristine).Patients were followed up by a paediatric endocrinology team specialized in management of PEBT. RESULTS Of 249 PEBT treated during this period,88 are alive in remission &amp;gt;2 years (69-MB, 15-CNS PNET,4-ATRT),median age at diagnosis 6 years. At a median follow-up of 5.6 years (range 3- 12.5years),63 patients(72%) had at least one endocrine disorder,26(29.%)≥2 hormonal deficiencies. The most common endocrine disorders were central hypothyroidism(57%),growth hormone deficiency(40%), central hypogonadism(5%)and central hypoadrenalism (3.5%).The median time to develop hypothyroidism was 2.8 years(range 5months to 8.5 years) from CSI. Growth hormone replacement therapy began after a median period of 4.2 years(range-1.5 to 11.5years) from CSI. Higher dose of CSI was associated with development of endocrine disorder (odds ratio [OR] 2.71; 95% CI, 1.03 to 7.04,p-0.04). CONCLUSIONS The high incidence of endocrine deficits in survivors of PEBT necessitates early and lifelong monitoring. Early and appropriate management is crucial to achieve full growth potential.
Postexercise severe ventricular ectopy in heart failure patients: New marker for aggregate risk**Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.
Authors: Daniel L. Dries, Ralph J. Verdino, Robert C. Kowal
Journal: Journal of the American College of Cardiology (2004)
Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles
Authors: Richard W. Grant, Jodi McCloskey, Meghan Hatfield, Connie Uratsu, James D. Ralston, Elizabeth Bayliss, Chris J. Kennedy
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Medically complex patients are a heterogeneous group that contribute to a substantial proportion of health care costs. Coordinated efforts to improve care and reduce costs for this patient population have had limited success to date. <h3>Objective</h3> To define distinct patient clinical profiles among the most medically complex patients through clinical interpretation of analytically derived patient clusters. <h3>Design, Setting, and Participants</h3> This cohort study analyzed the most medically complex patients within Kaiser Permanente Northern California, a large integrated health care delivery system, based on comorbidity score, prior emergency department admissions, and predicted likelihood of hospitalization, from July 18, 2018, to July 15, 2019. From a starting point of over 5000 clinical variables, we used both clinical judgment and analytic methods to reduce to the 97 most informative covariates. Patients were then grouped using 2 methods (latent class analysis, generalized low-rank models, with k-means clustering). Results were interpreted by a panel of clinical stakeholders to define clinically meaningful patient profiles. <h3>Main Outcomes and Measures</h3> Complex patient profiles, 1-year health care utilization, and mortality outcomes by profile. <h3>Results</h3> The analysis included 104 869 individuals representing 3.3% of the adult population (mean [SD] age, 70.7 [14.5] years; 52.4% women; 39% non-White race/ethnicity). Latent class analysis resulted in a 7-class solution. Stakeholders defined the following complex patient profiles (prevalence): high acuity (9.4%), older patients with cardiovascular complications (15.9%), frail elderly (12.5%), pain management (12.3%), psychiatric illness (12.0%), cancer treatment (7.6%), and less engaged (27%). Patients in these groups had significantly different 1-year mortality rates (ranging from 3.0% for psychiatric illness profile to 23.4% for frail elderly profile; risk ratio, 7.9 [95% CI, 7.1-8.8],<i>P</i> &lt; .001). Repeating the analysis using k-means clustering resulted in qualitatively similar groupings. Each clinical profile suggested a distinct collaborative care strategy to optimize management. <h3>Conclusions and Relevance</h3> The findings suggest that highly medically complex patient populations may be categorized into distinct patient profiles that are amenable to varying strategies for resource allocation and coordinated care interventions.
LINC-11. NEUROPATHOLOGY REVIEW OF LATIN AMERICAN CHILDHOOD AND ADOLESCENT BRAIN TUMOR PATIENTS: A MULTI-NATIONAL, MULTI-DISCIPLINARY PEDIATRIC NEURO-ONCOLOGY TELECONFERENCE EXPERIENCE
Authors: Diana S Osorio, Christopher R Pierson, Alvaro Lassaletta, Andres Morales la Madrid, Ibrahim Qaddoumi, Ute Bartels, Daniel R Boue’, Jonathan L Finlay
Journal: Neuro-Oncology (2020)

Abstract BACKGROUND Pediatric brain tumor classification has undergone significant evolution over the last decade requiring a high-level of expertise and diagnostic techniques. Such advances have created challenges for pathologists particularly in low-to-middle income countries (LMIC). We conduct weekly pediatric neuro-oncology teleconferences linking global pediatric neuro-oncologists from high-income countries (HIC) to review patients with pediatric subspecialists from Latin America. METHODS Three to five patients are discussed weekly and second neuropathology review is offered when a high-level of suspicion emerges of a questionable diagnosis based on clinical and radiographical information. Nationwide Children’s Hospital (NCH) provides second neuropathology review at no cost to institutions in Latin America that fulfill these criteria. RESULTS From July 2015 to December 2019 NCH reviewed 54 pathology samples from eleven Latin American countries. Of these, 33 (61.1%) cases resulted in diagnostic changes, of which 28 (51.8%) were significant, impacting treatment plans and overall patient outcomes. The remaining 21 (38.9%) confirmed institutional diagnosis; however, in eight of these 21 cases additional molecular information and/or further tumor subtyping unavailable in their home country at the time (eg: BRAF, RELA-fusion, medulloblastoma subtyping) was provided. CONCLUSIONS This study highlights the importance of centralized pathology review by institutions with the proper equipment, infrastructure and expertise in pediatric neuropathology. Furthermore, this documents the beneficial impact of teleconferencing for subspecialists in LMIC who must treat a wide variety of pediatric cancers with few resources and support. Additionally, our findings underscore the need for pediatric subspecialty training in LMIC.
RADT-41. ASSESSING THE ROLE OF ADJUVANT RADIATION THERAPY AND RISK FACTORS FOR RECURRENCE FOLLOWING GROSS TOTAL RESECTION OF ATYPICAL MENINGIOMAS
Authors: S Harrison Farber, Veronica So, Michael Mooney, Tyler Cole, Colin Przybylowski, Leland Rogers, Nader Sanai
Journal: Neuro-Oncology (2020)

Abstract While meningiomas are commonly benign brain tumors, as many as 30% may be classified as atypical, or WHO Grade 2. Patients are at risk of recurrence following resection and often are prescribed adjuvant radiation therapy (RT)-although most data on this treatment is retrospective and has shown mixed RESULTS: In this study we assessed the influence of adjuvant RT following gross total resection (GTR) in patients with newly diagnosed atypical meningiomas at our institution and sought to determine predictors of tumor recurrence. All patients who underwent GTR (Simpson Grade I and II) at their index operation from 1994-2014 were retrospectively reviewed. Patients then either underwent observation or adjuvant RT (Intensity-Modulated Radiation Therapy (IMRT) or stereotactic radiosurgery (SRS)). A total of 145 patients had documented GTR at the time of initial resection, including 88 females (61%) and 57 males (39%), with a mean age of 58 +/- 15.7 years. 118 patients were followed with observation after surgery while 27 (18.6%) patients received adjuvant RT prior to known recurrence (IMRT for 15 patients (55.5%) and SRS in 12 patients (44.4%)). Patients receiving adjuvant RT had significantly larger tumors, as well as a higher incidence of spontaneous necrosis and small cell phenotype on histopathology. Overall 5-year PFS in our cohort was 71.6% (CI 60.6%-84.7%) and was unchanged by adjuvant RT (p = 0.52). 23 patients (15.8%) had a recurrence with a mean follow up of 42.9 months (17.1-53.5 months). Male gender (HR=1.02, p=0.019), tumor size (HR=1.17, p= 0.002) and MIB-1 &amp;gt; 4 (HR=8.50, p=0.04) were associated with increased recurrence risk. There was no association between radiation type (SRS vs. IMRT) and risk of recurrence (p= 0.154). In our patients, adjuvant RT following GTR of atypical meningiomas did not improve PFS. Risk factors for recurrence included male gender, larger tumor size, and MIB-1 &amp;gt; 4.
Extended Versus Limited Pelvic Lymph Node Dissection During Radical Prostatectomy for Intermediate- and High-risk Prostate Cancer: Early Oncological Outcomes from a Randomized Phase 3 Trial
Authors: Jean F.P. Lestingi, Giuliano B. Guglielmetti, Quoc-Dien Trinh, Rafael F. Coelho, Jose Pontes, Diogo A. Bastos, Mauricio D. Cordeiro, Alvaro S. Sarkis, Sheila F. Faraj, Anuar I. Mitre, Miguel Srougi, William C. Nahas
Journal: European Urology (2020)