tbuckley/cabot-search huggingface dataset:
NIMG-76. DISCRETE LOWER-GRADE GLIOMA (DLGG) VERSUS INFILTRATIVE LOWER-GRADE GLIOMA (ILGG): CORRELATION OF RADIOLOGICAL CHARACTERISTICS WITH CLINICAL OUTCOMES
Authors: Ahsan Ali Khan, Mohammad Hamza Bajwa, Noman Khan, Muhammad Usman Khalid, Fatima Mubarak, Syed Ather Enam
Journal: Neuro-Oncology (2021)

Abstract INTRODUCTION Lower grade gliomas encompass grade 2 and 3 tumors. However, this term is more generalized and does not include the spectrum of radiological and tumor morphological patterns seen. Here we have established two distinct patterns of radiographic appearance seen within lower grade gliomas: ILGG and DLGG. Imaging plays a vital role in diagnosis, surveillance, characterization, and monitoring of intracranial tumors. Of particular importance is the differentiation of tumor features to reliably predict malignancy, tumor grade, possible molecular or genetic features, disease progression and recurrence, potential for malignant transformation, and postoperative outcomes. Our study will look at these radiographic characteristics of diffuse and infiltrating lower grade gliomas and discuss their predictive value. Understanding the distinct nature of these varieties of LGG will help us in surgical decision-making, prognostication, biopsy target and precision medicine. METHODS Pre-operative and post-operative MRI images of Grade 2 and 3 tumors were identified and analyzed in order to extract radiographic data, and correlated with patient demographics, clinical outcomes, extent of surgical resection, and molecular genetic analysis. RESULTS Out of 35 patients evaluated, 22 (62.9%) were labeled ILGGs and 13 (37.1%) were deemed DLGGs according to the pre-defined criteria. T2 habitat was higher in ILGG (mean = 2162) than DLGG (mean = 1482) as well as size, in cm (6.02 vs. 4.92). ADC habitat, lesion ADC, and percentage of the lesion that showed contrast-enhancement were similar. T2-FLAIR mismatch was significantly higher in ILGG (p = 0.02). Post-operative KPS scores were significantly higher in the DLGG group (p = 0.03). CONCLUSION T2-FLAIR mismatch can be a significant classifier for lower-grade gliomas. Our study shows there are differences in tumor morphology of diffuse and infiltrative lower-grade gliomas which can be correlated to outcomes after surgery. *Indicates corresponding author.
RADT-04. STEREOTACTIC LASER ABLATION (SLA) FOLLOWED BY CONSOLIDATION STEREOTACTIC RADIOSURGERY (SRS) AS A TREATMENT STRATEGY FOR BRAIN METASTASIS THAT RECURRED LOCALLY AFTER INITIAL RADIOSURGERY (BMRS)
Authors: Isabela Pena-Pino, Jun Ma, Yusuki Hori, Elena Fomchenko, Kathryn Dusenbery, Margaret Reynolds, Christopher Wilke, Yianling Yuan, Gene Barnett, Verionica Chang, Alireza Mohammadi, Clark Chen
Journal: Neuro-Oncology (2021)

Abstract INTRODUCTION In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54-85% while repeat SRS achieved LC12 of 54-79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS). METHODS Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and &amp;gt;3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume. RESULTS SLA achieved ablation of 73-100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16-40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93-1367 days) and median overall survival (OS) of 185 days (range: 99-1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=6) or died from systemic disease progression (n=10). None of the treated patients developed symptomatic radiation necrosis. CONCLUSIONS This collaborative institutional experience support efficacy and safety of SLA followed by consolidation SRS as a treatment for BMRS. The treatment strategy warrants further investigations.
Correlation of Quality of Life between Treatment Outcomes in the Majic Study Which Compared Ruxolitinib to Best Available Therapy in Polycythemia Vera
Authors: Isaak Ailts, Carolyn Mead-Harvey, Adam J. Mead, Sonia Fox, Rebecca H. Boucher, Christina Yap, Chandan Saha, Robyn Scherber, Aimee Jackson, Joanne Ewing, Jason Coppell, Steve Knapper, Mark W. Drummond, Anna L Godfrey, Amylou C. Dueck, Mary Frances McMullin, Ruben A. Mesa, Claire N. Harrison, Holly L. Geyer
Journal: Blood (2021)
Workforce: health leaders lament lost chance to secure safe staffing in Health and Care Bill
Authors: Matthew Limb
Journal: BMJ (2021)

Doctors’ and health policy leaders have accused the government of squandering an opportunity to guarantee safe staffing in the NHS following a House of Commons vote.

They voiced dismay over the defeat of an amendment to the Health and Care Bill that would have required ministers to reveal the true extent of NHS staffing shortages and plan to deliver a sufficient workforce.

The amendment, proposed by former health secretary and Conservative MP Jeremy Hunt, was rejected on 23 November by 280 votes to 219.

Hunt said that currently there is no public data on whether England is training enough healthcare workers to meet expected future demand. He …
Abstract 12139: Substance P Replacement Reduces Cardiac Fibrosis in Monkeys With Type 2 Diabetes
Authors: Giselle C Melendez, Kylie Kavanagh, Jessica L Lacy, Masha Block, Nazli Gharraee, Alexander Widiapradja, Scott P Levick
Journal: Circulation (2021)

Introduction: Type 2 diabetes mellitus (T2DM)-associated cardiac fibrosis contributes to heart failure, especially in women. We have data showing that diabetic mice with cardiomyopathy, including cardiac fibrosis, exhibit low levels of the neuropeptide substance P (SP); and SP replacement reverses cardiac fibrosis, independent of body weight and blood glucose. To understand the potential translational significance of these findings, we sought to determine in a T2DM monkey model if replacement SP could reverse cardiac magnetic resonance (CMR) imaging and circulating markers of fibrosis, while also assessing safety of administration. Methods: Female T2DM African Green monkeys were randomized to receive SP (n=4, 0.5 mg/Kg/day S.Q. injection) or vehicle (n=3) for 10 weeks. We obtained CMR imaging and blood samples to assess left ventricular (LV) function and fibrosis by T1 map-derived extracellular volume (ECV) and circulating procollagen type I C-terminal propeptide (PICP). Hematological parameters for toxicities were also assessed. We performed a blinded paired analysis of all parameters. Results: Monkeys receiving replacement SP exhibited a decrease in ECV (Pre: 31.6 ± 5.53% vs. Post: 25.2 ± 3.3%, p=0.03), concomitant with decreased PICP levels (Pre: 5148.58 ± 1143.5 ng/mL vs. Post: 3851.1 ± 1377.5 ng/mL, p=0.01). Animals receiving vehicle showed no changes in ECV (p=0.32) or PICP (p=0.16). No changes in LV ejection fraction were observed (p=0.89). Complete blood counts, metabolic panel (ΔA1c, SP: -0.45 ± 0.59 % vs vehicle: -0.53 ± 0.61 %, p=0.43), lipids, liver and pancreatic enzymes, and inflammation markers were unchanged (p&gt;0.05 for all). Conclusion: Replacement SP reversed cardiac fibrosis in a large preclinical model of T2DM, independent of glycemic control. No organ-related toxicity was associated with replacement SP. These results strongly support a potential application for replacement SP as an antifibrotic therapy for diabetic cardiac fibrosis.
Abstract 12071: Emergent Temporary Transvenous Pacemakers Were Infrequently Needed for Patients Presenting With Complete Heart Block at a Regional Hospital
Authors: GAURANGA MAHALWAR, Nicole Lao, Hanad Bashir, Indiresha Iyer
Journal: Circulation (2021)

Introduction: Patients presenting with Complete heart block (CHB) are emergently referred for placement of a temporary transvenous pacemaker (TTVP) for hemodynamic stability. Data on the immediate management and outcomes of such patients are lacking. Methods: Data collected; through retrospective chart review of patients presenting to the Emergency Department (ED) at a regional hospital from October 2017 to January 2021 with a diagnosis of new CHB; included age, sex, clinical, laboratory and ECG data, medications, interventions and length of stay. Results: There were 71 patients (31 women) of whom 19 were on beta blocker or Calcium channel blockers. Data (see Table 1) for all variables was available in 68 patients. Syncope, lightheadedness and dyspnea were common symptoms. The median age was 77 years. The median heart rate was 41bpm. Atropine was used in 13 patients. Five patients with initial Systolic Blood Pressure (SBP) &lt; 100mmHg received sympathomimetics. Syncope with pause occurred in 3 patients. A TTVP was placed in 12 patients. Among 22 patients with initial SBP &gt; 160mmHg one patient with a recent TAVR had a TTVP placed. All but five were managed in the ICU setting. On Univariate logistic regression (R statistical software 3.6.1) initial SBP, SBP &lt; 100mmHg and Initial Serum K level were clinically significant. In multivariate analysis, SBP was significant with a lower SBP predicting need for a TTVP [OR 0.96 (CI 0.91 - 0.99, p = 0.019)]. A permanent pacemaker (PPM) prior to discharge was placed in 64 patients on average in 1.6 days from presentation. 3 patients with STEMI and TTVP did not need a PPM. 1 transitioned to hospice and 1 patient died of sepsis. In 1 it was attributed to COVID-19 infection. Conclusions: TTVP was infrequently needed (16.66%) among patients presenting to the ED with CHB. Initial SBP and Serum K were clinically relevant factors. Prospective data related to the acute management of CHB is needed to identify predictors that can improve the care for such patients.
Abstract 11293: Trends in Pulmonary Embolism Mortality Rates Among Racial Minorities in the United States, 1999-2019
Authors: Ayla Cash, Abdul Mannan Khan Minhas, SALIK NAZIR, Robert W Ariss, Rajesh Gupta
Journal: Circulation (2021)

Introduction: Acute pulmonary embolism (PE) is a major cause of mortality in the United States (US). Recent reports indicate that PE-related mortality rates have increased among all Americans, non-Hispanic White Americans, and non-Hispanic Black Americans in the last decade. Here, we report PE-related mortality trends in the US among non-Hispanic American Indian or Alaska Natives (NHAIAN), non-Hispanic Asian or Pacific Islanders (NHAPI), and Hispanic and/or Latino Americans (HL) between 1999 and 2019. Methods: Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were examined to determine all-cause PE mortality trends from 1999 to 2019 among adults older than twenty-five years old. The annual mortality rates were calculated per 100,000 population and age-adjusted based on the US population in the year 2000. The annual percentage change (APC) with corresponding 95% confidence intervals (CIs) were calculated to determine trends. Results: While overall AAMR decreased from 14.7 to 13.5 (APC -0.4 [95% CI -0.6 to -0.2) between 1999 and 2013, overall AAMR increased from 13.5 to 14.5 (APC 1.3 [95% CI 0.7 to 1.9]) between 2013 and 2019. NHAIAN AAMR increased from 9.68 to 12.09 (APC 1.2 [95% CI 0.5 to 1.9]) between 1999 and 2019. Among NHAPI, AAMR fluctuations prior to 2016 were not statistically significant. NHAPI AAMR increased from 3.81 to 4.58 (APC 6.2 [95% CI 0.5-12.3]) between 2016 and 2019. Among HL, AAMR decreased from 8.91 to 8.19 (APC -0.5 [95% CI -0.8 to -0.1]) between 1999 and 2019. Conclusions: Despite significant improvements in PE risk stratification and clinical management, PE related mortality increased significantly among NHAIAN between 1999 and 2019 and NHAPI between 2016 and 2019. The only racial cohort with a statistically significant reduction in AAMR during the entire study period was HL.
Abstract 9796: Atypical Right Atrial Flutter with Double Loop Reentry Involving the Cavotricuspid Isthmus and Superior Vena Cava with Successful Ablation
Authors: Banveet K Khetarpal, Nareg Minaskeian, Awad Javaid, Komandoor S Srivathsan
Journal: Circulation (2021)

Introduction: Atrial flutter (AFL) with figure-of-eight reentry (FOER) is effectively terminated by catheter ablation (CA) of the shared isthmus. Case: A 50-year-old man with prior mitral valve (MV) repair presented to our hospital with palpitations for 9 months refractory to metoprolol. ECG showed coarse atrial fibrillation at 61 bpm. Echocardiography showed left ventricular LVEF of 45%. Electrophysiology study revealed AFL (cycle length, TCL 290 msec) with a concentric activation pattern on the coronary sinus (CS) catheter, and a chevron pattern on the Halo catheter placed against the lateral tricuspid annulus (TA). Entrainment map revealed a near equal post-pacing interval and TCL in proximal CS, low lateral right atrium (RA), and CTI. Incomplete line of block was noted in the anterior wall of RA near the superior vena cava (SVC), likely from prior atriotomy scar. Double loop reentry (DLR) was demonstrated with one wavefront (WV) traveling counterclockwise around the TA using the CTI, and the other WV traveling posteriorly around the SVC (Figure). After CTI ablation, TCL changed from 290 msec to 330 msec suggesting blocked CTI. Now, the WV was a single loop around the SVC, confirmed by repeat activation mapping. Linear ablation from anterior TA to the anterior aspect of the SVC terminated the AFL. Differential pacing from either side of the anterior line and the CTI demonstrated a conduction time of &gt; 200 msec and 150 msec in either direction, respectively. Decremental atrial pacing was unable to induce any arrhythmias. Discussion: FOER in this case is suggested by fusion of WVs in the lateral RA. The 2 circuits each had their own conduction gap, in the CTI and anterior RA wall near the SVC, respectively. DLR was proven by entrainment as well as activation mapping. The faster CTI-dependent AFL was entraining the upper loop reentry circuit. Conclusion: Atypical right AFL with DLR mimicking FOER was successfully terminated by CA of CTI and anterior line of ablation from TA to SVC.
Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals
Authors: Marwan M. Refaat, Charbel Gharios, M. Vinayaga Moorthy, Farah Abdulhai, Roger S. Blumenthal, Miran A. Jaffa, Samia Mora
Journal: Journal of the American College of Cardiology (2021)
PATH-37. DISTINCT GENOMIC SUBCLASSES OF HIGH-GRADE/PROGRESSIVE MENINGIOMAS: NF2-ASSOCIATED, NF2-EXCLUSIVE, AND NF2-AGNOSTIC
Authors: Erik Williams, Sandro Santagata, Hiroaki Wakimoto, Fred Barker, Priscilla Brastianos, Daniel Cahill, Shakti Ramkissoon, Brian Alexander, Tareq Juratli
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Genomic studies of high-grade/progressive meningiomas have reported a heterogeneous mutation spectrum. Here, we present a genomic survey of one of the largest multi-institutional cohorts of high-grade/progressive meningiomas to date. METHODS 850 high-grade/progressive meningiomas, including 441 WHO grade 2 and 176 WHO grade 3 meningiomas and 220 progressive WHO grade 1 meningiomas, were tested as part of a clinical testing program by hybridization capture of 406 cancer-related genes. Information from histopathology review and patient clinical data was assessed. RESULTS Genomic analyses converged to identify at least three distinct patterns of biologically-aggressive meningiomas. The first and most common contained NF2-mutant tumors (n = 426, 50%), was associated with male sex (64.4%, p = 0.0001) and often harbored additional mutations in CDKN2A/B (24%), and the chromatin regulators ARID1A (9%), and KDM6A (6%). A second group (NF2-agnostic) featured TERTp (n = 56) or TP53 mutations (n = 25) and were either NF2-mutant or wild-type, and displayed no association with either sex. The remaining group generally lacked NF2 mutations, and accounted for 40% of the cases-with three subgroups. One consistent primarily of grade 3 lesions harboring alterations in chromatin regulators BAP1 (n = 22) or PBRM1 (n = 16). A second subgroup contained AKT1 (n = 26), PIK3CA (n = 14) and SMO (n = 7) mutant skull-based meningiomas, and a third mixed subgroup included 237 meningiomas with a heterogeneous spectrum of low frequency and non-recurrent alterations. CONCLUSIONS Our findings indicate that the patterns of genomic alterations in high-grade/progressive meningiomas commonly group into three different categories. The most common NF2-associated canonical group frequently harbored CDKN2A/B alterations, which is potentially amenable to targeted therapies. An NF2-agnostic group harbored frequent TERTp and TP53 mutations. The final subclass, distinct from the canonical NF2 mutant associated pathway, was partly characterized by BAP1/PBRM1 alterations (rhabdoid/papillary histology) or skull-base disease.
Abstract 10968: Seasonal Variations in In-Hospital Mortality Caused by Acute Cardiovascular Diseases in Japan from JROAD-DPC Dataset
Authors: michikazu nakai, Yoshitaka Iwanaga, Sumita Yoko, Yusuke Sasahara, Koshiro Kanaoka, Yoshihiro Miyamoto
Journal: Circulation (2021)

Introduction: Previous studies have shown that the incidence of acute cardiovascular diseases (CVDs) increases in winter. However, there is few research regarding seasonal changes of the in-hospital mortality and its relationship with the detailed conditions. Hypothesis: We assessed whether the acute CVDs have related seasonal trends regarding of hospitalized-patients number and in-hospital mortality using a national-wide Japanese registry of all cardiac and vascular datasets-Diagnostic Procedure Combination (JROAD-DPC). Methods: Based on International Classification of Diseases, Tenth Revision (ICD-10) code, we identified the hospitalized patients with acute CVDs; acute myocardial infarction (AMI, ICD10:I20), acute heart failure (AHF, ICD10:I50+additional code 30101/30102), and acute aortic dissection (AAD, ICD10:I710) between April 2012 and March 2020. Season was distinguished into four categories (Spring: March-May, Summer: June-August, Fall: September-November, and Winter: December-February). Univariate multilevel mixed-effects logistic regression with institution as a random variable was conducted. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Result: 1,644,135 patients with acute CVDs (age: 76.2 ± 13.5, male: 57.7 %) were identified. The number of hospitalized patients was the most in Winter among the seasons (30.4%). Using Spring as a reference, ORs (95% CI) of in-hospital mortality in Summer were 0.97 (0.95, 0.98) for all, 0.97 (0.94, 0.99) for age younger than 75, 0.98 (0.96, 0.99) for male, and 0.95 (0.93, 0.97) for female. In contrast, those in Winter was 1.03 (1.02,1.04) for all, 1.02 (0.99, 1.05) for age younger than 75, 1.05 (1.03, 1.07) for male, and 1.01 (0.99, 1.03) for female. Furthermore, in each diagnosis, those in Summer were 0.81 (0.79, 0.85) for AMI and 1.06 (1.02, 1.09) for AHF and 0.77 (0.73, 0.82) for AAD, whereas those in Winter were 1.04 (1.01, 1.08) for AMI, 1.01 (0.98, 1.04) for AHF, and 0.94 (0.89, 0.99) for AAD. Conclusions: A clear seasonal pattern was found in hospitalized patients with acute CVDs in a recent large-scale nationwide dataset; however, different seasonal trends of in-hospital mortality were found in younger, female, and AHF or AAD patients.
Abstract 11507: Radiation Reduction in Catheterization Laboratory: Single Center Experience
Authors: Shashank Shekhar, Abhishek Ajay, Anirudh Kumar, Manpreet Kaur, Toshiaki Isogai, Anas M Saad, Abdelrahman Abushouk, Omar M Abdelfattah, Hassan Mehmood Lak, Medhat Farwati, Kevin Wunderle, Stephen G Ellis, Jaikirshan Khatri, Amar Krishnaswamy, Samir R Kapadia
Journal: Circulation (2021)

Introduction: Radiation reduction measures were incorporated in the Cleveland Clinic Catheterization laboratories to mitigate the hazards from radiation exposure to patients and personnel during diagnostic and interventional coronary procedures. We report our experience with these improved systems over a 10-year period. Methods: Fluoroscopes were modified in 2013 by reducing the default fluoroscopic pulse rate from 10 to 7.5 pules/s, added default low-dose acquisitions, revised field-of-view dose factors, and instructed operators to use larger fields-of-view with appropriate collimation. A retrospective data analysis of all patients undergoing diagnostic catheterization from 2009 to 2012 (pre-initiative group), and 2013 to 2019 (post-initiative group) was done using Siemens CARE analytics software. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (K a,r ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups after propensity matching them based on age, sex, BSA, and total fluoroscopic time. Results: The total fluoroscopic time for the pre-initiative group (N=18,181) was 8.02 seconds while that for the post-initiative group (N=25,868) was 8.05 seconds. After matching 18,181 patients in both the groups (mean age, 64 years; 62% males), a significant reduction (54.4%) in the mean K a,r was observed in the post- in comparison to the pre-initiative group (420.94 mGy vs. 921.21 mGy; p&lt;2.2e -16 ). Further analysis revealed a reduction in the mean acquisition- (59.3%; 217.33 mGy vs. 533.50 mGy; p&lt;2.2e -16 ) and fluoroscopy-mode (47.5%; 203.61 mGy vs. 387.71 mGy; p&lt;2.2e -16 ) air kerma in the post-initiative group. A sub-analysis of patients matched on the basis of their exact fluoroscopy and acquisition times also revealed a significant reduction in K a,r , acquisition- and fluoroscopy-mode air kerma in the post-initiative group relative to the pre-initiative group (43.95%, 44.04%, 43.78% respectively). Conclusions: Optimization of imaging systems can significantly reduce patient radiation exposures which directly affect the radiation exposure of the Cath lab personnel. Similar algorithms can be applied in other labs to achieve a reduction in radiation exposure.