Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis

Central nervous system vasculitides are elusive diseases that are challenging to diagnose because brain biopsies have high false-negative rates. We sought to test the ability of contrast-enhanced, high-resolution 3D vessel wall MR imaging to identify vascular inflammation and direct open biopsies of intracranial target vessels and adjacent brain parenchyma. Eight of 9 specimens revealed vascular inflammation. We conclude that vessel wall MR imaging can identify inflamed intracranial vessels, enabling precise localization of biopsy targets.

Synthesis of Light-Responsive Pyrene-Based Polymer Nanoparticles via Polymerization-Induced Self-Assembly

The use of an in situ, one-pot polymerization-induced self-assembly method to synthesize light-responsive pyrene-containing nanoparticles is reported. The strategy is based on the chain extension of a hydrophilic macromolecular chain transfer agent, poly(oligo(ethylene glycol) methyl ether methacrylate), using a light-responsive monomer, 1-pyrenemethyl methacrylate (PyMA), via a reversible addition-fragmentation chain transfer dispersion polymerization; yielding nanoparticles of various morphologies (spherical micelles and worm-like micelles). In this process, addition of comonomers, such as butyl methacrylate (BuMA) or methyl methacrylate (MMA), are required to obtain high PyMA monomer conversion (>80% in 24 h). The addition of comonomers reduces the π-π stacking of the pyrene moieties, which facilitates the diffusion of monomers in the nanoparticle core. The addition of BuMA (as a comonomer) offers P(PyMA-co-BuMA) core-forming chains with high mobility that enables the reorganization of chains and then the evolution of morphology to form vesicles. In contrast, when MMA comonomer is used, kinetically trapped spheres are obtained; this is due to the low mobility of the core-forming chains inhibiting in situ morphological evolution. Finally, the UV-light-induced dissociation of these light-responsive nanoparticles due to the gradual cleavage of the pyrene moieties and the subsequent hydrophobic-to-hydrophilic transitions of the core-forming blocks is demonstrated.

Contrast-Enhanced CISS Imaging for Evaluation of Neurovascular Compression in Trigeminal Neuralgia: Improved Correlation with Symptoms and Prediction of Surgical Outcomes

BACKGROUND AND PURPOSE

Thin-section MR imaging through the posterior fossa is frequently used for trigeminal neuralgia. Typical heavily T2-weighted imaging methods yield high anatomic detail and contrast between CSF and neurovascular structures, but poor contrast between vessels and nerves. We hypothesized that the addition of gadolinium-based contrast material to 3D-constructive interference in steady-state imaging would improve the characterization of trigeminal compression.

MATERIALS AND METHODS

Retrospective review of high-resolution MRIs was performed in patients without prior microvascular decompression. 3D-CISS imaging without contrast and with contrast for 81 patients with trigeminal neuralgia and 15 controls was intermixed and independently reviewed in a blinded fashion. Cisternal segments of both trigeminal nerves were assessed for the grade of neurovascular conflict, cross-sectional area, and degree of flattening. Data were correlated with symptom side and pain relief after microvascular decompression using the Fisher exact test, receiver operating curve analysis, and a paired t test.

RESULTS

Contrast-enhanced CISS more than doubled the prevalence of the highest grade of neurovascular conflict (14.8% versus 33.3%, P = .001) and yielded significantly lower cross-sectional area (P = 8.6 × 10^-6) and greater degree of flattening (P = .02) for advanced-grade neurovascular conflict on the symptoms side compared with non-contrast-enhanced CISS. Patients with complete pain relief after microvascular decompression had significantly lower cross-sectional area on contrast-enhanced CISS compared with non-contrast-enhanced CISS on preoperative imaging (P = 2.0 × 10^-7). Performance based on receiver operating curve analysis was significantly improved for contrast-enhanced CISS compared with non-contrast-enhanced CISS.

CONCLUSIONS

The addition of contrast material to 3D-CISS imaging improves the performance of identifying unilateral neurovascular compression for symptomatic trigeminal neuralgia and predicting outcomes after microvascular decompression.

Biologically Targeted Magnetic Hyperthermia: Potential and Limitations

Hyperthermia, the mild elevation of temperature to 40–43°C, can induce cancer cell death and enhance the effects of radiotherapy and chemotherapy. However, achievement of its full potential as a clinically relevant treatment modality has been restricted by its inability to effectively and preferentially heat malignant cells. The limited spatial resolution may be circumvented by the intravenous administration of cancer-targeting magnetic nanoparticles that accumulate in the tumor, followed by the application of an alternating magnetic field to raise the temperature of the nanoparticles located in the tumor tissue. This targeted approach enables preferential heating of malignant cancer cells whilst sparing the surrounding normal tissue, potentially improving the effectiveness and safety of hyperthermia. Despite promising results in preclinical studies, there are numerous challenges that must be addressed before this technique can progress to the clinic. This review discusses these challenges and highlights the current understanding of targeted magnetic hyperthermia.

Midwives' and women's views on accessing dental care during pregnancy: an Australian qualitative study

BACKGROUND

Maternal behaviours during pregnancy are likely to play a significant role in the development of dental caries in children. Although midwives are well placed to discuss oral health and provide information to women, dental attendance by women during pregnancy is minimal. This study aimed to explore midwives' experience of facilitating pregnant women's access to dental care and to document women's experience of receiving dental information and care during pregnancy.

METHODS

Focus groups with midwives and telephone interviews with women who were referred to Monash Health Dental Services were conducted to explore their perspectives and experiences. The qualitative data was thematically analysed.

RESULTS

Three focus groups with 13 midwives and telephone interviews with eight women who recently gave birth were conducted. Three key themes were identified: maternal oral health knowledge; barriers to accessing dental information and care during pregnancy; and suggested recommendations.

CONCLUSIONS

This study highlighted the barriers that exist for midwives to discuss oral health with women and refer women to dental care, and women's experiences of accessing dental care during pregnancy. Ongoing collaboration between the maternity and dental services is required to strengthen midwives' knowledge, confidence and practise in supporting women to access dental care during pregnancy.

High peak and high average radiofrequency power transmit/receive switch for thermal magnetic resonance

PURPOSE

To study the role of temperature in biological systems, diagnostic contrasts and thermal therapies, RF pulses for MR spin excitation can be deliberately used to apply a thermal stimulus. This application requires dedicated transmit/receive (Tx/Rx) switches that support high peak powers for MRI and high average powers for RF heating. To meet this goal, we propose a high-performance Tx/Rx switch based on positive-intrinsic-negative diodes and quarter-wavelength (λ/4) stubs.

METHODS

The λ/4 stubs in the proposed Tx/Rx switch design route the transmitted RF signal directly to the RF coil/antenna without passing through any electronic components (e.g., positive-intrinsic-negative diodes). Bench measurements, MRI, MR thermometry, and RF heating experiments were performed at f = 297 MHz (B₀  = 7 T) to examine the characteristics and applicability of the switch.

RESULTS

The proposed design provided an isolation of -35.7dB/-41.5dB during transmission/reception. The insertion loss was -0.41dB/-0.27dB during transmission/reception. The switch supports high peak (3.9 kW) and high average (120 W) RF powers for MRI and RF heating at f = 297 MHz. High-resolution MRI of the wrist yielded image quality competitive with that obtained with a conventional Tx/Rx switch. Radiofrequency heating in phantom monitored by MR thermometry demonstrated the switch applicability for thermal modulation. Upon these findings, thermally activated release of a model drug attached to thermoresponsive polymers was demonstrated.

CONCLUSION

The high-power Tx/Rx switch enables thermal MR applications at 7 T, contributing to the study of the role of temperature in biological systems and diseases. All design files of the switch will be made available open source at www.opensourceimaging.org.

Abstract P6-08-17: Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study

Background

Pregnancy associated breast cancer (PABC) is defined as breast cancer (BC) diagnosed during the gestational period (GP) or in the first year postpartum (PP). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first combined prospective and retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments and maternal outcomes. We present the retrospective findings to date.

Methods

We performed a retrospective multicentre observational study of patients (pts) with PABC treated in the eight Irish cancer centres from August 2001 to March 2017. Data extracted included information on pt demographics, tumour biology, staging, treatment administered and maternal outcomes. Standard biostatistical methods were used for analysis.

Results

111 PABC patients were identified. Sixty pts (54%) were diagnosed during the GP and 51 (46%) within 1 year PP. Median age at diagnosis was 36 years (yrs). Table 1 illustrates baseline characteristics. Two thirds of pts were node positive and a similar proportion had grade 3 pathology. Seventy pts (63%) were estrogen receptor (ER) positive, 36 (32%) HER2 positive, 25 (22%) triple negative. Twenty-two pts (20%) were metastatic at presentation. Seven pts (6%) had a known BRCA 1/2 mutation. The median OS (overall survival) and DFS (disease free survival) for the entire cohort was 107.4 and 94.2 months respectively (resp). There was no survival difference between those diagnosed during the GP versus PP. 5 yr DFS and OS was 68.6% and 69.2% resp. This compares unfavourably to results reported by the National Cancer Registry of Ireland in a similar age-matched BC population between 2000-2012 where the 5 yr OS was 86.5%. Variables in our study associated with poorer outcomes included younger age, tumour size, node positivity and lack of estrogen expression.

Baseline characteristics PABC patients (n=11) %(n)Diagnosed in GP (n=60) %(n)Diagnosed 1yr PP (n=51) %(n)p valueDemographic    Age at diagnosis3636(25-49)36(21-44)0.31Stage    I-II54(60)55(33)53(27)0.85III23(26)23(14)23(12)1IV20(22)18(11)22(11)0.81Unknown3(3)3(2)2(1)1Pathology    Grade 366(74)70(42)63(32)0.43Node positive66(73)68(41)63(32)0.55ER+/HER2-41(45)38(23)43(22)0.69ER+/HER2+23(25)28(17)16(8)0.17ER-/HER2+14(16)17(10)12(6)0.59Triple negative22(25)17(10)29(15)0.11Surgery    Breast conservation23(26)25(15)21(11)0.82Mastectomy56(63)57(34)59(30)0.84Adjuavnt/Neoadjuvant treatment    Chemotherapy73(81)77(46)69(35)0.39Anthracycline68(55)78(36)54(19)0.03Taxane89(72)93(43)83(29)0.16Anti HER2 agent21(23)18(11)24(12)0.63Endocrine therapy64(52)63(29)66(23)0.84Radiotherapy79(64)74(34)86(30)0.85Relapse in Stage I-III    Local relapse15(13)12(6)18(7)0.55Distant relapse24(21)22(11)25(10)0.80

Conclusions

PABC patients may have a poorer outcome. Our study reported higher rates of triple negative and HER2 positive breast cancer which are associated with more aggressive biology. Prospective evaluation of clinicopathological features, pharmacokinetics of treatments selected and maternal and fetal outcomes is imperative in this distinct pt group.

Citation Format: Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-17.

Abstract P3-10-16: Competing mortality risks: Cardiovascular risk versus risk of metastatic disease in breast cancer patients receiving adjuvant therapy

Background

Breast cancer is the most commonly diagnosed cancer in women in Ireland. The 5 year net survival is over 80%. Most women diagnosed with breast cancer do not die from the disease and instead cardiovascular disease (CVD) remains the most frequent cause of death. Many breast cancer patients are older and have established CVD risk factors. They are at further risk of a cardiovasular (CV) event due to exposure to anthracyclines, HER2 targeted agents, endocrine therapy and radiotherapy. In this study, we aimed to compare the 10 year risk of breast cancer mortality versus that of a CV event or death in an oncology day ward population at our centre through the use of online prognostic risk calculators. Furthermore, we sought to investigate the predicted outcome of lifestyle changes on their overall CV risk and level of interest in addressing these risk factors.

Methods

This was a cross cohort study of all breast cancer patients attending for adjuvant chemotherapy at our institution from September 2015 to September 2016. To calculate patients' 10 year CVD risk, we used the JBS3 online calculator. Using this calculator we could also predict patient's lifetime CV risk. To calculate patients' 10 year mortality risk from breast cancer we used NHS predict! These calculators incorporate several variables which we identified from chart review, the use of questionnaires and the performance of a serum lipid test.

Results

101 subjects were identified. All patients (pts) completed questionnaires. Eighteen pts were excluded from CV risk analysis due to lack of lipid profile. Of 83 pts, 83% (n=69) were >50 years of age and 17% (n=14) pts were <50 years of age. The median age in the >50 age group (grp) was 59 and 42 in the <50 age grp. The median BMI in the >50 and <50 grp was 29.2 and 26.4 respectively. Forty-two percent (n=29) of pts in the >50 grp were smokers/ex smokers and 49% (n=7) were in the <50 grp. Twenty-nine percent (n=20) in the >50 grp were on statins and 25% (n=17) were on antihypertensives. Fifty-two percent (n=36) of pts in the >50 grp and 66% (n=10) received anthracyclines. Fifty percent in both grps received left sided radiotherapy. Ninety five percent (n=63) were on endocrine therapy in the >50 grp and 93% (n=13) in the <50 grp. Forty-one percent in the >50 grp (n=28) and 29% (n=4) of patients in the <50 grp received Trastuzumab. In the >50 grp, 13% (n=9) were found to have a high 10 year cardiovascular risk (>20% risk of CV event) and 28% were found to be at moderate risk (n=19). Ten percent of patients were found to have a CV risk that exceeded their breast cancer mortality risk (n=7). Even though the 10 year CV risk was low in patients <50, their median lifetime risk was calculated at 52%. Eighty seven percent of pts were interested in receiving advice on reducing their cardiovascular risk. The predicted median 10 year cardiovascular risk of age>50 patients in the high risk group post CV risk modification was 8.8% (+/-5.6) versus 28% (+/-8) at baseline.

Conclusion

This patient population has significant CV risk factors at baseline. Benefits predicted with CV risk intervention model and significant patient interest indicates that formalised CV risk prevention strategy is needed.

Citation Format: Prior L, Featherstone H, Nugent K, Lim M, Kelly C. Competing mortality risks: Cardiovascular risk versus risk of metastatic disease in breast cancer patients receiving adjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-16.

NIR/blue light emission optimization of NaY1−(x+y)YbxF4:Tmy upconversion nanoparticles via Yb3+/Tm3+ dopant balancing

A data driven approach provides better understanding of the role of dopant balancing in the upconversion process and presents an effective strategy to enhance the optical properties of upconversion nanoparticles.

Cryo-conditioned rocky coast systems: A case study from Wilczekodden, Svalbard

This paper presents the results of an investigation into the processes controlling development of a cryo-conditioned rock coast system in Hornsund, Svalbard. A suite of nested geomorphological and geophysical methods have been applied to characterise the functioning of rock cliffs and shore platforms influenced by lithological control and geomorphic processes driven by polar coast environments. Electrical resistivity tomography (ERT) surveys have been used to investigate permafrost control on rock coast dynamics and reveal the strong interaction with marine processes in High Arctic coastal settings. Schmidt hammer rock tests, demonstrated strong spatial control on the degree of rock weathering (rock strength) along High Arctic rock coasts. Elevation controlled geomorphic zones are identified and linked to distinct processes and mechanisms, transitioning from peak hardness values at the ice foot through the wave and storm dominated scour zones to the lowest values on the cliff tops, where the effects of periglacial weathering dominate. Observations of rock surface change using a traversing micro-erosion meter (TMEM) indicate that significant changes in erosion rates occur at the junction between the shore platform and the cliff toe, where rock erosion is facilitated by frequent wetting and drying and operation of nivation and sea ice processes (formation and melting of snow patches and icefoot complexes). The results are synthesised to propose a new conceptual model of High Arctic rock coast systems, with the aim of contributing towards a unifying concept of cold region landscape evolution and providing direction for future research regarding the state of polar rock coasts.