B-28 Prognostic Utility of a Prediction Model for Memory Decline in Epilepsy Following Selective Amygdalohippocampectomy

Objective

It is important to evaluate risk for post-surgical cognitive decline in a systematic and reliable fashion due to the variable risk of memory decline following epilepsy surgery. Mathematical risk models have been developed to predict post-surgical memory decline (e.g., Stroup et al., 2003), but few studies have evaluated their prognostic utility. This study evaluated the predictive value of the Stroup et al., (2003) multivariate risk factor model in predicting postoperative verbal memory outcome among epilepsy patients who underwent left selective amygdalohippocampectomy.

Method

This retrospective study included 16 left-sided localization-related epilepsy surgery patients who underwent neuropsychological evaluation pre- and post-surgery. Patients were assigned to two risk groups: mild to moderate risk (15 to 60%) and severe risk (>61%) for postoperative memory decline, which was based on Stroup et al., (2003) criteria, suggesting that individuals with the highest risk had dominant hemisphere resections, no hippocampal sclerosis, normal Wada memory, and normal preoperative immediate and delayed memory scores. Memory decline was determined by pre- minus post-surgery memory test difference scores with 1.5 SD denoting a significant decline.

Results

The formula predicted postoperative memory decline with 75% accuracy for patients in the high risk group and no significant decline with 92% accuracy for patients in the mild to moderate risk group.

Conclusion

The results suggest that Stroup’s predictive formula for verbal memory outcome following epilepsy surgery may be useful for patients undergoing left selective amygdalohippocampectomy surgery, consistent with prior research suggesting prognostic utility with left temporal lobectomy patients (e.g., Johnson-Markve et al., 2009).

C-40 Effects of Treatment Expectancy on Self-Report and Neuropsychological Outcomes in Neurofeedback for Young Adults Seeking Treatment for Attention-Deficit/Hyperactivity Disorder (ADHD)

Objective

Though there is evidence that expectancy can impact outcomes of heath treatments, the role of expectancy in neurofeedback (NFB) for ADHD remains unclear. A pilot study found large expectancy effects on self-reported symptoms in NFB, but mixed evidence for sustained attention performance. We further investigate the effects of treatment expectancy on self-reported ADHD symptoms and neuropsychological performance in NFB.

Method

Young adults seeking treatment for ADHD expected to receive active NFB, but instead were randomly assigned to receive sham treatment with false feedback indicating above average (positive expectancy; n = 26), below average (negative expectancy; n = 23), or average (neutral expectancy; n = 24) attentive states. Primary outcomes were report of ADHD symptoms, and performance on a sustained attention test and working memory test.

Results

Mixed ANOVAs revealed a significant interaction for ADHD symptom report (p < .001). Groups did not differ in pre-NFB symptom report (p = .56). Symptom report by the positive expectancy group decreased over time (p < .001) but increased among negative (p = .02) and neutral (p = .02) groups. Post-NFB symptom report was higher for negative expectancy relative to positive (p < .001) and neutral (p = .002) groups. There was no significant difference between positive and neutral groups (p = .37).There were no significant interactions for sustained attention and working memory.

Conclusion

Results indicate that treatment expectancies impact self-report of ADHD symptoms and should therefore be considered in clinical trials of NFB that measure outcomes via symptom report. Future studies examining expectancy effects on measures of other neuropsychological domains are necessary.

Mutation of the rice TCM12 gene encoding 2,3-bisphosphoglycerate-independent phosphoglycerate mutase affects chlorophyll synthesis, photosynthesis and chloroplast development at seedling stage at low temperatures

Glycolysis is a central metabolic pathway that provides energy and products of primary metabolites. 2,3-Biphosphoglycerate-independent phosphoglycerate mutase (iPGAM) is a key enzyme that catalyses the reversible interconversion of 3-phosphoglycerate (3-PGA) to 2-phosphoglycerate (2-PGA) in glycolysis. Low temperature is a common abiotic stress in rice production. However, the mechanism for rice iPGAM genes is not fully understood at low temperature. In this study, the rice mutant tcm12, with chlorosis, malformed chloroplasts and impaired photosynthesis, was grown at a low temperature (<20 °C) to the three-leaf stage, while the normal phenotype at 32 °C was used. Chlorophyll fluorescence analysis and transmission electron microscopy were used to examine features of the tcm12 mutant. The inheritance behaviour and function of TCM12 were then analysed thorough map-based cloning, transgenic complementation and subcellular localisation. The thermo-sensitive chlorosis phenotype was caused by a single nucleotide mutation (T→C) on the fifth exon of TCM12 (LOC_Os12g35040) encoding iPGAM, localised to both nucleus and membranes. In addition, TCM12 was constitutively expressed, and its disruption resulted in down-regulation of some genes associated with chlorophyll biosynthesis and photosynthesis at low temperatures (20 °C). This is the first report of the involvement of rice iPGAM gene in chlorophyll synthesis, photosynthesis and chloroplast development, providing new insights into the mechanisms underlying early growth of rice at low temperatures.

Abstract P3-12-10: Utilization patterns and temporal trends of internal mammary nodal irradiation (IMNI) at a tertiary cancer centre

Purpose: Despite data from multiple randomized trials, the role and uptake of internal mammary nodal irradiation (IMNI) is variable. This study was designed to quantify the rates and determinants of IMNI at a tertiary cancer centre.

Methods: Treatment records of consecutively treated breast cancer (BC) patients receiving adjuvant locoregional (LR) radiotherapy (RT) from January 1, 2012 to October 31, 2017 was studied. LR-RT and use of IMNI as a function of clinicopathological factors, use of deep inspiratory breath-hold (DIBH) and dosimetric parameters were retrieved. Patients were divided into two groups:Group1 received LR-RT that included the IMN's, supraclavicular (SCLV) ± axillary regions,Group2 received LR-RT directed only to the SCLV±axillary areas. For the purpose of utilization analysis and temporal trends, early(2012-2015) and late(2016-2017) cohorts were examined based on the year of RT delivery. To determine if the use of IMNI was dependent on BC risk, we defined 3 risk categories:1) pT1/2, N0); 2)pT1/2, N1; and 3) pT3/4, N2/3 disease. Differences between the risk categories and groups were evaluated using chi-square/ Fisher's and Mann Whitney test for categorical and continuous variables, respectively. Univariable and multivariable logistic regression analysis was done to determine factors associated with the receipt of IMNI.

Results:A total of 1566 patients met eligibility (Group 1=376; Group 2=1190). Of these patients, the percentage receiving LR-RT remained constant (17%) over the study period but the proportion of patients receiving IMNI increased significantly each year (p&lt;0.0001), and was higher in the late vs. early treatment cohort (55% vs 8%, p&lt;0.0001).On univariable analysis, younger age, LVI positivity, medial/central location, increasing stage, PR negativity, mastectomy, axillary dissection ,receipt of chemotherapy and increasing number of positive nodes had higher odds of receiving IMNI. Radiation oncologists with &lt; or ≥5 years of practice was predictive of IMNI (31.3% vs 20.5%, p&lt;0.0001),staff having &lt;5years in practice being more likely to recommend IMNI. The distribution of patients in the different risk categories was similar between Groups 1 and 2 (p=0.097), and identified that the majority of patients receiving IMNI were in risk category 2(83%). Further comparison of risk categories suggested that the odds of receiving IMNI was lower in risk category 3 vs. category 1 (p=0.033). On multivariable analysis, decreasing age age (p=&lt;0.001) , medial quadrant(p=0.0026),PR negative(p=0.0011), mastectomy(p=0.0055) , increasing nodal positivity (p&lt;0.0001)and late RT cohort (p=0.001) had increased odds of IMNI. Overall use of DIBH was significantly higher in those receiving IMNI (45% vs 26%, p&lt;0.0001). Mean heart (2.2vs1.7Gy, p&lt;0.0001) and total lung doses (7.8vs6.6Gy,p&lt;0.0001) were also significantly higher with IMNI.

Conclusion: There was a significant increase in utilization of IMNI from 2012 to 2017. Younger age, medial location, PR negativity and increasing number of positive nodes predicted for receipt of IMNI. Staff with&lt;5years in practice were more likely to recommend LR-RT that included the IMNs. The use of DIBH significantly increased with IMNI and allowed for acceptable dosimetric constraints.

Citation Format: Misra S, Lee G, Maganti M, Koch CA. Utilization patterns and temporal trends of internal mammary nodal irradiation (IMNI) at a tertiary cancer centre [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-10.