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Tabor JK, Dincer A, O'Brien J, Lei H, Vetsa S, Vasandani S, Jalal MI, Yalcin K, Morales-Valero SF, Marianayagam N, Alanya H, Elsamadicy AA, Millares Chavez MA, Aguilera SM, Mishra-Gorur K, McGuone D, Fulbright RK, Jin L, Erson-Omay EZ, Günel M, Moliterno J. Variations in the genomic profiles and clinical behavior of meningioma by racial and ethnic group. J Neurosurg 2024:1-9. [PMID: 38518289 DOI: 10.3171/2024.1.jns231633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The influence of socioeconomic factors on racial disparities among patients with sporadic meningiomas is well established, yet other potential causative factors warrant further exploration. The authors of this study aimed to determine whether there is significant variation in the genomic profile of meningiomas among patients of different races and ethnicities and its correlation with clinical outcomes. METHODS The demographic, genomic, and clinical data of patients aged 18 years and older who had undergone surgery for sporadic meningioma between September 2008 and November 2021 were analyzed. Statistical analyses were performed to detect differences across all racial/ethnic groups, as were direct comparisons between Black and non-Black groups plus Hispanic and non-Hispanic groups. RESULTS This study included 460 patients with intracranial meningioma. Hispanic patients were significantly younger at surgery (53.9 vs 60.2 years, p = 0.0006) and more likely to show symptoms. Black patients had a higher incidence of anterior skull base tumors (OR 3.2, 95% CI 1.7-6.3, p = 0.0008) and somatic hedgehog mutations (OR 5.3, 95% CI 1.6-16.6, p = 0.003). Hispanics were less likely to exhibit the aggressive genomic characteristic of chromosome 1p deletion (OR 0.28, 95% CI 0.07-1.2, p = 0.06) and displayed higher rates of TRAF7 somatic driver mutations (OR 2.96 95% CI 1.1-7.8, p = 0.036). Black patients had higher rates of recurrence (OR 2.6, 95% CI 1.3-5.2, p = 0.009) and shorter progression-free survival (PFS; HR 2.9, 95% CI 1.6-5.4, p = 0.002) despite extents of resection (EORs) similar to those of non-Black patients (p = 0.745). No significant differences in overall survival were observed among groups. CONCLUSIONS Despite similar EORs, Black patients had worse clinical outcomes following meningioma resection, characterized by a higher prevalence of somatic hedgehog mutations, increased recurrence rates, and shorter PFS. Meanwhile, Hispanic patients had less aggressive meningiomas, a predisposition for TRAF7 mutations, and no difference in PFS. These findings could inform the care and treatment strategies for meningiomas, and they establish the foundation for future studies focusing on the genomic origins of these observed differences.
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Affiliation(s)
- Joanna K Tabor
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Alper Dincer
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 3Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Joseph O'Brien
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Haoyi Lei
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Shaurey Vetsa
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Sagar Vasandani
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Muhammad I Jalal
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Kanat Yalcin
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Saul F Morales-Valero
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Neelan Marianayagam
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Hasan Alanya
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | | | | | - Stephanie M Aguilera
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Ketu Mishra-Gorur
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Declan McGuone
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 4Pathology
| | - Robert K Fulbright
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 6Radiology and Biomedical Imaging, Neuroradiology Section, Yale School of Medicine, New Haven, Connecticut
| | - Lan Jin
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - E Zeynep Erson-Omay
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Murat Günel
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 5Genetics, and
| | - Jennifer Moliterno
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
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2
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Tillmanns N, Lost J, Tabor J, Vasandani S, Vetsa S, Marianayagam N, Yalcin K, Erson-Omay EZ, von Reppert M, Jekel L, Merkaj S, Ramakrishnan D, Avesta A, de Oliveira Santo ID, Jin L, Huttner A, Bousabarah K, Ikuta I, Lin M, Aneja S, Turowski B, Aboian M, Moliterno J. Application of novel PACS-based informatics platform to identify imaging based predictors of CDKN2A allelic status in glioblastomas. Sci Rep 2023; 13:22942. [PMID: 38135704 PMCID: PMC10746716 DOI: 10.1038/s41598-023-48918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Gliomas with CDKN2A mutations are known to have worse prognosis but imaging features of these gliomas are unknown. Our goal is to identify CDKN2A specific qualitative imaging biomarkers in glioblastomas using a new informatics workflow that enables rapid analysis of qualitative imaging features with Visually AcceSAble Rembrandtr Images (VASARI) for large datasets in PACS. Sixty nine patients undergoing GBM resection with CDKN2A status determined by whole-exome sequencing were included. GBMs on magnetic resonance images were automatically 3D segmented using deep learning algorithms incorporated within PACS. VASARI features were assessed using FHIR forms integrated within PACS. GBMs without CDKN2A alterations were significantly larger (64 vs. 30%, p = 0.007) compared to tumors with homozygous deletion (HOMDEL) and heterozygous loss (HETLOSS). Lesions larger than 8 cm were four times more likely to have no CDKN2A alteration (OR: 4.3; 95% CI 1.5-12.1; p < 0.001). We developed a novel integrated PACS informatics platform for the assessment of GBM molecular subtypes and show that tumors with HOMDEL are more likely to have radiographic evidence of pial invasion and less likely to have deep white matter invasion or subependymal invasion. These imaging features may allow noninvasive identification of CDKN2A allele status.
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Affiliation(s)
- Niklas Tillmanns
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Jan Lost
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Joanna Tabor
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Kanat Yalcin
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Marc von Reppert
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Leon Jekel
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Sara Merkaj
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Divya Ramakrishnan
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Arman Avesta
- Department of Radiation Oncology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Irene Dixe de Oliveira Santo
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
| | - Lan Jin
- R&D, Sema4, 333 Ludlow Street, North Tower, 8th Floor, Stamford, CT, 06902, USA
| | - Anita Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | | | - Ichiro Ikuta
- Department of Radiology, Mayo Clinic Arizona, 5711 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - MingDe Lin
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA
- Visage Imaging, Inc., 12625 High Bluff Dr, Suite 205, San Diego, CA, 92130, USA
| | - Sanjay Aneja
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Bernd Turowski
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Mariam Aboian
- Brain Tumor Research Group, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA.
- , New Haven, USA.
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3
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Tabor JK, O'Brien J, Vasandani S, Vetsa S, Lei H, Jalal MI, Marianayagam NJ, Jin L, Millares Chavez M, Haynes J, Dincer A, Yalcin K, Aguilera SM, Omay SB, Mishra-Gorur K, McGuone D, Morales-Valero SF, Fulbright RK, Gunel M, Erson-Omay EZ, Moliterno J. Clinical and genomic differences in supratentorial versus infratentorial NF2 mutant meningiomas. J Neurosurg 2023; 139:1648-1656. [PMID: 37243548 DOI: 10.3171/2023.4.jns222929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Mutations in NF2 are the most common somatic driver mutation in sporadic meningiomas. NF2 mutant meningiomas preferentially arise along the cerebral convexities-however, they can also be found in the posterior fossa. The authors investigated whether NF2 mutant meningiomas differ in clinical and genomic features based on their location relative to the tentorium. METHODS Clinical and whole exome sequencing (WES) data for patients who underwent resection of sporadic NF2 mutant meningiomas were reviewed and analyzed. RESULTS A total of 191 NF2 mutant meningiomas were included (165 supratentorial, 26 infratentorial). Supratentorial NF2 mutant meningiomas were significantly associated with edema (64.0% vs 28.0%, p < 0.001); higher grade-i.e., WHO grade II or III (41.8% vs 3.9%, p < 0.001); elevated Ki-67 (55.0% vs 13.6%, p < 0.001); and larger volume (mean 45.5 cm3 vs 14.9 cm3, p < 0.001). Furthermore, supratentorial tumors were more likely to harbor the higher-risk feature of chromosome 1p deletion (p = 0.038) and had a larger fraction of the genome altered with loss of heterozygosity (p < 0.001). Infratentorial meningiomas were more likely to undergo subtotal resection than supratentorial tumors (37.5% vs 15.8%, p = 0.021); however, there was no significant difference in overall (p = 0.2) or progression-free (p = 0.4) survival. CONCLUSIONS Supratentorial NF2 mutant meningiomas are associated with more aggressive clinical and genomic features as compared with their infratentorial counterparts. Although infratentorial tumors have higher rates of subtotal resection, there is no associated difference in survival or recurrence. These findings help to better inform surgical decision-making in the management of NF2 mutant meningiomas based on location, and may guide postoperative management of these tumors.
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Affiliation(s)
- Joanna K Tabor
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Joseph O'Brien
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Sagar Vasandani
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Shaurey Vetsa
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Haoyi Lei
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Muhammad I Jalal
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Neelan J Marianayagam
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Lan Jin
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | | | | | - Alper Dincer
- 3Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Kanat Yalcin
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Stephanie M Aguilera
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | | | - Ketu Mishra-Gorur
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Declan McGuone
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 4Pathology
| | - Saul F Morales-Valero
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Robert K Fulbright
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 5Radiology and Biomedical Imaging, and
| | - Murat Gunel
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
- 6Genetics, Yale School of Medicine, New Haven, Connecticut
| | - E Zeynep Erson-Omay
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
| | - Jennifer Moliterno
- Departments of1Neurosurgery
- 2The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut; and
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4
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Qureshi HM, Tabor JK, Pickens K, Lei H, Vasandani S, Jalal MI, Vetsa S, Elsamadicy A, Marianayagam N, Theriault BC, Fulbright RK, Qin R, Yan J, Jin L, O'Brien J, Morales-Valero SF, Moliterno J. Frailty and postoperative outcomes in brain tumor patients: a systematic review subdivided by tumor etiology. J Neurooncol 2023; 164:299-308. [PMID: 37624530 PMCID: PMC10522517 DOI: 10.1007/s11060-023-04416-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Frailty has gained prominence in neurosurgical oncology, with more studies exploring its relationship to postoperative outcomes in brain tumor patients. As this body of literature continues to grow, concisely reviewing recent developments in the field is necessary. Here we provide a systematic review of frailty in brain tumor patients subdivided by tumor type, incorporating both modern frailty indices and traditional Karnofsky Performance Status (KPS) metrics. METHODS Systematic literature review was performed using PRISMA guidelines. PubMed and Google Scholar were queried for articles related to frailty, KPS, and brain tumor outcomes. Only articles describing novel associations between frailty or KPS and primary intracranial tumors were included. RESULTS After exclusion criteria, systematic review yielded 52 publications. Amongst malignant lesions, 16 studies focused on glioblastoma. Amongst benign tumors, 13 focused on meningiomas, and 6 focused on vestibular schwannomas. Seventeen studies grouped all brain tumor patients together. Seven studies incorporated both frailty indices and KPS into their analyses. Studies correlated frailty with various postoperative outcomes, including complications and mortality. CONCLUSION Our review identified several patterns of overall postsurgical outcomes reporting for patients with brain tumors and frailty. To date, reviews of frailty in patients with brain tumors have been largely limited to certain frailty indices, analyzing all patients together regardless of lesion etiology. Although this technique is beneficial in providing a general overview of frailty's use for brain tumor patients, given each tumor pathology has its own unique etiology, this combined approach potentially neglects key nuances governing frailty's use and prognostic value.
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Affiliation(s)
- Hanya M Qureshi
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joanna K Tabor
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Kiley Pickens
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Haoyi Lei
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Muhammad I Jalal
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Aladine Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Brianna C Theriault
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Robert K Fulbright
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Ruihan Qin
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Jiarui Yan
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Lan Jin
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joseph O'Brien
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Saul F Morales-Valero
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
- The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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5
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Dincer A, Jalal MI, Gupte TP, Vetsa S, Vasandani S, Yalcin K, Marianayagam N, Blondin N, Corbin Z, McGuone D, Fulbright RK, Erson-Omay Z, Günel M, Moliterno J. The clinical and genomic features of seizures in meningiomas. Neurooncol Adv 2023; 5:i49-i57. [PMID: 37287582 PMCID: PMC10243847 DOI: 10.1093/noajnl/vdac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Meningiomas are the most common central nervous system tumors. Although these tumors are extra-axial, a relatively high proportion (10%-50%) of meningioma patients have seizures that can substantially impact the quality of life. Meningiomas are believed to cause seizures by inducing cortical hyperexcitability that results from mass effect and cortical irritation, brain invasion, or peritumoral brain edema. In general, meningiomas that are associated with seizures have aggressive features, with risk factors including atypical histology, brain invasion, and higher tumor grade. Somatic NF2 mutated meningiomas are associated with preoperative seizures, but the effect of the driver mutation is mediated through atypical features. While surgical resection is effective in controlling seizures in most patients with meningioma-related epilepsy, a history of seizures and uncontrolled seizures prior to surgery is the most significant predisposing factor for persistent postoperative seizures. Subtotal resection (STR) and relatively larger residual tumor volume are positive predictors of postoperative seizures. Other factors, including higher WHO grade, peritumoral brain edema, and brain invasion, are inconsistently associated with postoperative seizures, suggesting they might be crucial in the development of an epileptogenic focus, but do not appear to play a substantial role after seizure activity has been established. Herein, we review and summarize the current literature surrounding meningioma-related epilepsy and underscore the interaction of multiple factors that relate to seizures in patients with meningioma.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Muhammad I Jalal
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Trisha P Gupte
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Kanat Yalcin
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Nicholas Blondin
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zachary Corbin
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Declan McGuone
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert K Fulbright
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
| | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Moliterno
- Chenevert Family Brain Tumor Center, Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut, USA
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6
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Vetsa S, Vasandani S, Jalal M, Yalcin K, Youngblood M, Marianayagam N, Elsamadicy A, Qureshi H, Nadar A, Sandhu MR, Aguilera S, Mishra-Gorur K, McGuone D, Fulbright R, Jin L, Erson-Omay EZ, Günel M, Moliterno J. DISP-09. THE GENOMIC PROFILES AND CLINICAL MANIFESTATIONS OF MENINGIOMAS VARY AMONGST DIFFERENT RACES. Neuro Oncol 2022. [PMCID: PMC9660293 DOI: 10.1093/neuonc/noac209.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
While socioeconomic factors for racial disparities amongst sporadic meningioma patients have been explored, other potential influences are poorly understood. We sought to identify whether the genomic make-up is different amongst meningioma patients of different races and how they correlate with clinical variables.
METHODS
All patients who underwent surgery for sporadic meningioma and consented for whole exome sequencing were eligible. Genomic and clinical data were reviewed and analyzed.
RESULTS
537 intracranial meningiomas from 483 patients with the following racial profile were included: 75% White, 14% Black, 8% Latinx, 3% Asian. Compared with others, Whites were older at the time of diagnosis (p = 0.038) and surgery (p = 0.015). Black and Latinx patients were more likely to present with vision abnormalities (p = 0.006). Whites were more likely to have convexity meningiomas (p = 0.003), while Blacks were more likely to have tumors along the anterior fossa (p = 0.002) with associated somatic Hedgehog (HH) driver mutations (p = 0.008). Both Black and Latinx patients were more likely to have TRAF7 mutated meningiomas (p = 0.006). The highest number of copy number variations was seen in Blacks (p = 0.011) and this correlated with Blacks being more likely to have high-grade tumors, followed by Whites, Asians, and then Latinx (p = 0.020). Black patients trended toward decreased progression-free survival than others (median survival: 57 vs. 130 months; p = 0.06) despite similar extent of resection.
CONCLUSION
Overall, when mutational subgroup and location are considered, Black patients are more likely to have anterior skull base meningiomas with associated visual issues and corresponding somatic HH and TRAF7 mutations. With regards to tumor grade, Blacks harbor more aggressive sporadic meningiomas with a larger prevalence of high-grade meningiomas and associated underlying chromosomal instability compared to others. These findings have implications for meningioma care especially in minority populations, who may harbor more aggressive tumors.
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Vasandani S, Vetsa S, Jalal M, Yalcin K, Marianayagam N, Nadar A, Jin L, Fulbright R, Erson-Omay EZ, Günel M, Moliterno J. EPCO-40. INFRATENTORIAL NF2 MUTANT SPORADIC MENINGIOMAS DIFFER FROM THOSE IN SUPRATENTORIAL LOCATIONS AND ARE MORE BENIGN. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Approximately 50% of sporadic meningiomas, which originate throughout the neuroaxis, harbor bi-alleic NF2 loss. We sought to determine whether NF2 mutant meningiomas originating from different intracranial locations relative to the tentorium differ with regards to their genomic profile and clinical behavior.
METHODS
Clinical and whole exome sequencing data (WES) for all patients who underwent resection of NF2 mutant meningiomas and consented to WES were reviewed and analyzed.
RESULTS
258 NF2 mutant meningiomas were included and subdivided into supra- (sNF2) versus infra-tentorial (iNF2) groups (230 versus 28, respectively). Supratentorial location was significantly associated with genomically unstable tumors (percent genome altered median 12% vs. 1%, p< 0.001) and were more likely to harbor the more aggressive feature of chromosome 1p deletion (31.4% vs. 8.3%, p= 0.036). These malignant genomic features correlated with an increased incidence of high risk clinical features, including higher-grade (i.e. WHO Grade II/III) (48.9% vs. 7.14%, p < 0.001) and elevated Ki-67 (58.9% vs. 16.6%, p< 0.01), as well as larger volume (median 26.21 cm3 vs. 9.84 cm3, p< 0.001) and edema (65.8% vs. 25.9%, p= 0.001) in sNF2 meningiomas as compared with iNF2 tumors, respectively. Not surprisingly, although there was no difference in extent of resection between the groups (gross total resection (GTR), 96.26% vs. 96.15%, p= 0.45), patients with sNF2 tumors had more associated deaths (14.6% vs. 0%, p= 0.03) and a marginally shorter overall survival (p= 0.061). GTR was associated with longer progression-free survival (p= 0.037).
CONCLUSION
Within the homogeneous group of somatic NF2 mutated meningiomas, infratentorial tumors are seemingly more benign in their genomic make-up and clinical manifestation as compared to ones located in the supratentorial location. While GTR is useful to both groups in preventing recurrence, this benefit may be especially important in the clinically and genomically higher risk sNF2 tumors.
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Vetsa S, Nadar A, Vasandani S, Gorelick E, Bungard J, Barak T, Fulbright RK, Marianayagam NJ, Moliterno J. Criteria for Cerebrospinal Fluid Diversion in Retractorless Sphenoid Wing Meningioma Surgery: A Technical Report. J Neurol Surg Rep 2022; 83:e100-e104. [PMID: 36060292 PMCID: PMC9439877 DOI: 10.1055/s-0042-1753518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Sphenoid wing meningiomas (SWMs) can present surgical challenges, in that they are often obscured by overlying brain, encase critical neurovascular structures, and obliterate cerebrospinal fluid (CSF) cisterns. While brain retraction can enable access, its use can have potentially deleterious effects. We report the benefits and outcomes of the criteria we have developed for use of cerebrospinal diversion to perform retractorless surgery for SWMs. Design Technical report. Setting Yale School of Medicine and Yale New Haven Hospital. Participants Between May, 2019 and December, 2020, ten consecutive patients were included who met the presented criteria for SWM surgery with preoperative lumbar drain (LD) placement. Main Outcome Measures Length of hospital stay, surgical complications, and extent of resection. Results We have developed the following criteria for LD placement in patients with SWMs such that LDs are preoperatively placed in patients with tumors with one or more of the following criteria: (1) medial location along the sphenoid wing, (2) vascular encasement resulting in obliteration of the optic carotid cistern and/or proximal sylvian fissure, and/or (3) the presence of associated edema. CSF release, after craniotomy and sphenoid wing removal, allowed for optimization of exposure, leading to the maximal safe extent of tumor resection without brain retraction or any complications. Conclusions Preoperative LD placement is effective in allowing for maximal extent of resection of SWMs and may be considered in cases where local CSF release is not possible. This technique is useful in those tumors located more medially, with encasement of the vasculature and/or associated with edema.
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Affiliation(s)
- Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Arushii Nadar
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Evan Gorelick
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Jillian Bungard
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Tanyeri Barak
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Robert K. Fulbright
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States
| | - Neelan J. Marianayagam
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States,Address for correspondence Jennifer Moliterno, MD Department of Neurosurgery, Yale School of Medicine15 York St, LLCI 810, New Haven, CT 06520-8082United States
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Ashiru-Oredope D, Casale E, Harvey E, Umoh E, Vasandani S, Reilly J, Hopkins S. Knowledge and Attitudes about Antibiotics and Antibiotic Resistance of 2404 UK Healthcare Workers. Antibiotics (Basel) 2022; 11:antibiotics11081133. [PMID: 36010002 PMCID: PMC9404832 DOI: 10.3390/antibiotics11081133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Using the COM-B model as a framework, an EU-wide survey aimed to ascertain multidisciplinary healthcare workers’ (HCWs’) knowledge, attitudes and behaviours towards antibiotics, antibiotic use and antibiotic resistance. The UK findings are presented here. Methods: A 43-item questionnaire was developed through a two-round modified Delphi consensus process. The UK target quota was 1315 respondents. Results: In total, 2404 participants responded. The highest proportion were nursing and midwifery professionals (42%), pharmacists (23%) and medical doctors (18%). HCWs correctly answered that antibiotics are not effective against viruses (97%), they have associated side effects (97%), unnecessary use makes antibiotics ineffective (97%) and healthy people can carry antibiotic-resistant bacteria (90%). However, fewer than 80% correctly answered that using antibiotics increases a patient’s risk of antimicrobial resistant infection or that resistant bacteria can spread from person to person. Whilst the majority of HCWs (81%) agreed there is a connection between their antibiotic prescribing behaviour and the spread of antibiotic-resistant bacteria, only 64% felt that they have a key role in controlling antibiotic resistance. The top three barriers to providing advice or resources were lack of resources (19%), insufficient time (11%) and the patient being uninterested in the information (7%). Approximately 35% of UK respondents who were prescribers prescribed an antibiotic at least once in the previous week to responding to the survey due to a fear of patient deterioration or complications. Conclusion: These findings highlight that a multifaceted approach to tackling the barriers to prudent antibiotic use in the UK is required and provides evidence for guiding targeted policy, intervention development and future research. Education and training should focus on patient communication, information on spreading resistant bacteria and increased risk for individuals.
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Affiliation(s)
- Diane Ashiru-Oredope
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
- Correspondence:
| | - Ella Casale
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Eleanor Harvey
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Eno Umoh
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Sagar Vasandani
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
| | - Jacqui Reilly
- NHS National Services Scotland, Edinburgh EH12 9EB, UK
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Susan Hopkins
- HCAI, Fungal, AMR, AMU & Sepsis Division, United Kingdom Health Security Agency, London SW1P 3JR, UK
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Marianayagam NJ, Qureshi HM, Vasandani S, Vetsa S, Jalal M, Wu K, Moliterno J. Simultaneous microvascular decompression for trigeminal neuralgia and hemifacial spasm involving a dolichoectatic vertebral artery in an elderly patient: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22176. [PMID: 36046706 PMCID: PMC9301342 DOI: 10.3171/case22176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hyperactive cranial neuropathies refractory to medical management can often be debilitating to patients. While microvascular decompression (MVD) surgery can provide relief to such patients when an aberrant vessel is compressing the root entry zone (REZ) of the nerve, the arteries of elderly patients over 65 years of age can be less amenable to manipulation because of calcifications and other morphological changes. A dolichoectatic vertebral artery (DVA), in fact, can lead to multiple cranial neuropathies; therefore, a strategy for MVDs in elderly patients is useful. OBSERVATIONS A 76-year-old man presented with medically refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). A DVA was the conflicting vessel at the left REZs of the trigeminal and facial nerves. The authors performed a retrosigmoid craniotomy for MVD of the DVA with Teflon padding at both REZs in approximately 1 hour of operative time. The patient was free of facial pain and spasm immediately after surgery and at follow-up. LESSONS The authors described the case of an elderly patient with both TN and HFS caused by compression of a DVA. Simultaneous MVD with Teflon padding at both REZs provided symptomatic relief with limited surgical time. This can be a particularly useful and straightforward surgical strategy in the elderly population.
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Affiliation(s)
- Neelan J. Marianayagam
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Hanya M. Qureshi
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Muhammad Jalal
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Kun Wu
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; and
- Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut
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11
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Erson-Omay EZ, Vetsa S, Vasandani S, Barak T, Nadar A, Marianayagam NJ, Yalcin K, Miyagishima D, Aguilera SM, Robert S, Mishra-Gorur K, Fulbright RK, McGuone D, Günel M, Moliterno J. Correction: Genomic profiling of sporadic multiple meningiomas. BMC Med Genomics 2022; 15:131. [PMID: 35698142 PMCID: PMC9190101 DOI: 10.1186/s12920-022-01273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- E. Zeynep Erson-Omay
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Shaurey Vetsa
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Sagar Vasandani
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Tanyeri Barak
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Arushii Nadar
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Neelan J. Marianayagam
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Kanat Yalcin
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Danielle Miyagishima
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Stephanie Marie Aguilera
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Stephanie Robert
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Ketu Mishra-Gorur
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Robert K. Fulbright
- grid.47100.320000000419368710Department of Radiology and Biomedical Imaging, Neuroradiology Section, Yale School of Medicine, New Haven, CT USA
| | - Declan McGuone
- grid.47100.320000000419368710Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Murat Günel
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA ,grid.47100.320000000419368710Department of Genetics, Yale School of Medicine, New Haven, CT USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA. .,The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA. .,The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT, USA.
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12
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Erson-Omay EZ, Vetsa S, Vasandani S, Barak T, Nadar A, Marianayanam N, Yalcin K, Miyagishima D, Aguilera SM, Robert S, Mishra-Gorur K, Fulbright RK, McGuone D, Günel M, Moliterno J. Genomic profiling of sporadic multiple meningiomas. BMC Med Genomics 2022; 15:112. [PMID: 35568945 PMCID: PMC9107270 DOI: 10.1186/s12920-022-01258-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple meningiomas (MMs) rarely occur sporadically. It is unclear whether each individual tumor in a single patient behaves similarly. Moreover, the molecular mechanisms underlying the formation of sporadic MMs and clonal formation etiology of these tumors are poorly understood. METHODS Patients with spatially separated MMs without prior radiation exposure or a family history who underwent surgical resection of at least two meningiomas were included. Unbiased, comprehensive next generation sequencing was performed, and relevant clinical data was analyzed. RESULTS Fifteen meningiomas and one dural specimen from six patients were included. The majority of tumors (12/15) were WHO Grade I; one patient had bilateral MMs, one of which was Grade II, while the other was Grade I. We found 11/15 of our cohort specimens were of NF2-loss subtype. Meningiomas from 5/6 patients had a monoclonal origin, with the tumor from the remaining patient showing evidence for independent clonal formation. We identified a novel case of non-NF2 mutant MM with monoclonal etiology. MMs due to a monoclonal origin did not always display a homogenous genomic profile, but rather exhibited heterogeneity due to branching evolution. CONCLUSIONS Both NF2-loss and non-NF2 driven MMs can form due to monoclonal expansion and those tumors can acquire inter-tumoral heterogeneity through branched evolution. Grade I and II meningiomas can occur in the same patient. Thus, the molecular make-up and clinical behavior of one tumor in MMs, cannot reliably lend insight into that of the others and suggests the clinical management strategy for MMs should be tailored individually.
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Affiliation(s)
- E. Zeynep Erson-Omay
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Shaurey Vetsa
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Sagar Vasandani
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Tanyeri Barak
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Arushii Nadar
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Neelan Marianayanam
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Kanat Yalcin
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Danielle Miyagishima
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Stephanie Marie Aguilera
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Stephanie Robert
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA
| | - Ketu Mishra-Gorur
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA
| | - Robert K. Fulbright
- grid.47100.320000000419368710Department of Radiology and Biomedical Imaging, Neuroradiology Section, Yale School of Medicine, New Haven, CT USA
| | - Declan McGuone
- grid.47100.320000000419368710Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Murat Günel
- grid.47100.320000000419368710Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT 06520-8082 USA ,grid.490524.eThe Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT USA ,grid.417307.6The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT USA ,grid.47100.320000000419368710Department of Genetics, Yale School of Medicine, New Haven, CT USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA. .,The Chênevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA. .,The Susan Beris, MD Neurosurgical Oncology Program at Yale New Haven Hospital, New Haven, CT, USA.
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13
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Robert SM, Vetsa S, Nadar A, Vasandani S, Youngblood MW, Gorelick E, Jin L, Marianayagam N, Erson-Omay EZ, Günel M, Moliterno J. Correction to: The integrated multiomic diagnosis of sporadic meningiomas: a review of its clinical implications. J Neurooncol 2021; 156:215. [PMID: 34967924 PMCID: PMC8816771 DOI: 10.1007/s11060-021-03937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephanie M Robert
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Arushii Nadar
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Evan Gorelick
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Lan Jin
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - E Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA.
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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14
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Robert SM, Vetsa S, Nadar A, Vasandani S, Youngblood MW, Gorelick E, Jin L, Marianayagam N, Erson-Omay EZ, Günel M, Moliterno J. The integrated multiomic diagnosis of sporadic meningiomas: a review of its clinical implications. J Neurooncol 2021; 156:205-214. [PMID: 34846640 PMCID: PMC8816740 DOI: 10.1007/s11060-021-03874-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/09/2021] [Indexed: 12/28/2022]
Abstract
Introduction Meningiomas are generally considered “benign,” however, these tumors can demonstrate variability in behavior and a surprising aggressiveness with elevated rates of recurrence. The advancement of next-generation molecular technologies have led to the understanding of the genomic and epigenomic landscape of meningiomas and more recent correlations with clinical characteristics and behavior. Methods Based on a thorough review of recent peer-reviewed publications (PubMed) and edited texts, we provide a molecular overview of meningiomas with a focus on relevant clinical implications. Results The identification of specific somatic driver mutations has led to the classification of several major genomic subgroups, which account for more than 80% of sporadic meningiomas, and can be distinguished using noninvasive clinical variables to help guide management decisions. Other somatic genomic modifications, including non-coding alterations and copy number variations, have also been correlated with tumor characteristics. Furthermore, epigenomic modifications in meningiomas have recently been described, with DNA methylation being the most widely studied and potentially most clinically relevant. Based on these molecular insights, several clinical trials are currently underway in an effort to establish effective medical therapeutic options for meningioma. Conclusion As we enhance our multiomic understanding of meningiomas, our ability to care for patients with these tumors will continue to improve. Further biological insights will lead to additional progress in precision medicine for meningiomas.
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Affiliation(s)
- Stephanie M Robert
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Arushii Nadar
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Evan Gorelick
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Lan Jin
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - E Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA.
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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15
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Ashiru-Oredope D, Hopkins S, Vasandani S, Umoh E, Oloyede O, Nilsson A, Kinsman J, Elsert L, Monnet DL. Healthcare workers' knowledge, attitudes and behaviours with respect to antibiotics, antibiotic use and antibiotic resistance across 30 EU/EEA countries in 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 33769250 PMCID: PMC7995558 DOI: 10.2807/1560-7917.es.2021.26.12.1900633] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background While several studies have assessed knowledge, attitudes and behaviours of the public, physicians and medical students in a number of EU/EEA countries with respect to antibiotic use and antibiotic resistance, there is a paucity of literature for other healthcare workers. This survey aimed to fill this gap. Methods A 43-item online questionnaire was developed, validated and pilot-tested through a modified Delphi consensus process involving 87 Project Advisory Group (PAG) members, including national representatives and members of European health professional groups. The survey was distributed by the PAG and via social media to healthcare workers in 30 EU/EEA countries. Results Respondents (n = 18,365) from 30 EU/EEA countries participated. Knowledge of antibiotics and antibiotic use was higher (97%) than knowledge of development and spread of antibiotic resistance (75%). Sixty percent of respondents stated they had received information on avoiding unnecessary prescribing, administering or dispensing of antibiotics. Among respondents who prescribed, administered or dispensed antibiotics, 55% had provided advice on prudent antibiotic use or management of infections to patients, but only 17% had given resources (leaflets or pamphlets). For community and hospital prescribers, fear of patient deterioration or complications was the most frequent reason (43%) for prescribing antibiotics that were considered unnecessary. Community prescribers were almost twice as likely as hospital prescribers to prescribe antibiotics due to time constraints or to maintain patient relationships. Conclusion It is important to move from raising awareness about prudent antibiotic use and antibiotic resistance among healthcare workers to designing antimicrobial stewardship interventions aimed at changing relevant behaviours.
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Affiliation(s)
| | | | | | - Eno Umoh
- Public Health England (PHE), London, United Kingdom
| | | | - Andrea Nilsson
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - John Kinsman
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Linda Elsert
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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- The members of the #ECDCAntibioticSurvey Project Advisory Group are listed at the end of the article
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