P04.02.A Integrated diagnosis and therapeutic decision of pediatric nervous system tumors using a comprehensive genomic profiling test

Background

Nervous system tumors (NST) are one of the leading causes of cancer-related death in children. Next-generation sequencing has enabled the identification of an increasing number of genetic markers, allowing for a more accurate diagnosis, and may help guide clinicians towards a more specific therapeutic approach.

Material and Methods

Retrospective cohort study of pediatric and young adult patients with NST analyzed with FoundationOneHeme® (FOH) panel from March 2020 to April 2021. This panel was requested, in addition to previously performed pathological reviews and routine genetic tests, in order to obtain more accurate diagnoses and/or possible therapeutic targets.

Results

Fifty NST were analyzed with FOH panel, corresponding to 49 patients. Median age at NST diagnosis was 13 years (range 0-23 years); 50% were females. Initial diagnoses were: 10 pilocytic astrocytomas, 10 diffuse gliomas, 5 ependymomas, 6 mixed neuronal-glial tumors, 7 embryonal tumors, 3 meningeal tumors, 5 peripheral nervous system tumors (PNST) and 4 other types of tumors. There was a change in the final integrated diagnosis after performing the FOH panel in 10 patients (1 pilocytic astrocytoma, 3 diffuse gliomas, 4 mixed neuronal-glial tumors and 1 PNST). In thirty patients, at least one possible therapeutic target was identified: in 5 patients the target therapies are approved for the patients’ tumor type; in 20 patients, target therapies are approved for the same mutations in other tumor types; and in 30 patients target therapies are still being evaluated in ongoing clinical trials. After the results of the FOH panel were known, the previous therapeutic approach was changed in 15 patients, but in only 4 this was attributed to the new genomic findings.

Conclusion

Comprehensive genomic profiling tests can improve diagnostic accuracy and allow for a more reliable approach to the management of pediatric patients with nervous system tumors. Although in most patients there was no immediate therapeutic application of the potential targets found, the genomic data obtained could be very useful to patients who may have tumor progressions in the future.

P11.74.A Plexiform Neurofibromas prevalence and treatment modalities in a referral comprehensive cancer center

Background

Neurofibromatosis type 1 (NF1) is the most common tumor predisposition syndrome, with an incidence of 1/3500. Plexiform neurofibromas (PN) are benign tumors that can occur along the nerve sheath throughout the body, with unpredictable growth and with risk of malignant transformation. Symptoms will depend on their size and location, and include pain, deformity and functional impairment. There is a great variability in the PN severity and impact on quality-of-life (QOL). An unknown percentage of NF1 patients may need treatment, either medical and/or surgical.

Objectives

To assess the frequency of PN in a NF1 population followed in a comprehensive cancer center.

Material and Methods

Retrospective study. All patients with NF1 and PN followed in our center, between 31/12/2000 and 31/12/2021.

Results

Of 438 NF1 patients, 185 had PN (42%). 52 NF1 patients with PN were children (≤ 18). The most common symptoms were pain in 71 people (38,4%), deformity in 70 (37,8%) and functional impairment in 69 (37,3%). Several patients had a combination of these symptoms. Different treatment modalities were used for PN: medical, surgical or both. In this study, 54 patients (29,1%) were treated with MEK inhibitors (selumetinib), 74 patients (40%) were treated surgically and 12,4% (23) needed a combined approach (medical and surgical treatment).

Conclusion

PN are frequent in NF1 patients. A significant percentage is symptomatic and will require treatment, surgical, medical or both. There is no standard of care for PN NF1. The timing and sequence of medical and surgical treatment is yet to be defined.

Cystlike Lesions as a Late Sequela of Radiotherapy in Pediatric Patients

BACKGROUND AND PURPOSE

The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects.

MATERIALS AND METHODS

Children treated for brain tumors during a 30-year period (n = 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models.

RESULTS

Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity.

CONCLUSIONS

Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.

P14.89 What happens after 15 years? A clinical picture of a cohort of survivors of CNS tumors treated with whole-brain irradiation in a National Cancer Center

BACKGROUND

Radiotherapy (RT) is standard curative treatment for many tumours, specially brain tumours. However, RT causes damage to normal brain tissue due to genetic instability, impairment of synaptic plasticity and increased oxidative stress and inflammation. With improved treatment, patient survival also increased in years, making long-term effect of RT more evident. Late toxicities of RT are well described for pediatric survivors but there is scant literature on late toxicities in adult survivors and, in general, the adult brain is considered less susceptible to radiation damage.

MATERIAL AND METHODS

Retrospective analysis of adult patients treated with whole-brain RT with more than 15 years of follow-up. Clinical charts were reviewed to collect clinical, demographic and outcome data.

RESULTS

From 18 patients found (mean age at diagnosis of 27 years, 13 male/ 5 female), 5 were diagnosed with medulloblastoma, 5 CNS lymphoma, 5 with germinoma, 3 with ependymoma and 1 with teratocarcinoma. Most common presentations were headache (61,1%), seizure (16,7%) and dizziness (16,7%). 5 patients (27,8%) had hydrocephalus at diagnosis. All patients received whole-brain RT (mean 40Gys, varying between 21 to 60Gys), alongside with complete surgical resection in 11 patients (61,1%) and chemotherapy in 10 patients (55,6%). Mean follow-up time was 23,6 years and only 1 patient died due to lymphoma recurrence 16,7 years after the initial diagnosis. During follow-up, all patients had late RT induced changes, leukoencephalopathy in 16 patients (88,9%; mean 8,6 years after RT), ischemic stroke in 9 patients (50,0%; mean 16,0 years after RT), cerebral microbleeds in 14 patients (77,8%; mean 15,4 years after RT), cognitive decline in 12 patients (66,7%; mean 15,8 years after RT), radio-induced meningioma in 3 patients (16,7%; mean 18,1 years after RT) and epilepsy in 2 patients (11,1%; mean 10,5 years after RT). Also 1 patient had neurosensorial loss 14,2 years after RT and another one had subarachnoid haemorrhage due to ruptured aneurysm 19 years after RT.

CONCLUSION

Our results show that late RT induced effects are progressive and irreversible in the adult survivors, in a very similar manner as has been reported in the pediatric survivors. The impact on quality of live is increasing as patients survive longer. RT is still an important tool in neuro-oncology, but its role in curing brain tumors needs further study.

Feeding behavior and crop damage caused by capybaras (Hydrochoerus hydrochaeris) in an agricultural landscape

This study aimed to assess the yield loss caused by capybaras in rural areas of Dourados-MS, their feeding periods, crop preferences and the landscape characteristics of farms that may affect the occurrence of capybara's herds. Semi-structured interviews in 24 different farms were done during a period between April 2010 and August 2011. Field observations were held at different times of the day, and also during the night in order to record peaks of the feeding behavior in six farms. Direct counting of capybaras along with the group of animals reported as seen by the farmers during the interviews was used to estimate the size of herds. Data was analyzed using the Principal Components Analyses and the Analytic Hierarchy Process. The average number of capybaras found in a regular herd was 18.8 ± 7.90 animals. The average number of capybara herd by farms was of 1.38 ± 0.92 while the average number of capybaras by farms was 32.33 ± 27.87. Capybaras selected rice (Oryza sativa) when it was available (14.5% of devastation in 1.18% of total planted area); however, the most eaten crop was corn (Zea mays) with 38.55% of loss rate in 16.17% of the total planted area. Capybaras ate mostly in the evening and during the night. The availability of water resources in the rural area predisposed the occurrence of capybara's herds.

Sequential implementation of global quantum operations

We study the possibility for a global unitary applied on an arbitrary number of qubits to be decomposed in a sequential unitary procedure, where an ancillary system is allowed to interact only once with each qubit. We prove that sequential unitary decompositions are in general impossible for genuine entangling operations, even with an infinite-dimensional ancilla, being the controlled-NOT gate a paradigmatic example. Nevertheless, we find particular nontrivial operations in quantum information that can be performed in a sequential unitary manner, as is the case of quantum error correction and quantum cloning.

Sequential quantum cloning

Not all unitary operations upon a set of qubits can be implemented by sequential interactions between each qubit and an ancillary system. We analyze the specific case of sequential quantum cloning, 1-->M, and prove that the minimal dimension D of the ancilla grows linearly with the number of clones M. In particular, we obtain D=2M for symmetric universal quantum cloning and D=M+1 for symmetric phase-covariant cloning. Furthermore, we provide a recipe for the required ancilla-qubit interactions in each step of the sequential procedure for both cases.

Activities of NADPH-dependent reductases and sorbitol dehydrogenase in canine and feline lenses

OBJECTIVE

To measure activities of NADPH-dependent reductases and sorbitol dehydrogenase in lenses from healthy dogs and cats.

SAMPLE POPULATION

Lenses from 37 dogs and 23 cats. All animals were healthy and had serum glucose concentrations within reference limits.

PROCEDURE

Lenses were homogenized, and activities of NADPH-dependent reductases and sorbitol dehydrogenase were measured spectrophotometrically.

RESULTS

Activities of NADPH-dependent reductases and sorbitol dehydrogenase were significantly lower in lenses from cats than in lenses from dogs. However, the ratio of NADPH-dependent reductases activity-to-sorbitol dehydrogenase activity was significantly higher in lenses from cats than in lenses from dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicate that during periods of hyperglycemia, sorbitol would accumulate at a faster rate in the lenses of cats than in the lenses of dogs. Thus, the higher incidence of diabetic cataracts in dogs, compared with cats, is likely not attributable to a difference in the ratio of NADPH-dependent reductases activity-to-sorbitol dehydrogenase activity.

Diabetic cataracts: different incidence between dogs and cats

Diabetes mellitus is one of the most common endocrinopathies in the dog and cat. Diabetic cataract primarily affects the canine species and is rarely observed in the cat. It has been proposed that the incidence of cataracts in diabetic dogs is high because many of these patients have significant hyperglycemia despite insulin therapy. Age, gender, levels of serum glucose (before and during insulin therapy) and cataract formation were evaluated, retrospectively, in 23 dogs and 22 cats with diabetes mellitus. In the canine population, the groups with the highest frequency of presentation were females and sexually intact animals. In contrast, males and neutered animals were the most prevalent groups in the feline diabetic population. Over 80% of diabetic cats and dogs were older than 7 years. Our results confirm the almost total lack of cataracts in diabetic cats, while they were present in more than half of the dogs. A relation between the incidence of cataracts and the correspondent level of hyperglycemia in the canine and feline species could not be established. The estimation of the relative risk for the development of cataracts in diabetic dogs shows that some population groups have a higher probability for suffering from this ocular alteration. A relation between relative risk and the correspondent level of hyperglycemia in the various groups was not found. This fact indicates that other factors are involved in the unequal appearance of diabetic cataracts in dogs and cats.

Inhibition of epileptiform activity by serotonin in rat CA1 neurons

This investigation was performed to determine the ability of serotonin in inhibiting bicuculline-induced epileptiform bursts in brain slices of male Sprague-Dawley rats. In all experiments, intracellular recording techniques were employed on CA1 neurons of the hippocampus. The neurons were stimulated either directly by the recording electrode or indirectly (synaptic stimulation) using a bipolar electrode placed on the CA2/CA3 region. Serotonin (20 microM) inhibited the directly evoked bursts of action potentials and caused a membrane hyperpolarization and decrease in membrane input resistance in untreated CA1 neurons. In the same experiments, serotonin inhibited the synaptically evoked action potential as well. Additionally, serotonin inhibited epileptiform bursts induced by single presynaptic stimuli in the presence of bicuculline. Moreover, in the concomitant presence of serotonin and bicuculline, there was a decrease in the number of spikes in bursts evoked by direct stimulation. Inhibition of epileptiform bursts was also achieved with the selective 5-HT1A agonist 8-hydroxydipropyl-amino-tetralin (8-OH-DPAT). The presence of the 5-HT3 antagonist MDL 72222 (30 microM), and the 5-HT2 antagonist ketanserin (3 microM) did not influence the ability of serotonin to inhibit epileptiform bursts. In the presence of bicuculline, the inhibitory action of serotonin, 8-OH-DPAT or the combination of serotonin, MDL 72222 and ketanserin, was accompanied by a membrane hyperpolarization and a decrease in membrane input resistance. To ascertain if serotonin can be applied on other models of epilepsy, as well, we demonstrate the inhibition of epileptiform activity in the kainic acid treated brain slice preparation.(ABSTRACT TRUNCATED AT 250 WORDS)

99Tcm-HMPAO brain SPECT in the evaluation of prognosis after surgical resection of astrocytoma. Comparison with other noninvasive imaging techniques (CT, MRI and 201Tl SPECT)

High-grade astrocytoma represents the most common primary malignant brain tumour in the adult, and is associated with high morbidity and mortality rates. The aim of this study was to investigate the prognostic value of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) in predicting neurological function and tumour therapy response after surgical resection of astrocytoma. The correlation between 99Tcm-HMPAO studies and other noninvasive methods [computed tomography (CT), magnetic resonance imaging (MRI) and 201Tl (SPECT)] was evaluated. The clinical population included 21 patients with previous surgical debulking of astrocytoma. All patients were evaluated with 99Tcm-HMPAO brain SPECT. Seven patients, who suffered progressive clinical deterioration after radiotherapy, underwent dual-isotope SPECT imaging with 201Tl and 99Tcm-HMPAO. Neurological examinations and CT were performed in all patients. Magnetic resonance imaging was performed in seven patients. Prior to radiotherapy and/or chemotherapy, the patients with neurological improvement during the follow-up evaluation commonly showed less intense abnormal 99Tcm-HMPAO uptake than the patients without neurological improvement. In addition, after therapy none of the former patients had increased 99Tcm-HMPAO uptake. Most patients without neurological improvement had evidence of high focal uptake. Computed tomography and MRI usually demonstrated pathological contrast enhancement regardless of the presence or absence of improvement of neurological function. Foci of high 201Tl accumulation were observed on SPECT images in five patients. In four of these patients, the 99Tcm-HMPAO was greater than in normal brain, and in two patients the 99Tcm-HMPAO uptake was lower than in normal brain. One patient with decreased 99Tcm-HMPAO uptake in a medium-sized lesion had a normal 201Tl study. Our hypothesis that 99Tcm-HMPAO SPECT may be useful for providing prognostic information after surgical debulking of astrocytoma seems to be promising. Further studies are needed to document this new important role of 99Tcm-HMPAO SPECT.

Effects of ATP-sensitive K(+)-channel activators on transmitter release parameters at the frog neuromuscular junction

The frog neuromuscular junction was used to study KATP channel action and its relation to transmitter release. Diazoxide (10 microM) and cromakalim (300 microM) decreased the amplitude of the end-plate potential (EPP) without significantly affecting the miniature end plate potential (MEPP) amplitude. Thus, there was a significant decrease in the quantal content of EPP after administration of the KATP channel activators. These agents did not alter MEPP frequency or resting membrane potential (RMP). The diazoxide-induced decrease in EPP amplitude was antagonized by the KATP blocker glibenclamide (10 microM) suggesting KATP channel involvement. Glibenclamide (10 microM) by itself caused a significant decrease in the RMP without significantly affecting the parameters of transmitter release. The diazoxide-induced decrease in EPP amplitude was not readily reversible with washing, however, when glibenclamide was added after diazoxide, the effect was easier to reverse. The results indicate that the activators exert their effect predominantly at the presynaptic region.

Effects of gamma-aminobutyric acid on the compound action potential of the rat superior cervical ganglion

The effects on the ganglionic transmission of gamma-aminobutyric acid (GABA) and related drugs were studied in the rat isolated superior cervical ganglion. The extracellularly recorded postganglionic compound action potential was used as an index for ganglionic transmission. GABA reversibly inhibited the ganglionic transmission by blocking the action potential. The effect of GABA is markedly antagonized by bicuculline (20 microM) or picrotoxin (200 microM). Furosemide (1 mM) was also effective in antagonizing the ganglionic effect of GABA. The antagonism by bicuculline was not affected in the presence of pentobarbital (50 microM). Baclofen inhibited the ganglionic transmission through an activation of GABAB receptors since it was markedly antagonized by phaclofen. Muscimol and isoguvacine were less effective than GABA in blocking the ganglionic transmission. The GABA uptake inhibitor isonipecotic acid blocked the ganglionic transmission, probably by activating GABAA receptors, because the effect was antagonized by bicuculline, but the GABA uptake inhibitor guvacine had no significant effect on the ganglionic transmission. These results suggest that GABA causes a ganglionic blockade by activation of both GABAA and GABAB receptor subtypes.

The 5S ribosomal RNAs of Paracoccus denitrificans and Prochloron

The nucleotide sequences of the 5S rRNAs of Paracoccus denitrificans and Prochloron sp. are (formula: see text), respectively. Specific phylogenetic relationships of P. denitrificans with purple non-sulphur bacteria, and of Prochloron with cyanobacteria are demonstrated, and unique features of potential secondary structure are described.