Publication rates of podium presentations at the Society of Gynecologic Oncology (SGO) annual meetings

OBJECTIVES

Our study aimed to determine the publication rates of podium presentations from the 2017 and 2018 Society of Gynecologic Oncology (SGO) Annual Meetings; and to examine rates and predictors of oral presentations that resulted in publication.

METHODS

We reviewed podium presentations given at the 2017 and 2018 SGO Annual Meetings. Abstracts were evaluated for publication from January 1, 2017 to March 30, 2020 and January 1, 2018 to June 30, 2021, respectively, to allow for a 3 year period of publication.

RESULTS

In 2017 and 2018, 43 of 75 (57.3%) and 47 of 83 (56.6%) podium presentations were published within 3 years, respectively. No significant difference was found between the mean time to publication within 3 years (13.0 months vs 14.1 months for 2017 and 2018, respectively; p=0.96). Similarly, the mean difference of journal impact factors between both years did not reach significance (6.57 and 10.7 for 2017 and 2018, respectively; p=0.09). The median impact factor (IF) was 4.54 (range: 40.3) and 4.62 (range: 70.7) in 2017 and 2018, respectively. Of the presentations published, 53.4% (2017) and 38.3% (2018) appeared in the journal Gynecologic Oncology. Significant positive correlations for the likelihood of publication were determined among the following: funding status (r=0.93) including funding involving National Institutes for Health (r=0.91) or pharmaceutical (r=0.95), clinical trial study design (r=0.94), and pre-clinical research (r=0.95) (all p<0.005).

CONCLUSIONS

At the 2017 and 2018 SGO Annual Meetings 57% of podium presentations were published in a peer-reviewed journal within 3 years. Publication in peer-reviewed journals is crucial for timely distribution of clinical information to the medical community.

Challenges in treatment of gestational trophoblastic neoplasia in patients with MTHFR mutation: A case report

•We present a case of a patient with post molar pregnancy who has a MTHFR C677T mutation.•The mutation led to an alteration of recommended chemotherapy regimen.•No studies have reported treatment recommendations pertaining to gyn malignancies in patients with MTHFR allele.•We present a novel instance where MTHFR mutation altered a patient's treatment for gestational trophoblastic neoplasia.

Active COVID19 infection as a barrier to postpartum tubal ligation

OBJECTIVE

To identify patients unable to obtain postpartum bilateral tubal ligations (ppBTL) due to policy prohibiting "elective" procedures for COVID-positive patients at a single academic medical center in New Jersey.

METHODS

A retrospective study of patients requesting ppBTLs. Sociodemographic information and subsequent contraception and pregnancy outcomes were obtained via chart review.

RESULTS

Of 110 ppBTL requests from 2/1/2020 and 2/28/2022, 24 (22%) were canceled due to COVID infection. Of these patients, 10 (42%) were uninsured, 13 (54%) had Medicaid, and 22 (92%) were Hispanic/Latinx. Postpartum, five (21%) obtained interval tubal ligation, seven (37%) never received contraception, and one had a future pregnancy.

CONCLUSION

This policy affected uninsured patients by preventing access to permanent contraception.

A case of radiation-induced bullous pemphigoid in a vulvar cancer patient

•Radiation-induced bullous pemphigoid is a rare autoimmune disease.•There is only one prior documented case of radiation-induced bullous pemphigoid in a vulvar cancer patient.•A multidisciplinary approach is critical to identify and treat bullous pemphigoid.

Benign metastasizing leiomyoma in retroperitoneal lymph nodes with concurrent early stage cervical cancer

•

BML of the retroperitoneal lymph nodes is a rare, benign disease.

•

BML can mimic metastatic lymphadenopathy in the setting of concurrent malignancy.

•

BML in the retroperitoneal lymph nodes is a diagnosis of exclusion.

•

Consider biopsy if suspect metastatic disease in patients with BML risk factors.

Extrauterine leiomyomas can present as benign metastasizing leiomyoma involving lymph nodes, which can be mistaken for metastatic malignancy. We report a case of a 52-year-old female who presented with postmenopausal bleeding and was found to have an endocervical mass. Imaging demonstrated retroperitoneal lymphadenopathy and biopsy of the cervical mass showed adenocarcinoma of either uterine or cervical origin. Patient underwent hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy for bulky pelvic and para-aortic lymph nodes. Final pathology was consistent with FIGO 2019 stage IB2 adenocarcinoma of the cervix with concurrent and benign metastasizing leiomyomas involving retroperitoneal lymph nodes.

Pancreatic cancer prognosis is predicted by an ATAC-array technology for assessing chromatin accessibility

Unlike other malignancies, therapeutic options in pancreatic ductal adenocarcinoma (PDAC) are largely limited to cytotoxic chemotherapy without the benefit of molecular markers predicting response. Here we report tumor-cell-intrinsic chromatin accessibility patterns of treatment-naïve surgically resected PDAC tumors that were subsequently treated with (Gem)/Abraxane adjuvant chemotherapy. By ATAC-seq analyses of EpCAM+ PDAC malignant epithelial cells sorted from 54 freshly resected human tumors, we show here the discovery of a signature of 1092 chromatin loci displaying differential accessibility between patients with disease free survival (DFS) < 1 year and patients with DFS > 1 year. Analyzing transcription factor (TF) binding motifs within these loci, we identify two TFs (ZKSCAN1 and HNF1b) displaying differential nuclear localization between patients with short vs. long DFS. We further develop a chromatin accessibility microarray methodology termed "ATAC-array", an easy-to-use platform obviating the time and cost of next generation sequencing. Applying this methodology to the original ATAC-seq libraries as well as independent libraries generated from patient-derived organoids, we validate ATAC-array technology in both the original ATAC-seq cohort as well as in an independent validation cohort. We conclude that PDAC prognosis can be predicted by ATAC-array, which represents a low-cost, clinically feasible technology for assessing chromatin accessibility profiles.

Postpartum hemorrhage caused by uterine artery pseudoaneurysm: A case report

Background

Uterine artery pseudoaneurysms (UAPs) are a rare life-threatening complication presenting as vaginal bleeding. Transvaginal ultrasound doppler scans can diagnose UAPs in the immediate and later postpartum period. This case report highlights UAP management using minimally invasive interventions for fertility preservation.

Case

A 21-year-old woman presented on post-operative day 10 following a primary cesarean section with heavy vaginal bleeding and a UAP was confirmed on doppler sonography. A multidisciplinary approach determined the optimal management taking the patient's fertility into consideration. Initially, the UAP was injected directly with thrombin under ultrasound guidance. However, due to a subsequent hemorrhage, a uterine artery embolization was performed.

Conclusion

Recognition of UAP is critical in the management of postpartum vaginal bleeding. Patient goals should be balanced with the severity of UAPs to determine optimal management.

•

While rare, uterine artery pseudoaneurysms should be a differential diagnosis for delayed postpartum hemorrhages.

•

They should be investigated using transvaginal color doppler ultrasound.

•

Interdiscipllinary collaboration is imperative for patient-centered approaches to manage uterine artery pseudoaneurysm.

•

Uterine artery pseudoaneurysms must be treated in a timely fashion given their high morbidity and mortality.

Abstract LB-238: Genome wide cis-regulatory elements accessibility signature predicts early recurrence of the treatment-naïve resected subset of PDAC: A new paradigm for precision oncology

We have recently discovered a set of 1092 cis-regulatory elements in the human genome that are differentially accessible in the treatment-naïve resected subset of pancreatic ductal adenocarcinoma (PDAC) recurring within first 12 months of surgery. Recurrence, even after complete removal of the primary tumor, is a pressing issue in PDAC. We hypothesized that malignant cells of the recurrent and the non-recurrent PDAC tumors possessed differential accessibility patterns of cis-regulatory elements in the genome. To test this hypothesis, we interrogated genome wide chromatin accessibility landscape of EpCAM-sorted “pure” PDAC malignant cells (KRAS mutant allele frequency 45+22%) from 54 freshly resected tumors followed by the Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq). We identified a near-saturating total number of 126661 open chromatin peaks from duplicate ATAC-seq libraries from each of 40 (out of 54) patients (80 libraries with Irreproducible Discovery Rate (IDR)-cut-off &lt;0.01). We found 1092 peaks differentially represented (p&lt;0.001) in patients who recurred within first 12 months of surgery compared to the patients who didn't. We identified 62 transcription-factor binding motifs by MEME curated CisBP transcription factor binding motifs (TBFM) and FIMO that were differentially enriched in recurrent and non-recurrent patients (P &lt; 1x10-4). We selected the top listed two transcription factors, HNF1b and ZKSCAN1, from the non-recurrent and recurrent groups respectively, for further validation by immunohistochemistry (IHC) and immunofluorescence (IF) staining of tissue microarrays (TMA) prepared from formalin-fixed paraffin blocks of these tumors (N=40). With the blinded subjective scoring (0-3 scale) method using the combination of HNF1b and ZKSCAN1 we could predict recurrence with 83.33% accuracy. HNF1b nuclear staining pattern was completely absent from 7, weak in 4 and strong in 1 out of 12 recurrent patients. As opposed to that, strong nuclear staining of ZKSCAN1 in 3, moderate staining in 5, weak to moderate in 3 and no staining in 1 out of 12 patients was observed. Among the rest 28 patients, only 3 (10.7%) showed a clear cut opposite staining pattern, i.e., strong HNF1b and weak ZKSCAN1 nuclear staining, 7 patients showed the recurrence signature of staining and other 18 patients showed ambivalent patterns. Altogether, from the current study we conclude that epigenetic reprogramming, by increasing or decreasing accessibility of the cis-regulatory elements in the genome, regulates binding of the specific transcription factors, which in turn might control the PDAC heterogeneity of recurrence and chemoresistance.

Citation Format: Surajit Dhara, Sagar Chhangawala, Gokce Askan, Zhang Liguo, Smrita Sinha, Danielle Glassman, Kenneth Yu, Vinod Balachandran, Christina Leslie, Steven Leach. Genome wide cis-regulatory elements accessibility signature predicts early recurrence of the treatment-naïve resected subset of PDAC: A new paradigm for precision oncology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-238.

Cadaveric simulation: a review of reviews

BACKGROUND

Traditional surgical training, largely based on the Halstedian model "see one, do one, teach one" is not as effective in the era of working time restrictions and elaborate shift-patterns. As a result, contemporary surgeons turned to educational methods outside the operating theatre such as simulation. Cadavers are high fidelity models but their use has ethical and cost implications and their availability may be limited. In this review, we explore the role of cadaveric simulation in modern surgical education.

METHODS

All the Evidence-Based Medicine databases were searched for relevant reviews. The resulting studies were assessed for inclusion to this review, according to pre-determined criteria. Data extraction was performed using a custom-made spreadsheet, and the quality of included reviews was assessed using a validated scoring system (AMSTAR).

RESULTS

The literature review yielded 33 systematic reviews; five of which matched the inclusion criteria and were included in this review of reviews. Cadaveric simulation was found to have good face (subjective assessment of usefulness) and content validity (whether a specific element adds or retracts to the educational value) while trainees improved their surgical skills after practicing on cadavers. However, concerns have been raised about ethical issues, high cost and availability.

CONCLUSION

Cadavers are an effective medium for surgical teaching, and it may be appropriate for them to be used whenever surrounding conditions such cost and availability allow. Further research is required to provide evidence on whether there is equivalence between cadavers and other educational media which may not bear the same shortcomings.

Real-Time Genomic Profiling of Pancreatic Ductal Adenocarcinoma: Potential Actionability and Correlation with Clinical Phenotype

Purpose: Molecular profiling in cancer has identified potential actionable drug targets that have prompted attempts to discover clinically validated biomarkers to guide therapeutic decision-making and enrollment to clinical trials. We evaluated whether comprehensive genetic analysis of patients with pancreatic adenocarcinoma is feasible within a clinically relevant timeframe and whether such analyses provide predictive and/or prognostic information along with identification of potential targets for therapy.Experimental Design: Archival or prospectively acquired FFPE samples and matched normal DNA from N = 336 patients with pancreatic cancer were analyzed using a hybridization capture-based, next-generation sequencing assay designed to perform targeted deep sequencing of all exons and selected introns of 410 key cancer-associated genes. Demographic and treatment data were prospectively collected with the goal of correlating treatment outcomes and drug response with molecular profiles.Results: The median time from protocol consent to reporting of the genomic results was 45 days with a median time from tissue delivery of 20 days. All genetic alterations identified were stratified based upon prior evidence that the mutation is a predictive biomarker of drug response using the MSKCC OncoKB classification. Three of 225 patients (1%) received a matched therapy based upon the sequencing results.Conclusions: The practical application of molecular results to guide individual patient treatment is currently limited in patients with pancreatic adenocarcinoma. Future prospective molecular profiling efforts should seek to incorporate routine germline genetic analysis and the identification of DNA profiles that predict for clinical benefit from agents that target DNA damage repair and or immunotherapy. Clin Cancer Res; 23(20); 6094-100. ©2017 AACR.

High-energy orbital dislocations: the possibility of traumatic hypertelorbitism

In a 4-year period from 1983 to 1987, 7160 patients with blunt injuries were admitted to the Maryland Institute of Emergency Medical Services Systems Shock Trauma Center. Facial injuries occurred in 10 percent of this population. High-energy fractures (characterized by computed tomography) were seen in approximately 10 percent of these patients. In this high-energy group, five cases of high-energy orbital dislocations, some representing examples of traumatic hypertelorbitism, were observed. They represent 1.5 percent of the 342 midface fractures observed and 4.8 percent of the naso-orbital ethmoid fractures observed (105 patients). One additional patient is described who was seen at the UCLA Medical Center for late repair of the condition. High-energy impacts of the upper midface created fractures of both orbits, zygomas, and nasoethmoidal regions permitting lateral transposition, enlargement, and divergence of the orbits. Interorbital, intercanthal, and interpupillary distances were increased, criteria that confirm the diagnosis of hypertelorbitism. Fifty percent of the patients were bilaterally blind, and one patient sustained unilateral blindness.

Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment

The medial canthal tendon and the fragment of bone on which it inserts ("central" fragment) are the critical factors in the diagnosis and treatment of nasoethmoid orbital fractures. The status of the tendon, the tendon-bearing bone segment, and the fracture pattern define a clinically useful classification system. Three patterns of fracture are appreciated: type I--single-segment central fragment; type II--comminuted central fragment with fractures remaining external to the medial canthal tendon insertion; and type III--comminuted central fragment with fractures extending into bone bearing the canthal insertion. Injuries are further classified as unilateral and bilateral and by their extension into other anatomic areas. The fracture pattern determines exposure and fixation. Inferior approaches alone are advised for unilateral single-segment injuries that are nondisplaced superiorly. Superior and inferior approaches are required for displaced unilateral single-segment injuries, for bilateral single-segment injuries, and for all comminuted fractures. Complete interfragment wiring of all segments is stabilized by junctional rigid fixation. All comminuted fractures require transnasal wiring of the bones of the medial orbital rim (medial canthal tendon-bearing or "central" bone fragment). If the fracture does not extend through the canthal insertion, the canthus should not be detached to accomplish the reduction.

Malignant melanoma

The incidence of malignant melanoma is increasing faster than that of any other cancer except lung cancer in women. Understanding malignant melanoma and recognizing suspicious lesions is critical in curtailing the spread of this potentially fatal disease.

Rigid stabilization of sagittal fractures of the maxilla and palate

Rigid stabilization of sagittal fractures of the palate is described that utilizes plate and screw fixation in the palatal vault. Accurate reduction of facial width is obtained, and stability is significantly enhanced. An existing laceration or a longitudinal incision in the palatal mucoperiosteum provides exposure for maxillary adaption plate application. The transpalatal reduction should be supplemented by fixation at the piriform aperture, the zygomaticomaxillary and nasomaxillary buttresses, and by the use of an arch bar. Since slower bone healing may be observed following palatoalveolar fractures, the occlusion must be observed for deviation throughout a full 16-week period even though early motion and soft diet are permitted. Removal of the plate and screws in the roof of the mouth is sometimes required and utilizes local anesthesia.