[Clinical analysis of 14 patients aged ≤ 50 years with high-risk multiple myeloma treated with allogeneic hematopoietic stem cell transplantation]

Objective: To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in young patients with high-risk multiple myeloma (HRMM) and analyzed the factors affecting patient prognosis. Methods: In this retrospective study, we analyzed the clinical data of 14 patients with HRMM with cytogenetic abnormalities or high-risk biological factors who underwent allo-HSCT at the Hematopoietic Stem Cell Transplantation Center of the Institute of Hematology & Blood Diseases Hospital between November 2016 and November 2022. Results: There were seven males and seven females included in the study, with a median age of 39.5 (31-50) years at the time of allo-HSCT. The median number of treatment lines before transplantation was 2 (1-6) . Before allo-HSCT, 42.9% (6/14) of the patients did not achieve complete remission, while 35.7% (5/14) of the patients achieved measurable residual disease positivity. After transplantation, all patients were evaluated for their treatment response, and the overall response rate was 100% (14/14) . All 14 patients successfully underwent allo-HSCT, with median engraftment times for neutrophils and platelets of 11 (10-14) days and 13 (9-103) days, respectively. Acute grade Ⅱ-Ⅳ graft-versus-host disease (GVHD) occurred in five patients (35.7%) , and two patients (14.3%) developed moderate-to-severe chronic GVHD. The median follow-up time after allo-HSCT was 18.93 (4.10-72.53) months, with an expected 2-year transplant-related mortality rate of 7.1% (95% CI 0%-21.1%) and an expected 2-year overall survival rate of 92.9% (95% CI 80.3%-100.0%) . Moreover, the expected 1-year and 2-year progression-free survival rates were 92.9% (95% CI 80.3%-100.0%) and 66.0% (95% CI 39.4%-100.0%) , respectively, and the 2-year cumulative incidence of relapse was 28.9% (95% CI 0%-56.7%) . Upfront allo-HSCT following complete remission after induced therapy and the presence of chronic GVHD might be favorable prognostic factors. Conclusion: allo-HSCT is an effective treatment for improving the prognosis of young patients with HRMM.

[Intelligent intensive care unit design:will it be accessible in the future]

ICU is an essential location for critically ill patients to receive comprehensive diagnosis and treatment. However, the high intensity of ICU clinical work, the difficulty of diagnosis and treatment, and the poor humanistic environment require us to accelerate the pace of ICU reform. Therefore, the use of advanced technology to create an intelligent ICU department is imperative. The modern ICU is rich in electronic data and can collect a large amount of patient data during routine care, making it an ideal place to deploy intelligent digital platforms. The vast amounts of data generated by monitoring systems and electronic medical records provide fertile ground for the development of more accurate predictive models, better Clinical Decision Support System and more personalized diagnosis and treatment. At the same time, a well-designed and well-arranged ICU department will greatly enhance the patient's sense of occupancy, as well as increase the professional pride and sense of belonging. Therefore, the establishment of an intelligent ICU department is the only way for ICU to enter the fast lane of development, which will also have a profound impact on the development of ICU.

Cost-Effectiveness Analysis of 68Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma

BACKGROUND AND PURPOSE

While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium 68Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating 68Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However, 68Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of 68Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma.

MATERIALS AND METHODS

We developed a decision-analytical model based on both recommended guidelines on meningioma management and our institutional experience. Markov models were implemented to estimate quality-adjusted life-years (QALY). Cost-effectiveness analyses with willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were performed from a societal perspective. Sensitivity analyses were conducted to validate the results. Model input values were based on published literature.

RESULTS

The cost-effectiveness results demonstrated that 68Ga-DOTATATE PET/MR imaging yields higher QALY (5.47 versus 5.05) at a higher cost ($404,260 versus $395,535) compared with MR imaging alone. The incremental cost-effectiveness ratio analysis determined that 68Ga-DOTATATE PET/MR imaging is cost-effective at a willingness to pay of $50,000/QALY and $100,000/QALY. Furthermore, sensitivity analyses showed that 68Ga-DOTATATE PET/MR imaging is cost-effective at $50,000/QALY ($100,000/QALY) for specificity and sensitivity values above 76% (58%) and 53% (44%), respectively.

CONCLUSIONS

68Ga-DOTATATE PET/MR imaging as an adjunct imaging technique is cost-effective in postoperative treatment planning in patients with meningiomas. Most important, the model results show that the sensitivity and specificity cost-effective thresholds of 68Ga-DOTATATE PET/MR imaging could be attained in clinical practice.

[Effect of hyperandrogenism on pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer]

Objective: To explore the effects of hyperandrogenism (HA) on pregnancy outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET). Methods: A retrospective study was conducted on infertile women with PCOS undergoing IVF/ICSI-ET from January 2017 to June 2021 in our center. Patients were divided into HA group and NON-HA group according to the levels of testosterone. Propensity score matching (PSM) was used to balance the influence of female age and IVF/ICSI-ET for patients with gonadotropin-releasing hormone (GnRH)antagonist protocol and GnRH agonist protocol, separately. After the PSM procedure, 191 cases in HA group and 382 cases in NON-HA group, were included. Hormone levels and pregnancy outcomes were compared in the two groups. Results: The female age was comparable in two groups [HA: (29.6±3.7) vs NON-HA: (29.5±3.6), P=0.665]. The basal luteinizing hormone [(10.82±6.73) vs (7.76±5.30) IU/L], testosterone [(3.27±0.97) vs (1.60±0.59) nmol/L], free androgen index (7.13 vs 2.77), anti-mullerian hormone [(11.37±5.74) vs (9.67±4.67) ng/ml], fasting glucose [(5.18±0.49) vs (5.06±0.42) mmol/L], 1h glucose [(9.34±2.42) vs (7.99±2.21) nmol/L], 2 h glucose [(7.66±2.17) vs (6.64±1.84) nmol/L], 2 h insulin [(129.81±145.49) vs (97.51±86.92) mU/L], total cholesterol [(5.35±0.89) vs (4.92±0.92) mmol/L], triglycerides [(1.55±1.28) vs (1.33±0.77) mmol/L], and low density lipoprotein cholesterol levels [(3.38±0.66) vs (3.14±0.71) mmol/L] were significantly higher in HA group, compared with NON-HA group (P<0.05). The initiated gonadotropin dose was higher in HA group than that in NON-HA group [(126.96±33.65) vs (137.60±38.12) U, P=0.001], but moderate-severe ovarian hyperstimulation syndrome (OHSS) rate was similar in two groups (P>0.05). The rates of implantation, clinical pregnancy, miscarriage, and live birth were comparable between the two groups (P>0.05). Also, in the subgroups, the rates of implantation, clinical pregnancy, live birth, and miscarriage were similar in HA group and NON-HA group. Conclusions: The risks of hormonal abnormality and glucose-lipid metabolic disorder were higher in PCOS women with HA, whereas satisfactory pregnancy outcomes could be achieved under proper ovarian stimulation undergoing IVF/ICSI-ET.

[Intelligent intensive care unit makes medicine more accessible]

In the past half century, critical care medicine has made rapid development, and the survival rate of critically ill patients has significantly improved. However, what does not match the rapid development of the specialty is that the infrastructure of intensive care unit (ICU) has gradually appeared weaknesses and the development of humanistic care in ICU has lagged. Accelerating the digital transformation of the medical industry will help to improve the existing difficulties. The application of 5G and artificial intelligence (AI) technology to build an intelligent ICU,focusing on improving patients' comfort by strengthening humanistic care,while solve the shortcomings of the critical care dimension, such as lack of human and material resources, low alarm accuracy, insufficient response speed and ability, to better meet the needs of society and improve the level of medical services and humanistic care for critical diseases. We will review the development of ICU history, clarify the necessity of intelligent ICU construction and the core issues to be solved after the construction of intelligent ICU. Three components of the construction of intelligent ICU will be needed: intelligent space and environment management, intelligent equipment and goods management, intelligent monitoring and diagnosis and treatment. Finally, the people-oriented diagnosis and treatment concept will be realized through intelligent ICU.

RADT-19. CHEMORADIATION (CRT) TREATMENT WITH OR WITHOUT CONCURRENT TUMOR-TREATING FIELDS (TTFIELDS) IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM)

OBJECTIVES

Standard of care for newly diagnosed glioblastoma after resection includes concurrent temozolomide (TMZ) and radiation therapy followed by adjuvant TTF with maintenance TMZ. Preclinical studies suggest TTF and radiotherapy work synergistically. We evaluate the benefit of concurrent TTF with CRT vs adjuvant TTF with TMZ after CRT.

METHODS

Concurrent TTF with CRT patients were enrolled in a single-arm pilot study (clinicaltrials.gov Identifier: NCT03477110). For the comparison control of adjuvant TTF, adult patients with newly diagnosed GBM that had a KPS ≥ 60 who received treatment with CRT and adjuvant TMZ + TTF from three institutions were included. The adjuvant TTF cohort excluded patients who progressed during CRT or did not receive TMZ. PFS and OS were compared between groups.

RESULTS

A total of 87 patients were included in this study, of which 30 received concurrent TTF with CRT. Median patient age was 58 in the concurrent TTF group and 59 in the adjuvant TTF group. The median KPS in both groups was. MGMT methylation was present in 33.3% of the concurrent TTF and 32.0% in the adjuvant TTF group. 40% received GTR in the concurrent group and 38% received GTR in the adjuvant group. Multifocal disease was appreciated in 40% of patients in the concurrent TTF group. There was no significant difference in median OS (p=0.38) or PFS (p=0.76).

CONCLUSIONS

There was no difference in OS or PFS between concurrent or adjuvant TTF treatment groups. However, the adjuvant TTF group is expected to be a better prognosis due to the elimination of patients that progressed or declined after initial CRT. The current study suggested concurrent TTF treatment achieved outcomes to that of a better prognosis group. The survival benefit of concurrent TTF with CRT vs adjuvant TTF is being tested in the phase 3 TRIDENT EF-32 clinical trial (NCT04471844).

NCOG-24. TIME TO FIRST RECURRENCE AND SURVIVAL IN IDH-WILDTYPE GLIOBLASTOMA

INTRODUCTION

Time to recurrence is a source of considerable anxiety in glioblastoma. Assuming survival to a certain timepoint without tumor progression, how do odds/outcomes change relative to initial starting conditions? Is there a single timepoint with highest risk of tumor progression, after which "the longer you go, the longer you go"?

METHODS

Newly-diagnosed glioblastomas were retrospectively reviewed (n=209). Pre-2012 diagnoses (n=2) & IDH-mutants excluded (n=8). Median PFS/OS and remaining time to mPFS were calculated for sub-populations without disease progression (POD) at 0, 3, 6, 8, 12, and 24 months post-surgery.

RESULTS

199 IDH-wildtype glioblastomas identified -- 40% women, median age 63 years (range 26-91), 43% gross-total resection, 65% MGMT unmethylated, 65% upfront RT 60Gy (23% 40Gy) -- mPFS 8 months / mOS 19 months. Patients without POD within 3 months had mOS 20 months. Outcomes progressively improve at later timepoints-- mPFS 10/13/20/39 months and mOS 23/27/39/65 months, for patients without POD at 6/8/12/24 months post-surgery respectively. Patients without POD at 24 months comprised 10% of original cohort (n=20; 8 deaths). As a surrogate for risk of tumor progression, remaining time to mPFS was calculated (taken as difference between timepoint in question, and mPFS for the population of patients without POD up to that timepoint) and followed a J-shape curve -- 8 months (at 0 months post-surgery), 4 months (for patients without POD at 6 months post-surgery), 7-8 months (for patients without POD at 10-14 months post-surgery), to 13 and 15 months (for patients without POD at 18 and 24 months post-surgery, respectively).

DISCUSSION

Sub-populations without early progression appear to have improved survival relative to baseline, which has implications for clinical trials without internal controls. Nevertheless, highest risk for tumor progression seems to be at 6 months post-surgery, after which it appears "the longer you go, the longer you go."

PATH-32. CONCORDANCE FOR CDKN2A/B LOSS AND TERT MUTATION IN WHO 2021 CLASSIFICATION GRADE 3 MENINGIOMAS: A RETROSPECTIVE STUDY

BACKGROUND

The new WHO 2021 classification included CDKN2A/B loss and TERT mutation as new criteria for Grade 3 meningiomas, but excluded H3K27me3 loss. Malignant behavior may be influenced by DNA methyltransferases (DNMT3A). SUFU mutations may carry a predisposition for multiple meningiomas.

METHODS

In this retrospective study, 228 patients with Grade 2, Grade 3 or recurrent Grade 1 meningiomas with resections from 1990 to July 2021 at Columbia University Medical Center were assessed for recurrence, histologic features, and molecular alterations.

RESULTS

Of 228 patients with meningiomas, 9 were recurrent Grade 1, 9 were Grade 1 transformed to Grade 2, 109 were non-recurrent Grade 2, 77 were recurrent Grade 2, 13 were transformed Grade 2 to Grade 3, and 5 were non-recurrent Grade 3 and 6 were recurrent Grade 3. Median follow-up was 42.0 months. Of the recurrent/transformed tumors, 89 were radiation-resistant. Average mitotic counts for non-recurrent Grade 2 vs. recurrent/transformed Grade 2 and non-recurrent Grade 3 vs. recurrent Grade 3 meningiomas were 4 vs. 5, 24 vs. 27 mitoses/10HPF, respectively. Of 36 meningiomas evaluated with NGS, the most common alterations was NF2 (20/36). CDKN2A/B was lost in 5 meningiomas, three with Grade 2 that transformed to Grade 3 and two with recurrent disease. TERT was mutant in 3/36, 2 of which were Grade 2 that transformed to Grade 3 meningiomas. H3K27M me3 was tested by IHC in 4 patients, 3 with retained staining, all of whom did not recur and 1 with loss of staining in a Grade 1 transformed to Grade 2. DNMT3A was found in 2 tumors, both radiation-induced. SUFU occurred in 3/16, one of each grade, all solitary.

CONCLUSION

In our limited cohort, we observed concordance with the new WHO 2021 criteria for Grade 3 meningiomas

BIOM-12. PROLONGED RESPONSE TO THIRD-LINE TREATMENT WITH COMBINATION CCNU/TMZ IN AN MGMT METHYLATED IDH-WILDTYPE GLIOBLASTOMA

INTRODUCTION

Multiply recurrent glioblastoma suffers from poor response rates to treatment, and limited durability. We describe a case of an impressive response to third-line CCNU/TMZ.

BACKGROUND

Headaches brought a 76-year-old man to medical attention. MRI identified an enhancing right temporal mass -- path following resection demonstrated glioblastoma (IDH-wildtype, MGMT-methylated, TERT mutant; PTEN Y68H, CDKN2A/B loss, CCND3 amplification; VUS in POLE, ATM, GRIN2A, and ROS1). He received hypofractionated RT 40.05Gy/15-fractions plus 21-days concurrent TMZ 75 mg/m2, then 5-day-on / 23-day-off TMZ (150 mg/m2 cycles #1-3; 200 mg/m2 subsequent). MRI pre-cycle #6, nearly 6 months post-RT, showed increased enhancement/FLAIR consistent with local progression (POD).Second-Line: After screen-fail for clinical trial, initiated off-label regorafenib 160 mg/d, 21-days-on/7-days-off -- with partial response in enhancement at 3 weeks. With dose-reduction to 120 mg/d cycles #2-3 (for mounting fatigue), enhancement progressively worsened. Despite resuming higher 160 mg/d for cycle #4, enhancement progressed, consistent with POD.Third-Line: Given presence of MGMT promoter methylation (and extrapolating from CeTeG/NOA-09), combination CCNU 100 mg/m2 (day 1) and TMZ 100 mg/m2 (days 2-6; 8-week cycle) was started. There was improvement in enhancement/FLAIR, which continued to improve gradually through 6 cycles of CCNU/TMZ. Durability of response was surprising -- MRIs stable/improved at 15 months since starting CCNU/TMZ.

DISCUSSION

This case illustrates impressive response to CCNU/TMZ in the third-line. Delayed RT treatment effect is less likely given time elapsed from RT at initial progression (after 5 cycles of adjuvant TMZ), convincing but short-lived improvement to regorafenib (that progressively worsened through 3 more regorafenib cycles), and robust response only with CCNU/TMZ. He was also never on steroids (except post-operatively) nor bevacizumab. This suggests that improvement was mediated by antitumor effect against progressing tumor, rather than delayed RT treatment effect. MGMT methylation may have played a role in this patient's response to dual alkylator therapy.

[Establishment and evaluation of a model for predicting ISUP pathological grade≥2 before radical prostatectomy]

Objective: Based on the 2014 version of the International Association of Urological Pathology (ISUP) pathological classification standards, a prediction model that can predict the pathological classification of ISUP ≥2 in patients with prostate cancer (PCa) before radical prostatectomy (RP) was established and evaluated. Methods: The clinical data of 171 patients who had undergone RP from January 2017 to September 2020 in the Second Affiliated Hospital of Soochow University and obtained postoperative pathological results of all specimens were retrospectively collected. The patients were 46-83 (70±7) years old. For patients with RP ISUP pathologic stage as the gold standard, according to the pathological grading is level 2 or higher is divided into two groups(42 patients with ISUP grade=1 and 129 patients with ISUP grade ≥2). the predictors of ISUP pathology grade ≥2 after RP were screened by logistics regression analysis, predictive models were established and ROC curves were used to evaluate the efficacy of each model in diagnosing RP with pathological grade ≥2, and comparisons were conducted by DeLong test. Results: Compared with patients with ISUP grade=1, patients with ISUP grade≥2 had higher prostate specific antigen (PSA) and prostate specific antigen density (PSAD) (14.21(8.57, 24.98)ng/ml vs 7.98(5.41, 12.54)ng/ml, 0.33(0.20, 0.74)μg.L^-1.ml^-1 vs 0.16(0.12, 0.24)μg.L^-1.ml^-1), lower prostate volume (PV) (48.62(34.17,73.99)ml vs 38.94(28.15,54.84)ml)(all P<0.05). Multi-parameter magnetic resonance imaging (mp-MRI) prostate imaging and reporting system (PI-RADS) score, the positive ratio of puncture needles and the pathological grade of puncture ISUP were also significantly different between the two groups (all P<0.05). The combined mp-MRI PI-RADS score (OR=3.337, 95%CI: 1.990-5.593, P<0.001) and puncture ISUP pathological grading (OR=4.041, 95%CI: 1.960-8.334, P<0.001) had the highest diagnostic efficacy for pathological grading ≥2 after RP (AUC=0.916, P<0.05). Conclusion: The combined mp-MRI PI-RADS score and puncture ISUP pathological grading had the highest diagnostic efficacy for pathological grading ≥2 after RP.

NCOG-27. STATUS AS A CLINICAL TRIAL PARTICIPANT AND OUTCOME IN IDH-WILDTYPE GLIOBLASTOMA

INTRODUCTION

Standard of care for glioblastoma consists of surgery, followed by combined chemoradiation and adjuvant chemotherapy, as per the seminal EORTC study from 2005. Clinical trial patients, being a population selected for functional status, hepatic function, renal function, and lack of other malignancies, may have improved outcome over the general treated population.

METHOD

Single center retrospective analysis of status as a clinical trial patient in the upfront setting and other clinical factors/biomarkers, analyzed for correlation with outcomes (PFS/OS) in IDH-wildtype glioblastomas.

RESULTS

82 patients with IDH-wildtype glioblastoma were identified between 2014 and 2020, treated with standard of care or with an upfront clinical study (43% women; median age 66 years, range 35-91 years of age). 22 patients (27%) were treated with upfront clinical study. Status as a patient treated in an upfront clinical study did not correlate with outcome (hazard ratio HR PFS 0.99, CI 0.57-1.7, p=0.97; HR OS 1.09, CI 0.56-2.1, p=0.81). Frontal lobe was most frequently involved (n=36, 44%), followed by parietal lobe (n=33, 40%). Age was not a strong predictor of survival (R2 0.01). No statistically significant correlation was observed between outcome and laterality or location. MGMT promoter methylation was associated with improved PFS (HR 0.56, CI 0.33-0.94, p=0.03) and OS (HR 0.40, CI 0.19-0.85, p=0.02), with mPFS 6 months vs 9 months and mOS 16 months vs 20 months (unmethylated vs methylated respectively).

CONCLUSION

In this retrospective cohort of IDH-wildtype glioblastomas, age, tumor laterality, and tumor location were not significant predictors of outcome. MGMT promoter methylation predicted for superior PFS/OS. Patient selection for clinical studies are influenced by entry criteria, however at least in this retrospective review, status as a clinical study patient in the upfront setting did not correlate with outcome compared to patients treated with upfront standard of care.

[Clinical characteristics of 21 infertile women with non-classic 21-hydroxylase deficiency]

Objective: To investigate the clinical features of infertile women with non-classic 21-hydroxylase deficiency (21-OHD). Methods: The study enrolled 21 infertile women with non-classic 21-OHD in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2009 to December 2018. The clinical presentation, endocrine hormone, glucolipid metabolism and treatment outcome were retrospectively analyzed. The diagnosis of non-classic 21-OHD was comprehensively based on clinical and hormonal characteristics. Results: Among 21 cases, the age was (29.9±2.9) years, the mean age at menarche was (13.6±2.0) years, body mass index was (22.1±2.9) kg/m², and 38% (8/21) had oligomenorrhea. Hirsutism was diagnosed in 3 cases (14%, 3/21). Clitoromegaly was seen in 14% (3/21) and polycystic ovarian morphology was found in 33% (7/21) of the patients. The mean serum level of basal progesterone was (11.3±21.0) nmol/L, with 48% (10/21) having high basal progesterone level; after therapy by glucocorticoid, the level of progesterone was (1.9±2.0) nmol/L. Serum 17-hydroxyprogesterone concentration was (66.4±123.6) nmol/L; after therapy by glucocorticoid, it was (2.4±1.8) nmol/L. In the study increased testosterone, androstenedione and dehydroepiandrosterone sulfate were present in 62% (13/21), 52% (11/21) and 43% (9/21), respectively; and 52% (11/21) of patients manifested androgen excess and basal progesterone elevation; androgen levels decreased after therapy by glucocorticoid. The pregnancy rate was 76% (16/21). Out of 19 pregnancies, 6/19 ended in spontaneous miscarriages. Conclusions: Infertile women with non-classic 21-OHD are characterized by hyperandrogenism and basal progesterone elevation, whereas gonad axis disorder is not apparent. After no response to conventional therapy, adult infertile women with non-classic 21-OHD could achieve a desirable pregnancy outcome with proper treatment of glucocorticoid.

NIMG-67. DISAPPEARING DOTS – TRANSIENT LATE ENHANCING LESIONS YEARS AFTER BRAIN RADIOTHERAPY

BACKGROUND

Late-delayed radiation effects appear 6 months to years following radiotherapy. We characterize a species of small enhancing lesions in the late-delayed phase of post-radiotherapy that are distinct from the classic descriptions of radiation necrosis or pseudoprogression associated with mass effect and edema. These “disappearing dots” are small, do not exert mass effect nor edema, and spontaneously resolve.

METHOD

We retrospectively describe a series of cases with “disappearing dots” following brain radiotherapy.

RESULTS

There were 10 cases (4 men), median age 42 years (range 29-63). Diagnoses were glioblastoma (3); low grade astrocytoma, anaplastic astrocytoma, and anaplastic oligodendroglioma (2 each); and solitary fibrous tumor (1). All patients received 54-60 Gy (Gray) of external beam radiotherapy, except one (proton beam therapy to 60 cobalt Gray equivalent). Disappearing dots appeared at a median of 27 months (range 5-197) post-radiotherapy. Lesions were relatively small (~&lt; 1 cm3), peri-ventricular, and within the radiotherapy field. Most enlarged before resolving. Advanced MR imaging and fluorodeoxyglucose (FGD)-PET results were inconsistent. Lesions persisted a median of 8.5 months (range 1-49) before spontaneous resolution. All were asymptomatic. Biopsy in one case revealed treatment effects rather than recurrent tumor.

CONCLUSIONS

Asymptomatic small periventricular enhancing lesions can develop and remit spontaneously, years following brain radiotherapy. Such disappearing dots should be part of the differential diagnosis along with tumor recurrence. of new enhancing lesions in the late-delayed phase post-radiotherapy.

NCOG-58. IMPACT OF TIME FROM PRESENTATION TO TREATMENT INITIATION ON CLINICAL OUTCOMES IN CENTRAL NERVOUS SYSTEM LYMPHOMA

OBJECTIVE

To examine impact of time from presentation to treatment initiation (TPT) on clinical outcomes in a cohort of patients with central nervous system lymphoma (CNSL).

INTRODUCTION

Earlier work in our population found that multifocal disease, cerebrospinal fluid (CSF) sampling, and use of immunomodulatory therapies were associated with longer TPT in CNSL, but impact on clinical outcomes was not assessed.

METHODS

We retrospectively reviewed records of patients who were diagnosed with CNSL from 2010-2018 and treated at Columbia University Irving Medical Center (CUIMC). Regression models were applied to examine the impact of age, gender, response to methotrexate (MTX), use of radiation, and TPT &gt;/= 30 days on survival 1 year from diagnosis (one-year survival), overall survival (OS), and functional independence (FI, defined as Karnofsky Performance Status (KPS) &gt; 70).

RESULTS

There were sixty-nine patients (51% men; median age at diagnosis 70 years, range 21-90). Median TPT was 24 days (range 7-372). TPT was &lt; 30 days in 59 (85%) and &gt;/= 30 days in 10 (15%). One-year survival was 77%, and FI rate was 78%. Negative prognostic factors for OS were age &gt; 65 years (HR 5.34, CI 1.20-24.30, p=0.03) and absence of complete response to MTX (HR 2.40, CI 0.87-6.69, p=0.09). Only complete response to MTX predicted both FI (OR 4.71, CI 1.17-19.02, p=0.03) and one-year survival (OR 6.77, CI 1.98-23.13, p=0.002). Notably, OS was numerically improved among patients with TPT &gt;/= 30 days vs. &lt; 30 days (HR 0.31, p=0.27), though this did not meet statistical significance.

CONCLUSIONS

Longer TPT has been associated with worse outcomes in systemic lymphoma, but such a correlation has not always been observed in brain cancers such as glioblastoma. We found no negative impact of longer TPT on survival or FI.

NIMG-15. EVALUATING FLUCTUATING ENHANCEMENT IN OLIGODENDROGLIOMAS ON MAGNETIC RESONANCE IMAGING

OBJECTIVE

To identify and characterize patterns of fluctuating contrast enhancement on magnetic resonance imaging (MRI) in patients with oligodendrogliomas.

INTRODUCTION

Gliomas, particularly oligodendrogliomas, can exhibit fluctuating enhancement (FE) on MRI that can make it difficult to differentiate between treatment effect and active tumor.

METHODS

We are conducting a single-center retrospective review of clinical and radiographic data for patients with oligodendrogliomas treated at Weill Cornell Medicine (WCM) from 2/2000-5/2018. We have identified patients with FE on MRI and tracked lesions &gt; 5mm in at least one dimension to the resolution of the lesion or last available MRI. We have recorded time from initial diagnosis to development of FE, time from radiation to development of FE, and time from development to resolution of FE as well as molecular characteristics of each tumor.

RESULTS

A total of 122 patients with oligodendrogliomas were identified. Thus far, fluctuating enhancement has been identified in 11 patients (5 men, 6 women) with 38 total fluctuating lesions. Isocitrate dehydrogenase-1 (IDH-1) mutation was present in 5 tumors, and 1p/19q co-deletion was present in 6. Mean time from initial diagnosis to development of FE was 44.6 months. In patients who developed FE after radiation, mean time from radiation to development of FE was 35.0 months. Twenty-seven lesions resolved, and mean time from onset to resolution of FE was 5.6 months, while mean time from start of radiation to resolution of FE was 41.0 months. Additionally, we will perform perfusion analysis on lesions &gt; 5mm and identify patients who underwent surgical biopsy of FE with pathologic diagnosis.

CONCLUSIONS

FE has been identified in 11 patients thus far. We are expanding our analysis to identify a larger cohort of patients with FE. Characterizing patterns of FE may aid clinicians in differentiating FE due to treatment effect from active tumor.

Temporal attention is not affected by working memory load

Temporal attention refers to the ability to orient attention in time, which serves to enhance performance such as target detection and discrimination and is a fundamental component of cognitive function. Although some research indicates that temporal attention ability is affected by working memory updating, it is unclear whether temporal attention is also affected by the availability of working memory stores. To address this, participants were presented a dual-task paradigm requiring zero, three, or six digits to be held in working memory while engaged in a temporally cued visual discrimination task. Results show that working memory load did not differentially affect the ability to benefit from predictive temporal cues during the visual discrimination task. This indicates that temporal attention is not affected by available working memory stores. Interestingly, posterior beta band (12-30 Hz) activity was differentially modulated by temporal attention and working memory load, such that it decreased prior to expected targets and increased with load. Analysis across participants indicated that those individuals who exhibited greater temporal attention-based modulation of beta activity (i.e., predictive < neutrally cued) displayed improved discrimination performance, but also yielded lowered working memory accuracy. Thus, the ability to benefit from temporal attention processes while multitasking comes at the cost of lowered secondary task performance. Together, these results indicate that available working memory stores do not affect temporal attention ability. Rather, limitations in divided attention ability result in a performance cost that prioritizes one task over another, which may be indexed by beta band activity.

MNGI-10. ATYPICAL MENINGIOMA: EARLY OUTCOMES WITH OR WITHOUT POSTOPERATIVE RADIATION

BACKGROUND

Adjuvant radiotherapy (RT) in atypical meningioma, especially for gross-totally resected tumors, remains controversial.

METHODS

We retrospectively identified histologically-confirmed cases of WHO Grade II atypical meningioma at a large academic institution from 2004–2018. Clinicodemographic, surgical, radiation therapy (RT), and histopathologic data were collected, as well as imaging and clinical outcomes, with a median follow-up time of 26 months (IQR 32). Patients were stratified by resection status and whether or not upfront RT was administered. Additionally, subanalyses were performed to compare external beam RT (EBRT) and stereotactic radiosurgery (SRS). Progression was defined by radiology report.

RESULTS

Of 122 patients, 45 were excluded for lacking adequate records of previous treatment, less than 3 months follow-up, or lacking MR imaging. Of 77 patients analyzed, 57% (44/77) were female; median 59-years-old. 48% (24/50) of gross-total-resections (GTR) received upfront RT – only a single case progressed, at 39 months. Of 26 GTR patients without upfront RT, 8/26 (31%) progressed at median 19.5 months – of these, 2 were lost to follow-up, 5 received salvage RT, and 1 had surgery alone. Adjuvant RT was associated with superior progression free survival (PFS) in GTR (Cox proportional hazard ratio 0.15, likelihood-ratio p=0.025; median PFS not reached). Of 15 subtotal resections (STR) receiving upfront RT, 11 received EBRT and 4 received SRS – 6 progressed (median 37 months), all after EBRT. Upfront SRS demonstrated superior PFS over EBRT following STR (p=0.036). Across the cohort there was one confirmed death, a GTR patient (without RT) who suffered an ischemic stroke at 11 months.

CONCLUSION

This large single-center retrospective analysis indicates adjuvant RT improves PFS in GTR atypical meningiomas, in concordance with prior studies. It is limited by short median follow-up, possibly related to long-term stability in treated patients. In STR tumors, SRS may contribute to improved PFS compared to EBRT.

HOUT-26. FACTORS ASSOCIATED WITH TREATMENT DELAY IN CENTRAL NERVOUS SYSTEM LYMPHOMA

OBJECTIVE

To identify clinico-radiographic characteristics associated with delayed treatment initiation in central nervous system lymphoma (CNSL).

INTRODUCTION

Clinical and radiographic characteristics of CNSL are often varied with a broad differential diagnosis, potentially leading to delays in diagnosis and treatment.

METHODS

A single-center retrospective review of clinico-radiographic data was performed at Columbia University Irving Medical Center in patients with pathologically confirmed CNSL diagnosed from 1/2010–12/2018. Descriptive statistics and univariate logistic regression were used to identify variables associated with delayed treatment. Using visual binning, delayed treatment time was designated as >33 days from first presentation to medical attention to first chemotherapy for CNSL. Variables of interest included demographic data, presenting symptomatology, radiographic characteristics, location of initial presentation, and diagnostic and therapeutic interventions performed before biopsy.

RESULTS

Seventy patients (36 men (51%); median age at diagnosis 70 years, IQR 14.75 years; median time from first presentation to treatment 21 days, IQR 41.25 days) were included. Presentation with cognitive deficits suggested a strong, but not statistically significant, association with delayed treatment (OR=1.93, p=0.20), whereas presentation with focal neurologic deficits suggested protection against delayed treatment (OR=0.25, p=0.05). Initial presentation to a hospital suggested a strong, but not statistically significant, trend against delayed treatment (OR=0.41, p=0.08). Multifocal disease on neuroimaging (OR=7.18, p=0.001), pre-biopsy cerebrospinal fluid (CSF) sampling (OR=5.18, p=0.002), and pre-biopsy immunomodulatory treatment (including high-dose intravenous corticosteroids) for suspected neuroinflammatory disease (OR=6.33, p=0.03) had statistically significant associations with delayed treatment. Antimicrobial treatment before biopsy for suspected CNS infection suggested a trend toward delayed treatment, but the association was not statistically significant (OR=5.1, p=0.06).

CONCLUSIONS

Multifocal disease and pre-biopsy CSF sampling and immunomodulatory therapy were associated with delayed treatment initiation for CNSL in our single-center cohort. Recognizing factors associated with delayed treatment may allow physicians to circumvent these factors and permit more rapid diagnosis through tissue sampling.

NIMG-62. ATYPICAL IMAGING CHARACTERISTICS OF PRIMARY CNS LYMPHOMA AT INITIAL PRESENTATION LEADS TO FREQUENT MISDIAGNOSIS AND DELAYS IN DIAGNOSIS

BACKGROUND

Primary CNS lymphoma (PCNSL) has protean appearances on magnetic resonance imaging (MRI) that may lead to delays in diagnosis.

METHODS

We retrospectively reviewed histologically-confirmed PCNSL at Columbia University Irving Medical Center (CUIMC, 2010–2019), and characterize imaging features on pre-treatment MRI scans.

RESULTS

64 patients were analyzed. 61 of 64 (95%) presented with enhancement. 35 of 64 (55%) were multiply enhancing, and 26 of 64 (41%) were singly enhancing (of which 2 were dural-based). 3 of 64 (5%) were non-enhancing. 42 of 59 (71%) had diffusion restriction. 36 of 49 (73%) lacked susceptibility. 40 of 64 (63%) were periventricular. 28 of 64 (43%) had callosal involvement. In 14 of 54 (26%), lymphoma was either not included in the differential or specifically noted less likely in radiographic report – this radiographically misdiagnosed group was significantly more likely to be either non-enhancing or non-periventricular (p=0.026). Furthermore, radiographic misdiagnosis was associated with an increased risk of a more than 14-day delay from the initial MRI to the initial invasive study, either lumbar puncture or brain biopsy (p=0.04). Presentation with a single enhancing lesion, on the other hand, was associated with significantly faster time to diagnosis – median 4.6 days (IQR 3) vs 21.6 days (IQR 4.5) from initial MRI (p=0.04).

CONCLUSION

In PCNSL, imaging characteristics influence outcomes. While a classic single enhancing lesion is associated with rapid diagnosis, non-enhancing and non-periventricular disease are the most likely to be misdiagnosed and require a heightened index of suspicion to avoid delays to diagnosis.

Characterization of Spinal Needle Buckling Behavior

The use of large gauge (G) spinal anesthesia needles can increase complications due to buckling. The purpose of this study was to quantify the behavior of spinal needles in buckling using a repeatable laboratory model. A spinal anesthesia procedure and buckling complication was reproduced in vitro using a custom test fixture designed to match the boundary conditions of needle insertion as performed by an anesthesiologist and a uniaxial servohydraulic material testing machine (MTS, Eden Prairie, MN). Buckling tests were performed with 22 G Whitacre (Medline Industries, Inc., Northfield IL), SPROTTE® (Pajunk, Norcross, GA), and Gertie Marx (International Medical Development, Huntsville, UT) needles (n = 30) in a ballistics gelatin tissue surrogate (Clear Ballistics, Fort Smith, AR). In analyzing axial force results, critical buckling load results were 27.65 ± 0.92 N, signifying that needle fragility is not why buckling is challenging to detect. Force feedback during needle insertion increased linearly due to frictional forces from the tissue surrogate on the needle. The differential between the resultant insertion force and the critical buckling force is more important to the detection of needle buckling than the critical buckling force alone. A very small difference in these two forces could feel like expected resistance increase as the needle is further inserted into the multiple tissue layers. Comparison of the differential between the resultant insertion force and the critical buckling force should be considered when choosing a needle to best detect and prevent a buckling complication.

[The clinical significance of microcirculation and oxygen metabolism evaluation in acute kidney injury assessment in patients with septic shock after resuscitation]

Objective: To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME) in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Methods: Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO(2))and venoarterial pressure of carbon dioxide difference (Pv-aCO(2)) /arteriovenous O(2) content difference (Ca-vO(2)) by blood gas analysis, i.e. group A [ΔPtcO(2)>66 mmHg(1 mmHg=0.133 kPa) and Pv-aCO(2)/Ca-vO(2)≤1.23], group B (ΔPtcO(2)≤66 mmHg), group C (ΔPtcO(2)>66 mmHg and Pv-aCO(2)/Ca-vO(2)>1.23). Heart rate,mean arterial pressure,central venous pressure,noradrenaline dose,lactate,Pv-aCO(2),Ca-vO(2), lactate clearance, central venous oxygen saturation(ScvO(2)) and liquid equilibrium were assessed after resuscitation.AKI staging based on Kidney Disease Global Improving Outcomes (KDIGO) clinical practice guideline was analyzed. The predictive value of lactate, ScvO(2), Pv-aCO(2)/Ca-vO(2) to progression of AKI after resuscitation was determined using receiver operating characteristic(ROC)curve analysis. Results: A total of 49 septic shock patients were enrolled including 30 males and 19 females with mean age of (61.10±17.10)years old.There were 19 patients in group A,21 patients in group B, and 9 patients in group C. Acute physiology and chronic health evaluation Ⅱ score was 20.92±7.19 and sequential organ failure assessment score 12.02±3.28. There were 4 patients with AKI and 1 progressed in group A, 11 patients with AKI and 2 progressed in group B, 6 patients with AKI and 4 progressed in group C. The cutoff value of Pv-aCO(2)/Ca-vO(2) was equal or more than 2.20 for predicting progression of AKI, resulting in a sensitivity of 85.7% and a specificity of 73.8%. Conclusion: MicrOME is a significant parameter to predict the progression of AKI in patients with septic shock after resuscitation. Pv-aCO(2)/Ca-vO(2) is also a good predictive factor.

Role of Autophagy in Ovarian Cryopreservation by Vitrification

BACKGROUND

Ovarian cryopreservation by vitrification and transplantation are useful methods to recover female fertility after radiotherapy and chemotherapy. As type II programmed cell death, autophagy plays important roles in ovarian follicle development, ovarian follicle atresia and anti-stress injury.

OBJECTIVE

The potential role of autophagy in ovarian vitrification was investigated.

MATERIALS AND METHODS

Mouse ovaries were cryopreserved by vitrification, and autophagy was treated, after which the ovarian histology was checked, and ovarian follicles were counted. The apoptotic rate was detected by TUNEL, and apoptotic molecular marker cleaved caspase-3 was checked by immunofluorescence and western blot analysis.

RESULTS

Our results suggested that autophagy was increased in the process of vitrification compared with the fresh ovaries (p<0.05). The number of primordial follicles was decreased through inhibiting or over-activating the autophagy by autophagy inhibitor or activator (p<0.05). However, the number of primary follicles, antral follicles and atretic follicles was not significantly different compared with vitrified/warmed groups. The apoptotic rate was significantly increased in the vitrified/warmed, autophagy-inhibiting and over-activating groups compared with the fresh group (p<0.05), and this result was further confirmed by western blot analysis.

CONCLUSIONS

Taken together, autophagy was activated in the ovarian cryopreservation by vitrification and plays a role in a natural adaptive response to cold stress in ovarian cryopreservation by vitrification.

The significance of Akt/NF-κb signaling pathway in the posterior cataract animal model

OBJECTIVE

To establish SD rat posterior capsular opacification (posterior capsular opacification- PCO) animal model, and to detect the expression of Akt/NF-kb signaling pathway in the PCO model.

METHODS

30 healthy SD rats were randomly divided into control group (0d) and the experimental groups (7d and 14 d), there were 10 rats at all time points. All rats (right eye) were treated with the lens capsule, and the inflammatory reaction of the anterior segment of the eye and the occurrence of PCO at different time points were observed under the microscope. The TGF-β concentration of humor aquosus was measured at the different time points by ELISA method. Eyeballs were removed after the rats were killed. RT-PCR method was used to detect the gene expression levels of Akt and NF-κb and Westen Blot method to detect the protein expression of Akt, p-Akt, NF-κb and p-NF-κb.

RESULTS

TGF-β concentration, Akt and NF-κb gene expression, and Akt, p-Akt, NF-κb and p-NF-κb protein expression in humor aquosus, increased with the time and the time-dependence was significant.

CONCLUSION

Akt/NF-κb signaling pathway may be closely related to the occurrence and development of PCO, which may be related to the role of protein phosphorylation (Fig. 5, Ref. 20).

Gray matter correlates of migraine and gender effect: A meta-analysis of voxel-based morphometry studies

BACKGROUND

An increasing number of neuroimaging studies have revealed gray matter (GM) anomalies of several brain regions by voxel-based morphometry (VBM) studies in migraineurs. However, not all the studies reported entirely consistent findings. Our aim is to investigate concurrence across VBM studies to help clarify the structural anomalies underpinning this condition.

METHODS

A systematic search of VBM studies of patients with migraine and healthy controls (HC) published in PubMed and Embase databases from January 2000 to March 2014 was conducted. A quantitative meta-analysis of whole-brain VBM studies in patients with migraine compared with HC was performed by means of anisotropic effect size version of signed differential mapping (AES-SDM) software package.

RESULTS

Nine studies comprising 222 patients with migraine and 230 HC subjects were included in the present study. Compared to HC subjects, the patients group showed consistent decreased GM in the posterior insular-opercular regions, the prefrontal cortex, and the anterior cingulate cortex. Results remained largely unchanged in the following jackknife sensitivity analyses. Meta-regression analysis showed that a higher percentage of females in the patient sample was associated with decreased GM in the right dorsolateral prefrontal cortex.

CONCLUSIONS

This is the first quantitative whole-brain VBM meta-analysis in migraine showing strong evidence of brain GM anomalies within the pain-processing neural network. Further longitudinal investigations are needed to determine whether these structural anomalies are reversible with effective treatment on migraine.

A comparative study of intensity-modulated radiotherapy and standard radiation field with concurrent chemotherapy for local advanced cervical cancer

OBJECTIVE

This study aimed to compare three-dimensional conformal radiotherapy (3D CRT) and intensity-modulated radiotherapy (IMRT) combined with concurrent chemotherapy for cervical cancer.

MATERIALS AND METHODS

A total of 72 patients with Grades IIa-IIIb cervical cancer were randomly divided into two groups, namely, the IMRT group for IMRT plan (primary lesion, 45 Gy/22; the pelvic wall lymphatic drainage area, 50 Gy/22), and the 3D CRT group (conformal pelvic radiotherapy, 45 Gy/22; subsequent supplement of pelvic wall, 6.0 Gy/3). Both groups received concurrent chemotherapy of nedaplatin 30 mg/m2 weekly for six cycles, with an after-loading therapy of 6 Gy/6 each time.

RESULTS

In the IMRT group, the grade III diarrhea rate was 5.6% and the rate in the 3D CRT group was 30.6%; both groups significantly differed. No significant difference was observed between the overall survival and disease-free survival in first, second, and third years in both groups.

CONCLUSION

Cervical cancer IMRT can significantly reduce the incidence of acute enteritis. For standard 3D CRT, no significant difference was observed in overall survival and disease-free survival.

Attention network functioning in children with anxiety disorders, attention-deficit/hyperactivity disorder and non-clinical anxiety

BACKGROUND

Research with adults suggests that anxiety is associated with poor control of executive attention. However, in children, it is unclear (a) whether anxiety disorders and non-clinical anxiety are associated with deficits in executive attention, (b) whether such deficits are specific to anxiety versus other psychiatric disorders, and (c) whether there is heterogeneity among anxiety disorders (in particular, specific phobia versus other anxiety disorders).

METHOD

We examined executive attention in 860 children classified into three groups: anxiety disorders (n = 67), attention-deficit/hyperactivity disorder (ADHD; n = 67) and no psychiatric disorder (n = 726). Anxiety disorders were subdivided into: anxiety disorders excluding specific phobia (n = 43) and specific phobia (n = 21). The Attention Network Task was used to assess executive attention, alerting and orienting.

RESULTS

Findings indicated heterogeneity among anxiety disorders, as children with anxiety disorders (excluding specific phobia) showed impaired executive attention, compared with disorder-free children, whereas children with specific phobia showed no executive attention deficit. Among disorder-free children, executive attention was less efficient in those with high, relative to low, levels of anxiety. There were no anxiety-related deficits in orienting or alerting. Children with ADHD not only had poorer executive attention than disorder-free children, but also higher orienting scores, less accurate responses and more variable response times.

CONCLUSIONS

Impaired executive attention in children (reflected by difficulty inhibiting processing of task-irrelevant information) was not fully explained by general psychopathology, but instead showed specific associations with anxiety disorders (other than specific phobia) and ADHD, as well as with high levels of anxiety symptoms in disorder-free children.

Threat bias in attention orienting: evidence of specificity in a large community-based study

BACKGROUND

Preliminary research implicates threat-related attention biases in paediatric anxiety disorders. However, major questions exist concerning diagnostic specificity, effects of symptom-severity levels, and threat-stimulus exposure durations in attention paradigms. This study examines these issues in a large, community school-based sample. Method A total of 2046 children (ages 6-12 years) were assessed using the Development and Well Being Assessment (DAWBA), Childhood Behavior Checklist (CBCL) and dot-probe tasks. Children were classified based on presence or absence of 'fear-related' disorders, 'distress-related' disorders, and behavioural disorders. Two dot-probe tasks, which differed in stimulus exposure, assessed attention biases for happy-face and threat-face cues. The main analysis included 1774 children.

RESULTS

For attention bias scores, a three-way interaction emerged among face-cue emotional valence, diagnostic group, and internalizing symptom severity (F = 2.87, p < 0.05). This interaction reflected different associations between internalizing symptom severity and threat-related attention bias across diagnostic groups. In children with no diagnosis (n = 1411, mean difference = 11.03, s.e. = 3.47, df = 1, p < 0.001) and those with distress-related disorders (n = 66, mean difference = 10.63, s.e. = 5.24, df = 1, p < 0.05), high internalizing symptoms predicted vigilance towards threat. However, in children with fear-related disorders (n = 86, mean difference = -11.90, s.e. = 5.94, df = 1, p < 0.05), high internalizing symptoms predicted an opposite tendency, manifesting as greater bias away from threat. These associations did not emerge in the behaviour-disorder group (n = 211).

CONCLUSIONS

The association between internalizing symptoms and biased orienting varies with the nature of developmental psychopathology. Both the form and severity of psychopathology moderates threat-related attention biases in children.

A retrospective study of different treatments of limited-stage small-cell esophageal carcinoma and associated prognostic factor analysis

Primary, small-cell esophageal carcinoma (SCEC) is a rare but highly malignant tumor. Due to lack of randomized, controlled, prospective studies, there are currently no unified treatment modalities for SCEC. This study retrospectively analyzed the outcomes of different treatments and prognostic factors that influence overall survival in patients with limited-stage SCEC. The study included 106 patients pathologically diagnosed with limited-stage SCEC at Huai'an First People's Hospital, Nanjing Medical University (Huai'an, China), between 1998 and 2007. There were 66 males and 40 females, with a median age of 58 years (range: 45-77 years). Fourteen patients received surgery alone, 42 received surgery and postoperative chemotherapy, 11 received radiotherapy alone, and 39 received concurrent chemoradiotherapy. Combined modality treatment with and without chemotherapy yielded 5-year survival rates (5YSRs) of 27.2% and 0%, respectively. Associated median survival times were 22 months and 11 months, respectively, with a hazard ratio (HR) of 2.30 (95% confidence interval [CI]: 1.42-3.73, P = 0.001). Among patients treated with surgery plus postoperative chemotherapy or with concurrent chemoradiotherapy, the 5YSRs were 31.0% and 23.1%, respectively. Median survival times were 26 months and 18 months, with an HR of 1.25 (95% CI: 0.75-2.09, P = 0.725). Multivariate survival analysis using Cox regression model showed that chemotherapy was a positive independent prognostic factor for SCEC (HR 2.92, 95% CI: 1.25-6.80). Chemotherapy-based combined modality treatment appears to increase the long-term survival of patients with limited-stage SCEC. Similar overall survival rates results are achieved with surgery combined with chemotherapy as with concurrent chemoradiotherapy, with chemotherapy being an independent prognostic factor. Randomized, controlled, prospective studies are needed to identify optimal chemotherapy regimens for treating SCEC.

Resolution of pain after childbirth

BACKGROUND

Chronic pain after surgery occurs in 10-40% of individuals, including 5-20% of women after cesarean delivery in previous reports. Pain and depression 2 months after childbirth are independently associated with more severe acute post-delivery pain. Here we examine other predictors of pain at 2 months and determine the incidence of pain at 6 and 12 months after childbirth.

METHODS

Following Institutional Review Board approval, 1228 women were interviewed within 36 h of delivery. Of these, 937 (76%) were successfully contacted by telephone at 2 months, and, if they had pain, at 6 and 12 months after delivery. The primary outcome measure was presence of pain which began at the time of delivery. We also generated a model of severity of acute post-delivery pain and 2 month pain and depression.

RESULTS

Pain which began at the time of delivery was remarkably rare 6 and 12 months later (1.8% and 0.3% [upper 95% confidence limit, 1.2%], respectively). Past history of pain and degree of tissue damage at delivery accounted for 7.0% and 16.7%, respectively, of one aspect in the variability in acute post-delivery pain. Neither of these factors was associated with incidence of pain 2 months later.

CONCLUSIONS

Using a definition of new onset pain from delivery, we show a remarkably low incidence of pain 1 yr after childbirth, including those with surgical delivery. Additionally, degree of tissue trauma and history of chronic pain, risk factors for pain 2 months after other surgery, were unimportant to pain 2 months after cesarean or vaginal delivery.

Inorganic phosphorus fractionation and its translocation dynamics in a low-P soil

The translocation of different inorganic phosphorus (Pi) forms in a low-P soil (Langfang experimental station, Hebei province, China) over time was investigated using P fractionation extraction and a (32)P tracer technique. The L-value and P availability of the soil was assessed using 5 different maize genotype (Zea mays L.) cultivars. The results showed that the different Pi fractions in the soil increased in the order of H(2)SO(4)-extractable P (Ca(10)-P) > Na(3)C(6)H(5)O(7)-Na(2)S(2)O(4)-extractable P (O-P) > NH(4)Ac-extractable P (Ca(8)-P) > NaHCO(3)-extractable P (Ca(2)-P), NH(4)F-extractable P (Al-P), NaOH-Na(2)CO(3)-extractable P (Fe-P), and the content of plant-unavailable P (Ca(10)-P + O-P) was high, up to 79.1%, which might be an important reason for P deficiency in this low-P soil. The (32)P tracer results showed that after the addition of (32)P-Pi to the soil with no P fertilizer applied for 25 d, 29.0% of (32)P was quickly transformed into Ca(2)-P (rapidly available P), and 66.1% of (32)P was transformed into Al-P, Fe-P and Ca(8)-P (slowly available P). Only 5.0% of (32)P was transformed into O-P and Ca(10)-P (plant-unavailable P). Moreover, in the soil with P fertilizer applied, (32)P transformation into Ca(2)-P increased, and the transformation into Ca(8)-P + Fe-P + AL-P and O-P, Ca(10)-P significantly decreased compared to the soil with no P fertilizer applied (p < 0.05). This result suggested a higher rate for water-soluble P transformation to slowly available and plant-unavailable P in P deficient soil than in soil with sufficient P. The results of maize L-value determination showed that different genotype maize cultivars had different soil P-use efficiency and low-P tolerance mechanisms. Low-P tolerant cultivar DSY-32 regulated soil P-use efficiency and plant P content according to exogenous P fertilizer application. However, another low-P tolerant cultivar, DSY-2, used soil P more efficiently, regardless of the application of exogenous P.