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Neuro-oncology Advances 2024Meningiomas are the most common primary brain tumors. While most are benign (WHO grade 1) and have a favorable prognosis, up to one-fourth are classified as...
BACKGROUND
Meningiomas are the most common primary brain tumors. While most are benign (WHO grade 1) and have a favorable prognosis, up to one-fourth are classified as higher-grade, falling into WHO grade 2 or 3 categories. Recently, an integrated risk score (IRS) pertaining to tumor biology was developed and its prognostic relevance was validated in a large, multicenter study. We hypothesized imaging data to be reflective of the IRS. Thus, we assessed the potential of a machine learning classifier for its noninvasive prediction using preoperative magnetic resonance imaging (MRI).
METHODS
In total, 160 WHO grade 2 and 3 meningioma patients from 2 university centers were included in this study. All patients underwent surgery with histopathological workup including methylation analysis. Preoperative MRI scans were automatically segmented, and radiomic parameters were extracted. Using a random forest classifier, 3 machine learning classifiers (1 multiclass classifier for IRS and 2 binary classifiers for low-risk and high-risk prediction, respectively) were developed in a training set (120 patients) and independently tested in a hold-out test set (40 patients).
RESULTS
Multiclass IRS classification had a test set area under the curve (AUC) of 0.7, mostly driven by the difficulties in clearly separating medium-risk from high-risk patients. Consequently, a classifier predicting low-risk IRS versus medium-/high-risk showed a very high test accuracy of 90% (AUC 0.88). In particular, "sphericity" was associated with low-risk IRS classification.
CONCLUSION
The IRS, in particular molecular low-risk, can be predicted from imaging data with high accuracy, making this important prognostic classification accessible by imaging.
PubMed: 38957161
DOI: 10.1093/noajnl/vdae080 -
Human Fertility (Cambridge, England) Dec 2024Although the deleterious impact of chemotherapy regimen used to treat women of reproductive age with breast cancer on ovarian reserve has been extensively studied,... (Observational Study)
Observational Study
Although the deleterious impact of chemotherapy regimen used to treat women of reproductive age with breast cancer on ovarian reserve has been extensively studied, hardly anything has been reported on the effect of these protocols on theca cell function and ovarian androgen secretion. The aim of this prospective multicentric cohort study was to describe serum levels of total testosterone and androstenedione during chemotherapy and 24-month follow-up in 250 patients <40 years treated for breast cancer. Mean basal levels of androstenedione and total testosterone at diagnosis were 1.68 ng/mL and 0.20 ng/mL respectively. No correlation with age was found. Serum levels of androstenedione and total testosterone rapidly decreased after chemotherapy completion, before slowly increasing and almost returning to basal levels in all patients during 2-year follow-up. In conclusion our study demonstrates a chemotherapy-induced alteration of ovarian thecal function, resulting in a significant decrease in serum androgen levels. This alteration of theca cell function adds to the well-known alteration of granulosa cell function, resulting in a global, but partly transient, ovarian failure in young women treated for breast cancer. These data bring new insight into ovarian physiology and emphasize the need for pre and post-treatment ovarian follow-up. ClinicalTrial.gov identifier NCT01114464.
Topics: Humans; Female; Breast Neoplasms; Adult; Androstenedione; Prospective Studies; Testosterone; France; Young Adult; Adolescent; Androgens; Antineoplastic Agents
PubMed: 38957151
DOI: 10.1080/14647273.2024.2350758 -
Current Opinion in Pediatrics Aug 2024Congenital melanocytic nevi (CMN) and acquired nevi are prevalent in pediatric populations, with distinct characteristics and management considerations. This chapter... (Review)
Review
PURPOSE OF REVIEW
Congenital melanocytic nevi (CMN) and acquired nevi are prevalent in pediatric populations, with distinct characteristics and management considerations. This chapter aims to equip pediatricians with knowledge to discern between benign and high-risk nevi, facilitating appropriate referrals and management within primary care settings. Risk factors associated with malignant melanoma (MM) underscore the importance of vigilant monitoring and early referral to dermatology for suspicious lesions.
RECENT FINDINGS
Recent findings highlight the variability in CMN presentation and the evolving diagnostic strategies, emphasizing the need for multidisciplinary approaches to optimize patient outcomes.
SUMMARY
Management of CMN involves tailored surveillance and intervention strategies, with an emphasis on early identification of high-risk features for MM and neurocutaneous melanosis (NCM). Pediatricians play a crucial role in advocating for sun protection practices and facilitating timely referrals, thereby contributing to the overall well being of pediatric patients with nevi.
Topics: Humans; Referral and Consultation; Nevus, Pigmented; Skin Neoplasms; Child; Melanoma; Risk Factors
PubMed: 38957127
DOI: 10.1097/MOP.0000000000001375 -
BJOG : An International Journal of... Jul 2024
PubMed: 38957120
DOI: 10.1111/1471-0528.17904 -
Australian Journal of General Practice Jul 2024Ongoing symptoms of COVID-19 can persist for weeks or months after the initial COVID-19 infection. The aim of this study was to identify persistent symptoms (fatigue,... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Ongoing symptoms of COVID-19 can persist for weeks or months after the initial COVID-19 infection. The aim of this study was to identify persistent symptoms (fatigue, cognition, quality of life, anxiety, depression and physical measures) in unvaccinated community-managed patients following COVID-19 infection.
METHOD
This was a prospective nested observational study of health and wellbeing measures determined seven and 13 months after COVID-19 infection, alongside physical abilities after 18 months.
RESULTS
Data analyses were completed on 62 participants (60% female, median age 35 years). Severe fatigue was noted in 47% of participants at seven months and this had not improved significantly by 13 months (45%). Quality of life and mental health scores were significantly worse in individuals with severe fatigue. One-quarter of participants demonstrated mild cognitive impairment at seven months. After 18 months, walking and lung function were normal, but grip strength was reduced in 26% of participants.
DISCUSSION
A significant proportion of unvaccinated COVID-19 patients had not returned to pre-illness levels of health and function after one year; screening functional ability and mental wellbeing is warranted in unvaccinated people with COVID-19.
Topics: Humans; COVID-19; Female; Male; Prospective Studies; Adult; Quality of Life; SARS-CoV-2; Fatigue; Anxiety; Depression; Cognitive Dysfunction; Middle Aged
PubMed: 38957067
DOI: 10.31128/AJGP-07-23-6900 -
Australian Journal of General Practice Jul 2024
Topics: Humans; Leiomyoma; Female; Uterine Neoplasms
PubMed: 38957066
DOI: 10.31128/AJGP-08-23-6919 -
Australian Journal of General Practice Jul 2024Gallbladder polyps are increasingly being identified due to the widespread use of abdominal ultrasound imaging. They are concerning lesions due to their potential...
BACKGROUND
Gallbladder polyps are increasingly being identified due to the widespread use of abdominal ultrasound imaging. They are concerning lesions due to their potential malignant risk. It is hoped that managing them correctly will play a role in improving poor survival rates of gallbladder cancer. Awareness of these lesions is lacking. Management continues to be guided by expert opinion and observational studies and a number of consensus statements exist.
OBJECTIVE
This paper reviews and summarises the current literature and provides an approach for general practitioners based on the available guidance.
DISCUSSION
Although minor variation exists between consensus statements, the risk of malignancy for gallbladder polyps is still largely dictated by size, with those ≤5 mm generally considered to pose little risk and not requiring follow-up, whereas those ≥10 mm considered at greater risk and requiring referral for cholecystectomy.
Topics: Humans; Polyps; Gallbladder Neoplasms; Ultrasonography; General Practitioners; Gallbladder Diseases
PubMed: 38957064
DOI: 10.31128/AJGP-03-23-6775 -
Molecular Oncology Jul 2024Small cell lung cancer (SCLC) is a highly aggressive cancer with a dismal 5-year survival of < 7%, despite the addition of immunotherapy to first-line chemotherapy.... (Review)
Review
Small cell lung cancer (SCLC) is a highly aggressive cancer with a dismal 5-year survival of < 7%, despite the addition of immunotherapy to first-line chemotherapy. Specific tumor biomarkers, such as delta-like ligand 3 (DLL3) and schlafen11 (SLFN11), may enable the selection of more efficacious, novel immunomodulating targeted treatments like bispecific T-cell engaging monoclonal antibodies (tarlatamab) and chemotherapy with PARP inhibitors. However, obtaining a tissue biopsy sample can be challenging in SCLC. Circulating tumor cells (CTCs) have the potential to provide molecular insights into a patient's cancer through a "simple" blood test. CTCs have been studied for their prognostic ability in SCLC; however, their value in guiding treatment decisions is yet to be elucidated. This review explores novel and promising targeted therapies in SCLC, summarizes current knowledge of CTCs in SCLC, and discusses how CTCs can be utilized for precision medicine.
PubMed: 38956984
DOI: 10.1002/1878-0261.13696 -
Cancer Medicine Jul 2024Healthy cancer survivorship involves patients' active engagement with preventative health behaviors and follow-up care. While clinicians and patients have typically held...
A qualitative study of stakeholders' experiences with and acceptability of a technology-supported health coaching intervention (SHARE-S) delivered in coordination with cancer survivorship care.
PURPOSE
Healthy cancer survivorship involves patients' active engagement with preventative health behaviors and follow-up care. While clinicians and patients have typically held dual responsibility for activating these behaviors, transitioning some clinician effort to technology and health coaches may enhance guideline implementation. This paper reports on the acceptability of the Shared Healthcare Actions & Reflections Electronic systems in survivorship (SHARE-S) program, an entirely virtual multicomponent intervention incorporating e-referrals, remotely-delivered health coaching, and automated text messages to enhance patient self-management and promote healthy survivorship.
METHODS
SHARE-S was evaluated in single group hybrid implementation-effectiveness pilot study. Patients were e-referred from the clinical team to health coaches for three health self-management coaching calls and received text messages to enhance coaching. Semi-structured qualitative interviews were conducted with 21 patient participants, 2 referring clinicians, and 2 health coaches to determine intervention acceptability (attitudes, appropriateness, suitability, convenience, and perceived effectiveness) and to identify important elements of the program and potential mechanisms of action to guide future implementation.
RESULTS
SHARE-S was described as impactful and convenient. The nondirective, patient-centered health coaching and mindfulness exercises were deemed most acceptable; text messages were less acceptable. Stakeholders suggested increased flexibility in format, frequency, timing, and length of participation, and additional tailored educational materials. Patients reported tangible health behavior changes, improved mood, and increased accountability and self-efficacy.
CONCLUSIONS
SHARE-S is overall an acceptable and potentially effective intervention that may enhance survivors' self-management and well-being. Alterations to tailored content, timing, and dose should be tested to determine impact on acceptability and outcomes.
Topics: Humans; Female; Male; Middle Aged; Qualitative Research; Cancer Survivors; Mentoring; Aged; Pilot Projects; Survivorship; Adult; Neoplasms; Self-Management; Text Messaging; Patient Acceptance of Health Care; Health Behavior; Telemedicine
PubMed: 38956976
DOI: 10.1002/cam4.7441 -
Acta Dermato-venereologica Jul 2024Tumour budding (TB) correlates with increased local invasion in various neoplasms. Certain basal cell carcinomas (BCCs) exhibit local aggressiveness. Detecting adverse...
Tumour budding (TB) correlates with increased local invasion in various neoplasms. Certain basal cell carcinomas (BCCs) exhibit local aggressiveness. Detecting adverse prognostic factors in partial biopsies could aid in identifying cases with heightened local risk. The absolute number of TB (≤ 3 tumour cells) in excision specimens of 271 infiltrative BCCs (0: absent; 1: 1-2 foci; 2: ≥ 3 foci; 3: ≥ 10 foci), the histopathological subtype and depth of infiltration, perineural invasion, and other histological features were evaluated. A significant correlation was found between TB and both depth of infiltration (rho 0.445, p < 0.001) and perineural invasion (p = 0.009). In the multivariate analysis of depth and perineural invasion (multiple regression, stepwise), TB was identified as a significant covariate together with diameter, inflammation, and perineural invasion for the former, and depth for the latter. Conversely, no correlation existed between the WHO histological subtypes (infiltrating, sclerosing, and micronodular), and depth of infiltration or perineural invasion. This study demonstrates the value of TB as a biomarker for local invasiveness in BCC. In routine practice, a count of ≥ 3 TB foci in lesions incompletely excised or with narrow tumour-free surgical margins would be a straightforward and reproducible method to guide BCC treatment.
Topics: Humans; Carcinoma, Basal Cell; Skin Neoplasms; Neoplasm Invasiveness; Male; Female; Aged; Predictive Value of Tests; Middle Aged; Biopsy; Risk Factors; Multivariate Analysis; Aged, 80 and over; Adult; Retrospective Studies
PubMed: 38956962
DOI: 10.2340/actadv.v104.40172