Abstract 1122‐000153: Larger Functional Shunts are Associated with Greater Cerebrovascular Disease Burden

Introduction : The relationship between embolic stroke and patent foramen ovale (PFO) is well‐established. Our objective was to evaluate the association between high intensity transient signals (HITS) in contrast‐enhanced transcranial doppler ultrasonography (ceTCD), baseline MRI brain small vessel ischemic changes, and rates of acute ischemic stroke in the setting of focal neurological deficits. Methods : Electronic medical records of subjects with acute onset neurological symptoms who had ceTCD and MRI brain were evaluated. Subjects without a reported Spencer grade and/or MRI brain without available DWI and FLAIR sequences were excluded. Acute stroke rates and baseline Fazekas score in low‐grade (Spencer grade 1–2) and high‐grade (Spender grade 3–5) shunts were analyzed using Z score for 2 population proportions and Mann‐Whitney U test, respectively. Social Science Statistics was used for data analysis. Results : From June 2016 to August 2021, of 7,498 consecutive ischemic stroke patients, 132 patients were identified as possible strokes related to PFO and were hospitalized with focal neurological deficit, underwent ceTCD and MRI brain. Acute stroke was confirmed on DWI in 60% of Spencer grade 1 (n = 73), 72.2% of grade 2 (n = 19), 72.7% of grade 3 (n = 29), and 80% of grades 4 and 5 shunts (n = 11). Acute stroke rates between low grade (grades 1–2) and high grade shunts (grades 3–5), did not reach statistical significance (z = ‐0.9181; p = 0.17879). There was no significant difference in periventricular white matter disease (z = 0.85697; p = 0.19489). Fazekas scores assessing deep white matter disease were statistically significant between low‐ and high‐grade shunts (z = 1.92818; p = 0.0268 Conclusions : A trend towards statistical significance was observed in high‐grade shunt association with higher rate of acute stroke. Deep white matter disease burden may be significantly higher in high‐grade shunts. Further prospective studies are needed to corroborate our findings.

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Study the activity of P53 & Bcl-2 genes in the biopsies of inflamed colon from patients of ulcerative colitis

Journal of Biotechnology Research Center ◽

10.24126/jobrc.2010.4.1.90 ◽

2010 ◽

Vol 4 (1) ◽

pp. 34-43

Author(s):

Zainab M. T. Jafer ◽

Esmail K. Shubber

Keyword(s):

Ulcerative Colitis ◽

Intermediate Stage ◽

Hybridization Technique ◽

Low Grade ◽

High Grade ◽

Colonic Tissue ◽

Grade 3 ◽

Apoptosis Gene ◽

Tumor Gene

The study has been done on 36 samples of biopsies which drawn from patients suffered from ulcerative colitis, the samples were taken from female & male of different ages. The goal was to observe the gene expression of the suppresser tumor gene P53, & the suppresser apoptosis gene Bcl-2, by using in situ hybridization technique. The results showed that there were relationships between both genes (P53 & Bcl-2) in patients suffered from ulcerative colitis compared with healthy individuals. The suppresser gene P53 gave 63% in the high grade(3) , 29 % in the intermediate stage (2) & 8% in the low grade (1) .While for the suppresser apoptosis gene Bcl-2 , the results showed increasing in the activity of this gene , which gave 66% in the high grade(3) , 27% in the intermediate stage (2) , & 7% in the low grade (1) . These results indicate accumulated mutations in the gene P53 & increase in the activity of gene Bcl-2 in inflamed colonic tissue of chronic ulcerative colitis. This gave an indication of early detection for diagnostic, therapeutic and monitoring purposes.

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Redefining Stage I Endometrial Cancer: Incorporating Histology, a Binary Grading System, Myometrial Invasion, and Lymph Node Assessment

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e3182a5055e ◽

2013 ◽

Vol 23 (9) ◽

pp. 1620-1628 ◽

Cited By ~ 14

Author(s):

Joyce N. Barlin ◽

Robert A. Soslow ◽

Megan Lutz ◽

Qin C. Zhou ◽

Caryn M. St. Clair ◽

...

Keyword(s):

Endometrial Cancer ◽

Myometrial Invasion ◽

Staging System ◽

Stage I ◽

Low Grade ◽

List Type ◽

High Grade ◽

High Grade Carcinoma ◽

Concordance Probability ◽

Grade 3

ObjectiveWe propose a new staging system for stage I endometrial cancer and compare its performance to the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) systems.MethodsWe analyzed patients with 1988 FIGO stage I endometrial cancer from January 1993 to August 2011. Low-grade carcinoma consisted of endometrioid grade 1 to grade 2 lesions. High-grade carcinoma consisted of endometrioid grade 3 or nonendometrioid carcinomas (serous, clear cell, and carcinosarcoma). The proposed system is as follows:IA. Low-grade carcinoma with less than half myometrial invasionIA1: Negative nodesIA2: No nodes removedIB. High-grade carcinoma with no myometrial invasionIB1: Negative nodesIB2: No nodes removedIC. Low-grade carcinoma with half or greater myometrial invasionIC1: Negative nodesIC2: No nodes removedID. High-grade carcinoma with any myometrial invasionID1: Negative nodesID2: No nodes removedResultsData from 1843 patients were analyzed. When patients were restaged with our proposed system, the 5-year overall survival significantly differed (P < 0.001): IA1, 96.7%; IA2, 92.2%; IB1, 92.2%; IB2, 76.4%; IC1, 83.9%; IC2, 78.6%; ID1, 81.1%; and ID2, 68.8%. The bootstrap-corrected concordance probability estimate for the proposed system was 0.627 (95% confidence interval, 0.590–0.664) and was superior to the concordance probability estimate of 0.530 (95% confidence interval, 0.516–0.544) for the 2009 FIGO system.ConclusionsBy incorporating histological subtype, grade, myometrial invasion, and whether lymph nodes were removed, our proposed system for stage I endometrial cancer has a superior predictive ability over the 2009 FIGO staging system and provides a novel binary grading system (low-grade including endometrioid grade 1–2 lesions; high-grade carcinoma consisting of endometrioid grade 3 carcinomas and nonendometrioid carcinomas).

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A Comparison of Death Domain-Associated Protein 6 in Different Endometrial Carcinomas Histotypes

Biomarker Insights ◽

10.1177/1177271919864892 ◽

2019 ◽

Vol 14 ◽

pp. 117727191986489

Author(s):

Cao Jin ◽

Sean Hacking ◽

Miglena K Komforti ◽

Mansoor Nasim

Keyword(s):

Clear Cell ◽

Point Mutations ◽

Low Grade ◽

Nuclear Staining ◽

High Grade ◽

Death Domain ◽

Gynecology And Obstetrics ◽

Grade 3 ◽

Histologic Types ◽

Endometrial Carcinomas

Background: Death domain-associated protein 6 (DAXX) is involved in regulating apoptosis via subcellular localization. The presence of DAXX point mutations correlates well with loss of nuclear expression on immunohistochemistry (IHC). In this study, we sought to determine (1) whether DAXX expression pattern is the same across different uterine carcinoma subtypes, and (2) which uterine carcinomas show loss of nuclear DAXX IHC. Design: We studied 65 uterine carcinomas of the following histologic types: 30 endometrioid (12 FIGO [The International Federation of Gynecology and Obstetrics] grade 1, 12 FIGO grade 2, and 6 FIGO grade 3), 8 serous, 14 clear cell, and 13 undifferentiated/dedifferentiated type (UEC/DDEC). Nuclear DAXX IHC was assessed in each tumor and was graded semi-quantitatively as follows: 0% to 50%, 50% to 75%, and greater than 75% of lesional cells react. Results: A total of 61% (25/41) of high-grade carcinomas (FIGO grade 3, serous, clear cell, and UEC/DDEC]) showed retained DAXX nuclear staining in >75% of lesional cells, compared with only 4.2% (1/24) of the low-grade carcinomas (FIGO grades 1 and 2) ( P = .0001), where DAXX expression was cytoplasmic. In addition, in the 11 DDEC cases, all the differentiated components showed loss of nuclear DAXX compared with the undifferentiated components which retained nuclear DAXX expression. Conclusions: We demonstrate that loss of nuclear DAXX is present in low-grade endometrial carcinomas and the differentiated components in UEC/DDEC, but not in high-grade ones, suggesting DAXX’s role in tumor progression and its potential as a therapeutic target in high-grade endometrial carcinomas.

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White matter disease and sleep-disordered breathing after acute stroke

Neurology ◽

10.1212/01.wnl.0000086818.57992.b8 ◽

2003 ◽

Vol 61 (7) ◽

pp. 959-963 ◽

Cited By ~ 40

Author(s):

J. Harbison ◽

G. J. Gibson ◽

D. Birchall ◽

I. Zammit-Maempel ◽

G. A. Ford

Keyword(s):

White Matter ◽

Acute Stroke ◽

Sleep Disordered Breathing ◽

White Matter Disease ◽

Disordered Breathing

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Meta Analysis of Grade 3 and/or 4 Toxicities in Low-Grade Non-Hodgkin Lymphoma (LG-NHL) Patients Receiving Maintenance Rituximab (MR) Therapy: Impact of Schedule on Toxicity

Blood ◽

10.1182/blood.v118.21.2704.2704 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2704-2704

Author(s):

Chadi Nabhan ◽

Dana Villines ◽

Tina V. Valdez ◽

Michele Ghielmini ◽

Shu-Fang Hsu Schmitz ◽

...

Keyword(s):

Clinical Trials ◽

Research Funding ◽

Meta Analysis ◽

Statistical Significance ◽

Comparative Trial ◽

Progression Free Survival ◽

Low Grade ◽

Front Line ◽

Grade 3 ◽

The Impact

Abstract Abstract 2704 Background: MR has improved the outcome and progression-free survival (PFS) in patients with follicular lymphoma (FL) in front-line and relapsed settings. However, maintenance schedules have been empirically designed based on either B-cell depletion kinetics or rituximab levels, with no consensus on the optimal regimen. Overall, toxicities have been predictable and tolerable but the impact of MR schedule on toxicities has not been previously reported and could influence selection of maintenance regimens. Methods: Using PubMed, prospective clinical trials employing MR were identified. Data presented in abstract form or at meetings were deemed incomplete and thus excluded. Data were analyzed from published manuscripts as percentages of subjects experiencing an adverse event (AE). Percentages were considered as the unit of analysis as this adjusted for the uneven sample sizes. Data were collected for overall Grade 3 and/or Grade 4 toxicity (AE reported at any phase of treatment) and was further categorized as AE occurring during initial treatment or during MR. Grade 1 and 2 toxicities were excluded from meta-analysis, given lack of consistent reporting. No grade 5 toxicities were reported. The incidence, severity, and type of toxicity was analyzed by type of induction (Rituximab (R) vs. R plus chemotherapy), histology (FL vs. FL plus other LG-NHL), setting (front-line vs. relapsed), and MR schedule (one dose every 2 months vs. one dose every 3 months vs. 4 doses every 6 months). Results: Nine clinical trials involving 1,928 patients were included in this Meta analysis (4 of which were randomized controlled in the MR phase). Of those, 1,004 patients received MR. The mean percentage of Grade 3/4 toxicities during any phase of treatment was 26% (95% CI = 0.12–51.88) but when restricted to the MR phase; it was 12.88% (95% CI = 6.50–19.26). Toxicities were numerically higher in patients receiving R induction plus chemotherapy versus R induction alone and in patients receiving MR for relapsed disease versus newly diagnosed patients, but did not reach statistical significance (P = 0.661 and 0.517, respectively). However, patients receiving MR every 2 months were significantly more likely to develop grade 3 and 4 toxicities compared to patients receiving MR every 6 months (P = 0.005). No statistical differences were demonstrated between the 2 vs. 3 months schedules or when comparing the 3 vs. 6 months schedules (P = 0.342 and 0.267, respectively) (Table 1). Statistically significant differences were also found in studies restricted to FL versus others allowing non-FL histologies (P = 0.025) with the FL patients experiencing more toxicity than others. The most frequently reported toxicities were neutropenia and infections. There were no treatment-related deaths in any of the arms. Conclusions: Approximately 13% of patients receiving MR experience grade 3 and/or 4 toxicities, mainly consisting of neutropenia and infections. MR given every 6 months appears to provide the least grade 3 and 4 toxicities. There is a suggestion of increased toxicity in FL histologies. It is important to note that this meta-analysis did not address efficacy and only a true comparative trial can definitively establish the relative risk/benefit ratios amongst MR schedules. Disclosures: Nabhan: Genentech: Research Funding, Speakers Bureau. Ghielmini:Roche: Consultancy, Honoraria, Research Funding, Speakers Bureau. Smith:Genentech: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

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Delayed cognitive, behavioral, and radiological changes related to canial irradiation for pediatric brain tumors

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.20023 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 20023-20023

Author(s):

M. M. Abdel Wahab ◽

H. Hussien ◽

K. M. Maher

Keyword(s):

White Matter ◽

Brain Tumors ◽

Visual Memory ◽

Statistical Significance ◽

Pediatric Brain Tumors ◽

Low Grade ◽

White Matter Damage ◽

Cranial Radiation ◽

Pediatric Brain

20023 Purpose: To evaluate the delayed adverse changes in neuro-cognitive functions as well as white matter damage in radiated survivors of pediatric brain tumors. Methods: Forty two children (22 males) with primary brain tumors who were only treated with cranial radiation, were recruited. 28 patients were treated for low risk medulloblastoma, 10 patients for low grade astrocytoma, 3 patients for low grade ependymoma, and 1 patient for craniopharyngioma. Their ages ranged from 3 to 18 years (mean 10.3±3.98 years).They were subjected, initially just before radiotherapy and at follow-up 1–2 year after completion of cranial radiation, to serial clinical and neuropsychological assessments including Wechseler Intelligence Scale for Children, Vineland social maturity test, Benton Visual Memory Test, and Revised Behavior Problem Checklist. Magnetic resonance scans were also performed to detect the presence of white matter damage before radiotherapy and at follow up. Results: Initially, after surgery and before radiation, intelligence test scores were below normal scores for age and this was of high statistical significance (Total IQ: t= -3.02, P= 0.006). Visual memory test showed evidence of organicity in all cases. Social maturity showed a statistically significant decline as well (t= -2.11, P= 0.04). Follow-up after radiotherapy showed further decline with high statistical significance (Total IQ t= 3.228, P=0.003; visual memory t= 4.08, P= 0.001); An attentional problem has emerged (t= -6.12, P= 0.00). Both radiation dose and volume of radiation showed negative and statistically significant correlation with IQ. Age at diagnosis correlated positively and significantly with IQ ( r= 0.601, P=0.001). Multiple linear regression showed impaired neurocognitive function which was correlated with the degree of white matter damage. (standardized B= -0.577, P= 0.001) and young age at diagnosis (standardized B= -0.427, P= 0.014). Conclusions: Cranial radiation in pediatric brain tumors is associated with a decline in multiple neurocognitive functions including total IQ, visual memory, and attention; which are related to the toxic effect of cranial radiation on white matter of the brain especially in young age of childhood with high dose and whole cranial radiation. No significant financial relationships to disclose.

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Endovascular Treatment of Acute Embolism of the Major Cerebral Arteries

Interventional Neuroradiology ◽

10.1177/159101990401000303 ◽

2004 ◽

Vol 10 (3) ◽

pp. 213-223 ◽

Cited By ~ 1

Author(s):

S. Ota ◽

T. Ota ◽

K. Goto ◽

I. Inoue ◽

T. Ota

Keyword(s):

Clinical Outcome ◽

Intracranial Haemorrhage ◽

Cerebral Arteries ◽

Favorable Outcome ◽

Low Grade ◽

High Grade ◽

Timi Grade ◽

Grade 3 ◽

The Relationship ◽

Control Angiography

This study evaluated: 1) the effect of recanalization on changing clinical outcome, 2) the relationship between dose of Urokinase (UK) and incidence of recanalization and intracranial haemorrhage, and 3) the efficacy and feasibility of balloon disruption (BD) in the treatment of acute cerebral embolism. Sixty-one patients with acute embolism of the major cerebral arteries treated by endovascular approaches over the past nine years were retrospectively evaluated. Among them, 30 cases were treated by BD alone or in conjunction with intra-arterial fibrinolysis in the last five years. The other 31 cases, mostly treated in the first four years, were treated with intra-arterial fibrinolysis alone and were used as controls to evaluate the efficacy of BD. Control angiography was performed just after the reperfusion procedure to evaluate the degree of recanalization. Angiographic responses were graded using modified Thrombolysis in Myocardial Infarction (TIMI) criteria. Clinical outcome was evaluated using modified Rankin Scale (mRS) score at the time of discharge. Thirty-six of the 61 patients (59.0%) achieved high-grade recanalization (TIMI grade 3). Significantly more patients attained favorable outcome (mRS score 0–1) in the high-grade recanalization group than the low-grade recanalization group (41.7% vs. 16.0%, p< 0.05). Concerning patients treated with BD, significantly more patients attained good recanalization and significantly more patients were ambulatory (mRS score 0–3) than those treated with intra-arterial fibrinolysis alone (76.7% vs. 41.9%, p<0.01; 70.0% vs. 41.9%, p< 0.05, respectively). A significantly lower dose of UK was used, and relatively less intracranial haemorrhage was seen in patients treated with BD than those treated with intra-arterial fibrinolysis (194,000 ± 191,000 units vs. 388,000 ± 231,000 units, p=0.001; 16.7% vs. 38.7%, p = 0.055, respectively). Concerning morbidity and mortality of BD, there was one death caused by dissection of the M2 portion of the middle cerebral artery (MCA) that happened during BD on a distally migrated embolus. Although no conclusions can be drawn from our study, a favorable outcome for acute embolism of the major cerebral arteries is expected by attaining good recanalization. In addition, BD is an effective technique that can achieve high-grade recanalization alone, or reducing the dose of fibrinolytic agent.

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Characterization of abnormal diffusion properties of supratentorial brain tumors: a preliminary diffusion tensor imaging study

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/263 ◽

2008 ◽

Vol 1 (4) ◽

pp. 263-269 ◽

Cited By ~ 23

Author(s):

Weihong Yuan ◽

Scott K. Holland ◽

Blaise V. Jones ◽

Kerry Crone ◽

Francesco T. Mangano

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Imaging Study ◽

Low Grade ◽

High Grade ◽

The Mean ◽

Supratentorial Tumors ◽

Diffusion Properties

Object Diffusion tensor (DT) imaging was used in children with supratentorial tumors to evaluate the anisotropic diffusion properties between different tumor grades and between tumors and adjacent and contralateral white matter. Methods In this retrospective review, the authors review the cases of 16 children (age range 1–18 years) who presented to their institution with supratentorial tumors and were treated between 2004 and 2007. Eleven patients had low-grade and 5 had high-grade tumors. Fractional anisotropy (FA), mean diffusivity, and axial (λ∥) and radial (λ⊥) eigenvalues within selected regions were studied. Mitotic index, necrosis, and vascularity of the tumors were compared with DT imaging parameters. Results The mean diffusivity was significantly higher in low-grade than in high-grade tumors (p = 0.04); the 2 tumor grades also significantly differed for both λ∥ (p < 0.05) and λ⊥ (p < 0.05). Mean diffusivity values in low-grade tumors were significantly higher than in adjacent normal-appearing white matter (NAWM; p = 0.0004) and contralateral NAWM (p = 0.0001). In both low- and high-grade tumors, the FA was significantly lower than in NAWM (p < 0.0001 and p < 0.03, respectively) and contralateral NAWM (p < 0.0001 and p < 0.003, respectively). Tumor cellularity highly correlated with mean diffusivity and λ∥and λ⊥. Conclusions Diffusion tensor imaging is a useful tool in the evaluation of supratentorial tumors in children. The mean diffusivity appears to be a significant marker in differentiating tumors grades. Findings related to λ∥ and λ⊥ within tumor groups and between tumors and NAWM may be an indirect manifestation of the combined effects of axonal injury, demyelination, and tumor mass within the cranial compartment.

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Comparison of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Arterial Spin Labeling MR Imaging in Gliomas

BioMed Research International ◽

10.1155/2015/234245 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 20

Author(s):

Yuankai Lin ◽

Jianrui Li ◽

Zhiqiang Zhang ◽

Qiang Xu ◽

Zhenyu Zhou ◽

...

Keyword(s):

Diffusion Coefficient ◽

White Matter ◽

Mr Imaging ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Intravoxel Incoherent Motion ◽

Low Grade ◽

High Grade ◽

Low Grade Gliomas ◽

High Grade Gliomas

Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (D∗), slow diffusion coefficient (D), fractional perfusion-related volume (f), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF andD∗were higher in the high grade gliomas, whereas ADC,D, andfwere lower (allP<0.05). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) ofD∗, CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated withfin tumor (r=-0.619,P=0.001). ADC was positively correlated withDin both tumor and white matter (r=0.887,P=0.000andr=0.824,P=0.000, resp.). There was no correlation between CBF andD∗in both tumor and white matter (P>0.05). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas.

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The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles

10.21203/rs.3.rs-726950/v1 ◽

2021 ◽

Author(s):

Qiongyao Shi ◽

Senlin Shi ◽

Wenyan Song ◽

Feifei Zhao ◽

Haixia Jin ◽

...

Keyword(s):

Birth Weight ◽

Live Birth ◽

Cell Mass ◽

The Other ◽

Low Grade ◽

High Grade ◽

Significant Difference ◽

Group A ◽

Grade 3 ◽

The Impact

Abstract Background: A retrospectively cohort study was performed to compare the birth weight of different blastocyst grades in fresh transplantation cycle and explore the related factors affecting the birth weight. Methods: The 1301 fresh cycles of single blastocyst transplantation and single live birth profile were analyzed,four groups were divided according to the grade of transplanted blastocyst. There are 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Comparison were made among four groups of birth weight, general conditions, fertilization rate, embryo rate, cleavage rate and D5,D6 blastocyst formation rate and other laboratory indicators. And then comparison were performed among the birth weight of different groups which were divided by the degree of blastocyst expansion, and the classification of inner cell mass(ICM) and the trophectoderm(TE). Results: The study shows that the birth weight of group A is significantly higher than that of the other three groups (P < 0.05). And the high quality embryo rate and blastocyst rate of group A are significantly higher than those of the other three groups (P < 0.05). What’s more, the clinical pregnancy rate, implantation rate and live birth rate of high grade blastocyst are higher, but there are no significant difference in abortion rate. The birth weight of the degree of blastocyst expansion in grade 3 and below is significantly lower than that of those with grade 3 and above (P < 0.05). The birth weight of grade A of ICM is significantly higher than that of grade B (P < 0.05). The birth weight of grade B of TE is significantly heavier than that of grade C (P < 0.05). Conclusions: Our results indicate that high grade blastocyst transplantation can achieve better pregnancy outcome. Different blastocyst grades affect birth weight, and low grade blastocyst transplantation is associated with a single birth weight loss.

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