Small Cell Undifferentiated Histology Does Not Adversely Affect Outcome in Hepatoblastoma: A Report From the Children's Oncology Group (COG) AHEP0731 Study Committee

PURPOSE Small cell undifferentiated (SCU) histology in hepatoblastoma (HB) tumors has historically been associated with a poor prognosis. Tumors from patients enrolled on Children's Oncology Group (COG) study AHEP0731 underwent institutional and central pathologic review for identification of SCU histology. PATIENTS AND METHODS Patients with SCU histology identified at the local treating institution who had otherwise low-risk tumors were upstaged to the intermediate-risk treatment stratum, whereas those only identified by retrospective central review were treated per the local institution as low-risk. Patients with otherwise intermediate- or high-risk tumors remained in that treatment stratum, respectively. Central review was to be performed for all tissue samples obtained at any time point. Treatment was per local review, whereas analysis of outcome was based on central review. RESULTS Thirty-five patients had some elements (1%-25%) of SCU identified on central review of diagnostic specimens. All but two patient tissue sample retained nuclear INI1 expression. The presence of SCU histology did not correlate with age, alpha-fetoprotein level at diagnosis, or sex. The presence of SCU did not affect event-free survival (EFS). EFS at 5 years for patients with low-risk, intermediate-risk, and high-risk with SCU HB was 86% (95% CI, 33 to 98), 81% (95% CI, 57 to 92), and 29% (95% CI, 4 to 61), respectively, compared with EFS at 5 years for patients without SCU enrolled with low-risk, intermediate-risk, and high-risk of 87% (95% CI, 72 to 95), 88% (95% CI, 79 to 94), and 55% (95% CI, 32 to 74; P = .17), respectively. CONCLUSION The presence of SCU histology in HB does not appear to adversely affect outcome. Future studies should be able to treat patients with SCU HB according to risk stratification without regard to the presence of SCU histology.

P14.85 Impact of the neuro-radiologist and neuro-surgeon in contouring with the neuro-oncologist on local relapse rates for brain metastases treated with stereotactic radiosurgery

BACKGROUND The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS). MATERIAL AND METHODS A sequential audit was conducted of all patients receiving intracranial SRS at our local institution for the first 22 months of a new SRS service. Lesions were contoured first by clinical oncologist then reviewed/edited by the MDT. The initial contour was compared with final contour using Jaccard conformity and geographical miss indices. The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contour. The impact of the contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up (24–46 months). RESULTS 113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32–1.00) and 38% needed significant editing (JCI<0.95). Mean GMI was 0.03 (0.0–0.65) and 17% showed significant miss (GMI>0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p<0.05). There was no significant improvement on JCI or GMI shown over time. Dosimetric analysis indicated a strong association of conformity metrics with PTV dose metrics; a 0.1 change in GTV conformity metric association with 6–17% change in dose to 95% of resulting PTV. Greater association was seen in resection cavity suggesting the geographical nature of a typical contouring error gives rise to greater potential change in dose. Clinical outcomes compared well with published series. Median survival was 20 months and local relapse free rate in the treated areas of 0.89 (0.8–0.94) at 40 months, and 0.9 (0.83–0.95) radio-necrosis free rate at 40 months with a median 17 months to developing radio-necrosis for those that did. CONCLUSION This work highlights that a MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at our local institution compared with previously published data. Radio-necrosis rates are below 10%. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist. MDT input is recommended in particular in contouring of resection cavities.

Using Inter-institutional Collaboration to Generate Publishable Findings through Course-Based Undergraduate Research Experiences

Course-based undergraduate research experiences (CUREs) are high-impact practices that allow students to conduct research during class time. Benefits of a CURE can be maximized when integrated into a faculty member’s ongoing research. However, this can be particularly challenging for field biologists, especially when field sites are not situated near their university. Indeed, few existing CUREs are field based. One solution is to partner with a collaborator near the field site. We describe a semester-long CURE in an animal behavior class that involved collaboration among three institutions: researchers from two “distant” institutions have ongoing research at the “local” institution where the CURE took place. This model uses remote conferencing and strategic collaboration to meet all stakeholders’ needs. Undergraduate students engaged as active participants in collaborative inquiry-based work, learned in a cooperative context, and even participated in the publication process. The local principal investigator and their institution generated a high-impact course that integrated research and teaching. Likewise, the distant principal investigators were able to collect more extensive and longer-term field-based data than otherwise possible, and they gained valuable input from the local researchers that contributed to future projects. Remote collaborations open the door to international collaboration with smaller institutions, promoting greater inclusion in science.

Evaluation of periodontal condition in individuals with down syndrome: a case-control study

Ogival palate, macroglossia, anodontia, cleft tongue, delayed tooth eruption, low prevalence of caries and high prevalence of periodontal disease are the main oral manifestations of Down syndrome. The aim of the present observational study was to evaluate the periodontal condition in individuals with Down syndrome. The study included 30 individuals who were selected according to the age group to be studied, between 17 and 25 years old, in a local institution for the care of Down syndrome (DG) patients and 30 individuals who made up the control group and who did not have Down syndrome (CG), periodontal parameters were observed in both groups that were adjusted for habits. The results showed for the Plaque Index 41.2% of the individuals in the DS group while in the CG group in 45.5% without statistical difference. For the Gingival Index, it was observed that 39.7% in the DS group and in the CG group 44.2% without statistical difference between the groups (p <0.05). Family and institutional participation collaborates in the daily control of dental biofilm. In the present study, individuals in the DG group presented periodontal clinical parameters compatible with periodontal health and when compared to healthy individuals, they did not present clinical differences.

Severe tricuspid bioprosthetic valve stenosis as an unusual cause of pulmonary embolism: a case report

Background Bioprosthetic tricuspid valve stenosis (TS) is an uncommon and frequently under-diagnosed condition. Although the resulting right heart failure symptoms are well-known, the associated thrombogenic potential is under-recognized. Case summary A 44-year-old woman with bioprosthetic tricuspid valve (TV) replacement in 2001 was referred for urgent consultation due to acute worsening of dyspnoea and severe swelling and pain in her left arm and neck. She was diagnosed with atrial fibrillation 6 months before the presentation and was found to have right atrial (RA) thrombus with pulmonary embolism and extensive retrograde venous extension 1 month prior. Review of studies done at her local institution revealed 10 mmHg mean gradient (MG) across the bioprosthetic TV that was only reported as mild–moderate TS. Echocardiography done at our instruction confirmed suspicion of severe TS with calcified immobile leaflets. Computed tomography showed persistent RA thrombus and therefore surgical replacement of the TV was undertaken. Subsequently, patient’s dyspnoea rapidly improved. Discussion Progressive dyspnoea and symptoms of right heart failure in a patient with a history of bioprosthetic TV replacement should be investigated for prosthetic valve dysfunction. Due to its rarity, TS diagnosis can be overlooked on routine echocardiography. In our patient, despite a measured MG of 10 mmHg, the presence of critical TS was not initially recognized. As TS is associated with increased thrombogenic potential and given the rare occurrence of in situ RA thrombosis, physicians must have a high index of suspicion for TS in the appropriate clinical context.

The Legacy of Bla ma dkar po: An Unsettled Dispute between Chone and Labrang on the Inner Asian Frontier

From the 1860s to the 1890s, Bla ma dkar po, a Chone Tibetan lama rose to power in Xinjiang and became a major participant in the late Qing Inner Asian politics. With the support of Beijing, Lhasa, Mongol patrons and local tsho ba, the lama established a university monastery in his hometown, where was caught between Chone and Labrang in eastern Mdo smad. After he died of illness, the Qing court recognized him as a reincarnated ho thog thuin Dzungaria. Chone and Labrang contested for his spiritual and material legacies, competed for controlling his hometown, turned the reincarnation lineage into a local institution, and left the dispute unsettled up to the present. This article uses this case to examine the complex relations between Tibetan regional powers and local societiesin Mdo smad. It elaborates how the “long-term unsettling” became a solution for such a covert dispute. བླ་མ་དཀར་པོའི་གནའ་རྫས།ཡ་གླིང་ནང་མའི་མཐའ་མཚམས་ཁྲོད་ཀྱི་ཅོ་ནེ་དང་བླ་བྲང་བར་གྱི་ཡུན་རིང་ཐག་གཅོད་མ་བྱས་པའི་རྩོད་གཞི། སྤྱི་ལོ༡༨༦༠-༡༨༩༠ལོའི་བར།བླ་མ་དཀར་པོ་ནི་ཅོ་ནེའི་བོད་རིགས་ཀྱི་བླ་མ་ཤིན་ཅང་ས་ཆ་ནས་དབང་ཐང་རྒྱས་པར་མ་ཟད།ཆིང་རྒྱལ་རབས་ཀྱི་དུས་མཇུག་དུ་ཡ་གླིང་ནང་ཁུལ་གྱི་ཆབ་སྲིད་དུ་ཞུགས་མཁན་གཙོ་བོ་ཞིག་ཡིན།པེ་ཅིན།ལྷ་ས།སོག་པོ་བཅས་ཀྱི་སྤྱིན་བདག་དང་ས་གནས་དེའི་ཚོ་བའི་རྒྱབ་སྐྱོར་ལ་བརྟེན་ནས།བླ་མ་འདིའི་ཕ་ཡུལ།ཨ་མདོའི་ཤར་ཕྱོགས།ཅོ་ནེ་དང་བླ་བྲང་ས་ཆའི་བར་ནས་དགོན་པ་ཆེན་པོ་ཞིག་འཛུགས་བསྐྲུན་མཛད།ཁོང་རང་སྐུ་མྱངས་ནས་མྱ་ངན་ལས་འདས་བའི་རྗེས་སུ།ཆིང་སྲིད་གཞུང་གིས་ཁོ་རང་ཇིང་གུར་གྱི་ཡང་སྲིད་ཧོ་ཐོག་ཐུའི་ཆོ་ལོ་སྩལ།ཅོ་ནེ་དང་བླ་བྲང་བར་ཁོང་རང་གི་ཐུགས་དགོངས་དང་དངོས་པོའི་ཤུལ་བཞག་འགྲན་རྩོད་བྱུང་ནས།ཁོང་རང་གི་ཕ་ཡུལ་གྱིས་བརྩོན་ལེན་བྱེད་པར་ཚོད་འཛིན་བྱས།དེ་ནས་གདུང་རྒྱུད་འཛིན་པའི་གདུང་རབས་ཏེ་ས་གནས་ཀྱི་ལམ་ལུགས་སུ་འགྱུར།དེར་མ་ཟད་རྩོད་གཞི་འདི་ད་ལྟའི་བར་དུ་ཤུལ་ལུས་ཐག་གཅོད་མ་བྱས།རྩོམ་ཡིག་འདིར་ཨ་མདོའི་བོད་རིགས་ཀྱི་ས་ཁོངས་དབང་ཆ་དང་ས་གནས་སྤྱི་ཚོགས་བར་གྱི་རྙོག་འཛིང་གི་འབྲེལ་བ་དཔེ་མཚོན་དུ་བཟུང་ནས་བརྟག་ཞིབ་བྱས་ཡོད།ཁོ་བོས་“ཡུན་རིང་ཐག་གཅོད་མ་བྱས་པ”ཅི་ལྟར་འདི་འདྲའི་སྦས་བའི་རང་བཞིན་གྱི་རྩོད་གཞི་ཅག་གཅོད་བྱེད་ཐབས་ཞིབ་བརྗོད་བྱས་ཡོད། བརྡ་ཆད་གཙོ་བོ། བླ་མ་དཀར་པོ། ཅོ་ནེ། བླ་བྲང་། ཚོ་བ། གདུང་རྒྱུད་ལམ་ལུགས། ཡ་གླིང་ནང་མ།

Bridging the gap in respiratory medicine: How a pulmonologist from other continent can help African children who “can’t breathe?” The story of a European professor and his African trainee

An European pediatric pulmonologist successfully organized a 2-year in-house pediatric pulmonology training with simultaneous establishment of the first pediatric pulmonary center in Ethiopia. Collaboration of the local institution with a non-governmental organization (NGO) facilitated the realization of the program. Training cost was significantly low compared to the expected out of country training, with extra financial benefit enabling purchase of equipment for the center. Our experience shows that specialists from developed countries can be instrumental to establishing cost-effective training programs and founding of specialized services in low-income countries by training subspecialists in their own setting. NGOs and leading international professional societies can support such programs to relieve the suffering of the child who “can’t breathe” because s/he is born in a low income country.

Nail Disease: Clinical Decisions among Portuguese Dermatologists and Family Physicians

Onychomycosis is one of the most common nail disorders and may be difficult to distinguish from other causes of nail dystrophy, based on clinical grounds alone. With this study, we aimed to describe the use of fungal testing by dermatologists and family physicians in their daily current practice, analyze their respective familiarity with nail disease diagnosis, and ultimately treatment decision-making by both groups. An online survey was distributed among Portuguese dermatologists, trainees, and family physicians by email. The survey focused on the diagnostic impression, use of diagnostic methods to confirm a fungal infection, and the subsequent assessment of treatment. One hundred fifty-one responses were obtained, 60 (39.7%) from dermatologists and 91 (60.3%) from family physicians; 98.3% of dermatologists mentioned usually requesting a fungal testing at their local institution or outside, while this percentage was 50.5% among family physicians (<i>p</i> &#x3c; 0.001). Regarding the diagnosis, the median of correct diagnosis by the dermatologist group was higher (10/15) than the family physicians (6/15). Considering the treatment strategy, we observed that in the dermatologists’ group it would result in unnecessary treatment in a median of 2 cases, while in the family physicians’ group, in a median of 4 cases.