Make Treatment Plans Research Articles

Evaluation of influence factors on the width, length, and width to length ratio of the maxillary central incisor: A systematic review and meta-analysis.

The aim of this study was to analyze whether symmetry of left and right sides, gender, measuring method, and ethnicity have influences on width (W), length (L), and width to length ratio (W/L) of the maxillary central incisor (MCI) and provide a reference for dental treatment planning in the esthetic zone. An electronic search was conduct of the dental literature. Studies reporting data about measurements were included. Data were extracted and analyzed for the differences between left and right, male and female, different measuring methods, and ethnicities by Review Manager and Stata statistical software. Seventeen studies were included. There were no differences between measurement of the left and right groups, perceived and actual measuring groups. However, differences were found between genders in MCI's W and L but no difference in W/L. Differences were also found between Asians and Caucasian subjects in MCI's W, L, and W/L. The results of this meta-analysis suggest that symmetry of left and right sides and measuring method do not influence MCI dimension. Gender and ethnicity are found as influence factors for MCI dimension. We believe these findings can be helpful for dentists to decide and design the dimensions of the restorations for maxillary anterior teeth in clinical practices. In the process of designing maxillary anterior teeth for implantation, the contralateral MCI can be helpful to create a symmetrical esthetic restoration. For patients with maxillary anterior tooth loss or diastemas, dentists should divide the left and right space equally and keep the MCI contact area aligned with the midline. Dentists should take face size and gender into consideration when making treatment plans for the MCI. Facial parameters as well as the size ratios of the previous teeth can be evaluated and may influence the size and shape of the teeth. When measuring anterior teeth or facial dimensions for esthetic evaluation, the recommended method is to measure the perceived sizes of a facial view image created by a digital camera. Slight discrepancies may exist between the actual and measured values due to the curvature of the arch and the angle in which the photograph was taken.

The current status of pharmaceutical care provision in tertiary hospitals: results of a cross-sectional survey in China

BackgroundPharmaceutical care is attached with increasing importance around the world due to its clinical and economical effects. Tertiary hospitals are equipped with the richest healthcare resources and pioneer in the implementation of pharmaceutical care. Understanding current status of pharmaceutical care provision in tertiary hospitals not only helps to improve the practice in tertiary hospitals but also guide the development of pharmaceutical care in secondary and primary health institutions.MethodData of a cross-sectional survey were used. The cross-sectional survey was conducted from July 2015 to June 2016, involving 520 hospital directors, 740 clinical pharmacists, 1298 physicians, 778 dispensing pharmacists and 3096 patients from 292 hospitals of 23 provinces, 4 municipalities in mainland China. The survey aimed to comprehensively investigate the current status of pharmaceutical care and health care professional’s understanding of clinical pharmacist system in tertiary hospitals. This study reports results pertaining to current status of pharmaceutical care, including pharmacy department practice rules, guidelines and records, application of rational drug use software, staffing and working arrangement of clinical pharmacists and physicians, patients’ satisfaction toward pharmaceutical care.ResultsA majority of the tertiary hospitals established clinical pharmacist system (84.2%), clinical pharmacist management rules (89%), clinical pharmacists’ working ethics (89%) and applied clinical rational drug use software (93.8%). However, a number of hospitals did not establish a performance evaluation system (37%) and payment rules for pharmaceutical care (81.9%). Most of the clinical pharmacists met the educational background set by the government. Averagely there were 8.3 clinical pharmacists per hospital and 90.7% of the tertiary hospitals had at least five full-time clinical pharmacists. Pharmaceutical care services provided include checking prescriptions, making treatment plans and joining clinical rounds and etc. Both physicians and patients were generally satisfied with pharmaceutical care services provided.ConclusionChina has made progress in pharmaceutical care provision, but problems such as lack of rules for pharmaceutical care payment and a performance evaluation system, a monotonous variety of pharmaceutical care activities remain unsolved. Policy makers and hospitals directors are suggested to pay more attention to these problems.

Stress related to electronic health record (EHR) use among oncology trainees: A quality improvement study to optimize information gathering.

11015 Background: Poor EHR usability is associated with physician burnout [1]. Oncology providers are tasked with coordinating data from multiple sources/tabs within an EHR (biomarkers, genetic data, imaging, etc.) to make treatment plan decisions. It is hypothesized that oncology trainees will have decreased stress using an EHR tool to optimize data gathering. Methods: This single-institution quality improvement study aims to decrease the time and stress associated with navigating the EHR to review/document laboratory data among first-year clinical oncology fellows rotating on consult services at The Mount Sinai Hospital as measured by self-reported survey data. An EHR tool was built that pulls into the note a drop-down list of user-selectable laboratory panels grouped according to hematologic/oncologic disease presentations. A survey was sent to all fellows in the program to assess attitudes toward the EHR. All 1st-year fellows were given access to the EHR tool as they are the ones who primarily rotate on consult services. After 3 months, a follow-up survey was sent to 1st-year clinical fellows to assess satisfaction with the EHR intervention. Results: For the baseline survey, there are a total of 17 respondents (response rate 77%). 70.6% of fellows believe using the EHR increases their level of stress. The most prevalent reasons cited for frustrations with the EHR are “Hard to read other providers’ notes” (82.4%), “Gathering information from multiple different pages” (76.5%), “Increased documentation requirements” (76.5%), “Inability to quickly navigate the system” (64.7%). For the follow-up survey targeting 1st-year fellows, there are a total of 6 respondents (response rate 100%). 5 fellows tried the EHR tool at least once. Of those 5 fellows, 100% use it daily in clinical practice while on consult services, believe it makes notes more legible, believe it saves time spent in chart review, and believe it decreases their stress associated with navigating the EHR. Conclusions: A majority of clinical oncology fellows believe that the EHR contributes to their stress. The reasons cited suggest that interventions that optimize note-writing and chart-reviewing may decrease stress. The majority of fellows who used this EHR tool believe the tool improved their efficiency and stress levels. This suggests more widespread use of this tool among oncology clinicians may contribute to wellness although further studies to increase utilization must be taken.

Exosomal TUBB3 mRNA expression level to predict prognosis for abiraterone treatment in metastatic prostate patients.

244 Background: TUBB3 (Class III β-tubulin), a dynamic component of microtubules, is considered a prognostic biomarker of tumor aggressiveness and poor survival. Previous studies have researched into its indication of resistance to chemotherapeutic drugs. However, its association with abiraterone, a next-generation androgen-axis targeting drug in prostate cancer has not been studied yet. In this study, we aimed to find out if exosomal TUBB3 expression could predict the efficacy of abiraterone in metastatic prostate cancer patients. Methods: Blood samples of metastatic prostate cancer patients during different disease stages were collected. We isolated the exosomes and extracted the RNA for analysis of TUBB3 by ddPCR. Absolute target mRNA concentration was measured by ddPCR as copies per milliliter (copies/20ul). Clinical data were collected for all patients. Primary study endpoint was progression-free survival (PFS). Statistical analyses were performed with SPSS 25.0. Results: A total of 54 metastatic prostate cancer patients who have received abiraterone treatment were enrolled. Baseline characteristics are comparable between high (≥10 copies/20ul) and low (<10 copies/20ul) TUBB3 expression groups. Univariate analyses revealed that baseline hemoglobin≤120g/L, baseline sodium concentration >140 mmol/L, baseline potassium concentration >4.39 mmol/L and high exosomal TUBB3 expression were associated with shorter PFS, while only baseline sodium concentration and exosomal TUBB3 expression were independent prognosticators in multivariate analyses. In subsequently subgroup analyses, high exosomal TUBB3 expression demonstrates particularly high hazard ratio in multiple subgroups (patients younger than 70 years old, without neuroendocrine differentiation and immunohistochemical androgen-receptor splice variant 7 expression, with baseline PSA >100 ng/mL, and patients receiving abiraterone as first-line therapy). Conclusions: Exosomal TUBB3 expression has potential in making treatment plan and predict prognosis in metastatic prostate cancer patients. High exosomal TUBB3 expression indicates poor response to abiraterone, especially as first line therapy.

Convolutional Neural Networks With Intermediate Loss for 3D Super-Resolution of CT and MRI Scans

Computed Tomography (CT) scanners that are commonly-used in hospitals and medical centers nowadays produce low-resolution images, e.g. one voxel in the image corresponds to at most one-cubic millimeter of tissue. In order to accurately segment tumors and make treatment plans, radiologists and oncologists need CT scans of higher resolution. The same problem appears in Magnetic Resonance Imaging (MRI). In this paper, we propose an approach for the single-image super-resolution of 3D CT or MRI scans. Our method is based on deep convolutional neural networks (CNNs) composed of 10 convolutional layers and an intermediate upscaling layer that is placed after the first 6 convolutional layers. Our first CNN, which increases the resolution on two axes (width and height), is followed by a second CNN, which increases the resolution on the third axis (depth). Different from other methods, we compute the loss with respect to the ground-truth high-resolution image right after the upscaling layer, in addition to computing the loss after the last convolutional layer. The intermediate loss forces our network to produce a better output, closer to the ground-truth. A widely-used approach to obtain sharp results is to add Gaussian blur using a fixed standard deviation. In order to avoid overfitting to a fixed standard deviation, we apply Gaussian smoothing with various standard deviations, unlike other approaches. We evaluate the proposed method in the context of 2D and 3D super-resolution of CT and MRI scans from two databases, comparing it to related works from the literature and baselines based on various interpolation schemes, using 2× and 4× scaling factors. The empirical study shows that our approach attains superior results to all other methods. Moreover, our subjective image quality assessment by human observers reveals that both doctors and regular annotators chose our method in favor of Lanczos interpolation in 97.55% cases for an upscaling factor of 2× and in 96.69% cases for an upscaling factor of 4×. In order to allow others to reproduce our state-of-the-art results, we provide our code as open source at https://github.com/lilygeorgescu/3d-super-res-cnn.

CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario

CanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis–free survival (DMFS) of more than 95% was observed with significant separation (P < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.

Automatic Diagnosis Based on Spatial Information Fusion Feature for Intracranial Aneurysm.

Timely and accurate auxiliary diagnosis of intracranial aneurysm can help radiologist make treatment plans quickly, saving lives and cutting costs at the same time. At present, Digital Subtraction Angiography (DSA) is the gold standard for the diagnosis of intracranial aneurysm, but as radiologists interpret those imaging sequences frame by frame, misdiagnosis might occur. The utilization of computer-aided diagnosis (CAD) can ease the burdens of radiologists and improve the detection accuracy of aneurysms. In this article, a deep learning method is applied to detect the intracranial aneurysm in 3D Rotational Angiography (3D-RA) based on a spatial information fusion (SIF) method, and instead of a 3D vascular model, 2D image sequences are used. Given the intracranial aneurysm and vascular overlap having similar feature in the most time, rather than focusing on distinguishing them in one frame, the morphological differences between frames are considered as major feature. In the training data, consecutive frames of every imaging time series are extracted and concatenated in a specific way, so that the spatial contextual information could be embedded into a single two-dimensional image. This method enables the time series with obvious correlation between frames be directly trained on 2D convolutional neural network (CNN), instead of 3D-CNN with huge computational cost. Finally, we got an accuracy of 98.89%, with sensitivity and specificity of 99.38% and 98.19%, respectively, which proves the feasibility and availability of the SIF feature.

Prevalence of sexual dysfunction in patients receiving psychotropic medications

Introduction: Sexual dysfunction is a known adverse effect of psychotropic medications. Even though sexual difficulties are common in patients taking psychotropic medications; very few studies have been carried out in India. Objective: To study the prevalence and nature of SD among patients with mental illness receiving psychotropic medications under routine clinical condititions. Materials and Methods: This study was cross sectional hospital based study conducted at tertiary care hospital, Maharashtra, India. The study used a convenience sample selected during the outpatient unit of psychiatry department. The study sample consisted of 53 married male patients who presented with psychiatric illness as diagnosed by DSM-V criteria. Psychotropic- Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX)19, was used to assessed the participants sexual functioning. Results: Study sample consist of 53 married male patients, the mean age of study sample was 36.74 years, out of which most of the patients were from rural (64.2%) area. The results reveal that when there is exposure to psychotropic in the patient, changes are noticed in the sexual activity. Sexual dysfunction was highest in the antipsychotic group compared to others. Conclusion: Psychotropic- induced sexual dysfunction is very common among patients receiving antipsychotics medication. Clinicians should be aware about this while prescribing psychotropic medications and should make treatment plan to manage psychotropic- induced sexual dysfunction for better outcomes and patient’s compliance to treatment. Keywords: Mental illness psychotropics sexual dysfunction

Abstract 3535: Identification of multiple hepatocellular carcinoma using genomic approach

Abstract Multiple hepatocellular carcinoma (HCC) is categorized into two types; multicentric hepatocarcinogenesis (MC) and intrahepatic metastasis (IM). Although clinical discrimination of the types of multiple HCC has been proposed, it is quite difficult to determine it correctly even after histological diagnosis. In order to diagnose multiple HCC as MC or IM, we compared pairs of multiple HCC samples from 60 patients with multiple HCC and 2 patients with pairs of primary HCC and extrahepatic metastasis such as adrenal grand and lung metastasis with regard to molecular aberrations. Exome or capture sequences showed that more than 70% of somatic mutations were common in the pairs of IM, which were consistent with the result of a pair of primary HCC and extrahepatic metastasis, while no common somatic mutations was detected in genomic MC pairs. Notably, more than 60% of patients who were clinically diagnosed metachronous MC were genetically IM due to the concordance of mutation and shows significantly frequent tumor thrombus, suggesting that genomic IM pairs developed from the common ancestor. Epigenetically, methylation profiles were similar in a pair of IM, while those of MC were different each other. Consequently the accuracy of clinical diagnosis of multiple HCC was only 53.3%. In addition, cell-free DNA was analyzed using exome sequence in five patients with recurrent HCC, and found that somatic mutations of cell free DNA were similar to the primary HCC only in genomic IM but not in genomic MC cases. Intriguingly, overall survivals of patients with clinical IM was significantly shorter than those with clinical MC, while overall survivals of patients with genomic IM and genomic MC were almost similar. Taken together, comparison of mutations in a pair of HCCs makes it possible to classify multiple HCC into MC and IM, which is difficult to be correctly determined in clinical practice. In addition our data showed that it is not clinically important to determine the types of multiple HCC. Furthermore liquid biopsy for mutation analysis is available to make treatment plans for multiple HCC patients. Citation Format: Yutaka Midorikawa, Shogo Yamamoto, Kenji Tatsuno, Hiroki Ueda, Tadatoshi Takayama, Hiroyuki Aburatani. Identification of multiple hepatocellular carcinoma using genomic approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3535.

Computed Tomography-Guided Biopsy Assisted by 18F-FDG Coincidence Imaging for Solid Tumours

Objective: Early diagnosis of solid tumour is the key to making treatment plans. The traditional computed tomography (CT)-guided percutaneous biopsy often makes it difficult to determine the puncture point. The aim of this study is to analyze the collaborative application value of CT-guided biopsy assisted by 18F-FDG coincidence imaging for solid tumours. Methods: A retrospective analysis of 15 patients who underwent routine radiological examination can not form a correct diagnosis on body solid tumour. The needle was introduced under CT guidance in a step-by-step technique and correct needle position in the centre of FDG high concentration area in coincidence imaging. The biopsy specimens were examined under light microscopy and immunofluorescence. Result: All the lesions were successfully punctured, and the final diagnosis was malignant in 14 cases and benign in 1 cases. The sensitivity of CT-guided biopsy assisted by coincidence imaging was 92.9% (13/14), and the specificity was 100% (1/1). Compared with clinical final diagnosis, there was no significant difference between the two groups (P &gt;0.05). Two cases of lung biopsy patients had a small amount of blood in sputum after operation. Conclusion: The CT-guided biopsy assisted by 18F-FDG coincidence imaging may improve the diagnostic capability, especially in cases when a definitive diagnosis by imaging alone is difficult to make.

Review on Gender Difference in HSB and PTG after Natural Disaster

Millions of people are affected by the natural disasters in different regions of world. Survivors often witnesses prolong psychological distress by the death of loved one, damage of property, injuries and shortage of basic need. However, individual differences occur in their struggle with trauma, they also manifest positive change which is known as Post traumatic growth (Kleim &amp; Ehlers, 2009). This growth can occur in both male and female survivors, findings of researches are inconsistent.&#x0D; Help seeking behaviour refers to person’s communication to seek guidance and support for treatment either formally from the professionals or informally. Researches on HSB show few trends. Young people and female seek help informally before they ask for the formal help whereas male try to avoid seek help at first (Benson, 1990; Offer, Howard, Schonert, &amp; Ostrov, 1991; Rickwood &amp; Braithwaite, 1994).&#x0D; As per authors knowledge there is no published study available on gender role in help seeking behavior and PTG in natural disaster. The purpose to conduct this review article is to fill this gap in the literature. Furthermore, this will determine a role gender can play when seeking help and developing PTG and will help professionals to make treatment plans for different genders according to their needs.&#x0D;

Predicting Invasive Disease-Free Survival for Early-stage Breast Cancer Patients Using Follow-up Clinical Data.

Chinese women are seriously threatened by breast cancer with high morbidity and mortality. The lack of robust prognosis models results in difficulty for doctors to prepare an appropriate treatment plan that may prolong patient survival time. An alternative prognosis model framework to predict Invasive Disease-Free Survival (iDFS) for early-stage breast cancer patients, called MP4Ei, is proposed. MP4Ei framework gives an excellent performance to predict the relapse or metastasis breast cancer of Chinese patients in 5 years. MP4Ei is built based on statistical theory and gradient boosting decision tree framework. 5246 patients, derived from the Clinical Research Center for Breast (CRCB) in West China Hospital of Sichuan University, with early-stage (stage I-III) breast cancer are eligible for inclusion. Stratified feature selection, including statistical and ensemble methods, is adopted to select 23 out of the 89 patient features about the patient' demographics, diagnosis, pathology and therapy. Then 23 selected features as the input variables are imported into the XGBoost algorithm, with Bayesian parameter tuning and cross validation, to find out the optimum simplified model for 5-year iDFS prediction. For eligible data, with 4196 patients (80%) for training, and with 1050 patients (20%) for testing, MP4Ei achieves comparable accuracy with AUC 0.8451, which has a significant advantage (p < 0.05). This work demonstrates the complete iDFS prognosis model with very competitive performance. The proposed method in this paper could be used in clinical practice to predict patients' prognosis and future surviving state, which may help doctors make treatment plan.

Outcome assessment of apical surgery: A study of 234 teeth

Apical surgery is an option for management of endodontically-treated tooth with persistent periapical lesions or symptom and sign. The objective of this study was to investigate the correlation between the demography, preoperative, postoperative factors and healed rate of apical surgery. Subjects were retrospectively collected from patients who received apical surgery/apicoectomy at the Endodontic Department, National Taiwan University Hospital from January 2013 to June 2015. The standard apical surgery procedures were performed. The demography, preoperative clinical and radiographic examination data as well as postoperative variables were collected. The outcome assessment was carried out after surgery. Statistical analysis was performed by chi square test to evaluate the potential outcome predictors. Total 187 patients and 234 teeth receiving apical surgery were included. 53 male and 134 female patients were collected. The age was ranged between 17 and 89 years old and the mean age was 43.64 years old. Better healed rate with significant differences were observed in female patient (p<0.05), age≤60 years old (p<0.01), preoperative root canal filling material>2mm short of apex (p<0.01), lesion size from ≤2mm to≤12mm (p<0.05) and follow-up period≧12 months (p<0.01) groups. Gender, age, preoperative root canal filling material extent, lesion size and follow-up period may affect the outcome of apical surgery. Tooth type, post, prosthesis, and lesion area showed no marked effect on apical healing. These results provide more detailed information for the clinical practitioners to make treatment plans and are important for clinical endodontic practices.

Frailty in geriatric head and neck cancer: A contemporary review

To provide a summary of the current frailty literature relating to head and neck cancer. Ovid MEDLINE, PubMed, Google Scholar. A comprehensive review of the literature was performed from 2000 to 2017 using key words frailty, elderly, geriatric, surgery, otolaryngology, head and neck cancer. The aging population has led to an increased diagnosis of head and neck cancer in elderly patients. The prevalence of comorbidities, disabilities, geriatric syndromes and social issues can make treatment planning and management in this population challenging. Chronological age alone may not be the optimal approach to guiding treatment decisions, as there is marked heterogeneity amongst this age group. Individualization of treatment can be achieved by assessing for the presence of frailty, which has growing evidence as an important marker of health status in geriatric oncology. Frailty is a complex geriatric syndrome characterized by a state of increased vulnerability to stressors and is associated with morbidity, mortality, and treatment toxicity. Screening for frailty may provide an efficient method to identify those who would benefit from further assessment or pretreatment optimization, and to provide prognostic information to assist clinicians and patients in formulating the most ideal treatment plan for the elderly individual with head and neck cancer. Frailty has emerged as an important concept in geriatric oncology, with wide significance in head and neck cancer. Incorporating frailty assessments into clinical practice may provide otolaryngologists pertinent information regarding health status and outcomes leading to optimal care of the elderly cancer patient. Laryngoscope, 128:E416-E424, 2018.

Accuracy and Reliability of Radiographic Estimation of Volar Lip Fragment Size in PIP Dorsal Fracture-Dislocations

Background: A cadaveric study was performed to evaluate the accuracy and reliability of radiographic estimation of the volar lip fragment size in proximal interphalangeal joint fracture-dislocations. Methods: Middle phalangeal base volar lip fractures of varying size and morphology were simulated in 18 digits. Radiographs and digital photographs of the middle phalangeal joint surface were obtained pre- and postinjury. Ten orthopedic surgeons of varying levels of training estimated the fracture size based on radiographs. The estimated joint involvement on radiograph was compared with the digitally measured joint involvement. Results: Radiographic estimation underestimated the volar lip fragment size by 9.02%. Estimations possessed high intraobserver (0.76-0.98) and interobserver (0.88-0.97) reliabilities. No differences were detected between levels of surgeon training. Conclusions: The significant underestimation of the volar lip fragment size demonstrates the lack of radiographic estimation accuracy and suggests that surgeons should be mindful of these results when making treatment plans.

How do health care workers manage a patient with multiple care needs from both health and social care services? - A vignette study.

IntroductionTo assess how health care professionals outline the management of care and explore which health or social care professionals were involved in the patient's treatment.MethodsA survey with a patient vignette for general practitioners (n = 31) and registered nurses (n = 31) working daily in Finnish health centres located in four cities. Respondents answered structural questions and explained in detail the care process that they tailored for the patient. The care process was examined using content analysis.ResultsA physician–nurse working pair was declared to be in charge of the care process by 27% of respondents, a registered nurse by 9% and a general practitioner by 11%. However, 53% reported that no single person or working pair was in charge of the care process (response rate 72%). The concluding result of the analyses of the presented process was that both treatment practices and the professionals participating in the patient's treatment varied. Collaboration with social services was occasional, and few care processes included referrals to social services.ConclusionFor the patient who needs both health and social care services, the management of care is a challenge. To improve the chances of patients being actively involved in making treatment plans at least three factors need to be addressed. Firstly, a written treatment plan should explicate the care process. Second, collaboration and interaction between health and social care services should be strengthened, and third, a contact person should be named to avoid care gaps in primary health care. Next-step data from patients need to be collected to get their views on care management and compare these with those from general practitioners and registered nurses.

Abstract 4392: Genetic diagnosis of multiple hepatocellular carcinoma

Abstract Multiple hepatocellular carcinoma (HCC) is categorized into two types; multicentric hepatocarcinogenesis (MC) and intrahepatic metastasis (IM). Although discrimination of the types of multiple HCC is of clinical importance, it is quite difficult to determine it correctly even after histological diagnosis. In order to determine multiple HCC as MC or IM, we compared pairs of multiple HCC samples from 40 patients with multiple HCC and 2 patients with pairs of primary HCC and extrahepatic metastasis such as adrenal grand and lung metastasis with regard to molecular aberrations. Exome sequence showed that more than 70% of somatic mutations were common in the pairs of IM, which were consistent with the result of a pair of primary HCC and extrahepatic metastasis, while no common somatic mutations was detected in genomic-MC (gMC) pairs. Notably, more than 60% of clinically metachronous-MC cases were diagnosed as genomic-IM (gIM) due to the concordance of mutation and shows significantly frequent tumor thrombus, suggesting that gIM pairs developed from the common ancestor. In addition, cell-free DNA was analyzed using exome sequence in five patients with recurrent HCC, and found that somatic mutations of cell free DNA were similar to the primary HCC only in gIM but not in gMC cases. Taken together, comparison of mutations in a pair of HCCs makes it possible to classify multiple HCCs into MC and IM, which is difficult to be correctly determined in clinical practice. Furthermore liquid biopsy for mutation analysis is available to make treatment plans for multiple HCC patients. Citation Format: Yutaka Midorikawa, Shogo Yamamoto, Kenji Tatsuno, Hiroki Ueda, Shingo Tsuji, Genta Nagae, Tadatoshi Takayama, Hiroyuki Aburatani. Genetic diagnosis of multiple hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4392. doi:10.1158/1538-7445.AM2017-4392

Multiple Low Flow Vascular Malformation with Phleboliths – A Case Report

: Objective: Venous malformation involving head and neck region is a rare entity. Hence, application of precise and leading diagnostic techniques, gives the accurate localization of the source vessel allowing for making treatment plan more satisfactory. Methods: We present a case of 30-year-old male patient with venous malformation involving head and neck region. We update the review of literature and also discuss the leading diagnostic aids for this rare entity disease so that iatrogenical accidents can be lessened. Case description: Our patient presented with solitary swelling in the left lower cheek region, left side of lateral border of tongue and 2 – 3 small nodular swellings at the lateral border of the neck, lined obliquely over the sternocleidomastoid muscle. All the swellings were soft in consistency and non-tender, with no rise in temperature except for the swelling on the tongue. The lesion was confirmed by a radiograph which showed phleboliths. The ultrasound shows heterogeneously hypoechoic with multiple anechoic sinusoidal spaces (longitudinal plane) with mild vascularization and spectral analysis shows monophasic venous flow. This was later confirmed by direct puncture venography of the left cheek. Conclusion: The spectrum of vascular malformations is too vast; hence it becomes challenging to diagnose the lesion and fit it in the spectrum. These lesions are termed as intramuscular venous malformations based on clinical imaging and pathologic criteria and hence dentists must be aware of the clinical expression of these lesions in order to prevent iatrogenically related accidents and to minimize potential spontaneous crises for the patient. Having said that and keeping in mind the broad spectrum of vascular malformation, we present a clinically well diagnosed case of venous malformation, which illustrates phleboliths.Key words: Venous malformations (VMs), Arteriovenous malformation (AVM), Phleboliths, sclerotherapy, Venography and Hemangioma.

Variability of treatment planning of seed implantation: A Japanese multicenter simulation study

PurposeThis multicenter study was conducted to evaluate the current variability of treatment planning of seed implantation in Japanese centers and the feasibility of two virtual trials. Methods and MaterialsTwo types of contour data were sent to 12 radiation oncologists with a request letter that asked them to make treatment plans on the data in the same manner as in their own practice. Five of the 12 radiation oncologists were asked to participate in the two virtual trials in which the D90 (dose to the hottest 90% of prostate volume) was 1) required to be set at just 180 Gy and 2) increased as much as possible without violating other limitations. ResultsA relatively high dose with a small deviation was irradiated to the prostate in Japanese centers (mean D90 = 188 Gy; SD = 10 Gy). In the virtual trials, all five physicians could achieve 180 Gy for the D90 with a very small deviation, although the urethral dose showed relatively large deviations. Dose escalation without increase of urethral dose or V150 was difficult, although the rectum could be spared by most of the physicians. ConclusionOur study showed a relatively high dose with a small deviation was prescribed to the prostate in Japanese centers. Consolidated protocols such as D90 = 180 Gy could be available for future trials. Meanwhile, our study suggested that some cautions might be needed for urethral dose and the V150, even when a relatively low D90 was requested.

URGENCY OF INTEGRATED ASSESSMENT ON DRUGS CRIME (A Study in Purbalingga Regency)

Various rules are formulated to repress the drug abuser and trafficking, one of which is through integrated assessment. The paper explains the philosophy of integrated assessment and implementation of the integrated assessment in Purbalingga Regency. This research is empirical by applying methods of survey, observation, interview and literature review. Data were collected and analyzed qualitatively by descriptive analysis. Based on the research result, integrated assessment is a mechanism designed to differentiate drug abusers and addicts from drug traffickers and also to make treatment plan for the drug addicts and drug abusers. In Purbalingga, integrated assessment has been implemented since 2015. Yet practically several obstacles are identified including assessment request and assessment result is overdue issued, lack of coordination among Integrated Assessment Team, secretary facilities of Integrated Assessment Team is not adequate, infrastructure of rehabilitation place is limited and the programs of rehabilitation do not procedurally run.Key words: Integrated Assessment, Drugs Crime, Penal Meditation