5^th International Conference on Neuro-Oncology and Brain Tumor August 14-15, 2019 Tokyo, Japan

Biography:

Lynnette Lyzwinski is pursuing her PhD in Medicine at the School of Medicine at University of Queensland in the Department of Psychiatry and the Centre for Online Health. Her research interests include clinical trials and health promotions behaviors for promoting mental well-being and reducing lifestyle behavioral risk factors. She has special interests in mHealth, mindfulness and lifestyle medicine.

Abstract:

Background: University students are at risk of weight gain during their studies. Key factors related to weight gain in this population include unhealthy weight related behaviors due to stress. Mindfulness holds promise for weight management. However, there has not been a previous trial that has explored the effectiveness of a student-tailored mindfulness app for stress, weight related behavior’s and weight. There is limited evidence that current mindfulness apps use evidence-based mindfulness techniques. A novel app was developed that combined evidence-based mindfulness-based stress reduction and mindful eating techniques that were tailored to university students, with student relevant themes for targeting weight behavior’s, weigh and stress.

Method: A two arm Randomized Controlled Trial (RCT) of 11 weeks duration was undertaken at the University of Queensland. Students were randomized to the mindfulness app (N=45) or to a behavioral self-monitoring electronic diary (e-diary) (N=45) for diet and exercise. Analysis of covariance was used to compare differences in weight, stress, mindfulness, mindful eating, physical activity and eating behaviors between both groups.

Results: Neither the mindfulness app group nor the e-diary group lost weight nor there were no differences between groups at follow-up. The mindfulness app group had significantly lower stress levels (adherers only), lower emotional eating and uncontrolled eating as well as higher mindfulness and mindful eating levels overall (p-values<0.05). The e-diary group had Higher Metabolic Equivalents (MET) of moderate activity levels (p-value<0.05). However, the effect sizes were small. Regular adherence to the mindfulness exercises in the app was low in the group. The majority of students (94%) liked the app and found it to be acceptable. The most helpful reported meditation was the short breathing exercise observing the breath (39.5% preferred it) compared with other exercises.

Conclusion: A mindfulness app demonstrated effectiveness for stress, eating behaviors, mindfulness as well as mindful eating but the effect sizes were small. Future studies should be conducted over longer periods of time and with greater participant compliance.

Biography:

Ankita Gupta is Senior Resident at Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Abstract:

This prospective study was conducted to investigate the impact of prophylactic Granulocyte-Colony Stimulating Factor (G-CSF) on acute hematological toxicity and treatment interruptions in patients of medulloblastoma receiving Craniospinal Irradiation (CSI). Patients of medulloblastoma post-surgical excision were given CSI in a dose of 36 Gy at 1.8 Gy per fraction and concurrent vincristine along with biweekly administration of G-CSF in a dose of 15 mg/kg, followed by a Posterior Fossa (PF) boost of 18 Gy. Weekly hemogram was performed for documentation of hematological toxicity and resultant treatment interruptions were noted. The results were compared with historical controls from a retrospective analysis conducted at our institute. A total of 28 patients were included in the study. Hematological toxicity was observed in 11 (39.3%) patients, of which grade 3 and grade 2 toxicities were seen in 10 and 1 patients respectively (RTOG). All these patients suffered breaks in CSI. Of these, interruptions lasting for more than 5 days were observed only in 2 (7.6%) patients. This is well below the results from our previous analysis when patients did not receive prophylactic G-CSF during CSI and 73.1% suffered treatment breaks due to hematological toxicity. We also observed that younger age (<10 years) was significantly associated with the development of hematological toxicity (p=0.028, Chi-Square), while no correlation was obtained with pre-treatment blood counts. The interim results of this study suggest that prophylactic application of G-CSF during CSI for medulloblastoma results in lower hematological toxicity and hence, less treatment interruptions. Recruitment is ongoing and whether this approach translates into improved treatment efficacy will be confirmed after the final results with longer follow-up are obtained.

Biography:

Loreto Yanez is a Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Use of Stereotactic Radiosurgery in the Treatment of Adults With Metastatic Brain Tumors. Graber, J. et al.

Abstract:

In Santiago the first cyberknife equipment (model M6) was installed at Fundación Arturo López Pérez in 2016. The first patient was treated on March 21, 2016. Cyberknife radiosurgery has been done in intra and extracranial targets. Interestingly three cases have been young adults (mean 35 years old, 2 female one man) with the diagnosis of cervical schwannomas. None of them has stigmata or diagnosis of neurofibromatosis. Two patients had a confirmatory biopsy. Since this treatment has not very extensible been published in the literature the aim of this work is to review the pathogenesis, incidence, diagnosis, radiology characteristics and treatment of spinal schwannomas and the possible indications, therapeutic doses and results of radiosurgery. For this complicated surgical location, radiosurgery presents as a reasonable and safe option for patients with symptomatic or enlarging schwannomas, clinically effective.

Biography:

Erika Berggren is currently working as a Health Care Development Leader at the Academic Primary Health Care Centre, Stockholm County Council and affi liated with Karolinska Institute's Department of Neurobiology, Care Sciences and Society.

Abstract:

Primary health care professionals can fi nd it diffi cult to participate in continuing education despite their need for up-to-date knowledge. Suitable models for addressing this problem are rare. Th is study aimed to evaluate a continuing educational model tailored for primary health care circumstances (ConPrim). Th e model considers the need for inter-professional education to facilitate teamwork; pedagogical theory and methods to achieve a deeper level of understanding; and content adapted to the circumstances of primary health care to help fi ll knowledge gaps and make attendance more attractive. ConPrim consists of three steps that build on each other: a web-based program, a practical exercise, and a case seminar. Th is study tested ConPrim by using it to develop and evaluate an intervention in the subject “Nutritional care of patients cared for at home.” District nurses/registered nurses and general practitioners/physicians (n=87) working with home care at 10 primary health care centers in Stockholm, Sweden, completed a post-intervention questionnaire about the model. Th e professionals found the design attractive and user-friendly and the pedagogical methods to promote inter-professional and interactive learning. Th ey rated the time spent as acceptable for all parts except the practical exercise; found the design suitable to primary health care; and thought the intervention increased their knowledge about a subject they viewed as useful and relevant to their work. ConPrim seems well-suited for continuing inter-professional education in primary health care. Future studies could test the model in other subject areas where there is a gap between evidence-based knowledge and practice.

Biography:

Lena Lund has completed PhD in Medical Science from Karolinska Institute in 2015. She is currently working as a Head of the Lifestyle Unit at the Academic Primary Health Care Centre in Stockholm.

Abstract:

Chronic Obstructive Pulmonary Disease (COPD) is mostly caused by smoking and patients’ prognoses are related to whether or not they continue to smoke aft er diagnosis. Quitting is therefore crucial to COPD treatment, but many patients fi nd it difficult to stop smoking. To investigate which factors infl uence quit attempts among patients with COPD, our research groupinterviewed smokers with COPD to identify factors associated with success in quitting. Th  ese factors were used to develop the.Trying to quit smoking Questionnaire (TTQ), which measures pressure-fi lled mental states, use of destructive pressure-relief strategies and ambivalent thoughts about quitting. Th is study evaluated whether the TTQ could predict smoking cessation outcomes in smokers with COPD. One hundred and nine smokers completed the TTQ at baseline and three months later. Logistic regression was used to measure the association between TTQ scores and making at least one quit attempt, reducing the intensity of smoking, and achieving abstinence. Higher total TTQ scores were signifi cantly associated with a lower probability of at least one quit attempt. In a secondary analysis, we found that patients who were ready to make a quit attempt but also experienced pressure-fi lled mental states had a lower probability of attempting to quit. However, patients who did not feel ready to quit and who simultaneously experienced pressure-fi lled mental states halved the number of cigarettes they smoked. Th e TTQ can identify specifi c mental processes related to success in quitting and can be useful when counselling patients with COPD who need to quit smoking.

Biography:

Liisa Samuelsson has completed her MSc in Medical Science at Karolinska Institute in 2017. She works as a Health Care Development Leader in the fi eld of nutritional care, developing and providing continuing professional education for primary health care personnel in Stockholm County.

Abstract:

In 2011, the Stockholm County Council gave District Nurses (DNs) the right to prescribe Oral Nutritional Supplements (ONS). DNs are registered nurses who have completed an additional year of specialist education in primary care. Th e council charged the academic primary health care center with developing a course that would give DNs the knowledge they needed and the right to prescribe ONS. A group at the center used the Structure of the Observed Learning Outcome (SOLO) taxonomy to design a two-and-a-half-day course that covers identifying and analyzing older patients’ nutritional problems, planning and carrying out nursing care measures, prescribing ONS and following up and evaluating the measures. Th is questionnaire study evaluated participants’ perceived nutritional care and actual level of knowledge about nutritional care before and aft er the course. A total of 493 district nurses in Stockholm County participated in the course, which was given over a period of two to three months. Before and aft er the intervention, participants completed a study-specifi c questionnaire that covered their perceived nutritional care and actual level of knowledge. Th ere were signifi cant improvements in participants work with nutrition care and in their knowledge of all subject areas covered aft er the course (p=0.000-0.014). However, all participants did not fully achieve all learning objectives. DNs’ improvements as a result of the intervention lay the foundation for good nutritional care for older patients in primary care. Th e results have been used to improve the course, and an assessment of the revised course is ongoing.

Biography:

Abdullah Mohammad Al Fareed has graduated from College of Medicine from University-Imam Abdulrahman Bin Faisal University. He is currently pursuing his Pediatrics Hemato-Oncology Fellowship in King Fahad Specialist Hospital.

Abstract:

Embryonal tumors constitute approximately 15% of all primary CNS tumors occurring in patient less than 18 years old. The most common embryonal tumors are: Medulloblastoma (MB) (62%), Atypical Teratoid Rhabdoid Tumors (ATRT) (15%), CNS Primitive Neuroectodermal Tumors (PNET) (14.9%), other embryonal tumors (8%). MB The most common malignant brain tumor of childhood occurs in the posterior fossa, like other embryonal tumors may metastasize either early or late in the disease course. The aim is to study the treatment outcome of medulloblastoma in children and adolescents treated at King Fahad Specialist Hospital Dammam from 2012 to 2016. The objective is to study the clinical symptoms and signs of medulloblastoma in our cohort, histopathological subtypes, evaluate approach to therapy (surgery, chemotherapy, and radiation therapy), to evaluate all the complications related to the disease and/or to the treatment, distribution and incidence of MB by sex, age and histologic types, calculate the relapse rate, correlation between the above points and the outcome, identify inherited syndromes associated with medulloblastoma in our cohort study. It’s a retrospective chart review for all children’s less than 16 years of age diagnosed with MB from January 2012 till December 2016. Survival curves were generated using Kaplan-Meier method. Overall Survival (OS) is defining as time from diagnosis until death from any cause. Event Free Survival (EFS) is defining as time from diagnosis until the occurrence of event. Events are failure to achieve remission, relapse, or death from any cause.

Biography:

Hyeong Cheol Moon is currently working as a Medical Physicist at Chungbuk National University Hospital. He has published more than 10 papers in reputed journals. He is interested in ultra-high field 7T MRI, quality assurance for gammaknife radiosurgery and artificial neural network.

Abstract:

Predictions of patient outcomes after radiotherapy are essential to medical practice with the neurosurgeon, oncologist and medical physicist. Stereotactic Radiosurgery (SRS) is commonly used for brain metastases that are 3 cm or smaller in maximum diameter. Fractionation was introduced that the total dose of radiation is divided into small doses over a period of several days; there are fewer toxic effects on healthy cells. However, LINAC-based SRS have reported some studies, but Gammaknife Radiosurgery (GKRS) based has been rarely reported. We employed neural network approach towards predicting the outcomes after hypo fractionated GKRS to large brain metastatic brain tumors (>3 cm). Features engineering in this database included standard clinical and GKRS treatments parameters. A neural network consists of feed-forward which is the most well-known many applications in the functional approximation and back-propagation network is used for training. Our training process was performed Keras tools of categorical cross-entropy in lost function and Stochastic Gradient Descent (SGD) for optimization. A learning rate of 1.0x10^-6. The best accuracy had around 95% and error under 0.05 in multi-layer neural networks. And single neural networks showed around 90% accuracy. This neural network approach was able to provide the best prediction of large brain tumor outcomes under hypo fractionated treatment. Furthermore, we could demonstrate a paradigm for personalized treatments for further development tools in medical care.

Biography:

Frank van de Goot is a registered Anatomical Pathologist and an expert witness in the field of forensic pathology. He studied Medicine and Anatomical Pathology at the VU University Medical Center in Amsterdam, The Netherlands, and Rechtsmedizin at the Zentrum für Rechtsmedizin in Frankfurt am Main, Germany. The first seven years of his career he worked both as a Forensic Pathologist at the Dutch Forensic Institute (NFI) in The Hague, The Netherlands and as an Anatomical Pathologist at the VU University Medical Center. He now works at Symbiant Pathology Expert Centre, where he is on a mission to improve forensic and autopsy education for both medical and non-medical students.

Abstract:

We report the case of a 57 years old, male patient. The patient was previously diagnosed with an small cell neuro-endocrine carcinoma of the lung for which he received treatment. The patient encountered sudden collapse with a short epileptic episode.

During routine scanning (CT/MRI brain) a circumscript lesion was found in the right frontal cerebral lobe. Biopsy revealed a small cell neuro-endocrine tumour. Immunohistochemistry revealed positivity for Synaptofysin, CD56 and TTF-1. Chromogranin was negative. Ki67 was highly expressed. Pankeratin was negative. The immune profiling was similar to the previously diagnosed lung process. Surprisingly GFAP was strongly positive as well.

Due to the GFAP expression, molecular profiling was performed.

This, leading undoubtedly to the conclusion that this was not a metastatic process from the lung but a strongly neuro-endocrine differentiated glioblastoma mimicking metastasis of a small cell lung carcinoma in a patient known with such a tumour.

This case is illustrative for the use of molecular profiling in brain tumours, even when it appears to be an “obvious” diagnosis.

MRI-scan revealed a small mass in the right frontal lobe, Due to its round structure a metastasis was suggested, but a primary brain tumour was not excluded due to the partly cystic appearance of the lesion. Diagnostic biopsy was advised.

H&E histology revealed a small cell pattern with massive necrosis, moulding and many mitosis. The pattern was similar to the previous process in the lung. However, not similar to the lung was the appearance of mild vascular proliferation.

 Conclusion and literature:

 Although this tumour had the initial appearance of metastasis of a pulmonary small cell neuro-endocrine carcinoma, additional molecular profiling prevented this unusual pitfall. Eventually the lesion appeared to be rare differentiation of a glioblastoma multiforme

Biography:

Bernadeth Lyn C Piamonte is a Neurology Resident at the University of the Philippines, Philippine General Hospital. She graduated cum laude at the University of the Philippines College of Medicine. She takes special interest in particular fields in neurology such as dementia and interventional neuroradiology.

Abstract:

Background: Among tumors of germ cell origin, the pure variant of testicular choriocarcinoma is extremely rare, accounting for 0.3% of testicular germ cell tumors and 0.19% of all testicular malignancies. About 10% of choriocarcinoma metastasizes to the brain, with tumor bleed being the most common cerebrovascular complication.

Case Presentation: We describe an unusual case of a 54-years-old male with pure testicular choriocarcinoma presenting not only with brain tumor hemorrhages, but also cerebral infarctions of varying ages on cranial imaging. Further workup also demonstrated metastatic lesions to the lungs and liver. Despite treatment with Cisplatin based systemic chemotherapy, he succumbed to febrile neutropenia and subsequently to septic shock.

Conclusion: The co-existence of brain tumor hemorrhages and infarctions in a patient with metastatic pure testicular choriocarcinoma is unusual and to the best of our knowledge, the first report of this kind in the literature. Early recognition of metastatic testicular choriocarcinoma by knowing such varied presentations allows for timely workup and subsequent pursuance of potentially life-saving treatments.

Biography:

Loreto Yanez is a Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Use of Stereotactic Radiosurgery in the Treatment of Adults With Metastatic Brain Tumors. Graber, J. et al.

Abstract:

Abstract

On March, 2016, the first Cyber knife M6 started Radiosurgery treatments at Fundación Arturo López Perez, in Santiago de Chile. This was the third facility in Chile with available radiosurgery in our country, the other centers have: Gamma knife (2) and LINAC based (1). Until April 2019, 309 patients have been treated, both intra and extra cranial. Intracranial cases comprehend the 51.6% of the cases, more than half of these were brain metastases. We present interesting neuro-cases to illustrate our experience.

Conclusion: Extra cranial treatment indications in our experience so far are scarce, information should be reinforced so that referal is expanded. This technique allows effective and safe treatments, widely demonstrated.

Biography:

Hsin-yu Chiang has completed her PhD at the age of 29 years from Boston University. She is an associate professor in Fu-Jen Catholic University. She has published more than 25 papers in international journals and has been serving as an editorial board member of different journal. 

Abstract:

Social perception (SP) is an ability to identify the rules, roles, and context in situations. SP has shown to associate with functional outcomes in people with schizophrenia and become a target of intervention. However, the currently-available measures of SP has two limitations: 1) most SP measures were developed decades ago, which makes some items out-of-date; and 2) the scoring of these SP measures may have been affected by examinee’ gender, but such impacts have not been controlled. The objectives are: 1) to create an up-to-date assessment for SP (ASP), and 2) to control the impacts of  gender on scoring. We developed the ASP based on its definition. We used Rasch analysis to calibrate the item difficulties and differential item functioning of sex (DIF of sex) of these SP items. The misfit items (infit or outfit mean square ≥ 1.4) and DIF items (DIF value ≥ 0.38) would be removed. A total of 236 patients were recruited in this study. After deleting the 7 DIF items (no misfit item was found), the remaining 26 items showed acceptable model fits (infit MNSQ = 0.90–1.14; outfit MNSQ = 0.79–1.22), supporting its construct validity. In addition, the removal of DIF items means the control of the impacts of gender on scoring, suggesting that the ASP can provide un-biased assessments for both genders. The distribution of item difficulties could cover the range of the patients’ SP levels (i.e., difference between the adjacent item difficulties was < 0.39), indicating that the ASP can be used in patients with various SP levels. The average Rasch reliability of these SP items were 0.68, suggesting the acceptable reliability. Our results reveal that the ASP serves as a reliable and valid assessment.

Biography:

Varanporn Panasittivana has completed her Master’s degree from Public Health, Mahidol University, Thailand. She is currently working at Ramathibodi Chakrinareubodindra Hospital and also the Head of Nurse at Intensive Care Unit, Faculty of Medicine, Ramathibodi Hospital, Thailand.

Abstract:

Caring and preventing complications of peripheral intravenous infusion in patient is crucial in ICU. Th is experimental development research designs was aimed at developing a working model for nursing patients with peripheral intravenous infusion at the medical intensive care unit. Th e research study was conducted from June 16 to September 15, 2017. Th e sample of work was care implementation for patients with peripheral intravenous infusion during pre- and post-experimental phases in total of 167 times. Th e sample of participants included 69 service receivers, 47 service providers/nurses and 2 managers. Th e nursing care was measured in 5 aspects: Quantity, quality, duration, satisfaction of individuals involved and economics. Data was analyzed using descriptive statistics, T-values, Paired T tests, Wilcoxon Signed-Rank test, Mann-Whitney U test with the alpha level at 0.05. Th e research fi ndings revealed that the workers’ workload did not increase, but the accuracy rate to follow the standard increased (p=0.003); work duration did not increase, the workers’ satisfaction did not decrease, and cost per service unit decreased (p<0.001). For recommendations, the research should be continuously conducted throughout the entire hospital and developed to be a good working model of the country with higher effi ciency. Policies on health service provisions should be more intense by focusing more on integrative work and multidisciplinary participation for patients to receive quality nursing care.