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2014 CUA Abstracts

ABSTRACT: Background: The incidence of small renal masses (SRMs) has increased in recent years in line with increased in abdominal imaging. SRMs are defined as enhancing solid lesions measuring ? 4cm. We present our experience with percutaneous renal tumour biopsy (RTB) of SRMs, which to our knowledge, is the largest to date. Methods: We reviewed our database to ascertain the incidence of benign, malignant and non-diagnostic biopsies of SRMs performed at our institution from 2001 to July 2013. A total of 519 RTBs were performed (496 SRMs). The diagnostic rate was compared over time. The accuracy of the biopsies was correlated with the definitive pathology in the cases where the biopsy led to surgery. Results: The mean size of the 519 biopsied lesions was 2.5 (±0.9) cm. The diagnostic rate at the first biopsy was 89.1% (442/496). Of the diagnostic biopsies, 116 (26.2%) were benign and 326 (73.7%) were malignant. Of the 54 non-diagnostic biopsies, 23 (42.6%) had a repeat biopsy. A diagnosis was obtained in 19 cases (82.6%; 8 [42.1%] benign, 11 [57.9%] malignant). Therefore RTB led to a diagnosis in 461 of the 496 SRMs (92.9%). Over time, there was a decrease in the rate of non-diagnostic biopsies from 15.0% to 6.0% (p>0.05). Of the available surgical pathology, there was agreement between histology in 92.5% (125/135). For the conventional cell carcinoma (n=85), there was concordance between histology and grade in 97.6% (83/85) and 96.1% (74/77), respectively. Conclusions: RTB of SRMs provided a diagnosis in 92.9% of the cases. Surgery was avoided in more than 23% of patients following RTB because of benign histology. The rate of non-diagnostic biopsies diminished over time. Finally, there was a high correlation between the biopsy and the final pathology with regards to both histology and grade. In an era where overdiagnosis and overtreatment of favourable cancers is gaining attention, routine RTB for SRM leads to diminished intervention and, going forward ,personalization of care.

SUBMITTER: Richard P

PROVIDER: S-EPMC4095672 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Project description:Introduction and Objectives: Optimizing targeted therapy in patients with metastatic renal cell carcinoma (RCC) would improve clinical outcomes but patient derived xenograft (PDX) models are lacking. We present a novel pre-clinical model that is superior to nude mice for accommodating RCC PDXs. This preclinical model implants RC PDXs into the chorioallantoic membrane (CAM) of avian embryos and is a patient-specific platform that could be advantageous for physicians in the future when deciding what treatment options are best for their patients. This drug panelling platform is rapid, cost-effective, and relies on the highly angiogenic CAM to support RCC PDXs. Methods: Commercial and patient derived RCC cell lines, were grown to full confluence and transduced to generate fluorescently labeled versions of each cell line. Cells were implanted into the CAM. Tumors were treated every two days by applying 10 ?L (10 ?M) of indicated drug onto the tumor onplant. The drugs that were paneled include Sunitinib, Sorafenib, Pazopanib, Axitinib and a vehicle treatment. After 7–8 days of incubation post-implantation, tumor take rate was determined by the presence of tumor growth in the CAM using a fluorescent stereoscope. Results: The highest tumor take rates were observed in the vehicle treatments of the embryos, ranging from 50–86%. Both commercial and primary cell lines saw a reduction in tumor take rate with the application of various anti-angiogenic drugs. Specifically, XP121 tumors were resistant to Sorafenib; 786-0, XP121; XP206 were resistant to Pazopanib; T258, XP121 were resistant to Sunitinib; and lastly, T258 tumors were resistant to Axitinib (Table 1). Conclusions: RCC PDXs onplanted in the CAM of avian embryos offer a robust and cost-effective platform to predict sensitivity/resistance to targeted therapies. When evaluating several patient-derived RCC cell lines, drug paneling revealed other alternative treatment options for these PDXs. More importantly, RCC PDXs that were shown to be Sunitinib-resistant in both the patient and in mouse-based PDXs, also produced the same resistance phenotype in the CAM.

Project description:Rationale: Learning styles (LS) of medical residents change over time from the more passive Assimilator toward more active preferences like Accommodator or Converger. We have shown pharmacy residents to be predominantly Assimilators at the start of their residency program. Whether learning styles of pharmacy residents change after they enter practice has never been studied. Objective: To describe the evolution of learning styles of pharmacy residents as they transition from residency into practice. Study Design and Methods: Prospective observational survey and semi-structured interviews. A complete provincial cohort of former pharmacy residents (n=28) who had their LS characterized during their residency and were now 1 year post-residency were invited to repeat the Pharmacists’ Inventory of Learning Styles (PILS). Interviews were administered to consenting participants to gain additional insights. Results: 27 residents (96%) completed the PILS survey and 16 (59%) completed the interview. 13 (48%) changed their dominant LS and 20 (74%) changed their secondary LS. Six (22%) participants did not change either LS. The overall proportion of dominant Assimilators (59%) and Convergers (26%) remained similar to baseline (52% and 26%, respectively), meaning participants had adopted and abandoned different learning styles in similar numbers. Change in LS was associated with receiving preceptor training (p<0.05). Of the 12 preceptors interviewed, 58% stated that they had adjusted their teaching practices based on knowledge of their LS. Conclusions: Change in dominant and/or secondary learning style is common after 1 year in practice compared to during pharmacy practice residency. There is no overall direction to the shifts, however, with residents transitioning in and out of more active learning styles with similar frequency. Overall after a year in practice, the cohort of former residents we studied remained mostly Assimilators, who prefer passive learning approaches. These results contrast with medical students, who adopt more active preferences like Accommodator.

Project description:ObjectiveTo investigate whether language used in science abstracts can skew towards the use of strikingly positive and negative words over time.DesignRetrospective analysis of all scientific abstracts in PubMed between 1974 and 2014.MethodsThe yearly frequencies of positive, negative, and neutral words (25 preselected words in each category), plus 100 randomly selected words were normalised for the total number of abstracts. Subanalyses included pattern quantification of individual words, specificity for selected high impact journals, and comparison between author affiliations within or outside countries with English as the official majority language. Frequency patterns were compared with 4% of all books ever printed and digitised by use of Google Books Ngram Viewer.Main outcome measuresFrequencies of positive and negative words in abstracts compared with frequencies of words with a neutral and random connotation, expressed as relative change since 1980.ResultsThe absolute frequency of positive words increased from 2.0% (1974-80) to 17.5% (2014), a relative increase of 880% over four decades. All 25 individual positive words contributed to the increase, particularly the words "robust," "novel," "innovative," and "unprecedented," which increased in relative frequency up to 15,000%. Comparable but less pronounced results were obtained when restricting the analysis to selected journals with high impact factors. Authors affiliated to an institute in a non-English speaking country used significantly more positive words. Negative word frequencies increased from 1.3% (1974-80) to 3.2% (2014), a relative increase of 257%. Over the same time period, no apparent increase was found in neutral or random word use, or in the frequency of positive word use in published books.ConclusionsOur lexicographic analysis indicates that scientific abstracts are currently written with more positive and negative words, and provides an insight into the evolution of scientific writing. Apparently scientists look on the bright side of research results. But whether this perception fits reality should be questioned.

Project description:ObjectivesAccess to full texts of randomised controlled clinical trials (RCTs) is often limited, so brief summaries of studies play a pivotal role. In 2008, a checklist was provided to ensure the transparency and completeness of abstracts. The aim of this investigation was to estimate adherence to the reporting guidelines of the Consolidated Standards of Reporting Trials (CONSORT) criteria for abstracts (CONSORT-A) in RCT publications.Primary endpointAssessment according to the percentage of compliance with the 16 CONSORT-A criteria per study.Materials and methodsThis study is based on a full survey (212 RCT abstracts in dental implantology, PubMed search, publication period 2014-2016, 45 journals, median impact factor: 2.328). In addition to merely documenting 'adherence' to criteria, the authors also assessed the 'complete implementation' of the requested information where possible. The collection of data was performed independently by two dentists, and a final consensus was reached. The primary endpoint was evaluated by medians and quartiles. Additionally, a Poisson regression was conducted to detect influencing factors.ResultsA median of 50% (Q1-Q3: 44%-63%) was documented for the 16 criteria listed in the CONSORT-A statement. Nine of the 16 criteria were considered in fewer than 50% of the abstracts. 'Correct implementation' was achieved for a median of 43% (Q1-Q3: 31%-50%) of the criteria. An additional application of Poisson regression revealed that the number of words used had a locally significant impact on the number of reported CONSORT criteria for abstracts (incidence rate ratio 1.001, 95% CI 1.001 to 1.002).ConclusionTransparent and complete reporting in abstracts appears problematic. A limited word count seems to result in a reduction in necessary information. As current scientific knowledge is often not readily available in the form of publications, abstracts constitute the primary basis for decision making in clinical practice and research. This is why journals should refrain from limiting the number of words too strictly in order to facilitate comprehensive reporting in abstracts.

Project description:Objectives: Myocardial fibrosis in noninfarcted myocardium is emerging as a principal phenotype of vulnerability to adverse events such as mortality and hospitalization for heart failure (HHF), but its optimal noninvasive measurement remains uncertain despite consistently robust histologic validation data for extracellular volume fraction (ECV). We therefore compared ECV, native T1, post contrast T1, the gadolinium contrast partition coefficient (lambda), and the presence of nonischemic scar in their associations with mortality and HHF outcomes. Method: To quantify of myocardial fibrosis, we performed T1 mapping (MOLLI) in basal and mid short axis slices with cardiovascular magnetic resonance (CMR) before contrast and 12-30 minutes post contrast bolus in 1185 consecutive patients without amyloidosis, hypertrophic or stress cardiomyopathy. We assessed associations with outcomes using Kaplan-Meier plots and chi square values from univariable Cox regression models. All standard T1 mapping parameters were obtained: native and post contrast myocardial T1, the partition coefficient lambda, and ECV. ECV = (1-hematocrit) · [?R1myocardium]/[?R1bloodpool], where R1 = 1/T1 Late gadolinium enhancement imaging with phase sensitive reconstruction identified nonischemic scar. Results: Over a median of 1.7 years, 111 individuals experienced events after CMR: 55 HHF events and 74 deaths. ECV yielded better separation of Kaplan-Meier curves in a dose dependent fashion (Figure) and also stronger associations with the combined endpoint of death or HHF. The ECV chi square (77.3, p < 0.001) was at least twice as large as the Native T1 chi square (37.5, p < 0.001), the lambda chi square (34.8, p < 0.001) and nonischemic scar (chi square = 20.5, p<0.001). Post-contrast T1 was not associated with outcomes, even when adjusting further for time after contrast bolus, renal function, and patient weight (chi square <3, p >0.10). Conclusion: Analogous to histologic previously published validation data, quantitative ECV myocardial fibrosis measures associated with outcomes far stronger than other surrogate measures outcome measures such as native T1, post contrast T1 and nonischemic scar on LGE images. These data suggest that ECV is the noninvasive metric of choice to measure myocardial fibrosis. Figure. Kaplan-Meier Plots for T1 mapping parameters.

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2014 CUA Abstracts

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