Pregnancy After Breast Cancer – Prognostic Safety and Pregnancy Outcomes According to Oestrogen Receptor Status: A Systematic Review

Katie Nolan,Michael R. Boland,Arnold D.K. Hill 한국유방암학회 2022 Journal of breast cancer Vol.25 No.6

Purpose: Breast cancer is the primary cause of cancer-related death in women. Women diagnosed with estrogen receptor (ER)-positive breast cancer have prolonged treatment durations. Owing to the paucity of research and lack of consensus regarding conception planning and pregnancy for patients with ER-positive breast cancer, we aimed to assess pregnancy and survival outcomes in women with ER-positive breast cancer during and after treatment. Methods: We conducted a systematic review of the available studies on pregnancy after ERpositive breast cancer. The assessed outcomes included overall survival (OS), disease-free survival (DFS), hormonal therapy duration, and pregnancy outcomes. Results: Ultimately, 2,669 patients from five studies were included in this study. When all breast cancer receptor subtypes were included in the analysis, pregnancy after breast cancer was associated with a time-dependent protective effect on both DFS and OS. This protective effect was not evident when examining ER-positive patients with subsequent pregnancies, and no significant differences in DFS were observed. ER-positive patients who became pregnant received significantly lower rates of hormonal therapy. Hormonal treatment at the time of pregnancy was correlated with increased rates of termination owing to concerns about teratogenic effects. Conclusions: Pregnancy after breast cancer did not significantly affect DFS in ER-positive patients over a follow-up period of 5–10 years from diagnosis, although did significantly affect hormonal treatment duration in the reviewed studies. Further analysis and in-depth studies are required to assess the effects of altered hormonal treatment times, as well as patient management related to pregnancy planning after breast cancer.

Automated Prediction of Ischemic Brain Tissue Fate from Multiphase Computed Tomographic Angiography in Patients with Acute Ischemic Stroke Using Machine Learning

Wu Qiu,Hulin Kuang,Johanna M. Ospel,Michael D. Hill,Andrew M. Demchuk,Mayank Goyal,Bijoy K. Menon 대한뇌졸중학회 2021 Journal of stroke Vol.23 No.2

Background and Purpose Multiphase computed tomographic angiography (mCTA) provides time variant images of pial vasculature supplying brain in patients with acute ischemic stroke (AIS). To develop a machine learning (ML) technique to predict tissue perfusion and infarction from mCTA source images. Methods 284 patients with AIS were included from the Precise and Rapid assessment of collaterals using multi-phase CTA in the triage of patients with acute ischemic stroke for Intra-artery Therapy (Prove-IT) study. All patients had non-contrast computed tomography, mCTA, and computed tomographic perfusion (CTP) at baseline and follow-up magnetic resonance imaging/noncontrast- enhanced computed tomography. Of the 284 patient images, 140 patient images were randomly selected to train and validate three ML models to predict a pre-defined Tmax thresholded perfusion abnormality, core and penumbra on CTP. The remaining 144 patient images were used to test the ML models. The predicted perfusion, core and penumbra lesions from ML models were compared to CTP perfusion lesion and to follow-up infarct using Bland-Altman plots, concordance correlation coefficient (CCC), intra-class correlation coefficient (ICC), and Dice similarity coefficient. Results Mean difference between the mCTA predicted perfusion volume and CTP perfusion volume was 4.6 mL (limit of agreement [LoA], –53 to 62.1 mL; P=0.56; CCC 0.63 [95% confidence interval [CI], 0.53 to 0.71; P<0.01], ICC 0.68 [95% CI, 0.58 to 0.78; P<0.001]). Mean difference between the mCTA predicted infarct and follow-up infarct in the 100 patients with acute reperfusion (modified thrombolysis in cerebral infarction [mTICI] 2b/2c/3) was 21.7 mL, while it was 3.4 mL in the 44 patients not achieving reperfusion (mTICI 0/1). Amongst reperfused subjects, CCC was 0.4 (95% CI, 0.15 to 0.55; P<0.01) and ICC was 0.42 (95% CI, 0.18 to 0.50; P<0.01); in non-reperfused subjects CCC was 0.52 (95% CI, 0.20 to 0.60; P<0.001) and ICC was 0.60 (95% CI, 0.37 to 0.76; P<0.001). No difference was observed between the mCTA and CTP predicted infarct volume in the test cohort (P=0.67). Conclusions A ML based mCTA model is able to predict brain tissue perfusion abnormality and follow-up infarction, comparable to CTP.

A high-resolution climate record spanning the past 17 000 years recovered from Lake Ohau, South Island, New Zealand

Levy, Richard H.,Dunbar, Gavin B.,Vandergoes, Marcus J.,Howarth, Jamie D.,Kingan, Tony,Pyne, Alex R.,Brotherston, Grant,Clarke, Michael,Dagg, Bob,Hill, Matthew,Kenton, Evan,Little, Steve,Mandeno, Darc Copernicus GmbH 2018 Scientific drilling Vol.24 No.-

<P><p><strong>Abstract.</strong> A new annually resolved sedimentary record of Southern Hemisphere mid-latitude hydroclimate was recovered from Lake Ohau, South Island, New Zealand, in March 2016. The Lake Ohau Climate History (LOCH) project acquired cores from two sites (LOCH-1 and -2) that preserve sequences of laminated mud that accumulated since the lake formed <span class='inline-formula'>∼</span><span class='thinspace'></span>17<span class='thinspace'></span>000 years ago. Cores were recovered using a purpose-built barge and drilling system designed to recover soft sediment from thick sedimentary sequences in lake systems up to 150<span class='thinspace'></span>m deep. This system can be transported in two to three 40<span class='thinspace'></span>ft long shipping containers and is suitable for use in a range of geographic locations. A comprehensive suite of data has been collected from the sedimentary sequence using state-of-the-art analytical equipment and techniques. These new observations of past environmental variability augment the historical instrumental record and are currently being integrated with regional climate and hydrological modelling studies to explore causes of variability in extreme/flood events over the past several millennia.</p> </P>

Endovascular Therapy for Ischemic Stroke

Ramana M R Appireddy,Andrew M Demchuk,Mayank Goyal,Bijoy K Menon,Muneer Eesa,Philip Choi,Michael D. Hill 대한신경과학회 2015 Journal of Clinical Neurology Vol.11 No.1

The utility of intravenous tissue plasminogen activator (IV t-PA) in improving the clinical outcomes after acute ischemic stroke has been well demonstrated in past clinical trials. Thoughmultiple initial small series of endovascular stroke therapy had shown good outcomes as compared to IV t-PA, a similar beneficial effect had not been translated in multiple randomizedclinical trials of endovascular stroke therapy. Over the same time, there have been parallel advances in imaging technology and better understanding and utility of the imaging in therapy ofacute stroke. In this review, we will discuss the evolution of endovascular stroke therapy followed by a discussion of the key factors that have to be considered during endovascular stroketherapy and directions for future endovascular stroke trials.

Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision- Making on Outcomes in Patients with Acute Ischemic Stroke

Johanna M. Ospel,Ondrej Volny,Wu Qiu,Mohamed Najm,Moiz Hafeez,Sarah Abdalrahman,Enrico Fainardi,Marta Rubiera,Alexander Khaw,Jai J. Shankar,Michael D. Hill,Mohammed A. Almekhlafi,Andrew M. Demchuk,May 대한뇌졸중학회 2021 Journal of stroke Vol.23 No.3

Background and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation. Methods Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) <70 mL, mismatch-ratio >1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0–2) based on these imaging paradigms were compared. Results Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT. Conclusions Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.