Update on management of craniopharyngiomas

Journal of Neuro-Oncology - Craniopharyngiomas are locally-aggressive tumors arising along the hypothalamic-pituitary axis. Treatment is nuanced as a result of their proximity and adherence to...     

Benzophenone-3 promotion of mammary tumorigenesis is diet-dependent

Benzophenone-3 is a putative endocrine disrupting chemical and common ingredient in sunscreens. The potential of endocrine disrupting chemicals to act as agonists or antagonists in critical hormonally regulated processes, such as mammary gland development and mammary tumorigenesis, demands evaluation of its potential in promoting breast cancer. This study identifies the effects of BP-3 on mammary tumorigenesis with high-fat diet during puberty versus adulthood in Trp53-null transplant BALB/c mice. Benzophenone-3 exposure yielded levels in urine similar to humans subjected to heavy topical sunscreen exposure. Benzophenone-3 was protective for epithelial tumorigenesis in mice fed lifelong low-fat diet, while promotional for epithelial tumorigenesis in mice fed adult high-fat diet. Benzophenone-3 increased tumor cell proliferation, decreased tumor cell apoptosis, and increased tumor vascularity dependent on specific dietary regimen and tumor histopathology. Even in instances of an ostensibly protective effect, other parameters suggest greater risk. Although benzophenone-3 seemed protective on low-fat diet, spindle cell tumors arising in these mice showed increased proliferation and decreased apoptosis. This points to a need for further studies of benzophenone-3 in both animal models and humans as a potential breast cancer risk factor, as well as a more general need to evaluate endocrine disrupting chemicals in varying dietary contexts.     

Validation of the National Institute of Neurological Disorders and Stroke Spinal Cord Injury MRI Common Data Elements Instrument

BACKGROUND AND PURPOSE:The National Institute of Neurological Disorders and Stroke common data elements initiative was created to provide a consistent method for recording and reporting observations related to neurologic diseases in clinical trials. The purpose of this study is to validate the subset of common data elements related to MR imaging evaluation of acute spinal cord injury.MATERIALS AND METHODS:Thirty-five cervical and thoracic MR imaging studies of patients with acute spinal cord injury were evaluated independently in 2 rounds by 5 expert reviewers. Intra- and interrater agreement were calculated for 17 distinct MR imaging observations related to spinal cord injury. These included ordinal, categoric, and continuous measures related to the length and location of spinal cord hemorrhage and edema as well as spinal canal and cord measurements. Level of agreement was calculated using the interclass correlation coefficient and kappa.RESULTS:The ordinal common data elements spinal cord injury elements for lesion center and rostral or caudal extent of edema or hemorrhage demonstrated agreement ranging from interclass correlation coefficient 0.68 to 0.99. Reproducibility ranged from 0.95 to 1.00. Moderate agreement was observed for absolute length of hemorrhage and edema (0.54 to 0.60) with good reproducibility (0.78 to 0.83). Agreement for the Brain and Spinal Injury Center score showed the lowest interrater agreement with an overall kappa of 0.27 (0.20, 0.34). For 7 of the 8 variables related to spinal cord injury, agreement improved between the first and second evaluation. Continuous diameter measures of the spinal cord and spinal canal using interclass correlation coefficient varied substantially (0.23 to 0.83).CONCLUSIONS:Agreement was more consistent for the ordinal measures of spinal cord injury than continuous measures. Good to excellent agreement on length and location of spinal cord hemorrhage and edema can be achieved with ordinal measures alone.

In 2006, the National Institute of Neurological Disorders and Stroke (NINDS) began a process to develop common data elements (CDEs) to provide a standardized method for the collection of clinical data related to neurologic diseases.^1-3 Recognizing that there is a lack of clear and consistent terminology for spine disorders, particularly spinal cord injury (SCI), in 2014, the NINDS convened a workgroup comprising expert stakeholders for the development of SCI CDE instruments that included clinical care assessments and imaging.^3-8 This new set of SCI CDE instruments aimed to increase the efficiency and value of clinical research studies and treatment, increase data quality, facilitate data sharing, and help educate new clinical investigators.³ Investigators are expected to incorporate the CDE modules in grant applications and National Institutes of Health–funded research.The MR imaging SCI CDE subset was created to be a comprehensive and standardized terminology for describing MR imaging findings in patients with SCI. This collection consists of a case report form (CRF) containing 35 discrete measures and responses divided into 4 main categories: general imaging characteristics, spinal injury features, canal and cord measurements, and chronic SCI features. The responses are of 3 types: Boolean, categoric, and an ordinal range representing specific anatomic locations. These measures were chosen to represent both objective and subjective assessment derived from routine clinical MR images. The workgroup codified these features using existing CDEs that have proved value in the published literature, and when ones did not exist, the workgroup developed the feature and the response parameters.As with the development of any CRF used for a clinical trial or research, the goal is to provide an instrument that provides useful data representations that are reproducible across trained observers and institutions, require minimal cognitive effort, minimize ambiguity, and are both accurate and precise. Reproducibility of the observations through rigorous testing by multiple observers is a needed step to validate the instrument before clinical or research use. However, the evaluation process may not entirely reproduce the clinical environment in which it is meant to be used such that datasets and observers are overly prepared or optimized. Therefore, the goal of this study is to determine the inter- and intrarater reliability of the NINDS MR imaging CDEs when assessed by MR imaging experts with familiarity with SCI. We hypothesize that there will be good to excellent agreement (kappa >0.4) among the expert raters after limited training.