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OBJECTIVE Immune checkpoint inhibitors (ICI) and stereotactic radiosurgery (SRS) are commonly utilized in the management of brain metastases. Treatment-related imaging changes (TRIC) are a frequently observed clinical manifestation and are commonly classified as radiographic radiation necrosis. However, these findings are not well characterized and may predict for response to SRS and ICI. METHODS The diagnosis-specific graded prognostic assessment was used to guide variable selection. TRIC were determined based upon MRI, PET/CT, or MR spectroscopy and a consensus by local clinical providers was required. RESULTS The analysis included 697 patients with 4,536 brain metastases across 11 institutions in 4 countries. The median follow-up after SRS was 13.6 months. The median age was 66 years, 54.1% of patients were male, and 57.3%, 36.3%, and 6.4% were non-small cell lung cancer, melanoma, and renal cell carcinoma (RCC) histology, respectively. TRIC were observed in 9.8%. On univariable analysis, Karnofsky Performance Status (KPS) (hazard ratio [HR]: 0.98; p < 0.001), presence of TRIC (HR: 0.67; p = 0.03), female sex (HR: 0.67; p < 0.001), and prior resection (HR: 0.60; p = 0.03) were associated with improved OS. On multivariable analysis, KPS (HR: 0.98; p < 0.001) and the presence of TRIC (HR: 0.66; p = 0.03) were associated with improved OS. A V12 Gy ≥ 10 cm3 (Odds Ratio [OR]: 2.78; p < 0.001), prior whole brain radiation therapy (OR: 3.46; p = 0.006), and RCC histology (OR: 3.10; p = 0.01) were associated with an increased probability of developing TRIC. The median OS in patients with and without TRIC was 29.0 and 23.1 months, respectively (log-rank p = 0.03). CONCLUSION TRIC following ICI and SRS are associated with a median OS benefit of approximately 6 months. Further prospective study is warranted to further elucidate the role and etiology of this common clinical scenario.

Objective We evaluated the effects of menstrual types inclusive of PMS on reports of chronic pain intensity and psychopathology in twenty-eight women (mean age 38.93 ± 13.51) with Sickle Cell disease (SCD). Methods Using the Menstrual Symptoms Questionnaire, we compared women with PMS to those with less distressing spasmodic cycle types. Results Thirty-four percent of the sample used oral contraception; there were no significant effects of birth control use on reports of pain. Women with PMS characterized the sensory (p = .04) and affective (p = .04) experiences of their SCD-related chronic pain, including their current pain intensity (p = .03), as significantly greater than women with primary spasmodic menstrual type. Further, there was a trend towards significance for women with PMS to report greater levels of overall pain intensity (p = .07) and average pain intensity over the past month (p = .08). Conclusions The authors interpret these results to suggest that there may be a complex interaction of neurohormonal, biological, and psychological factors associated with PMS that influence manifestation and experience of chronic pain in patients with SCD.

Settling cues in the form of coralline algae were presented to groups of hatchery-reared red abalone (Haliotis rufescens, Swainson 1822) larvae daily from day 4 to day 32 posthatch (temperature, 14°C). Survival of postlarval abalone after settlement was monitored for 30 days to quantify the effect of delayed metamorphosis on the subsequent survival of benthic juvenile abalone. After exposure to live coralline algae, an average of 85% of the larvae metamorphosed and settled the following day. The number of settled postlarvae increased gradually the longer the settling cue was withheld. Postsettlement juveniles were raised in individual containers on mixed diatoms for up to 34 days. Red abalone larvae remained competent to settle 32 days after fertilization. Larvae that metamorphosed from day 4 through day 19 had longer survival during the next 30 days (average, 19%) than those presented with a settling cue from day 20 to day 32 (average, 8%). Statistical analysis using a threshold cut point indica...

Introduction: Childhood arterial ischemic stroke (CAIS) affects 1.6 per 100,000/year and recurs in up to 20% at 5 years. Arteriopathies are common, predict recurrence, and affect the carotid (anterior) and vertebrobasilar (posterior) circulations differently. Differences in recurrence between anterior and posterior circulation CAIS have not been evaluated. Hypothesis: Recurrence is higher for stroke involving the posterior circulation (PCAIS) than anterior circulation (ACAIS). Methods: We analyzed 107 CAIS cases (61 isolated ACAIS, 46 isolated PCAIS) from a single-center prospective consecutive cohort from 1/1/06-1/1/15, with median age 7.7 years (IQR=3.1-13.6) and 70% male. Incidence of recurrent stroke was assessed with Kaplan-Meier survival estimates. Cox proportional hazards models compared recurrence risk between PCAIS and ACAIS. Results: Median follow-up was 20.9 months (IQR 8.7-40.4). Recurrent stroke occurred in 9/46 PCAIS cases (19.6%; 8 males; 2 with multiple recurrences) and in 2/61 ACAIS cases (3.3%; 2 males). All PCAIS cases with recurrence were receiving antithrombotic therapy (aspirin or anticoagulant). Stroke risk factors in PCAIS with recurrence were: cervical dissection (4), sickle cell anemia (1), cardiac disease (2), multiple factors (2), thrombophilia (1), and unknown (1). For ACAIS, recurrence-free survival at 1 month, was 100%, and at 1 and 5 years was 96% (95% CI 85-99%). For PCAIS, recurrence-free survival at 1 month, 1 year, and 5 years was 88% (95% CI 75-95%), 81% (95% CI 66-90%), and 74% (95% CI 52-87%) [Figure]. The hazard ratio for recurrence in PCAIS compared to ACAIS was 6.4 (95% CI 1.4-29.8, p=0.017) in univariable analysis and 6.8 (95% CI 1.3-35.7, p=0.023) adjusting for sex, cardiac cause, and dissection. Conclusions: At 5 years, 26% of children with PCAIS in our cohort had recurrent stroke compared to only 4% of children with ACAIS. Children with PCAIS may benefit from closer monitoring and additional prevention strategies.