An independently validated nomogram for isocitrate dehydrogenase-wild-type glioblastoma patient survival.

BackgroundIn 2016, the World Health Organization reclassified the definition of glioblastoma (GBM), dividing these tumors into isocitrate dehydrogenase (IDH)-wild-type and IDH-mutant GBM, where the vast majority of GBMs are IDH-wild-type. Nomograms are useful tools for individualized estimation of survival. This study aimed to develop and independently validate a nomogram for IDH-wild-type patients with newly diagnosed GBM.MethodsData were obtained from newly diagnosed GBM patients from the Ohio Brain Tumor Study (OBTS) and the University of California San Francisco (UCSF) for diagnosis years 2007-2017 with the following variables: age at diagnosis, sex, extent of resection, concurrent radiation/temozolomide (TMZ) status, Karnofsky Performance Status (KPS), O6-methylguanine-DNA methyltransferase (MGMT) methylation status, and IDH mutation status. Survival was assessed using Cox proportional hazards regression, random survival forests, and recursive partitioning analysis, with adjustment for known prognostic factors. The models were developed using the OBTS data and independently validated using the UCSF data. Models were internally validated using 10-fold cross-validation and externally validated by plotting calibration curves.ResultsA final nomogram was validated for IDH-wild-type newly diagnosed GBM. Factors that increased the probability of survival included younger age at diagnosis, female sex, having gross total resection, having concurrent radiation/TMZ, having a high KPS, and having MGMT methylation.ConclusionsA nomogram that calculates individualized survival probabilities for IDH-wild-type patients with newly diagnosed GBM could be useful to physicians for counseling patients regarding treatment decisions and optimizing therapeutic approaches. Free software for implementing this nomogram is provided: https://gcioffi.shinyapps.io/Nomogram_For_IDH_Wildtype_GBM_H_Gittleman/

Less Invasive Phenotype Found in Isocitrate Dehydrogenase-mutated Glioblastomas than in Isocitrate Dehydrogenase Wild-Type Glioblastomas: A Diffusion-Tensor Imaging Study

PURPOSE: To explore the diffusion-tensor (DT) imaging-defined invasive phenotypes of both isocitrate dehydrogenase (IDH-1)-mutated and IDH-1 wild-type glioblastomas. MATERIALS AND METHODS: Seventy patients with glioblastoma were prospectively recruited and imaged preoperatively. All patients provided signed consent, and the local research ethics committee approved the study. Patients underwent surgical resection, and tumor samples underwent immunohistochemistry for IDH-1 R132H mutations. DT imaging data were coregistered to the anatomic magnetic resonance study and reconstructed to provide the anisotropic and isotropic components of the DT. The invasive phenotype was determined by using previously published criteria and correlated with IDH-1 mutation status by using the Freeman-Halton extension of the Fisher exact probability test. RESULTS: Nine patients had an IDH-1 mutation and 61 had IDH-1 wild type. All of the patients with IDH-1 mutation had a minimally invasive DT imaging phenotype. Among the IDH-1 wild-type tumors, 42 of 61 (69%) were diffusively invasive glioblastomas, 14 of 61 (23%) were locally invasive, and five of 61 (8%) were minimally invasive (P < .001). CONCLUSION: IDH-mutated glioblastomas have a less invasive phenotype compared with IDH wild type. This finding may have implications for individualizing the extent of surgical resection and radiation therapy volumes.NIHR Clinician Scientist Fellowship (NIHR/CS/009/011); Chang Gung Medical Foundation; Chang Gung Memorial Hospital; Commonwealth Scholarship Commission; Cambridge Commonwealth Overseas Trust; NIHR Cambridge Biomedical Research Centr

Strong convergence rates for explicit space-time discrete numerical approximations of stochastic Allen-Cahn equations

The scientific literature contains a number of numerical approximation results for stochastic partial differential equations (SPDEs) with superlinearly growing nonlinearities but, to the best of our knowledge, none of them prove strong or weak convergence rates for full-discrete numerical approximations of space-time white noise driven SPDEs with superlinearly growing nonlinearities. In particular, in the scientific literature there exists neither a result which proves strong convergence rates nor a result which proves weak convergence rates for full-discrete numerical approximations of stochastic Allen-Cahn equations. In this article we bridge this gap and establish strong convergence rates for full-discrete numerical approximations of space-time white noise driven SPDEs with superlinearly growing nonlinearities such as stochastic Allen-Cahn equations. Moreover, we also establish lower bounds for strong temporal and spatial approximation errors which demonstrate that our strong convergence rates are essentially sharp and can, in general, not be improved.Comment: 104 page

Web services synchronization health care application

With the advance of Web Services technologies and the emergence of Web Services into the information space, tremendous opportunities for empowering users and organizations appear in various application domains including electronic commerce, travel, intelligence information gathering and analysis, health care, digital government, etc. In fact, Web services appear to be s solution for integrating distributed, autonomous and heterogeneous information sources. However, as Web services evolve in a dynamic environment which is the Internet many changes can occur and affect them. A Web service is affected when one or more of its associated information sources is affected by schema changes. Changes can alter the information sources contents but also their schemas which may render Web services partially or totally undefined. In this paper, we propose a solution for integrating information sources into Web services. Then we tackle the Web service synchronization problem by substituting the affected information sources. Our work is illustrated with a healthcare case study.Comment: 18 pages, 12 figure