In lieu of an abstract, here is a brief excerpt of the content:A Bittersweet Score:A Father’s Account of His Family’s 20-Year Journey After a Pediatric Brain Tumor DiagnosisChristopher RileyI hadn’t seen him for 20 years, not since the day he drilled a hole in Peter’s head and left the stainless steel drill and bloody bit on the bedside table. He figured prominently in the story I often told of that day when he, a doctor in training, [End Page (...) 3] informed my wife Kathy and me that, “Wow,” our five-year-old son had “an impressive tumor” in his brain. He announced it with the admiration I reserve for a touchdown pass or stunning sunset. Since that day, he had become a venerable physician. Back then he was the resident who met us in the ER after our pediatrician told us that the MRI of Peter’s brain was “not normal,” that “there might be a growth.” As if there might not be. I imagined that Peter’s brain might simply have an unusual shape, or that the scan revealed some undiscovered fracture and the authorities only wanted to lock me up and all with my son would be well. The thrilled young doctor slew those hopes with an ice pick: “Wow, that’s an impressive tumor.” I said, “That’s the first time anyone has used the word tumor.” The doctor appeared mortified and started over.Now 20 years later we found ourselves at the same party and I felt a compulsion to introduce myself, remind him we’d met that day in 1993, and tell him what had become of Peter and his family in the decades since he’d made that mortifying mistake, one I hoped had become for him a defining moment. To my disappointment, he didn’t seem to remember.Peter was my red-haired boy. Fearless and whip smart, he told a stream of knock-knock jokes and performed dance routines choreographed by his 8-year-old sister Rachel. Six months of headaches, vomiting and clumsy falls led to discovery of the tumor. When I phoned my parents with the news, I couldn’t speak the words, words that felt as if they spelled my boy’s doom. My body refused to pronounce them.The war for Peter’s life began with surgery. I sat with Kathy in the surgical waiting area, fearing every minute that I would see the surgeon approaching with his shoulders slumped in mortal defeat. I learned during those hours that fear of your child’s death is a physical pain, a constriction in the chest, a suffocation. At the end of that wait, the surgeon told us the tumor was out and Peter had survived. The pathology indicated the tumor was a medulloblastoma. Without additional treatment, including radiation, it was certain to come back. Kathy’s knees buckled. Having just endured one life-and-death battle, we were plunged into another. To complicate matters, Peter wasn’t waking from surgery. Even after the anesthesia wore off, Peter remained groggy, unable to move or focus his eyes.Through the following days, Peter failed to rouse or speak. Sores formed at the back of his neck where his unswallowed saliva pooled. Neurologists doubted he knew us. His doctors hoped Peter would recover but it was possible he would remain as he was indefinitely. As I sat holding his useless hand, watching his useless body, I thought I’d never loved him as much as I did now.Peter’s doctors presented two treatment options. The first consisted of relatively high doses of daily radiation, the most effective known method for preventing the return of the cancer. But radiation wasn’t good for young brains. It “shaved IQ points,” they said in wild understatement. So they offered a second, experimental option, one that reduced radiation by a third and added months of chemotherapy. The doctors hoped this new regimen would be as effective as the old but cause less cognitive damage. They asked us to choose. It seemed impossible. We gathered the scant available data. We weighed the risks. We prayed. We took a leap. Without asking him, we made a decision for Peter we knew... (shrink)

This narrative symposium brings to light the extreme difficulties faced by parents of children diagnosed with brain tumors. NIB editorial staff and narrative symposium editors, Gigi McMillan and Christy A. Rentmeester, developed a call for stories that was distributed on several list serves and posted on Narrative Inquiry in Bioethics’ website. The call asks parents to share their personal experience of diagnosis, treatment, long–term effects of treatment, social issues and the doctor–patient–parent dynamic that develops during this process. Thirteen (...) stories are found in the print version of the journal and an additional six supplemental stories are published online only through Project MUSE. One change readers may notice is that the story authors are not listed in alphabetical order. The symposium editors had a vision for this issue that included leading readers through the timeline of this topic: diagnosis–treatment–acute recovery–recurrence–treatment (again)– acute recovery (again)– long-term quality of life– (possibly) end of life. Stories are arranged to help lead the reader through this timeline. Gigi McMillan is a patient and research subject advocate, co-founder of We Can, Pediatric Brain Tumor Network, as well as, the mother of a child who suffered from a pediatric brain tumor. She also authored the introduction for this symposium. Christy Rentmeester is an Associate Professor of Health Policy and Ethics in the Creighton University School of Medicine. She served as a commentator for this issue. Other commentators for this issue are Michael Barraza, a clinical psychologist and board member of We Can, Pediatric Brain Tumor Network ; Lisa Stern, a pediatrician who has diagnosed six children with brain tumors in her 20 years of practice; and Katie Rose, a pediatric brain tumor patient who shares her special insights about this world. (shrink)

Neuroimaging is critical in the diagnosis and treatment of brain cancers; however, the first detection of tumors is a challenge. Detection techniques like image segmentation are heavily reliant on the segmented image’s resolution. Magnetic resonance imaging tumor segmentation has emerged as a new study area in the medical imaging field. This spongy and delicate mass of tissue is the brain. Stable conditions allow for patterns to enter and interact with each other. To put it simply, a (...) tumor is a mass of tissue that has grown unchecked by the natural mechanisms that keep it under control. When cells divide uncontrollably, they create a cancerous tumor. Brain tumors can be detected and segmented using a variety of methods. A new method for detecting brain tumors using MRI images is presented in this research. An innovative Woelfel filter is used for enhancement, and morphological segmentation approaches combined with anisotropic diffusion are used for segmentation. Segmentation of brain tumors can be accomplished using thresholding and morphological techniques, which are both effective. The tumor will be located and identified using morphological image processing. Image denoising refers to the process of removing artefacts such as noise and aliasing from digital images. Here MATLAB programming language is utilised as it incorporates all the toolboxes required for the application involved in the work. (shrink)

In the case of magnetic resonance imaging (MRI) imaging, image processing is crucial. In the medical industry, MRI images are commonly used to analyze and diagnose tumor growth in the body. A number of successful brain tumor identification and classification procedures have been developed by various experts. Existing approaches face a number of obstacles, including detection time, accuracy, and tumor size. Early detection of brain tumors improves options for treatment and patient survival rates. Manually segmenting (...) brain tumors from a significant number of MRI data for brain tumor diagnosis is a tough and time-consuming task. Automatic image segmentation of brain tumors is required. The objective of this study is to evaluate the degree of accuracy and simplify the medical picture segmentation procedure used to identify the type of brain tumor from MRI results. Additionally, this work suggests a novel method for identifying brain malignancies utilizing the Bagging Ensemble with K-Nearest Neighbor (BKNN) in order to raise the KNN’s accuracy and quality rate. For image segmentation, a U-Net architecture is utilized first, followed by a bagging-based k-NN prediction algorithm for classification. The goal of employing U-Net is to improve the accuracy and uniformity of parameter distribution in the layers. Each decision tree is fitted on a little different training dataset during classification, and the bagged decision trees are effective since each tree has minor differences and generates slightly different skilled predictions. The overall classification accuracy was up to 97.7 percent, confirming the efficiency of the suggested strategy for distinguishing normal and pathological tissues from brain MR images; this is greater than the methods that are already in use. (shrink)

This issue of Narrative Inquiry in Bioethics explores the concerns and point of view of parents who have had to confront the devastating diagnosis of a pediatric brain tumor. This commentary, written by a general pediatrician, is a synthesis of several narrative themes which touch on a range of topics from relapse to long-term sequelae and other issues that effect a growing population of pediatric brain tumor patients. It offers a glimpse into the problems that (...) need to be addressed by health professionals, educators and support teams who provide short and long term care to these patients and their families. (shrink)

ObjectiveHopelessness and depression are strongly associated with suicidality. Given that physical and psychological outcomes can be altered with hope, hope is a therapeutic goal of increasing importance in the treatment of brain tumor patients. Moreover, it is not yet understood which factors affect the perception of hope in brain tumor patients. In addition, it remains uncertain whether lower-grade brain tumor patients suffer less from psycho-oncological distress than higher-grade brain tumor patients.MethodsNeuro-oncological patients were (...) examined perioperatively with the Distress Thermometer and the Herth Hope Index. In addition, psychological comorbidities and an assessment of general psycho-oncological distress were recorded.ResultsSixty-six brain tumor patients were included. No differences between higher- and lower-grade brain tumor patients were observed for general psycho-oncological distress and hope. However, higher-grade brain tumor patients showed a significantly higher level of depression and more negative expectations regarding therapeutic success. The extent of depression correlated negatively with hope.ConclusionUnexpectedly, higher-grade brain tumor patients remained as hopeful as lower-grade brain tumor patients despite the devastating diagnosis, higher levels of depression, and a worse expectation of therapeutic success. Conversely, lower-grade brain tumor patients experience as much psycho-oncological distress as patients with a higher-grade brain tumor, underpinning the imperative need for comprehensive psycho-oncological screening. For all brain tumor patients, considering hope is important to avoid suicides resulting from hopelessness and depression. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Road to Understanding and Acceptance of the Late Effects of Pediatric Brain Tumors and TreatmentJeanne CarlsonWe had little warning or time to adjust to our daughter’s diagnosis. A call from her third grade teacher reporting that Sarah seemed to be having vision problems rapidly led to eye exams, an MRI, and the discovery of a Germinoma brain tumor in the suprastellar region of Sarah’s (...) brain. We were terrified but began treatment feeling optimistic about the outlook for Sarah’s recovery. Luckily, Sarah’s treatment was relatively non–invasive and quick, chemotherapy and radiation, five months start to finish. We were thrilled to have Sarah’s treatment behind us.As any parent of a child with a life–threatening illness knows, family life is seriously disrupted by the countless doctor, lab, and hospital visits, the worry, and the financial strain that are suddenly added to the demands of everyday life. We did our best to balance our focus on both of our children as Sarah is a twin and we didn’t want her brother Will to suffer as a result of his sister’s illness. It wasn’t easy but we found a way to schedule Will’s usual play dates, baseball practice, and family time. We were all happy and relieved when Sarah’s treatment was completed, yet we would later learn that we had been incredibly naïve in two ways; we thought that our brain tumor journey was over after Sarah’s treatment was completed and we thought that we’d brought Will through the process without effect. We had a lot to learn.At the time of diagnosis we knew that Sarah’s memory and ability to express emotion had already been impacted by the tumor but we didn’t yet know what that would mean to her quality of life. We were virtually unaware however that at age nine the chemotherapy and radiation treatments that Sarah received would result in profound late effects. Following treatment Sarah successfully completed 3rd grade and even received excellent STAR test scores (California state standardized tests). In 4th grade however, Sarah’s performance began to diverge from that of her peers and she found herself struggling in school and unable to make friends. We began looking for ways to help our daughter.What followed was a five year long journey through testing, evaluations, individualized education plans (IEPs), and therapies, which, in the end, left our family needing to accept the fact that although Sarah remains intelligent and artistically talented, she suffers from a constellation of late effects that will always affect her ability to function in the world. As a result of Sarah’s tumor and treatment she struggles with Auditory Processing Disorder, word finding problems, poor executive function, inability to recognize how she feels, significant difficulty making decisions, inability to read social cues, poor memory, slow processing, an emotional age of about nine, and lots of anxiety. She is also panhypopituitary, meaning that she has no remaining pituitary function and must take replacement medications by pill and injection, has hypothalamic obesity (HO), which is primarily controlled by more medication, and Raynaud’s Disease. The HO is an ongoing challenge because if Sarah does gain weight she can’t lose it again and exercise is not an easy solution because, like many pediatric brain tumor survivors, Sarah is easily fatigued. Finally, although Sarah’s vision improved after treatment her vision loss is significant enough to prevent her from driving. We pieced together this understanding of Sarah’s challenges and disabilities slowly so it wasn’t until the end of our children’s middle school years that we finally accepted the magnitude of the damage caused by the tumor and treatment. Thereafter we changed our focus from what Sarah might achieve in life to how to support [End Page 21] her in the activities at which she still excels and how to keep her active, interested in life, and feeling good about herself.It would have been a huge gift if we had been provided with information about the possible late effects that can result from treating the brain of a 9–year–old... (shrink)

Preoperative diagnosis of gastric cancer and primary gastric lymphoma is challenging and has important clinical significance. Inspired by the inductive reasoning learning of the human brain, transfer learning can improve diagnosis performance of target task by utilizing the knowledge learned from the other domains (source domain). However, most studies focus on single-source transfer learning and may lead to model performance degradation when a large domain shift exists between the single-source domain and target domain. By simulating the multi-modal (...) information learning and transfer mechanism of human brain, this study designed a multisource transfer learning feature extraction and classification framework, which can enhance the prediction performance of the target model by using multisource medical data (domain). First, this manuscript designs a feature extraction network that takes the maximum mean difference based on the Wasserstein distance as an adaptive measure of probability distribution and extracts the domain-specific invariant representations between source and target domain data. Then, aiming at the random generation of parameters bringing uncertainties to prediction accuracy and generalization ability of extreme learning machine network, the 1-norm regularization is used to implement sparse constraints of the output weight matrix and improve the robustness of the model. Finally, some experiments are carried out on the data of two medical centers. The experimental results show that the area under curves (AUCs) of the method are 0.958 and 0.929 in the two validation cohorts, respectively. The method in this manuscript can provide doctors with a better diagnostic reference, which has certain practical significance. (shrink)

A brain tumor is an abnormal mass or growth of a cell that leads to certain death, and this is still a challenging task in clinical practice. Early and correct diagnosis of this type of cancer is very important for the treatment process. For this reason, this study aimed to develop computer-aided systems for the diagnosis of brain tumors. In this research, we proposed three different end-to-end deep learning approaches for analyzing effects of local and (...) deep features for brain MRI images anomaly detection. The first proposed system is Directional Bit-Planes Deep Autoencoder which extracts and learns local and direction features. The DBP-DAE by decomposition of a local binary pattern into eight bit-planes extracts are directional and inherent local-structure features from the input image and learns robust feature for classification purposes. The second one is a Dilated Separable Residual Convolutional Network which extracts high and low-level features. The main advantage of this approach is that it is robust and shows stable results regardless to size of image database and to solve overfitting problems. To explore the effects of mixture of local and deep extracted feature on accuracy of classification of brain anomaly, a multibranch convolutional neural network approach is proposed. This approach is designed according to combination of DBP-DAE and DSRCN in an end-to-end manner. Extensive experiments conducted based on brain tumor in MRI image public access databases and achieves significant results compared to state-of-the-art algorithms. In addition, we discussed the effectiveness and applicability of CNNs with a variety of different features and architectures for brain abnormalities such as Alzheimer’s. (shrink)

The size and organization of the brain are determined by the activity of progenitor cells early in development. Key mechanisms regulating progenitor cell biology involve miRNAs. These small noncoding RNA molecules bind mRNAs with high specificity, controlling their abundance and expression. The role of miRNAs in brain development has been studied extensively, but their involvement at early stages remained unknown until recently. Here, recent findings showing the important role of miRNAs in the earliest phases of brain development (...) are reviewed, and it is discussed how loss of specific miRNAs leads to pathological conditions, particularly adult and pediatric brain tumors. Let‐7 miRNA downregulation and the initiation of embryonal tumors with multilayered rosettes (ETMR), a novel link recently discovered by the laboratory, are focused upon. Finally, it is discussed how miRNAs may be used for the diagnosis and therapeutic treatment of pediatric brain tumors, with the hope of improving the prognosis of these devastating diseases. (shrink)

Increasing evidence indicates that extracellular vesicles (EVs) secreted from tumor cells play a key role in the overall progression of the disease state. EVs such as exosomes are secreted by a wide variety of cells and transport a varied population of proteins, lipids, DNA, and RNA species within the body. Gliomas constitute a significant proportion of all primary brain tumors and majority of brain malignancies. Glioblastoma multiforme (GBM) represents grade IV glioma and is associated with very poor (...) prognosis despite the cumulative advances in diagnostic procedures and treatment strategies. Here, the authors describe the progress in understanding the role of EVs, especially exosomes, in overall glioma progression, and how new research is unraveling the utilities of exosomes in glioma diagnostics and development of next‐generation therapeutic systems. Finally, based on an understanding of the latest scientific literature, a model for the possible working of therapeutic exosomes in glioma treatment is proposed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How I Hate You, CancerClaire YarMigraine. That’s what we thought. They run in my family, so why not? My beautiful, bright, extroverted ten–year–old daughter’s neurological exam was unremarkable, but she had a bad headache and was vomiting in the early morning hours. Migraine didn’t seem that much of a stretch. Our savvy pediatrician had a gut feeling that it was more than a migraine and sent her for an (...) MRI.We had not even left the children’s hospital before I received a voicemail to call our pediatrician. When I returned the call, on our way to pick up Ellie’s younger brother from school and already running late I heard the words that no parent wants to hear, “I have bad news. We found a brain tumor and it’s rather large”. This conversation would turn our lives into a frenzy of fear and leave unanswered (unanswerable?) questions. I was told to bring her to the ER where we would be met by a neurosurgeon and oncologist. I could not process this information. My initial fears were too scary to utter. Was she going to die? Do children survive brain surgery “intact”? Is it operable? Oncologist = scary cancer, doesn’t it? Did we do something to cause it? What if our insurance doesn’t cover the best treatment?Clinging to the life I knew before—needing to stay in the “before,” not even pulling the car over, I reached backwards, held Ellie’s leg and spoke the words out loud for the first time. That’s what a brain tumor diagnosis does to your family. It breaks up time into “before” and “after”. Her reaction was a terrified wail and then, oddly, hysterical laughter. Is that what shock looks like? My own reaction to the call was of stunned silence. The sound of my heartbeat and the blood rushing in my ears meant I could not ask the questions I had in that moment.Ellie has always been exceptional. She is a bright light in any room. At only ten–years–old, she spoke like a teenager; had the vocabulary of an adult. Never again would I be able to take this for granted. In every waking moment that our lives were unoccupied with the practicalities of a brain tumor diagnosis, the questions I couldn’t think of or say out loud during that terrible phone call continually flooded my thoughts. Your child’s brain is everything after all; it’s what makes them “them.”An avid horse rider, she had been off her favorite horse’s back for a few weeks saying that the bouncing hurt her neck. I had kept her off school for several days, but we had seen marked improvement in [End Page E12] the day or two leading up to that devastating D–Day of diagnosis, and she had been back at school doing well. Only a week before, Ellie had been dancing at a party with friends. How could she have a brain tumor?We rushed home and hurriedly packed our bags for “at least a week”—and I recall that life seemed to be both in slow motion and traveling at the speed of light. I desperately wanted to turn the clock back to the innocence we had known a few hours before. This was way too much news to hear in one day. Even when I heard the diagnosis, I was surprised that we would have to go to the hospital that day. Now! Don’t people get time to process or plan and get second opinions? We had no time to tell family and friends or ask for help. We didn’t have the luxury of time. Time is another thing I no longer take for granted.Upon arrival at the large children’s hospital we felt as if we were given so much information, but looking back, I now know that these angels are trained in giving parents only what they can handle—in tiny pieces, nibble by nibble. You don’t (can’t) hear half of it anyway. Our families live far from us, and trying to gather and figure out... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Prepping for the Day You Hope Never Arrives:Facing RecurrenceTerra TrevorMy 14–year–old son was eight years past diagnosis of a brain tumor. Gone were the pristine sick days when his white hooded sweatshirt stayed spotlessly clean for weeks at a time. Each time he left a muddy footprint on the kitchen floor I rejoiced; it felt so good to have a healthy kid again. However, my son (...) was a survivor of an anaplastic ependymoma, grade IV, brain tumor, and although I wanted to be out of the woods, I knew we were not. I’d climbed out of the space where medical problems were fi led in my mind, yet I kept the door open because statics showed that the type of brain tumor he had, frequently recurred.Still, I was determined to keep our lives as ordinary as possible. But for a brain tumor family this meant staying connected to sources of support. Parent programs, patient and sibling support groups [End Page 27] and camps, and we remained connected to hospital resources. Most of all we needed to have fun as a family, and we attended the cancer survivor picnics and parties our hospital hosted, where the doctors served as volunteers, grilling hamburgers and dishing up ice cream for the guest of honor patients.My husband and I felt confident that as long as we worked as a team with our doctors and stayed connected to resources offered, we would find a way to meet any challenges that might surface.In the end ultimately what saved us was this mosaic of support provided to us over the years from a multitude of good people and organizations offering help when we needed it most. And I had the opportunity to learn to accept help, which it turns out, is far harder than offering to help.Shortly after my son Jay celebrated his 8th year as a brain tumor survivor, I watched him open the medicine cabinet and reach for the bottle of Advil, for the second time in a row that day. “Do you have a headache again?” I asked. He shrugged his shoulders, then hiccupped hard, and ducked his head in the toilet and threw up. Tears welled in his eyes. I sank into the deep, silent panic that made me calm.Our primary care physician called in an authorization for an MRI. Jay hid his fear behind a mask of quiet strength. It was ten days before his fifteenth birthday.While we waited for the MRI appointment, that week Jay was elected student of the month, and he got a lead part in the school play. My idyll of family hood continued until the MRI confirmed my worst fear—the tumor was back, and this time its fingers spread into the brainstem.We had to decide on a plan of treatment. Surgery was scheduled. When Jay was admitted to the hospital and I requested that he be placed in the pediatric ward, an environment he was familiar with, they agreed. Although Jay was a teenager, the recurrence caused him to revert emotionally back to a younger age. It was as if he was seven–years–old again, reliving his first brain tumor experience, and he kept his childhood security item—a small teddy bear with him, tucked under the hospital covers, like he had with the first diagnosis.Luck held. With surgery most of the tumor was resected and symptoms disappeared. Three days later, on Thanksgiving, he was feeling well enough to be excited about the Thanksgiving dinner our hospital provided us. A table and chairs were brought in, along with a feast of good food. The nurses gave Jay lavish attention, they laughed at the corny jokes he told, and made us feel like special company.Within a week Jay was out of the hospital, recovering well. But what to do about the remaining brain tumor slivers that were inoperable? He had already received his lifetime dose of whole brain radiation, and chemotherapy available offered little hope of curing a recurrent tumor. But there was a small chance that stereotactic radiation might stall tumor growth. We set up a consultation.We had... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Advocates, Not Problem ParentsAnonymous TwoNothing could have prepared us for the shock of hearing that our son had a brain tumor.Rob* was 13½, an active, healthy eighth grader, when he developed a headache so bad he couldn’t get out of bed in the morning. We saw the pediatrician three times over the next ten days. On the third visit, after ruling out problems at home, stress at (...) school, strep throat and mono, he sent us for an MRI. When the radiology tech handed me the films and told us to drive back to the pediatrician’s office, I knew we were in trouble. Sure enough, after all the other patients had left, our long–time doctor called us into his tiny office, shut the door and fumbled with the films as he pointed to a white spot that he said was a brain tumor.So began the experience that would change the course of our lives. We remember the diagnosis in detail and relive it in slow motion. We recall packing suitcases, driving to the hospital, waiting to be seen in the emergency room, and walking through doors marked “Pediatric Hematology/Oncology” for the first time.We date everything “BC” (Before Cancer) or “AD” (After Diagnosis). We are grateful every day that [End Page 13] our son is alive, but we know he is forever changed. We are changed: Our nuclear family, our extended family, everyone who knew us and supported us at the time was affected. A pediatric cancer diagnosis is a bomb that shatters your world without warning. If you’re lucky, you can pick up a lot of the pieces, maybe even most of them, but the world you re–enter is never the one you inhabited before.Our doctor delivered the diagnosis to Rob and me at the same time. I’ve thought about this many times and perhaps one day will ask him: Why did he choose to do it that way? Was it a conscious decision or just happenstance? Was it kinder, in the long run—like pulling off a band–aid quickly—or terribly risky? What if I had collapsed at the news? I asked to step into the hall to use the phone. In a state of numbness, I called my husband. He knew we had had an MRI a few hours earlier. “Come quickly,” I said. “There’s a mass.”We chose to go to a top-ranked major medical center and were admitted that evening. A couple of days later, the discovery of tumor markers in Rob’s cerebrospinal fluid and blood confirmed a central nervous system mixed germ cell tumor. We were told he would require six cycles of chemotherapy, followed by six weeks of radiation, and possibly second–look surgery and high-dose chemo with stem cell rescue on top of that. We were given a consent form listing a catalogue of short–and long–term side effects, among them the likelihood of infertility. We were urged to start treatment as soon as possible.By sheer coincidence I had just completed a project for a small, nonprofit organization that existed to inform young adult cancer patients about their fertility rights and options. I knew that infertility concerns were usually pushed aside at diagnosis to make way for other priorities, namely the urgency of starting treatment. And that’s exactly the kind of pressure we were facing.But my husband and I were not ready to sign away our son’s fertility in what felt like a no–confidence vote, a capitulation. We needed to believe that he would survive and put this horror behind him, that he would look forward to marriage and starting a family. We were willing to cede nothing to the disease at this early stage of the game. Was this rational, naive or selfish on our part? I don’t know.The medical team seemed surprised when we asked for a delay in treatment in order to collect sperm samples. They warned that our son’s condition could decline suddenly—and that postponing treatment by even several days might be dangerous. However, at our insistence, they agreed to the delay... (shrink)

Brain tumor classification plays a niche role in medical prognosis and effective treatment process. We have proposed a combined feature and image-based classifier for brain tumor image classification in this study. Carious deep neural network and deep convolutional neural networks -based architectures are proposed for image classification, namely, actual image feature-based classifier, segmented image feature-based classifier, actual and segmented image feature-based classifier, actual image-based classifier, segmented image-based classifier, actual and segmented image-based classifier, and finally, CFIC. The (...) Kaggle Brain Tumor Detection 2020 dataset has been used to train and test the proposed classifiers. Among the various classifiers proposed, the CFIC performs better than all other proposed methods. The proposed CFIC method gives significantly better results in terms of sensitivity, specificity, and accuracy with 98.86, 97.14, and 98.97%, respectively, compared with the existing classification methods. (shrink)

When the language-dominant hemisphere is damaged by a focal lesion, the brain may reorganize the language network through functional and structural changes known as adaptive plasticity. Adaptive plasticity is documented for triggers including ischemic, tumoral, and epileptic focal lesions, with effects in clinical practice. Many questions remain regarding language plasticity. Different lesions may induce different patterns of reorganization depending on pathologic features, location in the brain, and timing of onset. Neuroimaging provides insights into language plasticity due to its (...) non-invasiveness, ability to image the whole brain, and large-scale implementation. This review provides an overview of language plasticity on MRI with insights for patient care. First, we describe the structural and functional language network as depicted by neuroimaging. Second, we explore language reorganization triggered by stroke, brain tumors, and epileptic lesions and analyze applications in clinical diagnosis and treatment planning. By comparing different focal lesions, we investigate determinants of language plasticity including lesion location and timing of onset, longitudinal evolution of reorganization, and the relationship between structural and functional changes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Over the YearsKimberly RockerMy daughter was diagnosed with an Ependymoma brain tumor in 1986 at the age of 19 months. Our journey began when we realized that we had become concerned about her falling. For example, we were staying at a lodge with a large stone fi replace and both my husband and myself were careful to cover the area with pillows from the couch. Then there (...) were the sporadic “jokes” from strangers who would say, “what has she been drinking?” as she walked past with a slight stagger in her gait. We took her to the pediatrician who listened to my concerns and then watched her walk in a narrow hallway. Surprisingly, she didn’t seem to stagger and she walked very “toddler–like” down the hall. We learned later that this tighter area would help compensate for my daughter’s lack of balance. We were told that she simply needed to develop her gross motor skill more and that she would outgrow it and I was simply an over–concerned first time mom. Unfortunately, the pediatrician failed to recall that my daughter had been walking since she was 11 ½ months old and the current lack of coordination and balance was actually a regression in her motor skills. This negative change in her abilities should have been seen as a red flag.I still couldn’t shake the nagging feeling that something was wrong. Since our doctor had been unresponsive to my concerns, I made an appointment with another doctor. I told my husband that if the new doctor is just as unconcerned about our daughter’s gross motor skills, then I would let it go. The new doctor refrained from making judgments about my parenting skills and concerns. She listened carefully as I described the situation. She examined my daughter and watched her walk in the large hospital hallway. Her next step, one that our regular doctor failed to do, was to measure her head circumference. The measurement exceeded the 100–percentile mark. They were immediately concerned and ordered a CT scan right away. The diagnosis was a brain tumor and due to the size and location, they didn’t expect her to live. We called family and said our beautiful little girl was very sick and was going to die.As a parent, we often know our children well. This can be both a help and a hindrance. Since the changes in our daughters walking skills declined gradually over several months, it was difficult for us to see just how far she had declined. We have a [End Page 25] video of our daughter taken just a few weeks before her diagnosis. I have only watched it a couple of times because it is difficult to see. It is painfully obvious that there is something terribly wrong. It does make me question our parenting and ability to know what is best for our child’s well being. Add to that a doctor that made you feel very inadequate as a parent, it was hard to have the confidence to question the doctor. But, that small quiet voice kept getting louder, demanding to be heard.My daughter will be 29 years old this August. One thing I remember very clearly during that first year is that I just wanted to know that somewhere there was another child who survived to live a happy, healthy life. At that time, it was difficult to find. During those first few months after our diagnosis, we met three other families who had daughters with brain tumors, Nina, Larissa and Wendy. My daughter is the only one still alive. We thank God for the gift of life He gave to our daughter but are full of sorrow for the families that suffered such a difficult loss. There were many miracles and many challenges along the way regarding her recovery. I believe our story can give hope to families as they struggle with this terrible diagnosis.One of our first miracles was the fact that the neurosurgeons were able to remove all visible evidence of the tumor. This is rarely the case since removing the tumor can also damage healthy areas of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethan’s GiftMichelle BurgessEthan was your average boy next door. He loved everything most 8–year–old boys do including playing baseball, swimming, and watching his favorite baseball team, the Philadelphia Phillies.On December 3rd 2008, life for our family changed forever when Ethan was diagnosed with Diffuse Intrinsic Pontine Glioma, a rare inoperable brainstem tumor. DIPG is in essence a death sentence. There are no survivors and life expectancy after (...) class='Hi'>diagnosis is only 9–12 months. Our family was devastated.For the next 14 months, we lived life to the fullest, never taking a single moment or day for granted. As Ethan’s condition worsened, and it became clear that he was close to passing, I spoke with Ethan’s doctor about my desire to be able to donate Ethan’s corneas and his brain tumor for research. He informed me that because of Ethan’s type of tumor that he may be a candidate for donation of other organs as well if that is something we wanted to do.Knowing that there was nothing we could do to save Ethan, it was something that we felt we could do to help others so we decided to explore the option of donating Ethan’s other organs. We were put in contact with the Gift of Life.Two representatives from Gift of Life came to our home and discussed at length with us what would have to happen to make organ donation possible at the time of Ethan’s passing. Specifically that Ethan would have to pass away at the hospital and in the operating room. This was very different than the hospice environment that we had planned. They also had told us that Ethan was only the second young person that they had ever dealt with that the families had planned ahead of time to donate organs. The other person was a teenager who planned his own organ donation.On January 26th 2010, Ethan’s pain had become unmanageable at home and his breathing had become very labored. I spoke with his oncologist and he advised me to bring Ethan to the hospital to try and get his pain under control.We loaded Ethan up in the car for the one–hour car ride to the hospital. On the way to the hospital Ethan fell asleep while being cuddled by me in the backseat. When we arrived at the hospital we noticed that his fingers and toes had turned purple. The nurses immediately checked his oxygen and it had fallen to only 10 %.The doctors advised that he had slipped into a coma in the car, one that he would never awake from. He was immediately placed on life support. A scan was done and it was evident that the progressing tumor was placing pressure on the areas of the brain that controlled basic life functions such as breathing. Ethan could not recover.The decision was made to begin to look for recipients for Ethan’s organs. Because Ethan had not reached the point of brain death, his donation would have to be a post cardiac death transplant, meaning, life support would be removed, when his heart stopped beating and he passed away, the organ procurement would begin. However, he [End Page E1] would not be able to donate his heart. This was very sad for us, knowing how strong his little heart was, but we did understand the process.On January 28th 2010, our family spent the day saying goodbye to Ethan. Even though he could not respond, we know that he could hear us. The nurse was wonderful, doing everything possible to accommodate our large family and despite all the tubes and machines, make it so that I could cuddle with my little boy one last time.Ethan was moved to the operating room and with his stepfather and I on one side and his father and stepmother on the other, life support was removed. Watching my son take his last breath, while I held his hand, kissed his cheeks, told him I loved him and that it was okay to let go and go to Heaven was the hardest moment of... (shrink)

When talking about decisionmaking for children with a life-threatening condition, the death of children with brain tumors deserves special attention. The last days of the lives of these children can be particularly harsh for bystanders, and raise questions about the suffering of these children themselves. In the Netherlands, these children are part of the group for whom a wide range of end-of-life decisions are discussed, and questions raised. What does the end-of-life for these children look like, and what motivates (...) physicians and parents to make decisions that may affect the life and death of these children? This article highlights the story of the parents of the sisters Roos and Noor. When both their daughters were diagnosed with a hereditary brain tumor, they had to make similar decisions twice. Their story sheds light on the suffering of children in the terminal phase, and how this suffering may motivate parents and physicians to make decisions that influence the end of life of these children’s lives.We argue that complete knowledge about suffering in the terminal phase of children with brain tumors is impossible. However, by collecting experiences like those of Roos and Noor, we can move toward an experienced-based understanding and better guide parents and physicians through these hardest of decisions. (shrink)

In Patricia Churchland's 2006 essay on free will, she cites the case of a middle-aged man who, without any prior history of misbehavior, suddenly became obsessed with child pornography and started to molest his 8-year-old stepdaughter. He was subsequently discovered to have a brain tumor affecting the frontal lobes, and when it is successfully treated his aberrant behavior stopped.Thomas Szasz is famous for his denunciation of the concept of mental illness, and his critique is partly responsible for instigating (...) an enduring philosophical discourse about the nature of mental disorder. Szasz's key insight was the recognition that we find it important to distinguish between situations that are characterized by... (shrink)

Two experiments tested the hypothesis that neurological abnormalities decrease punishment by decreasing perceptions of free will. Experiment 1 found that a brain tumor decreased punishment for criminal behavior by decreasing perceptions of the afflicted criminal’s free will. This effect was stronger for liberal and non-religious participants than for conservative and religious participants. Experiment 2 replicated Experiment 1 and additionally found that a brain tumor decreased perceptions of the afflicted criminal’s conscious decisions and true self, thereby decreasing (...) perceptions of his free will, thereby decreasing his punishment. Collectively, these results suggest that neurological abnormalities decrease punishment by decreasing perceptions of free will, especially among liberals and non-religious people. These results also suggest that neurological abnormalities decrease perceptions of free will – and ultimately decrease punishment – by decreasing perceptions of conscious decisions and the true self. (shrink)

Researchers have documented negative physical and emotional consequences for both family caregivers of persons with cancer as well as caregivers of persons with a neurologic disorder. However, there is a unique subset of caregivers who must provide care for someone who may suffer from both a short, terminal trajectory of disease, as well as neurological and neuropsychiatric sequelae — the caregiver of a person with a primary malignant brain tumor. The purpose of this article was to describe a (...) conceptual framework for providing care for a person with a primary malignant brain tumor. The demands of this particular care situation are described, as well as potential resources available to the caregiver to meet those demands. Finally, the stress response that results from the balance between care demands and caregiver resources is illustrated. Development of a conceptual framework for this caregiving population is the first step in assisting nurses to identify factors that place caregivers of persons with a primary malignant brain tumor at risk for negative consequences, and to design interventions to improve caregiver health. (shrink)

Background: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical–legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. Aim: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain (...) death and the maintenance of potential organ donors for transplantation purposes. Study Design: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. Ethical considerations: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. Results: Two main categories emerged from the analysis: brain death diagnosis and its implications and maintenance of the potential organ donor and its repercussion in the donation–transplantation process. Six subcategories were also identified: understanding the brain death diagnosis as a tool to aid decision-making; diagnosis as guarantee of rights; difficulties encountered to establish the diagnosis; clinical criteria adopted in Brazil and related ethical–legal aspects; specificities of care to the brain dead person and outcomes; and nurse’s duties toward the brain dead person. Conclusion: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario. (shrink)

Survivors of childhood brain tumors face many obstacles to living independently as adults. Causes for lack of independence are multifactorial and generally are investigated in terms of physical, cognitive, and psychosocial treatment–related sequelae. Little is known, however, about the role of expectation for survivors’ function. From a mixed–methods study including qualitative interviews and quantitative measures from 40 caregiver–survivor dyads, we compared the data within and across dyads, identifying four distinct narrative profiles: (A) convergent expectations about an optimistic future, (B) (...) convergent expectations about a less optimistic future, (C) non–convergent expectations about a less optimistic future, and (D) non–convergent expectations about an unclear future. Dyads both do well and/or struggle in systematically different manners in each profile. These profiles may inform the design of interventions to be tested in future research and help clinicians to assist families in defining, (re–)negotiating, and reaching their expectations of function and independence. (shrink)

New targets for brain tumor therapies may be identified by mutations that cause hereditary microcephaly. Brain growth depends on the repeated proliferation of stem and progenitor cells. Microcephaly syndromes result from mutations that specifically impair the ability of brain progenitor or stem cells to proliferate, by inducing either premature differentiation or apoptosis. Brain tumors that derive from brain progenitor or stem cells may share many of the specific requirements of their cells of origin. These (...) tumors may therefore be susceptible to disruptions of the protein products of genes that are mutated in microcephaly. The potential for the products of microcephaly genes to be therapeutic targets in brain tumors are highlighted hereby reviewing research on EG5, KIF14, ASPM, CDK6, and ATR. Treatments that disrupt these proteins may open new avenues for brain tumor therapy that have increased efficacy and decreased toxicity. -/- . (shrink)

Background: Maximum safe resection of infiltrative brain tumors in eloquent area is the primary objective in surgical neuro-oncology. This goal can be achieved with direct electrical stimulation to perform a functional mapping of the brain in patients awake intraoperatively. When awake surgery is not possible, we propose a pipeline procedure that combines advanced techniques aiming at performing a dissection that respects the anatomo-functional connectivity of the peritumoral region. This procedure can benefit from intraoperative monitoring with computerized tomography scan (...) and brain shift correction. Associated with this intraoperative monitoring, the additional value of preoperative investigation combining brain mapping by navigated transcranial magnetic stimulation with various neuroimaging modalities has not yet been reported.Case Report: A 42-year-old left-handed man had increased intracranial pressure, left hand muscle deficit, and dysarthria, related to an infiltrative tumor of the right frontal lobe with large mass effect and circumscribed contrast enhancement in motor and premotor cortical areas. Spectroscopy profile and intratumoral calcifications on CT-scan suggested an WHO grade III glioma, later confirmed by histology. The aforementioned surgical procedure was considered, since standard awake surgery was not appropriate for this patient. In preoperative time, nTMS mapping of motor function was performed, combined with magnetic resonance imaging -based tractography reconstruction of 6 neural tracts and resting-state functional MRI connectivity of sensorimotor and language networks. In intraoperative time, DES mapping was performed with motor evoked response recording and tumor resection was optimized using non-rigid image transformation of the preoperative data to iCT data. Image guidance was updated with correction for brain shift and tissue deformation using biomechanical modeling taking into account brain elastic properties. This correction was done at crucial surgical steps, i.e., when tumor bulged through the craniotomy after dura mater opening and when approaching the presumed eloquent brain regions. This procedure allowed a total resection of the tumor region with contrast enhancement as well as a complete regression of IICP and dysarthria. Hand paresis remained stable with no additional deficit. Postoperative nTMS mapping confirmed the good functional outcome.Conclusion: This case report and technical note highlights the value of preoperative functional evaluation by nTMS updated intraoperatively with correction of brain deformation by iCT. This multimodal approach may become the optimized technique of reference for patients with brain tumors in eloquent areas that are unsuitable for awake brain surgery. (shrink)

Gliomas are diffuse and invasive brain tumors with the nefarious ability to evade even seemingly draconian treatment measures. Here we introduce a simple mathematical model for drug delivery of chemotherapeutic agents to treat such a tumor. The model predicts that heterogeneity in drug delivery related to variability in vascular density throughout the brain results in an apparent tumor reduction based on imaging studies despite continual spread beyond the resolution of the imaging modality. We discuss a clinical (...) example for which the model-predicted scenario is relevant. The analysis and results suggest an explanation for the clinical problem of the long-standing confounding observation of shrinkage of the lesion in certain areas of the brain with continued growth in other areas. (shrink)

Balancing self‐renewal and differentiation of stem cells is an important issue in stem cell and cancer biology. Recently, the Drosophila neuroblast (NB), neural stem cell has emerged as an excellent model for stem cell self‐renewal and tumorigenesis. It is of great interest to understand how defects in the asymmetric division of neural stem cells lead to tumor formation. Here, we review recent advances in asymmetric division and the self‐renewal control of Drosophila NBs. We summarize molecular mechanisms of asymmetric cell (...) division and discuss how the defects in asymmetric division lead to tumor formation. Gain‐of‐function or loss‐of‐function of various proteins in the asymmetric machinery can drive NB overgrowth and tumor formation. These proteins control either the asymmetric protein localization or mitotic spindle orientation of NBs. We also discuss other mechanisms of brain tumor suppression that are beyond the control of asymmetric division. (shrink)

Objective: To investigate the differences between patients returning to work and those who did not after brain tumor surgery.Methods: Patients were evaluated before surgery and after 3 months. The Montreal Cognitive Assessment test, Trail-Making Test, 15-word Rey–Osterrieth Word List, F-A-S tests, and Karnosfky Performance Status were used to assess cognitive status, attention, executive functions, memory, word fluency, and functional status. Patient-reported outcome measures used to evaluate emotional distress and disability were the Hospital Anxiety and Depression Scale and World (...) Health Organization Disability Assessment Schedule. Clinical and work-related variables, PROMs, and cognitive tests were compared using chi-squared, t-test or Mann–Whitney U test.Results: Sixty patients were included. Patients returning to work were 61.3 and 31.0% among people with meningioma and glioma, respectively. They reported lower postoperative disability and lesser home-to-work travel time. Patients with meningioma also showed better preoperative and postoperative attention and executive functions, better postoperative functional and cognitive status, and lower frequency of treatments.Conclusions: These variables should be considered in a clinical context to plan interventions for people who need support during return to work and in future research to investigate preoperative and postoperative predictive factors of going back to work. (shrink)

PurposeAlthough an increasing body of literature suggests a relationship between brain irradiation and deterioration of neurocognitive function, it remains as the standard therapeutic and prophylactic modality in patients with brain tumors. This review was aimed to abstract and evaluate the prediction models for radiation-induced neurocognitive decline in patients with primary or secondary brain tumors.MethodsMEDLINE was searched on October 31, 2021 for publications containing relevant truncation and MeSH terms related to “radiotherapy,” “brain,” “prediction model,” and “neurocognitive impairments.” (...) Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool.ResultsOf 3,580 studies reviewed, 23 prediction models were identified. Age, tumor location, education level, baseline neurocognitive score, and radiation dose to the hippocampus were the most common predictors in the models. The Hopkins verbal learning and the trail making tests were the most frequent outcome assessment tools. All studies used regression as machine learning method. All models were judged to have a high risk of bias mainly due to issues in the analysis.ConclusionExisting models have limited quality and are at high risk of bias. Following recommendations are outlined in this review to improve future models: developing cognitive assessment instruments taking into account the peculiar traits of the different brain tumors and radiation modalities; adherence to model development and validation guidelines; careful choice of candidate predictors according to the literature and domain expert consensus; and considering radiation dose to brain substructures as they can provide important information on specific neurocognitive impairments. (shrink)

Gene therapy approaches have great promise in the treatment of neurodegenerative disorders and malignant brain tumors. Neuwelt et al. review available viral-mediated gene therapy methods and their blood-brain-barrier (BBB) disruption delivery technique, briefly mentioning nonviral mediated gene therapy methods. This commentary discussed the BBB disruption delivery technique, viral and nonviral mediated gene therapy approaches to Parkinson's disease, and the potential use of antisense oligo to suppress malignant brain tumors.

Background: The risk of surgery in eloquent areas is related to neuropsychological dysfunctions. Maximizing the extent of resection increases the overall survival. The onco-functional balance is mandatory when surgery involves cognitive areas, and maximal information on the cognitive status of patients during awake surgery is needed. This can be achieved using direct cortical stimulation mapping and, in addition to this, a neuropsychological monitoring technique called real-time neuropsychological testing. The RTNT includes testing protocols based on the area where the surgery is (...) performed. We reported on tests used for left temporal lobe surgery and our RTNT decision tree.Case Report: We reported our RTNT experience with a 25-year-old right-handed man with 13 years of schooling. He reported daily partial seizures. MRI revealed the presence of a low-grade glioma involving the temporo-insular cortex. The neuropsychological status presurgery which was within the normal range was combined with functional magnetic resonance imaging and diffusion tensor imaging information. Awake surgery plus RTNT was performed. Direct electrical stimulation during object naming elicited a motor speech arrest. Resection was continuously accompanied by the RTNT. The RTNT provided enriched information to the surgeon. Performance never dropped. A slight decrement in accuracy emerged for pseudoword repetition, short-term memory and working memory, phonological processing, and verbal comprehension. Total resection was performed, and the histological examination confirmed the nature of the lesion. Immediate postsurgery performance was within the normal range as it was the fMRI and DTI assessment.Conclusion: The RTNT provides essential information that can be used online, during surgery, for clinical aims to provide the surgeon with useful feedback on the cognitive status of patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ice Cream for BreakfastMichelle MethvenIn June of 2011, on a warm sunny day in Toronto, Canada, my partner and I brought our daughter Stella into the local hospital emergency room for what we believed would be a routine check–up. She had been exhibiting worsening clumsiness and limping for the previous two weeks and we thought it would be easier just to get her seen and have whatever it was (...) dealt with rather than wait two months to see a specialist. My partner and I believed it was likely a severe ear infection, or maybe Lyme disease from a recent camping trip. We each called our workplaces and said we would be an hour or so late. Nothing could have prepared us for the news 22 hours after arriving at the hospital, that Stella had a cancerous mass in her brain. After a biopsy three days later to confirm the diagnosis, Stella was diagnosed with Diffuse Intrinsic Pontine Glioma (DIPG), and given less than a year to live.Parents most often describe DIPG as “a monster.” The tumour saturates the pons and shuts down nerve pathways one at a time. In no particular order, and in no particular time, sufferers (most often young children) lose the ability to walk, sit up, hold up their head, speak and see. The pons is also responsible for breathing, swallowing and regulating the heartbeat, so death can come in many forms at any given time. Though it destroys the brain’s ability to command, the person continues to think and understand as the main part of the brain is untouched. Different from most cancers, chemotherapy and radiation have almost no effect on DIPG; even trials with the most toxic chemotherapies do not slow its progress.My partner and I were shaken to the core at this diagnosis. Looking at our energetic, redheaded [End Page 31] mop–topped little imp, it was impossible to fathom that she had just been given a fatal diagnosis. Yet we knew the doctors at the hospital were among the best and most sought–after in the world, so denial was never a part of our mantra.A week after Stella was diagnosed, we met with a neuro–oncologist to discuss our plans. The only treatment that is slightly effective for DIPG is focal radiation, which can stall the tumor’s growth, granting what is known as a “honeymoon period” of no new symptoms. The honeymoon lasts approximately six months, but there are no guarantees. Twenty percent of children get no honeymoon whatsoever after radiation, and others get only weeks. The doctor we met with confirmed radiation would not be curative, but would “buy time”. He explained that radiation involved six weeks of treatment, seven days a week. Following the six weeks of treatment, there would be a period of anywhere from one to six months in which Stella would likely be asymptomatic. However, at some point, the symptoms generally return and when they do, children deteriorate relatively quickly. Sometimes it takes a month or two, but on occasion there is as little as two weeks between progression and death.As Stella’s parents, we were not convinced that the prescribed radiation was something we wanted to subject Stella to. Because she was only two, and a very spirited and energetic child, it would have been virtually impossible to have her lie quietly on the table in hospital each day for six weeks while radiation was put behind her ear. The neuro–oncologists’ solution was that Stella be sedated for each daily radiation treatment, which would make her groggy for a big part of the day and necessitate needles and IV. As parents, we were presented with an impossible gamble. Do we risk taking away six weeks of her still somewhat symptom–free life for a possible extra three to six months later? And the timing was difficult as well. It was late June. If we chose to radiate it would mean spending the entire summer shuttling her between hospital and home with no weeks at the cottage, and much less time to attend neighbourhood BBQ’s, parties, trips to the park, the library, science centre and zoo... (shrink)

In this paper an Artificial Neural Network (ANN) model, for predicting the category of a tumor was developed and tested. Taking patients’ tests, a number of information gained that influence the classification of the tumor. Such information as age, sex, histologic-type, degree-of-diffe, status of bone, bone-marrow, lung, pleura, peritoneum, liver, brain, skin, neck, supraclavicular, axillar, mediastinum, and abdominal. They were used as input variables for the ANN model. A model based on the Multilayer Perceptron Topology was established (...) and trained using data set which its title is “primary tumor” and was obtained from the University Medical Centre, Institute of Oncology, Ljubljana, Yugoslavia Test data evaluation shows that the ANN model is able to correctly predict the tumor category with 76.67 % accuracy. (shrink)

Thousands of candidate cancer biomarkers have been proposed, but so far, few are used in cancer screening. Failure to implement these biomarkers is attributed to technical and design flaws in the discovery and validation phases, but a major obstacle stems from cancer biology itself. Oncogenomics has revealed broad genetic heterogeneity among tumors of the same histology and same tissue (or organ) from different patients, while tumors of different tissue origins also share common genetic mutations. Moreover, there is wide intratumor genetic (...) heterogeneity among cells within any single neoplasm. These findings seriously limit the prospects of finding a single biomarker with high specificity for early cancer detection. Current research focuses on developing biomarker panels, with data assessment by machine‐learning algorithms. Whether such approaches will overcome the inherent limitations posed by tumor biology and lead to tests with true clinical value remains to be seen. (shrink)

No apologies are needed for returning to the subject of brain death and its definition. There has been so much public discussion that it is important for public confidence that the issues should be clarified. In the following two contributions - one from a professor of neurosurgery and the other from a lawyer - an attempt is made to convince doctors (if that is needed) and lay people alike that what appears to be a new bogy is not one (...) at all but a confusion of thought arising from the use of new technology to treat brain-damaged patients. This, however, might not be the view of Mr Skegg (Journal of medical ethics, 2, 190) who, fearful of the situation, has argued for a statutory definition of death. Professor Jennett discusses the findings of a conference of the Royal Colleges of the United Kingdom which met to try and remove uncertainty surrounding the diagnosis of brain death. In his view the Colleges' document is to be welcomed for `its authority and its practicality' and `should lead to more humane medical practice'. Mr Kennedy, from a legal position, comes to the same conclusion, that with a good code of practice, as advocated by the Royal Colleges, no legislation is called for. (shrink)

BackgroundThis essay provides an ethical and conceptual argument for the use of informed consent prior to the diagnosis of brain death. It is meant to enable the family to make critical end-of-life decisions, particularly withdrawal of life support system and organ donation, before brain death is diagnosed, as opposed to the current practice of making such decisions after the diagnosis of death. The recent tragic case of a 13-year-old brain-dead patient in California who was maintained (...) on a ventilator for over 2 years illustrates how such a consent would have made a crucial difference.MethodsConceptual, philosophical, and ethical analysis.ResultsI first consider a conceptual justification for the use of consent for certain non-beneficial and unwanted medical diagnoses. I suggest that the diagnosis of brain death falls into this category for some patients. Because the diagnostic process of brain death lacks the transparency of traditional death determination, has a unique epistemic structure and a complex risk-benefit profile which differs markedly from case to case, and presents conflicts of interest for physicians and society, I argue that pre-diagnostic counseling and informed consent should be part of the diagnostic process. This approach can be termed as “allow cardiac death”, whose parallel logic with “allow natural death” is discussed. I also discuss potential negative impacts on organ donation and health care cost from this proposal and offer possible mitigation. I show that the pre-diagnostic counseling can improve the possibility for well-thought-out decisions regarding organ donation and terminating life-support system in cases of hopeless prognosis. This approach differs conceptually from the pluralism of the definition of death, such as those in New Jersey and Japan, and it upholds the Uniform Determination of Death Act.ConclusionsMy intention is not to provide an instant panacea for the ongoing impasse of the brain death debate, but to point to a novel conceptual ground for a more pragmatic, and more patient- and family-centered approach. By enabling the family to consent to or decline the diagnostic process of brain death, but not to choose the definition of death, it upholds the current legal definition of death. (shrink)

High-resolution neuroimaging modalities are used often in studies involving healthy volunteers. Subsequently, a significant increase in the incidental discovery of asymptomatic intracranial abnormalities raised the important ethical issues of when follow-up and treatment may be necessary. We examined the literature to establish a practical set of criteria for approaching incidental findings. Our objective is to develop an algorithm for when follow-up may be important and to provide recommendations that would increase the likelihood of follow-up. A systematic literature search was performed (...) using the PubMed and MEDLINE databases to identify articles describing brain tumors and intracranial aneurysms. The treatment algorithm we present suggests that incidental intracranial masses suspicious for glioma should be biopsied or resected, while other masses are to be followed with serial imaging based on the expected growth pattern. Lack of follow-up can result in adverse outcomes that can be mitigated by using technology to facilitate communication and improve follow-up care. The importance of training physicians to be good communicators is also stressed. New technology including automated telephone systems, texting and email will improve access to patients and hopefully encourage compliance and follow-up. (shrink)

In this work, a system for the classification of liver dynamic contest- enhanced CT images is presented. The system simultaneously analyzes the images with the same slice location, corresponding to three typical acquisition moments. At first, the texture features are extracted separately for each acquisition mo- ment. Afterwards, they are united in one “multiphase” vector, characterizing a triplet of textures. The work focuses on finding the most appropriate features that characterize a multi-image texture. At the beginning, the features which are (...) unstable and dependent on ROI size are eliminated. Then, a small subset of remaining features is selected in order to guarantee the best possible classification accuracy. In total, 9 extraction methods were used, and 61 features were calculated for each of three acquisition moments. 1511 texture triplets, corresponding to 4 hepatic tissue classes were recognized. As a classifier, an adaptive boosting algorithm with a C4.5 tree was used. Experiments show that a small set of 12 features is able to ensure classification accuracy exceeding 90%, while all of the 183 features provide an accuracy rate of 88.94%. (shrink)