ABSTRACT
[This corrects the article DOI: 10.1038/s41525-017-0014-7.].
ABSTRACT
High-grade meningiomas frequently recur and are associated with high rates of morbidity and mortality. To determine the factors that promote the development and evolution of these tumors, we analyzed the genomes of 134 high-grade meningiomas and compared this information with data from 587 previously published meningiomas. High-grade meningiomas had a higher mutation burden than low-grade meningiomas but did not harbor any statistically significant mutated genes aside from NF2. High-grade meningiomas also possessed significantly elevated rates of chromosomal gains and losses, especially among tumors with monosomy 22. Meningiomas previously treated with adjuvant radiation had significantly more copy number alterations than radiation-induced or radiation-naïve meningiomas. Across serial recurrences, genomic disruption preceded the emergence of nearly all mutations, remained largely uniform across time, and when present in low-grade meningiomas, correlated with subsequent progression to a higher grade. In contrast to the largely stable copy number alterations, mutations were strikingly heterogeneous across tumor recurrences, likely due to extensive geographic heterogeneity in the primary tumor. While high-grade meningiomas harbored significantly fewer overtly targetable alterations than low-grade meningiomas, they contained numerous mutations that are predicted to be neoantigens, suggesting that immunologic targeting may be of therapeutic value.
ABSTRACT
BACKGROUND: Patients with elevated hemoglobin A1c (HbA1c) levels have an increased risk of adverse short- and long-term outcomes after cardiac surgical procedures. Whether elevated HbA1c levels are associated with lower socioeconomic position (SEP) has been unknown. METHODS: All adult patients undergoing cardiac surgical procedures at Kansas University Medical Center in Kansas City, Kansas in 2014 (n = 567) were reviewed. Of those patients, 531 had a preoperative HbA1c level measured. HbA1c was delineated as 7% or lower or greater than 7%. The two aims of this study were to evaluate a possible association of HbA1c and SEP and to evaluate for a possible association of HbA1c levels and poor outcomes after cardiac surgical procedures. The primary postsurgical outcomes were infections and intensive care unit length of stay. RESULTS: HbA1c levels greater than 7% were associated with lower SEP (p = 0.005) and with increased risk of infection postoperatively (p < 0.001). Total hospital length of stay tended to be longer for patients with HbA1c greater than 7% (p = 0.009). CONCLUSIONS: Elevated HbA1c levels are associated with lower SEP. This association not only may hinder the ability to correct HbA1c levels, but also may impart a risk for elevated HbA1c levels. Additionally, patients who present for cardiac operations with HbA1c greater than 7% have an increased risk of postoperative infections.
