Introduction
Management of patients with intracranial metastases from an unknown primary tumor (CUP) varies compared to those with metastases of known primary tumor origin (CKP). The National ...Institute for Health and Care Excellence (NICE) recognizes the current lack of research to support the management of CUP patients with brain metastases. The primary aim was to compare survival outcomes of CKP and CUP patients undergoing early resection of intracranial metastases to understand the efficacy of surgery for patients with CUP.
Methods
A retrospective study was performed, wherein patients were identified using a pathology database. Data was collected from patient notes and trust information services. Surgically managed patients during a 10-year period aged over 18 years, with a histological diagnosis of intracranial metastasis, were included.
Results
298 patients were identified, including 243 (82.0%) CKP patients and 55 (18.0%) CUP patients. Median survival for CKP patients was 9 months (95%CI 7.475–10.525); and 6 months for CUP patients (95%CI 4.263–7.737,
p
= 0.113). Cox regression analyses suggest absence of other metastases (
p
= 0.016), age (
p
= 0.005), and performance status (
p
= 0.001) were positive prognostic factors for improved survival in cases of CUP. The eventual determination of the primary malignancy did not affect overall survival for CUP patients.
Conclusions
There was no significant difference in overall survival between the two groups. Surgical management of patients with CUP brain metastases is an appropriate treatment option. Current diagnostic pathways specifying a thorough search for the primary tumor pre-operatively may not improve patient outcomes.
Introduction5-aminolevulinic acid (5-ALA) is a proagent developed for fluorescent-guided surgery for high-grade glioma patients associated with a significant increase in resection conferring ...survival. 5-ALA was shown to penetrate the blood–brain barrier accumulating in malignant glioma cells with high selectivity, sensitivity and positive predictive value. However, those have yet to be explored aiding diagnosis for tumours of the central nervous system (CNS) other than high-grade gliomas (HGG). No up-to-date systematic review exists reporting the major surgical outcomes and diagnostic accuracy. We sought to conduct a systematic review of the literature summarising surgical outcomes, evaluate the quality of diagnostic accuracy reported in the literature and qualitatively assess the evidence to inform future studies.Methods and analysisWe will search electronic databases (Medline, Embase) with subsequent interrogation of references lists of articles reporting the use of 5-ALA for brain tumours other than high-grade glioma adult patients, which also report the extent of resection and/or survival. Prospective and retrospective cohort and case–control studies with more than five patients will be included. Two independent reviewers will screen the abstracts and full articles, with a third reviewer resolving any conflicts. The data will be extracted in a standardised template and outcomes will be reported using descriptive statists. The quality of non-randomised studies will be appraised.Ethics and disseminationThe study will summarise the available evidence on the effect of the clinical utility of 5-ALA in achieving resection and improving survival and its diagnostic accuracy for tumours of the CNS other than HGG. The data will be presented nationally and internationally and the manuscript will be published in a peer-reviewed journal. No ethical approvals were needed. The aim is to inform prospective studies minimising reporting bias allowing for more reliable, reproducible and generalisable results. The study has been registered in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.PROSPERO registration numberCRD42021260542.
Deep brain stimulation (DBS) surgery targeting the ventral intermediate thalamic nucleus (Vim) has proven efficacy in the treatment of tremor.
The primary aim is to investigate whether there is a ...statistically significant difference in patient outcomes when CT-guided targeting of the Vim is compared with MRI-guided targeting.
This is a retrospective study concerning patients undergoing Vim-targeted DBS at the Department of Neurosurgery, Royal Victoria Infirmary in Newcastle (9
August 2012 to 4
January 2019). Fahn-Tolosa-Marin Tremor Scale (FTM TS) and EQ-5D scores were collected from patient notes. Statistical analysis was performed using IBM
SPSS
Statistics Version 24. Independent samples
-tests were used to compare means.
Independent samples
-test did not reveal a statistically significant difference between CT (
= 10; FTM TS mean = 65.40, SD = 11.40; EQ-5D mean = 39.50, SD = 17.87) and MR (
= 7; FTM TS mean = 60.57, SD = 7.50; EQ-5D mean = 32.14, SD = 9.94) groups in pre-surgery FTM TS (t(15) = 0.977,
= 0.344) and EQ-5D (t(15) = 0.982,
= 0.342) scores. No statistically significant difference between the CT (FTM TS mean = 24.12, SD = 20.47; EQ-5D mean = 75.56, SD = 15.63) and MR (FTM TS mean = 22.86, SD = 6.72; EQ-5D mean = 70.43, SD = 15.48) groups was revealed at 1 year assessment of FTM TS (t(14) = 0.155,
= 0.879) and EQ-5D (t(14) = 0.654,
= 0.524). The median difference between pre- and post-surgery FTM TS and EQ-5D scores in the CT group at 1 year was 43.00 and 35.00, respectively. The MR patient group median difference in pre- and post-surgery at 1 year was 35.00 and 35.00 respectively.
No statistically significant difference between CT and MR image-guided targeting patient groups was detected.
To review the current scope of emergency neurosurgical referrals as well as examine the long-term use of a web-based referral system.
This was a single-centre retrospective observational study. ...Referral information was collected retrospectively over a year period after the implementation of a web-based referral system (June 2019-June 2020). Information such as demographics, clinical information, referrer details and neurosurgical response times and outcomes were collected. Statistical analyses were performed on R Version 6.3.1.
Our unit received 5949 referrals with a median age of 63 years old (range: 0-107 years) (male=50.3%). We observed an average of 16.3 referrals per day (range: 4-32), with Fridays having the highest average and the weekend days receiving statistically fewer referrals (p<0.001). 35.9% of referrals occurred within hours (8:00-17:00 Monday-Friday), with A+E making up approximately 50% of referrals. Common reasons for referral were traumatic brain injury, intracranial tumours, and degenerative spine. The median time from referral to first response was 32 minutes, occurring within an hour in 72.9% of cases. The median times to definite response was 83 minutes, occurring within 2 hours in 58.2% of cases. Factors found to impact the response time were referral emergency and time of day. Our acceptance rate over this period was 18.5%.
With increasing number of referrals, it is feasible to provide traceable advice in a timely manner through an electronic web-based referral system transferable to any specialty. Insights could be used to direct resources and workforce planning according to emergency referral patterns.
An overview is presented on the central role that zeolites and other nanoporous materials currently play in the Fluid Catalytic Cracking (FCC) process as well as how this role evolved over the course ...of the years since its inception. Today, utilization in FCC constitutes the vast majority of global zeolite catalyst consumption by volume. FCC is the main conversion process in a typical fuels refinery, and as the most critical ingredient of the catalyst, zeolites are responsible for producing majority of the gasoline used around the world as well as taking an important role in the production of other transportation fuels (e.g., diesel, jet fuel) and building blocks for the petrochemical industry (e.g., propylene, butylenes). Therefore, it can be stated that zeolite catalysts fuel our industrialized society and provide the building blocks for its advancement; consequently, zeolites have a direct impact on the future of the global economy and its sustainability. Strategies that involve zeolites and other nanoporous materials for improving performance of FCC operation and ensuring its environmental sustainability were reviewed. Zeolite modifications were examined with each leading to an improvement in zeolite stability under severe conditions in an FCC unit. The importance of diffusion pathways within an FCC catalyst particle, leading to higher accessibility of the active zeolite sites, were explored, and the importance of a well-designed catalyst architecture, allowing FCC feed, intermediates, and final products to diffuse freely in and out of the catalyst particle were discussed. The role of contaminant metals in FCC was investigated, and some mitigation strategies for the most common FCC contaminants, nickel and vanadium, were presented. The impact of contaminant iron was discussed alongside catalyst architecture, particularly surface porosity of the catalyst particle. Utilization of other nanoporous materials in FCC, especially as environmental additives, was summarized. Testing considerations were screened with an emphasis on matching laboratory deactivation to refinery FCC observations.
Display omitted
•An overview on the role of zeolites in Fluid Catalytic Cracking (FCC) is provided .•Utilization of other nanoporous materials in FCC, especially as environmental additives was summarized .•Strategies that involve zeolites and other nanoporous materials for improving FCC operation and environmental sustainability were reviewed .•Testing considerations were reviewed with an emphasis on matching laboratory deactivation to refinery FCC observations.
Abstract BACKGROUND Clinical studies in infant medulloblastoma (iMB; <5 years) have, to date, focussed on modestly-sized or national trials cohorts and have not directly compared therapeutic ...approaches or placed these in the context of dedicated biomarker studies, to inform future treatment strategies. METHODS We assembled a multi-national cohort of molecularly and clinically-annotated iMBs (<5 years at diagnosis; n=646), the largest to date. We investigated molecular pathology, treatments received, and relationships to outcome within this population. RESULTS The SHH group (iMBSHH; n=267, 40%) predominated, encompassing SHH-1 (37.7%, median age 2.0 years), SHH-2 (47.0%, 1.4 years) and SHH-3 (14.4%, 3.0 years) WHO subgroups. MBEN histology was significantly enriched in SHH-2, and SUFU mutation and MYCN amplification in SHH-1 and SHH-3, respectively. Notably, TP53 mutations were identified in all subgroups; in SHH-1 and SHH-2 (each n=3) tumours lacked features typically associated with TP53-mutated SHH-3 (LCA histology and MYCN amplification) and did not have a worse survival. Upfront radiation-sparing treatments were used in 132/267 children and comprised regimens founded on intraventricular methotrexate (IVT-MTX; 54.5%), high-dose (HDCTx; 22.0%) or standard-dose (23.5%) chemotherapy. Across all radio-naive iMBSHH, non-DN/MBEN histology (HR 2.76, CI 1.26-6.01, p=0.011) and SHH-1 (vs SHH-2, HR 2.51, CI 1.25-5.01, p=0.009) conferred worse PFS in univariable analysis; subgroup was the only independently prognostic risk-factor (multivariable analysis; SHH-1 HR 2.65, CI 1.27-5.51, p=0.009). 5-year OS for HDCTx recipients was very favourable in SHH-1 (100%) and SHH-2 (93.3%), and subgroup-dependent for IVT-MTX (SHH-1; 76.4%, SHH-2; 100%, p=0.009). In CSI-treated iMBSHH (n=49), non-DN/MBEN histology (HR 10.23, CI 2.22-47.04, p=0.003) and MYCN amplification (HR 7.35, CI 2.01-26.87, p=0.003) conferred worse PFS. CONCLUSION iMBSHH outcomes in this cohort are dependent upon WHO subgroup, histology and therapy received. These findings provide an evidence-based foundation for selection of cohorts and therapies for prospective assessment in forthcoming iMBSHH clinical trials (e.g. SIOP-CONNECT-YC-MB-LR).
Background
The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. ...The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment.
Methods
A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop. Two assessors used a novel modified Objective Structured Assessment of Technical Skills (mOSATS) assessment tool, comprising 5 domains ranked according to a 5-point scale to rate delegates’ ability to create a burr hole. Qualitative data from previous workshops were collected, consisting of open-ended, closed-ended and 5-point Likert scale responses to pre- and post-workshop questionnaires. Data were analysed using SPSS® software.
Results
Delegates scored a mean total of 62.1% (21.75/35) and 85.1% (29.8/35) in pre- and post-workshop assessments respectively revealing a statistically significant improvement. Regarding percentage of improvement, no significant difference was shown amongst candidates when comparing the number of neurosurgical cases observed and/or assisted in the past. There was no significant difference in the overall rating between the last two workshops (4.89 and 4.8 out of 5, respectively). One hundred percent of the attendees reported feeling more confident in assisting in theatre after the last two workshops.
Conclusion
We show that a simulation workshop cannot only objectively quantify the improvement of surgical skill acquisition but can also be beneficial regardless of the extent of prior experience.
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