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Introduction
Brain mapping through a direct cortical and subcortical electrical stimulation during an awake craniotomy has gained an increasing popularity as a powerful tool to prevent neurological deficit while increasing extent of resection of hemispheric diffuse low-grade gliomas in adults. However, few case reports or very limited series of awake surgery in children are currently available in the literature.Methods
In this paper, we review the oncological and functional differences between pediatric and adult populations, and the methodological specificities that may limit the use of awake mapping in pediatric low-grade glioma surgery.Results
This could be explained by the fact that pediatric low-grade gliomas have a different epidemiology and biologic behavior in comparison to adults, with pilocytic astrocytomas (WHO grade I glioma) as the most frequent histotype, and with WHO grade II gliomas less prone to anaplastic transformation than their adult counterparts. In addition, aside from the issue of poor collaboration of younger children under 10 years of age, some anatomical and functional peculiarities of children developing brain (cortical and subcortical myelination, maturation of neural networks and of specialized cortical areas) can influence direct electrical stimulation methodology and sensitivity, limiting its use in children.Conclusions
Therefore, even though awake procedure with cortical and axonal stimulation mapping can be adapted in a specific subgroup of children with a diffuse glioma from the age of 10 years, only few pediatric patients are nonetheless candidates for awake brain surgery.3.
Object
A brainstem glioma is an incurable brain tumor that can be complicated by hydrocephalus. A ventriculoperitoneal (VP) shunt is generally performed for the control of hydrocephalus. This study aimed to reveal the safety and efficacy of an endoscopic third ventriculostomy (ETV) for hydrocephalus in brainstem gliomas.Methods
Six patients who had pontine glioma with hydrocephalus underwent an ETV between May 2010 and November 2015. In all the cases, there were one or more symptoms of hydrocephalus (headache, nausea, vomiting, or lethargy). Retrospective review of these patients was performed using the medical records and neuroimagings.Result
The ETV was performed safely and there were no intraoperative complications in all patients. The mean follow-up period was 12.3 months. An immediate symptomatic relief of hydrocephalus and an adequate control of symptoms were achieved without a VP shunt in all patients.Conclusions
The ETV is considered to be an effective and safe procedure for the treatment of hydrocephalus in brainstem gliomas. Determining the ventriculostomy site according to the preoperative MRI in each case is considered to be important for the safe procedure.4.
Russell Maxwell Andrew S. Luksik Tomas Garzon-Muvdi Michael Lim 《Current neurology and neuroscience reports》2017,17(6):50
Purpose of Review
Malignant gliomas, including glioblastoma and anaplastic astrocytoma, are the most frequent primary brain tumors and present with many treatment challenges. In this review, we discuss the potential of cellular- and viral-based immunotherapies in the treatment of malignant glioma, specifically focusing on dendritic cell vaccines, adoptive cell therapy, and oncolytic viruses.Recent Findings
Diverse cellular- and viral-based strategies have been engineered and optimized to generate either a specific or broad antitumor immune response in malignant glioma. Due to their successes in the preclinical arena, many of these therapies have undergone phase I and II clinical testing. These early clinical trials have demonstrated the feasibility, safety, and efficacy of these immunotherapies.Summary
Dendritic cell vaccines, adoptive cell transfer, and oncolytic viruses may have a potential role in the treatment of malignant glioma. However, these modalities must be investigated in well-designed phase III trials to prove their efficacy.5.
Simona Gaudino Rosellina Russo Tommaso Verdolotti Massimo Caulo Cesare Colosimo 《Child's nervous system》2016,32(10):1813-1822
Introduction
Advanced magnetic resonance imaging (MRI) techniques is an umbrella term that includes diffusion (DWI) and diffusion tensor (DTI), perfusion (PWI), spectroscopy (MRS), and functional (fMRI) imaging. These advanced modalities have improved the imaging of brain tumors and provided valuable additional information for treatment planning. Despite abundant literature on advanced MRI techniques in adult brain tumors, few reports exist for pediatric brain ones, potentially because of technical challenges.Review of the literature
The authors review techniques and clinical applications of DWI, PWI, MRS, and fMRI, in the setting of pediatric hemispheric low-grade gliomas.Personal experience
The authors propose their personal experience to highlight benefits and limits of advanced MR imaging in diagnosis, grading, and presurgical planning of pediatric hemispheric low-grade gliomas.Discussion
Advanced techniques should be used as complementary tools to conventional MRI, and in theory, the combined use of the three techniques should ensure achieving the best results in the diagnosis of hemispheric low-grade glioma and in presurgical planning to maximize tumor resection and preserve brain function.Future perspectives
In the setting of pediatric neurooncology, these techniques can be used to distinguish low-grade from high-grade tumor. However, these methods have to be applied on a large scale to understand their real potential and clinical relapse, and further technical development is required to reduce the excessive scan times and other technical limitations.6.
Background
The authors present the case of a 31-year-old man with a malignant glioma. He had been treated for cerebral hydatid as a child, and 22 years later he developed a glioma at the site of his previous disease.Discussion
Could chronic inflammatory change following intracranial hydatid disease have induced neoplastic transformation of glial cells?7.
H. Jonathon Rendina Kristi E. Gamarel John E. Pachankis Ana Ventuneac Christian Grov Jeffrey T. Parsons 《Annals of behavioral medicine》2017,51(2):147-158
Background
Minority stress theory represents the most plausible conceptual framework for explaining health disparities for gay and bisexual men (GBM). However, little focus has been given to including the unique stressors experienced by HIV-positive GBM.Purpose
We explored the role of HIV-related stress within a minority stress model of mental health and condomless anal sex.Methods
Longitudinal data were collected on a diverse convenience sample of 138 highly sexually active, HIV-positive GBM in NYC regarding sexual minority (internalized homonegativity and gay-related rejection sensitivity) and HIV-related stressors (internalized HIV stigma and HIV-related rejection sensitivity), emotion dysregulation, mental health (symptoms of depression, anxiety, sexual compulsivity, and hypersexuality), and sexual behavior (condomless anal sex with all male partners and with serodiscordant male partners).Results
Across both sexual minority and HIV-related stressors, internalized stigma was significantly associated with mental health and sexual behavior outcomes while rejection sensitivity was not. Moreover, path analyses revealed that emotion dysregulation mediated the influence of both forms of internalized stigma on symptoms of depression/anxiety and sexual compulsivity/hypersexuality as well as serodiscordant condomless anal sex.Conclusions
We identified two targets of behavioral interventions that may lead to improvements in mental health and reductions in sexual transmission risk behaviors—maladaptive cognitions underlying negative self-schemas and difficulties with emotion regulation. Techniques for cognitive restructuring and emotion regulation may be particularly useful in the development of interventions that are sensitive to the needs of this population while also highlighting the important role that structural interventions can have in preventing these disparities for future generations.8.
Background
Corticosteroids are commonly used in the management of primary central nervous system (CNS) tumors and CNS metastases to treat cancer- and treatment-related cerebral edema and improve neurologic function. However, they are also associated with significant morbidity and mortality, given their wide range of adverse effects.Purpose of Review
To review the mechanism of action, pharmacology, and toxicity profile of corticosteroids and to critically appraise the evidence that supports their use in neuro-oncologic practice based on the latest scientific and clinical data.Recent Findings
Recent data suggest that corticosteroids may negatively impact survival in glioma patients. In addition, corticosteroids should be incorporated as a standard criterion to assess a patient’s clinical and radiographic response to treatment.Summary
Corticosteroids should be used judiciously in neuro-oncologic patients, given the potential deleterious effects on clinical outcome and patient survival. Anti-angiogenic agents, which lack these adverse effects, may be a reasonable alternative to corticosteroids.9.
Background
Most work testing links between emotional competencies and health has focused on self-reported and/or trait assessments. However, more objective assessments of skills and knowledge may also predict health relevant outcomes.Purpose
The current study investigated whether performance-based tests of emotional knowledge and expressive skill predicted symptoms of depression and anxiety, self-reported physical symptoms, perceived health, and a range of immunoregulatory molecules.Methods
Eighty females aged 18–35 completed self-report assessments before attending a testing session in which they provided blood samples and completed performance-based assessments of expressive skill and emotional knowledge.Results
Greater expressive skill predicted better self-reported outcomes, but links to immunoregulatory molecules were mixed. Expressive skill for contempt and anger predicted higher, whereas skill for happiness predicted lower, concentrations of immunoregulatory molecules.Conclusions
These data highlight the need to extend research beyond self-reported emotional competencies and suggest that performance-based skill and knowledge metrics may be associated with health relevant outcomes.10.
Katherine B. Vaughan Andrew T. Kaczynski Sonja A. Wilhelm Stanis Gina M. Besenyi Ryan Bergstrom Katie M. Heinrich 《Annals of behavioral medicine》2013,45(1):28-38
Background
Parks are key community assets for physical activity, but some evidence suggests these resources are not equitably distributed.Purpose
This study examined disparities by income and race/ethnicity in the availability, features, and quality of parks across Kansas City, Missouri.Methods
All parks and census tracts (CTs) were mapped using geographical information systems, and park features and quality were determined via audits. Multivariate analyses of covariance analyzed differences in park availability, features, and quality across low-, medium-, and high-income and race/ethnicity CT tertiles.Results
Low-income CTs contained significantly more parks, but also had fewer parks with playgrounds and more quality concerns per park. High minority CTs had more parks with basketball courts, but fewer parks with trails. Medium-income CTs contained more aesthetic features per park.Conclusions
Future research should examine policies that contribute to and that might rectify disparities in park features and quality, especially in low-income and high minority areas.11.
Background
Few studies have examined potential disparities in access to transportation infrastructures, an important determinant of population health.Purpose
To examine individual- and area-level disparities in access to the road network, public transportation system, and a public bicycle share program in Montreal, Canada.Methods
Examining associations between sociodemographic variables and access to the road network, public transportation system, and a public bicycle share program, 6,495 adult respondents (mean age, 48.7 years; 59.0 % female) nested in 33 areas were included in a multilevel analysis.Results
Individuals with lower incomes lived significantly closer to public transportation and the bicycle share program. At the area level, the interaction between low-education and low-income neighborhoods showed that these areas were significantly closer to public transportation and the bicycle share program controlling for individual and urbanicity variables.Conclusions
More deprived areas of the Island of Montreal have better access to transportation infrastructure than less-deprived areas.12.
Hart IsaacsJr. 《Child's nervous system》2016,32(11):2085-2096
Introduction
The purpose of this review is to document the various types of astrocytoma that occur in the fetus and neonate, their locations, initial findings, pathology, and outcome. Data are presented that show which patients are likely to survive or benefit from treatment compared with those who are unlikely to respond.Materials and methods
One hundred one fetal and neonatal tumors were collected from the literature for study.Results
Macrocephaly and an intracranial mass were the most common initial findings. Overall, hydrocephalus and intracranial hemorrhage were next. Glioblastoma (GBM) was the most common neoplasm followed in order by subependymal giant cell astrocytoma (SEGA), low-grade astrocytoma, anaplastic astrocytoma, and desmoplastic infantile astrocytoma (DIA). Tumors were detected most often toward the end of the third trimester of pregnancy.Conclusion
A number of patients were considered inoperable since their tumor occupied much of the intracranial cavity involving large areas of the brain. High-grade astrocytomas were more common than low-grade ones in this review. Fetuses and neonates with astrocytoma have a mixed prognosis ranging from as low as 20 % (GBM) to a high of 90 %. The overall survival was 47/101 or 46 %.13.
Patrick Roth Dorothee Gramatzki Michael Weller 《Current neurology and neuroscience reports》2017,17(4):35
Purpose of Review
Glioblastoma represents one of the major challenges in neurooncology and approximately half of the patients are 60 years or older. We summarize the particular situation of elderly glioblastoma patients with a focus on therapeutic considerations.Recent Findings
Favorable molecular markers such as mutations in the isocitrate dehydrogenase (IDH) 1 or 2 genes are virtually absent in glioblastomas in elderly patients. Treatment options are similar to the situation in young patients and comprise surgical resection, radiation therapy, and alkylating chemotherapy. The performance status as well as comorbidities may have a stronger impact on the individual treatment decision than in young patients. The MGMT promoter methylation status allows for a stratification of treatment beyond the surgical intervention. In patients with MGMT promoter methylated tumors, monotherapy with temozolomide is superior to radiotherapy alone. Similarly, the benefit conferred by combined temozolomide-based chemoradiotherapy compared to radiotherapy alone is largely restricted to patients with MGMT promoter-methylated tumors. At recurrence, no standard treatment has been established.Summary
The prognosis for elderly patients with glioblastoma remains poor. The MGMT promoter methylation status helps guiding treatment decisions and withholding inactive, but potentially harmful treatments.14.
Misha Nili Syed Abidi Stephania Serna Simon Kim Heather Edgell 《Clinical autonomic research》2017,27(6):411-415
Purpose
Deep breathing assesses autonomic function; however, many researchers/clinicians do not account for hyperventilation, brain blood flow or blood pressure.Methods
Men and women (with/without oral contraceptives) participated. women participated during low and high hormone phases of the menstrual cycle. Blood pressure, end-tidal carbon dioxide, middle cerebral artery velocity and cerebrovascular resistance were assessed.Results
Deep breathing decreased end-tidal carbon dioxide and middle cerebral artery velocity while increasing cerebrovascular resistance in all participants; blood pressure decreased in men. There were no influences of menstrual cycle or oral contraceptives.Conclusions
Men have different autonomic responses to deep breathing compared to women.15.
Objective
To review existing evidence regarding interactions between the autonomic nervous system and the immune system functions in multiple sclerosis.Methods
We reviewed the literature regarding new insights linking autonomic dysfunction to immune deregulation in multiple sclerosis, with particular focus on the specific influence of sympathetic and parasympathetic dysfunction on inflammatory and neurodegenerative processes.Results
Autonomic dysfunction is common in multiple sclerosis, representing a significant cause of disability. Several connections between pathologic immune pathways and the autonomic nervous system function were found.Conclusions
Autonomic dysfunction may enhance inflammatory and neurodegenerative pathways that are of major importance in multiple sclerosis. Autonomic dysfunction can present with highly variable manifestations. Sympathetic and parasympathetic dysfunction displays different patterns in multiple sclerosis, with specific impact on inflammation and neurodegeneration.16.
Luca Mattei Francesco Prada Federico Giuseppe Legnani Alessandro Perin Alessandro Olivi Francesco DiMeco 《Child's nervous system》2016,32(10):1907-1914
Purpose
Pediatric low-grade gliomas (LGGs) are the most frequent solid tumor in childhood. Based on an increasing number of literature reports, maximal safe resection is recommended as the first line of treatment whenever possible. However, distinguishing tumor tissue from the surrounding normal brain is often challenging with infiltrating neoplasms, even with the assistance of intraoperative, microscopic and conventional neuronavigation systems. Therefore, any technique that enhances the detection and visualization of LGGs intraoperatively is certainly desirable.Methods
In this paper, we reviewed the role of intraoperative conventional ultrasound and contrast-enhanced ultrasound (CEUS) as a tool for extending tumor resection in LGGs. Moreover, our experience with this technology is reported and discussed.Results
Both B-mode and CEUS are helpful in highlighting LGGs, detecting tumor margins and providing additional information such as vascularization, thus improving the safety of a more radical resection.Conclusions
Although the full potentialities of the method are yet to be explored, intraoperative ultrasound is a promising tool in oncologic surgery and LGG surgery.17.
Jaspreet Johal Marios Loukas Christian Fisahn Jens R. Chapman Rod J. Oskouian R. Shane Tubbs 《Child's nervous system》2016,32(11):2105-2109
Purpose
The purpose of this paper was to comprehensively review hemivertebrae in regard to their classification, embryology, etiology, diagnosis, clinical manifestations, and management of this developmental anomaly.Methods
This subject review of hemivertebrae was composed after conducting a thorough review of the available literature on this topic using PubMed and other standard search engines.Results
Hemivertebrae are incomplete vertebral column segments that can result in congenital scoliosis and be associated with a range of other structural anomalies. Presentations may differ and based on location and classification, treatments may vary.Conclusion
Hemivertebrae are structural anomalies of the vertebral column that can potentially disrupt the spine’s normal curvature. Their clinical impact depends on factors such as degree of segmentation and concurrence with other structural anomalies. It is hoped that this review will provide the clinician who treats patients with hemivertebrae a resource in better understanding this finding and its subsequent pathological effects.18.
Michael A. Kanters Jason N. Bocarro Michael B. Edwards Jonathan M. Casper Myron F. Floyd 《Annals of behavioral medicine》2013,45(1):113-121
Background
School-based extracurricular sport remains an effective strategy to increase physical activity. However, school sport is often limited to a small number of elite athletes. Few schools provide more inclusive sport programs that offer a wider array of activities regardless of ability.Purpose
The aim of this study was to examine school sport participation in middle schools (ages 11–14) with contrasting school sport delivery strategies (intramural vs. interscholastic).Methods
Data were obtained through an online survey administered to students at four public middle schools (grades 6–8) in a southeastern US city (n?=?2,582).Results
More students participated in school sports at intramural schools. Boys were more likely to participate in after-school sports at intramural schools. Low-income and Black children, two groups at greater risk of physical inactivity and other negative outcomes, had greater participation in intramural programs.Conclusions
After-school intramural sports in middle school is a promising strategy for increasing sport participation.19.
Background
“Bath salts” or synthetic cathinone toxicity remains a potentially deadly clinical condition. We report a delayed leukoencephalopathy with persistent minimally conscious state.Methods
Case report.Results
A 36-year-old man presents with delayed encephalopathy, dysautonomia, fulminant hepatic failure, and renal failure from severe rhabdomyolysis after consuming bath salts. MRI showed diffusion restriction in the splenium of the corpus callosum and subcortical white matter.Conclusions
The combination of acute leukoencephalopathy, rhabdomyolysis and fulminant hepatic failure may point to bath salt inhalation and should be known to neurointensivists.20.