Minimal access excision of Aortic Valve Fibroelastoma: A case report and review of the literature

ABSTRACT: Papillary fibroelastomas are rare primary tumours of cardiac origin accounting for approximately 10% of all primary cardiac neoplasms. Due to a high thromboembolic risk, surgical excision is the mainstay of treatment these patients and median sternotomy the most widely used approach. We describe the case of a 43 year-old lady presenting with acute myocardial infarction secondary to aortic valve papillary fibroelastoma subsequently excised using a minimal access technique. From our experience mini-sternotomy offers excellent exposure and allows for safe resection in such cases, improving cosmesis without compromising either intra or post-operative outcome.     

Mechanisms underlying input-specific expression of endocannabinoid-mediated synaptic plasticity in the dorsal cochlear nucleus

A hallmark of brain organization is the integration of primary and modulatory pathways by principal neurons. Primary sensory inputs are usually not plastic, while modulatory inputs converging to the same principal neuron can be plastic. However, the mechanisms determining this input-specific expression of synaptic plasticity remain unknown. We investigated this problem in the dorsal cochlear nucleus (DCN), where principal cells integrate primary auditory nerve input with plastic, parallel fiber input. Our previous DCN studies have shown that parallel fiber inputs exhibit short- and long-term plasticities mediated by endocannabinoid signaling. Here we show that auditory nerve inputs to principal cells do not show short- or long-term endocannabinoid-mediated synaptic plasticity. Electrophysiological and electron microscopy studies indicate that input specificity arises from selective expression of presynaptic cannabinoid (CB1) receptors in parallel fiber terminals, but not in auditory nerve terminals. However, pairing of parallel fiber activity with auditory nerve activity elicits plasticity in parallel fiber inputs, thus suggesting a role for synaptic plasticity in multisensory integration.     

Holistic needs assessment in brain cancer patients: A systematic review of available tools

This systematic review describes tools which could be considered for use for holistic needs assessment (HNA) in brain cancer. MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO were searched. Studies were included which met the following criteria; primary research published in English which reported the development, psychometric testing or clinical utility testing of patient‐reported outcome measures (PROMs) for the assessment of adult brain cancer patients’ needs, problems or concerns or generic cancer needs assessment tools developed specifically on a brain cancer or brain tumour population. Nine articles describing four tools were identified. The tools were first assessed using the COSMIN protocol for systematic reviews of measurement properties and then assessed for their quality and usefulness as a holistic needs assessment tool. None of the four tools had strong psychometric properties; however, the two symptom questionnaires had better psychometric properties but would need adapted to holistically assess the multiple domains of need. The two HNA tools had only minimal psychometric testing. The lack of a tool, which adequately meets all requirements for HNA, supports the need to further development of tools to optimise this intervention.