Global Perspectives on Task Shifting and Task Sharing in Neurosurgery.

BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. RESULTS: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). CONCLUSIONS: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs

Bleeding spinal artery aneurysms. J Neurosurg Spine.

Abstract The authors report a case of acute subarachnoid hemorrhage due to the rupture of multiple anterior spinal artery aneurysms. In view of the clinical and radiological findings, surgery was excluded and a wait-and-see policy was followed. A magnetic resonance imaging study performed 3 months after presentation and an angiographic study performed 6 months after presentation confirmed spontaneous regression of the aneurysms and preservation of blood flow through the anterior spinal artery

High Mobility Group A (HMGA): Chromatin Nodes Controlled by a Knotty miRNA Network

High mobility group A (HMGA) proteins are oncofoetal chromatin architectural factors that are widely involved in regulating gene expression. These proteins are unique, because they are highly expressed in embryonic and cancer cells, where they play a relevant role in cell proliferation, stemness, and the acquisition of aggressive tumour traits, i.e., motility, invasiveness, and metastatic properties. The HMGA protein expression levels and activities are controlled by a connected set of events at the transcriptional, post-transcriptional, and post-translational levels. In fact, microRNA (miRNA)-mediated RNA stability is the most-studied mechanism of HMGA protein expression modulation. In this review, we contribute to a comprehensive overview of HMGA-targeting miRNAs; we provide detailed information regarding HMGA gene structural organization and a comprehensive evaluation and description of HMGA-targeting miRNAs, while focusing on those that are widely involved in HMGA regulation; and, we aim to offer insights into HMGA-miRNA mutual cross-talk from a functional and cancer-related perspective, highlighting possible clinical implications

Activation of endogenous neural stem cells in the adult human brain following subarachnoid haemorrhage

5In the adult human brain, the presence of neural stem cells has been documented in the subgranular layer of the dentate gyrus of the hippocampus and in the sub- ventricular zone of the lateral ventricles. Neurogenesis has also been reported in rodent models of ischemic stroke, traumatic brain injury, epileptic seizures, and in- tracerebral or subarachnoid hemorrhage. However, only sparse information is available about the occurrence of neurogenesis in the human brain under similar patho- logical conditions. In the present report, we describe neural progenitor cell proliferation in the brain of patients suffering from subarachnoid hemorrhage (SAH) resulting from ruptured aneurysm. Ten cerebral samples from both SAH and control patients obtained, respec- tively, during aneurysm clipping and deep brain tumor removal were analyzed by reverse transcription fol- lowed by polymerase chain reaction (RT-PCR) and/or immunohistochemistry (IHC). In tissue specimens from SAH patients, RT-PCR and IHC revealed the expression of a variety of markers consistent with CNS progenitor cells, including nestin, vimentin, SOX-2, and Musashi1 and -2. In the same specimens, double immunohisto- chemistry followed by confocal analysis revealed that Musashi2 consistently colocalized with the proliferation marker Ki67. By contrast, no such gene or protein expression profiles were detected in any of the control specimens. Thus, activation of neural progenitor cell proliferation may occur in adult human brain following subarachnoid hemorrhage, possibly contributing to the promotion of spontaneous recovery, in this pathological condition.First published evidence substantiating the activation of neural progenitor cell proliferation in the adult human brain following subarachnoid hemorrhagenonemixedSGUBIN D.; AZTIRIA E.; PERIN A.; LONGATTI P.; LEANZA G.Sgubin, D.; Aztiria, E.; Perin, A.; Longatti, P.; Leanza, Giampier

Skillful decadal prediction of unforced southern European summer temperature variations

International audienceWe assess the capability of decadal prediction simulations from the Coupled Model Intercomparison Project phase 6 (CMIP6) archive to predict European summer temperature during the period 1970-2014. Using a multi-model ensemble average, we show that Southern European (SEU) summer temperatures are highly predictable for up to ten years in CMIP6. Much of this predictive skill, is related to the externally forced response: historical simulations explain about 90% of observed SEU summer temperature variance. Prediction skill for the unforced signal of SEU summer temperature is low: initialized model simulations explain less than 10% of observed variance after removing the externally forced response. An observed link between unforced SEU summer temperature and preceding spring Eastern North Atlantic-Mediterranean sea surface temperature (SST) motivates the application of a dynamical-statistical model to overcome the low summer temperature skill over Europe. This dynamical-statistical model uses dynamical spring SST predictions to predict European summer temperature, and significantly increases decadal prediction skill of unforced European summer temperature variations, showing significant prediction skill for unforced Southern European summer temperature 2-9 years ahead. As a result, dynamical-statistical models can benefit the decadal prediction of variables with initially limited skill beyond the forcing, such as summer temperature over Europe

Skillful decadal prediction of unforced southern European summer temperature variations

International audienceAbstract We assess the capability of decadal prediction simulations from the Coupled Model Intercomparison Project phase 6 (CMIP6) archive to predict European summer temperature during the period 1970–2014. Using a multi-model ensemble average, we show that Southern European (SEU) summer temperatures are highly predictable for up to ten years in CMIP6. Much of this predictive skill, is related to the externally forced response: historical simulations explain about 90% of observed SEU summer temperature variance. Prediction skill for the unforced signal of SEU summer temperature is low: initialized model simulations explain less than 10% of observed variance after removing the externally forced response. An observed link between unforced SEU summer temperature and preceding spring Eastern North Atlantic—Mediterranean sea surface temperature (SST) motivates the application of a dynamical-statistical model to overcome the low summer temperature skill over Europe. This dynamical-statistical model uses dynamical spring SST predictions to predict European summer temperature, and significantly increases decadal prediction skill of unforced European summer temperature variations, showing significant prediction skill for unforced Southern European summer temperature 2–9 years ahead. As a result, dynamical-statistical models can benefit the decadal prediction of variables with initially limited skill beyond the forcing, such as summer temperature over Europe

Skillful decadal prediction of unforced southern European summer temperature variations

International audienceAbstract We assess the capability of decadal prediction simulations from the Coupled Model Intercomparison Project phase 6 (CMIP6) archive to predict European summer temperature during the period 1970–2014. Using a multi-model ensemble average, we show that Southern European (SEU) summer temperatures are highly predictable for up to ten years in CMIP6. Much of this predictive skill, is related to the externally forced response: historical simulations explain about 90% of observed SEU summer temperature variance. Prediction skill for the unforced signal of SEU summer temperature is low: initialized model simulations explain less than 10% of observed variance after removing the externally forced response. An observed link between unforced SEU summer temperature and preceding spring Eastern North Atlantic—Mediterranean sea surface temperature (SST) motivates the application of a dynamical-statistical model to overcome the low summer temperature skill over Europe. This dynamical-statistical model uses dynamical spring SST predictions to predict European summer temperature, and significantly increases decadal prediction skill of unforced European summer temperature variations, showing significant prediction skill for unforced Southern European summer temperature 2–9 years ahead. As a result, dynamical-statistical models can benefit the decadal prediction of variables with initially limited skill beyond the forcing, such as summer temperature over Europe

Radioguided occult lesion localization in deep schwannomas of the peripheral nerves: Results of a preliminary case series

The detection of small deep schwannomas of the peripheral nerves has been increasing since the the use of precise neuroimaging techniques has become more widespread; however, although nonpalpable lesions can be well defined by images, it is often difficult to identify them during the surgical procedure. The authors report seven cases of nonpalpable small deep schwannomas surgically treated after their identification using the radioguided occult lesion localization (ROLL) technique

Skillful decadal prediction of unforced southern European summer temperature variations

International audienceAbstract We assess the capability of decadal prediction simulations from the Coupled Model Intercomparison Project phase 6 (CMIP6) archive to predict European summer temperature during the period 1970–2014. Using a multi-model ensemble average, we show that Southern European (SEU) summer temperatures are highly predictable for up to ten years in CMIP6. Much of this predictive skill, is related to the externally forced response: historical simulations explain about 90% of observed SEU summer temperature variance. Prediction skill for the unforced signal of SEU summer temperature is low: initialized model simulations explain less than 10% of observed variance after removing the externally forced response. An observed link between unforced SEU summer temperature and preceding spring Eastern North Atlantic—Mediterranean sea surface temperature (SST) motivates the application of a dynamical-statistical model to overcome the low summer temperature skill over Europe. This dynamical-statistical model uses dynamical spring SST predictions to predict European summer temperature, and significantly increases decadal prediction skill of unforced European summer temperature variations, showing significant prediction skill for unforced Southern European summer temperature 2–9 years ahead. As a result, dynamical-statistical models can benefit the decadal prediction of variables with initially limited skill beyond the forcing, such as summer temperature over Europe