Endoscope-Assisted Extreme Lateral Supracerebellar Infratentorial Approach for Resection of Superior Cerebellar Peduncle Pilocytic Astrocytoma: Technical Note.

(1) Background: Superior cerebellar peduncle (SCP) lesions are sparsely reported in the literature. The surgical approaches to the cerebello-mesencephalic region remain challenging. In this article, we present the extreme lateral supracerebellar infratentorial (ELSI) approach to treat a large hemorrhagic pilocytic astrocytoma of the SCP. (2) Methods: An 11-year-old boy, known for neurofibromatosis Type I, presented to the emergency department of our institution with symptoms and signs of intracranial hypertension. The cerebral magnetic resonance imaging (MRI) revealed a large hemorrhagic lesion centered on the SCP provoking obstructive hydrocephalus. Following an emergency endoscopic third ventriculocisternostomy (ETV), he underwent a tumor resection via an endoscope-assisted ELSI approach. (3) Results: ELSI approach allows for a wide exposure with direct access to lesions of the SCP. The post-operative course was uneventful, and the patient was discharged home on post-operative day 5. Post-operative MRI revealed a near total resection with a small residual tumor within the mesencephalon. (4) Conclusion: ELSI approach offers an excellent exposure with the surgical angles necessary for median and paramedian lesions. The park-bench position with appropriate head flexion and rotation offers a gravity-assisted relaxation of the tentorial and petrosal cerebellar surfaces. The endoscope can be an adjunct to illuminate the blind areas of the surgical corridor for an improved tumor resection without significant cerebellar retraction

Quantitative Analysis of the MGMT Methylation Status of Glioblastomas in Light of the 2021 WHO Classification.

Glioblastomas with methylation of the promoter region of the O(6)-methylguanine-DNA methyltransferase (MGMT) gene exhibit increased sensitivity to alkylating chemotherapy. Quantitative assessment of the MGMT promoter methylation status might provide additional prognostic information. The aim of our study was to determine a quantitative methylation threshold for better survival among patients with glioblastomas. We included consecutive patients ≥18 years treated at our department between 11/2010 and 08/2018 for a glioblastoma, IDH wildtype, undergoing quantitative MGMT promoter methylation analysis. The primary endpoint was overall survival. A total of 321 patients were included. Median overall survival was 12.6 months. Kaplan-Meier and adjusted Cox regression analysis showed better survival for the groups with 16-30%, 31-60%, and 61-100% methylation. In contrast, survival in the group with 1-15% methylation was similar to those with unmethylated promoter regions. A secondary analysis confirmed this threshold. Better survival is observed in patients with glioblastomas with ≥16% methylation of the MGMT promoter region than with <16% methylation. Survival with tumors with 1-15% methylation is similar to with unmethylated tumors. Above 16% methylation, we found no additional benefit with increasing methylation

Advancing synoptic cancer reports beyond English: the University of Bern/PathoLink approach.

Synoptic reporting (SR) increases completeness and improves the understanding of pathology reports for tumours as compared to the more traditional “narrative” style. Furthermore, it is an important step towards higher levels of structured data capture [1]. SR is defined by a set of required data elements (RDE) specific for each tumour type and a characteristic paired format of RDE and response. The College of American Pathologists (CAP) requires accredited pathology laboratories to report many cancer types in a synoptic format and for this purpose publishes a comprehensive set of protocols [2]. More recently, the International Collaboration for Cancer Reporting (ICCR)—sponsored amongst others by the European Society of Pathology—has started to publish synoptic protocols with the aim to “produce internationally standardised and evidence-based datasets for the pathology reporting of cance

Effects of formalin fixation on polarimetric properties of brain tissue: fresh or fixed?

Imaging Mueller polarimetry (IMP) appears as a promising technique for real-time delineation of healthy and neoplastic tissue during neurosurgery. The training of machine learning algorithms used for the image post-processing requires large data sets typically derived from the measurements of formalin-fixed brain sections. However, the success of the transfer of such algorithms from fixed to fresh brain tissue depends on the degree of alterations of polarimetric properties induced by formalin fixation (FF). Comprehensive studies were performed on the FF induced changes in fresh pig brain tissue polarimetric properties. Polarimetric properties of pig brain were assessed in 30 coronal thick sections before and after FF using a wide-field IMP system. The width of the uncertainty region between gray and white matter was also estimated. The depolarization increased by 5% in gray matter and remained constant in white matter following FF, whereas the linear retardance decreased by 27% in gray matter and by 28% in white matter after FF. The visual contrast between gray and white matter and fiber tracking remained preserved after FF. Tissue shrinkage induced by FF did not have a significant effect on the uncertainty region width. Similar polarimetric properties were observed in both fresh and fixed brain tissues, indicating a high potential for transfer learning

Prime beef cuts : culinary images for thinking 'men'

The paper contributes to scholarship theorising the sociality of the brand in terms of subject positions it makes possible through drawing upon the generative context of circulating discourses, in this case of masculinity, cuisine and celebrity. Specifically, it discusses masculinity as a socially constructed gender practice (Bristor and Fischer, 1993), examining materialisations of such practice in the form of visualisations of social relations as resources for 'thinking gender' or 'doing gender'. The transformative potential of the visualisations is illuminated by exploring the narrative content choreographed within a series of photographic images positioning the market appeal of a celebrity chef through the medium of a contemporary lifestyle cookery book. We consider how images of men 'doing masculinity'are not only channelled into reproducing existing gender hierarchy and compulsory heterosexuality in the service of commercial ends, but also into disrupting such enduring stereotyping through subtle reframing. We acknowledge that masculinity is already inscribed within conventionalised representations of culinary culture. In this case we consider how traces of masculinity are exploited and reinscribed through contemporary images that generate resources for rethinking masculine roles and identities, especially when viewed through the lens of stereotypically feminised pursuits such as shopping, food preparation, cooking, and the communal intimacy of food sharing. We identify unsettling tensions within the compositions, arguing that they relate to discursive spaces between the gendered positions written into the images and the popular imagination they feed off. Set against landscapes of culinary culture, we argue that the images invoke a brand of naively roughish "laddishness" or "blokishness", rendering it in domesticated form not only as benign and containable, but fashionable, pliable and, importantly, desirable. We conclude that although the images draw on stereotypical premeditated notions of a feral, boisterous and untamed heterosexual masculinity, they also set in motion gender-blending narratives

Optimization viewpoint on Kalman smoothing, with applications to robust and sparse estimation

In this paper, we present the optimization formulation of the Kalman filtering and smoothing problems, and use this perspective to develop a variety of extensions and applications. We first formulate classic Kalman smoothing as a least squares problem, highlight special structure, and show that the classic filtering and smoothing algorithms are equivalent to a particular algorithm for solving this problem. Once this equivalence is established, we present extensions of Kalman smoothing to systems with nonlinear process and measurement models, systems with linear and nonlinear inequality constraints, systems with outliers in the measurements or sudden changes in the state, and systems where the sparsity of the state sequence must be accounted for. All extensions preserve the computational efficiency of the classic algorithms, and most of the extensions are illustrated with numerical examples, which are part of an open source Kalman smoothing Matlab/Octave package.Comment: 46 pages, 11 figure

Dietary interventions for managing glucose abnormalities in cystic fibrosis:a systematic review protocol

Abstract Background Glucose abnormalities in cystic fibrosis (CF) are common, but there is limited evidence to guide their dietary management. Progressive impaired glucose tolerance eventually leads to cystic fibrosis-related diabetes (CFRD), the most prevalent complication of CF, which is associated with increased morbidity and mortality. Optimising glycaemic control improves clinical status and reduces mortality; insulin therapy is the primary means of controlling glycaemia in CFRD, but its role in managing pre-diabetes is less clear. CF dietary therapy requires a high calorie diet due to increased energy expenditure and malabsorption, but this energy-dense diet is typically high in fat and sugar, and high sugar intakes often result in hyperglycaemia in individuals who have impaired glucose handling. Current guidelines for the dietary management of glucose abnormalities in CF are based on clinical consensus rather than empirical evidence. A systematic review conducted in 2012 on the effects of low glycaemic index dietary intervention in CF concluded that there is a dearth of evidence in this area. This review will update the systematic review by Balzer et al. in 2012 and will broaden the scope of their review to include any type of dietary intervention for managing glucose abnormalities in CF. Methods Quantitative studies of dietary interventions to manage glucose abnormalities in individuals aged over 5 years with CF and glucose abnormalities will be reviewed. No limits will be placed on language or study design. The comparator will be standard CF dietary therapy (energy dense, high-fat diet) in addition to insulin therapy for individuals with CFRD. Electronic databases will be searched for completed quantitative studies published in peer-review journals that focus on dietary interventions for managing glucose abnormalities in CF. Searches will be conducted from 2000 up to the present day to reflect the evolving improvements in CF management. No restrictions will be placed on study design or language. Duration of the dietary intervention must be a minimum of 2 months and only interventions in out-patient or community settings will be included. Studies must report on dietary intervention, glycaemic control, anthropometry and lung function. Evidence will be assessed for heterogeneity and a narrative review or meta-analysis conducted as appropriate. Discussion This systematic review will elucidate current knowledge of the effects of dietary interventions for managing glucose abnormalities in the vulnerable CF clinical population. Systematic review registration PROSPERO registration number: CRD42018085569 www.crd.york.ac.uk/prospero

Ambiguous loss and incomplete abduction narratives in Kosovo

Ten mothers of men and boys who were abducted and listed as missing during the war in Kosovo in 1998/1999 were interviewed in Kosovo in the spring of 2012. Although the missing are presumed dead by the authorities, the mothers continue to live in a state of emotional ambiguity where a presumption of death is balanced with the hope of being reunited. In the absence of absolute proof, finding the remains of their loved ones becomes a major preoccupation. Using a social phenomenological approach, this study explored the social and political complexities existing within the life-world of these women. The findings suggest that they live in a continual state of psychological distress, and even when remains are returned, the unknown elements of the narrative of their abduction and murder only add to their distress and force many into self-imposed emotional exile away from community and close family