Neurologic Outcomes for Adult Spinal Cord Ependymomas Stratified by Tumor Location: A Retrospective Cohort Study and 2-Year Outlook

Determine whether craniocaudal spinal cord tumor location affects long-term neurologic outcomes in adults diagnosed with spinal ependymomas (SE). A retrospective cohort analysis of patients aged ≥ 18 years who underwent surgical resection for SE over a ten-year period was conducted. Tumor location was classified as cervical, thoracic, or lumbar/conus. Primary endpoints were post-operative McCormick Neurologic Scale (MNS) scores at \u3c 3 days, 6 weeks, 1 year, and 2 years. One-way ANOVA was performed to detect significant differences in MNS scores between tumor locations. Twenty-eight patients were identified. The average age was 44.2 ± 15.4 years. Sixteen were male, and 13 were female. There were 10 cervical-predominant SEs, 13 thoracic-predominant SEs, and 5 lumbar/conus-predominant SEs. No significant differences were observed in pre-operative MNS scores between tumor locations (p = 0.73). One-way ANOVA testing demonstrated statistically significant differences in post-operative MNS scores between tumor locations at \u3c 3 days (p = 0.03), 6 weeks (p = 0.009), and 1 year (p = 0.003); however, no significant difference was observed between post-operative MNS scores at 2 years (p = 0.13). The mean MNS score for patients with thoracic SEs were higher at all follow-up time points. Tumors arising in the thoracic SE are associated with worse post-operative neurologic outcomes in comparison to SEs arising in other spinal regions. This is likely multifactorial in etiology, owing to both anatomical differences including spinal cord volume as well as variations in tumor characteristics. No significant differences in 2-year MNS scores were observed, suggesting that patients ultimately recover from neurological insult sustained at the time of surgery

Impact of Surgical Timing on Neurological Outcomes for Spinal Arachnoid Cyst: A Single Institution Series

Objective Spinal arachnoid cysts (SACs) are rare lesions that often present with back pain and myelopathy. There is a paucity of literature evaluating the impact of surgical timing on neurological outcomes for primary SAC management. To compare long-term neurological outcomes in patients who were managed differently and to understand natural progression of SAC. Methods We conducted a retrospective analysis of adult patients treated for SAC at our institution from 2010 to 2021, stratified into 3 groups (conservative management only, surgical management, or conservative followed by surgical management). Study outcome measures were neurological outcomes as measured by modified McCormick Neurologic Scale (MNS), postoperative complications, and cyst recurrence. Nonparametric analysis was performed to evaluate differences between groups for selected endpoints. Results Thirty-six patients with SAC were identified. Eighteen patients were managed surgically. The remaining 18 patients were managed conservatively with outpatient serial imaging, 7 of whom (38.9%) ultimately underwent surgical treatment due to neurological decline. Most common presenting symptoms included back pain (50.0%), extremity weakness (36.1%), and numbness/paresthesia (36.1%). Initial/preoperative (p = 0.017) and 1-year postoperative (p = 0.006) MNS were significantly different between the 3 groups, but not at 6 weeks or 6 months postoperatively (p > 0.05). Additionally, at 1 year, there was no difference in MNS between patients managed surgically and those managed conservatively but ultimately underwent surgery (p > 0.99). Conclusion Delayed surgical intervention in minimally symptomatic patients does not seem to result in worse long-term neurofunctional outcomes. At 1 year, postoperative MNS were significantly higher in both surgical groups, when compared to the conservative group highlighting worsening clinical picture regardless of preoperative observational status

Morphometry of subaerial shield volcanoes and glaciovolcanoes from Reykjanes Peninsula, Iceland: Effects of eruption environment

We present a morphometric study of 33 basaltic volcanic edifices from the Reykjanes Peninsula, Iceland, using a 20 m resolution digital elevation model (DEM). Slope values distinguish subaerial from intraglacial eruption environments, with glaciovolcanic edifices having average slope values that are > 5° higher than subaerial shields. The 26 analyzed glaciovolcanic edifices are separated into 3 groups based on size, and are also categorized following the new classification scheme of tuyas by Russell et al. (2014), into 15 tindars, 1 conical tuya, 3 flat-topped tuyas and 7 complex tuyas. The glaciovolcanic edifices show a continuum of landforms ranging from small elongated tindars to large equidimensional flat-topped tuyas. The smaller edifices ( 0.1 km3) are flat-topped tuyas. The mid-sized edifices (0.01–0.1 km3) show a wide variety of shapes and classify either as tindars or as complex tuyas, with only one edifice classifying as a conical tuya. Edifice elongation tends to decrease with volume, suggesting that small edifices are primarily fissure controlled, whereas larger edifices are mainly controlled by a central vent. The mid-sized complex tuyas are transitional edifices, suggesting that some intraglacial eruptions start as fissure eruptions that subsequently concentrate into one or more central vents, whereas the mid-sized tindars suggest a sustained fissure eruption. There is a tectonic control on the orientation of the edifices evidenced by a strong correlation between edifice elongation azimuth and mapped faults and fractures. Most edifice elongations cluster between 020° and 080°, coinciding with the strike of normal faults within and at the boundary of regional volcanic systems, but some edifices have elongations that correlate with N–S striking book-shelf faults. This implies that intraglacial eruptions are controlled by pre-existing pathways in the crust, as has been previously observed for subaerial fissure eruptions. In terms of classification, quantification of the limits between the four tuya types proposed by Russell et al. (2014) is difficult because of the transitional nature shown by several edifices. A threshold of 1.8 in ellipticity index (E.I.) values can be used to distinguish tindars from the other three types. Flat-topped tuyas are distinguished by their greater overall size, their large and relatively flat summit regions, reflected in bimodal slope distributions, and their low E.I. and low to intermediate irregularity index (I.I.) values. The only analyzed conical tuya has very low E.I. and I.I. values, very small summit regions and very steep flank slopes. The complex tuyas have variable morphometries, but are in general characterized by high I.I. values and very irregular slope distributions. No correlation is observed between edifice-scale morphology and lithology (e.g. pillow dominated or hyaloclastite dominated).Fil: Pedersen, G. B. M.. University of Iceland. Institute of Earth Sciences. Nordic Volcanological Center; IslandiaFil: Grosse, Pablo. Fundación Miguel Lillo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Tucumán; Argentin

Novel Echocardiographic Biomarkers in the Management of Atrial Fibrillation

Purpose of Review: Atrial fibrillation (AF) is the most common arrhythmia in adults. The number of patients with AF is anticipated to increase annually, mainly due to the aging population alongside improved arrhythmia detection. AF is associated with a significantly elevated risk of hospitalization, stroke, thromboembolism, heart failure, and all-cause mortality. Echocardiography is one of the key components of routine assessment and management of AF. Therefore, the aim of this review is to briefly summarize current knowledge on “novel” echocardiographic parameters that may be of value in the management of AF patients. Recent Findings: Novel echocardiographic biomarkers and their clinical application related to the management of AF have been taken into consideration. Both standard parameters such as atrial size and volume but also novels like atrial strain and tissue Doppler techniques have been analyzed. Summary: A number of novel echocardiographic parameters have been proven to enable early detection of left atrial dysfunction along with increased diagnosis accuracy. This concerns particularly experienced echocardiographers. Hence, these techniques might improve the prediction of stroke and thromboembolic events among AF patients and need to be further developed and disseminated. Nonetheless, even the standard imaging parameters could be of significant value and should not be discontinued in everyday clinical practice. © 2019, The Author(s)