Inflammatory pseudotumor of the cavernous sinus and skull base

ManuscriptInflammatory pseudotumor is a non-neoplastic process of unknown etiology characterized by a proliferation of connective tissue with an inflammatory infiltrate. Intracranial inflammatory pseudotumors classically involve the cavernous sinus but can also occur in the supratentorial or infratentorial compartments and spinal canal. Symptoms are dependent on location, and when present in the cavernous sinus, typically include cranial nerve palsies of those nerves in the cavernous sinus. These lesions are rapidly responsive to steroid therapy. Surgery is typically indicated for biopsy only, but complete resection may be justified for lesions outside the cavernous sinus

Work hour restrictions: impact on neurosurgical resident training at the University of Utah

Journal ArticleResident work hour restrictions imposed by the Accreditation Council for Graduate Medical Education became effective on July 1, 2003. To evaluate the effect of these regulations on resident operative experience, we reviewed and compared the surgical experience of junior and senior neurosurgical residents four years before and one year after the ACGME restrictions were implemented. Resident work hours since May 2003 and operative caseload during the study period were recorded in commercially available data systems. The mean number of hours worked per week by junior and chief residents decreased f r om 104 and 110 hours before the ACGME work hour restrictions to 81 and 84 hours afterward, respectively. During the four academic years before the work hour limitations took effect, the mean number of major cases performed each year was 802.5 for the chief residents and 849.3 for t he junior residents. Following the restrictions, little changed for t he chief residents. However, the junior residents averaged only 467 cases, a 45 percent decrease f r om t he previous years studied. The mean number of cases covered by each junior resident per month decreased by 30.5 percent after the work hour restrictions were instituted, and the mean number of cases covered per post-call junior resident in one month declined 47.8 percent, from 23 to 12. At our institution, the ACGME work hour restrictions have resulted in decreased resident work hours for all residents at t he expense of the operative experience for junior residents. The operative caseload for chief residents has not been affected

Sporadic osteochondroma of the cervical spine

Journal ArticleOsteochondroma is the most common benign tumor of bone, but axial skeleton involvement is uncommon and usually indicates a hereditary cause such as osteochondromatosis (hereditary multiple exostosis). 1 Approximately 7% of hereditary osteochondromas occur along the vertebral column, which is double the rate of vertebral column occurrences among sporadic cases.4 We present a rare pediatric case of a large sporadic osteochondroma arising from the C-3 lamina. A previously healthy 13-year-old girl with no family history of osteochondroma noticed a posterior neck mass that continued to enlarge over the following year. On examination, the mass was readily visible and nontender to palpation. The patient denied clumsiness of the hands or feet, paresthesias, or neck pain. No motor weakness, sensory disturbance, or hyperreflexia was noted. A lateral plain radiograph demonstrated a calcified mass arising dorsally from the posterior elements of the cervical spine between C-2 and C-4 (Fig. 1). Computerized tomography (CT) scans revealed that the mass was arising from the lamina of C-3 with bone remodeling of the C-2 and C-4 laminae (Fig. 2). Magnetic resonance imaging demonstrated a large multilobulated, cystic, and irregularly enhancing mass with calcified components, measuring 5.8 3 5.5 3 8.7 cm and causing mild cord compression at C3?4 (Fig. 2). The differential diagnosis for this rapidly growing spinal bone lesion included osteochondroma, osteoblastoma, osteosarcoma, and chondrosarcoma. The patient underwent a complete resection via a posterior midline cervical incision. At surgery, the tumor appeared lobulated, well-circumscribed, firm, and calcified (Fig. 3). The tumor and the C-3 lamina were removed. The results of a pathological examination were consistent with an osteochondroma. The postoperative CT scan demonstrated a gross-total resection with stable sagittal alignment

Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches

The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw–rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection

Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research

The adoption and implementation of evidence-based interventions (EBIs) are end goals of translational research, however, potential end-users’ perceptions of an EBI’s value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level, and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities

Groundwater dynamics in coastal gravel barriers backed by freshwater lagoons and the potential for saline intrusion: Two cases from the UK

“NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Marine Systems. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Marine Systems, [VOL 123, (01.08.13)] DOI 10.1016/j.jmarsys.2013.04.004". The full text is under embargo until 01.08.15

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN