Six-Month Survivorship Prediction in Spinal Metastatic Patients by Oncologists Shows Reliable Prognostication.

STUDY DESIGN: A retrospective analysis of oncologist-provided prognoses vs actual survival outcomes of patients referred with Metastatic spinal cord compression (MSCC) to a supra-regional multidisciplinary team (MDT). OBJECTIVES: Prognostic scoring systems, such as the revised Tokuhashi, are commonly used to help guide the treatment of MSCC. However, scoring systems do not accommodate for the improved outcomes of contemporary cancer therapy. Oncologist-provided prognoses play an important role in real world rapid decision making. There is a paucity of evidence assessing the accuracy of the oncologist-provided prognosis. We conducted a retrospective study to evaluate this. METHODS: Data was captured between January 2015 and December 2018. Patients were split into 2 groups: Group 1 (prognosis estimated <6 months) and Group 2 (prognosis estimated >6 months). Median overall survival (mOS) and hazard ratio for death (HR) was assessed. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the oncologist's prognosis. RESULTS: 829 patients were included. mOS in Group 1 was 5.8 months (95% CI 4.2-7.4 m), and in Group 2 mOS was not reached. Log rank test gave a Chi2 of 131 (P < .001). Cox regression analysis revealed a HR of .30 (P < .001). Area under the ROC curve was 78%. CONCLUSIONS: Oncologist-provided prognosis is accurate in this cohort of unselected, consecutive MSCC patients. It reduced reliance on scoring systems that can become outdated. Given the rapid progress in cancer treatment, the oncologist's prognostic prediction is integral in efficient and effective MSCC management to help rapidly determine surgical candidacy.

Acute foot drop secondary to lumbar disc prolapse after seizure.

Generalised tonic-clonic seizures have been reported to cause musculoskeletal injuries including vertebral fractures usually without resultant neurological deficit. Lumbar disc prolapse resulting in neurological deficits following seizures has not been reported. We report a 43-year-old man who presented after a generalised seizure at which point he developed worsening of low back pain and left sciatica followed by an acute foot drop. His lumbo-sacral MRI demonstrated a diffuse disc bulge at L4-5 level and a large, caudally migrated, free disc fragment with resulting severe canal stenosis at L4/5 and left lateral recess stenosis at L5/S1. He underwent urgent left L4/5 and L5/S1 micro-discectomies with resolution of his symptoms. We illustrate a rare but important treatable complication of seizures. Detailed history and clinical examination in patients with post-ictal neurological deficit should be conducted to identify the specific cause. Appropriate imaging should be performed if there remains any doubt regarding diagnosis.

Paraganglioma of the cauda equina: a tertiary centre experience and scoping review of the current literature.

Cauda equina paragangliomas are rare benign extra-adrenal neuroendocrine tumours arising from the neural crest cells associated with autonomic ganglia. These tumours are often mistaken preoperatively for ependymomas or schwannomas. Patients present with axial or radicular pain with or without neurological deficits. Recurrence, secretory features and length of follow-up are controversial. We conducted a retrospective cohort study of paraganglioma through searching a prospectively maintained histopathology database. Patient demographics, presentation, surgery, complications, recurrence, follow-up and outcome between 2004 and 2016 were studied. The primary aim was to collate and describe the current evidence base for recurrence and secretory features of the tumour. The secondary objective was to report outcome and follow-up strategy. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Ten patients were diagnosed (M:F 7:3) with a mean age of 53.6 ± 5.1 (range 34-71 years). MRI scans revealed intradural lumbar enhancing lesions. All patients had complete microsurgical excisions without adjuvant therapy with no recurrence with a mean follow-up of 5.1 ± 1.4 years. Tumours were attached to the filum terminale. Electron microscopic images demonstrated abundant neurosecretory granules with no evidence of catecholamine production. A total of 620 articles were screened and 65 papers (including ours) combining 121 patients (mean age 48.8 and M:F 71:50) were included. The mean follow-up was 3.48 ± 0.46 (range 0.15-23 years). Back pain was the most common symptom (94%). Cure following surgery was achieved in 93% of the patients whilst 7% had recurrence. Total resection likely results in cure without the need for adjuvant therapy or prolonged follow-up. However, in certain situations, the length of follow-up should be determined by the treating surgeon.

The Agatston Urban Nutrition Initiative: working to reverse the obesity epidemic through academically based community service.

The Agatston Urban Nutrition Initiative (AUNI) presents a fruitful partnership between faculty and students at a premier research university and members of the surrounding community aimed at addressing the problem of childhood obesity. AUNI uses a problem-solving approach to learning by focusing course activities, including service-learning, on understanding and mitigating the obesity culture.

Growth faltering and catch-up growth in relation to environmental change in children of a disadvantaged community from Guatemala City.

The extent and persistence of stunting and growth status across a 10-year period, and their relationship to changes in the home environment, have been analyzed using data from a 10-year longitudinal study of three birth cohorts, seen initially at 3, 5, and 7 years and examined annually thereafter. The children came from an economically disadvantaged community located on the periphery of Guatemala City. The sample used in the analysis consisted of 271 subjects with complete growth and SES data over a 10-year period. Stunting was high initially, with 43.5% of the sample displaying USNCHS height z-scores < -2.0 at the first examination. Growth status at the first visit was a significant predictor of status after 10 years. The odds ratio for stunting in adolescence if stunted in early childhood was 18.39. Characteristics of the household at the first visit were a significant determinant of height, weight, estimated arm muscle, the triceps skinfold, and the BMI at the last visit, after adjusting for confounding variables. Changes in household status between the first and last visits were associated with greater growth increments in height and weight but not in the BMI, triceps skinfold, or estimated arm muscle circumference. These analyses have demonstrated that improved growth status during adolescence relative to status 10 years earlier (a form of catch-up growth) was attributable to two factors: first, for the sample as a whole there was a general improvement in growth status with a mean change in height-and weight-for-age z-scores of 0.218 and 0.420, respectively; second, the change in household score from first to last visit was a significant determinant of growth increment over that period, but only in the case of height and weight. Thus, while the early environment is a powerful determinant of later growth status, some catch-up growth can be identified both as a general systemic response as well as a response to changing environmental conditions. © 1995 Wiley-Liss, Inc.

Physical growth, nutritional status, and dietary intake of African-American middle school students from Philadelphia.

As part of an integrated program of academically based participatory action research, measurements of nutritional status and dietary intakes were collected from 11- to 15-year-old African-American youth attending an innercity Philadelphia middle school. Statures and weights were collected on 136 individuals and 24-hr recalls, distributed across the week, on 113. Using the U.S. reference data, statures were not significantly different from U.S. age/sex means, but weights were significantly greater. With the U.S. Black population (NHANES I and II) serving as a reference for the body mass index, 23.5% of the sample were classed as obese, with a BMI >90th centile. This is greater than has been reported for Philadelphia Whites, for U.S. Blacks in general, or for other samples from the U.S. and Canada. Intakes of vitamins were at or above two-thirds of RDAs except for vitamin D, with a median of 28.1% of the recommended allowance. Low intakes were also recorded for dietary fiber (36.9% RDA) and zinc, with a median intake of 63% RDA. The median intake of fat was 101.3% RDA, of saturated fat, 102.2% RDA, of cholesterol, 76% RDA, and of polyunsatured fat, 48.2% RDA. The median intake of sodium was 2701 mg, 112.5% RDA. Overall, the data indicate a population with a very high prevalence of obesity, and diets high in saturated fat and low in polyunsaturated fat. Also of potential concern is the indication of low intakes of zinc and high intakes of sodium. Given the increased health risks of urban African-Americans, these findings on young adolescents suggest the need to develop programs designed to improve diets and enhance health in general in this age group. © 1994 Wiley-Liss, Inc.

Application of the Preece-Baines growth model to cross-sectional data: Problems of validity and interpretation.

The Preece-Baines growth model (PBGM) is a family of curves that conform to the shape of the human growth curve. It is most often used to analyze longitudinal records on individuals, but it can be applied to cross-sectional data from population surveys. The purpose of this study was to determine empirically the validity of applying the PBGM to cross-sectional data to make inferences about the timing and nature of the adolescent growth spurt. Longitudinal records (n = 339) from the Third Harvard Growth Study were analyzed individually using the PBGM. Results for each sex were pooled to characterize longitudinal growth in this population. Ten independent random cross-sectional samples were generated from the same data set. These were divided by sex and the age means for height were analyzed using the PBGM. Comparisons between the pooled longitudinal estimates and those from the random cross-sectional samples indicated that the PBGM can accurately estimate the age at peak height velocity in males, as well as other characteristics of the adolescent growth spurt when using cross-sectional data. In females, spurious results were obtained when cross-sectional data are used. Possible sources of bias are discussed. © 1994 Wiley-Liss, Inc.

Fatness and fat pattering in 12-17-year-old youth from the Chandigarh zone of Northwest India.

Fatness and fat patterning were studied in a sample of 502 youth, 12-17 years of age, of high and low socioeconomic status (SES) from the Chandigarh Zone of northwest India. Fatness estimates were based on six skinfolds, while fat patterning was analyzed through the centripetal fat and waist/hip ratios, and through principal components of skinfolds. In all analyses, fat patterns were adjusted for general body fatness. Upper SES subjects were larger and fatter than lower SES subjects of the same age and sex. As expected, females displayed higher fatness levels than males, a more peripheral distribution of body fat, and lower body patterning of trunk fat. Lower SES was associated with a centripetal, rather than a peripheral, fat pattern. After correction for amount of fat, there were no differences between SES groups in the waist/hip ratio, within-sex. Compared to U.S. youth of a similar age range, Indian subjects displayed higher BMI-adjusted centripetal fat and waist/hip ratios. Lower SES was associated with reduced body fatness along with a centralized pattern of fat deposition, which could reflect a greater mobilization of peripheral fat to meet the metabolic demands of growth. While there was some suggestion of an ethnic effect in the two ratios, this could not be demonstrated with confidence.

Skinfold thicknesses, body circumferences and their relationship to age, sex, and socioeconomic status in adults from Northwest India.

Subcutaneous fatness, measured anthropometrically, was analyzed in a sample of 651 males and females, 18-49 years of age, of high and low socioeconomic status (SES) from the Chandigarh zone of Northwest India. There were significant differences between lower and upper SES males and females. In general, all groups tend to show increases in indicators of fatness between the 18-29 and the 30-39 year age groups. However, there was less consistency across groups between 30-39 and 40-49 years. There is no difference in sexual dimorphism between SES groups. Means of lower SES subjects are approximately 1 S.D. below those of U.S. reference data. Using the body mass index as a criterion, no lower SES individuals were classified as overweight or obese. In the upper SES sample, 12.1% were classified as overweight.

Socioeconomic correlates of fertility, mortality, and child survival in mothers from a disadvantaged, urban Guatemalan community.

Social and economic determinants of fertility, mortality, and child survival were studied in a sample of 519 mothers from EL Progreso, a disadvantaged community located on the outskirts of Guatemala city. Fertility (children ever-born) and mortality (number of children who had died postnatally) data were obtained from interviews, along with data on the characteristics of the mothers, fathers, and the households. Contraceptive use was recorded on a subsample of 167 mothers of 5-year old children. Following factor analyses, three variables were selected for analysis: Years of schooling of the father and the mother and the type of fuel used for cooking. Father's education and type of fuel were significantly related to maternal fertility, while only the educational attainment of the mother was related to child mortality and survival. When contraceptive use was included in the ANCOVA in the subsample, it was a significant determinant of fertility, while father's education became nonsignificant. In terms of mortality, contraceptive use was a significant determinant, while the significance of the mother's education fell to a borderline value (P = 0.084).