Fifteen-Year Institutional Retrospective Case Series of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction.

OBJECTIVE: In the present study, we updated our previously reported case series of patients who had undergone decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) (2005-2020). To the best of our knowledge, the present case series constitutes the largest reported series from a UK neurosurgical unit of decompressive craniectomy for mMCAI. METHODS: We extracted data regarding the clinical discriminators, surgical timescales, and functional outcomes of patients. RESULTS: A total of 67 patients had undergone decompressive craniectomy. The 30-day mortality was 17.9% (n = 12). Of the 67 patients, 31 were male (46.3%) and 36 were female (53.7%). Their mean age was 45 years (range, 16-64 years). The mean age of the survivors was 43 years (range, 16-62 years) compared with 50 years (range, 38-64 years) for those who had died. The median ictal and preoperative Glasgow coma scale score was 14 (range, 7-15) and 8 (range, 3-15), respectively. The corresponding motor scores were 6 and 5. The mean interval from ictus to neurosurgical unit admission was 18.25 hours (range, 0.5-66 hours) and from admission to decompressive craniotomy was 7.30 hours (range, 0.5-46 hours). Of the 67 patients, 63% had undergone "early" craniectomy (<48 hours from mMCAI evolution), with 89% of these patients having undergone craniectomy <24 hours after neurosurgical unit admission. The mean maximum anteroposterior craniectomy diameter was 13.01 cm (range, 10.29-15.56 cm), and mean surface area was 94.38 cm2 (range, 74.75-132.32 cm2). Overall, 46% of patients had had a modified Rankin scale score of <3 (range, 0-6) from discharge to 12 months postoperatively. The median neurosurgical unit length of stay was 15 days (range, 6 hours to 365 days). CONCLUSIONS: The findings from the present update have confirmed that local practice has remained consistent with current evidence. However, patient selection might be optimized if diffusion-weighted magnetic resonance imaging and computed tomography perfusion were used at the original middle cerebral artery infarct admission.

Forty years of clinical excellence at the Dr A Lakshmipathi Neurosurgical Centre and Post-Graduate Institute of Neurological Surgery, Voluntary Health Services (VHS) Hospital.

The Achanta Lakshmipathi Neurosurgical Center (ALNC) and Post Graduate Institute of Neurological Surgery is a private teaching neurosurgical institution located in the VHS (Voluntary Health Services) Hospital Chennai. It has been a leader and trendsetter among the private academic neurosurgical training institutions, and because of its unique legacy, has influenced the progress of Neurosurgery in India. The center was the second neurosurgical Institute to be created by Prof. B Ramamurthi and has trained neurosurgeons in the unique ALNC school of Neurosurgery. The Institute has grown to become a centre of excellence in microsurgery, and spinal surgery and has become a training centre for neurosurgery since 1985. The unique humanitarian aspects of the Voluntary Health Services Hospital helped in bringing the best of Neurosurgery to all strata of society. Forty years after its inception, the ALNC continues its delivery of excellence in clinical neurosurgery and academics.

Survey of UK histopathology consultants' attitudes towards academic and molecular pathology.

OBJECTIVE: Academic pathology is facing a crisis; an ongoing decline in academic pathology posts, a paucity of academic pathologist's in-training and unfilled posts at a time when cellular pathology departments are challenged to deliver increasing numbers of molecular tests. The National Cancer Research Institute initiative in Cellular & Molecular Pathology commissioned a survey to assess attitudes of cellular pathology consultants towards research in order to understand barriers and identify possible solutions to improve this situation. As cellular pathology is encompassing an increasing number of diagnostic molecular tests, we also surveyed the current approach to and extent of training in molecular pathology. METHODS: The survey was distributed to all UK-based consultant pathologists via the Pathological Society of Great Britain & Ireland and Royal College of Pathologist networks. Heads of Department were contacted separately to obtain figures for number of academic training and consultant posts. RESULTS: 302 cellular pathologists completed the survey which represents approximately 21% of the total cellular histopathology workforce. Most respondents (89%) had been involved in research at some point; currently, 22% were undertaking research formally, and 41% on an informal basis. Of those previously involved in research, 57% stopped early in their consultant career. The majority of substantive academic posts were Professors of which 60% had been in post for >20 years. Most respondents (84%) used molecular pathology in diagnostic work, independent of where they worked or the length of time in post. Notably, 53% of consultants had not received molecular pathology training, particularly more senior consultants and consultants in district general hospitals. CONCLUSIONS: The survey reveals that the academic workforce is skewed towards senior individuals, many of whom are approaching retirement, with a missing cohort of 'junior consultant' academic pathologists to replace them. Most pathologists stop formal research activity at the beginning of a consultant career. While molecular pathology is an increasing part of a pathologist's workload, the majority of consultant cellular pathologists have not received any formal molecular training.

#VascularSurgery.

BACKGROUND: To characterize the vascular surgery Twitter network. METHODS: A total of 20,841 consecutive tweets by 8,282 unique Twitter accounts regarding vascular surgery from October 23, 2014 to January 15, 2018 were analyzed. Twitter analytics, including activity metrics, content analysis, user characteristics, engagement, and network analysis were performed using Symplur Signals, a health care social media analytics platform. RESULTS: Vascular surgery tweets, the number of users tweeting about vascular surgery, and vascular surgery tweet impressions have increased by an annual average of 77.8%, 55.3%, and 209.1% from 2015 to 2017, respectively. Twitter activity trend analysis showed consistent growth over the study period with an average of 25.7 ± 2.6 additional tweets per month (P < 0.001). As for tweet content, 2,220 tweets (10.7%) were pertaining to patients, and 2,198 tweets (10.5%) were regarding new or innovative topics. 15,422 tweets (74.0%) included links to journals or websites and 6,826 tweets (32.8%) contained at least 1 image. Deep venous thrombosis, pulmonary embolism, diabetes, endovascular interventions, trauma, and practice guidelines were among the most commonly discussed health topics. Physicians composed 5,618 tweets (27%), while patients submitted 2,447 tweets (11.7%). As for engagement, 8,886 tweets (42.6%) were retweets, 11,816 tweets (56.7%) mentioned at least 1 other user, and 786 tweets (3.8%) were replies. Network analysis revealed central hubs to be vascular surgery societies, academic institutions, academic journals, and physicians. CONCLUSIONS: The use of Twitter to discuss vascular surgery is growing rapidly with increasing use by vascular surgeons and vascular medicine physicians. An effort to involve more patients in the vascular surgery Twitter social network may allow for more opportunities to educate, and garner interest and support for vascular surgery.

Clinical trial registration and reporting: a survey of academic organizations in the United States.

BACKGROUND: Many clinical trials conducted by academic organizations are not published, or are not published completely. Following the US Food and Drug Administration Amendments Act of 2007, "The Final Rule" (compliance date April 18, 2017) and a National Institutes of Health policy clarified and expanded trial registration and results reporting requirements. We sought to identify policies, procedures, and resources to support trial registration and reporting at academic organizations. METHODS: We conducted an online survey from November 21, 2016 to March 1, 2017, before organizations were expected to comply with The Final Rule. We included active Protocol Registration and Results System (PRS) accounts classified by ClinicalTrials.gov as a "University/Organization" in the USA. PRS administrators manage information on ClinicalTrials.gov. We invited one PRS administrator to complete the survey for each organization account, which was the unit of analysis. RESULTS: Eligible organization accounts (N = 783) included 47,701 records (e.g., studies) in August 2016. Participating organizations (366/783; 47%) included 40,351/47,701 (85%) records. Compared with other organizations, Clinical and Translational Science Award (CTSA) holders, cancer centers, and large organizations were more likely to participate. A minority of accounts have a registration (156/366; 43%) or results reporting policy (129/366; 35%). Of those with policies, 15/156 (11%) and 49/156 (35%) reported that trials must be registered before institutional review board approval is granted or before beginning enrollment, respectively. Few organizations use computer software to monitor compliance (68/366; 19%). One organization had penalized an investigator for non-compliance. Among the 287/366 (78%) accounts reporting that they allocate staff to fulfill ClinicalTrials.gov registration and reporting requirements, the median number of full-time equivalent staff is 0.08 (interquartile range = 0.02-0.25). Because of non-response and social desirability, this could be a "best case" scenario. CONCLUSIONS: Before the compliance date for The Final Rule, some academic organizations had policies and resources that facilitate clinical trial registration and reporting. Most organizations appear to be unprepared to meet the new requirements. Organizations could enact the following: adopt policies that require trial registration and reporting, allocate resources (e.g., staff, software) to support registration and reporting, and ensure there are consequences for investigators who do not follow standards for clinical research.

National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme research funding and UK burden of disease.

BACKGROUND: HTA Programme funding is governed by the need for evidence and scientific quality, reflecting funding of the National Institute for Health Research (NIHR) by the NHS. The need criterion incorporates covering the spectrum of diseases, but also taking account of research supported by other funders. This study compared the NIHR HTA Programme portfolio of research with the UK burden of disease as measured by Disability-adjusted Life Years (DALYs). METHODS: A retrospective cross-sectional study using a cohort of all funded primary research and evidence syntheses projects received by the HTA Programme from April 2011 to March 2016 (n = 363); to determine the proportion of spend by disease compared with burden of disease in the UK calculated using 2015 UK DALY data. RESULTS: The programme costing just under £44 million broadly reflected UK DALY burden by disease. Spend was lower than disease burden for cancer, cardiovascular and musculoskeletal diseases, which may reflect the importance of other funders, notably medical charities, which concentrate on these diseases. CONCLUSION: The HTA Programme spend, adjusted for other relevant funders, broadly matches disease burden in the UK; no diseases are being neglected.

The AFIP/ARP Atlases of Pathology Past, Present, and Future.

The AFIP (Armed Forces Institute of Pathology) Atlases (Fascicles) have been in continuous publication for nearly 75 years and have enjoyed a highly regarded reputation for their excellence. Throughout this time period, more than 130 volumes, encompassing the 1st to 4th series have been published. Since their inception in the 1940's, the Fascicles have evolved from loose-leafed atlases illustrated with black and white images, to hardbound monographs with full color images and expansion of scope, including relevant clinical information, cytopathology, and the most recent advances in immunohistochemistry and molecular diagnostics. Each of the volumes undergoes a rigorous review process by the Editor-in-Chief, Associate Editors, members of the Editorial Advisory Board, and external reviewers. The 5th series, under the editorial direction of Drs. Elizabeth Montgomery and Jason Hornick, is well underway and will include an Epub version and a virtual slide box, in addition to the hardbound book. The Atlases of Nontumor Pathology will also continue to be published. With the closure of the AFIP in 2011, the American Registry of Pathology (ARP) has assumed full responsibility for the publication of both the Tumor and Nontumor Fascicles.

Twenty five years of the National Academy of Medical Sciences of Ukraine - progress and priorities for future of radiation medicine and biology. / DVADTsIaT' P'IaT' ROKIV NATsIONAL'NOÏ AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY ­ PROGRES TA PRIORYTETY NA MAY̆BUTNIe RADIATsIY̆NOÏ MEDYTsYNY TA RADIOBIOLOGIÏ.

After the creation of the Academy of Medical Sciences of Ukraine in 1993 the Research Center for Radiation Medicine was among the first institutions to join the Academy (fig. 1). Estab lishing the Academy was among the first steps of the independent Ukrainian government and aimed to provide a high level health care for population. It was extremely needed for the minimization of Chornobyl medical consequences. This choice was related to a growing recognition of the scientific research in fulfilling the Сenter's mission - study of the effects of low dose radiation on human body and radiation protection of the exposed population.The Center entered the Academy as a potent insti tution. Director General Dr. Anatoly Romanenko and his first deputy prof. Oles Pyatak were lucky to concentrate in three institutes of the Center a talent ed workforce including director of the Institute of Clinical Radiology prof Volodymyr Bebeshko, director of the Institute of Epidemiology and Prophylaxis of radiation Injuries prof. Volodymyr Buzunov, director of the Institute of Experimental Radiology prof. Mikhail Rudnev. Drs. T. Azaren kova, S. Galkina, V. Boer, T. Treskunova were appointed as scientific secretaries. Dosimetry divi sion was headed by brilliant prof Ilya Likhtarev and his staff Drs. I. Los, V. Korzun, V. Repin, O. Pere voznikov, O. Bondarenko, V. Chumak and others.The Center met creation of the Academy with expe rienced research and clinical staff encountering 1587 members, including 272 research staff, 28 doctors of science and 98 PhDs, modern diagnostic and labo ratory equipment, 300 beds in clinical departments and construction of hospital and out patient hospi tal in Svyatoshin. Scientific staff included experi enced prof. I. Khomaziuk, prof. B. Prevarsky, prof. V. Zamostian, prof. P. Chayalo, prof. M. Omelya nets, prof. A. Prysyazhnyuk. Dr. A. Niagu, Dr. E. Stepanova, Dr. A.Chumak, Dr. V. Klymenko, Dr. D. Komarenko, M. Pilinska, L.Ovsiannikova, O. Pi rogova. were among the first academic supervisors in studies of Chornobyl health effects and got professor certificates in this new area. First PhD theses were successfully passed by Dr. E. Gorbov, and Dr. of Sciences - by Dr. D. Bazyka. Basics of future aca demic research directions were elaborated that time by Drs. O. Kovalenko, Zh. Minchenko, V. Talko, I. Holyavka, D. Belyi, D. Yakimenko, E. Mikhai lovska, V. Malyzhev, V. Sushko, A. Cheban, K. Lo ganovsky, K. Bruslova, I. Dyagil, T. Liubarets, O. Kucher, G. Chobotko, and others. Later the major ity of these studies formed a background for Chornobyl legislation, regulatory directives, pre sented as dissertations.A quarter of century passed. The Center as a part of the National Academy of Medical Sciences resisted the challenges and moved forward, was recognized worldwide and fulfilled its main mission - providing highly qualified health care to radiation exposed. Staff numbers decreased (1,091), but work amount has increased. Since 2000, new premises were installed - a hospital with the biggest in Ukraine outpatient clin ic, new laboratory facilities, the last of which was in troduced in 2013. The Academy became a national one and since 2011 the Center was recognized as a national research institution (NRCRM), staff mem bers received 3 State Awards of Ukraine in the Field of Science and Technology, numerous personal awards.During this period, NRCRM staff conducted and published priority research data on radiation risks and molecular mechanisms of leukemia, including chronic lymphocytic, myelodysplastic syndrome, multiple myeloma, thyroid cancer, breast cancer in Chornobyl accident cleanup workers. Studies of the mechanisms of non tumor pathology - cardio vascular, cerebrovascular, cognitive disorders are in process. Of high importance are studies of possible transgenerational effects of radiation. The devel oped new technologies and protocols for the advanced care of radiation exposed were intro duced to the general health care system, the addi tional departments of oncology and chemotherapy were equipped and started activities, databases of cancer cases in exposed population and separate groups of exposed were introduced, as well as an international database of radiation injuries. The Clinical and Epidemiological registry of the NRCRM is in function and developed. An adapta tion of research directions with a respect to the pathomorphosis of radiation induced diseases in the remote period after irradiation will continue.Performed complex studies of the effects of incorporation of 131I on the fetus and the next gen eration of experimental animals became important for understanding the mechanisms of formation of radiation effects. Introduction of new foodstuffs and supplements with radiation protective proper ties was of positive effect for population protection during the first years.In the area of dosimetry a substantial progress has been achieved in reconstruction of thyroid doses in the Ukrainian population, dosimetric passportisation of settlements, radiochemistry, the creation of new methods for reconstructive dosimetry for cleanup workers - SEAD, RADRUE, and ROCKVILLE. All developments are implemented to practice, tens of thousands of doses have been restored. International recognition has received for the method of in utero doses reconstruction. As editor in chief, I regard it successful to incorporate our bilingual edition «Problems of Radiation Medicine and Radiobiology¼ into the NCBI MedLine, SCOPUS and other data bases, that creates an unique opportunity to widely disseminate results of the Center's research.Strategies for the future. Ukraine belongs to countries with a priority development of nuclear energy. Even with the increase in the production of clean energy, there is no other way than the further deployment of a complete nuclear fuel cycle and energy industrial complex, the expansion of the nuclear technologies to all sectors of the economy.The main potential threats to radiation safety include the aging of the material base of the NPPs with the prolongation of the working life for nuclear reactors with the expired terms of exploitation; the existence of a «nuclear legacy¼ sites of the former USSR in the territories of enterprises for the extrac tion and processing of uranium ores. About 5,000 institutions and enterprises use more than 25,000 sources of ionizing radiation in general. The use of radiological technologies and sources of ionizing radiation in medicine is increasing, in particular the burden on patients and staff in invasive cardiac sur gery. This will require significant efforts from the NRCRM to ensure an adequate radiation protec tion of the population, taking into account the experience collected during the mitigation of health effects of Chornobyl. Radiological threats of malev olent use of nuclear technology hasn't be forgotten.The mission of the NRCRM is to expand basic research of the health effects of ionizing radiation, elaboration and implementation of the care and radiation protection of population. Background for future is paved by a successful implementation of a special program of medical and biophysical control of personnel during transformation of the Shelter object into an environmentally safe sys tem, the State social program of increasing safty, labor hygiene and environment for 2014-2018; many years of successful cooperation with the State Nuclear Regulatory Inspectorate, the Natio nal Commission for Radiation Protection, «Ener goatom¼ company, the relevant departments of the Ministry of Health, international organizations such as WHO, UNSCEAR, IAEA, IARC, the US National Cancer Institute, IRSN, Nagasaki, Hiroshima, Fukushima universities and others.From the editorial board I congratulate the staff of the Center with the twenty fifth anniversary of the Academy. I would like also to wish the National Academy of Medical Sciences of Ukraine new ad vances in medical science and practice, sustainabil ity, unity, development and worldwide recognition.

State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ - research activities and scientific advance in 2016. / REZUL'TATY ROBOTY DU «NATsIONAL'NYY̆ NAUKOVYY̆ TsENTR RADIATsIY̆NOÏ MEDYTsYNY NATsIONAL'NOÏ AKADEMIÏ MEDYChNYKh NAUK UKRAÏNY¼ U 2016 ROTsI.

Research activities and scientific advance achieved in 2016 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine¼ (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident; fulfillment of tasks of «State social program for improving safety, occupational health and working environment in 2014-2018 years¼.The report also shows the results of scientific organizational and health care work, staff training. The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 17, 2016.

[Research Networks in Public Health: Requirements for Sustainability and Effectiveness - a Sociological Perspective]. / Wissenschaftsnetzwerke in Public Health: Voraussetzungen wirksamer Nachhaltigkeit aus soziologischer Perspektive.

The Public Health White Paper draws up a vision of public health as a living, decentralized network that can help improve the health of the population in a sustained fashion. However, the central question remains open as to which prerequisites public health networks should fulfill in order to be effective in the long term. The aim of this paper is to provide a sociological view of the issue and offer some discussion ideas. Parsons' structural functionalism leads to the thesis that science networks in public health require structures that ensure that the 4 basic functions of viable social networks - (1) adaptation, (2) goal attainment, (3) integration and (4) latent pattern maintenance - are fulfilled. On this theoretical basis, suggestions are made to establish functional formal structures in public health networks.

Analysis of Compensation Disparities between Junior Academic and Private Practice Vascular Surgeons.

BACKGROUND: Compensation may be a significant factor for academic vascular surgeons seeking or changing employment. We compared compensation for academic and private practice vascular surgeons practicing for approximately similar duration. METHODS: Compensation data for academic and private practice vascular surgeons were obtained from the Association of American Medical Colleges (AAMC) and Medical Group Management Association (MGMA), respectively. Comparisons of nominal annual compensation data were made between Group 1 (assistant professor vascular surgeons versus private practice vascular surgeons in practice for 1-7 years), Group 2 (associate professor vascular surgeons versus private practice vascular surgeons in practice for 8-17 years), and Group 3 (professor vascular surgeons versus private practice vascular surgeons in practice for ≥18 years) from 2003 to 2012. RESULTS: In Group 1, there was a $54,500 difference in 2003 (P = 0.043) which increased to $110,500 by 2012 (P = 0.001). In Group 2, there was a $44,200 difference in 2007 (P = 0.016) which increased to $53,400 by 2010 (P = 0.034). In Group 3, there was no statistically significant difference in compensation (P ≥ 0.999). CONCLUSIONS: There is a significant and increasing disparity in compensation in favor of private practice vascular surgeons compared with assistant professor vascular surgeon faculty. Differences equalized with increasing seniority and experience. Compensation plans should be market based and in line with nonacademic benchmarks as well.

Beyond Seed and Soil: Understanding and Targeting Metastatic Prostate Cancer; Report From the 2016 Coffey-Holden Prostate Cancer Academy Meeting.

INTRODUCTION: The 2016 Coffey-Holden Prostate Cancer Academy (CHPCA) Meeting, "Beyond Seed and Soil: Understanding and Targeting Metastatic Prostate Cancer," was held from June 23 to June 26, 2016, in Coronado, California. METHODS: For the 4th year in a row, the Prostate Cancer Foundation (PCF) hosted the CHPCA Meeting, a think tank-structured scientific conference, which focuses on a specific topic of critical unmet need on the biology and treatment of advanced prostate cancer. The 2016 CHPCA Meeting was attended by 71 investigators from prostate cancer and other fields, who discussed the biology, study methodologies, treatment strategies, and critical unmet needs concerning metastatic prostate cancer, with the ultimate goal of advancing strategies to treat and eliminate this disease. RESULTS: The major topics of discussion included: the molecular landscape and molecular heterogeneity of metastatic prostate cancer, the role of the metastatic microenvironment, optimizing immunotherapy in metastatic prostate cancer, learning from exceptional responders and non-responders, targeting DNA repair deficiency in advanced prostate cancer, developing and applying novel biomarkers and imaging techniques, and potential roles for the microbiome in prostate cancer. DISCUSSION: This article reviews the topics presented and discussions held at the CHPCA Meeting, with a focus on the unknowns and next steps needed to advance our understanding of the biology and most effective treatment strategies for metastatic prostate cancer. Prostate 77:123-144, 2017. © 2016 Wiley Periodicals, Inc.