Extracellular RNAs (exRNAs) have been identified in all tested biofluids and have been associated with a variety of extracellular vesicles, ribonucleoprotein complexes and lipoprotein complexes. Much of the interest in exRNAs lies in the fact that they may serve as signalling molecules between cells, their potential to serve as biomarkers for prediction and diagnosis of disease and the possibility that exRNAs or the extracellular particles that carry them might be used for therapeutic purposes. Among the most significant bottlenecks to progress in this field is the lack of robust and standardized methods for collection and processing of biofluids, separation of different types of exRNA-containing particles and isolation and analysis of exRNAs. The Sample and Assay Standards Working Group of the Extracellular RNA Communication Consortium is a group of laboratories funded by the U.S. National Institutes of Health to develop such methods. In our first joint endeavour, we held a series of conference calls and in-person meetings to survey the methods used among our members, placed them in the context of the current literature and used our findings to identify areas in which the identification of robust methodologies would promote rapid advancements in the exRNA field.
Background Compensation has historically been unequal for men versus women in medical fields, particularly in surgical subspecialties. Objective We analyzed associations between gender and compensation and identified factors associated with compensation among male and female academic neurosurgeons in the United States (US) public institutions. Methods This is a cross-sectional study of available data for the 2016-2017 fiscal years associated with male and female neurosurgical faculty from public, academic institutions within the US. The data used for analysis included total annual salary, which consisted of the base salary and additional compensation. Other gleaned data included faculty demographics, training, and academic appointments. The male and female neurosurgeons' data were separated into two respective gender groups and then were compared. Predictors of compensation were identified using univariable and non-imputed and multiply-imputed multivariable statistical models. Results The cohort was comprised of 460 neurosurgery faculty members (female n=34; male n=426). Total annual salaries were comparable between the genders. Females were more likely to be younger (p=0.001), to have completed neurosurgery training recently (p=0.003), to have had fellowship training (p=0.011), and to have lower h-indices (p=0.003) compared to males. Males and females differed in academic ranks (p=0.035) and neurosurgical subspecialties (p=0.038).
Background: Pain and pain-related diseases pose a major treatment challenge. Current medical treatments frequently provide inadequate pain control to patients, or cause dependence and other unwanted side-effects. Despite initial failures of open-label trials to show efficacy in the use of deep brain stimulation (DBS) for pain, several groups have reported utility of this modality on carefully selected patients. There are several characterized pain pathways in operation in the human brain. A common theme to the pathways thus far identified is their dependence on the neurotransmitter serotonin for modulation of pain. Deep brain stimulation for pain may well activate one of the serotonin-dependent pathways to stimulate relief. Greater experience, and improvements in both technology and patient selection, has paved the way for the potential use of electrical stimulation of subcortical structures to manage intractable and nociceptive pain syndromes and also for the mechanistic study of the pathways involved in the symptomatic relief of pain caused by stimulation. Methods: We preoperatively loaded four patients with 4 grams of L-tryptophan, and implanted DBS electrodes in the periaqueductal gray (PAG). Results: Upon loading the patients with 4 grams of L-tryptophan two weeks preoperatively and the continual use of tryptophan at doses greater than 2.5 grams, we note a significant improvement in the pain symptoms of all of our patients implanted at the PAG. Upon decrease in L-tryptophan dose below 2.5 grams, every patient experienced return of their pain symptoms despite PAG stimulation. The average length of followup is 9.75 months with a range of three to 14. Conclusions: Tryptophan loading of the patient prior to PAG electrode placement, and the continued use of tryptophan postoperatively correlates with better outcomes and more significant pain reduction. Tryptophan probably increases serotonin levels and results in activation of anti-nociceptive pain pathways at the PAG.
Aberrant regeneration of the third nerve occurs as a result of synkinetic ‘miswiring’ of the third nerve following its injury, such as in third cranial nerve palsy due to tumor, trauma, or aneurysm. The case presented is an elderly woman with new vertical diplopia, which led to a diagnosis of a third cranial nerve palsy, thought to be caused by a 5 mm blister aneurysm of the posterior communicating artery. However, neuro-ophthalmological evaluation diagnosed aberrant regeneration of the third nerve, with the cause of her new vertical diplopia being an ipsilateral fourth nerve palsy. The patient underwent endovascular treatment of her aneurysm using stent-assisted coiling. This procedure was complicated by an episode of air embolism, from which the patient made a good recovery. This patient’s presentation demonstrates that the cause of any diplopia must be established, and presents a novel, semi-schematic illustration of aberrant regeneration of the third nerve that should aid clinicians in its recognition.
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