Neoadjuvant Therapy with Everolimus for Subependymal Giant Cell Astrocytoma: A Case Report

Direct surgical resection remains to be the standard treatment for tuberous sclerosis complex (TSC) with subependymal giant cell astrocytoma (SEGA). Medical therapy with everolimus (mammalian target of rapamycin inhibitor or mTOR) serves as a second-line treatment for patients with SEGA who are determined to be ineligible for surgical resection. Some recent studies have reported that neoadjuvant therapy for SEGA may be a useful, novel treatment. In this study, we herein present a case of SEGA and demonstrate the efficacy of preoperative everolimus therapy. We have also examined the utility and safety of neoadjuvant therapy for SEGA and investigated four previously reported cases of preoperative administration of mTOR inhibitors. In these cases, everolimus was administered preoperatively to shrink the tumor although the duration of treatment varied. Afterward, gross total tumor removal was conducted in all the cases. No postoperative complications were reported during the follow-up period. These findings indicate that neoadjuvant therapy with an mTOR inhibitor can be a potential treatment for SEGA. The findings of this present study also suggested that a short administration period of about 2 months may be sufficient to achieve preoperative tumor reduction.

Physiologically-Based Kinetic Modeling Predicts Similar In Vivo Relative Potency of Senecionine N-Oxide for Rat and Human at Realistic Low Exposure Levels

SCOPE

This study aims to determine if previously developed physiologically-based kinetic (PBK) model in rat can be modified for senecionine (SEN) and its N-oxide (SENO), and be used to investigate potential species differences between rat and human in relative potency (REP) of the N-oxide relative to the parent pyrrolizidine alkaloid (PA).

METHODS AND RESULTS

In vitro derived kinetic parameters including the apparent maximum velocities (V_max ) and Michaelis-Menten constants (K_m ) for SENO reduction and SEN clearance are used to define the PBK models. The rat model is validated with published animal data, and the toxicokinetic profiles of SEN from either orally-administered SENO or SEN are simulated. REP values of SENO relative to SEN amount to 0.84 and 0.89 in rat and human, respectively.

CONCLUSION

The REP value can be dose- and species-dependent, with the values for rat and human being comparable at low realistic exposure scenarios. In summary, PBK modeling serves as a valuable New Approach Methodology (NAM) tool for predicting REP values of PA-N-oxides and may actually result in more accurate REP values for human risk assessment than what would be defined using in vivo animal experiments.

Family-SEN School Collaboration and Its Importance in Guiding Educational and Health-Related Policies and Practices in the Hungarian Minority Community in Romania

Special education practice allows for the educational principles of parental involvement, pointing to a common dialogue on health issues and general well-being. Special education professionals primarily empower the families of children with atypical development by relying on the organizational factors of individual support and services. The decision-making/partnering factors of the educational and general health processes, on the other hand, receive less attention. The present study aims to explore the place of the parent-school relationship within the framework of a special educational institution in Romania. Involving Hungarian special education teachers (N = 12) from Romania, we analyze the school involvement of the parents of students with special educational needs in Bihor County, Romania, concerning their children's academic achievement and well-being. The qualitative research data were recorded through semistructured interviews and were organized through deductive categorization, as well as being analyzed thematically using Atlas.ti. The results highlighted the essential elements of the parent-school relationship, e.g., communication practices, active inclusion programs, support services, and peer acceptance plans. We believe it is important to emphasize that, in the study, families frequently better understood their child's situation and health-related issues and advocated more effectively for the recognition of their rights. However, as an active player in everyday education, the teacher can better organize development activities for the child's specific needs and plan complex habilitation/rehabilitation. To sum up, a parent-educator team approach can result in more successful educational and health outcomes, as well as a more accepting social image in the cognitive, emotional, and social development fields.

Subjective Well-Being among Parents of Children with Special Educational Needs in Hong Kong: Impacts of Stigmatized Identity and Discrimination under Social Unrest and COVID-19

The COVID-19 pandemic and social unrest have posed a unique set of challenges to Hong Kong. During these two social events, parents of children with special educational needs (SEN) who were already experiencing caregiving pressure, likely coped with additional stressors; they were at a higher risk of mental health problems. A pre-registered, cross-sectional survey study was carried out among 234 Hong Kong parents of children with SEN, investigating the associations of stigmatized identity, perceived discrimination, and subjective well-being under the impact of these social events. Utilizing the Bayesian modelling, we found that highly self-stigmatized parents not only perceived more daily-life discriminating behaviors against them, but also reported having higher distress, more negative emotions, and lower life satisfaction. A higher perceived impact of social events and more discrimination were also associated with lower well-being. Additionally, stigmatized identity, perceived discrimination, and perceived impact of social events demonstrated unique associations with well-being variables, indicating they were substantial stressors. The study called out for public attention to the mental health conditions among parents of children with SEN and other disadvantaged groups in society.

The Positive Impact of Joint Activities on Students Attitudes Toward Peers With Disabilities

Background: Attitudes toward peers with disabilities play a crucial role in implementing inclusive education. This study examines how students' attitudes are associated with gender; having relatives with disabilities and the frequency of contact with them; attending a class that includes students with special educational needs (SEN); and having previous contact with SEN students through joint activities. Methods and Procedures: The participants included 652 elementary school students (grades 4-6) who completed a short version of the Chedoke-McMaster Attitudes Toward Children with Handicaps (CATCH) questionnaire in Arabic. Outcomes and Results: Students in inclusive classes express more positive attitudes in comparison with students in regular classes. However, previous contact through joint activities was associated with more positive attitudes. Females were more likely to hold positive views than males. Having relatives with disabilities had no effect; however, a high frequency of contact with them was associated with more positive perspectives. Conclusions and Implications: The findings on students' attitudes indicate that joint activities between students with and without disabilities are important to promote positive attitudes. Planned opportunities to increase frequent contact, and to promote joint activities between students with and without SEN are recommended.

Eye Care for Children in Special Schools: An Audit of Provision

Introduction:

Children and young people with Special Educational Needs (SEN) are 28 times more likely to have eye problems than their typically developing peers. An ideal approach to the eye care for children attending special schools in England has been developed. Work in this area continues to evolve; therefore, an audit about existing services across the United Kingdom (UK) was undertaken.

Method:

A survey to ascertain key aspects of services for children with SEN that exist in the UK was developed and disseminated via Survey Monkey and at British and Irish Orthoptic Society (BIOS) events to all leads of the orthoptic profession.

Results:

Ninety-four service areas replied to the survey. Of these, 65 areas provide a special school service, 30 also provide a specialist service for SEN’s in hospital/community clinics; five provide only a specialist service in hospital/community clinics, and 24 reported no specialist service provision, outside that provided to everyone. In the school environment, 29 (44%) areas include vision and orthoptic assessment, whereas 31 (48%) include vision, orthoptic, and refraction assessment. All but two services were reported as orthoptic-led, 26 (40%) special school services involved optometric input within school, and no services had optical dispensing within school.

Discussion:

The results of this survey suggest that access to all aspects of eye care is not always available in school where a service exists. Families have to travel to the hospital or community optometrist for further assessment, which is not suitable in a number of cases, though it may be desirable, in some.

Should Colour Vision Deficiency Be a Recognized Special Education Need (SEN)?

A colour vision deficiency (CVD) is a condition that affects about one in 12 of the male population, and one in 200 of the females. On average, there is at least one student in every classroom affected by a reduced colour vision. In schools and in teaching, colours are used as a tool to identify, group, highlight, warn and explain. For a colour vision deficient student, the colours used to code the information may be a source of confusion instead of a tool to decode. This paper provides an overview of the possible academic and social-emotional challenges for CVD students and propose strategies and actions to raise awareness and enable colour universal design.

Genes and quantitative genetic variation involved with senescence in cells, organs, and the whole plant

Senescence, the deterioration of morphological, physiological, and reproductive functions with age that ends with the death of the organism, was widely studied in plants. Genes were identified that are linked to the deterioration of cells, organs and the whole plant. It is, however, unclear whether those genes are the source of age dependent deterioration or get activated to regulate such deterioration. Furthermore, it is also unclear whether such genes are active as a direct consequence of age or because they are specifically involved in some developmental stages. At the individual level, it is the relationship between quantitative genetic variation, and age that can be used to detect the genetic signature of senescence. Surprisingly, the latter approach was only scarcely applied to plants. This may be the consequence of the demanding requirements for such approaches and/or the fact that most research interest was directed toward plants that avoid senescence. Here, I review those aspects in turn and call for an integrative genetic theory of senescence in plants. Such conceptual development would have implications for the management of plant genetic resources and generate progress on fundamental questions raised by aging research.

A lack of vision: evidence for poor communication of visual problems and support needs in education statements/plans for children with SEN

OBJECTIVE

Visual dysfunction is more common in children with neurological impairments and previous studies have recommended such children receive visual and refractive assessment. In the UK, children with neurological impairment often have educational statementing for Special Educational Needs (SEN) and the statement should detail all health care and support needs to ensure the child's needs are met during school life.

STUDY DESIGN

This study examined the representation of visual information in statements of SEN and compared this to orthoptic visual information from school visual assessments for children in a special school in Northern Ireland, UK.

METHODS

The parents of 115 school children in a special school were informed about the study via written information. Participation involved parents permitting the researchers to access their child's SEN educational statement and orthoptic clinical records.

RESULTS

Statement information was accessed for 28 participants aged between four and 19 years; 25 contained visual information. Two participants were identified in their statements as having a certification of visual impairment. An additional 10 children had visual acuity ≥ 0.3 logMAR. This visual deficit was not reported in statements in eight out of these 12 cases (67%). 11 participants had significant refractive error and wore spectacles, but only five (45%) had this requirement recorded in their statement. Overall, 10 participants (55%) had either reduced visual acuity or significant refractive error which was not recorded in their statement.

CONCLUSIONS

Despite additional visual needs being common, and described in clinical records, the majority of those with reduced vision and/or spectacle requirements did not have this information included in their statement. If visual limitations are not recognized by educational services, the child's needs may not be met during school life. More comprehensive eye care services, embedded with stakeholder communication and links to education are necessary to improve understanding of vision for children with neurological impairments.

A phase II study of endoscopic submucosal dissection for superficial esophageal neoplasms (KDOG 0901)

BACKGROUND

Most previous studies of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms were retrospective; prospective studies are scant.

OBJECTIVE

To prospectively assess the efficacy and safety of ESD for superficial esophageal neoplasms.

DESIGN

Phase II study.

SETTING

University hospital.

PATIENTS

Fifty-two patients (median age 68 years; 48 men) who had a histologic diagnosis of superficial esophageal cancer without metastasis on CT or high-grade intraepithelial neoplasia (HGIN) were enrolled from April 2009 through November 2011.

INTERVENTION

ESD was used to treat 56 lesions. All procedures were done by 4 endoscopists who each had previously performed ESD in more than 100 patients with gastric tumors.

MAIN OUTCOME MEASUREMENTS

The primary endpoint was the R0 resection rate, and secondary endpoints were the safety and the rate of accurately diagnosing tumor depth on endoscopic examination.

RESULTS

The median treatment time was 69 minutes (24-168 minutes). The histopathologic diagnosis was squamous cell carcinoma in 49 lesions, HGIN in 5, and tubular adenocarcinoma in 2. The en bloc resection rate and R0 resection rate were 100% and 94.6%, respectively. The rates of adverse events during ESD and after ESD were 22.2% and 53.8%, respectively, but most events were mild. One patient (1.9%) had mediastinal emphysema without perforation. The rate of accurately diagnosing tumor depth on endoscopic examination was 76.8%.

LIMITATIONS

Single-center, nonrandomized study.

CONCLUSION

Our study showed that ESD was an effective and relatively safe treatment for superficial esophageal neoplasms. ESD may be a useful treatment option for superficial esophageal neoplasms in hospitals with endoscopists who are experts in performing ESD for gastric tumors. (

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000002047.).

A circuitry and biochemical basis for tuberous sclerosis symptoms: from epilepsy to neurocognitive deficits

Tuberous sclerosis complex (TSC) is an autosomal dominant monogenetic disorder that is characterized by the formation of benign tumors in several organs as well as brain malformations and neuronal defects. TSC is caused by inactivating mutations in one of two genes, TSC1 and TSC2, resulting in increased activity of the mammalian Target of Rapamycin (mTOR). Here, we explore the cytoarchitectural and functional CNS aberrations that may account for the neurological presentations of TSC, notably seizures, hydrocephalus, and cognitive and psychological impairments. In particular, recent mouse models of brain lesions are presented with an emphasis on using electroporation to allow the generation of discrete lesions resulting from loss of heterozygosity during perinatal development. Cortical lesions are thought to contribute to epileptogenesis and worsening of cognitive defects. However, it has recently been suggested that being born with a mutant allele without loss of heterozygosity and associated cortical lesions is sufficient to generate cognitive and neuropsychiatric problems. We will thus discuss the function of mTOR hyperactivity on neuronal circuit formation and the potential consequences of being born heterozygous on neuronal function and the biochemistry of synaptic plasticity, the cellular substrate of learning and memory. Ultimately, a major goal of TSC research is to identify the cellular and molecular mechanisms downstream of mTOR underlying the neurological manifestations observed in TSC patients and identify novel therapeutic targets to prevent the formation of brain lesions and restore neuronal function.