Negative Consensus Research Articles

Programmed Death Ligand-1 Combined Positive Score Concordance and Interrater Reliability in Primary Tumors and Synchronous Lymph Node Metastases in Resected Cases of p16+ Oropharyngeal Squamous Cell Carcinoma.

Pembrolizumab is used in patients with metastatic head and neck squamous cell carcinoma contingent upon the programmed death ligand-1 (PD-L1) combined positive score (CPS). To compare PD-L1 CPS scores derived from paired resected primary tumors (PTs) and lymph node metastases (LMs) in patients with p16+ oropharyngeal squamous cell carcinoma (OPSCC). We identified 38 resected p16+ OPSCCs for which paired PTs and LMs were available. PD-L1 immunohistochemistry using the SP263 antibody clone was done on both the PT and the LM. CPS scoring was performed by 4 observers, and data were analyzed at the CPS cut points of greater than or equal to 1 and 20 in regard to interobserver and interspecimen agreement. Overall agreement between consensus CPS scoring of PT and LM was seen in 76% of paired specimens (κ = 0.53). No specimen received a negative consensus score. Interobserver agreement for both PT and LM was fair to substantial (κ = 0.54 and 0.51, respectively) and was inferior to that seen in a prospective series of unselected head and neck squamous carcinoma cases evaluated at our institution (κ = 0.84). Given the high rates of interobserver and interspecimen variability, evaluation of additional material or by additional observers may be of value in performing CPS scoring in cases of p16+ OPSCC. This is particularly the case when a negative or low-positive result is being evaluated in a patient who is otherwise a good candidate for immunotherapy.

Patterns of Care for Adolescent With Schizophrenia: A Delphi-Based Consensus Study.

BackgroundThe current conceptualization of schizophrenia as neurodevelopmental disorder should lead to innovative public health policies in terms of a reorganization of the mental health care systems, particularly in the transition from adolescence to adulthood, to reduce personal, familiar, and social costs and burdens. The purpose of the project was to perform a survey among a panel of Italian schizophrenia experts, to share evidence-based information on adolescent schizophrenia and explore the degree of consensus among professionals in the following four macro-areas: early diagnosis; pharmacological treatment; health care system organization and transition process from adolescent to adulthood; and psychosocial interventions.MethodsThe consensus process consisted of a two-step web-based Delphi method, which took place between June and November 2021. The survey was developed by a panel of four psychiatrists and four child neuropsychiatrists, identified as key opinion leaders (KOLs). The KOLs identified 21 statements involving a total of 70 items with a major need of clarification on early-onset schizophrenia (EOS). The survey was distributed to 86 specialists in psychiatry and child neuropsychiatry.ResultsThe results revealed a large agreement among the expert group on all the investigated areas of adolescent schizophrenia patterns of care and management. Consensus was ultimately reached for 67 items of the Delphi survey (95.7%), while negative consensus was reached for 2 items and no consensus was reached for 1 item.ConclusionsOverall, results showed a significant gap between the acquired scientific knowledge and clinical practice. In this scenario, it should be necessary to plan specific initiatives at a multiple level, to edit recommendations on clinical decision-making, as well as to prompt changes at the political and organizational levels, also involving scientific societies, patients, and family associations, to overcome the barriers that delay the implementation process.

Osteoporotic vertebral fractures: radiologic diagnosis, clinical and radiologic factors affecting surgical decision making: WFNS spine committee recommendations.

With the varied literature on osteoporotic vertebral fracture that may predispose to diagnostic and management dilemma, it is timely to evaluate and streamline the evidence. The aim of this review is to create recommendations on osteoporotic vertebral fractures regarding radiologic diagnosis, and clinical and radiological factors affecting surgical decision making. A computerized literature search was done using PubMed, Google scholar and Cochrane Database of Systematic Reviews from 2010 to 2020. For radiologic diagnosis, the keywords "osteoporotic vertebral fractures" and "radiologic diagnosis" were used yielding 394 articles (19 relevant articles). For clinical and radiological factors affecting surgical decision making, the keywords "osteoporotic vertebral fractures," "radiologic diagnosis," and "surgery" were used yielding 568 articles (25 relevant articles). All pertinent data were reviewed, and consensus statements were obtained in two virtual separate consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine committee. The statements were voted and yielded positive or negative consensus using the Delphi method. This review summarizes the WFNS Spine Committee recommendations on the radiologic diagnosis, and clinical and radiological factors affecting surgical decision making of osteoporotic vertebral fractures.

Safinamide in the treatment pathway of Parkinson\u2019s Disease: a European Delphi Consensus

Safinamide is a highly selective, reversible MAO B-inhibitor recently marketed in European and North American countries. To better define clinical indications regarding motor and non-motor symptoms, targeted population and safety of this compound, ten movement disorders specialists, experts in their field, convened and developed a panel of statements on: the role of glutamate in Parkinson’s disease, introduction to fluctuations, efficacy of safinamide on motor symptoms, motor complications and non-motor symptoms, quality of life, safety of safinamide and target population for use. Strong consensus was reached for all the statements on the efficacy of safinamide on motor symptoms, motor fluctuations, quality of life and safety. Among non-motor symptoms, a positive consensus was reached for the symptoms sleep/fatigue, mood, and pain while there was a lack of consensus for the statements regarding the efficacy of safinamide in improving cognition, urinary and sexual functions. The statement on orthostatic hypotension obtained a negative consensus. The consistent and large agreement reached in this Delphi panel perfectly reflects the perception of efficacy, safety and tolerability of safinamide as evident from pivotal trials and clinical practice and shows how these findings may guide movement disorders specialists in their clinical therapeutic approach. The impact of non-motor symptoms in PD is considerable, and management remains an unmet need. In this context, the ability of safinamide to impact some non-motor symptoms may represent the most promising and distinctive feature of this compound and deserves further investigations.

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

BackgroundGroin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain.MethodsThirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus.ResultsHigh participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section.ConclusionExperts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making.

A construção da imagem do funcionário público brasileiro: uma análise crítico-discursiva de artigos de opinião do jornal Gazeta do Povo

The theme of this research is the discourse referring to public servants in two opin-ion articles published by Gazeta do Povo newspaper in 2017 and 2020. The general objective is investigate how the image of Brazilian civil servants is constructed, discursively, in opinion arti-cles. The specific objectives are to investigate how lexical choices, the use of metaphors and the semantic meaning of the lexicon build the image of these workers. This is a qualitative research, of an interpretive nature, which has in the selected opinion articles the direct source of the data to be interpreted. The analysis work is based on theoretical assumptions for ACD, by Van Dijk (2018), based on the socio-cognitive line, based on the discourse-cognition-society triad, elements that are in a constitutive relationship and play important role in the production and understanding of discourses. We concludeis that the lexical choices, metaphors and imagery resources that build the lo-cal and global meanings of the discourses, materialize ideologies and social practices that constitute the mental model of public servants of their, authors and the defamatory and stereotyped nature of the articles make a predominantly negative consensus regarding the public servants.

Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations.

Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.

Зовнішньополітична «самоізоляція» Російської Федерації як кремлівський наратив

The article outlines the instrumental potential of the Kremlin’s narrative of the Russian Federation’s foreign policy “self-isolation”. The definition of Russia’s foreign policy course as “self-isolationist” is contradictory and misleading. In the context of relations between countries, the concepts of “self-isolation”, “isolationism” are characterized by connotations of non-interference in international affairs, restriction of international participation to avoid involvement in dangerous and undesirable conflicts. Instead, Russia’s foreign policy is aggressive, reflecting the Kremlin’s hegemonic ambitions. Putin seeks to urge the international community to secure Russia’s status as a global actor, to recognize so-called “Russian interests”, and to legitimize the de facto balance of power. The narrative in question is intended to use the media to reposition Russia as an aggressor country with undisguised expansionist aspirations, a “victim country” of the “collective West”. With this maneuver, the Kremlin hopes to justify the need to tolerate Russia’s malicious actions in the international arena, the expediency of restoring communications and establishing a dialogue with it. The factors that determine the use of new approaches in the foreign policy of the Russian Federation and its content are being analyzed. Thus, within Russia, the messages about Russia’s foreign policy “selfisolation” allow the general public of Russians, deeply affected by the complex of national inferiority, to play the card of “external enemy”, fantasize about “global confrontation with the West”, thus consolidating Russian society and maintaining internal stability. As a result, Russia has formed a political system with the features of a regime of negative consensus. In the international arena, Russia is economically, politically, and socio-culturally uncompetitive about Western countries. The Kremlin is trying to stifle this non-competitiveness by imitating isolationism, combining it with nuclear blackmail and military aggression. A perceptive possibility is being actualized aiming at studying the Kremlin’s geopolitical game, projected at transforming the Russian Federation into a global state, in the context of the communicative strategies of framing, priming, and agending.

The Association Between Cognitive Deficits and Clinical Characteristic in First-Episode Drug Naïve Patients With Schizophrenia.

Background: Schizophrenia is a severe mental disease which characterized by positive symptom, negative symptom, general pathology syndrome and cognitive deficits. In recent years, many studies have investigated the relationship between cognitive deficits and clinical characteristics in schizophrenia, but relatively few studies have been performed on first-episode drug-naïve patients.Methods: Eighty seven first-episode drug-naïve schizophrenia patients were assessed for positive symptom, negative symptom, general pathology symptom and cognitive deficits from the Positive and Negative Symptom Scale and MATRICS Consensus Cognitive Battery. Psychotics depression were assessed using the Calgary depressing scale for schizophrenia. The relationship between clinical characteristics and cognitive deficits were assessed using correlation analysis and linear regression analysis.Results: The prevalence of cognitive deficits among the patients in our study was 85.1% (74/87) which was much higher than that in the general population. According to correlation analysis, negative symptom was negatively correlated with speed of processing and social cognition, and general pathology showed a negative correlation with attention/vigilance. In addition, a positive correlation was found between age and speed of processing. No correlation was found between cognitive deficits and positive symptom.Conclusions: This study confirmed that negative symptom is negatively related with some domains of cognitive function in first-episode drug naïve schizophrenia patients.Trail Registration: NCT03451734. Registered March 2, 2018 (retrospectively registered).

Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations.

Epidemiology, prevention, early management of cervical spine trauma and it's reduction are the objectives of this review paper. A PubMed and MEDLINE search between 2009 and 2019 were conducted using keywords. Case reports, experimental studies, papers other than English language and and unrelated studies were excluded. Up-to-date information on epidemiology of spine trauma, prevention, early emergency management, transportation, and closed reduction were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Global incidence of traumatic spinal injury is higher in low- and middle-income countries. The most frequent reasons are road traffic accidents and falls. The incidence from low falls in the elderly are increasing in high-income countries due to ageing populations. Prevention needs legislative, engineering, educational, and social efforts that need common efforts of all society. Emergency care of the trauma patient, transportation, and in-hospital acute management should be planned by implementing detailed protocols to prevent further damage to the spinal cord. This review summarizes the WFNS Spine Committee recommendations on epidemiology, prevention, and early management of cervical spine injuries.

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations.

To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.

Computational evaluation of endocrine activity of biocidal active substances

Exposure to endocrine disrupting chemicals is an important public health concern although only a few endocrine disruption chemicals have been identified so far. To speed up their identification, in silico toxicological models appear to be the most appropriate, since the potential endocrine disruption of a large number of compounds can be estimated in a short time. In this study three in silico models (Endocrine disruptome software, VirtualToxLab and COSMOS KNIME) have been used. In silico predictions of the endocrine disruption potential of biocidal active substances have been made and predictions then compared with the available in vitro experimental binding affinities to androgen, estrogen, glucocorticoid and thyroid receptors. The chosen models had similar accuracies (around 60%), while differences were shown between the models in specificity and sensitivity. VirtualToxLab was the most balanced model. Additionally, three combined models were prepared and evaluated. As expected, the majority rule approach model was more accurate and balanced. However, the positive consensus rule model, that improved the specificity of predictions (≥80% for all studied nuclear receptors) was more applicable. This reduction of false positive predictions is especially useful in the search for positive (active) compounds. On the other hand, the novel negative consensus rule model improved the specificity of prediction (≥80% for all studied nuclear receptors), giving good predictions of negative (inactive) compounds that can be excluded from further testing. The results obtained by these combined models have great added value, since they can significantly reduce further experimental testing.

Insulin Resistance and Oxidative Stress: In Relation to Cognitive Function and Psychopathology in Drug-Naïve, First-Episode Drug-Free Schizophrenia.

Objective: The present study aimed to examine whether insulin resistance and oxidative stress are associated with cognitive impairment in first-episode drug-free schizophrenia (SZ) patients.Methods: Ninety first-episode SZ patients and 70 healthy controls were enrolled. Fasting insulin (FINS) and markers of oxidative stress [oxidized glutathione (GSSG), superoxide dismutase (SOD), nitric oxide (NO) and uric acid (UA) levels] were measured in serum before pharmacological treatment was initiated. Psychiatric symptoms and cognitive function were assessed with the Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB), respectively. In addition, the homeostatic model assessment of insulin resistance (HOMA-IR) was also studied.Results: HOMA-IR and serum levels of GSSG and NO were significantly higher in SZ patients than in healthy controls (P < 0.001), while the serum levels of SOD were significantly lower than in healthy controls (P < 0.001). HOMA-IR, GSSG and NO levels were significantly correlated to the total cognitive function scores of the patient group (r = −0.345,−0.369,−0.444, respectively, P < 0.05). But these factors were not co-related to the cognitive functions in the healthy control group. And, levels of SOD, UA were not associated with the total cognitive function scores in both the patient and the healthy control groups. NO was positively correlated with general pathological and the total score in the PANSS, and was negatively correlated with six cognitive domains (r = −0.316 to −0.553, P < 0.05).Conclusions: The levels of insulin resistance and oxidative stress are elevated, and correlated with the severity of cognitive impairment in drug-naïve, first-episode SZ patients. Treatment approaches targeting on reducing insulin resistance and oxidative stress may improve cognitive function in SZ patients.

To AB or Not to AB? Dispute Settlement in WTO Reform

ABSTRACT Recent debates on the operation of the World Trade Organization’s dispute resolution mechanism have focused primarily on the appellate body. We argue that this neglects the first-order issue confronting the rules-based trading system: sustaining the principle of depoliticized conflict resolution that is reflected in the negative consensus rule for the adoption of dispute settlement findings. Improving the quality of the work of panels by appointing a roster of full-time professional adjudicators, complemented by reforms to World Trade Organization working practices that reduce incentives to resort to formal dispute settlement, can resolve the main issues that led to the appellate body crisis. Effective, coherent, and consistent World Trade Organization dispute resolution need not include an appellate body. An appropriately redesigned single-stage process can serve just as well, if not better.

Classification and Nomenclature: Progressive Collapsing Foot Deformity.

The historical nomenclature for the adult acquired flatfoot deformity (AAFD) is confusing, at times called posterior tibial tendon dysfunction (PTTD), the adult flexible flatfoot deformity, posterior tibial tendon rupture, peritalar instability and peritalar subluxation (PTS), and progressive talipes equinovalgus. Many but not all of these deformities are associated with a rupture of the posterior tibial tendon (PTT), and some of these are associated with deformities either primarily or secondarily in the midfoot or ankle. There is similar inconsistency with the use of classification schemata for these deformities, and from the first introduced by Johnson and Strom (1989), and then modified by Myerson (1997), there have been many attempts to provide a more comprehensive classification system. However, although these newer more complete classification systems have addressed some of the anatomic variations of deformities encountered, none of the above have ever been validated. The proposed system better incorporates the most recent data and understanding of the condition and better allows for standardization of reporting. In light of this information, the consensus group proposes the adoption of the nomenclature "Progressive Collapsing Foot Deformity" (PCFD) and a new classification system aiming at summarizing recent data published on the subject and to standardize data reporting regarding this complex 3-dimensional deformity. Level V, consensus, expert opinion. CONSENSUS STATEMENT ONE: We will rename the condition to Progressive Collapsing Foot Deformity (PCFD), a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus.Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%.(Unanimous, strongest consensus)CONSENSUS STATEMENT TWO: Our current classification systems are incomplete or outdated.Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%.(Unanimous, strongest consensus)CONSENSUS STATEMENT THREE: MRI findings should be part of a new classification system.Delegate vote: agree, 33% (3/9); disagree, 67% (6/9); abstain, 0%.(Weak negative consensus)CONSENSUS STATEMENT FOUR: Weightbearing CT (WBCT) findings should be part of a new classification system.Delegate vote: agree, 56% (5/9); disagree, 44% (4/9); abstain, 0%.(Weak consensus)CONSENSUS STATEMENT FIVE: A new classification system is proposed and should be used to stage the deformity clinically and to define treatment.Delegate vote: agree, 89% (8/9); abstain, 11% (1/9).(Strong consensus).

A cross-sectional survey of attitudes towards education in implant dentistry in the undergraduate dental curriculum

BackgroundAn ongoing debate in dental education is whether implant dentistry, as a multidisciplinary domain, should be integrated into the undergraduate curriculum. The aim of the present study was to evaluate the perspectives of novices, clinical educators, and experienced dentists with regard to the importance of theoretical and practical implant dentistry teaching content in undergraduate dental education. The specific objective was to determine whether a consensus could be found concerning aspects of theoretical knowledge, implant position planning, implantation, prosthetic treatment procedures, postoperative care, and prerequisite experiences that should be provided in undergraduate dental education.ResultsA positive consensus existed in terms of theoretical education, assistance in surgical and prosthodontic procedures, implant planning and restoration in straightforward cases (i.e., posterior single crowns and bridges, overdentures on nonconnected implants), and postoperative care. A negative consensus existed for bone augmentation. Implantation was supported by novices (i.e., students and graduates). In addition, more experienced dentists were more likely to oppose implantation performed by undergraduates. The most preferred implantation method was implant insertion using a digitally fabricated drilling template, after surgical flap elevation.ConclusionsStudents and graduates preferred a comprehensive undergraduate education that included implant dentistry. Dentists working in private practice, and especially dentists working as university educators, were critical towards the integration of implant-related learning content into undergraduate education. The intention of medical education is to impart knowledge to students and to prepare them for life-long learning and continual professional development after graduation. Thus, an undergraduate dental curriculum that provides students a solid introduction and knowledge foundation in implant dentistry is recommended.

Distributed Artificial Neural Networks-Based Adaptive Strictly Negative Imaginary Formation Controllers for Unmanned Aerial Vehicles in Time-Varying Environments

Formation control techniques have been widely implemented in networked multirobot systems. In this article, we present a novel framework for swarm multiagent systems based on the relative-position output feedback consensus supported with the new concept of adaptive strictly negative imaginary consensus controllers, leveraging the learning capability of artificial neural networks. For experimental validation, we consider the case of two quadcopters moving together while carrying a dynamic load. We employ Kharitonov's theorem to study the stability of the proposed adaptive control systems. Finally, a rigorous real-time experimental study is conducted to highlight the merits of the proposed formation control algorithms.

Negative online reviews and consumers’ service consumption

The growing reliance on the Internet as an information source for services raises the need for more research focusing on electronic word of mouth (eWOM). Drawing on construal level theory and the sunk costs fallacy, we examine how psychological distance and prior investments in information search influence service consumers’ reactions to negative eWOM. We find that when consumers perceive the service consumption to be psychologically proximal, temporal investments in information search diminish the impact of negative eWOM on behavioral intentions. This effect is so robust that even a highly negative forum consensus does not mitigate it. Conversely, when the consumption experience is perceived as distal, temporal investments fail to buffer the impact of negative eWOM, and a forum consensus magnifies the impact. Our findings have important implications for service firms, as service consumers may make many of their evaluations and decisions under the influence of psychological distance and sunk costs.

Lumbar Spinal Stenosis: Introduction to the World Federation of Neurosurgical Societies (WFNS) Spine Committee Recommendations

IntroductionLumbar spinal stenosis (LSS) is a common degenerative disease that every spine surgeon will come across in daily practice. Despite this, the natural history and treatment have not been well established and standardized as yet, and there have been few guidelines published on this topic to date. The aim of the World Federation of Neurosurgical Society Spine Committee Consensus Conference is to define evidence-based and expert-based recommendations for the diagnosis and treatment of LSS, considering the different possibilities and facilities in countries worldwide.MethodsAn international committee of spinal surgeons reunited to perform the Consensus Conference on the topic of LSS. The Delphi method was applied to administer a questionnaire and obtain a consensus on various topics. A multidisciplinary committee defined 6 panels: 1) natural course and diagnosis of LSS; 2) conservative treatment and follow-up; 3) percutaneous techniques; 4) decompressive surgery; 5) fusion surgery; 6) mobility preserving surgery. The statements and the literature review were presented and voted.ResultsA total of 44 statements were stated and then voted by 16 experienced spine surgeons to obtain the final results. A total of 36 statements reached a consensus, of which 34 reached a positive consensus and 2 a negative consensus, whereas no consensus was reached in 8 cases.ConclusionsIn the absence of evidence-based medicine, these recommendations offer support for all practitioners, independent from economic resources and personal experience. Obviously, further studies are needed and will be well accepted to support or modify these recommendations.

Maintenance Repetitive Transcranial Magnetic Stimulation (rTMS) Weakly Improved Treatment Effect in Patients with Treatment-Resistant Schizophrenia Who Responded to maintenance ECT and Adjunct Olanzapine Treatment - A Pilot Study

Objectives: Maintenance treatment with electroconvulsive therapy (ECT) and adjunct antipsychotics can alleviate symptoms of treatment-resistant schizophrenia (TRS), although cognitive impairment is a side effect. Transcranial magnetic stimulation (TMS) has alleviated symptoms and improved cognitive impairment caused by maintenance ECT treatment. This study aimed to investigate long-term treatment effects of maintenance repetitive TMS combined with maintenance ECT and adjunct antipsychotics (MTEO) on TRS patients. Methods: Eighty TRS patients underwent MTEO or sham-MTEO treatments for 24 months. Severity of illness and patient cognition were evaluated with Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB), respectively. Global functional connectivity density (gFCD) was used to assess alterations in brain activity. Results: Compared to the sham-MTEO group, the MTEO group exhibited an increase in mean MCCB total score [140.8 ± 17.5 vs. 165.5 ± 10.2, respectively; P < 0.05]. Compared to baseline, reductions in PANSS scores were significant in both groups. Also compared to baseline, a marked increase in gFCD was only observed in the left prefontal lobe, parietal lobe, and insular lobe in the MTEO group (FWE correct, P < 0.01). The sham-MTEO group exhibited an increase in gFCD in the temporal lobe and anterior cingulated cortex at baseline. In the striatum, gFCD decreased in both groups. Conclusions: This novel MTEO treatment for TRS patients improved cognitive ability based on PANSS and MCCB scores, and this improvement may be related to increased brain activity in the prefontal, parietal, and insular lobes. Thus, further study of this treatment approach is warranted.