Treatment strategy for multisegmental cervicomedullary ependymoma: illustrative case.

BACKGROUND: Сervicomedullary ependymoma (CME) is a rare tumor of the central nervous system. The CME treatment strategy is insufficiently represented in the literature and is a complex task for neurosurgeons. OBSERVATIONS: The authors describe an infrequent case of a large multisegmental CME that extended from the medulla oblongata to the cervical spinal cord at the level of the sixth cervical vertebra in a 21-year-old female. Neurological disorders presented with headache, dysphagia, hypophonia, and weakness in the limbs. Subtotal removal of the tumor was performed according to intraoperative neurophysiological monitoring (IONM) results. A wait-and-see approach with patient follow-up was chosen. LESSONS: Total tumor removal of the CME is the most important favorable prognostic factor. Subtotal resection can be considered if the borders of the tumor are unclear and the result of IONM is unfavorable. The role of postoperative radiation therapy in the case of subtotal removal of the tumor remains controversial.

Treatment of Cognitive Impairment and the Role of Demographic Factors in Disease Progression: The Final Results of the Russian Observational Program "DIAMANT".

BACKGROUND: Chronic cerebral ischemia (CCI) is a form of cerebrovascular disease manifested as a vascular cognitive impairment (VCI). The management of the patients with CCI is determined by a healthy lifestyle and early therapy aimed at correcting and preventing this disease. Divaza is a drug with endothelial protective and nootropic effects. We present the final efficacy and safety analysis of all-Russian, open-label, prospective, observational, multicenter study of Divaza and emphasize the role of demographic and socioeconomic factors in cognitive disorder (CD) progression. METHODS: CCI patients (n = 2,583) with or without CD were enrolled. Patients received Divaza (2 tablets 3 times per day for 12 weeks). Montreal Cognitive Assessment (MoCA) testing was required. The change in the mean MoCA score post-treatment was used as the primary endpoint. As the secondary endpoints, the number of patients with a MoCA <26 and ≤17 (dementia); the percentage of patients with a MoCA score improvement in different age groups; the dynamics of mean MoCA score in age groups; and the relationship between CD and sex or regional social/economic factors were assessed. RESULTS: Divaza therapy led to a significant improvement: the mean MoCA score was up to 20% higher post-treatment (Wilcoxon test, p < 0.0001 vs. baseline). The number of participants with MoCA ≥26 increased by 33.6%. The number of patients with dementia was 4.1 times less after therapy (p < 0.00001 vs. baseline). Divaza improved cognitive functions of patients in each age group. Findings demonstrate that regional socioeconomic factors contribute to CD development and severity. The observed divergence between sexes was a result of a larger number of women enrolled. The study confirmed the safety of Divaza. CONCLUSIONS: In the study, we observed the efficacy of Divaza for the treatment of CD: a therapy contributed to an increase in the mean MoCA score and the positive dynamics in the number of patients with cognitive improvement.

Vertical Profiles of Droplet Size Distributions Derived from Cloud-Side Observations by the Research Scanning Polarimeter: Tests on Simulated Data.

The Research Scanning Polarimeter (RSP) is an airborne along-track scanner measuring the polarized and total reflectances with high angular resolution. It allows for accurate characterization of liquid water cloud droplet sizes using the rainbow structure in the polarized reflectance. RSP's observations also provide constraints on the cumulus cloud's 2D cross section, yielding estimates of its geometric shape. In this study for the first time we evaluate the possibility to retrieve vertical profiles of microphysical characteristics along the cloud side by combining these micro- and macrophysical retrieval methods. First we constrain cloud's geometric shape, then for each point on the bright side of its surface we collect data from different scans to obtain the multi-angle polarized reflectance at that point. The rainbow structures of the reflectances from multiple points yield the corresponding droplet size distributions (DSDs), which are then combined into vertical profiles. We present the results of testing the proposed profiling algorithm on simulated data obtained using large eddy simulations and 3D radiative transfer computations. The virtual RSP measurements were used for retrieval of DSD profiles, which then were compared to the actual data from the LES-model output. A cumulus congestus cloud was selected for these tests in preparation for analysis of real measurements made during the Cloud, Aerosol and Monsoon Processes Philippines Experiment (CAMP2Ex). We demonstrate that the use of the non-parametric Rainbow Fourier Transform (RFT) allows for adequate retrieval of the complex altitude-dependent bimodal structure of cloud DSDs.

Remote Sensing of Droplet Number Concentration in Warm Clouds: A Review of the Current State of Knowledge and Perspectives.

The cloud droplet number concentration (N d) is of central interest to improve the understanding of cloud physics and for quantifying the effective radiative forcing by aerosol-cloud interactions. Current standard satellite retrievals do not operationally provide N d, but it can be inferred from retrievals of cloud optical depth (τ c) cloud droplet effective radius (r e) and cloud top temperature. This review summarizes issues with this approach and quantifies uncertainties. A total relative uncertainty of 78% is inferred for pixel-level retrievals for relatively homogeneous, optically thick and unobscured stratiform clouds with favorable viewing geometry. The uncertainty is even greater if these conditions are not met. For averages over 1° ×1° regions the uncertainty is reduced to 54% assuming random errors for instrument uncertainties. In contrast, the few evaluation studies against reference in situ observations suggest much better accuracy with little variability in the bias. More such studies are required for a better error characterization. N d uncertainty is dominated by errors in r e, and therefore, improvements in r e retrievals would greatly improve the quality of the N d retrievals. Recommendations are made for how this might be achieved. Some existing N d data sets are compared and discussed, and best practices for the use of N d data from current passive instruments (e.g., filtering criteria) are recommended. Emerging alternative N d estimates are also considered. First, new ideas to use additional information from existing and upcoming spaceborne instruments are discussed, and second, approaches using high-quality ground-based observations are examined.

Information content of bistatic lidar observations of aerosols from space.

We present, for the first time, a quantitative retrieval error-propagation study for a bistatic high spectral resolution lidar (HSRL) system intended for detailed quasi-global monitoring of aerosol properties from space. Our results demonstrate that supplementing a conventional monostatic HSRL with an additional receiver flown in formation at a scattering angle close to 165° dramatically increases the information content of the measurements and allows for a sufficiently accurate characterization of tropospheric aerosols. We conclude that a bistatic HSRL system would far exceed the capabilities of currently flown or planned orbital instruments in monitoring global aerosol effects on the environment and on the Earth's climate. We also demonstrate how the commonly used a priori "regularization" methodology can artificially reduce the propagated uncertainties and can thereby be misleading as to the real retrieval capabilities of a measurement system.

New Statistical Model for Variability of Aerosol Optical Thickness: Theory and Application to MODIS Data over Ocean.

A novel model for the variability in aerosol optical thickness (AOT) is presented. This model is based on the consideration of AOT fields as realizations of a stochastic process, that is the exponent of an underlying Gaussian process with a specific autocorrelation function. In this approach AOT fields have lognormal PDFs and structure functions having the correct asymptotic behavior at large scales. The latter is an advantage compared with fractal (scale-invariant) approaches. The simple analytical form of the structure function in the proposed model facilitates its use for the parameterization of AOT statistics derived from remote sensing data. The new approach is illustrated using a year-long global MODIS AOT dataset (over ocean) with 10 km resolution. It was used to compute AOT statistics for sample cells forming a grid with 5° spacing. The observed shapes of the structure functions indicated that in a large number of cases the AOT variability is split into two regimes that exhibit different patterns of behavior: small-scale stationary processes and trends reflecting variations at larger scales. The small-scale patterns are suggested to be generated by local aerosols within the marine boundary layer, while the large-scale trends are indicative of elevated aerosols transported from remote continental sources. This assumption is evaluated by comparison of the geographical distributions of these patterns derived from MODIS data with those obtained from the GISS GCM. This study shows considerable potential to enhance comparisons between remote sensing datasets and climate models beyond regional mean AOTs.

Analysis of fine-mode aerosol retrieval capabilities by different passive remote sensing instrument designs.

Remote sensing of aerosol optical properties is difficult, but multi-angle, multi-spectral, polarimetric instruments have the potential to retrieve sufficient information about aerosols that they can be used to improve global climate models. However, the complexity of these instruments means that it is difficult to intuitively understand the relationship between instrument design and retrieval success. We apply a Bayesian statistical technique that relates instrument characteristics to the information contained in an observation. Using realistic simulations of fine size mode dominated spherical aerosols, we investigate three instrument designs. Two of these represent instruments currently in orbit: the Multiangle Imaging SpectroRadiometer (MISR) and the POLarization and Directionality of the Earths Reflectances (POLDER). The third is the Aerosol Polarimetry Sensor (APS), which failed to reach orbit during recent launch, but represents a viable design for future instruments. The results show fundamental differences between the three, and offer suggestions for future instrument design and the optimal retrieval strategy for current instruments. Generally, our results agree with previous validation efforts of POLDER and airborne prototypes of APS, but show that the MISR aerosol optical thickness uncertainty characterization is possibly underestimated.

Non-invasive alternating current stimulation induces recovery from stroke.

BACKGROUND: Recovery of post-stroke deficits can be achieved by modulating neuroplasticity with non-invasive brain stimulation. To evaluate potential effects of repetitive transorbital alternating current stimulation (rtACS) on stroke recovery we carried out a randomized, drug-controlled clinical trial. METHODS: Ninety-eight patients that had suffered ischemic stroke 21.4 months earlier were randomly assigned to either group D (n=30) receiving conventional drug therapy, group ACS (n=32) treated for 12 days with rtACS, or group D/ACS (n=36) receiving combined drug therapy/rtACS. Stroke severity level (SSL) was assessed by the NIH-NINDS stroke scale before and after treatment and at a 1-month follow-up to evaluate motor impairments (weakness, ataxia), sensory loss, visual field defects, and cortical deficits (aphasia, neglect). At each time point standard EEG recordings (10-20 system) were conducted. RESULTS: Before therapy SSL was moderate (9.18 ± 0.78) without significant group difference (F =0.86, p=0.43). After 12 days of treatment, SSLs of groups ACS and D/ACS significantly improved by 22.5% and 25.1% over baseline, respectively, with no such change in the control group D (+3%). SSL improvements were mainly due to recovery of motor, sensory, and speech functions. After 1-month follow-up, an additional improvement of 9.7% and 9.4% was seen for the group ACS and D/ACS which led to a total change of +32.3% and +34.7% over baseline. EEG recordings revealed greater interhemispheric synchrony between both temporal lobes which were positively correlated with clinical outcome. CONCLUSIONS: Non-invasive rtACS applied to post-stroke patients can modulate brain plasticity and induce recovery from neurological deficits long after the early post lesion recovery is over.

Optical depth measurements by shadow-band radiometers and their uncertainties.

Shadow-band radiometers in general, and especially the Multi-Filter Rotating Shadow-band Radiometer (MFRSR), are widely used for atmospheric optical depth measurements. The major programs running MFRSR networks in the United States include the Department of Energy Atmospheric Radiation Measurement (ARM) Program, U.S. Department of Agriculture UV-B Monitoring and Research Program, National Oceanic and Atmospheric Administration Surface Radiation (SURFRAD) Network, and NASA Solar Irradiance Research Network (SIRN). We discuss a number of technical issues specific to shadow-band radiometers and their impact on the optical depth measurements. These problems include instrument tilt and misalignment, as well as some data processing artifacts. Techniques for data evaluation and automatic detection of some of these problems are described.