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Hello from the Glance College Neuroscience Society, which is a society for young neuroscientists and students who have an interest in neurosurgery, neurology, and clinical neurosciences
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in association with SNI, Surgical Neurology International.
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An information resource, which is an internet journal with Nancy Epstein as its editor-in-chief and SNI Digital, a new information resource with editorially selected neurosurgery and medical
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information on a multimedia platform with operative videos, expert interviews, podcasts, and global interactive discussions of information. James Osmond is its editor-in-chief.
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Together,
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the Glasgow Neuro Society and SNI and SNI Digital are pleased to present selected papers from the Glasgow Neuro Society Conference in 20252026
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with panel discussions, abstracts, and audience reactions
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This conference and these programs were organized for the Glasgow Neuro Society by Reza Tamid, who's the president of the Glasgow Neuro Society, and is at the University of Glasgow in the School of
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Medicine, and he can be reached at the web address below and the
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phone number
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The guest discussions include Professor Matthew Walters, who's the head of the School of Medicine, Dentistry and Veterinary Medicine and a Consultant, Stroke Physician and Professor of Clinical
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Pharmacology at the University of Glasgow.
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Also, Dr. Zia
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Wang, who is a Consultant Neurologist at the Institute of Neurological Sciences in Queen Elizabeth University in Glasgow.
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Mr. Kalin Matheson, who's a consultant or a surgeon and spine surgeon at the same institution, Institute of Neurologic Sciences at Queen Elizabeth University Hospital in Glasgow. All will be you
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provide comments on the presented papers.
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Good evening, everyone, and thank you very much for joining us today. I'm Reza, and on behalf of Glasgow Neuro, it's a pleasure to welcome you all to this author panel discussion, held as part
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of our annual Glasgow Neuro conference. The aim of tonight's session is simple, to go beyond the standard abstract presentation. Each presenter will briefly share their work, and will open the
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discussion around its clinical relevance, strengths, limitation, and possible feature direction We're very pleased to be running this session in collaboration with Surgical Neurology International
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Digital, or SNI Digital. SNI Digital is a peer-reviewed, global video-based platform for neurosurgery and neuroscience, built around discussions and the exchange of ideas. We're very grateful to
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the SNI Digital team for supporting this session, and especially to Professor James Osman, Professor Nancy Epstein, I'm Mr. James Cook
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I want
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to briefly thank this year's Glasgow Neuro Committee. A lot of work has gone on behind the scenes to organize this conference, coordinate presenters, and make sessions like this possible. So thank
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you to everyone involved. We're very fortunate today to be joined. The first paper presented at
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the Glasgow Neuro Society Conference is entitled, The Eligibility for Tola Brutinib in Progressive Multiple Sclerosis, Patients in the NHS, it's a National Health Service, Landarckshire Hospital.
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Tola Nute Brutinib
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is an investigational drug aimed at treating non-relapsing, secondarily progressive, Multiple Sclerosis by inhibiting Brutinib tyrosine carakirines.
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which helps reduce inflammation in the brain and spinal cord. Very significant study.
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It's presented by Mary-Am Alamere, who's at the Medical School of the School of Medicine and Veterinary Medicine in Glasgow, the University in Glasgow, UK.
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The key parts of the abstract are as follows. This is a study of a database comprising over 1, 000 MS patients within the NHS Leonardshire Hospital, and with that was done. The patients all had
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progressive MS and were identified and assessed for eligibility based on clinical trial criteria
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The conclusion from the study is that the audit highlights a significant patient population
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at the NHS, Leonardshire, who may benefit for telebrutinib, as demonstrated by the marked impact of age restriction on the rates of eligibility to treatment. And additionally, the study explored
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the mechanisms underlying disability progression in MS and out.
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So the Brutein M may counteract them by modulating B cell in an eight immune pathways within the CNS. Very significant of this study. Some of the audience reactions is that it's very useful. It's a
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useful audit, the age cutoff, impact was something I hadn't fully appreciated in the design until now. We're gonna go back and look at our own data with this in mind
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Again, the progressive multiple sclerosis patient group with inactive diseases or cohort that gets forgotten about in the outpatient setting.
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And it's helpful to see that the numbers laid out so clearly for the west of Scotland and that this may be a promising treatment.
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It's worth liking this kind of real word eligibility data for the Scottish Medicine's consortium. when TOLO, TOLO Brutanib, comes up for review.
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So our first presentation is the eligibility for TOLO Brutanib in progressive, multiple sclerosis patients in NHS, Lanarkshire. Well, Mariam, whenever you're ready, please go ahead. Thank you.
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Hey, hello everyone. My name is Mariam Aftantas, as part of an
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SSC Was basically a study just to look for how many patients would be eligible for polyprutinib, which is a new therapy that's anticipated to become available for secondary progressive, multiple
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sclerosis patients. So just for a bit of a background, progressive, secondary progressive, multiple sclerosis doesn't have any treatments that are
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like available for it, to reduce the rate of. progression. Ochre Lezumov has recently become available for primary progressive amass, leaving a gap in the treatment of secondary progressive amass.
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Toilet Brutinip is a Bruton tyrosine kinase inhibitor, which has been found to reduce the disability that is caused by secondary progressive amass that's independent from relapse activity, which is
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the biggest treatment, which is the biggest gap in the treatment of secondary progressive amass. The
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biggest study
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for toilet Brutinip has been Hercules, tested toilet Brutinip in a population of patients and one of the criteria was the patients being in the 18 to 68 age group.
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One of the problems with this is that the majority of patients with psychiatry because of multiple sclerosis are on the other side because it's typically as diagnosed after relapsing dramatic multiple
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sclerosis which may cause a problem if truly Britain was to become available for a second to progress of multiple sclerosis. This study was based in NHS Lanucher and one of like basically found that
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if the 18 to 60 age limit was applied
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there would be a significant decrease in the number of patients who are eligible for this treatment.
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The study looked at the age distribution and the eligible secondary progress of multiple sclerosis group. About 14 of them, sorry 48 about
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27 were over the age of 60. So almost half the patient would be not eligible for toilet brewton if this age limit was applied.
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One of the things the study also looked at as if the age limit was to increase 65, to
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more patients would be eligible because the majority of patients who are above the age of 60 are below the age of
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65. And I think that looking at patient demographics is very important when making guidelines. And I'm not sure how long till the brew center will take to become available in the United Kingdom.
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But yeah, I'm
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anticipating an older
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age limit older age limits for age limits. effect was to become approved
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Okay
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Okay,
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okay, I think that's me. I'm happy to take any questions. Okay, and thank you. So, so Marion, so what's the clinical implications of this study then?
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I think the clinical implications would be if studies were made to that remind the age demographics for multiple sclerosis and the United Kingdom The upper age limit would reflect that in the
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guidelines. If the age limit was set to be, the upper age limit was set to be 60. The majority of patients of secondary progressive MS wouldn't be eligible for it. However, a larger scale studies
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were performed to that remind the patient that demographics like the age demographics for a secondary progressive multiple sclerosis This might push the
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upper age limit to 65 or. maybe older depending on
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what the study showed. Okay, okay, thank you.
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So, apart from the age limit, is there any other clinical criteria from and so for the eligibility for this drug? Yeah, so there are many criteria, like one of them as a liver disease because
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toilet brew center has been found to cause some problems with the liver, but I think one of the main things is the extended stability skills code. So patients, basically they have to be able to
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walk with the use of one walking aid and if their mobility was worse than that, they wouldn't be eligible for toilet brew center Um, so I think that this would be, um, like the most clinically
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relevant criterion for toilet brew cleanup because if a patient was 65, otherwise like not with many other comorbidities and if they were able to walk or mobilize with the aid of one walking stick or
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without using any walking aids, they would still be considered
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a great candidate for toilet brew cleanup So yeah, there are many other
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criteria and they're all listed in the Hercules study. Okay,
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thank you. So if that's the case, you know, there is a clear sort of a baseline function and mobility is a sort of an important eligible criteria. And if that's the case, have you looked at that
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together with the age? Yeah, yeah, yeah, yeah. study, I calculated the number of eligible patients,
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and, like, for a total of root in a using all the criteria except age, and then I applied the age limitation and looked at how that changed the the level of patients that would be eligible for a
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total of root in a and there would be a 48 48 decrease as the number of patients if we take the age criterion into account while applying all the other criteria. Okay, great, thank you, and very
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good, so what what do you think about the limitation of your study is? I think the middle limitation is the small patient group. The original database that I used had like 1, 000 patients over 1,
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000 patients. patients. However, secondary progressive multiple sclerosis is not as common as other types, mainly relapsing, remitting. So, my patients, my study looked at 155 patients with
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secondary progressive multiple sclerosis, which is a very small patient population to
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do. Does this make sense?
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Yeah. Okay. So, is that the total secondary progressive MS population within the the thousand MS that a patient in line extra is that the
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total MS population in line extra? Well, I think I'm sorry, can you repeat the So the 1000 patient is that the total number of the MS patient in line lecture and from that you had all the, you
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managed to get all patient's data from the, who has a diagnosis of secondary progressive MS, okay, great. Thank you.
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Well done. Thanks very much
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Could I ask, what are the cost implications for extending the,
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the age, top of each bracket and how expensive is this drug and is there any studies or do you know of any information regarding, does it reduce hospitalization, for example, in that age group and
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then a supplemental creation of, does it any side effects that are more likely to occur in the elderly population compared to the younger group? Yeah, in terms of cost. The first thing that comes
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to mind is the cost of the drug itself. I assume because it's a new drug, it would be expensive. So if we drastically increase the number of patients who would be eligible for the drug, that would
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be more expensive. However, the main cause of disability in patients with secondary progressive multiple sclerosis is the disability that they acquire. That is independent from the relapses And
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this would reduce, for example, falls. This would reduce so many other health implications for these patients. So it would reduce admissions to hospitals. However, I imagine that it would be
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more costly to prescribe this medication for a larger number of patients The second part of the question was regarding the
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health side effect. and the older age groups. The main side effects that are associated to totally Britain of our flu-like symptoms and increased susceptibility to certain infections.
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Like for example, the flu or the common cold.
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I would imagine that older patients would be more a stress of things like these. And I presume that it would be a matter of balancing risks of benefits and benefits like risks of telebrotinib versus
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the benefits of reducing the progression of disability. The other main thing is liver disease. It's the most severe side effect of telebrotinib. However, one of the criteria for patients to be
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eligible for a telebrotinib is for them to have adequate liver function. So I assume maybe looking at the other criteria on selecting patients. According to the other criteria, regardless of their
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age, would limit their susceptibility to certain side effects.
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But they would possibly be more at risk of simple infections.
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Thank you. Thank you. If no other questions, thank you, Maureen. I really enjoyed your presentation. Thank you so much. Thank you so much everyone, thank you Thank you. Second paper, it's a
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paper on microglia and astrocyte response and Parkinson's disease. By Florence Doe, Craig, Terrace, Anamalic are affiliated with the Inbaromedical School and the Imperial College of London in
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Edinburgh and London.
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The key parts of this abstract in paper on microglia and astrocyte response in Parkinson's disease are that Parkinson's disease, PD, is a common neurodegenerative disease. Many patients progress to
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develop Parkinson's disease dementia,
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PDD. However, the mechanism behind this is unclear No, there's no available intervention to all this disease.
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Higher levels of cortical beta-amyloid plaques and alpha-synuclein and their colocalization in Parkinson's disease dementia, PDD, may enhance the triggering of microglia and nitrous astrocytes,
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which are involved in clearing this pathology, very significant So, you are standing using.
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material from patients, immunofluorescence staining was performed on the middle temporal gyrus from 10 Parkinson's disease in a bench of patients and 10 patients with just Parkinson's disease on
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postmortem brains. The densities of the
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microglia and astrocytes were quantified and the results showed that microglia second significantly accumulated around the beta analyte plaques, particularly in Parkinson's disease dementia, very
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significant finding that this would be an inflammatory disease. Some of the audience reactions, looking forward to seeing where this goes when the cohort expands. The spatial analysis approaches
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are right when to take with this kind of question, very impressive presentation and topic
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So, our next presentation. will be microglia and astrocellular cells in Parkinson's disease. Florence, you can take the floor. Thank you. Good evening, I'm Florence and I'm very thankful for
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the opportunity to present my project on microglia and astrocell response in Parkinson's disease. So Parkinson's is one of the most common neurodegenerative diseases. It is commonly known for its
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motor symptoms like bradykinesia and rigidity However, about 50 of patients would actually develop dementia, which is also known as Parkinson's disease dementia, or PDD. Unfortunately, there is
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no intervention to halt or predict the progression at the moment. So we are interested to investigate why only some of the patients would develop dementia when the others do not. Two pathologies
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accumulate more prominently in PDD brains compared to PD without dementia development, namely beta-umblet plaques and alpha-synuclein aggregates.
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When these two pathologies coexist in the same brain region, patients are more likely to develop dementia. So the question really is, why does copathology drive worse outcomes? Our hypothesis is
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that glial cells are the key. In other neurological conditions, our facility can be transferred to and activate both microglia and astrocytes, which would then in turn release cytokines and
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contribute to neurodegeneration When these two pathologies are present simultaneously, we believe that the glial response is disregulated in a way that we don't fully understood at the moment.
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Therefore, we performed immunofluorescence dating on post-mortem brain tissue to visualize microglia and astrocyte density, as well as evaluating their morphologies, and we also conducted a
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comparison both near and far from the pathological deficits. There are a couple of key findings. First, magiglia cluster around amylate, particularly in PDD patients. It is not too surprising and
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is consistent with the role of magiglia being involved in amyloid clearance. However, the fact that there is a preferential clustering in PDD could suggest that magiglia is more engaged and involved,
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or potentially more overwhelmed when patients develop dementia. We've also seen that copathology creates a complex environment that modulated magiglia density. So what that can imply is that having
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both pathologies within the same environment could lead to a distinct signaling environment that changes how magiglia respond.
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Astrocyte density on the other hand was not very affected by the proximity to pathology. This is likely reflecting a lower astrocyte mortality, which is also reported in a wider literature. So, we
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are very interested in further exploring their morphology which can tell us a bit more about their activation states. We've seen that there is a relative hypertrophy in astrosette when they are close
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to alpha synuclein compared to only amyloid deposits or copathology which could suggest that alpha synuclein is the primary driver of reactive astrogliosis process in Parkinson's
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So to conclude our study opens up a window to further investigate into the PDD mechanism and to gain mechanistic insight of what is driving the progression from PDD to PDD. We also believe that in
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the future there is a role for our findings to be further developed into therapeutic target and potentially further develop glial targeted therapies to halt the progression from PD to PDD.
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Thank you very much, Florence. That's a very nice study, very good presentation. So I'll start by asking, so what do you think about the
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clinical implication of your study is? I
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think our study and our findings are still at the early stage for clinical implication or direct application But I think what we are trying to achieve from this study is to first to see whether glial
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cells are involved in this pathogenesis process and how they're involved. And in the wider neurodegeneration kind of investigation, I think there are a lot of studies looking into modulating glial
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cells, such as enhancing their neuroprotection function or role, or to block certain pathways, that's neurotoxic. So I think this in the future could potentially be translated into PDD patients to
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stop such dementia development, but I think it is still at this early stage at the moment. Thank you. So what do you think this study has added onto the literature? Okay I think in the
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literature, there is currently not a lot of studies, particularly on PDD patients. There is more around PD in general, as well as dementia with Lewy bodies. So I think our study is specific and
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focused on glial cells and also to look into a direct comparison between PD and PDD patients, which has not been fairly. very calmly investigated, and there were some studies previously on
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microglia activation in PDD patients using pet imaging, but I think the literature on astro-sides is relative to these scars as well. So overall, I think this is a novel study to look into real
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cells in general and PDD patients. Okay, so in
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that case, you know, do you find that there is a similar findings in other neurodegenerative conditions such as, you know, we body dementia, or maybe Alzheimer's dementia, or maybe even vascular
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dementia?
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I'm not very sure about vascular dementia. I've not read a lot of literature about it, unfortunately. But I think overall literature-wise, there is a strong, well, there is a suggestion that
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glial cells seems to have more activation or activity in like dementia with lewy bodies compared to PDD patients. So I think
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there is definitely a trend or a common ground that microglia and astrocytes are involved in handling or dealing with pathological deficits. And in the field of Alzheimer's, there's a lot of study
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around like disease-associated microglia and also how astrocytes are neurotoxic and how they can actually facilitate the transfer of pathological deficits into neurons rather than actually performing
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phagocytosis efficiently. So I think from other neurodegenerative conditions we've seen a lot of mechanistic investigation, which can be essentially also happening in PDE patients, but we're not
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very sure only with the findings from our current study. Okay, great. Thank you. Thanks very much. Can I hand over to you? Yeah, thank you. I was just curious on a few points. How many
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specimens did you look at in order to come to
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your conclusions and how you can see
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it? Okay, so with in our cohort there are 10 PD patients and 10 PDD patients, and I've only performed staining on one tissue sample from each patient, but we've imaged from multiple areas within
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that tissue section, and that gives us about like 3, 000 microglia and astrocytes each at the end to perform analysis. I think there is definitely discrepancy in variation between patients, but
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statistically speaking it's not a significant variation.
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Okay, and you could quite clearly tell the difference with that in a normal brain with the gripping of the
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microglia around the proteins So we also did perform staining on control like non-PD or PDD patients, but that's only a comparison for the density so we didn't do that for morphology. In terms of
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density there is a statistically significant elevation of accumulation of microglia
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only, sorry, in PD and PDD patients, particularly around Ambloid. I'm not sure about astrocytes. Oh, sorry. I'm not sure about morphology because we didn't do that comparison with control
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subjects. Okay. And how did you decide which part of the brain to perform the sample? So we did only sample it on the middle temporal jars. And that's because from the literature, it does suggest
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that this area is where amyloid start to deposit early in the disease process. And also, an alpha-serine can aggregates will start up here at a later stage of PG. So kind of finding a middle ground
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between a likely area that we can locate both pathologies in the same region, if that makes sense. Thank you, presentation.
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Lawrence, really nice. Thank you very much indeed.
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So, your astrocyte showed a morphological complexity gradient, didn't they? And there were more complex in PDD than in PDE.
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How might this inform the temporal sequence of glial activation in disease progression and what sort of therapeutic implications might there be as a consequence?
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So, I think with our findings it could suggest that astrocytes when they are in PDD patients are less hypertrophic or less active. Now, whether it means that they are less responsive to topotology
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or they are already entering like a state of dysfunction, that's something that we can't be certain. So, I think it will be quite important to kind of understand the functional implication of the
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morphology.
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But what I have hypothesized would be that these astrocytors are actually becoming less functional and responsive to pathology. So in terms of their putic kind of implication, I would expect that
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potentially by enhancing the, for example, the neuroprotective role, such as phagocytosis of astrocytes that it can
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more effectively clear the pathological tapestips. But I think as you can probably tell, there are a lot of hypothesis involved, which will definitely need to be further explored. Absolutely. I
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mean, you're right. I mean, there's a lot of conjecture at a very early stage with this, but it's a very important clinical question.
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Do you think your data support a model where Arthur
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Cineklay initiates astromlosis
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emulate and modifies it. So you've then got cumulative changes associated with the cognitive decline. And does that introduce any sort of potential therapeutic ideas?
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Or can you repeat your question once again? Yeah. So I mean, just look at your data.
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The alpha synths in the Euclian, some get my tongue around that, initiates astronomical priorities. And then that's later modified and cumulative changes occur that are associated with cognitive
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decline. Does that offer a potential window for glile targeted therapy, do you think?
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I think definitely astro, sorry, two dogs in the room with me who clearly disagree with that question.
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I think Elvis and Euclin, definitely the earlier pathology or pathological deficits that's being accumulated in Parkinson's in general. So, Um. with that, if perhaps we can effectively clear
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office in your clinic before even amort to start to deposit, which is highly associated with the major development, then potentially there is a timing or a window that we can develop certain therapy
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for it. Yeah, that answers question. Thank you very much Please go back to you.
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The next topic is a case report or caught a coin, a neuroendocrine tumor of the filing terminal in a summary of the literature.
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It's presented by Phil Kleece,
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Coriades, Christopheros, Christopheros, and Christina Oaxio and Demetrius from Fricarius,
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affiliated
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with the Eruteo hospital in Cyprus. Also, from the University of Edinburgh and the United Kingdom and the Oxenu Diagnostic Pathology Laboratory in Cyprus.
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Key points from this study or the introduction caught a coin of neuroendocrine tumors, previously known as caught a coin-appear ganglionmas, or very rare vascular tumors of
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this spine, which are mostly benign, slow growing, and well-demarcated from the surrounding structures. The key problem is how do you recognize them? So they presented a case of a man in his 50s
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with a clinical history of low back pain, exacerbated at night with right-sided sciatic on L4.
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Magnetic resonance imaging of the lumbar spine revealed an intrageral mass at the upper level of E4 with strong homogeneous enhancement following gadolinium contrast administration So they've
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localized a mass at L4 in
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the cotard china.
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And the conclusion is, though, these are rare tumors. And it prevents the establishment of strict guidelines because they're so rare for their diagnosis and treatment. By reviewing the existing
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data, you can find safe and effective ways of diagnosing and selecting the best treatment option for such patients. Some of the audience reactions were a generally interesting write-up of a very
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rare case, I agree. Really like the discussions generated by Professor Walters. It's an important reminder that these tumors don't always look like what you expect on imaging. That's true. And
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the point about the 2022 reclassification of this tumor is well-made. A lot of clinicians still call these paragangly illness
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without a habit -
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very nicely presented study.
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Thank you so much, Florence, I really like your talk, but that's you, Don. Thank you so much again. Thank you. The Claudae Quina
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neuroendocrine tumor of the film terminology, a case report and summary of the literature. Over to you, Theo. Thanks very much. So my name is Theo. I'm
39:33
a second year medical student at the University of Edinburgh. Thank you very much for having me. So I'm presenting a case of a rare cardiac quina in your endocrine tumor So our patient was a man in
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his mid-50s with a rather long therapeutic course. So he initially presented to a different center with a right leg sciatica and was diagnosed with a lumbar disc herniation without having any imaging.
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He was treated twice so he had a couple of recurrences of his pain with NSAIDs and with corticosteroids, but sought a second opinion after his second recurrence or by he presented to our center with
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low back pain. which would wake him at night and a 10 out of 10 right leg sciatica. On
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imaging, we found an interdural lesion near the superior border of L4, which was hyper-intense on T2, ISO-intense on T1, and enhanced homogenously on T1 with contrast. And our initial
40:35
differential for this was an epinemoma meningioma or schronoma. So we removed the tumor by gross total resection, and this was later histologically confirmed as a coda equina neuroendocrine tumor.
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So the aim of presenting this case was both as a learning tool, so to present a case of a rare neoplasm, which is not commonly encountered in practice as only around 300 of these tumors have ever
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been reported in the literature, therefore making its identification quite difficult when it presents in patients of these 300 cases and we were able to locate
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data for 194 in our literature review, the majority of whom were males in their 50s and presented with log back pain and reticulopathy, so very non-specifically, with a very small minority
41:27
presenting with isolated papilladema and symptoms of raised ICP. So, basically, given our patient's initial misdiagnosis, we also felt that it was quite important to highlight the need for an
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increased index of suspicion of maybe serious causes of low back pain and patients who initially present with the standard symptoms of a disc herniation and then experience repeated or rapid
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recurrence of pain after a conservative treatment. So, in our patient's case, despite the repeated recurrence, no imaging was initially sought, which led to continuation of an incorrect treatment
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and though he did make a full and complete recovery, delays in treatment of CNET caused by the nonspecific presentation have been reported to leave some patients with permanent neurological injury in
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some of the cases that we found in the literature. That's me, I'm happy to answer questions and discuss
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Thank you very much. It was a very clear presentation, quite an interesting topic.
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So, are there any radiological tales or findings that you're aware of when the MRI scan that would give you a hint or any clinical findings that maybe give you a hint that this is what you're dealing
42:54
with? So, in terms of clinical findings, the answers really know. They nearly always present very benign. They almost always are misdiagnosed unless imaging is immediately sought, unless the
43:10
patient presents with some sort of a rapid neurological deficit, but that doesn't usually happen. In terms of imaging, there's been description of a couple of signs, so there's a sort of salt and
43:24
pepper appearance that was described by one, by one author, because of rich vascularization. of the tumor. It's a very vascular tumor. There's also been a tadpole sign, sort of, described, so
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the tumor being the head of the tadpole and then dilated and tortuous vessels above or below it, being the tail of the tadpole. But even then, they aren't super specific signs. It can also have a
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sort of peripheral hypodense
44:00
rim on T2 because of the sort of hemociderin deposits because it can sometimes bleed into itself. But that's pretty much it. In terms of clinical findings, there's nothing to differentiate it from
44:14
other causes of low back pain. And intraoperatively, who are some of the concerns that the surgeon may have or the anaesthetist may have when resecting these children.
44:27
The primary concern, given the vascularity, is the potential for bleeding. It is quite small, but it is very vascular, so it's important to try and remove the tumor and block. In this case, we
44:44
also removed the phylum as well, and then ensuring adequate coagulation, so adding a local hemostatic is a good thing to do. That's what we did in this case Pretty much, this is the gist, I think,
44:59
for this tumor here. Did you come across any case studies where there were your secretory tumors with difficulties with blood pressure control, et cetera? Not a single one. And actually, this is
45:12
why they were reclassified. So they used to be called Paragon gliomas back before their reclassification in 2022. But they were found, first of all, to have a lot of differences terms of
45:29
immunohistochemical staining, and also transcription factors, the pigeonetics and such, but also they were found to nearly always be non-secretory, which, uh, paraglionmas tend to be secretory,
45:41
so that's what sort of led to them being reclassified. So they don't actually secrete hormones, they don't cause any alteration in blood pressure or anything like that And, uh, their record
45:53
entries? Uh, nearly nothing. It was around, I want to say, uh, if you give me a second, sorry, I've missed that. I think they recurred in five. Yeah, five individuals. So of 194, uh,
46:09
five, that was 26. So nearly nothing. They're benign, uh, WHO grade one Very good. Thank you. I hand you over to my colleagues. So
46:23
Theo, in the, um, in the case you you mentioned that you know this man presented with sciatic. pain, and it seems like a recurrent site, a good pain. I mean, this kind of symptoms is very
46:35
common in clinical practice. People don't respond to analgesias, it's, it's,
46:44
I would say there is a huge number of that. If we were to be vigilant and maybe pick out, pick out the potential red flags and thinking about what sort of a patient that we should scan. Do you, do
46:60
you maybe, you know, by looking through the literature, did you think there is any clue that, that you can enlighten us? So in terms of red flags, I mean, generally the symptoms of corticuina
47:14
come up in mind. So it's the saddle anesthesia or bladder valve dysfunction and such. But the thing we've are my findings of the literature in terms of quadaquin and urindochron tumors is that they
47:29
nearly never affected patients to such an extent, they nearly always just presented with that low back pain in that sciatica. Now in our patients case, what sort of clued us in was the very rapid
47:46
recurrence, so they were treated twice and had recurred within a period of about three to four months, and the pain kept getting worse and worse after every single recurrence, and the other thing
47:58
that had clued us in was that they had night's pain, so they would be woken up at night with low back pain, so that would probably be what would be good to look at, for the night pain was more so
48:09
the clue. Okay, great.
48:14
Thank you.
48:16
So, I suppose, you know, in the cases where you looked at How many of them were quite late presenters and is that any, I suppose, any consequences? So the median symptom duration for the cases I
48:37
had looked at was around 10 months, but I had found some that were on sort of the two-year mark. So the range was four months to 24 months The patients that presented later tended to do worse. So
48:52
the ones that had a longer symptom duration tended to have some sort of remaining symptoms, and they were also the patients that would present with the worse symptoms. So they would have parastasia,
49:07
which only happened in about 25 of people. They would have some sort of a weakness, or even bowel and bladder dysfunction Bow and bladder dysfunction only occurred in 14 of those 194 patients, but
49:22
it often happened in those late presenters, and it was often, I think that would remain after the surgery. But when I say often, I mean, it was a minority of patients. It's just that it happened
49:36
more often in late presenters than it did in early presenters. And they were often misdiagnosed with something else. They'd be treated conservatively for a while. They'd recur a few times, and
49:46
then eventually, an MRI would be done and they'd find a tumor
49:52
Okay, great. Thank you, thanks very much. Thank you.
49:57
They are a lovely presentation. Thank you very much for it. Tell me about the hierarchy of evidence that we use as clinicians to reassure ourselves that we're making the right decisions when we're
50:10
treating patients. And tell me where case reports can sit in that stratification. Well, the hierarchy evidence, of course, first we go with the guidelines because the guidelines tend to. be
50:23
founded on the best evidence from
50:29
that can be found at the time. And then we would go with meta-analyses, especially meta-analyses of
50:39
RCTs, then systematic reviews, RCTs and going lower and lower down. At the bottom you would find case reports That's the bottom. Absolutely. So tell me, I mean, so you've now got experience
50:51
preparing case reports. Given that this is a very rare condition, you know, 300 cases have been reported, what specific types of data do you think people who publish these case reports in the
51:03
future should be collecting in order to best inform the management of this very rare condition. Clearly it's very rare indeed. Randomized control trials are going to be enormously challenging to do.
51:16
We're going to be left with essentially case report and anecdote to inform our decisions but to optimize that situation. What information do you think we should be collecting when we're doing case
51:25
reports of this condition?
51:30
That's a very good question actually. And it's
51:35
very relevant 'cause I struggled to find a lot of the data for these patients. So of the 300, I found 194, which I mean two thirds of the patients only two thirds having enough data to be included
51:46
in the literature search is quite abysmal I mean, demographics, first of all, definitely those were recorded in the majority of patients. What I found
51:59
was that symptoms were often very nonspecifically described. So a very good detailed description of symptoms as part of the case report. And especially if the language surrounding them could somehow
52:15
be standardized, though I think that would be very difficult because then it's, if - If there is no standardization surrounding the language, it becomes difficult to figure out exactly what the
52:27
offer means and how it correlates to what a different offer means in terms of what the patient presented with. And trying to
52:38
collect follow-up data for, at the very least, the 12-month period would be very good because a lot of these cases were published very quickly after the patient left surgery They didn't really have
52:51
time to collect follow-up data. So that would also be good.
52:58
Yeah, I think the rest of the
53:01
findings were very well described. Perhaps a little bit further would have been good in terms of the MRI findings because though there were some studies fact, specifically described the MRI findings,
53:15
which is where I got the tadpole sign the salt pepper appearance from. they were case series of 20 to 22-ish patients.
53:26
Many of the case reports themselves didn't actually describe the MRI very well, or they wouldn't include both T1 and
53:36
T2 and contrast, so that would also be good. Excellent. Now, you're talking about imaging there. I mean, I'm not a professor of expertise in this area, but urine country, which quite often
53:48
will will express somatostatin receptors, for example, there is the specific functional pet imaging that can be done to detect that. Is that something you encountered in your review of the
53:59
literature or did your patient have any pet imaging at all? No, no, the patient, then this patient didn't have any pet imaging and the majority of patients
54:09
in the literature I found didn't have pet imaging, so I suspect they would end up doing an MRI, then. that they would immediately go in and try to remove it. And since the majority, I believe
54:24
were gross total resections. I don't think Pat was sought after. Okay. And finally, very, very quickly, a very presaic question. On 2022, obviously, WHO reclassified, you know, what had
54:35
been called a paragon via
54:39
OMA to a neuroendocrine tumor. From a patient perspective, and I mean, just from sort of just, you know, telling the patient, you've got a paragon, ganglionoma versus you've got
54:52
a neuroendocrine tumor. What impact do you think that reclassification or that change in the taxonomy might have?
55:02
Well, I think in your endocrine tumor sounds a little bit more frightening than the same paragon glioma, possibly because of the fact that a paragon glioma, I mean, those are words that that a
55:15
patient will never have heard. your endocrine perhaps alludes to something a bit more scary and it doesn't represent the tumor very well because it is a very benign tumor that once removed is going
55:28
to most likely result in no recurrence and no remaining symptoms. So I'd imagine it's a bit more scary and a bit more difficult for the clinician to then go and try and reassure the patient and go no,
55:42
no, don't worry, it's fine, it's not as bad as it sounds. I think that's absolutely right and that's a sort of clinical practice issue I think is very important. It's important that the clinician
55:54
who's treating the patient tells them exactly what you've just said before they get to a computer and Google neuroendocrine tumor and terrify themselves with a wide range of disastrous outcomes that
56:05
can occur in that condition. Paragonically, home has obviously almost never metastasized, as you've said, and are essentially much better diagnosis to have. So that change in taxonomy from a
56:16
patient is increased risk. Probably not the greatest. That's great. Thank you very much. Thank you. Thank you Theo. I really enjoyed your presentation and I really like the answer you gave there,
56:28
just as well. It was excellent. Thank you. Yeah, thanks so much. Am I good to head off? Yeah, yeah, thank you. Have a good rest of your day.
56:40
The next study was the Natural History of Pineal Sists, a retrospective cohort study
56:48
by
56:50
Ui Cheng, Xinjiaap, Isaradashti, Stephen Tomini, Kevin
56:60
Osu, Agimai, Edward J. St. George, who are affiliated with the medical school, School of Medicine and Veterinary Medicine at Glasgow, University of Glasgow, Department of Neurosurgery at the
57:11
Royal London Hospital in UK, and the Department of Neurosurgery of the Institute of Neurologic Sciences in Glasgow
57:23
As a study in the pineal cysts is interesting, their goal is to assess pineal cysts. They're frequently identified incidentally on neuroimaging, yet their clinical significance is they're thought
57:40
to be benign, but nobody knows for sure. While most of these remain stable, concerns persist regarding their potential to cause obstructive hydrocephalus, made brain compression, other mass
57:54
effects, study is aimed to describe the natural history of pineal cysts in adults in the west of Scotland.
58:05
A retrospective observational study was conducted at the Institute of Neurologic Sciences in Glasgow, including adult patients who underwent brain MRIs. between 2011 and 20, a large period, with
58:23
radiology reports noting a pineal cyst. They had a total of 598 patients, very large series. With pineal cysts from among 1851 MRI scans, mean age range was around 70, 37 years from 29 to 49
58:46
years
58:48
That comprised 68 of that population was female. The conclusion is that pineal cysts are generally stable in sedatal findings. Larger cysts greater than 15 millimeters may cause clinically
59:05
significant effects, including hydrocephalus of migraines and headache diagnosis,
59:14
which may or may not be related to the cyst, but that's part of the clinical challenge. Some of the audience reactions are 598 patients as a large dataset, probably one of the largest in UK, that
59:28
I've seen in pineal cysts, common in one person. Another said, we need to be aware that if a lot of these cyst clinicians won't refer them or follow them up, that's true. Female predominance is
59:44
interesting and matches what's been hidden in smaller studies It's worth a follow up paper on its own. It's worth seeing the numbers on the correlation with headaches.
1:00:02
So, our next presentation is on the natural history of pineal cysts, a retrospective cohort by Shen Yue, you can count for now, thank you. Okay, sure. So I was told to explain this as if I'm
1:00:19
explaining to some random present corridor. So in essence, I'll do just that So my study is based on pineal cysts, which is obviously, as the name suggests, a cyst sprouting from the spot pineal
1:00:33
gland. There, one little short-chringo brain that is essentially
1:00:40
your rights to be controlling a sleep cycle. So our thought is that we're wondering if there's any biological factors that could have affected the size of the cysts, since there are studies that
1:00:55
have challenged that It could cause a. picture similar to central venous strombosis, if
1:01:03
there's too much crowding of
1:01:06
the area associated with it. So,
1:01:11
we took about 600 data points or via MRI scan and in the simplest terms that I can say is that there's no real biological factor that affects it, no gender, no comorbidities or any socio-chemical
1:01:33
background. The
1:01:36
only thing that affects the size is the time that we left it to brew, essentially. So, if we leave the cis understudy for a longer period of time,
1:01:51
there's a higher likelihood of the cis becoming a bigger size.
1:01:59
The question that we had was, is there any chances of us being able to be more lax with the
1:02:11
essentially the guidelines surrounding the surveillance of these cis? Because after having a chat with the neuroadiologists, it would open a lot of MRI waiting suites And essentially, if these cis
1:02:28
are truly benign in terms of their structural effects, then technically, then we could save the NHS some financial output as well. But obviously, these are very, very optimistic. So I would like
1:02:49
more senior review or any senior input regarding these implications.
1:03:02
Excellent. Very well done, nice and clear. There's a certain familiarity. You and
1:03:10
I discussed this last Saturday, the Saturday before, didn't we, at another meeting. So we're going to ask you a different question this time. Only what 12 of SIS change in size on follow-up and
1:03:24
of
1:03:26
those 57 decreased in size. And yet, born in 100 patients roughly just under that developed hydrocephalus and required surgery. So imagine I'm a patient and I've just been told I've got a 22mm
1:03:46
pineal cyst. I've already got a neurosurgical haircut, so I'm ready for the knife I've needed. How would you cancel me? What do you say in terms of my risks of
1:03:58
So first of all, if we're putting it quite objectively, your 22 millimeter would depend on the first reason on why was the scan indicated first. So
1:04:15
why was the scan indicated? Was it an incidental finding? Or was the cis actually presenting in a way that is affecting your activity of daily living to the point that you need to see a doctor to
1:04:27
get it sorted. But if you're putting it really objectively, 22 millimeters, I feel like -
1:04:35
So the scan was done for functional neurological disorder,
1:04:40
and I attended a stroke clinic having been referred with symptoms that were not likely to be served with vascular, but a stroke doctor would know his MRI as we tend to do, and this is an incidental
1:04:52
finding Okay. So.
1:04:60
I feel like the only thing I can work on work based on that is the size, so I feel like I need to tell you that 22 is quite a relatively big
1:05:13
size, but the essence of that, the essence for me is that I'm really naive, so feel free to correct me on this, but the essence for me is that if the cis, despite being that size, it's not
1:05:29
causing, it's not directly causing that issue that you're having, or it's basically just in lane-mentum sitting there. I would prefer not to touch it because it's a really deep structure.
1:05:47
I don't know if that
1:05:50
Yeah, it sounds very reasonable to me, absolutely. Now, you said that I think it was at 1 in 10 from your abstract. slightly more than that, had tactile compression on the imaging, but in no
1:06:04
cases of paranoid syndrome or anything that would suggest
1:06:10
clinically significant tactile compression, so what does that suggest about the pathophysiological threshold for developing a dorsal midbrain syndrome from a pineal cyst? How good is the radiology?
1:06:27
Well, obviously our radiology
1:06:32
is based on, we didn't do the volume studies that you've suggested the other day, so I feel like I don't have enough information to actually give you an answer that you're looking for, that's one
1:06:44
thing.
1:06:48
Unfortunately, I don't think I can give you an answer that you're looking for, which is due to the
1:06:56
treasures of our
1:06:58
imaging, perhaps? I mean, does it not suggest that tectoral compression radiologically is poorly correlated with clinical manifestations that,
1:07:13
you know, that, you know, if you've got a number of patients, you've got what looks like tectoral compression, you don't have any symptoms that are consistent with that. That's just maybe the
1:07:24
radiologist or the the radiological calling of the
1:07:31
compression isn't correlating well with with what's actually clinically meaningful. I mean, I don't I'm not a New York citizen. I don't know. It's just just a suggestion.
1:07:46
Would the neurosurgeon in the room would like to answer that question? Yeah, that's a good idea. That's a good idea. I'm in Shakira's as well. I am a neurosurgeon and I also do not know the
1:07:60
answer. Yeah, it's a really good presentation. It's an interesting group presentation So I
1:08:10
can remember coming across various topics where literature would be describing to experience. There are papers out there that suggest that if you approach these and furnish straight them, then
1:08:28
headaches get better and that is very much against what I would be, what I was taught
1:08:33
as a registrar, what I've seen as a consultant over the years Um.
1:08:42
and it's very much towards conservative management for the vast majority of these. If this scan happens to be a CT scan, that you are incidentally picking up the lesion, would you advocate for MR?
1:08:58
Should we be doing a contrast scans for all these, as well as those two questions for you?
1:09:05
Oh, and this is a hard question because I just finished exams, everything's out of the window now. I think
1:09:15
if we find a lesion, or like the very naive answer, would be if I found a lesion on a CT that I don't know the components of it, I might ask when MR just be on the safer side, especially in
1:09:30
something that's quite so deep and like with so many intricate structures around it,
1:09:40
Yeah, I mean, I think it does sound reasonable. Although the role, you will get some pushback from some of the new radiologists, I think. I've also had new radiologists say that they don't
1:09:52
mention these cysts because of the relevance, which is obviously the other end of the spectrum from those individuals that are in papers about illustrating them and to improve headaches So you've, I
1:10:09
think, come across a really very interesting topic. I guess the main question with these things is how you manage expectations in patients, and how do you advise them when they have this because
1:10:28
that correlation between headache, they have a headache, they don't have a headache before, and they've just found a cyst, and therefore those two things must be linked And how do you survive?
1:10:39
sort of weight in their field of vision, somewhere to see what actually the two men are being linked. Where would you approach that? So how are I approach telling them that this is not correlated
1:10:54
with each other between headaches and sis, is that the question? Yeah. Okay.
1:11:01
I feel like it's gonna be,
1:11:04
forgive me because I'm really naive on this, obviously.
1:11:09
I think it's gonna be a sense of telling them the sis might be contributing to the headache but the headache might not be entirely due to the sis. It could be something on the, on the scoring as
1:11:15
well. Because you can, because like not everyone migraine has a pineous sis
1:11:27
or not everyone with pineous sis has a migraine
1:11:31
So
1:11:33
I feel like we need to manage that expectation. And obviously there might be overlapping, but the second part of this study that we're doing is looking at that correlation with each other. But then
1:11:52
if we're looking at that correlation, we don't really see the expected
1:12:02
outcome as well because literature says that migraine is more prominent in females, but we don't really see a larger cis size in females, gender doesn't affect the size of the cis that we're looking
1:12:16
at. So that has a bit of contraindication with each other. So I feel like to answer the question perfectly, I need to look into this in much more detail section, rather than just going off what we
1:12:36
have based on this study eventually.
1:12:40
Yeah, very good, thank you. I just had a question, I want to add something. Mr. Matheson, I know another paper, the controversial papers you're talking about regarding headaches, and there's
1:12:50
been news articles as well on just an individual patient perspective with the same kind of professor in the group that's doing the surgeries for pineal cyst and headaches. So, genuinely, I might
1:13:01
have missed this, but was there any sort of statistical tests done on your cohort of 600 patients?
1:13:10
To see any sort of numbers for headache with pineal cyst size? I'm trying to think, I'm trying to think,
1:13:20
remember the second part for the study, because that's where we focus on the headaches. Forgive me for that. But
1:13:29
I do not record it entirely, because that second part is the first part of the study that I was going to focus on here here by belief.
1:13:40
I think we did a logistic regression regarding it, but unfortunately I don't really record the results. I do remember the news articles and everything that you're talking about probably.
1:13:53
Yeah, that's why I think that's why we're pushing really hard on the SIS study at the time when we're doing it as well. But yeah, unfortunately I don't think I have an answer for your reason. I'm
1:14:05
really sorry about that No reason. It would be interesting to see just kind of what the numbers were. Yeah, I have to look at it. Look it up again, sorry
1:14:19
That's everything from me, from us, anyone else? So can I ask something from a different angle, because I'm
1:14:32
not a surgeon, if I found this as the incidental finding, my first protocol is to go to find radiologists and to see what they think, and most of them, sometimes they would suggest follow-up. So
1:14:47
what do you think about follow-up imaging
1:14:52
in a panelist? So
1:14:57
as mentioned, my study is based on the size of the cis, and in lean-mentums,
1:15:06
re-nivly, the only thing that affects it is that if we let it grow, then you'll grow. So, but the thing is that, obviously, we're looking at the man, is it. labor, is
1:15:21
it rambolignantly, is it benign? So I very naively think that if it's not causing an issue, we don't touch it, but we can follow it up. The current protocol is based on the I think the symptoms
1:15:38
and the sizes essentially. But for that,
1:15:46
despite following that protocol, we've been noticing a lot of cis tend to remain quite dormant in a long period in the middle of it. So we're wondering if that could be changed a wee bit, but
1:16:03
obviously it's a very naive point of thought, unfortunately. But I do agree that follow up to be safe is a is required, obviously, because we don't know the course of the cis, we can project into
1:16:19
the future regarding the course of the cis. But the question that I have essentially is like, when is it okay, the cis is, there's a high likelihood of the cis to be benign, to be staying in that
1:16:34
dimension. And the patient is fine with that dimension, they're not causing symptoms, not causing problems. And maybe we can be more lenient with your follow-up rather than very rigidly. But
1:16:46
obviously, I don't have the insights to comment on that confidently, unfortunately,
1:16:54
if that answers the question. Okay, and thank you. The other thing, I mean, it's mainly followed up from prof waters, so sort of a hypothetical question. So if this is a use-identifying thing
1:17:09
from a patient with functional, neurological. disorder.
1:17:16
And I think once we found this, and it's reported, we applied to tell patient that.
1:17:25
And it's not uncommon that you face some patients who are extremely anxious. And in that sort of a situation, you know, how you're going to reassure them. And you're going to give them yearly
1:17:41
scans. And
1:17:44
you know, because they keep following you or emailing you every, every few months, worried about the pine eye cysts doing all sorts of things. And they doing Google's, which gives them, and
1:18:00
maybe not necessarily accurate, accurate information regarding that
1:18:08
Okay, so there's a few parts to this. I think first of all, the first thing I need to tell Dr. Google doesn't have a medical certificate or medical license.
1:18:19
So it's advice for to come to us. But I feel like to actually address their main problem is that I need to understand the correlation between incidence of opinuses in the cohort patients with
1:18:34
functional neurological disorder. That's the first thing I need to do. So obviously there might be statistics, it might be very cited journals for that to give me information to actually
1:18:49
quote to them and stuff like that. But that's why I think we should follow - I
1:18:57
feel like guidelines are made for a reason, like very naively thinking, correct me if otherwise. Since there are guidelines regarding the scans around this says, I don't think it would be - and I
1:19:12
would - I don't think it should be an obstacle for us to follow
1:19:18
the guidelines in the early one because we can't project the trajectory of the cis. Looking back, we know this individual cis is dormant, but we can't know at that point of time in the style, if
1:19:32
that makes sense
1:19:36
My question would be, I mean, if they keep coming back and we keep reporting, this is constant, this is normal, it's not really expanding. I feel like as a patient knowing that this is there
1:19:52
might cause me anxiety, but the fact that it's not causing me an issue needs to be phrased in a way
1:20:03
that, well, it's not anxiety inducing to them, but the fact that this is quite dormant and we learn to just take it as a product myself, so I have a shot of last in my knee, so I've learned to
1:20:16
take it as a part of myself at this point.
1:20:20
But yeah, the quit. So from a patient perspective, I think
1:20:27
knowing the correlation, that's one thing which I do know of the time I hate. And following the guidelines gives them a sense of like safety that we're doing what we're supposed to do.
1:20:43
Yeah, and yeah, I think that's the main thing that I need to get that across to assure them.
1:20:55
I don't even answer this question I'm sorry. Very good. Very good. Thank you. So yeah, I think all the medical sort of things you've suggested I would have quoted the evidence but if they still
1:21:06
extremely anxious I would just
1:21:13
I'll just tell them directly that it's anxiety that they need to deal
1:21:22
with on top of the routine for a lot. So it's not rude for me to tell them that you're probably just really anxious about this. So it's not rude for me to say that? No, I think if anxiety is the
1:21:38
issue, you also need to address anxiety because the way they look at them as a holistic whole person. And if anxiety causes the main problem, then you need to address anxiety. OK, OK, thank you.
1:21:58
OK, thank you, sorry. What are you going to say? No, I'll just say thank you. OK, thank you, anyway. And yeah, it would be really interesting to see kind of statistical analysis further on
1:22:09
with the cohort. symptoms in general, but now I really enjoy your presentations. Thank you so much. Thanks for having me. Goodness.
1:22:18
The next paper is interesting. It's about the exposure to neurosurgery among undergraduate medical students in Europe, a scoping review by G. T. J. Sawat, who is at the Bowen Hospital Royal
1:22:33
College of Surgeons in Ireland.
1:22:37
And the key points of his abstract are there are 101 articles that they found in the literature. In their search, 10 of them were identified as suitable to the scope of the review. The limited
1:22:51
exposure to neurosurgery and the undergraduate medical curriculum was common, a common theme across all these articles. And a large multi-country study in southeastern Europe found that 80 of the
1:23:04
respondents We're not able to require knowledge about pursuing. a neurosurgical career through their curriculum. Only 33 of them reported the neurosurgery, presentations were organized at their
1:23:20
university. So not a very great exposure to neurosurgery. Conclusions exposure to neurosurgery through the undergraduate medical curriculum in Europe remains limited in adopting a basic framework of
1:23:35
didactic neurosurgery teaching, as well as an involvement in the operating theater can boost interest in understanding.
1:23:44
Conferences play a vital role in bridging a gap in
1:23:49
the curriculum by improving access to neurosurgery and fostering better understanding of the field. Absolutely excellent study, excellent conclusion. Some of the other reactions were the iris data
1:24:04
on clinical rotations was interesting and quite low. might be a good idea to see what the Scottish picture looks like. Another common was conferences like this one really do make a difference. I
1:24:16
picked neurosurgery after going to one as a third year medical student and the last common is my university in the UK only has two weeks of neurology and neurosurgery combined. So what he found is
1:24:29
there was very limited exposure to neurosurgery and the curriculum of most of the medical schools.
1:24:39
So our next presentation is exposure to neurosurgery among undergraduate medical students in Europe, a scoping review presented by HSOI. I'll let you have the four not HSOI. Good option. Should I
1:24:53
share my poster or how should we do this? So the way we kind of do it is you can speak. This is the only thing that will be up. This is more of an informal discussion. No need to kind of talk
1:25:06
about the artwork itself, but yes. Super, yeah. So good afternoon everyone. My name is Tej just thanks again Reza for the introduction and for arranging this. And thank you doctor for your time.
1:25:20
So the project that I worked on was during my final year of medical school. It was about getting an overview of where the current situation is in terms of exposure to neurosurgery among undergraduate
1:25:34
medical students And the focus, sorry, the
1:25:40
motivation for this came from my interest in medical education as a career. And also as a part of my training, I hope to have an academic post alongside my training roles. So I was curious about
1:25:56
where the current status of exposure to neurosurgery stands And so I started sort of solving off with. a scoping review to understand where in Europe we are currently and that resulted in, I
1:26:15
followed the scoping review guidelines and then came up with about close to 100 papers on PubMed M based Google scholar and then filtered those down to about 15 publication
1:26:31
which focused on surveying our sort of qualitative and quantitative studies involving medical students and their experience with neurosurgery as an undergraduate subject. So in that I, in the
1:26:49
scoping review I found
1:26:53
some useful information about
1:26:57
how students are exposed to neurosurgery in the undergrad in the undergraduate years. So one of the big And.
1:27:06
of these sources was lectures in the undergraduate curriculum and followed by conferences which helped bridge the gap between courses and
1:27:22
practical experience. So one of the papers that stood out to me was, I did it all until 2024, which showed that only 33 of medical students that they surveyed had access to nursery lectures of
1:27:35
their institutions and about 20 received knowledge
1:27:43
about pretty soon in your surgical career. However, contrast that about 43 of the students surveyed were interested in nursery surgery. So this showed that was a big gap. And then similar studies
1:27:55
across all the European countries also showed that the exposure in nursery was quite limited. And another study that was interesting to me in this COVID review was
1:28:09
that a study conducted by a SCAR PARS at all, 2016, in which they surveyed senior medical students who were about to study a foundation year. And they found that one third of the students had
1:28:21
difficulty in identifying conditions that required neurosurgical referrals. So something that would be very pertinent to that role as a F1, F-I-1 doctor. So overall, I think this recording review
1:28:34
helped me understand that where the gaps currently are in across the studies that surveyed medical students across Europe and how
1:28:49
those have been mitigated in different ways, so be it through conferences, be it through partial experiences or placements And then that sort of, I hope that this The next stage in this would be
1:29:04
that I would work with one of my mentors at
1:29:10
Beaumont Hospital in Ireland to see if we can implement an audit or a program in which we can have an intervention in terms of either a tutorial or a course that can be implemented and then serving
1:29:28
how the students find that in terms of their education experience. So with that, I'd like to conclude my talk. Thank you very much for your time.
1:29:39
Okay. Thank
1:29:45
you. So, Taja, how do you think your project is sort of clinically relevant?
1:29:52
So I think
1:29:58
the idea to start off with is where do we stand currently in terms of the future doctors having exposure to neurosurgery. So I think that to me was the biggest relevance to me personally was getting
1:30:13
an idea of where we are at the current moment and what the gaps might be and how and then that could spark the discussion of how can we proceed to fill those gaps and how can we provide more exposure,
1:30:28
more experience to future doctors who might be interested in the field or who will be working as colleagues with neurosurgeons, be it in neurology,
1:30:40
be it in other fields in which they might have referred
1:30:44
to neurosurgery. Okay, thank you. So, in the University of Glasgow, so one of the, I think, I think it's a force
1:30:58
50 placement. half sessions of placement between half our weeks,
1:31:06
is based in the Institute of Neurology, so the students have chance to have more exposure of neurology, neurosurgery,
1:31:21
and other neuroscience related to specialties. Is that something that have you, do you have in your university?
1:31:34
So currently the weight works in Ireland is that, so I attended Royal College of Surgeons, which luckily is affiliated with Wilmore Hospital where the main neurosurgical centre is based in the
1:31:46
country. So for us we had more access in the sense that it was, if we had a surgical placement, one of them could be neurosurgery by default, just because the teaching hospital
1:32:00
The Royal College was the Neuroscience Center. When it comes to the other five medical universities in Ireland, they would have to do it as an elective in which they use their summer month or they
1:32:15
use a free block in their curriculum to pursue. And they would have to arrange it either through their college or through their own by reaching out to the consultants in neurosurgery here So I'd say
1:32:29
formally it was part in just really one school and then the other one would be Cork, which also has a neurosurgical center. So apart from these two universities, all the other five, they would
1:32:42
need to arrange it sort of on a case-by-case basis.
1:32:49
Okay, okay. Thank you. And I think, you
1:32:54
know, The medicine nowadays becomes. more on the more specialized, you know, I think when you're in medical school, you're generally and probably, you know, big divide and the big specialties
1:33:12
like general medicine, uh, often got any pediatrics and surgery. Now, neurosurgery is obviously even for us, that's sort of like a tertiary referee. It's very highly specialized, so I suppose
1:33:30
how do you balance the need for the medical students, you know, they need as broad knowledge as possible while, you know, you clearly feel that maybe they need some sort of knowledge in very
1:33:52
specialized area. So how do you balance this need because you only have so much time?
1:34:01
Yeah, that's a very good question. Thank you. So I think the way I was sort of thinking about this is I haven't materialized the idea really, but sort of like a
1:34:16
foundational framework that every medical student would get would be about
1:34:23
referrals for neurosurgery I think that would be something that's pertinent to every future doctor is if they come across during their role in A and E or in any other service in which the patient
1:34:39
develops symptoms that might need neurosurgery referral. So something quite,
1:34:49
I wouldn't say common, but something that they would come across probably is correguina syndrome if they have symptoms of that, or if they're altered mental status, if that they have findings on CT
1:35:02
brain, what would be the next step, how and when to contact neurosurgery. I think just getting that foundational basis that I think a course or because I think logistically having a placement for
1:35:20
every medical student would be possibly beyond the means of most colleges and possibly not even relevant because I can understand that many students might not want to have that level of exposure, but
1:35:37
something like a foundational framework, a foundational course in which I think is taught through the theoretical curriculum because everyone does learn about the red flag symptoms that that is part
1:35:51
of the curriculum. However, teaching that in sort of a practical course in which they either practice doing a referral or practice conveying it to a neurosurgical as to show a registrar, because
1:36:08
that would be the practical job would be possibly in Ireland, it would be the first-year doctor, other intern calling the neurosurgical team to pass on a referral. And that would be the first point
1:36:22
of contact. And if needed, it would be escalated to the registrar So I think practising that in
1:36:31
a practical tutorial, I think that would be quite interesting. And something that I would be interested in exploring
1:36:42
as part of maybe an audit for a study. OK, OK. I mean, I'm going to make a comment. Unfortunately, Mr. Masterson is not here. I would like to hear his opinion, you know, how he feel about
1:36:59
FY1's directly refer patients, new surgeons, you know,
1:37:06
as a neurologist, we get a lot of referrals and the quality of referrals differs significantly depending on the, the grade of the doctors who refer the patient home And I think from our perspective,
1:37:27
you know, because of the experience that FY1, FY1,
1:37:33
especially FY2, they've had some experience in medicine and surgery.
1:37:41
Because of the experience we would probably prefer, you know, if they have a question, if they are not sure the first protocol they should speak to their seniors and.
1:37:55
Whether, you know, making referrals, especially tertiary referrals, should probably at least come from the level of the
1:38:09
old-grade to senior SHOs that I don't know, to know
1:38:18
if you've seen, junior, certain surgical levels, or registrar levels, I
1:38:23
would have, I would have think, rather than directly, directly from from FY1s.
1:38:34
Yeah, apologies. So I'll just elaborate a bit more. I think I might have just glazed over it, but the way it works for us, at least in my experiences, if it's within hours during working hours,
1:38:47
then the whole team would have a discussion and they would explain to the intern or the FY1 as to this is the content of the that we would like you to put up in the system so it is discussed with the
1:38:59
team however it does come down to the intern to actually sit down and write it and then make a phone call if needed so I think there is a bit of element in which yes you you would be part of the
1:39:12
discussion you would have run it by your registrars but at the end of the day it is the intern making the call so I think having that level of confidence as well because sometimes when it's 40
1:39:24
patients and when they've discussed every referral that they wanted to make to different departments I think things might get lost and it might still be a bit of a challenge and then when it comes to
1:39:36
after hours during emergencies so that has to go through the surgical registrar call and that's that's the way it would work yeah yeah no I totally agree and again I think you know making the referral
1:39:55
self is a learning point. The same referral that I made when I was FY1 or then compared to the referral I made when I'm the registrar, you would give different information and you have different
1:40:12
insight. So, I
1:40:19
mean, the hospital nowadays is very busy. So, a lot of referrals we get from very junior member of teams do have very limited information and some you know from our side it's it's part of the job
1:40:39
to ask the right questions and get them to then go to get the right information. But again and I think the the the team, the junior doctor. based on this senior also, have the responsibility of
1:40:58
you, going to ask your junior doctor to make a referral, actually you need to make a clear, you know, why you want the referral, what the question is, and these are all sort of
1:41:13
clinically quite relevant here.
1:41:20
Thank you, Tijas. I just had a quick question as well, and I might have missed this one year. We're speaking, but did you notice any sort of patterns in between the countries and the differences
1:41:33
in the exposure to neurosurgery that you reviewed? Yeah, so I was hoping there would be a lot more variety in the countries that were surveyed, but actually the majority of the publications were
1:41:51
from the UK and Ireland, and I think over there it was similar trends. More so in, I think the two cities that were in Ireland, I think those were, you know, those would reflect the trend that I
1:42:04
mentioned, that it's the two medical universities that have the neurosurgical centers, so I think that did affect the exposure. When came to the UK I think.
1:42:18
It was also similar trend depending on the proximity to the neurosurgical centers and access. And there wasn't a Europe-wide study, or there wasn't like a study funded by the EU or sort of like
1:42:33
consortium of countries. So I think that would have been also been an interesting one to see
1:42:41
how the exposure differs across countries And then the largest study in it covered countries mostly in southern Europe. So Greece, Serbia, Albania, Turkey. So that was the largest study that I
1:42:58
included in the scoping idea. Thank you. Thank you so much. Thank you very much. I don't have any more questions, Dr. Wong.
1:43:10
No more questions. Thank you very much. Thank you for your time Our next president.
1:43:17
The next paper is on the efficacy and safety of mTOR inhibitor therapy in a Canadian pediatric tuberous sclerosis complex cohort. It was by Reta, Reta Edge, Ajumari, Mila Valsik, Ashwag,
1:43:35
Al-Sillami, Ariazak, Lauren Shahn, and they are affiliated with
1:43:45
the hospital for six children, the Division of Neurology and Division of Pediatrics in Toronto, a very good hospital. King Abdullah Specialized Children Hospital, Department of Pediatrics, and
1:43:59
the Ministry of National Guard in Jeddah, Saudi Arabia, in the University of Toronto, Department of Pediatrics in Toronto, Canada. MTOR, also known as Mechanistic Target of Rampomycin, is a
1:44:15
protein kinase. that regulates cell growth, proliferation, and survival. While Rampamycin is a drug that inhibits its mTOR activity,
1:44:35
The findings in this study show that tuberous sclerosis complex is a genetic condition which we know barked by benign tumors in the multiple organ systems as mutations in the tuberous sclerosis
1:44:50
complex lead to overactivation of a mechanistic target of rampobisin-m-tor pathway Their inhibitors are useful as indicated in for sub-pinnamel giant cell astrocytomas.
1:45:08
Renal, angiolyleipomas, and drug resistant efflux are very interesting. While M-tor is widely used in adults, workers needed to assess their value in children work can be helpful.
1:45:22
So this study is the first to describe the efficacy and tolerability of M-tor inhibitors in a pediatric.
1:45:32
To boost to risk orosis, cow heart. Future work will include standardization, a seizure data collection to study epilepsy outcomes, and impact on neuropsychiatric symptoms and contribution to
1:45:47
specific genetic variants. Some of the audience reactions are the point about seizure data. Standardization is a wider issue across pediatric neurology Another common is neuropsychiatric outcomes
1:46:02
would be good to see. That's where families really want answers and curve it and you have an instance in. Nicely structured and interesting presentation. Interesting study on a troubling disease
1:46:17
with a potential treatment. Presentation is on the efficacy and safety of M-tore inhibitor therapy in a Canadian pediatric reverse sclerosis complex cohort. presented by Retouch Abumar. I'll let
1:46:34
you have the fore now, Retouch. Thank you so much. So hi guys, my name is Retouch Abumar and I'm a medical student at the University of Aberdeen. And today I'm just going to be presenting a
1:46:47
project that I've been working on over the summer at Sick Kids Hospital in Canada. And this project really just is focusing on the efficacy and safety of mTOR inhibitor therapy in a Canadian
1:46:60
pediatric to-risk closest complex cohort. So firstly for some context. So what is to-risk closest complex or TSC for short? This is an autosomal dominant genetic condition. So it has an incidence
1:47:15
of generally between 1 in 6, 000 to 1 in 10, 000 live births. So it's a quite rare condition and it's caused by pathogenic variants in the TS1 or TS2 genes. And this ultimately leads to the
1:47:31
overactivation of the mechanistic target of rapamycin or mTOR pathway. And this ultimately leads to abnormal cell growth, proliferation and tumor genesis. And that's why this condition is
1:47:43
characterized by benign tumors or hammer tomas in various organ systems, including the brain, kidney, heart, mouth, et cetera So, MTOR inhibitors or MTORI, including both seralmus and everalmus,
1:47:59
inhibit the MTOR signaling. So, they decrease protein synthesis and cell growth and they ultimately reduce the tumor genesis. And that's why they are a growingly useful therapy for TSC-associated
1:48:12
manifestations, commonly including sub-evendymal giant cell astrocytomas or
1:48:18
sagas in the brain, renal angiomyelitic pomas in the kidneys or AMLs and. drug-resistant epilepsy, and these were generally the focus of our project. However, it's also important to note that
1:48:31
because MTRI work on various organ systems in a nonspecific way, there are some undesirable adverse events that commonly occur. And these include neutropenia, hyperlipidemia, and
1:48:45
stomatitis in ulcers. But this ultimately leads to the objective of our study, which was to evaluate the efficacy and safety of MTRI in patients with pediatric TSC at Sickhead's Hospital. So in
1:48:59
terms of our methods, data was obtained from Sickhead's Prospective Observational TSC Clinical Outcomes Database, which had a total of 107 patients. And these were comprised of patients who had a
1:49:13
genetically indoor clinic and confirmed TSC diagnosis. So patients with a diagnosis of TSC who also received MTRI therapy were included in the study. And this was a total of 19 patients. So overall
1:49:27
results, like in terms of our demographics, it was a pretty well representative sample about how far patients were males, how for females. In regards to the genetic testing, about 68 of patients
1:49:40
had a TS2 pathogenic variant while
1:49:44
26 had a TS1 variant. And in terms of the indications of mtery therapy or why patients were started on mtery in the first place,
1:49:54
316 were for sagas, 211
1:49:57
were for AMLs, 211 for epilepsy, and about 105
1:50:03
were for prophylaxis. And so the median age of mtery initiation was about 84 years for this patients. So in terms of the type of mtery that patients were started on, 13 of them were on seralamus,
1:50:17
while the other six were on everalamus. And in terms of their differences, they generally have the same mechanism of action and efficacy in general, although, overall, this just has a greater
1:50:29
oral bioavailability and it's just more readily absorbed. But in terms of our general results, what we saw was that therapeutic benefit, whether that was tumor stability or regression was achieved
1:50:42
in eight out of the eight, so 100 of patients with sagas and 11 out of the 12 or 917 of patients with AML's 24-month post-MTRI initiation. And these results are generally also quite consistent with
1:50:58
what we see in the literature. However, it's also important to consider the long-term efficacy and benefits of MTRI. So various studies have shown regrowth of AML's and sagas following the
1:51:10
discontinuation of MTRI therapy. And so therefore, this warrants the need for additional research to establish guidelines and recommendations sustained or potentially indefinite MTRI therapy to
1:51:22
really prevent these rebound growths from happening. However, the cost of a probable lifelong medication also does pose a financial burden on families. And so increasing drug coverage would also be
1:51:35
vital to advocate for our patients. In regards to the epilepsy outcomes, the variability in reporting seizure frequency made MTRI affects quite inconclusive for epilepsy There's also generally quite
1:51:49
limited data in the literature showing the efficacy of MTRI for reducing seizure frequency in burden, especially because of its inconclusive mechanism unlike the tumors, the nine tumors. In terms
1:52:03
of adverse events, seralamus and everalamus were generally well tolerated. Yet 100 of the patients reported at least one adverse event during therapy. So these were commonly between grade one or
1:52:15
two, so mild to moderate in severity, which is also quite consistent with the literature. Common adverse events, as I mentioned, four were things like hyperillipidemia, stomatitis, neutropenia,
1:52:27
some rashes, viral infections, and pneumonia. However, most of these adverse events were generally transient. So they were temporary, and many of them self-resolved or required medications to
1:52:39
treat.
1:52:42
Additionally, mTORI holds or discontinuations were commonly due to adverse events, which caused some inconsistent medication delivery for some of the patients. But overall, just to conclude,
1:52:54
mTORI, as we saw in our study, is an effective target at therapy for SEGA and AMLs. Adverse events were experienced by all the patients and some patients had to hold or discontinue mTORI for these
1:53:05
reasons. However, therapy was generally well tolerated with mainly only mild to moderate adverse events experienced by these patients. But overall, that concludes just a general summary our
1:53:17
project and um. I'm happy to take any questions as well.
1:53:23
Okay, great. Thank you.
1:53:27
So, Richard, what's the clinical implications of your study? Yeah, that's a good question. So, as
1:53:34
I mentioned before, you know, these medications, as we saw in our study, they do show volume reduction in the AMLs and SAGOs, but I guess the main concern here is the long-term efficacy. Some
1:53:35
studies have shown that if you stop taking mTOR inhibitors, then the AMLs
1:53:59
or SAGOs can regrow. So, this then, you know, indicates, okay, do these patients do to be on lifelong mTORIs and what complications does that have in the future? Because we saw that, you know,
1:54:12
adverse events are common, even from the get-go of taking these medications, but what are the long-term implications, patients who, during adulthood, might need to be taking amterise. So I guess
1:54:23
that's the main clinical implications, really those long term efficacy and safety of these, of these medications. And that's again, something that we're going to be continuing to look at. I don't
1:54:34
know if this is like a retrospective study, but we also want to look MTRI of, of implications term long the, again see, and points data our of some tweak of kind to, just nature prospective more
1:54:38
a in it at,
1:54:47
both ceramis and herbalness for these patients. Okay. Okay. Thank you. So, um, uh, is this a single center or is this a, um, uh, a few centers, multi-center study? So this is a single
1:55:04
center. Um, the data that I've, that I took was from last summer. So at that point, we had 19 patients on untoward inhibitors, but, um, As of now, currently there are 25 patients total. So,
1:55:19
you know, some patients are, you know, some newer patients on our amateur inhibitors. But we did contact last summer or some other sites to gather more patients again, 'cause TSC is quite rare
1:55:30
condition. But Sick Kids Hospital has a specific TSC clinic. So we actually have the largest sample in our area. So that's why, you know, it could work as a single center, but there are a few
1:55:44
patients in other hospitals that were also planning to gather some data from. But as of now, it's currently a single center. Okay, okay. And how, so in your cohort, how many
1:56:01
patients had the tuberculosis in total? So OPE,
1:56:07
or is that more of them?
1:56:11
Sorry, so how many had TSCs? So I was just wondering, is there everyone who had tuberous sclerosis on this treatment or is it just a proportion of these patients on this treatment? Yeah,
1:56:27
so we had 107 patients total with TSC, so only 19 of them were on mTOR inhibitors, specifically for these indications. So the other patients might have not needed mTOR inhibitors because either
1:56:42
they didn't have AMLs or SAGAs or
1:56:46
they were asymptomatic and didn't really require treatment, but only 19 of them were on mTOR inhibitors for these indications. Okay, and the average length of them being on this treatment is how
1:57:02
long? Sorry? The average length of the treatment
1:57:09
So, the each. We were gathering information on sort of the patients that have been or are currently on emptor inhibitor therapy. So the general length so far that we see is about eight years on
1:57:23
emptor inhibitor therapy. But again, the newer patients that we're gathering are obviously not on it as long. But that's why for sort of the SEGA and AML outcomes, we decided to look at it 24
1:57:36
months post initiation. We want to look at, okay, after two years, what is the SEGA and AML volume looking like? So that's why we want to create sort of a set point to gather this data for the
1:57:51
outcomes, clinical outcomes. Okay, so the longest the children who are on the treatment is about 80 years also, is that correct? Yes, that's correct, yeah. Okay, so I mean, this is very new
1:58:08
to me and
1:58:11
this treatment. So is this a licensed treatment for adult population? So currently it is licensed for adults in the US. I believe also in Canada and the UK. So it's generally licensed for
1:58:31
especially, every all of this is licensed for patients as a per asymptomatic growing sagas in adults and children. And I believe it's also licensed for as an adjunctive therapy for treatment
1:58:47
resistant epilepsy as well. So it is, overall, this specifically is licensed for those indications.
1:58:55
But it's also interesting because in Canada, there's greater availability for seralamus compared to everalamus. So seralamus is generally more available and it's. generally cheaper for patients.
1:59:08
So that's why a majority of our patients are on seralimists compared to everalimists.
1:59:14
So I guess that's important to take in mind because a lot of the research is being done on everalimists, but in clinical practice, seralimists is what's being prescribed. So I guess it's important
1:59:18
to take that and consider it to consideration when looking at sort of research and the
1:59:29
literature right now. I mean, adult population, if the patient will start it on the M2 inhibitor, does that mean they will be on it long-termly or is it a point to stop? I believe as of now, I
1:59:41
mean, the
1:59:50
reason why I guess we looked at it in a pediatric perspective was because, you know, sagas and AMLs commonly present in adulthood. And so a lot of times these patients We'll start mTOR inhibitors
2:00:03
down the line. But we also, but we see now that, you know, Sega's name is also very common in pediatrics. And so that's why this is kind of a niche sort of research sort of take that we're
2:00:12
looking at. So there isn't as much research in the pediatric population compared to the adult population. But generally, so that's why we see more data and more literature in the adult population.
2:00:24
And that's why, for example, I don't know if you heard the there's the exist one in two trials, which are randomized control trials for long-term efficacy of mTOR inhibitors are for the adult
2:00:36
population. So there's definitely more research, larger samples for adults compared to pediatrics right now. So that's why we decide to look more into the pediatric population right now. Okay,
2:00:48
great, thank you. And so in your research, have you look at the literatures? Is there any other center that also, maybe look at the pediatric population.
2:01:05
Yeah, so there is quite a bit of research. I mean, when I was doing the literature review about like two years ago or so, there is quite a bit of research on the pediatric population, especially
2:01:17
for SEGA's and AML's
2:01:21
in especially in the US
2:01:24
In terms of sort of other indications, though, like as I mentioned before in our study, it was really hard to capture seizure data because,
2:01:33
you know, seizures vary on a day to weekly to monthly basis for children and so it's very hard to capture the frequency and the type of seizures that children are experiencing And so that's why
2:01:45
that's a huge sort of gap in the literature that we see right now is really the effects of import inhibitors on epilepsy. And so that's why for, you know, specifically at sick kids and going
2:01:57
forward, we want to create more of a standardized model and way to collect seizure data. So, looking at the exact frequency of seizures, the type of seizures children are experiencing, and it's
2:02:14
again, it's quite difficult because the parents are the ones that are witnessing these seizures at home, and so it might be difficult for them to capture this data. And so, it's very hard to gauge
2:02:23
how Emptor and Himmers can therefore have effect on epilepsy in general, which again, it's a huge kind of growing area for research because 80 of TSC patients have epilepsy, especially treatment
2:02:37
resistant. So this is definitely a growing area of research that we hope to also kind of contribute to, especially as we kind of move towards creating more standardized approach to this data
2:02:50
collection. Okay. And is it effective in controlling seizures in
2:02:59
the adult population? Um, see that in itself actually is, it's a gray area. So even in the adult population, there isn't much data on, um, collecting, um, on seizure frequency. So again,
2:03:13
it's just, it's because of the mechanism, I guess. So for mTOR inhibitors, obviously we see that the way it works is that it inhibits the mTOR pathway. So it reduces that tumorogenesis. So it
2:03:25
would make sense to work in SEGA's and AMLs, but for epilepsy, the, the mechanism is quite inconclusive and not, it's quite a gray area. So because of the mechanism, it's hard to also, you know,
2:03:36
predict what it could have, what the effects could have on, on seizures. Okay. Great. Thank you very much. Um, as I've, you've got any questions.
2:03:50
I have any questions. I thank you. Thank you. We touched those really great. Thank you. Bye bye. Thank you very much. Thank you. Thanks. For our next break
2:03:60
This paper is on the impact of a webinar series on student perspectives to neuroscience research barriers. By Amelia Parsi, Elside
2:04:13
Bilal,
2:04:15
Selnon Wigap, and Chandruh, Kelly Uppermore.
2:04:23
They're affiliated with the Edinburgh School of Medicine, Edinburgh Cancer Research Center of the University of Edinburgh. And Edinburgh, United Kingdom Center for Brain Science at the University
2:04:36
of Edinburgh, and the Department of Clinical Neuroscience at the NH National Health System, Lothian Edinburgh Hospital, the United Kingdom.
2:04:48
It's a very interesting study. The background is the research engagement among medical students tends to be minimal until it becomes a curricular requirement. and the specific barriers to early
2:05:02
involvement remain very unclear. The General Medical Council highlights that new guidelines should know how to contribute to research for medical students and to deliver high quality patient care.
2:05:17
In line with this, our study aimed to identify what are the barriers to neuroscience research engagement and to evaluate the impact of a targeted webinar series on influencing medical students'
2:05:31
perspectives.
2:05:34
Their methods from September to December of 2023,
2:05:41
they developed and delivered a four part online webinar series to students across 20 universities worldwide.
2:05:50
Academic clinicians presented neuroscience research projects, discussing research methods, academic practice, tips for getting involved,
2:06:01
And there was all anonymous pre - and post-webinar Google Forms surveyed were distributed to the students.
2:06:11
And the results indicated prior to the webinar, students rated about 56 of them feeling equipped to engage in research. But post-webinar, this increased to 78, which is significant. And among the
2:06:26
students for prior dissertation experience, 95 reported an increased interest in research, while 66 of the students expressed uncertainty about exploring research opportunities.
2:06:42
52 reported that the webinar series helped them. I'll deviate these barriers. And additionally, 95 felt they had gained a better understanding of neuroscience research. And 64 felt the series
2:06:56
increased that are likely out of future opportunities. So they all became much more interested after the seminar in pursuing and getting interested in research. The audience reaction show I'd love
2:07:10
to bring this format to my own university. Happy to chat offline about how to do it. This is a good example of a student-led intervention with measurable impact should be published as a short linked
2:07:23
report in a medical education focused journal, which this will be done And the fact that you reach students across 20 universities is quite impressive on its own. I agree with that.
2:07:39
Next presentation is the impact of a webinar series on student perspectives to neuroscience research barriers presented by Amelia Parsi. Amelia, oh, you speak. Go ahead. That's good. Yeah, so
2:07:53
just to get a little summary about what our project was looking into before starting this project. we noticed that there was a huge gap in how comfortable students felt engaging with research,
2:08:08
particularly neuroscience research, and engagement across medical schools and medical students' density. We are being minimal until it's an optional requirement in terms of the dissertation or part
2:08:22
of the medical school curriculum. And so we wanted to basically talk with us and see what the particular barriers are that students tend to face, or if there is anything that we can do as students
2:08:40
or brush for more engagement, particularly in neuroscience research. And so what we did from period of September to December 20, we created an online webinar series, where we invited academic
2:08:57
clinicians to come and present their research work. and also give students information on their careers. And each session was finalized with a Q and A session where students, but in a judgment-free
2:09:12
zone, ask all their questions to those academic clinicians about how they got started and personal advice and things like that. And so these webinars were available for students' access from any
2:09:31
university around the world. And we had about 20 universities that were included or academic clinicians were clinicians both from the UK, but also international as well. And then before and after
2:09:48
each webinar, we created anonymized Google Forms that asked students' questions about what the particular areas were to research. and how those barriers and their mindset towards getting involved
2:10:05
with research change often depending on what my series is. And in terms of our results, we noticed that their world is pretty significant increase in the
2:10:19
ability of students to feel like confident getting engaged with research. So before this theory, for example, students rated 28 out of five And how equipped they felt to engage with research and
2:10:33
afterwards, the same piece of 39 out of five. We noticed that many students who had prior exposure through medical school requirements, a good dissertation felt a lot more confident getting
2:10:47
involved with research. And overall, our study basically found that the webinar series did have a pretty good impact are making students feel more comfortable. and know what the steps are to make
2:11:03
and so we think that having a really early structured research exposure opportunity for students can be really good to the thing about student research engagement and it might be something to think
2:11:18
about in terms of medical school curriculum as well since dissertations often try to
2:11:25
later on in the local school journey, you know, I don't know about it.
2:11:34
Great. Thank you. Um, Amelia, could I just point out, I think there was some echoing as the, um, uh, Oh, sorry. You know, the song quality wasn't great.
2:11:47
And were you able to hear me? Yeah, hello
2:11:54
I think it may still be somewhere Queen.
2:11:60
Sorry about that. Yeah, there's something in the background.
2:12:05
Anyway, let's share how to fix. Okay. Anyway,
2:12:12
I can't hear you. Okay. It's just that the sound quality was not great So, okay. So thank you for the presentation. Can I ask because this project is very much based on, you know, to help
2:12:31
medical students to understand research and develop their research skills. So how is your project clinically relevant then? So, we mentioned in our background that one of the GMC.
2:12:53
The criteria is that all graduates should know how to contribute research and develop high-quality patient care. And I think this relates clinically because having a really good research foundation
2:13:09
and knowing how to go about research could be a tool that makes you a better clinician in terms of being able to keep up with recent guidelines, being involved in those updates of guidelines and
2:13:11
contributing to research as a
2:13:27
direct impact and through clinical side of things as well so you can be able to have a better position. So indirectly, I think it does have an impact on clinical research but on clinical practice
2:13:43
the project itself is kind of just looking at how to build that foundation. Okay, great. Thank you So do you think it is important? or medical
2:13:57
students to have some experience in research.
2:14:03
I think it's definitely important for all medical students to have at least some exposure to research. And I think that there are some gaps between medical schools across the UK. Some medical
2:14:15
schools don't really focus on it as much until later on And so focus on it at all, and it's mostly student driven, whether they get involved in research. And I think kind of aligning not between
2:14:29
the curriculum or giving students more exposure. I think is definitely beneficial, because like I mentioned, being involved with research
2:14:40
has an impact on clinical practice as well And knowing what's going on in terms of new developments of drugs or treatment funds, I think it's really important to be aware of it. as a medical student,
2:14:59
also as a physician later on. Yeah, great. Thank you. So I suppose part of
2:15:05
the importance, I agree and I think it is important for medical students to have some research experience. I mean, not everyone would want to do research as part of the
2:15:22
career or as a whole career. But in doing how
2:15:30
the
2:15:32
data analysis has happened in the different research method for someone who even they don't want to be involved in research as I suppose, you know, critically the for appraisal
2:15:52
For the papers, for the evidence, it's important because part of the clinical practice is to apply the evidence into your practice and
2:16:07
to knowing that you need to know what evidence that, you know, has sound
2:16:16
bases from the research, I suppose Yeah, I think it is important. I'm just, just, just adding on. Just adding on to that I think it's also important because a lot of students may not even know
2:16:35
that they're interested in research or think that they're not interested because of the lack of exposure, but however, once they actually get involved or get involved with the project that choose
2:16:49
and not they're interested in.
2:16:52
I think that opinions can also change on whether they're actually interested in research, and I think it's important that everyone gets some sort of exposure to kind of explore whether they're
2:17:03
interested or not.
2:17:06
Yeah. Yeah, very good. Very good point So, I suppose the next question is the webinar series
2:17:18
that you use in this study. I assume it's sort of a more general research methodologies and statistics and things like that So, so why is it specific to neuroscience research then?
2:17:40
So, when we did this project, we did it with the Edinburgh University Murrow Society And so we were particularly interested in narrow because we were part of that. society and we have a particular
2:17:54
interest in that field.
2:17:57
Additionally, just by doing literature reviews, we also found that with neuroscience, particularly neurophobia is a huge barrier. And many students think that neurology and neurosurgery for some
2:18:15
reason is a lot harder than other specialties that they've been exposed to And university so far and so we kind of want to explore that further and see why this neurophobia exists and what exactly are
2:18:31
the specific reasons and how we can powerful those reasons. So I guess the combined interest from already being a part of the neuro-society and then also knowing that this neurophobia exists from our
2:18:45
literature to you is what made us really want to hone in on this idea and see it. We could help. on top of the barrier by providing students with mentorship.
2:18:58
Okay, thank you. And I take it in, in that case, are these sort of
2:19:07
webinars the, you know, can they be applied to, I suppose to
2:19:13
more sort of a general medical education scenario? Yeah,
2:19:21
I think they definitely could be. I think we were very specific in our study, but I think that the impact can be a lot more general. I think creating a webinar series, tackling different
2:19:37
specialties and bringing in different clinicians is a very attainable goal. And I think it would have a similar impact as well as research as a whole is if something that students don't really get
2:19:49
involved with until later on.
2:19:52
It's not just particularly in response to research. So I think that
2:19:57
all of our series are just enough to be applied to medical students in general. Okay, okay. And I mean, it is a very good study that demonstrates the intervention has definitely had, you know,
2:20:11
being
2:20:17
beneficial
2:20:20
So what's the next step then?
2:20:26
I think the next step, now that we know that something like this can be beneficial, we actually did this a couple of years ago. So since then we've continued to do this series and we've kind of
2:20:38
expanded the series by bringing in different sub-specialists within the neurofield, whether it be neurosurgery or neuroscience or neurobiology
2:20:49
We've also brought it to the attention of our buttocks. school and we have conversations with the dean of medicine about how earlier research exposure has a good impact and it is a tool that I think
2:21:03
all medical students should have in order to do good clinicians even if it is minimal exposure. So I think the next steps would be to continue with the webinar series. You mentioned a great point
2:21:16
about how this applies to medical students in general so potentially even collaborating with other societies and giving them the ideas so that they can do the same for different specialties within
2:21:30
their student groups.
2:21:33
And yeah really just discussing things with the medical school as well just to see if it's going to be implemented in the very few months since we
2:21:44
know that that is the biggest driver of student engagement.
2:21:48
Absolutely absolutely and Great, and thank you very much. Thank you so much. Rosa, have you got any questions? Yeah, Amelia, thank you for the presentation. I really liked your talk. I just,
2:22:03
I sat up two questions kind of joined together. The first one would be, did you notice any kind of year group within medical school that kind of joined your webinar series a lot more than compared
2:22:19
to the other year groups? And did you notice any particular findings in terms of what they said their perspectives were controlled for, or kind of differentiated like a year one, year two's
2:22:34
perspective versus year four, year five, and were there any kind of major differences there?
2:22:41
Yeah, those are really good questions. I'll talk for your first question first. In terms of particular year groups that got involved, There was a high volume of like first years and then also
2:22:55
fourth slash fifth years, and I think for different reasons. I think around fourth and fifth year students are trying to build their CVs and trying to get involved with research and trying to think
2:23:10
about how they're going to build their careers. And I think that the webinar series is a really good way to not only find mentors to help them with that, but also learn more about how to get
2:23:22
involved in research and build the careers. We had that QA session at the end, but then we also had lots of first-year students as well who basically didn't really know much but wanted to get
2:23:34
involved and just learn how to get involved from scratch. In terms of the barriers that were different between the two, I think overall the most common barrier. students out it was just not knowing
2:23:51
where to start or who to contact. And I think that also really reflected on the first years in the younger years. So not really knowing how to access resources at medical school and
2:24:07
not really knowing how to contact mentors, how to send them emails, how to make meetings with them. I think that was the biggest barrier for that group For the group that were mostly four years and
2:24:21
50 years, they'd already gotten some exposure through dissertations and through medical school curriculums. We have something in Edinburgh called an SSC5, which is like a student selected research
2:24:34
component that they had to do during medical school. So they did have some exposure, but at that point, it was mostly just like finding the right mentor and how
2:24:46
to find a project with their interest in them. So I think through the webinar series, they're all able to ask their specific questions to these academic clinicians, and they were able to get their
2:24:59
answers, which was really helpful. But yeah, the barriers
2:25:05
they've come to to have a look at their different groups. Thank you. Thank you for your answer. I don't have any more questions. Thanks.
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