Scientific meeting

Scientific meeting

It is ironic that doctors, for whom protecting health are a primary responsibility, contribute to global warming through unnecessary attendances at international conferences.

High quality medical education is essential for patient care, and the educational benefits of conference attendance must also be considered. But “let’s be honest, when did you last learn anything really important at a large meeting?”

Evidence that attending conference lectures improves practice is scant.


Annual scientific meetings serve as a forum for the dissemination of new research findings. The presentations of these meetings should be of high scientific quality because they have the potential to impact future research projects and current clinical practice. Moreover, the publication of these findings as full articles is extremely important to increase its dissemination. Unfortunately, while evaluating the publication rate of 307,028 abstracts presented in biomedical meetings, a systematic review reported that only 37.3% were further published, leaving a great number of studies restricted to the events.

Medical conferences: value for money? 1).

Student/trainee conferences are typically cheaper than professional conferences, but as they are not acknowledged in national scoring systems for medical and surgical training applications, they may have worse attendance than otherwise possible.


In a cross-sectional database review, 162 conferences were identified through a systematic search of two conference databases by three independent researchers. χ2 tests were used to compare scientific quality between student/trainee and professional conferences and the likelihood of offering different types of discounts. Independent t-tests were employed to determine cost differences between the two categories of conferences.

The data revealed that there was no significant difference between student/trainee and professional conference’s likelihood of declaring information on their abstract review processes (p=0.105). There was no difference in speaker seniority, determined by the tool the authors developed (p=0.172). Student/trainee conferences were significantly more likely to offer workshops (p<0.0005) and were cheaper than professional conferences (p<0.0005).

These results show that student/trainee conferences offer a similar level of scientific quality to professional medical conferences in the UK at a fraction of the cost, which should be reflected within the national scoring systems 2).


The advantages of Web conferencing are multiple. It removes the need for long and expensive travels that take up a lot of time, and remove you from your family and practice. By avoiding cost for travel and stay, conferences (and therefore, knowledge) can be made accessible for a larger audience, especially in developing countries. By avoiding travel itself, assuming you do not travel by bike or sailboat, CO2 emission can be reduced too. Online conferencing also allows for a more flexible schedule: you may not be able to attend a conference abroad for that one surgery or appointment that cannot be postponed. In that case you may still be able to attend other lectures or sessions if you can follow them from your office or your home. It is perfectly possible to include checks whether you actually watched a video, which would allow for CME points as you would get during an on-site conference 3).

The quality of a scientific meeting can be quantified by the rate of full publications arising from the presented abstracts and the impact factor of the journals in which the studies were published.

The aim of a study of Sarica et al. was to investigate the publication rates of presentations from the 2013 World Society for Stereotactic and Functional Neurosurgery (WSSFN) quadrennial meeting.

Scopus and PubMed databases were searched for the authors of the presentations to identify full publications arising from the relevant abstracts. Author and content matching were used to match an abstract with a full publication. Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis.

In total, 77% (57/74), 56% (44/79), and 50% (79/157) of the paper, flash, and poster presentations, respectively, have been published, with an overall publication rate of 58% (180/310). Articles received a total of 5,227 citations, with an average of 29 ± 64.1 citations per article. The first authors who published their studies had a significantly higher h-index than those who did not publish (p = 0.003). The most preferred journals for publication were Journal of NeurosurgeryActa Neurochirurgica, and Stereotactic and Functional Neurosurgery. The majority of the articles (117/180 [65%]) were published in a quartile 1 or 2 journal. The average journal impact factor (JIF) was 4.5 for all presentations, and 7.8 for paper session presentations. Studies presented in paper sessions were published in significantly higher-impact factor journals than those presented in poster sessions (p < 0.001).

The WSSFN Congress had a relatively high overall publication rate (58%) compared to both other neurosurgical congresses and congresses in other scientific fields. The average JIF of 7.8 is a reflection of the high quality and high impact of the paper session presentations 4).

Six Tips for Getting the Most from Your Next Conference

  1. Sit at the front during talks: Even if this is not your style (or especially if this is not your preference), this will help you feel more involved in the talk.

  2. Take copious notes: Whether you need them or not, taking notes during presentations helps focus the mind.

  3. Rate all speakers for content and presentation: This is a way to keep yourself alert as well as help yourself think critically about talks’ content. For the best presentations, it will also give you notes about style or techniques to integrate into your next talk.

  4. Break away: People tend to attend conferences with colleagues, co-workers, and friends – people they already know. But during talks and at meal times, try and sit with people you don’t know. You are bound to learn something new, whether it is about work in your field, how other institutions function, or how different people approach questions relevant to your work.

  5. Be excited about your science: If you’re excited about your science, others will feed off of that excitement. Whether it is during a formal talk, a panel discussion, a poster session or just talking to people in the hallways, keep in mind that you are selling your science. Also remember that everyone is being bombarded with talks and research: the enthusiasm you muster will go a long way to getting peoples’ attention.

  6. Size matters: Small meetings often have a singlemindedness about a particular subject that can benefit all participants. There are likely to be fewer competing sessions at small meetings, and you can probably actually meet the speakers, instead of stand in line.


1)

Swash M, Lees AJ. Medical conferences: value for money? J Neurol Neurosurg Psychiatry. 2019 Apr;90(4):483-484. doi: 10.1136/jnnp-2018-319248. Epub 2018 Oct 18. PubMed PMID: 30337441.
2)

Sharp EW, Curlewis K, Clarke THS. Stop paying through the nose: student and trainee medical conferences offer better value for money than professional alternatives. Postgrad Med J. 2019 Nov;95(1129):577-582. doi: 10.1136/postgradmedj-2019-136734. Epub 2019 Jul 24. PubMed PMID: 31341039.
3)

Kubben PL. Online conferencing: Less CO(2), more effective? Surg Neurol Int. 2012;3:115. doi: 10.4103/2152-7806.102322. Epub 2012 Oct 13. PubMed PMID: 23226602; PubMed Central PMCID: PMC3512339.
4)

Sarica C, Kucuk F, Ozen A, Aksu Sayman O. Publication Patterns of Presentations at the 16th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery. Stereotact Funct Neurosurg. 2020 Feb 19:1-7. doi: 10.1159/000505703. [Epub ahead of print] PubMed PMID: 32074619.

Everolimus for subependymal giant cell astrocytoma

Everolimus for subependymal giant cell astrocytoma

As a result of a trial, the US Food and Drug Administration (FDA) approved everolimus for patients with subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex who are not candidates for curative surgical resection.

Patients ≥ 3 years of age with increasing size of SEGA lesions have had a sustained reduction of SEGA volume on everolimus 1).

A retrospective study included TSC patients being treated with oral everolimus for subependymal giant cell astrocytomas (SEGAs) and angiomyolipomas (AMLs). We recorded the changes in facial angiofibroma. Changes in the Angiofibroma Grading Scale (AGS) indicators were recorded according to erythema, average lesion size, lesion density, and percent involvement on the forehead, nose, cheeks, and chin. The scores were recorded before and after the administration of oral everolimus.

Twenty-one patients being treated with oral everolimus were enrolled in this study. The mean age was 20.5 years (range 11-44 years, 4 males, and 17 females). The mean dose of oral everolimus was 3.6 mg/day. Clinically meaningful and statistically significant improvement was observed in erythema (p = 0.001), average lesion size (p < 0.001), lesion density (p < 0.001), and percent involvement (p < 0.001). Changes in the AGS findings were statistically significant on the forehead (p = 0.001), nose (p < 0.001) cheeks (p < 0.001), and chin (p = 0.004).

Everolimus shows evident improvement and is approved for TSC-associated SEGAs and AMLs. The current study demonstrated the efficacy of oral everolimus in reducing facial angiofibromas, showing the parallel benefits of the treatment protocol for TSC 2).

Case reports

A 21-year female patient with large bilateral angiomyolipoma (AML) in both kidneys with the longest diameter more than 12.3 cm and subependymal giant cell astrocytoma (SEGA). Treatment with everolimus (EVE) was initiated at a dose of 10.0 mg/day and continued during the following 3 years. Magnetic resonance imaging (MRI) was performed before treatment with everolimus was initiated, and consequently at 12 and 36 months for follow-up of the efficacy of the treatment. After 3 years, the total size of the largest AML decreased by ~24.0% in the longest diameter. A reduction in the total size of SEGA was also observed. The most common adverse effect of treatment was stomatitis grades 3 to 4 and one febrile episodes associated with a skin rash that required a reduced dose of EVE. In conclusion, the everolimus treatment improved even such a large renal AML and the effect persisted during the long-term administration with a small number of adverse effects. A positive effect was observed on the brain tumor as well 3).


A case of a woman with TSC and Multifocal micronodular pneumocyte hyperplasia (MMPH) who received everolimus, for the treatment of a subependymal giant cell astrocytoma (SEGA). After 3 months of therapy, a remarkable decrease in density of all pulmonary MMPH lesions was observed, without any change in size. This shows that everolimus is active on MMPH similarly to its effects on SEGA, renal angiomyolipomas, and pulmonary lymphangioleiomyomatosis in TSC, and suggests that the dysregulated activation of mTOR which characterizes TSC also plays a role in the pathogenesis of MMPH 4).


The aim of a study was to evaluate the efficacy of oral everolimus for TSC-associated angiofibromas.

This retrospective study included TSC patients being treated with oral everolimus for subependymal giant cell astrocytomas (SEGAs) and angiomyolipomas (AMLs). We recorded the changes in facial angiofibromas. Changes in the Angiofibroma Grading Scale (AGS) indicators were recorded according to erythema, average lesion size, lesion density, and percent involvement on the forehead, nose, cheeks, and chin. The scores were recorded before and after the administration of oral everolimus.

Twenty-one patients being treated with oral everolimus were enrolled in this study. The mean age was 20.5 years (range 11-44 years, 4 males, and 17 females). The mean dose of oral everolimus was 3.6 mg/day. Clinically meaningful and statistically significant improvement was observed in erythema (p = 0.001), average lesion size (p < 0.001), lesion density (p < 0.001), and percent involvement (p < 0.001). Changes in the AGS findings were statistically significant on the forehead (p = 0.001), nose (p < 0.001) cheeks (p < 0.001), and chin (p = 0.004).

Everolimus shows evident improvement and is approved for TSC-associated SEGAs and AMLs. The study demonstrated the efficacy of oral everolimus in reducing facial angiofibromas, showing the parallel benefits of the treatment protocol for TSC 5).


1)

Franz DN, Agricola K, Mays M, Tudor C, Care MM, Holland-Bouley K, Berkowitz N, Miao S, Peyrard S, Krueger DA. Everolimus for subependymal giant cell astrocytoma: 5-year final analysis. Ann Neurol. 2015 Dec;78(6):929-38. doi: 10.1002/ana.24523. Epub 2015 Nov 9. PMID: 26381530; PMCID: PMC5063160.
2)

Wei CC, Hsiao YP, Gau SY, Wu YT, Wu CT, Wu MH, Tsai JD. The Efficacy of Everolimus for Facial Angiofibromas in Tuberous Sclerosis Complex Patients Treated for Renal Angiomyolipoma/Subependymal Giant Cell Astrocytoma. Dermatology. 2020 Oct 8:1-6. doi: 10.1159/000510222. Epub ahead of print. PMID: 33032292.
3)

Rambabova Bushljetik I, Lazareska M, Barbov I, Stankov O, Filipce V, Spasovski G. Bilateral Renal Angiomyolipomas and Subependymal Giant Cell Astrocytoma Associated with Tuberous Sclerosis Complex: a Case Report and Review of The Literature. Balkan J Med Genet. 2021 Mar 23;23(2):93-98. doi: 10.2478/bjmg-2020-0017. PMID: 33816078; PMCID: PMC8009567.
4)

Daccord C, Nicolas A, Demicheli R, Chehade H, Hottinger AF, Beigelman C, Lazor R. Effect of everolimus on multifocal micronodular pneumocyte hyperplasia in tuberous sclerosis complex. Respir Med Case Rep. 2020 Nov 25;31:101310. doi: 10.1016/j.rmcr.2020.101310. PMID: 33312857; PMCID: PMC7720070.
5)

Wei CC, Hsiao YP, Gau SY, Wu YT, Wu CT, Wu MH, Tsai JD. The Efficacy of Everolimus for Facial Angiofibromas in Tuberous Sclerosis Complex Patients Treated for Renal Angiomyolipoma/Subependymal Giant Cell Astrocytoma. Dermatology. 2020 Oct 8:1-6. doi: 10.1159/000510222. Epub ahead of print. PMID: 33032292.

Chiari type 1 deformity classification

Chiari type 1 deformity classification

Nishikawa et al. classified Chiari malformation type I (CM-I) according to the mechanism of ptosis of the brain stem and cerebellum, based on a morphometric study of the posterior cranial fossa (PCF) and craniovertebral junction (CVJ). Surgery was performed to manage the mechanism of the hindbrain ptosis. They calculated the volume of the PCF (VPCF) and the area surrounding the foramen magnum (VSFM) and measured the axial length of the enchondral parts of the occipital bone (occipital bone size) and the hindbrain. According to these measures, they classified CM-I into type A (normal VPCF, normal VSFM, and normal occipital bone size), type B (normal VPCF, small VSFM, and small occipital bone size), and type C (small VPCF, small VSFM, and small occipital bone size). Foramen magnum decompression (FMD) (280 cases) was performed on CM-I types A and B. Expansive suboccipital cranioplasty (ESCP) was performed on CM-I type C. Posterior craniocervical fixation (CCF) was performed in cases with CVJ instability. Lysis of the adhesion and/or sectioning of the filum terminale was performed on cases with tethered cord syndrome. Both ESCP and FMD had a high rate of improvement of neurological symptoms (87%) and recovery rate. There was only a small number of complications. CCF had a high rate of improvement of neurological symptoms (88%) and joint stabilization. In the management of Chiari malformation, appropriate surgical methods that address ptosis of the hindbrain should be chosen. Each surgical approach resulted in a good improvement of neurological symptoms 1).


Valentini et al. suggested defining an association of Chiari type 1 deformity plus untreated sagittal synostosis, a new subtype of complex CM1. For the high percentage of complications and multiple procedures needed to solve the CM1, they advise identifying by 3D-CT scan these children before performing craniovertebral decompression (CVD). They suggest also that if left untreated, sagittal synostosis may lead to the delayed occurrence of a challenging subset of CM1 2).


Chiari malformation Type 1.5 (CM 1.5) was defined as the association of Chiari malformation Type I (CM I) and brainstem herniation.

Although CM 1.5 patients presented with brainstem herniation and more severe tonsillar herniation, other clinical and imaging features and surgical outcomes were similar to CM I patients. Liu et al. think CM 1.5 is just a subtype of CM I, rather than a unique type of Chiari malformations 3).


Taylor et al. identify two subtypes, crowded and spacious, that can be distinguished by MRI appearance without volumetric analysis. Earlier age at surgery and the presence of syringomyelia are more common in the crowded subtype. The presence of the spacious subtype suggests that crowdedness alone cannot explain the pathogenesis of Chiari I malformation in many patients, supporting the need for further investigation 4).

see Pediatric Chiari type 1 deformity.

see Chiari type 1 deformity and syringomyelia.


1)

Nishikawa M, Bolognese PA, Kula RW, Ikuno H, Takami T, Ohata K. Surgical Management of Chiari Malformations: Preliminary Results of Surgery According to the Mechanisms of Ptosis of the Brain Stem and Cerebellum. J Neurol Surg B Skull Base. 2021 Apr;82(2):264-272. doi: 10.1055/s-0039-1697977. Epub 2019 Sep 30. PMID: 33816049; PMCID: PMC8009696.
2)

Valentini LG, Saletti V, Erbetta A, Chiapparini L, Furlanetto M. Chiari 1 malformation and untreated sagittal synostosis: a new subset of complex Chiari? Childs Nerv Syst. 2019 Jul 21. doi: 10.1007/s00381-019-04283-0. [Epub ahead of print] PubMed PMID: 31327038.
3)

Liu W, Wu H, Aikebaier Y, Wulabieke M, Paerhati R, Yang X. No significant difference between Chiari malformation type 1.5 and type I. Clin Neurol Neurosurg. 2017 Mar 30;157:34-39. doi: 10.1016/j.clineuro.2017.03.024. [Epub ahead of print] PubMed PMID: 28384597.
4)

Taylor DG, Mastorakos P, Jane JA Jr, Oldfield EH. Two distinct populations of Chiari I malformation based on presence or absence of posterior fossa crowdedness on magnetic resonance imaging. J Neurosurg. 2017 Jun;126(6):1934-1940. doi: 10.3171/2016.6.JNS152998. Epub 2016 Sep 2. PubMed PMID: 27588590.
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