High purity Sucrase (maltase; Bacillus stearothermophilis) / β-Galactosidase (Aspergillus niger) for use in research, biochemical enzyme assays and in vitro diagnostic analysis.
One Unit of sucrase activity is defined as the amount of enzyme required to release one μmole of glucose per minute from sucrose (10 mM) in sodium phosphate buffer (100 mM), pH 6.8 at 40oC.
This enzyme mixture gives complete hydrolysis of sucrose, maltose and lactose under the defined assay conditions, with no hydrolysis of the trisaccharide, β-D-Fruf-(2,1)-β-D-Fruf-(2,1)-β-D-Fruf.
Used for removal of sucrose, maltose and lactose in the measurement of dietary fibre.
Efficacy of reducing sugar and phenol–sulfuric acid assays for analysis of soluble carbohydrates in feedstuffs.
Hall, M. B. (2013). Animal Feed Science and Technology, 185(1), 94-100.
Reducing sugar (RSA) and phenol–sulfuric acid (PSA) assays are commonly used to analyze water-soluble carbohydrates. However, questions have arisen as to their accuracy for measurements of feedstuffs with diverse carbohydrate profiles. This study evaluated the efficacy of RSA and PSA as they would commonly be applied in feed analysis laboratories in measuring a variety of purified carbohydrates. Carbohydrates analyzed were glucose (Glc), fructose (Fru), galactose (Gal), sucrose (Suc), maltose (Mal), lactose (Lac), raffinose (Raf), and inulin (Inu). Variations on the methods used were PSA using Suc (PSA-Suc) or Glc (PSA-Glc) as standard sugars, and RSA with a 50:50 Glc:Fru blend as the standard with four hydrolysis methods: acid hydrolysis with 0.037 M sulfuric acid (RSA-H2SO4) or 0.5M hydrochloric acid (RSA-HCl), or enzymatic hydrolysis with invertase (RSA-Inv) or an enzyme blend including sucrase, α-glucosidase, and β-galactosidase (RSA-EnzBl). Recovery of carbohydrate was calculated on a dry matter (DM) basis as (carbohydrate detected g/kg DM)/(carbohydrate present kg/kg DM), with 'close to' complete recovery defined as values falling within the range of 920–1080 g/kg. Monosaccharide recovery did not differ between unhydrolyzed vs. hydrolyzed samples in RSA indicating no destruction of carbohydrate by hydrolysis method. For RSA, recoveries of Glc, Fru, and Gal were 979, 1042, and 706 g/kg, respectively. Such response differences among monosaccharides are inherent to RSA, and can affect carbohydrate recovery values. Methods that provided close to complete recovery by carbohydrate were: PSA-Suc and all RSA for Suc; PSA-Glc and RSA-EnzBl for Mal and Lac; PSA-Suc, RSA-H2SO4, RSA-HCl, and RSA-Inv for Raf; and RSA-H2SO4 and RS-HCl for Inu. None of the assays gave complete recovery of the diverse set of purified carbohydrates. Allowing a range of 920–1080 g/kg for recoveries on individual carbohydrates, RSA-H2SO4 and RSA-HCl would give the closest to complete recovery values for feeds such as forage and soybean in which Suc, Raf, and Inu were important, whereas RSA-EnzBl would be useful in feeds such as forages or dairy products when Suc, Mal, and Lac are of interest. The allowed 920–1080 g/kg range of acceptable recoveries addresses the point that given very diverse carbohydrate complements of feeds, these assays will not be extremely precise, but may still be serviceable for diet formulation. The most accurate measurements will be achieved by selection of detection method, hydrolysis method, and carbohydrate standard to give greatest recovery of predominant carbohydrates in feedstuffs.


text:
#include_next <stdlib.h>

#ifndef GLIBCEMU_STDLIB_H
#define GLIBCEMU_STDLIB_H 1

#include <sys/cdefs.h>

__BEGIN_DECLS

long int random(void);

void srandom(unsigned int seed);

extern void qsort_r(void *base, size_t nmemb, size_t size,
                    int (*compar)(const void *, const void *, void *),
                    void *arg);

__END_DECLS

#endif

redpajama_set_name: RedPajamaGithub


text:
Scientists Use Artificial Intelligence to Classify Plant Species
Zayan Guedim Sep 10, 2017 at 5:15 am GMT
Sep 10, 2017 at 5:15 am GMT
Sukjai Photo | Shutterstock.com
Deep learning algorithms were trained to recognize and classify thousands of plant and animal specimen, with great results.
Can you tell the difference between a cheetah and a leopard, an alpaca and a llama, a donkey and a mule?
What about plants? Can you differentiate a daisy from a chamomile flower? A rose from a begonia?
No? Neither can I! But, for my part, I decided a long time ago I'd let computers do all of my thinking.
Finally, they're catching me up.
To be fair, those were common examples of animals and plants that are easily confused. There are several millions of species that share many traits while being far apart–biologically speaking.
Deep learning recognizes and classifies thousands of plant and animal specimen.Click To Tweet
If you have a plant whose name you don't know, you now have the option to upload photos to plant identification groups on Facebook and let members identify it for you.
You can also use a specialized app that allows you to identify a plant based on one or more photos, which is effective in some cases, but not always.
Deep Neuronal Networks Trained to ID Animal and Plant Species
A few years ago, deep learning networks were having a hard time telling a cat from a human, but now, they're able to identify thousands of species.
In 2012, Google's neural network made headlines after it taught itself to differentiate between the shapes of humans and cats with 70% accuracy.
Now, merely five years later, a contest asked researchers to train an AI to ID over 5000 different species of plants and animals.
Under the aegis of Google, the contest, called the iNaturalist Challenge 2017, was held between June and July on Kaggle by Grant Van Horn, a graduate student at the California Institute of Technology.
As part of the iNat dataset, there were 675,000 training and validation images, corresponding to 5,089 plant and animal species. This was put at the disposal of the participating teams.
Final results of the iNat challenge are yet to be disclosed, but some teams claim their neuronal networks managed to get 85% prediction accuracy.
Taxonomic AI: Automatically Classifying Thousands of Herbarium Specimen
A herbarium is a collection of dried and pressed plants, put between sheets of paper, usually carefully composed by researchers.
With an estimated 350 million plant species in the world, only a small portion of that has been digitized.
Erick Mata-Montero of the Institute of Technology-Costa Rica and botanist Pierre Bonnet of the French Agricultural Research Centre for International Development have contributed to the Pl@ntNet app project by doing the digitizing work.
Pl@ntNet is an app that helps to identify plant specimen based on pictures.
Now, as reported by Nature, the team trained a similar AI algorithm to identify thousands of dried plants composing a very rich herbarium.
The research duo fed their algorithm with 260,000 pictures taken from herbarium sheets, corresponding to over 1,000 different species.
The AI algorithm took up the challenge and made a correct answer 90% of the time intially. Then, it finished with an 80% accuracy (correctly identifying 208,000 plants)–enough to make a human taxonomist green with envy.
Both initiatives demonstrate the significant AI progress made in recent years and speak volumes about the advances ahead and the innumerable opportunities that are opening up with this technology.
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redpajama_set_name: RedPajamaCommonCrawl


Choosing a colour palette is both an important and very daunting part of decorating your home. Most people are not very good with pairing colours or complementing them. This can end up in some serious disasters. Choosing colours is something personal. The colours in our homes show our personality and taste. Therefore, we need to be very careful how we choose them and how we combine them. But how to pick among thousands of colours and countless colour combinations and schemes? Well, you'll need to follow a few general rules, pick the right option for you, and go for it. Here are some tips for picking colour palettes for your home.
The first thing you need to do, is pick the colours you would like to see in your home. Most of us already have a favourite colour they would like to work around. For the rest, useful tools like the colour wheel can help you take a look at all the colours, and choose the ones that please you the most. Nowadays there are plenty of online tools, which not only show you all the colours, but they also show you which colours match them, which ones complement them and which ones contrast them. There are primary, secondary and tertiary colors.
Primary colours – red, blue and yellow. They are pure and cannot be created.
Secondary colours – orange, purple and green. They are created by mixing equal parts of 2 primary colours. For example, blue and yellow make green.
Tertiary colours – they are a mixture of secondary and primary colours, in various parts. The original colours lose their vividness to create a new, less bright shade. Decorators use white and black to soften or darken the hue.
Monochromatic – the monochromatic colour scheme uses tones of the same colour with the addition of black or white to darken or lighten the colour. For instance, in this palette you can use standard blue, dark navy blue and light sky blue. They are all hues of the same colour, and they can be used to create various interesting effects.
Analogous – the analogous scheme uses colours, which appear next to each other on the colour wheel. In this case, yellow should be used with orange or green, blue would go with green or purple, etc. These combinations usually create a very colourful and soothing atmosphere in the room.
Contrast – The contrast scheme is favourite to many decorators, because it brings more energy and introduces more colour to the house. Here a combination of two contrasting colours is used, like green and blue, red and purple, yellow and orange, black and white even.
Complementary – In the complementary colour palette, two opposing colours are used to create a bold and dramatic scheme. One of the colours dominates, while the other is used to compliment the first one. A popular combination here is blue and orange.
The easiest and safest way to pick colours for your home, is to work vertically. In this case, you should use a dark colour for the floor, medium colours for the walls and furniture, and a light colour for the ceiling. When you think about it, this arrangement replicates the outside world, because in our environment, the darker colours are usually below our feet, the medium ones are all around us (trees, buildings, etc.), and the lightest ones are in the sky.
Many people think, that they should pick colours for the walls and floors first, and look for furniture afterwards. But the truth is, that it's a lot easier to pick the furniture first and decide on a wall colour afterwards, because paint is cheaper than furniture, and this way you won't have to check every furniture store for the right sofa colour. And if you're into patterned furniture, all you need to do is pick the colours you like from the patterns. For your walls, you should pick the dominating colour of the pattern. Or, if you want a more neutral wall colour, then you should consider the whites and beiges of the pattern.
There are many rooms in the house, and most homeowners have issues deciding where to start. Professional designers advise to start either from the biggest room, from the most used one, or from the formal parts of the house. This usually means the living room and the entryway. First you need to choose the colour palette for these places, then pull one colour from this palette, tone it down and use it for one or more of the other rooms. For example, you can take the bright red sofa from your living room, tone it down to burgundy or amaranth, and use this new colour to decorate more private areas of the house, like the bedroom or bathroom.
Many homeowners find it useful to use the 60-30-10 rule when choosing the colours of their homes. This rule is very simple – you just divide the colours into components. So, 60% is the colour of the walls (dominant), 30 % is the secondary colour (the upholstery and appliances), and the accent colour takes 10% of the room, which is basically your accessories. This combination works every time, because the ratio ensures the proper balance between the colours, and they all pop just enough to look interesting.
Most people aim for either warm or cool colours when they decorate their homes. But what they often underestimate, is the power of warm and cold contrasts. For instance, gray goes well with warm honey-coloured hues, some shades of red complement perfectly certain shades of blue, and so on. This combination is perfect for common areas around the house, because they create enough intensity to wake up even the sleepiest person.
If you have 1 favourite colour that you would like to display in full, then you should try the monochromatic arrangement. The best way to make this look work, is by balancing them with black or white. So, if you choose to have everything in the room blue, then white floors and walls will complement it best, making the room look saturated, but not too overpowering.
Limiting your colour palette to three colours is a strategy, that will guarantee you success in every kind of space. This solution in non-intrusive, it looks good in both big and small spaces, and it's always on trend. For instance, a combination of navy blue, sunny yellow and grass green would be the perfect palette for a bedroom, because it's fresh and calming at the same time.
Many people think that painting a small room white will make it seem bigger. Well, they are right, but it doesn't mean that this is the only option. In the last few years a new trend is on the rise – to paint a small room in a colour that will make it pop. So, instead of the boring white, try something bold and bright for your small rooms, it will provide them with more character and will make people look twice when they walk past them.
Jane Wilson is a business manager, a mother and a blogger from Melbourne, Australia. She manages the local branch of Fantastic Cleaners – a home improvement company, which provides a wide range of services to home and business owners. She also has a small blog, called Modern Housewives, where she shares all kinds of tips on topics like home maintenance and gardening, as well as interesting events around Melbourne.


text:
Diving>
Under the Sea: 12 Best Snorkel Spots in the U.S.
Post category:Diving / Dry Tortugas / Key Largo / Key West / Marathon / Tourism
Summer may be slipping away, but you still have time to slip beneath some waves. The best part is — you don't even have to leave the country to do it. Yahoo Travel went in search of easily accessible and interesting places to don fins, mask, and snorkels for a fun day of fish peeping. You might be surprised by just how close to home a few of these are.
New London, Conn.
Ocean Beach Park has something for everyone — a sugar-sand beach, a water park, boardwalk games and attractions, amusement rides, and even an Olympic-size swimming pool. Snorkelers can expect to see schools of sea bass, small urchins, and crabs, but they can also expect chilly water. This week's reported temperatures are in the low 70s; expect that to drop into the upper 60s by September.
Snorkeling in Rhode Island? (Photo: Block Island Tourism)
Block Island, R.I.
This quiet and stunningly beautiful island situated between Montauk and Martha's Vineyard has blissful beaches and water clear enough for snorkeling. The warm Gulf Stream often brings juvenile tropical fish close to shore in this area, making it perfect for possible sightings of colorful fish. Water temperatures are currently a chilly 72 degrees. That will drop into the 60s in the coming months.
The water in Virginia Beach might not be crystal clear, but it's still worth the trip. (Photo:Thinkstock)
Virginia Beach, Va.
The Mid-Atlantic States are not often known for superior snorkeling, primarily due to less-than-perfect water clarity. Everybody loves the beaches, but there is not always a good reason to look beneath the waves. Lynnhaven Dive Centerwill not only teach you the correct way to snorkel, but help you find the perfect spot to put your face in the water. Surface water temperatures are currently in the 80-degree range. Expect that to drop into the 70s in September.
Radio Island, N.C.
Mention snorkeling to most Carolinians and they will scoff — there are an abundance of deep-water wrecks that attract scuba divers, but not much for those wanting a peak from the surface. The jetty at Radio Island is the exception. Discovery Diving in Moorehead City provides directions to the jetty where snorkelers can join the shore divers looking for seabass, flounder, and an occasional flash of tropical color. Water temperature is around the 80-degree mark, but prepare for a dip into the 70s soon.
Peanut Island (Photo: USIslands.org)
Riviera Beach, Fla.
Peanut Island is situated in the Intracoastal Waterway, making it one of the most fascinating parks in Florida. The list of ocean-going sea life that you might see here is a long one, and includes squid, rays, octopus, and brilliantly colored tropical fish. The best time for snorkeling is around high tide. The waters here are a comfortable 85-degrees well into September.
Photo: John Pennekamp Coral Reef State Park Concession
Key Largo, Fla.
Now you are getting to the good stuff. John Pennecamp Coral Reef State Park attracts divers and snorkelers year round. Rent a boat, kayak the mangroves, or take a guided snorkeling tour. The choice is yours! The current water temperature is a toasty 89-degrees. Expect that warmth to slowly dissipate, but remain in the 80s throughout September.
La Jolla, Calif.
Seals, sea lions, and leopard sharks, oh my! SD Expeditions takes divers and snorkelers to see the best that the area has to offer under water, including docile leopard sharks. Your guide will even teach you the "Sting-ray shuffle" method of entering the water that is safe for both you and the bottom-feeding sea life you can expect to see. The Pacific is currently a chilly 70 degrees at La Jolla, dipping into the mid-60's in September.
Photo: Sombrero Reef Marine Sanctuary
Marathon, Fla.
See the world-famous Sombrero Reef Marine Sanctuary withSpirit Snorkeling. Unlike many dive and snorkeling operations, Spirit takes only snorkelers, freeing them to visit nothing but the shallow spots that provide snorkelers the closest look at the reefs. Expect water temps well into the 80's throughout September and even into October.
Bailey's Harbor, Wis.
Water temperatures that have already fallen into the 60s may make the snorkeling tour offered by Lakeshore Adventures a bit too frigid for all but the hardiest. You may prefer a clear-bottom kayak instead to see the maritime history beneath the waves in Door County, saving snorkeling for next summer.
Photo: Dry Tortugas National Park
Key West, Fla.
Several beaches on Key West offer fun snorkeling opportunities from shore, but for pristine snorkeling, take the ferry to Dry Tortugas National Park. The wrecks and patchy reef system surrounding the islands of the national park are home to a diverse array of sea life. Current water temperatures are near 90, and should hold in the 80s throughout most of the fall season.
Photo: River Ventures
Crystal River, Fla.
If swimming with manatees is not on your bucket list, it should be. It's a little early to see large numbers of manatees, but come September and October, there will be rise in the manatee population. Reputable outfitters can take you to the manatees without disturbing their fragile habitat and provide all the gear you need, including wetsuits. Try RiverVentures, which also offers kayak tours and rentals. The water temperature in the river is a brisk 72 degrees year-round.
Snorkelers can enjoy some submerged farm equipment. (Photo: Haigh Quarry)
Kankakee, Ill.
For something completely different, try Haigh Quarry, known as the Caribbean of the Midwest. That may be a bit of an exaggeration, but it certainly works in a pinch as a place to stick your head in the water. You will see an odd assortment of old boats and farm equipment and plenty of cold-water fish. The current water temperature at the surface is a comfortable 78 degrees. That will drop rapidly as the days grow shorter.
Catalina Island, Calif.
An underwater kelp forest in Catalina. (Photo: Thinkstock)
The comparatively warmer waters surrounding Catalina Island bring sub-tropical sea life to the Pacific. The kelp beds are home to seals and sea lions, dolphins, turtles, crustaceans, and vivid orange garibaldi damselfish. Learn how to snorkel and enjoy a guided tour from shore or from a boat with Snorkeling Catalina. The water temperature is a cool 70 degrees well into September.
Source: Under the Sea: 12 Best Snorkel Spots in the U.S.
Tags: Pennekamp, Snorlel
Key Largo's Ken Nedimyer a National Award of Excellence Winner
Women Divers United in Florida Keys Conservation
Kenneth Lohmann Leaving His Mark Offshore Hammer Point Tavernier


BRT Fire and Rescue Supplies invite you to browse our extensive product range of fire and rescue products sourced from quality local and international manufacturers. We supply state and industrial fire departments across Australia by offering an extensive range of fire fighting pumps, nozzles, monitors, LED scene and safety lighting for bushfire and structural operations. Our products are sourced globally from world renowned manufacturers such as; Akron Brass, Scotty Fire Fighter, Vallfirest, Cutters Edge, Tohatsu Fire Pumps, Nightstick as well as our own Big Red Truck products which are made in Australia.
Our company exists to be a tested, proven and trusted supplier of fire and rescue equipment. Fire and Rescue personnel rely on our expertise and experience that delivers confidence, performance and reliability in dangerous life and death situations, where every second counts. As we approach our 20th Anniversary, BRT Fire and Rescue Supplies continues to maintain our vision to be the leader of our industry in quality, innovation and technology.
This website is frequently updated to provide the most accurate, informative and education information provided by the manufacturers we represent. The website is also the home of BIG RED TRUCK, BRT's own range of quality and innovative products. You can also find us and keep up to date with new product updates and special offers with our Facebook and YouTube pages. Visitors to this site are also invited to sign up to our Cooee Newsletter providing the latest product updates and equipment releases.
Subscribe to our FREE email product news and receive The latest updates.
If you missed the latest product news don't worry go to BRT Newsletter Archive.


During tuesday's IAB event in Toronto, entitled The Business of Digital: Metrics – Cracking Cross-Platform, Paul Briggs from Emarketer presented the market insights shaping the Digital Trends of the upcoming year: Artificial Intelligence, Neuro-Marketing, Digital-Out-of-Home (DOOH), Digital Audio and Privacy Regulations.
Specifically with regards to DOOH trends, Campsite was named as a key element for the growth within the Canadian industry. Many are predicting that DOOH investments will surpass traditional OOH ad spending in 2018, thanks to significant static-to-digital conversion, enhanced audience targeting and the accessibility of data.
By delivering an entirely automated process to users, the Campsite platform was designed to become the main hub of the Canadian industry. Recently, the partnership with Native Touch, which allows location-based data from mobile devices to improve targeting options, elevates Campsite to the rank of an unavoidable asset for the development and standardization of the industry.
Campsite's grocery environment is powered by a true 21st century place-based digital network, offering a well-balanced entertaining loop of ads and branded content to customers where "a little wait" is always inescapable: the check-out line. Statistically speaking, 95% of Canadians visited a grocery store an average of 1.6 times in the past week; all of them having to make a stop at the cash register.


text:
Q: how to replace values in all column with condition? The searched result is all about one column, my question is how to replace values in all column when its vale meet a certain condtion
for example
df=
1 20 30
1 4 5
5 8 10

now if the value is larger than 10, replace value to be 10

so my expected result is

df=
1 10 10
1 4 5
5 8 10

the one I am thinking to do is like this:
mask=df>10
df.loc[mask]=10

I got an error of
TypeError: 'float' object is not iterable
Thanks for your help

A: Use DataFrame.clip if need replace to same value:
df = df.clip(upper=10)
print (df)
   0   1   2
0  1  10  10
1  1   4   5
2  5   8  10

Your solution should be changed:
df[df>10]=10
print (df)
   0   1   2
0  1  10  10
1  1   4   5
2  5   8  10

Or with DataFrame.mask:
df = df.mask(df > 10, 10)
print (df)
   0   1   2
0  1  10  10
1  1   4   5
2  5   8  10

redpajama_set_name: RedPajamaStackExchange


text:
Riksväg 29 är en riksväg mellan Karlshamn och Växjö. Vägen förbinder en stor del av småländska inlandet med Karlshamns hamn och västra Blekinge. I Djuramåla, söder om Tingsryd, löper riksväg 29 samman med riksväg 27. Delen söder om E22 är gemensam med riksväg 15.

Standard och planer
Vägen är vanlig, ganska rak landsväg. Hastighetsbegränsningen är till största delen 90 km/tim. Det finns inga kända ombyggnadsplaner (2013).

Historia

Vägen har hetat riksväg 29 sedan år 1962, och innan dess hette den länsväg 76. Vägen längs med Mieån är flera hundra år gammal medan vägen mellan Djuramåla (vägskälet med riksväg 27) och Gäddeviksås byggdes som en AK-väg under 1930-talet.

Vägen var länge en smal och olycksdrabbad väg, som varit samma sedan åtminstone 1940-talet. Sommaren 2004 invigdes dock en ny sträcka igenom Blekinge och Småland som förkortade och förbättrade vägen. En huvudanledning till att vägbygget kom till stånd var en tankbilsolycka 1994 längs den gamla vägen som följde Mieån, som är tillflöde till Karlshamns dricksvattenreserv Långasjön. Vägen förbi Asarum utanför Karlshamn invigdes på det tidiga 1980-talet.

Trafikplatser, korsningar och anslutande vägar

|}

Referenser

29

redpajama_set_name: RedPajamaWikipedia


text:
Amarone Families Press Release
" OUR AMARONE MUST REMAIN EXCLUSIVE, PRECIOUS AND RIGHTLY PRICED ".
TEN HISTORICAL FAMILIES IN VALPOLICELLA ARE JOINING TOGETHER TO UNDERLINE THE IDENTITY OF AMARONE.
The crisis is worrying Italian wineries and the families of Amarone provide a strong reply. In absolute trade down, while oenological universe is trying to progressively reduce prices (very often to the detriment of quality), twelve important families in Valpolicella (Allegrini, Begali, Brigaldara, Masi, Musella, Nicolis, Speri, Tedeschi, Tenuta Sant'Antonio, Tommasi, Venturini, Zenato) join efforts in the name of Amarone.
Here it is the strategy of the newborn association – AMARONE FAMILIES alone represent 55% of the whole value of high-quality Amarone (more than 40% of the total market). Exclusiveness and total quality for the protection and promotion of one of the three quality Italian red wines best known in the world.
"Amarone must remain precious and rightly priced – this is the must announced in Rome by the President Sandro Boscaini (Masi) on the occasion of the press conference organized to introduce the association- so stop to low-cost logics and to the standardisation of taste to satisfy international palate.
The appeal and commercial success of our wine really lie in its identity, a personality which consolidated in the years and comes from the masterly art of historical and specialized producers. Today we want to confirm these values, without conditions".
A hit of pride to defend one of the Italian wines that conquered the world and is enjoying a surprising success in the international market (which absorbs 70% of the entire production)), with twelve wineries in countertrend in a time when some historical Italian wines see their identity in danger, discussing whether "softening" or not their own production rules or longing to get more "modern" through a strong injection of international grape varieties - Amarone raises the stakes on quality and original character of the product. Aim: avoiding to lose the connotation of exclusive and naturally expensive wine, considering the original craft of a delicate production process which implies an accurate selection of grapes, an original drying process (locally known as "appassimento") and a long maturation in noble woods.
To do this, the association technically adopts a "voluntary regulation", which makes its rules even more selective: minimum alcohol volume up to 15%, higher dry extract, release in the market with a minimum of 30 months of maturation. And when necessary, due to problematic harvests, the decision not to classify a vintage.. It follows a price policy which, even watchful to the market, considers the high costs due to a high-quality grape growing and to the special care that this wine requires. In other words, no selling off in the name of a history and quality that cannot accept to be undervalued.
Even today low-cost Amarone, which can be found at the supermarket at really low prices, - and to the disadvantage of its image - surpasses in market shares the high-quality Amarone, represented in primis by the producers from Valpolicella expressing themselves through this Association.
In particular, the constant rise in production is worrying, considering that in 2011 fifteen millions bottles may be released on the market when the actual absorbing is of about 8 millions. A relevant part of this surplus in production is due to operators and areas recently converted to Amarone simply following its notoriety and business appeal. This not only affects the products but also the territory being Amarone its symbol and flagship.
Boscaini explains: "Nature and tradition left Valpolicella a unique heritage, also in terms of marketing, thanks to a differentiation of products which allows to lead several market segments, from the simple drinkable Valpolicella up to the most important Valpolicella Classico Superiore, from the full-bodied Ripasso to the sumptuous Amarone. But today this patrimony is being compromised because of reckless actions confusing the consumer as regards the territory potentials.
The grandeur of this wine is not made up of the simple adoption of a certain oenological technique, but of the capacity to express a territory and its history.
Not by chance, among the features required for being member of the association- which will put a special logo on the label – there are the familiar character of the winery, an oenological history of Amarone production of least 15 years, (and the twelve associated wine producers sum more than 1600 years!), a presence on the market with more than 20.000 bottles and a brand known at least in 5 countries, outside Italy.
The twelve members of Amarone Families underline that the Association is open, and hope to grow, to all the families that have the nec
essary requirements and that made th most of the heritage of the ancient art which makes this wine unique in the hills of Valpolicella.
For more information please contact IEEM office:
I.E.E.M. (International Event and Exhibition Management)
18800 NE 29th Avenue #317
Miami - Aventura, FL 33180
www.ieemusa.com


text:
class AddAnonymousToComments < ActiveRecord::Migration[5.0]
  def change
    add_column :comments , :anonymous , :boolean , default: false
  end
end


text:
BD+C Higher Education Trends Report Features ARC Projects & Perspectives
08.03.17 / BY ARC
The robotics lab at the 71,000-sf John J. Bowen Center for Science and Innovation, on the campus of Johnson & Wales University.
A FEATURE STORY ON TRENDS IN HIGHER EDUCATION in Building Design and Construction magazine examines how university clients are adapting to meet the changing needs of career-minded students. The June 2017 feature, titled 'Building for the Future,' quotes ARC Principal Rob Quigley and includes recent ARC university projects as examples of the campus adaptation trend.
"Preparing students for life after graduation has become the primary motivator behind construction initiatives at U.S. colleges and universities," reports BD+C Senior Editor John Caulfield. "College curriculums that focus on the professions with the most fertile employment opportunities are also shaping institutions' construction and renovation strategies," he wrote.
A recent example cited in the BD+C report is the John J. Bowen Center for Science and Innovation at Johnson & Wales, an ARC design that opened last August in Providence, R.I. The 71,000-sf STEM building provides teaching labs, classrooms, and collaboration spaces for engineering, graphic arts, biology, physics, chemistry, and computer science. It features a street-level makerspace equipped with 3D printers, laser cutters, and computers where student projects are visible from the street.
Students in Johnson & Wales University's street-level makerspace.
Rob Quigley is quoted on the new investments by university administrators at Johnson & Wales and other schools in science facilities designed to provide an advantage for non-science majors. "Science is being integrated into schools that traditionally weren't science oriented," he said. "To help prepare students for careers in a science-and-technology-dominated economy, science is evolving from an elective to a prerequisite."
Also mentioned in the BD+C trends report is the need for "building designs that stimulate collaboration and socialization" on campus. ARC's design for Jennison Hall at Bentley University is cited as an example of this trend. The Bentley renovation and addition fosters team learning and collaboration throughout. The new 85,000-sf space, opened in January of 2017, also provides science labs and technology spaces to enrich the learning experience of business majors at Bentley.
Team learning and collaboration space in the renovated Jennison Hall at Bentley University


text:
Spinal ependymoma …
Reza Yassari MD MS,
Jonathan Nakhla MD,
Rafael De la Garza MD
Spinal ependymoma
Reza Yassari MD MS, Jonathan Nakhla MD, Rafael De la Garza MD
Rimas V Lukas MD
The authors provide an updated summary of spinal ependymomas, highlighting new molecular features of the most common primary intraspinal tumor of adults as well as imaging characteristics. The update includes published epidemiological data, surgical treatment options, comments on the occurrence of these tumors in pregnancy, and updates in the evolving imaging modalities for diagnosis using diffusion tensor imaging.
In 1887, Horsley performed the first reported successful removal of an intradural, extramedullary tumor (46). With the help of Sir William Gowers, Horsley removed a "fibromyxoma" overlying the spinal cord at the T4 level. Postoperatively, the patient developed a debilitating pain syndrome but later experienced a full neurologic recovery. In the following 50 years, pioneering neurosurgeons such as Elsberg, Frazier, and Cushing took particular interest in extramedullary tumors, recognizing their frequently benign nature and often dramatic recovery from profound neurologic deficit (41; 31; 27). In 1911, Elsberg and Beer reported the first successful removal of an intramedullary spinal cord tumor (32). Frazier also commented on the potential for the removal of encapsulated intramedullary neoplasms (41). However, early attempts at removal of intrinsic intramedullary spinal cord tumors were associated with serious operative morbidity and mortality, such as complete paralysis.
For the next several decades, there was little impetus to modify the approach of biopsy, dural decompression, and radiation therapy, despite the recognition that after a relatively short remission, serious disability or death ensued. This "traditional" attitude was based on the assumption that it was not feasible to carry out extensive removal of tumors from within the center of the spinal cord without inflicting additional neurologic injury (26; 52). In 1954 Greenwood, with the aid of bipolar cautery and loupe magnification, reported 6 patients who underwent complete removal of intramedullary ependymomas (48). By 1963 Greenwood had treated 9 patients with surgery alone. There was no tumor recurrence in his surviving patients (7) with a mean follow-up of 9 years (49). With time, it has become clear that the majority of intramedullary spinal ependymomas can be radically excised with an acceptable morbidity and mortality, and a low incidence of recurrence (51; 83; 75; 119; 40; 52; 24; 23; 04; 78; 129; 39; 19; 34).
The clinical manifestations of intramedullary spinal cord tumors in general and ependymomas in particular are different in modern series (MRI era) compared with older series. Sensory complaints such as dysesthesia and back pain are the most common presenting symptoms. These symptoms are often nonspecific initially, and a high index of suspicion is necessary to allow early diagnosis of these lesions, especially without trauma history or prior complaints (108). Disease onset is usually insidious, and the duration of symptoms prior to diagnosis varies from several weeks up to 15 years (average of 14 months) (126). In a series of 38 patients with "true" intramedullary ependymomas, treated between 1985 to 1991 by Epstein and colleagues, only 5 presented primarily with motor dysfunction (34). Most of these patients (30) presented with only subjective sensory symptoms (dysesthesias), delaying the diagnosis. Patients with subtle motor signs may be evaluated for other conditions until neurologic deterioration occurs (89). The sensory symptoms may be in the hands or in the trunk as the tumors spread along the cervical and thoracic cord with an average span of 2 to 3 segments. Unusual and falsely localizing signs and symptoms may result from subarachnoid hemorrhage (02; 114), hydrocephalus due to raised cerebrospinal fluid pressure (98), and intramedullary cyst formation (120). Rarely, bleeding from spinal ependymomas may lead to secondary superficial siderosis of the nervous system and sensorineural hearing loss (71). Hemorrhagic presentations of ependymomas have been associated with anticoagulation, epidural anesthesia, pregnancy, and trauma (90).
Patients with ependymomas arising in the cauda-equina and filum-terminale region usually present with longstanding symptoms associated with extradural cord compression include segmental, hemicord, and transverse dysfunction. Local or radicular pain is the most common symptom. Pain may be dull or sharp, constant or intermittent. Urinary dysfunction and motor weakness follow if the tumor is not diagnosed early. Less than 30% of patients with caudal ependymomas present with weakness. Early symptoms of extramedullary corticospinal tract compression or, rarely, intramedullary conus medullaris extension include stiffness, fatigue, and gait abnormalities. Severe loss of motor function is now uncommon.
A 45-year-old male presented with a 1-year history of sensory dysesthesias. Laboratory testing, including workup for diabetes and vitamin deficiency, was completely unremarkable. Neurologic exam was remarkable for sensory loss in the arms, trunk, and legs; however, there was no motor weakness. Patient described worsening gait. An MRI of the brain was unremarkable; however, an MRI of the C-spine showed an enhancing mass with a hemosiderin cap expanding the spinal cord at C6 and C7. He underwent a surgical procedure for resection of the intramedullary mass with laminoplasty. His sensory deficits worsened immediately postoperatively; he remained otherwise at his neurologic baseline. At his 3-months follow-up visit, the dysesthesia improved but persisted.
Ependymomas arise from ependymal cells forming the lining of the ventricles and the central. The etiology of ependymomas is unknown. Abnormalities characterized by gain on chromosomes 1q, 2, 5, 7, 9p, 12, 15, 18, 20, and X as well as losses on chromosome 6, 9, 13q and 22q have been described in spinal ependymomas, but their significance is unclear (12; 106; 97; 81; 57; 13; 58). Nearly all spinal cord ependymomas have gains on chromosome 7, whereas the most common chromosome loss is 22q, occurring in 60% of patients (57). In some adult tumors, there is involvement of the neurofibromatosis type 2 gene on chromosome 22q (101; 124), but in other patients, the neurofibromatosis type 2 gene is not involved, suggesting the involvement of another tumor suppressor gene on chromosome 22q (67). Familial autosomal dominant intramedullary ependymoma associated with the neurofibromatosis type 2 gene and without other features of neurofibromatosis type 2 has been described (130). Hagel and colleagues propose that most spinal gliomas associated with neurofibromatosis type 2 are likely spinal ependymomas based on immunohistochemistry and electron microscopy (53). Although rare, ependymomas have been reported in patients with neurofibromatosis type 1 as well (17). Loss of heterozygosity on 22q is inversely corrected with loss of heterozygosity of 11q. Loss of heterozygosity of 11q may be accompanied by mutations of the MEN1 gene, which is associated with malignant presentation (102). Preliminary gene expression profiling studies of spinal ependymomas suggest that they have increased expression of HOXb5, PLA2G, and CDKN2A and can be differentiated from intracranial tumors (66). Genes found to be hypermethylated include RASSF1A and TRAIL. HIC-1 was only hypermethylated in intracranial ependymoma. MGMT was rarely found to be hypermethylated. The stem cells for ependymoma have been proposed to be radial-glial (102).
The relative abundance of ependymomas of the spinal cord may be in proportion to the distribution of ependymal tissue throughout the CNS (82; 123; 78). About 50% of spinal ependymomas arise from the central canal of the cervical and thoracic spinal cord. They are the most common intramedullary spinal cord tumor in adults (34). The rest (approximately 50%) arise from the intradural portion of the filum terminale (109). Because of its neuroectodermal derivation, Slooff and Kernohan classified these tumors as intramedullary (116). From a surgical and clinical perspective, however, most of the ependymomas in the filum/cauda-equina region are extramedullary. A minority of these tumors may have their epicenter located within the tissue of the conus medullaris and, therefore, are "true" intramedullary neoplasms.
Ependymomas are unencapsulated but well circumscribed glial neoplasms (64).
Spinal ependymoma (gross pathology)
This child died of respiratory failure. The tumor replaces most of the spinal cord at the C3 and C4 levels. Well-demarcated tumor tissue has fallen out of the slice taken at C2. (Contributed by Dr. Sherman Stein.)
Most appear as reddish, sausage-shaped growths with moderate vascularity. Shortly after Bailey and Cushing (06; 07) formally classified ependymomas as a distinct neoplastic entity, Kernohan and colleagues described 3 and later proposed 4 histological grades of ependymomas (62). Most spinal ependymomas exist in a histological benign form with little infiltrative potential and exhibit slow growth as evidenced by prolonged symptom duration preceding diagnosis, preservation of neurologic function in patients with extreme spinal cord compression, and characteristically long survival times following various forms of treatment (116). Cellular ependymomas, the most common histologic subtype, are characterized by areas of perivascular pseudorosettes and consist of fusiform cells arranged around small blood vessels. True ependymal rosettes, reproducing in miniature the lining of a normal ependymal cavity, are uncommon, especially in spinal ependymomas (81). Tanycytic ependymomas are a rare variant characterized by long spindle cells with eosinophilic cell processes and focal perivascular pseudorosettes (61). Anaplastic (malignant) ependymomas of the spinal cord are uncommon. In the series of 169 spinal ependymomas, only 5 tumors showed malignant change (116).
In the cauda equina region, the vast majority of ependymomas are myxopapillary (16; 117). Malignant variants of myxopapillary ependymomas have been reported (29; 100). This variant is not unique to the lumbar location (103; 76).
Myxopapillary ependymoma (photomicrograph)
Myxopapillary ependymomas are characterized by the pseudopapillary architecture, as well as the perivascular and intercellular deposition of mucin. (Contributed by Dr. Julio Garcia and Dr. Eduardo Eyzaguirre.)
The histological appearance of myxopapillary ependymomas consists of a papillary arrangement of cuboidal or columnar tumor cells surrounding a vascularized core of hyalinized and purely cellular connective tissue (117; 118). These tumors have traditionally been considered the most benign form of ependymomas (116; 117). The benign clinical behavior is probably also closely related to tumor location in addition to any inherent biological characteristic.
Intracranial ependymomas tend to spread along the cerebrospinal fluid pathways and may lead to leptomeningeal seeding of the spinal cord. According to autopsy data, spinal seeding can be expected in 25% of cases subsequent to surgery of the primary intracranial tumor. This review will not address this entity (36).
Ependymomas are relatively rare tumors, accounting for only 4% to 6% of primary central nervous system neoplasms. Intracranial ependymomas generally occur in children and young adults and represent 1% to 8% of primary brain tumors. About one-third to one-half of all ependymomas arise within the spinal canal. They represent the most common intramedullary spinal neoplasm in the adult population and account for 40% to 60% of the 2700 primary spinal cord tumors diagnosed in the United States each year (126; 21; 107; 121; 50). Intramedullary ependymomas are seen most frequently in the fourth decade of life and are rare below the age of 10 years (50; 80). In children, older age and spinal location are predictive of improved 5-year survival (79).
Filum ependymomas may arise at any age but are more common in early and middle adult years (42; 21), with a peak occurrence in the third to fifth decade (87; 116; 38). Men are slightly more commonly affected than women (80). Familial cases have been reported (105).
Earlier series of intraspinal tumors tended to include more extramedullary lesions, whereas modern series probably overemphasize the relative number of intramedullary spinal cord tumors, being more oriented toward surgical "challenges." It is, therefore, difficult to quantify the real incidence of intramedullary versus extramedullary and extradural tumors (96).
There is an association between multiple spinal cord ependymomas and Neurofibromatosis type 2 (81). Based on SEER data, the incidence of ependymomas appears to have increased over the past 30 years in adults but not in children (80). However, spinal ependymomas associated with NF-2 seem to have an indolent course and may be observed or treated with surgery resection (03).
There is currently no prevention for spinal cord ependymomas.
Intramedullary ependymomas are a group of spinal cord tumors with a well-defined clinical presentation and MRI appearance. The differential diagnosis includes astrocytomas, gangliogliomas, oligodendrogliomas, subependymomas, hemangioblastomas, metastases, and benign lesions such a lipomas (108). Clinically, the sensory phenomena, manifested by dysesthesias, are present in the great majority of patients with intramedullary ependymomas. It may be related to the common location of the tumor around the central canal. It is different from patients with spinal cord astrocytomas and gangliogliomas in whom the presenting problem is usually back pain followed by progressive motor dysfunction. When sensory phenomena are part of the initial symptomatology in patients with astrocytomas, they are usually manifested as loss of sensation rather than dysesthesias. Unlike astrocytomas, gadolinium-enhanced MRI in patients with ependymomas often shows clear demarcation of the rostral and caudal poles of the tumor. When viewed on cross-sectional images, the cord is expanded uniformly, unlike the astrocytomas in which the cord is usually "lumpy." In a comparative MRI analysis of 43 patients, the presence of syringohydromyelia appeared to be a significant factor in distinguishing ependymoma from astrocytomas (63). Furthermore, inflammatory lesions (multiple sclerosis, neuromyelitis optica, lupus, etc.) may also mimic spinal cord ependymomas.
Subependymoma is a distinct tumor entity characterized by slow growth and usually noninvasive behavior (50). MRI, even with enhancement, is often not distinguished between a subependymoma and the more common ependymoma (77; 85; 91). Spinal cord subependymomas follow a benign course. The surgical treatment is identical to that for ependymomas.
Plain films are insensitive in evaluating patients with suspected intradural pathology. Even secondary bony changes such as erosion or foraminal widening are better demonstrated with computed tomography (127). Plain films are better, however, for diagnosis of instability and quantification of scoliosis and kyphosis.
MRI is the diagnostic procedure of choice for primary and recurrent intramedullary spinal ependymomas (125; 08; 86; 65; 74). Following gadolinium injection, more than 90% of lesions enhance homogeneously and brightly, and have sharply defined rostral and caudal margins. Ependymomas originate from the region of the central canal, expand symmetrically within the spinal cord, and typically squeeze the surrounding neural tissue to only a few millimeters of thickness. About 30% of intramedullary ependymomas are associated with a rostral or caudal cyst, similar to that noted for spinal cord astrocytomas. Myxopapillary ependymomas of the conus medullaris also exhibit contrast enhancement, although not always as intensely as those within the cord parenchyma. The presence of syringohydromyelia on MRI favors the diagnosis of ependymoma and can help to differentiate it from astrocytoma (63).
Spinal myxopapillary ependymoma (MRI)
Sagittal and axial images demonstrate 2 intradural extramedullary lesions in the thoracic (A, C) and lumbar region (B, D) consistent with metastatic spinal myxopapillary ependymoma. This patient presented at 11 years of age with a...
These tumors may appear hyperintense on T1-weighted images as a result of the accumulation of mucin (60).
Myxopapillary spinal ependymoma (MRI)
This sagittal, contrast-enhanced, T1-weighted image reveals a uniformly enhancing tumor at T12 and L1. It is contiguous with a large cyst in the cord parenchyma. (Contributed by Dr. Sherman Stein.)
Presurgical MRI with diffuse tensor imaging to evaluate the relationship between neoplasm and white matter fiber tracts has helped in differentiating noninfiltrating neoplasms, such as spinal ependymomas, from other infiltrative and more aggressive neoplasms, which are considered not resectable. This allows an understanding of the neoplasm that is not appreciated with conventional MRI and may facilitate in preserving neurologic function after surgery (47).
Because of their rarity, the management of spinal ependymomas has evolved empirically over the years based on case series and retrospective studies (126; 69). There are no prospective randomized studies available to guide the management of these patients.
Surgery. With advances in neurosurgical techniques, the "traditional" approach of biopsy, dural decompression, and radiation therapy for intramedullary gliomas is no longer recommended. This course of treatment was based on the assumption that it is not feasible to carry out extensive removal of tumors from within the center of the spinal cord without a great likelihood of inflicting additional neurologic injury (26; 52; 93). This guideline, however, has been revised because the majority of these neoplasms are low-grade neoplasms that are surgically curable (73). Modern neurosurgical aids such as the operating microscope, the intraoperative ultrasound (35), the CO2 laser (28), and especially ultrasonic aspiration (33; 22) have dramatically improved the results and the operative morbidity of spinal ependymomas (34; 73).
Spinal ependymoma (operative appearance)
Following thoracic laminectomy and dural opening, the swollen spinal cord is evident. (Contributed by Dr. Sherman Stein.)
Ependymomas of the cauda equina can usually be seen immediately following dural opening.
Myxopapillary ependymoma of conus medullaris (operative appearance)
A. Blood vessels and roots of the cauda equina are splayed over the tumor. B. After tumor excision, roots and vessels have relaxed. The ventral dura is now visible. (Contributed by Dr. Sherman Stein.)
The nerve roots are displaced laterally but may lie posteriorly and obscure the tumor in patients with a ventrally located tumor. In these cases, it is relatively simple to remove the tumor en bloc by dividing the distal filum terminale caudal to the tumor and then displacing the entire mass out of the cauda equina and incising the remainder of the tumor just below the conus medullaris. The relationship of the tumor to the conus medullaris is variable. In many cases, the entire mass is within the filum, and it is not necessary to pursue tumor fragments rostrally into the conus medullaris. Occasionally, however, this pursuit may be mandatory in an effort to obtain a surgical cure. It is essential that neural tissue in the conus medullaris not be manipulated in any way and that tumor fragments be "extracted" from below.
A few ependymomas of the cauda equina seem to have grown from the region of the conus medullaris and have erupted out of the filum, with tumor tissue filling the entire thecal sac below the conus medullaris. In these cases, the normal neural elements of the cauda equina are not displaced circumferentially around the mass but rather run through the tumor tissue. In these cases, it is necessary to remove the tumor bit by bit by working between and around the neural elements until all of the neoplastic tissue is removed. In such an occurrence, it is frequently necessary to extract remaining tumor fragments from within the conus medullaris. However, it is again important to leave the neural tissue undisturbed and remove tumor fragments by working through that area from which the tumor has grown into the thecal sac. Rarely, ependymomas may grow caudally into the sacrum with the tumor being mostly or entirely extradural and may reach gigantic size (18; 30; 25; 45).
True intramedullary ependymomas almost invariably have a "true" cleavage plane between the tumor and adjacent neural tissue (34). Although this contributes to "total" excision of these neoplasms, it is also a potential hazard, because it encourages the surgeon to attempt an en bloc resection and to remove the entire mass in 1 or 2 large pieces. If this is attempted, there will be excessive and unnecessary manipulation of normal neural tissue. To avoid these complications, the ependymoma should be centrally "debulked" as with an astrocytoma, and only when the core of the tumor has been removed should the surgeon develop the plane of cleavage between the tumor and adjacent tissues. This may be accomplished by retracting the remaining tumor tissue into the residual cavity and not by retracting the spinal cord from the tumor. Some authors, however, favor en bloc excision of these tumors (56; 68).
The decision to perform an instrumented fusion in addition to the laminectomy is a difficult decision. A study by Sciubba and colleagues involving 32 patients who underwent cervical laminectomy without fusion for resection of an intradural tumor (18 intramedullary and 14 extramedullary) were followed to assess for kyphotic deformity that subsequently resulted in the need for a subsequent fusion surgery (110). Each increasing number of laminectomies performed was associated with a 3.1-fold increase in the likelihood of subsequent vertebral instability. At a mean follow-up interval of 25.2 months, 33% (4 of 12) of the patients who had undergone a 3 or more level laminectomy required subsequent fusion compared with 5% (1 of 20) who had undergone a 2 level or less laminectomy (p = 0.03). Four (36%) of 11 patients initially presenting with myelopathic motor disturbance required subsequent fusion compared with 1 (5%) of 21 presenting initially with myelopathic sensory or radicular symptoms (p = 0.02). Age, the presence of a syrinx, intramedullary tumor, C-2 laminectomy, C-7 laminectomy, and laminoplasty were not associated with subsequent symptomatic instability requiring fusion (110).
Radiation therapy. The efficacy and the need for adjuvant radiation therapy following surgery of spinal ependymomas is still unclear (44; 95; 24; 43; 113; 78; 128; 129; 126; 115; 112; 107; 59; 94). Generally, radiation therapy is withheld following "complete" tumor resection, except for patients with high-grade tumors (126; 115; 72). Controversy exists mainly regarding incompletely resected tumors (111). Most authors recommend postoperative radiation therapy in all patients with residual tumor (126; 115; 84; Gomez et al 2005; 05). There is increasing evidence that adjuvant radiation therapy increases the time-to-tumor progression. Others recommend careful monitoring (with MRI) of patients with minimal residual disease and reoperation in those with substantial residual tumor. For these authors, radiation therapy is reserved for the rare occasion of patients with documented rapid tumor growth or in the occasion that the tumor could not be radically removed (20). In general, ependymomas receive approximately 5040 cGy in 180 cGy fractions, whereas malignant ependymomas and multifocal ependymomas receive between 5040 cGy and 5400 cGy, respectively (59). There are studies suggesting the feasibility and safety of stereotactic radiosurgery in patients with spinal cord tumors (104; 10). Additional studies will be necessary to determine the long-term toxicity of this technique and its precise role.
Chemotherapy. Chemotherapy has no role for the majority of patients with low-grade or myxopapillary ependymomas. For patients with tumors that recur after surgery and radiation therapy, a variety of chemotherapeutic agents, including platinum agents, procarbazine, temozolomide, and etoposide have been tried with only limited success (113; 128; 09; 15). There are also anecdotal data suggesting that irinotecan (122) and imatinib (37) may have activity in ependymomas.
The results of surgery for caudal ependymomas are excellent. Complications are generally related to wound healing and perioperative fistulas. A joint neurologic and plastic surgery approach was developed to reduce the morbidity of wound closure following extensive and complicated laminectomy (132; 131). The fascia requires particular attention because this is usually the only watertight layer. The fascia and muscle are released both superficially from the subcutaneous tissues and deeply from the bony elements. If this is not enough to achieve closure with no tension, relaxing incisions are performed. The musculofascial layer is closed with "figure-of-8" Novafil or Prolene sutures that are tightly knotted. If there is any doubt regarding the watertightness of the closure, it is tested with injection of fluid under pressure. Improvement of the perioperative deficit is often dramatic and depends mainly on the severity and duration of the existing deficit. Filum ependymomas generally do not recur following en bloc resection. There is about a 20% recurrence rate if tumor is left behind (117). It appears that gross-total resection seems to be particularly beneficial for WHO grade II spinal ependymomas (88).
In a series by Epstein and colleagues of adult intramedullary spinal cord ependymomas treated surgically, 37 out of 38 patients had gross total removal of their tumor, as confirmed by a postoperative MRI (34). There has been no clinical or radiographic evidence of recurrence after a mean follow-up period of 24 months in any patient in whom total removal was accomplished. The morbidity of the surgical procedure was directly related to the preoperative neurologic status. Patients with little or no disability preoperatively are at little risk to sustain an injury, whereas patients with more significant neurologic dysfunction have a greater likelihood of being impaired by surgery. In one study, spontaneous regression of residual tumor after surgical resection was noted in 37% of patients (54).
For patients treated with surgery and radiation therapy, the overall 5-year survival ranges from 83% to 97%, and 10-year survival from 68% to 95% (126; 107). Patients with myxopapillary ependymomas generally have a better prognosis than other types of low-grade ependymomas (100% 5 year survival) (107). Local recurrence is the predominant pattern of failure (129; 126). Rarely, cerebrospinal fluid dissemination, spread to extravertebral soft tissues, and distant metastases may occur (81). The majority of patients who develop recurrent disease generally do so within 3 years of diagnosis, although there are numerous reports of recurrent disease developing over 10 years after treatment (126).
Nonmodifiable risk factors including age, tumor location (eg, spinal vs. intracranial), and associated mutations substantially influence the natural history of ependymomas. Poor prognostic factors for ependymomas include incomplete resection (128; 14; 01; 11), impaired preoperative neurologic function (54), age less than 20 years, the presence of 3 to 4 anaplastic features (necrosis, mitosis, vascular proliferation, cellular pleomorphism, or overlapping nuclei), and a MIB-1 proliferation index of greater than 20% (99). In children with ependymoma, older age and spinal location are correlated with improved survival (79).
There are reports in the literature of pregnant women who are discovered to have spinal ependymoma. The management of these patients presents unique surgical and anesthetic challenges (70; 55; 92). Intratumoral or subarachnoid hemorrhagic presentations of ependymoma are associated with pregnancy (90).
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Reza Yassari MD MS
Dr. Yassari of Albert Einstein College of Medicine has no relevant financial relationships to disclose.
Jonathan Nakhla MD
Dr. Nakhla of Albert Einstein College of Medicine has no relevant financial relationships to disclose.
Dr. De la Garza of Albert Einstein College of Medicine has no relevant financial relationships to disclose.
Dr. Lukas of Northwestern University Feinberg School of Medicine received honorariums from Novocure for speaking engagements, honorariums from Novocure and Merck for advisory board membership, and research support from BMS as principal investigator.
Fred J Epstein MD (original author), Patrick Y Wen MD, Shlomo Constantini MD, J Paul Duic MD, Santosh Kesari MD PhD, Jai Grewal MD, and Harpreet K Grewal MD
Familial autosomal dominant intramedullary ependymoma associated with the neurofibromatosis type 2 gene
Neoplasm of uncertain behavior of brain and spinal cord: 237.5
Neoplasm of uncertain or unknown behaviour of brain and central nervous system: D43
ICD-O
Ependymoma, NOS: M9391/3
astrocytomas
gangliomas
oligodendrogliomas
subependymomas
hemangioblastomas
benign lesions
Brainstem gliomas in adults
Central neurocytoma
Malignant astrocytomas
Spinal astrocytoma
Spinal cord tumors
NIH: Spinal Tumors
Spinal meningioma
Cerebrovascular complications of cancer
Arachnoid cyst
Atypical teratoid/rhabdoid tumors