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INTRODUCTION: National and international trends continue to show greater emphasis on endovascular techniques for the treatment of cerebrovascular disease. The cerebrovascular neurosurgeon however must be adequately equipped to treat these patients via both open and endovascular techniques. METHODS: The decline in open cerebrovascular cases for aneurysm clipping has forced many trainees to pursue open cerebrovascular fellowships to increase case volume. An alternative strategy has been employed at our institution, which is early identification of subspecialty focus with resident driven self-selection of open cerebrovascular cases. RESULTS: This has allowed recent graduates to obtain enfolded endovascular training and a significant number of open cerebrovascular cases in order to obtain competence and exposure. DISCUSSION: We advocate for further self-selection paradigms supplemented with simulation training in order to obviate the need for extended post-residency fellowships.

Objectives This open-label, randomized phase II trial evaluated antitumor efficacy of an antiestrogen, fulvestrant, in combination with human epidermal growth factor receptor (EGFR) inhibitor, erlotinib, in advanced non-small cell lung cancer (NSCLC) patients. Materials and Methods Patients with advanced or metastatic NSCLC, ECOG 0–2, previous chemotherapy unless patient refusal, and no prior EGFR-directed therapy were randomized 2:1 to erlotinib 150 mg oral daily plus 500 mg intramuscular fulvestrant on day 1, 15, 29 and every 28 days thereafter or erlotinib alone 150 mg oral daily. The primary end point was objective response rate (ORR); secondary endpoints included progression free survival (PFS) and overall survival (OS). Results Among 106 randomized patients, 100 received at least one dose of study drug. ORR was 16.4% (11 of 67 patients) for the combination versus 12.1% (4 of 33 patients) for erlotinib (p = 0.77). PFS median 3.5 versus 1.9 months [HR = 0.86, 95% CI (0.52–1.43), p = 0.29] and OS median 9.5 versus 5.8 months [HR = 0.92, 95% CI (0.57–1.48), p = 0.74] numerically favored the combination. In an unplanned subset analysis, among EGFR wild type patients (n = 51), but not EGFR mutant patients (n = 17), median PFS was 3.5 versus 1.7 months [HR = 0.35, 95% CI (0.14-0.86), p = 0.02] and OS was 6.2 versus 5.2 months [HR = 0.72, 95% CI (0.35–1.48), p = 0.37] for combined therapy versus erlotinib, respectively. Notably, EGFR WT patients were more likely to be hormone receptor-positive (either estrogen receptor α- and/or progesterone receptor-positive) compared to EGFR mutant patients (50% versus 9.1%, respectively) (p = 0.03). Treatment was well tolerated with predominant grade 1–2 dermatologic and gastrointestinal adverse effects. Conclusion Addition of fulvestrant to erlotinib was well tolerated, with increased activity noted among EGFR wild type patients compared to erlotinib alone, albeit in an unplanned subset analysis.

Nitrogen (N) leaching from agricultural soils is a major concern in the southeastern USA. A winter cover crop following the summer crop rotation is essential for controlling N leaching and soil run-off, thereby improving sustainable development. Rotation of peanut (Arachis hypogea L.) and cotton (Gossypium hirsutum L.) with bahiagrass (Paspalum notatum) (i.e. sod-based rotation) can greatly improve soil health and increase crop yields and profitability. In the sod-based rotation, the winter cover crop is an important component. The objective of this study was to determine effects of summer crops, cotton and peanut, on growth and physiology of a subsequent oat (Avena sativa L.) cover crop in both a conventional (Peanut-Cotton-Cotton) and sod-based (Bahiagrass-Bahiagrass-Peanut-Cotton) rotations. Two rotations with an oat cover crop were established in 2000. In the 2006-07 and 2007-08 growing seasons, oat plant height, leaf chlorophyll and sap NO3-N concentrations, shoot biomass, and N uptake were determined. Our results showed that the previous summer crop in the two rotations significantly influenced oat growth and physiology. Oat grown in the sod-based rotation had greater biomass, leaf chlorophyll and NO3-N concentrations as compared with oat grown in the conventional rotation. At pre-heading stage, oat in the sod-based rotation had 44% greater biomass and 32% higher N uptake than oat in the conventional rotation; oat following peanut produced 40 to 49% more biomass and accumulated 27 to 66% more N than oat following cotton. Therefore, the sod-based rotation improved not only summer crops, but also the winter cover crop. Increased oat growth and N status from the sod-based rotation indicated greater soil quality and sustainability. bahiagrass / crop rotation/ oat biomass / nitrogen uptake / soil quality / sustainability