Chronic recurrent multifocal osteomyelitis in a 3.5-year-old boy.

We report an extremely rare case of multifocal bone disorder in a 3.5-year-old boy who appeared for left forearm and arm pain and multiple periods of fever with an unusual presentation of lymphoma/leukemia and highlight diagnostic challenges leading to a misdiagnosis, which was then diagnosed and treated for chronic recurrent multifocal osteomyelitis (CRMO). Based on a left arm biopsy and whole-body scans, he was eventually diagnosed with CRMO. Taken together, in this case, we noticed a notable amelioration after a 5-month treatment with nonsteroidal anti-inflammatory drugs on multiple bone pains.

Cobalt chromium-Titanium rods versus Titanium-Titanium rods for treatment of adolescent idiopathic scoliosis; which type of rod has better postoperative outcomes?

OBJECTIVE: Compare the outcome of spinal deformity correction between Ti-Ti and CrCo-Ti rods for the treatment of spinal Adolescent Idiopathic Scoliosis (AIS) using rods mentioned with all pedicle screws and translation technique. METHOD: 59 patients operated for spinal deformity (Lenke 1 or 2) AIS. The patients were divided into two groups by random allocation using Ti-Ti rods (n = 29) and CrCo-Ti rods (n = 30) and the alone difference among them in the surgical procedure was rod material (Ti-Ti or CrCo-Ti rods) and finally, radiological outcomes were compared preoperatively, postoperatively and at last follow-up for 12 months. RESULTS: Patients' main curve correction after surgical procedure regardless type of rod was 48.95±11.04 (13-75) degree. Success rate of spinal deformity correction following surgical procedure regardless of type of administered rod was 86.76 ± 11.30 percent (62.5-100%). Mean of deformity correction rate was 91.49±10.67% using CrCo-Ti rods versus 81.86±9.88% using Ti-Ti rods (P-value=0.01). Angle change was 3.29±6.60 for kyphosis angle and 0.59±7.76 for lordosis angle. Rate of main curve correction was not significantly different considering patients' gender (P-value0.657). Main curve correction success rate was in association with patients' age and type of rod (P-value=0.054, r=-1.863 and P-value=0.001, r=8.865 respectively). CONCLUSION: CrCo-Ti rods have the ability to produce higher correction rates in AIS compared to Ti-Ti rod of the same diameter. CrCo-Ti rods provide significant and stable spinal correction, especially in correction of main curve. This rate was associated with patients' age and type of rod administered but not gender.

Predictive and prognostic value of TLR9 and NFKBIA gene expression as potential biomarkers for human glioma diagnosis.

BACKGROUND: Malignant gliomas are the most common form of primary intracranial tumors with the highest mortality rates. Various gene alterations are considered as prognostic markers in glioma. But, the relevant molecular mechanisms in this setting are not well-understood. OBJECTIVE: The aim of this study was to assess the association and prognostic value of TLR9 and NFKBIA with clinical significance and also their impact on patient survival in human glioma. METHODS: Expression of TLR9 and NFKBIA mRNA in the tissues was determined by immunohistochemistry and qRT-PCR methods. Kaplan-Meier curves and Cox proportional hazards regression model were used to assess the association of TLR9 and NFKBIA with clinical outcomes of patients. RESULTS: Quantitative real-time PCR analysis showed that TLR9 mRNAs is markedly expressed in glioma tissues than in non-neoplastic tissues (mean±SD: 3.26±0.40 vs. 0.71±0.36, P<0.001). There was also a significant difference between TLR9 mRNAs and high grade glioma (P<0.001).NFKBIA mRNAs was significantly identified in non-neoplastic tissues compared with glioma specimens (mean±SD: 2.76±0.30 vs. 0.94±0.35, P<0.001). Lower levels of NFKBIA mRNA were significantly related to advanced grade of gliomas (P<0.001). Furthermore, Immunoreactivity for high expression of TLR9 was detected in 65% of cases (26/40) that was associated with high grade glioma (P=0.001). No statistically significant correlation was found between TLR9 and other clinical parameters (P>0.05). Immunoreactivity for high expression of NFKBIA was observed in 32.5% (13/40) of cases and NFKBIA expression was decreased in patients with high grad glioma (P=0.014). There was no significant correlation between NFKBIA protein expression and age, sex, and relapse. The Kaplan-Meier analysis indicated that patients with high expression of TLR9 and low expression of NFKBIA are significantly related to poorer OS (P<0.001). In addition, the multivariate Cox regression model revealed that TLR9 and NFKBIA protein expressions (low/high) and tumor grade were potentially an independent predictor of survival in patients (hazard ratio, 2.132, 2.411, 2.13 [95% confidence interval, 1.825-3.782, 1.61-3.231, 1.542-3.92]; P=0.012,P=0.018, P=0.001). CONCLUSION: These data indicate that TLR9 and NFKBIA protein expressions act as independent predictor of survival for the diagnosis of glioma and a prognostic biomarker for those with a tumor at an advanced pathological grade.

A histopathological analysis of the epidemiology of coronary atherosclerosis: an autopsy study.

BACKGROUND: Atherosclerosis accounts for a large proportion of cardiovascular system associated morbidity and mortality. We studied the possible association between the histopathological changes of the coronary atherosclerotic lesions and the risk of sudden cardiac death (SCD) using autopsy cases. METHODS: We performed an autopsy analysis (n = 13, 4 women, 9 men mean age 67.5 years; age range 56-93 years) of SCD which occurred in patients aged over 50 years during March 2010 to December 2013. The following variables were considered: sex, age, medical history, autopsy findings to macroscopic and histological evaluation of the heart. The autopsies were performed according to standard techniques. In all subjects, the heart was dissected following standard autopsy protocol and a 5 cm section of the right coronary artery (RCA) in the atrio-ventricular groove from its origin, a 5 cm segment of the left anterior descending artery (LADA) distal to the origin of the circumflex artery, but including the region of origin of the circumflex branch and left coronary artery (LCA) from its origin till the circumflex branch were excised, dissected out, fixed in 10% formalin, marked for identification and sent for histopathological analysis. RESULTS: Atherosclerotic plaques were identified in 6.5% of specimens, 69.34% of males and 30.66% of female. Such plaques were typically concentric and more represented with necrosis, calcification, cholesterol crystals, and giant cells, as well as had a higher inflammatory cell count. Furthermore, intima and media thickness of coronary arteries were significantly higher in studied specimens with visualize the connective tissue layers of the adventitia and the fatty acid containing adipose cells in the periadventitial tissue. Furthermore, the degree of microscopic lesion of atherosclerosis increased proportionally with the increase in the intensity of lipid deposition and with the percentage of collagen in the atherosclerotic plaques. CONCLUSION: In this study, age estimate to be a risk factor for coronary atherosclerosis in individuals more than 50 years old and may be used to predict SCD. Altogether, an enhanced understanding of the pathobiologic processes responsible for atherosclerotic changes might allow for early identification of a high-risk coronary plaque and thereby provide a rationale for innovative diagnostic and/or therapeutic strategies for the management of coronary patients and prevention of acute coronary syndromes.

Cobalt chromium-Titanium rods versus Titanium-Titanium rods for treatment of adolescent idiopathic scoliosis; which type of rod has better postoperative outcomes?

SUMMARY OBJECTIVE; Compare the outcome of spinal deformity correction between Ti-Ti and CrCo-Ti rods for the treatment of spinal Adolescent Idiopathic Scoliosis (AIS) using rods mentioned with all pedicle screws and translation technique. METHOD; 59 patients operated for spinal deformity (Lenke 1 or 2) AIS. The patients were divided into two groups by random allocation using Ti-Ti rods (n = 29) and CrCo-Ti rods (n = 30) and the alone difference among them in the surgical procedure was rod material (Ti-Ti or CrCo-Ti rods) and finally, radiological outcomes were compared preoperatively, postoperatively and at last follow-up for 12 months. RESULTS; Patients' main curve correction after surgical procedure regardless type of rod was 48.95±11.04 (13-75) degree. Success rate of spinal deformity correction following surgical procedure regardless of type of administered rod was 86.76 ± 11.30 percent (62.5-100%). Mean of deformity correction rate was 91.49±10.67% using CrCo-Ti rods versus 81.86±9.88% using Ti-Ti rods (P-value=0.01). Angle change was 3.29±6.60 for kyphosis angle and 0.59±7.76 for lordosis angle. Rate of main curve correction was not significantly different considering patients' gender (P-value0.657). Main curve correction success rate was in association with patients' age and type of rod (P-value=0.054, r=-1.863 and P-value=0.001, r=8.865 respectively). CONCLUSION; CrCo-Ti rods have the ability to produce higher correction rates in AIS compared to Ti-Ti rod of the same diameter. CrCo-Ti rods provide significant and stable spinal correction, especially in correction of main curve. This rate was associated with patients' age and type of rod administered but not gender.

RESUMO OBJETIVO: Comparar o resultado da correção da deformidade da coluna vertebral com ligas de Ti-Ti e CrCo-Ti para o tratamento da Escoliose Idiopática do Adolescente (EIA) na coluna usando as ligas mencionadas com todos os parafusos pediculares e técnica de tradução. MÉTODO: 59 pacientes operados por EIA com deformidade da coluna vertebral (Lenke 1 ou 2). Os pacientes foram divididos em dois grupos por alocação aleatória usando ligas de Ti-Ti (n = 29) e ligas de CrCo-Ti (n = 30) e a única diferença entre eles no procedimento cirúrgico foi o material da liga (ligas de Ti-Ti ou CrCo-Ti) e, finalmente, resultados radiológicos foram comparados no pré-operatório, pós-operatório e no último retorno por 12 meses. RESULTADOS: A correção da curva principal do paciente após o procedimento cirúrgico, independentemente do tipo de liga, foi de 48,95±11,04 (13-75) graus. A taxa de sucesso da correção da deformidade da coluna vertebral após o procedimento cirúrgico, independentemente do tipo de liga administrada, foi de 86,76 ± 11,30% (62,5-100%). A média da taxa de correção da deformidade foi de 91,49±10,67% usando ligas de CrCo-Ti e 81,86±9,88% usando ligas de Ti-Ti (valor de P = 0,01). A mudança de ângulo foi de 3,29±6,60 para o ângulo de cifose e de 0,59±7,76 para o ângulo de lordose. A taxa de correção da curva principal não foi significativamente diferente considerando o sexo dos pacientes (Valor de P 0,657). A taxa de sucesso da correção da curva principal foi associada à idade do paciente e ao tipo de liga (valor de P=0,054, r=-1,863 e valor de P=0,001, r=8,865, respectivamente). CONCLUSÃO: As ligas de CrCo-Ti têm a capacidade de produzir taxas de correção mais altas em EIA em comparação com a liga de Ti-Ti do mesmo diâmetro. As ligas de CrCo-Ti fornecem uma correção espinhal significativa e estável, especialmente na correção da curva principal. Essa taxa foi associada à idade e ao tipo de liga administrada, mas não ao sexo.