Evaluation of multidetector CT Hounsfield unit measurements as a predictor of efficacy and complications in percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

Introduction: More than 30 years after the initial experience of Galibert and Deramond with percutaneous vertebroplasty, the procedure has gone through countless refinements and clinical evaluations. Predictors for the success and failure of the procedure in the literature vary and are focused on the duration of complaints, type of fracture, presence of edema on MRI scans, etc. We propose using a quantitative method based on a standard CT examination of the thoracic or lumbar spine to assess the risks and potential success of performing vertebroplasty. Materials and methods: This is a single-center prospective observational study on 139 patients treated with percutaneous vertebroplasty (pVPL) for a single symptomatic osteoporotic vertebral compression fracture (OVCF). We measured the levels of disability and pain preoperatively and again at the 3-, 6- and 12-month marks using the standardized VAS and ODI questionnaires. Every patient in the study was evaluated with postoperative multidetector CT (MDCT) to determine the presence, extent, and localization of vertebral cement leakage and to measure the adjacent vertebrae's minimal and mean density in Hounsfield units (HUmin and HUmean, respectively). Results: We determined that a slight (r = -0.201) but statistically significant (p = 0.018) correlation existed between HU measurements taken from radiologically intact adjacent vertebrae and the procedure's effect concerning the pain levels at the 3-month follow-up. This correlation failed to reach statistical significance at 12 months (p = 0.072). We found no statistically significant relationship between low vertebral cancellous bone density and cement leakage on postoperative scans (p = 0.6 for HUmin and p = 0.74 for HUmean). Conclusion: We have moderately strong data that show a negative correlation between the mean values of vertebral cancellous bone density in patients with OVCF and the effect of pVPL in reducing pain. Lower bone densities, measured this way, showed no increased risk of cement leakage.

Management of Mirror Middle Cerebral Artery Aneurysms: Surgical Results and Morphological Parameters.

AIM: To investigate the safety and applicability of two main methods for treating mirror intracranial aneurysms, based on correlations in their geometric characteristics. MATERIAL AND METHODS: We conducted a retrospective analysis on 125 patients who underwent 138 surgical interventions for MCA aneurysms and were treated with microsurgical clipping and endovascular embolization at the Department of Neurosurgery in the University Hospital "St. Iv. Rilski", Sofia, in 2013-2019. In six of these cases, we observed mirror MCA aneurysms. RESULTS: All six patients with "mirror" aneurysms were female. In one case, a third aneurysm was observed on the anterior communicating artery; hence, a total of 13 aneurysms were treated. The average age of the group was 48.16 years. All patients had known risk factors, such as high blood pressure and tobacco smoking. Four patients presented with aneurysmal subarachnoid hemorrhage (aSAH). All patients underwent surgical treatment in two stages-with obliteration of the intracranial aneurysm leading to subarachnoid bleeding in the first stage and planned surgical intervention within a month in the second stage to exclude unruptured aneurysms. During the one-month interval, there were no SAH incidents. However, we observed one patient with a postoperative neurological deficit and one with recanalization of the aneurysm on follow-up at 3 months, requiring re-embolization. In both cases, endovascular treatment was performed despite the unfavorable anatomical features (aspect ratio ≤1.5 and neck size ≥4 mm). The clinical outcome, in all operated patients, for "mirror" aneurysms of the MCA was reasonable (mRS: 0-2). CONCLUSION: The choice of treatment for "mirror" aneurysms should be determined on an individual basis by the clinical manifestations and morphological characteristics of intracranial aneurysms. In cases of aSAH, where "mirror" aneurysms are present, both can be treated safely via microsurgical clipping or endovascular embolization after thorough investigation and ensuring prioritization of the offending lesion.

Reactivity Graph Yields Interpretable IgM Repertoire Signatures as Potential Tumor Biomarkers.

Combining adaptive and innate immunity induction modes, the repertoire of immunoglobulin M (IgM) can reflect changes in the internal environment including malignancies. Previously, it was shown that a mimotope library reflecting the public IgM repertoire of healthy donors (IgM IgOme) can be mined for efficient probes of tumor biomarker antibody reactivities. To better explore the interpretability of this approach for IgM, solid tumor-related profiles of IgM reactivities to linear epitopes of actual tumor antigens and viral epitopes were studied. The probes were designed as oriented planar microarrays of 4526 peptide sequences (as overlapping 15-mers) derived from 24 tumor-associated antigens and 209 cancer-related B cell epitopes from 30 viral antigens. The IgM reactivity in sera from 21 patients with glioblastoma multiforme, brain metastases of other tumors, and non-tumor-bearing neurosurgery patients was thus probed in a proof-of-principle study. A graph representation of the binding data was developed, which mapped the cross-reactivity of the mixture of IgM (poly)specificities, delineating different antibody footprints in the features of the graph-neighborhoods and cliques. The reactivity graph mapped the major features of the IgM repertoire such as the magnitude of the reactivity (titer) and major cross-reactivities, which correlated with blood group reactivity, non-self recognition, and even idiotypic specificities. A correlation between an aspect of this image of the IgM IgOme, namely, small cliques reflecting rare self-reactivities and the capacity of subsets of the epitopes to separate the diagnostic groups studied was found. In this way, the graph representation helped the feature selection in its filtering step and provided reduced feature sets, which, after recursive feature elimination, produced a classifier containing 51 peptide reactivities separating the three diagnostic groups with an unexpected efficiency. Thus, IgM IgOme approaches to repertoire studies is greatly augmented when self/viral antigens are used and the data are represented as a reactivity graph. This approach is most general, and if it is applicable to tumors in immunologically privileged sites, it can be applied to any solid tumors, for instance, breast or lung cancer.

Grisel's syndrome in adults: A case report.

BACKGROUND: The non traumatic, post inflammatory atlantoaxial rotatory instability, also known as Grisel's syndrome is a relatively rare condition usually affecting children. Adult cases are rare and even less frequently reported with separate case reports describing a single patient. Although antibiotic treatment and close neurological monitoring seem to be the gold standard of care, there is no general consensus on the optimal timing and extent of the surgical treatment. CASE DESCRIPTION: We present a case of C1-C2 spondylitis, secondary to retropharyngeal abscess, without atlantoaxial instability on initial evaluation that progressed to C1-C2 subluxation with rapidly developing myelopathy 3 months after optimal antibiotic therapy and complete clinical and biochemical remission. CONCLUSION: Grisel's syndrome is a rare condition in adults with secondary instability in spite of successful antibacterial treatment, which requires decompression and delayed surgical fixation in our case.

A genome-wide association study implicates the BMP7 locus as a risk factor for nonsyndromic metopic craniosynostosis.

Our previous genome-wide association study (GWAS) for sagittal nonsyndromic craniosynostosis (sNCS) provided important insights into the genetics of midline CS. In this study, we performed a GWAS for a second midline NCS, metopic NCS (mNCS), using 215 non-Hispanic white case-parent triads. We identified six variants with genome-wide significance (P ≤ 5 × 10-8): rs781716 (P = 4.71 × 10-9; odds ratio [OR] = 2.44) intronic to SPRY3; rs6127972 (P = 4.41 × 10-8; OR = 2.17) intronic to BMP7; rs62590971 (P = 6.22 × 10-9; OR = 0.34), located ~ 155 kb upstream from TGIF2LX; and rs2522623, rs2573826, and rs2754857, all intronic to PCDH11X (P = 1.76 × 10-8, OR = 0.45; P = 3.31 × 10-8, OR = 0.45; P = 1.09 × 10-8, OR = 0.44, respectively). We performed a replication study of these variants using an independent non-Hispanic white sample of 194 unrelated mNCS cases and 333 unaffected controls; only the association for rs6127972 (P = 0.004, OR = 1.45; meta-analysis P = 1.27 × 10-8, OR = 1.74) was replicated. Our meta-analysis examining single nucleotide polymorphisms common to both our mNCS and sNCS studies showed the strongest association for rs6127972 (P = 1.16 × 10-6). Our imputation analysis identified a linkage disequilibrium block encompassing rs6127972, which contained an enhancer overlapping a CTCF transcription factor binding site (chr20:55,798,821-55,798,917) that was significantly hypomethylated in mesenchymal stem cells derived from fused metopic compared to open sutures from the same probands. This study provides additional insights into genetic factors in midline CS.

Operative technique for calvarial reconstruction of sagittal craniosynostosis.

AIM: The purpose of this study was to retrospectively evaluate the efficacy of the developed by the authors surgical technique in patients with a radiographically confirmed diagnosis of sagittal craniosynostosis. MATERIAL AND METHODS: 34 children with scaphocephaly underwent surgical treatment with the authors' operative technique. Quantitative assessments of the operative results, based on the preoperative and postoperative (1 year after the procedure) measurements of the cephalic index (cranial width / cranial length x 100), were performed in all patients. RESULTS: The presented original authors' surgical technique resulted in a significantly good skull shape immediately after the procedure. The mean preoperative cephalic index was 64.5, and the mean immediate postoperative index- 75.0, yielding a mean improvement of 10.5. There were no intraoperative complications. One case required a small postoperative correction. CONCLUSION: The presented operative technique provides immediate and significant surgical correction of the head shape, demonstrated by quantitative measurements using the cephalic index and by photographs.