Application of Protein-Protein Interaction Network Analysis in Order to Identify Cervical Cancer miRNA and mRNA Biomarkers.

Cervical cancer (CC) is one of the world's most common and severe cancers. This cancer includes two histological types: squamous cell carcinoma (SCC) and adenocarcinoma (ADC). The current study aims at identifying novel potential candidate mRNA and miRNA biomarkers for SCC based on a protein-protein interaction (PPI) and miRNA-mRNA network analysis. The current project utilized a transcriptome profile for normal and SCC samples. First, the PPI network was constructed for the 1335 DEGs, and then, a significant gene module was extracted from the PPI network. Next, a list of miRNAs targeting module's genes was collected from the experimentally validated databases, and a miRNA-mRNA regulatory network was formed. After network analysis, four driver genes were selected from the module's genes including MCM2, MCM10, POLA1, and TONSL and introduced as potential candidate biomarkers for SCC. In addition, two hub miRNAs, including miR-193b-3p and miR-615-3p, were selected from the miRNA-mRNA regulatory network and reported as possible candidate biomarkers. In summary, six potential candidate RNA-based biomarkers consist of four genes containing MCM2, MCM10, POLA1, and TONSL, and two miRNAs containing miR-193b-3p and miR-615-3p are opposed as potential candidate biomarkers for CC.

Can treatment with teicoplanin improve the prognosis of COVID-19 patients?

AIM: In patients with COVID-19, no validated efficient treatment has been reported. Herein, we examine the effect of treatment with teicoplanin in hospitalised patients with COVID-19. METHODS: This retrospective study included 115 hospitalised patients in one medical centre. Fifty-four patients with laboratory-confirmed COVID-19 who received teicoplanin plus standard care were included in the Teicoplanin arm of this study, whereas 61 patients who were treated with standard care (SC) according to the Turkish Health Organization guidelines were included in the control arm. Patients' baseline characteristics, clinical presentation, treatment and outcomes were compared between the two groups. RESULTS: In this non-randomised control study, all baseline characteristics were comparable between the two arms and there were no significant differences in the presenting symptoms, comorbidities and clinical outcomes between the two groups. However, the mortality rate was significantly lower in the teicoplanin group than in the control group (1.9% vs 14.8%; P < .05). In addition, no adverse reactions were found in the teicoplanin arm. CONCLUSIONS: Teicoplanin administration is associated significantly with lower mortality in hospitalised patients with COVID-19 in our study. Further clinical investigations is required to verify the role of teicoplanin in COVID-19 patients.

Heterotopic Ossification in Cervical Disk Surgery Is Still a Problem. What Are the Key Factors for a Solution?

BACKGROUND: The aim of our study was to determine the presence of heterotopic ossifications (HO) in a series of patients with cervical disk arthroplasty treated with different type of prosthesis, as well as to analyze the most suitable systems for diagnosis. METHODS: A retrospective study of patients with cervical disk disease treated with cervical arthroplasty between May 2005 and December 2009, was performed. Patients were divided into 3 groups, depending on the prosthesis implanted: (Group A: Baguera prosthesis, Group B: ProDisc prosthesis, and Group C: PCM prosthesis). The presence of heterotopic ossifications was evaluated with both, simple radiology and computed tomography. RESULTS: As a summary of the results on motion preservation, computed tomography scans showed that 63% of the cervical arthroplasties in Group A presented good mobility at the first check point (December 2010), whereas cervical arthroplasties in Group B and Group C had 74% and 65% severe motion restrictions, respectively (Grade III or Grade IV, according to McAfee classification). The differences between groups were statistically significant when comparing Groups A and B, and Groups A and C (P < 0.05), but there were no differences between Groups B and C (P < 0.05). At the second check point (December 2014), the good mobility was just preserved in the 26% of the disk replacements (all in Group A). CONCLUSIONS: Our results showed that, although cervical disks provide optimal mid-term results, the incidence of HO seems to increase with time. Long term studies, with a larger sample size should be conducted to evaluate the appearance of HO and cervical motion after total disk replacement.

A Very Quickly Prepared, Colored Silicone Material for Injecting into Cerebral Vasculature for Anatomical Dissection: A Novel and Suitable Material for both Fresh and Non-Fresh Cadavers.

AIM: Cadaveric studies have a great impact on neuroanatomy learning. Cadaver preparation may take a lot of effort, especially at the phase of intravascular color filling. The authors describe their silicone dye technique and a novel mixture which is self-curing, quick to prepare and easy to inject. MATERIAL AND METHODS: The first one of these processes is undoubtedly embalming and decapitation of the cadaver. If possible, the most appropriate time that should be preferred is immediately after the donor's death. Preparation for cadaveric dissection of the brain requires some fundamental steps that can be summarized into: a) Embalming and decapitation, b) Exposing, cannulization and irrigation of main vascular structures, c) Preparing colored silicone, d) Injection of colored silicone and staining the vascular tree, e) Sample maintenance RESULTS: Our method of preparation of silicone dye and injection enables neurosurgeons and anatomists to fill cerebral and dural vascular structures, and even diploic veins nicely in both fresh and aged cadaveric heads. Moreover, the main vascular structures and their branches in the lateral and third ventricles are painted remarkably beautifully. CONCLUSION: We tried to provide our experience about the preparation of head cadavers for anatomical dissection using a novel mixture of colored silicone that is very easy to prepare and inject with very satisfactory results.

Long-Term Benefits of Percutaneous Anatomical Restoration of Vertebral Compression Fractures Linked to Malignancy.

AIM: To evaluate the efficacy, feasibility and safety of a percutaneous anatomical vertebral body reduction for the treatment of VCF (vertebral compression fracture) linked to malignancy. Vertebroplasty and percutaneous kyphoplasty have played essential roles in the treatment of painful vertebral metastasis, although there are few reports with long survival that have evaluated the long-term efficacy, adjacent fractures and vertebral body (VB) re-collapse associated with these procedures. We aimed to evaluate the longterm efficacy and the complications associated with malignancy and changes in spinal biomechanics. MATERIAL AND METHODS: The retrospective study examined 32 patients with osteolytic VCF due to malignant infiltration of the vertebral body. A visual analogue scale, the EQ5 and radiological analysis (i.e., X-ray and CT scan) were used to assess back pain, quality of life and complications. RESULTS: Statistically significant reductions in anterior and central vertebral body heights (6.2 mm-19.6 ± 4.2 mm- and 5.8 mm- 16.7 ± 7.8 mm-, respectively) that resulted in reductions of the regional Cobb angles exceeding 30% were observed. There was also a statistically significant improvement in quality of life. The average survival was longer than those reported in most published articles, and the average follow-up period was 30.9 months. CONCLUSION: Anatomical restoration (i.e., cortical ring reduction with endplate rebalancing) is potentially beneficial for a wellselected group of patients with spine metastases and long life expectancies because this procedure avoids the complications typical of these types of treatments (e.g., leakage, adjacent fractures and re-collapse).

Perimesencephalic subarachnoid hemorrhage: Etiologies, risk factors, and necessity of the second angiogram.

AIM: In this paper, we aim to present our experience with a series of patients with PMSAH. In addition, the clinical course of perimesencephalic subarachnoid hemorrgade (PMSAH) is discussed with an evaluation of etiologies, risk factors, and the necessity for a second angiogram on follow-up. MATERIALS AND METHODS: The data for this study were obtained retrospectively from patients who were treated at the Uludag University, School of Medicine, Department of Neurosurgery, Division of Neurovascular Surgery's clinic with a diagnosis of PMSAH between January 1980 and March 2002. RESULTS: We identified a total of 24 patients, 12 male. The mean age at the time of hemorrhage was 53 ± 12 years. In all patients, the onset was typical with a sudden severe headache. Five of the patients were Hunt-Hess Grade I, 15 were Grade II, and 4 were Grade III. The initial 4-vessel angiography was normal in 23 cases. Twenty-two had a second 4-vessel angiography, and all were normal. We observed acute hydrocephalus in 5 patients (20.8%). We did not observe re-bleeding during the follow-up of our patients. CONCLUSION: Patients with PMSAH have a particularly excellent outcome, and there is no need to evaluate these patients with repeat angiography.

Epidural anesthesia in elective lumbar microdiscectomy surgery: is it safe and effective?

AIM: The aim of this study was to evaluate effectiveness and safety of epidural anesthesia in elective lumbar microdiscectomy surgery. MATERIAL AND METHODS: Twenty-seven patients (78%, female), who were admitted for single level simple microdiscectomy surgery between May 2012 and December 2013 in single spine center of a university hospital, were enrolled into the study. Clinical evaluations with demographical and per-operative data were collected prospectively. RESULTS: Mean age was 60.04 years. Mean weight, height, and BMI of the study population were 77.7 kg, 160.22 cm, 30.26; respectively. Mean operation duration was 45.56 minutes. Mean VAS score for pain was 0.78 at immediate post-op, 0.52 at 4th hour, and 0.35 at post-operative 24th hour. Ramsay sedation scale (RSS) scores steadily decreased from 2.07 in the immediate post-operative time to 1.93 at 4th hour and 1.88 at 24th hour. The only correlation seen between patient demographics and RSS was body weight seen in immediate post-operative period. Improvements for VAS scores for pain at 4th and 24th hours were 28% and 31%; respectively. Three patients had nausea, one of them vomited after the surgery. All patients were satisfied and would consider epidural anesthesia in future similar surgeries. CONCLUSION: Epidural anesthesia provides a safe and effective method for elective lumbar microdiscectomy surgery.

Is intraoperative ultrasound required in cervical spinal tumors? A prospective study.

AIM: To determine the role of intraoperative ultrasonography (IOUSG) in the surgical management of patients with intradural spinal tumors. MATERIAL AND METHODS: Twenty-six patients with intradural spinal cord tumors were surgically treated under intraoperative ultrasonographic guidance between January 2007 and May 2011. Guidance with IOUSG was used in 26 patients, of which 14 fourteen had extramedullary and 12 had intramedullary tumors. Intraoperative ultrasound assistance was used to localize each tumor exactly before opening the dura. The extent of tumor resection was verified using axial and sagittal sonographic views. The extent of tumor resection achieved with IOUSG guidance was assessed on postoperative early control MRI sections. RESULTS: Total tumor resection was achieved in 22 (84%) of 26 cases. All of the residual tumors were typically intramedullary and infiltrative. The sensitivity of IOUSG for the determination of the extent of resection was found to be 92%. Ultrasonography was found to be effective in identification of tumor boundaries and protection of spinal cord vessels. The average time spent for IOUSG assessment was 7 minutes. CONCLUSION: Intraoperative ultrasonography is practical, reliable and highly sensitive for spinal cord surgery. It not only enhances surgical orientation, but also reduces morbidity and helps to resect the tumor completely.

Spinal textiloma (gossypiboma): a report of three cases misdiagnosed as tumour.

BACKGROUND: Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. AIMS: The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. STUDY DESIGN: Retrospective study. METHODS: This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. RESULTS: The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. CONCLUSION: Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes.

Neuronal protective effects of focal ischemic pre- and/or postconditioning on the model of transient focal cerebral ischemia in rats.

We investigated the neuroprotective effects of pre- and postconditioning on infarct volume in the transient middle cerebral artery occlusion (MCAo) model in rats. Thirty-two male rats were divided into occlusion, preconditioning, postconditioning and both pre- and postconditioning groups. MCAo (120 minutes) was monitored with continuous cerebral tissue oxygen (O2) pressure (PtiO2). Pre-conditioning comprised 10 minutes of MCAo, 24 hours prior to the 120 minute MCAo. The postconditioning algorithm was 30 seconds of reperfusion followed by 30 seconds of MCAo. This cycle was repeated 3 times at the onset of reperfusion. Comparison of infarct volumes showed a significant difference between the conditioned groups and occlusion group. Although there was better protection in the preconditioning group compared with the other two conditioned groups, the results did not reach statistically significant levels. The results suggest that preconditioning, postconditioning and pre/post conditioning have protective effects on cerebral ischemia.

Recurrent pneumonia caused by transdiaphragmatic erosion of a ventriculoperitoneal shunt into the lung. Case report.

To the best of the authors' knowledge, this report represents the first description of a ventriculoperitoneal (VP) shunt that migrated into the chest cavity where it caused recurrent pneumonias. This 15-year-old boy with a history of hydrocephalus treated with VP shunt therapy as an infant presented with a 2-year history of chronic coughing and recurrent pneumonia. A high-resolution chest computed tomography scan revealed a right lower lobe infiltration and evidence of migration of the peritoneal shunt tubing through the diaphragm into the lung parenchyma. The catheter was pulled back into the peritoneal cavity via a simple abdominal incision. The patient's long-term outcome was excellent, and there was complete cessation of the pneumonia.

Endoscopically-assisted resection of a choroid plexus vascular malformation traversing the cerebral aqueduct: technical case report.

OBJECTIVE: We report a case of a choroid plexus vascular malformation of the cerebral aqueduct, third, and fourth ventricles of an adolescent female that was resected with endoscopic assistance. CLINICAL PRESENTATION: A 14-year-old girl presented with a 1-week history of headaches and emesis. A noncontrasted computed tomographic scan of the head demonstrated enlarged lateral and third ventricles. Subsequent magnetic resonance imaging scans with and without contrast revealed an enhancing mass originating in the third ventricle, traversing the cerebral aqueduct, and terminating in the fourth ventricle. RESULTS: We used a suboccipital approach to remove the vascular malformation after endoscopically disconnecting it from its feeding and draining vessels in the third ventricle. Total excision was performed. Postoperative magnetic resonance imaging scans and arteriograms confirmed complete resection of the vascular malformation. CONCLUSION: Choroid plexus vascular malformations can exist intraventricularly and can be confused with a neoplasm. Resection of these intraventricular lesions can be performed with endoscopic assistance.

Lumbar spinal extradural angiolipomas. Two case reports.

Spinal extradural angiolipomas are benign tumors mostly localized in the thoracic region. A 50-year-old woman and a 36-year-old man presented with rare lumbar spinal angiolipoma manifesting as low back pain but without neurological signs. Magnetic resonance imaging showed lumbar extradural tumors at the L4-5 and L1-2 levels, respectively. Each patient underwent complete surgical resection of the epidural tumors. Histological examination revealed characteristics of angiolipomas in both tumors. The symptoms of both patients improved postoperatively and no recurrence of the tumors was found 1 year after surgery.

Critical care management of severe head injury in children.

BACKGROUND: Our aim was to analyze prognostic factors and their association with outcome among children with severe head injury. METHODS: We conducted a retrospective study among children (n=55) with severe head injury [Glasgow Coma Score (GCS) ?8] who were admitted to our Neurosurgical Intensive Care Unit (ICU) from January 1996 to September 2003. The patients were immediately evaluated with cranial computed tomography (CT) for the severity of head injury as well as for the causes of secondary insults such as hypoxia and hypotension, metabolic and hematological alterations. Outcome analysis was assessed according to Glasgow Outcome Scale Score (GOS) six months after the injury. RESULTS: A poor result occurred in 31 patients (57%) while 24 patients (43%) had favourable results. Multivariate analysis showed significant independent prognostic effect for admission mean systolic blood pressure, presence of hypoxia, multiple trauma, admission GCS score and multiple intracranial lesions (p<0.05). Admission WBC counts and serum glucose levels were not correlated with GOS. CONCLUSION: This study describes clinicoradiologic findings and prognostic factors regarding severe head injury in pediatric patients. The goals of managements of pediatric patients with severe traumatic head injury include normalizing intracranial pressure, optimizing arterial blood gases and systemic blood pressure, and prevention of factors that exacerbate secondary brain injury.

Minimally incisional stabilization of unstable L5 burst fracture.

BACKGROUND: Burst fractures of the L5 vertebral body are uncommon. Treatment options described include prolonged immobilization and surgical stabilization, most commonly with an instrumented fusion from L4 to the sacrum. METHODS: We describe the use of a minimally incisional technique to provide temporary internal fixation in a patient with an L5 burst fracture who was not a candidate for prolonged immobilization. RESULTS: This technique resulted in an excellent outcome without the requirement for a fusion. CONCLUSION: Minimally incisional fixation procedures are a treatment option for select patients with L5 burst fractures.

Large cavernous hemangioma of the frontal bone.

A 53-year-old woman presented with a rare case of cavernous hemangioma of the frontal bone manifesting as right frontal stabbing headache and local swelling. Computed tomography revealed an extensive, well-defined, radiolucent, osteolytic lesion in the right frontal bone. The inner and outer tables of the skull were eroded and the lesion had compressed the brain parenchyma. Right frontal craniotomy was performed, and the lesion with a 1 cm-wide margin of surrounding uninvolved bone was removed. The defect was reconstructed with titanium mesh. The patient did well after the operation. The cosmetic results were satisfactory and follow up at 6 months post-surgery revealed no recurrence.