A Novel Prognostication System for Spinal Metastasis Patients Based on Network Science and Correlation Analysis.

AIMS: During the progress of oncological diseases, there is an increased probability that spinal metastases may develop, requiring personalised treatment options. Risk calculator systems aim to provide assistance in the therapeutic decision-making process by estimating survival chances. The predictive ability of such calculators can be improved, thereby optimising the choice of personalised therapy. The aim of this research was to create a new risk assessment system and show a method with which other centres can develop their own local score. MATERIALS AND METHODS: We created a database by retrospectively processing 454 patients. The prognostic factors were selected via a network science-based correlation analysis that maximises Uno's C-index, keeping only a small number of predictors. To validate the new system, we calculated the D-statistic, the Integrated Discrimination Index, made a five-fold cross-validation and also calculated the integrated time-dependent Brier score. RESULTS: As a result of multivariate Cox analysis, we found five independent prognostic factors suitable for the design of the risk calculator. This new system has a better predictive ability compared with six other well-known systems with an average C-index of 0.706 at 10 years (95% confidence interval 0.679-0.733). CONCLUSIONS: An accurate estimation of the life expectancy of cancer patients is essential for the implementation of personalised medicine. The training performance of our system is encouraging, indicating the benefit of a network science-based visualisation step. We believe that in order to further improve the prediction ability, it is necessary to systematise previously 'unknown' factors (e.g. radiological morphology).

How does patient-rated outcome change over time following the surgical treatment of degenerative disorders of the thoracolumbar spine?

PURPOSE: Patient-rated measures are considered the gold standard for assessing the outcome of spine surgery, but there is no consensus on the appropriate timing of follow-up. Journals often demand a minimum 2-year follow-up, but the indiscriminate application of this principle may not be warranted. We examined the course of change in patient outcomes up to 5 years after surgery for degenerative spinal disorders. METHODS: The data were evaluated from 4287 consecutive patients (2287 women, 2000 men; aged 62 ± 15 years) with degenerative disorders of the thoracolumbar spine, undergoing first-time surgery at the given level between 01/01/2005 and 31/12/2011. The Core Outcome Measures Index (COMI; scored 0-10) was completed by 4012 (94%) patients preoperatively, 4008 (93%) at 3-month follow-up, 3897 (91%) at 1-year follow-up, 3736 (87%) at 2-year follow-up, and 3387 (79%) at 5-year follow-up. 2959 (69%) completed the COMI at all five time-points. RESULTS: The individual COMI change scores from preoperatively to the various follow-up time-points showed significant correlations ranging from r = 0.50 (for change scores at the earliest vs the latest follow-up) to r = 0.75 (for change scores after 12- vs 24-month follow-up). Concordance with respect to whether the minimum clinically important change score was achieved at consecutive time-points was also good (70-82%). COMI decreased significantly (p < 0.05) from preop to 3 months (by 3.6 ± 2.8 points) and from 3 to 12 months (by 0.3 ± 2.4 points), then levelled off up to 5 years (0.04-0.05 point change; p > 0.05). The course of change up to 12 months differed slightly (p < 0.05) depending on pathology/whether fusion was carried out. For patients undergoing simple decompression, 3-month follow-up was sufficient; those undergoing fusion continued to show further slight but significant change up to 12 months. CONCLUSIONS: Stable group mean COMI scores were observed for all patients from 12 months postoperatively onwards. The early postoperative results appeared to herald the longer term outcome. As such, a 'wait and see policy' in patients with a poor initial outcome at 3 months is not advocated. The insistence on a 2-year follow-up could result in a failure to intervene early to achieve better long-term outcomes.

Whiplash-Associated Disorders : Clinical and medico-legal guidelines on the methods of ascertainment.

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.

Modified minimally invasive surgical approach to cervical neuromas with intraforaminal components: hemi-semi-laminectomy and supraforaminal burr hole (modified foraminotomy) technique.

OBJECTIVE: The aim of this study was to develop a minimal invasive approach suitable for exploring neuromas with an intraforaminal component in the cervical spine with the aim of preservation of as much of the mechanically relevant bone structures and facet joints as possible. METHODS: The authors used the hemi-semi-laminectomy combined with supraforaminal burr hole technique in 7 adult patients with neuroma extending inside the foramen in the region of the cervical spine. RESULTS: Under the operating microscope the operating field was sufficient for tumour removal according to the keyhole concept. The approach did not affect the extent of tumour resection, or neurological outcome. The affected nerve roots included C3 in 3 cases, C5 in 2, C4 and C6 in 1 case. The average follow-up was 9 months, with a range from 6 to 13 months. Histological results were as follows: 4 schwannomas and 3 neurofibromas. CONCLUSION: This modified surgical approach fulfills the requirements of other minimal invasive techniques and helps to prevent damage to the crucial posterior stabilizers of the spine, and disintegration of the vertebral arches and facet joints is reduced. The approach is suitable for exploring and removing neuromas located in the spinal canal and the neuroforamen.

Lesion of the amygdala on the right and left side suppresses testosterone secretion but only left-sided intervention decreases serum luteinizing hormone level.

The effect of right- and left-sided intra-amygdaloid injection of kainic acid on the hypothalamo-hypophyseal-testicular axis was studied in rats. Both right- and left-sided injection of the neurotoxin into the amygdala resulted in a significant decrease in basal testosterone secretion in vitro of both testes and in serum testosterone concentration. In addition, left-sided administration of kainic acid significantly suppressed serum luteinizing hormone level, while right-sided intervention did not alter this parameter. The results of the present study provide further evidence on the involvement of the amygdala in the control of testicular steroidogenesis. Furthermore, the observations suggest functional asymmetry of the amygdala concerning the mechanism of suppressed testosterone secretion.

Unilateral paramedian-sagittal brain cut extending from the level of the anterior commissure to the midlevel of the third ventricle above the amygdala affects gonadal function in male rat: a lateralized effect.

The aim of the present investigations was to study involvement of fiber systems to and from the insular cortex above the amygdala in the neural control of the hypophysio-testicular axis in male rats. Animals were subjected to a unilateral paramedian-sagittal brain cut above the amygdala, extending from the level of the anterior commissure to the midlevel of the third ventricle and causing among others partial deafferentation of the insular cortex. Right-sided cut induced a significant rise in basal testosterone secretion in vitro of both testes as compared to intact or sham-operated controls without affecting serum testosterone level. By contrast, left-sided cut slightly suppressed testicular steroidogenesis and significantly decreased serum testosterone concentration. In animals underwent sham or actual cut on either side, serum luteinizing hormone levels were similar, but significantly lower than those in intact controls. No change was observed in serum FSH concentration of any experimental group. The results indicate that afferent and efferent connections of the partially deafferented cortical regions including among others the insular cortex are involved in the control of testosterone secretion. The data further suggest functional laterality of the interrupted structures.

Lesion of the insular cortex affects luteinizing hormone and testosterone secretion of rat. Lateralized effect.

The possible involvement of the insular cortex in the neural control of the hypophyseal-testicular axis was studied in male rats. Right- but not left-sided lesion of the insular cortex resulted in a significant decrease in basal testosterone secretion in vitro and serum testosterone concentration. Both right- and left-sided lesions of the insular cortex induced significant increase in serum luteinizing hormone (LH) concentration. Unilateral lesion of the insular cortex on either sides had no effect on serum follicle stimulating hormone (FSH) level. The results indicate that the insular cortex is involved in the control of testosterone and LH secretion. The data further suggest that the right insular cortex plays a predominant role in the control of male endocrine reproductive processes.

The effect of callosotomy on testicular steroidogenesis in hemiorchidectomized rats: a pituitary-independent regulatory mechanism.

In recent years, increasing number of data indicate that cerebral structures exert a direct, pituitary-independent, neural regulatory action on the endocrine glands. In addition, both experimental and clinical observations indicate functional asymmetry of the control system. Therefore, the objective of the present study was to study the effect of callosotomy on testicular steroidogenesis and serum gonadotrop concentrations in rats subjected to left- or right-sided orchidectomy. In animals underwent callosotomy plus left-sided orchidectomy the basal testosterone secretion in vitro of the remaining (right) testis was significantly higher than that of intact controls, and of rats subjected to sham surgery plus left orchidectomy. In contrast, either sham operation or callosotomy plus right-sided orchidectomy did not interfere with testicular steroidogenesis. Sham surgery or callosotomy plus left orchidectomy induced a significant rise in serum follicle-stimulating hormone concentration while right orchidectomy combined either with sham surgery or callosotomy did not alter this parameter. There was no statistically significant difference between experimental groups in serum testosterone and luteinizing hormone concentrations. The results indicate the involvement of the corpus callosum in a pituitary-independent neural control of testicular steroidogenesis. The data further suggest a different response in steroidogenesis of the left and the right testis following hemicastration and callosotomy.

Aneurysm of the internal auditory artery: our experience and review of the literature.

The aneurysms of the internal auditory artery (IAA) situated distal from anterior inferior cerebellar artery (AICA)-IAA junction, are extremely rare lesions. A case of distal aneurysm if IAA is presented causing subarachnoid haemorrhage (SAH) and complete ipsilateral deafness. After the neurosurgical treatment the hearing of the patient definitely improved. The literature of distal aneurysms of AICA is reviewed focusing on the clinical features of these malformations, causing cerebello-pontine angel (CPA) symptoms with or without SAH.