Finding Novel Anti-carcinomas Compounds by Targeting SFRP4 Through Molecular Modeling, Docking and Dynamic Simulation Studies

BACKGROUND

Secreted Frizzled-Related Protein 4 (SFRP4) is a glycoprotein that acts as a competitor of both canonical and non-canonical Wnt pathways. SFRP4 is mostly expressed in ovary and plays a significant role as a target molecule to cure ovarian carcinoma.

OBJECTIVE

Multiple chemical agonists are being used to cure ovary melanoma. We are interested in theoretically analyzing the compounds through computational approaches for their potential inhibitory effects against SFRP4.

METHODS

Compounds were sketched in Chemsketch drawing tool and minimized through chimera tool. Because the crystal structure of SFRP4 is not available in Protein Data Bank, homology modeling approach was used to predict Three-Dimensional (3D) crystal structure of SFRP4. Moreover, multiple computational approaches such as molecular docking and Molecular Dynamic (MD) simulations along with various online tools were employed to screen the best inhibitor against ovary melanoma.

RESULTS

The docking results showed that 1d and 1e compounds revealed significant binding energy values (-9.10 and -9.00 kcal/mol, respectively) compared with the standard drugs such as cis-platin and docetaxel (-3.30, -10.80 kcal/mol), respectively. Moreover, MD simulation results showed that 1d has little fluctuations throughout the simulation period as depicted by the root mean square deviation and root mean square fluctuation graphs.

CONCLUSION

The present in-silico study provides a deeper insight into the structural attributes of 1d compound and its overall molecular interactions against SFRP4 and gives a hypothetical gateway to use this compound as a potential inhibitor against ovarian carcinoma.

Cut-off Value for Body Mass Index in Predicting Surgical Success in Patients with Lumbar Spinal Canal Stenosis

STUDY DESIGN

Case-control.

PURPOSE

To determine optimal cut-off value for body mass index (BMI) in predicting surgical success in patients with lumbar spinal canal stenosis (LSCS).

OVERVIEW OF LITERATURE

BMI is an essential variable in the assessment of patients with LSCS.

METHODS

We conducted a prospective study with obese and non-obese LSCS surgical patients and analyzed data on age, sex, duration of symptoms, walking distance, morphologic grade of stenosis, BMI, postoperative complications, and functional disability. Obesity was defined as BMI of ≥30 kg/m2. Patients completed the Oswestry Disability Index (ODI) questionnaire before surgery and 2 years after surgery. Surgical success was defined as ≥30% improvement from the baseline ODI score. Receiver operating characteristic (ROC) analysis was used to estimate the optimal cut-off values of BMI to predict surgical success. In addition, correlation was assessed between BMI and stenosis grade based on morphology as defined by Schizas and colleague in total, 189 patients were eligible to enter the study.

RESULTS

Mean age of patients was 61.5±9.6 years. Mean follow-up was 36±12 months. Most patients (88.4%) were classified with grades C (severe stenosis) and D (extreme stenosis). Post-surgical success was 85.7% at the 2-year follow-up. A weak correlation was observed between morphologic grade of stenosis and BMI. Rates of postoperative complications were similar between patients who were obese and those who were non-obese. Both cohorts had similar degree of improvement in the ODI at the 2-year followup. However, patients who were non-obese presented significantly higher surgical success than those who were obese. In ROC curve analysis, a cut-off value of ≤29.1 kg/m2 for BMI in patients with LSCS was suggestive of surgical success, with 81.1% sensitivity and 82.2% specificity (area under the curve, 0.857; 95% confidence interval, 0.788-0.927).

CONCLUSION

This study showed that the BMI can be considered a parameter for predicting surgical success in patients with LSCS and can be useful in clinical practice.

CLASSIFICATION OF SCHIZOPHRENIA USING SVM VIA fNIRS

In the present study, a classification of functional near-infrared spectroscopy (fNIRS) based on support vector machine (SVM) is presented. It is a non-invasive method monitoring human brain function by evaluating the concentration variation of oxy-hemoglobin and deoxy-hemoglobin. fNIRS is a functional optical imaging technology that measures the neural activities and hemodynamic responses in brain. The data were gathered from 11 healthy volunteers and 16 schizophrenia of the same average age by a 16-channel fNIRS (NIROXCOPE 301 system developed at the Neuro-Optical Imaging Laboratory, continuous-wave dual wavelength). Schizophrenia is a mental disorder that is characterized by mental processing collapse and weak emotional responses. This mental disorder is usually accompanied by a serious disturbance in social and occupational activities. The signals were initially preprocessed by DWT to remove any systemic physiological impediment. A preliminary examination by the genetic algorithm (GA) suggested that some channels of the recreated fNIRS signals required further investigation. The energy of these recreated channel signals was computed and utilized for signal arrangement. We used SVM-based classifier to determine the cases of schizophrenia. The result of six channels is higher than 16 channels. The results demonstrated a classification precision of about 87% in the discovery of schizophrenia in the healthy subjects.

Treatment of Cystic Craniopharyngioma with Intracystic Stereotactic Instillation of Phosphorus 32

OBJECTIVE

Cystic craniopharyngiomas are considered the most common intracranial nonglial tumor in children with the tendency for cyst formations. The aim of this study was to evaluate the effect of intracystic phosphorus 32 (P32) therapies on controlling the growth of the cystic component of craniopharyngioma.

MATERIALS & METHODS

This clinical study was conducted on 47 patients with cystic craniopharyngioma from March 1998 to June 2012 at Shohada Tajrish Hospital, Tehran, Iran. Patients were treated with stereotactic intracystic P32. The mean cyst volume was 23.5 ml, and the dose of radiation to the inner cyst wall was 250 Gy.

RESULTS

The overall response rate was 78.1% and the mean survival was 113.1±11months. The survival rate at 1, 3, 5, and 10 years after p32 therapy was 91%, 77%, 73%, and 52%, respectively. There was no mortality related to the procedure and no visual or endocrinal deterioration. Visual improvement occurred in 88% of patients presented with recent deterioration due to the cyst enlargement.

CONCLUSION

Intracystic p32 therapy was an effective and almost safe procedure for the treatment of cystic component of craniopharyngioma.

Diffusion Tensor Imaging for Glioma Grading: Analysis of Fiber Density Index

Introduction:

The most common primary tumors of brain are gliomas and tumor grading is essential for designing proper treatment strategies. The gold standard choice to determine grade of glial tumor is biopsy which is an invasive method. The purpose of this study was to investigate the role of fiber density index (FDi) by means of diffusion tensor imaging (DTI) (as a noninvasive method) in glial tumor grading.

Methods:

A group of 20 patients with histologically confirmed diagnosis of gliomas were evaluated in this study. We used a 1.5 Tesla MR system (AVANTO; Siemens, Germany) with a standard head coil for scanning. Multidirectional diffusion weighted imaging (measured in 12 noncollinear directions), and T1 weighted nonenhanced were performed for all patients. We defined two regions of interest (ROIs); 1) White matter fibers near the tumor and 2) Similar fibers in the contralateral hemisphere.

Results:

FDi of the low-grade gliomas was higher than those of high-grade gliomas, which was significant (P=0.017). FDi ratio (ratio of fiber density in vicinity of the tumor to homologous fiber tracts in the contralateral hemisphere) is higher in low-grade than high-grade tumors, (P=0.05). In addition, we performed ROC (receiver operating characteristic) curve and the area under curve (AUC) was 0.813(P=0.013).

Conclusion:

Our findings prove significant difference in FDi near by low-grade and high-grade gliomas. Therefore, FDi values and ratios are helpful in glial tumor grading.

Brain metastases in cancer patients attending a Gamma Knife Center: A study from a single institute in Iran

Background:

This study was aimed to explore data on brain metastases in cancer patients attending the Iranian Gamma Knife Center.

Meterials and Methods:

This was a retrospective study. In all 5216 case records of patients who referred to the Iranian Gamma Knife Center for treatment of brain tumors during year 2003-2011 were reviewed. Data were explored to identify patients who developed brain metastases due to cancer and assessed the information as applied to cancer patients including survival analysis.

Results:

Two hundred and twenty patients were identified as having brain metastases due to cancer. The mean age of patients was 54.0 (standard deviation [SD] =12.7) years. Patients were followed for an average of 7 months after treatment with gamma-knife. The median survival time for different the Graded Prognostic Assessment (GPA) was: GPA: 0-1, 4.0 ± 0.4 months; GPA: 1.5-2.5, 6.0 ± 0.7 months; GPA: 3, 9.0 ± 0.9 months; and GPA: 3.5-4.0, 12.0 ± 1.8 months and the overall median survival was 7.0 (SD = 0.6) months.

Conclusion:

The findings suggest that many cancer patients in Iran might develop brain metastasis. Although, this is not a very high incidence compared with the existing statistics from other countries, there is an urgent need to explore the issue further.

The role of stenosis ratio as a predictor of surgical satisfaction in patients with lumbar spinal canal stenosis: a receiver-operator characteristic (ROC) curve analysis

BACKGROUND

The aim of this study was to elucidate independent factors that predict surgical satisfaction in lumbar spinal canal stenosis (LSCS) patients.

METHODS

Patients who underwent surgery were grouped based on the age, gender, duration of symptoms, walking distance, Neurogenic Claudication Outcome Score (NCOS) and the stenosis ratio (SR) described by Lurencin. We recorded on 2-year patient satisfaction using standardized measure. The optimal cut-off points in SR, NCOS and walking distance for predicting surgical satisfaction were estimated from sensitivity and specificity calculations and receiver operator characteristic (ROC) curves.

RESULTS

One hundred fifty consecutive patients (51 male, 99 female, mean age 62.4±10.9 years) were followed up for 34±13 months (range 24-49). One, two, three and four level stenosis was observed in 10.7%, 39.3%, 36.0 % and 14.0% of patients, respectively. Post-surgical satisfaction was 78.5% at the 2 years follow up. In ROC curve analysis, the asymptotic significance is less than 0.05 in SR and the optimal cut-off value of SR to predict worsening surgical satisfaction was measured as more than 0.52, with 85.4% sensitivity and 77.4% specificity (AUC 0.798, 95% CI 0.73-0.90; P<0.01).

CONCLUSIONS

The present study suggests that the SR, with a cut-off set a 0.52 cross-sectional area, may be superior to walking distance and NCOS in patients with degenerative lumbar stenosis considered for surgical treatment. Using a ROC curve analysis, a radiological feature, the SR, demonstrated superiority in predicting patient satisfaction, compared to functional and clinical characteristics such as walking distance and NCOS.

Monte Carlo calculations and experimental measurements of the TG-43U1-recommended dosimetric parameters of 125I (Model IR-Seed2) brachytherapy source

A new design of I125 (Model IR‐Seed2) brachytherapy source has been manufactured recently at the Applied Radiation Research School, Nuclear Science and Technology Research Institute in Iran. The source consists of six resin beads (0.5 mm diameter) that are sealed in a cylindrical titanium capsule of 0.7 mm internal and 0.8 mm external diameters. This work aims to evaluate the dosimetric parameters of the newly designed I125 source using experimental measurements and Monte Carlo (MC) simulations. Dosimetric characteristics (dose rate constant, radial dose function, and 2D and 1D anisotropy functions) of the IR‐Seed2 were determined using experimental measurements and MC simulations following the recommendations by the Task Group 43 (TG‐43U1) report of the American Association of Physicists in Medicine (AAPM). MC simulations were performed using the MCNP5 code in water and Plexiglas, and experimental measurements were carried out using thermoluminescent dosimeters (TLD‐GR207A) in Plexiglas phantoms. The measured dose to water in Plexiglas data were used for verification of the accuracy of the source and phantom geometry in the Monte Carlo simulations. The final MC simulated data to water in water were recommended for clinical applications. The MC calculated dose rate constant (Λ) of the IR‐Seed2 I125 seed in water was found to be 0.992±0.025 cGy h−1U−1. Additionally, its radial dose function by line and point source approximations, gL(r) and gp(r), calculated for distances from 0.1 cm to 7 cm. The values of gL(r) at radial distances from 0.5 cm to 5 cm were measured in a Plexiglas phantom to be between 1.212 and 0.413. The calculated and measured of values for 2D anisotropy function, F(r,θ), were obtained for the radial distances ranging from 1.5 cm to 5 cm and angular range of 0°‐90° in a Plexiglas phantom. Also, the 2D anisotropy function was calculated in water for the clinical application. The results of these investigations show that the uncertainty of the experimental data is within ±7% between the measured and simulated data in Plexiglas. Based on these results, the MC‐simulated dosimetric parameters of the new I125 source model in water are presented for its clinical applications in brachytherapy treatments.

PACS number(s): 87.56.bg

The prediction of successful surgery outcome in lumbar disc herniation based on artificial neural networks

BACKGROUND

The aim of this study was to develop an artificial neural networks (ANNs) model for predict successful surgery outcome in lumbar disc herniation (LDH).

METHODS

An ANN model and a logistic regression (LR) model were used to predict outcomes outcomes. The age, gender, duration of symptoms, smoking status, surgical level, visual analog scale (VAS) of leg/ back pain, the Zung Depression Scale (ZDS), and the Japanese Orthopaedic Association (JOA) Score, were determined as the input variables for the established ANN model. The Macnab classification was used for outcome assessment. ANNs on data from LDH patients, who had surgery, were trained to predict 2-year successful discectomy using several input variables. Sensitivity analysis to the established ANN model was used to identify the relevant variables. For evaluating the two models, the area under a receiver operating characteristic (ROC) curve (AUC), accuracy rate of predicting, and Hosmer-Lemeshow (H-L) statistics were considered.

RESULTS

A total of 203 (96 male, 107 female, mean age 48.3±9.8 years) patients were caterigized into training, testing, and validation data sets consisting of 101, 51, and 51 cases, respectively. Surgical successful outcome was: categorized as excellent, 32%; good, 40.9%; fair, 20.7% and poor, 6.4% at 2-year follow-up. Compared to the LR model, the ANN model showed better results: accuracy rate, 95.8%; H-L statistic, 41.5%; and AUC, 0.82% of patients.

CONCLUSIONS

The findings show that an ANNs can predict successful surgery outcome with a high level of accuracy in LDH patients. Such information is of use in the clinical decision-making process.

Treatment Results for Pineal Region Tumors: Role of Stereotactic Biopsy Plus Adjuvant Therapy vs. Open Resection

AIM

Pineal tumors represent uncommon intracranial tumors with highly diverse histologic subtypes. There still exists a controversy in literature about what influences overall survival and outcome.

MATERIAL AND METHODS

We present the results of 48 patients with pineal tumor treated either by stereotactic biopsy followed by adjuvant therapy (23 patients) or open surgical resection without (18 patients) or with (7 patients) adjuvant therapy in Shohada Tajrish Hospital, Iran (1993-2008).

RESULTS

Unremarkable pathology yield was 3/23 in the biopsy and 1/25 in the surgical group. Perioperative mortality and morbidity were 4.3% and 0% in the biopsy group and 32.0% and 4.0% in the surgical group. Analysis showed that age, gender, cranial nerve deficit, motor deficit, preoperative Karnofsky Performance Score (KPS), midbrain involvement, and brain stem involvement had no effect on neither perioperative mortality nor long-term survival, while local invasion and pineocytoma pathology increased perioperative mortality and presence of hydrocephalus and pineoblastoma pathology significantly decreased long-term survival. Hospitalization length was shorter in the stereotactic biopsy plus adjuvant therapy group.

CONCLUSION

The results of the study suggests that although gross total resection is the standard of care in most pineal tumors nowadays, stereotactic biopsy followed by adjuvant therapy may still be a safe and viable option.

Use of artificial neural networks to predict the probability of developing new cerebral metastases after radiosurgery alone

BACKGROUND

The present study aimed to predict the probability of developing new cerebral metastases after Gamma Knife radiosurgery (GKR) alone in patients with 1-3 brain metastases by artificial neural network (ANN) model.

METHODS

AAN and other methods were used. The AAN has been investigated in comparison of other models of analysis, including the logistic regression (LR) and the recently introduced Huttenlocher method. Patients were divided into a distant brain failure (DBF) or a distant brain control (DBC) within 6 months of follow-up. Eleven factors were determined as the input parameters for the established ANN and were trained to predict of DBF. Sensitivity analysis was performed. The ROC curve, accuracy rate, and Hosmer-Lemeshow (H-L) tests were used to assess the three different prediction methods.

RESULTS

A total of 192 patients were categorized into the training (N.=96), testing (N.=48), and validation (N.=48) data sets in ANN. DBC rate was 60.4; based on the Huttenlocher classification method, it was 40.7% in Group I, 49.2% in Group II, and 88.1% in Group III. The number of cerebral metastases, primary tumor type, extra-cerebral metastases and recursive partitioning analysis (RPA) were the most important variables indicated by the ANN analysis. Compared to the other two methods, ANN model was associated to superior results: accuracy rate, 95.3%; H-L statistic, 40.9%; and AUC, 0. 0.88%.

CONCLUSIONS

The ANNs can be used to effectively help for predicting DBF in patients with 1-3 brain metastasis treated with GKR alone.

Prediction of individual differences in risky behavior in young adults via variations in local brain structure

In recent years the problem of how inter-individual differences play a role in risk-taking behavior has become a much debated issue. We investigated this problem based on the well-known balloon analog risk task (BART) in 48 healthy subjects in which participants inflate a virtual balloon opting for a higher score in the face of a riskier chance of the balloon explosion. In this study, based on a structural Voxel Based Morphometry (VBM) technique we demonstrate a significant positive correlation between BART score and size of the gray matter volume in the anterior insula in riskier subjects. Although the anterior insula is among the candidate brain areas that were involved in the risk taking behavior in fMRI studies, here based on our structural data it is the only area that was significantly related to structural variation among different subjects.

Cavernomas: Outcomes after gamma-knife radiosurgery in Iran

Background:

Treatment of cavernomas remains a challenge in surgically inaccessible regions. The purpose of this study was to evaluate outcomes after gamma-knife surgery (GKS) for these patients.

Materials and Methods:

A retrospective review of 100 patients treated between 2003 and 2011 was conducted in order to evaluate hemorrhage rates, complications, radiation effects after GKS. Dosage at the tumor margin was stratified into two groups: those that received ≤13 Gy; and those who received >13 Gy. The demographic and clinical characteristics of patients including age, gender, and hemorrhage rates were extracted from care records.

Results:

The median age was 32.5 years (ranging from 15 to 79). 44% were female. The median follow-up time was 42.2 months (ranging from 24 to 90). The median volume of the lesions was 1050.0 mm³ (ranging from 112.0 to 4100.0) before GKS. A reduction of 27.5% in median size of cavernomas was achieved at the last follow-up. There was 12% treatment-related morbidity after GKS. The hemorrhage rate in the first 2 years after GKS was 4.1% and 1.9% thereafter. There was no mortality due to GKS, and 93 patients were alive at the last follow-up. The radiation-related complication developed with marginal dose 13 Gy.

Conclusion:

The GKS for cavernomas appears to be a safe and beneficial in carefully selected patients. Low-dose GKS may be effective for the management of cavernous malformations.

Artificial neural networks in neurosurgery

Artificial neural networks (ANNs) effectively analyze non-linear data sets. The aimed was A review of the relevant published articles that focused on the application of ANNs as a tool for assisting clinical decision-making in neurosurgery. A literature review of all full publications in English biomedical journals (1993-2013) was undertaken. The strategy included a combination of key words 'artificial neural networks', 'prognostic', 'brain', 'tumor tracking', 'head', 'tumor', 'spine', 'classification' and 'back pain' in the title and abstract of the manuscripts using the PubMed search engine. The major findings are summarized, with a focus on the application of ANNs for diagnostic and prognostic purposes. Finally, the future of ANNs in neurosurgery is explored. A total of 1093 citations were identified and screened. In all, 57 citations were found to be relevant. Of these, 50 articles were eligible for inclusion in this review. The synthesis of the data showed several applications of ANN in neurosurgery, including: (1) diagnosis and assessment of disease progression in low back pain, brain tumours and primary epilepsy; (2) enhancing clinically relevant information extraction from radiographic images, intracranial pressure processing, low back pain and real-time tumour tracking; (3) outcome prediction in epilepsy, brain metastases, lumbar spinal stenosis, lumbar disc herniation, childhood hydrocephalus, trauma mortality, and the occurrence of symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid haemorrhage; (4) the use in the biomechanical assessments of spinal disease. ANNs can be effectively employed for diagnosis, prognosis and outcome prediction in neurosurgery.

A validation study of the Iranian version of STarT Back Screening Tool (SBST) in lumbar central canal stenosis patients

BACKGROUND

This study aimed to translate and validate the STarT Back Screening Tool (SBST) in Iran.

METHODS

This was a prospective clinical validation study. The translation and cross-cultural adaptation of the original questionnaire was performed, and a total of 269 patients with lumbar central canal stenosis were asked to respond to the questionnaire at their first visits. Patients also were asked to complete the Oswestry Disability Index (ODI). Reliability was assessed by internal consistency using the Cronbach's alpha coefficient. Validity was evaluated by performing convergent validity and responsiveness to change.

RESULTS

Mean patient age was 58.6 [standard deviation (SD) = 10.9] years; 56.5 % were women. According to patients' imaging, they were diagnosed as grade 1 (n = 86), grade 2 (n = 107), and grade 3 (n = 76). In general, the SBST showed good psychometric properties. Cronbach's alpha coefficient for overall scale (Q1-Q9) and psychosocial subscale (Q5-Q9) was 0.82 and 0.79, respectively. The ODI correlated strongly with overall SBST scores, lending support to its good convergent validity (r = 0.81; P < 0.001). Responsiveness to change also indicated desirable results.

CONCLUSION

In general, the Iranian version of the SBST performed well, and findings suggest that it is a reliable and valid measure for screening low back pain in patients with lumbar central canal stenosis in primary care settings.

Use of artificial neural networks to predict surgical satisfaction in patients with lumbar spinal canal stenosis

Object

The purpose of this study was to develop an artificial neural network (ANN) model for predicting 2-year surgical satisfaction, and to compare the new model with traditional predictive tools in patients with lumbar spinal canal stenosis.

Methods

The 2 prediction models included an ANN and a logistic regression (LR) model. The patient age, sex, duration of symptoms, walking distance, visual analog scale scores of leg pain or numbness, the Japanese Orthopaedic Association score, the Neurogenic Claudication Outcome Score, and the stenosis ratio values were determined as the input variables for the ANN and LR models that were developed. Patient surgical satisfaction was recorded using a standardized measure. The ANNs were fed patient data to predict 2-year surgical satisfaction based on several input variables. Sensitivity analysis was applied to the ANN model to identify the important variables. The receiver operating characteristic–area under curve (ROC-AUC), Hosmer-Lemeshow statistics, and accuracy rate were calculated for evaluating the 2 models.

Results

A total of 168 patients (59 male, 109 female; mean age 59.8 ± 11.6 years) were divided into training (n = 84), testing (n = 42), and validation (n = 42) data sets. Postsurgical satisfaction was 88.7% at 2-year follow-up. The stenosis ratio was the important variable selected by the ANN. The ANN model displayed a better accuracy rate in 96.9% of patients, a better Hosmer-Lemeshow statistic in 42.4% of patients, and a better ROC-AUC in 80% of patients, compared with the LR model.

Conclusions

The findings show that an ANN can predict 2-year surgical satisfaction for use in clinical application and is more accurate compared with an LR model.

Role of stereotactic biopsy in histological diagnosis of multiple brain lesions

Background and Aim:

The current advances in diagnostic and therapeutic modalities and increasing in survival of patients with systemic diseases and immunosuppressive cases have caused to increasing frequency and variety of Central Nervous System neuropathologic processes indicating the necessary need for accurate localization of space-occupying lesions by cytology and histology. This study was aimed to evaluate the usefulness and safety of stereotactic biopsy in histological diagnosis of such lesions.

Materials and Methods:

Of 2081 patients underwent stereotactic biopsy of brain lesions using Riechert-Mundinger system, 158 had multifocal brain lesions, and were enrolled.

Results:

The ages of studied cases were ranged from 2 years to 75 years (Mean age: 41.3 year), 114 were male and 44 were females. Incidence of histopathologic diagnosis of multifocal brain lesions included Astrocytoma grade II (41.3%), Astrocytoma grade I (12.9%), glioblastoma multiform (11.1%), Astrocytoma grade III (10.2%), malignant lymphoma (10.2%), metastasis (4.6%), pilocytic Astrocytoma (2.7%), abscess (2.7%), craniopharyngioma (1.8%) vascular malformations (0.9%), and tuberculosis (0.9%). Mortality due to operation is none.

Conclusions:

Histopathologic diagnosis of multiple brain lesions is necessary for decision of appropriate management and stereotactic biopsy of brain lesion is a useful and safe method for histological diagnosis.

Long-Term Results of stereotactic Brachytherapy (Temporary 125Iodine Seeds) for the Treatment of Low-Grade Astrocytoma (Grade II)

Background

Treatment of low-grade astrocytoma (WHO grade II) (LGA II) remains a challenge. There is limited information regarding the long-term effects of stereotactic brachytherapy (SBT) (temporary ¹²⁵Iodine seeds) on patients with LGA II.

Objectives

The purpose of this study was to evaluate disease control and survival after stereotactic brachytherapy in patients with circumscribed and relatively small size tumors.

Materials and Methods

A retrospective review of 29 patients, treated between 1991 and 2011, was conducted to evaluate survival, complications, and local disease control after stereotactic brachytherapy. They belonged to a larger group of 48 cases with low-grade gliomas, treated with stereotactic brachytherapy. The demographic and clinical characteristics in patients including age, sex, and survival time were extracted from records.

Results

Thirteen patients were male and 16 were female, with the median age of 29 years (range, 2.5 – 64 years). The median follow-up was 95 (range, 6 – 240) months. Based on Pignatti classification, 10 patients were at low- and 19 patients at high-risk. The median overall as well as progression-free survivals for patients were 135 months (95% confidence interval: 76 – 194) and 96 months (95% confidence interval: 1 – 199), respectively. Five- and 10-year progression-free survivals were 41.4 % and 34.5 %, respectively, and the 5- and 10-year overall survivals were 65.5 % and 44.8%, respectively. Progression-free survival was not significantly higher in smaller size tumors (P = 0.224), nor for spherical versus non-spherical tumors (P = 0.307). There was no treatment-related morbidity after stereotactic brachytherapy, and no radiogenic complications occurred during the follow-up period. Mortality due to tumor progression occurred in 4 patients (14%), and 11 patients were alive at the last follow-up.

Conclusions

The stereotactic brachytherapy for patients with circumscribed and relatively small size tumors appears to be a safe, feasible, and minimally-invasive treatment.

Severity of symptoms, physical functioning and satisfaction in patients with lumbar spinal stenosis: a validation study of the Iranian version of the Swiss Spinal Stenosis Score (SSS)

Background:

A common cause of low back pain is lumbar spinal stenosis (LSS). The Swiss Spinal Stenosis Score (SSS) is a well-known questionnaire measuring the severity of symptoms, physical functioning and patient’s satisfaction in these patients. This study aimed to translate and validate the SSS in Iran.

Methods:

This was a prospective clinical validation study. Forward-backward procedure was applied to translate the original questionnaires into Persian. A sample of patients with lumbar spinal stenosis completed the questionnaire twice: pre- and post-operative (6-month follow-up) assessments. To test reliability the internal consistency was assessed; Validity was evaluated using known groups comparison. In addition Oswestry Disability Index was used to perform convergent validity.

Results:

In all 121 patients were entered into the study. The mean age of patients was 62.3 (SD equal to 10.2) years. Cronbach’s alpha coefficient for the SSS was found to be 0.88. Validity assessment was performed using common group’s analysis and showed satisfactory results. The instrument discriminated efficiently between sub-groups of patients who differed in age, severity of lumbar spinal stenosis, and Self-Paced Walking Test (SPWT). The change in Oswestry Disability Index strongly correlated with the change in patients’ scores on the SSS, lending support to its good convergent validity (r equal to 0.82; P Less than 0.001).

Conclusions:

The Iranian version of the Swiss Spinal Stenosis Score performed well and the findings suggest that it is a valid measure of the severity of symptoms, physical function and satisfaction among lumbar spinal stenosis patients.

Keywords:

Lumbar, Spinal stenosis, Swiss Spinal Stenosis Score

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for low back disorders: a validation study from Iran

Background:

Lumbar Disc Herniation (LDH) and Lumbar Spinal Stenosis (LSS) are the most common diagnoses of low back and leg pain symptoms. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a measure of health related quality of life in these patients. This study aimed to cross-culturally translate and validate the JOABPEQ in Iran.

Methods:

This was a prospective clinical validation trial. The translation and cross-cultural adaptation of the original questionnaire were performed in accordance with the published guidelines. A total of 103 patients with LDH or LSS were asked to respond to the questionnaire at two time points: pre- and post-operation (pre- and post-operative assessments) and were followed up for 6 months. To evaluate the reliability the internal consistency was assessed using the Cronbach's alpha coefficient and validity was assessed using the convergent validity. Responsiveness to the clinical change also was assessed comparing patients’ pre- and postoperative scores.

Results:

The Cronbach’s alpha coefficients for the JOABPEQ at preoperative and postoperative assessments ranged from 0.71 to 0.81 indicating a good internal consistency for the questionnaire. Furthermore, the correlation of each item with its hypothesized subscale of the JOABPEQ showed satisfactory results suggesting that the items had a substantial association with the subscale representing the concept. Further analysis also indicated that the questionnaire was responsive to change (P less than 0.0001).

Conclusions:

In conclusion, the Iranian version of JOABPEQ performed well and the findings suggest that it is a reliable and valid measure of back pain evaluation among LDH and LCS patients.

Keywords:

Japanese Orthopedic Association Back Pain Evaluation Questionnaire, Low back pain, Postoperative

Functional evaluation using the modified Japanese Orthopedic Association score (mJOA) for cervical spondylotic myelopathy disease by age, gender, and type of disease

Background:

Cervical spondylotic myelopathy (CSM) is a common cause of significant clinical morbidity. The modified Japanese Orthopedic Association score (mJOA) is a very short instrument for functional evaluation in these patients. This study aimed to evaluate functionality in patients diagnosed with CSM diseases using the mJOA and to compare the scores based on age, sex, and type of disease.

Methods:

A sample of patients with CSM who were candidate for decompressive surgery entered into this cross sectional study. The mJOA scores were obtained for the functional assessment of patients. Score on the mJOA range from 0 to 18 with higher scores indicating a better condition. In addition to descriptive statistics, the data were compared among study subgroups as categorized by age, gender and type of disease.

Results:

A total of 63 patients were studied. The mean age of the patients was 54 ± 8.3 (SD)(range 21-79 years) All patients diagnosed as having cervical herniated disc (n = 36) or cervical spinal stenosis (n = 27). Overall, the mean mJOA score for all patients was 9.82 (SD = 1.0). The mJOA score for men were significantly higher than women (P less than 0.0001). The mJOA score in younger patients was significantly higher than older patients (P less than 0.0001). No significant difference was observed for type of disease (P = 0.47).

Conclusions:

The findings of the study suggest that functionality score as measured by the mJOA can be a useful parameter for clinicians help them to manage patients with cervical spondylotic myelopathy prior to surgery.

Keywords:

Score, Cervical, Spondylotic, Myelopathy

A graded prognostic assessment scale to predict overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery

Background:

The present study aims to evaluate the Graded Prognostic Assessment (GPA) score for predicting overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery.

Methods:

This was a cross sectional study conducted on the patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery during 2003 to 2011. Clinical and radiological parameters were evaluated, and the GPA score were determined. Kaplan–Meier and log-rank tests were used to assess prognostic factors of the GPA.

Results:

Two hundred and twenty patients were eligible to enter the study during the eight years course of study. The mean age of the patients was 54 ± 12.7 years (ranged 19 to 82 years) and were followed up for an average of 7 (range=1-25) months post Gamma-knife surgery. Median survival times according to the GPA were: GPA 0–1, 4 ± 0.4 months; GPA 1.5–2.5, 6 ± 0.7 months; GPA 3, 9 ± 0.9 months; and GPA 3.5–4.0, 12 ± 1.8 months and overall survival were 7 ± 0.6 months. The level of statistical significance among GPA groups was p less than 0.0001.

Conclusions:

It seems that the preoperative GPA is able to predict Gamma-knife radiosurgery results in patients with brain metastases. However, the results should be confirmed with further clinical trial assessments.

Keywords:

Brain metastases, GPA Score, Gamma-knife radiosurgery, Predict

Updated measuring motor, sensory and sphincter dysfunctions in patients with cervical myelopathy using the modified Japanese Orthopedic Association (mJOA) score: a validation study

Background:

Cervical myelopathy population (CMP) is a common cause of significant clinical morbidity. This study aimed to translate and validate the modified Japanese Orthopedic Association score (mJOA) English version in Iran.

Methods:

This was a prospective clinical validation study. Psychometric properties of the questionnaire were assessed using internal consistency; inter-observer reliability, discriminant validity, and responsive ness of the questionnaire to change.

Results:

A total of 63 patients were studied. The mean mJOA score was 9.82 (SD = 1.0). Internal consistency of the mJOA as measured by Cronbach’s alpha coefficient was satisfactory (alpha = 0.77). Inter-observer agreement as measured by Kappa statistics also was found to be acceptable (0.75). Known-groups comparison was performed to test discriminant validity and the findings indicated that the mJOA was able to differentiate between males and females and different age groups as expected (P less than 0.0001). Finally the questionnaire was found to be responsive to change as patients’ pre- and post-operative scores on the mJOA (P less than 0.0001).

Conclusions:

The Iranian version of mJOA performed well and the findings suggest that it is a reliable and valid measure of motor, sensory and sphincter dysfunctions among CMP patients.

Keywords:

Cervical myelopathy patients, Grading scale, Modified japanese orthopedic Association score

The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for low back disorders: a validation study from Iran

BACKGROUND

Lumbar disc hernia (LDH) and lumbar spinal stenosis (LSS) are the most common diagnoses of low back and leg pain symptoms. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a measure of health-related quality of life in these patients. This study aimed to cross-culturally translate and validate the JOABPEQ in Iran.

METHODS

This was a prospective clinical validation study. The translation and cross-cultural adaptation of the original questionnaire was performed in accordance with published guidelines. A total of 103 patients with LDH or LSS were asked to respond to the questionnaire at two points in time: pre- and postoperative assessments (6 months follow-up). To test reliability, the internal consistency was assessed by Cronbach's alpha coefficient, and validity was assessed using convergent validity. Responsiveness to change was also assessed comparing patients' pre- and postoperative scores.

RESULTS

The Cronbach's alpha coefficients for the JOABPEQ at pre- and postoperative assessments ranged from 0.71 to 0.81, indicating a good internal consistency for the questionnaire. In addition, the correlation of each item with its hypothesized subscale of the JOABPEQ showed satisfactory results, suggesting that the items had a substantial association with the subscale representing the concept. Further analysis also indicated that the questionnaire was responsive to change (P < 0.0001).

CONCLUSIONS

In general, the Iranian version of JOABPEQ performed well, and the findings suggest that it is a reliable and valid measure of back pain evaluation among LDH and LCS patients.

Computed tomography-guided stereotactic biopsy of intracranial lesions in pediatric patients

PURPOSE

The primary objective of this study was to report the results of author's 18-year experience of diagnostic stereotactic biopsy procedures in children with intracranial lesions.

METHODS AND MATERIALS

A retrospective analysis was conducted on stereotactic procedures performed on children with brain tumor between 1989 and 2007.

RESULTS

Stereotactic biopsy of intracranial tumors was performed in 172 children (69 girls, and 103 boys) with the mean age of 9.17 ± 3.66 years at the time of diagnosis. The most frequent anatomical location of lesions was brainstem (45.9%). Glioma was the most common diagnosis, represented in 90.7% of patients (156 patients). Other diagnosed tumors (4.7%) were classified as metastatic (1.7%), lymphomas (1.2%), oligodendroglioma (0.6%), craniopharyngioma (0.6%), and pineocytoma (0.6%). Nonneoplastic lesions were revealed in 4.7% of patients.

CONCLUSION

The most frequent brain pathology of children is glioma, but the incidence of brain lesions other than gliomas and the frequency of brain lesions in the inoperable areas are compelling reasons to establish tissue diagnosis.