Relationship between the Expression of Matrix Metalloproteinases and Their Tissue Inhibitors in Patients with Brain Tumors

Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) play critical roles in regulating processes associated with malignant behavior. These endopeptidases selectively degrade components of the extracellular matrix (ECM), growth factors, and their receptors, contributing to cancer cell invasiveness and migratory characteristics by disrupting the basal membrane. However, the expression profile and role of various matrix metalloproteinases remain unclear, and only a few studies have focused on differences between diagnoses of brain tumors. Using quantitative real-time PCR analysis, we identified the expression pattern of ECM modulators (n = 10) in biopsies from glioblastoma (GBM; n = 20), astrocytoma (AST; n = 9), and meningioma (MNG; n = 19) patients. We found eight deregulated genes in the glioblastoma group compared to the benign meningioma group, with only MMP9 (FC = 2.55; p = 0.09) and TIMP4 (7.28; p < 0.0001) upregulated in an aggressive form. The most substantial positive change in fold regulation for all tumors was detected in matrix metalloproteinase 2 (MNG = 30.9, AST = 4.28, and GBM = 4.12). Notably, we observed an influence of TIMP1, demonstrating a positive correlation with MMP8, MMP9, and MMP10 in tumor samples. Subsequently, we examined the protein levels of the investigated MMPs (n = 7) and TIMPs (n = 3) via immunodetection. We confirmed elevated levels of MMPs and TIMPs in GBM patients compared to meningiomas and astrocytomas. Even when correlating glioblastomas versus astrocytomas, we showed a significantly increased level of MMP1, MMP3, MMP13, and TIMP1. The identified metalloproteases may play a key role in the process of gliomagenesis and may represent potential targets for personalized therapy. However, as we have not confirmed the relationship between mRNA expression and protein levels in individual samples, it is therefore natural that the regulation of metalloproteases will be subject to several factors.

Safety and efficacy of simple training protocol in patients after mild traumatic brain injury

AIMS

Mild Traumatic Brain Injury (mTBI) is the most common type of craniocerebral injury. Proper management appears to be a key factor in preventing post-concussion syndrome. The aim of this prospective study was to evaluate the effect and safety of selected training protocol in patients after mTBI.

METHODS

This was a prospective study that included 25 patients with mTBI and 25 matched healthy controls. Assessments were performed in two sessions and included a post-concussion symptoms questionnaire, battery of neurocognitive tests, and magnetic resonance with tractography. Participants were divided into two groups: a passive subgroup with no specific recommendations and an active subgroup with simple physical and cognitive training.

RESULTS

The training program with slightly higher initial physical and cognitive loads was well tolerated and was harmless according to the noninferiority test. The tractography showed overall temporal posttraumatic changes in the brain. The predictive model was able to distinguish between patients and controls in the first (AUC=0.807) and second (AUC=0.652) sessions. In general, tractography had an overall predictive dominance of measures.

CONCLUSION

The results from our study objectively point to the safety of our chosen training protocol, simultaneously with the signs of slight benefits in specific cognitive domains. The study also showed the capability of machine learning and predictive models in mTBI patient recognition.

Embolization of Ruptured Infratentorial Pial AVM in Pregnancy

A primigravida 22-year-old woman, at a gestation of 23 weeks, experienced bleeding from a pial arteriovenous malformation (AVM) located in the right cerebellum. After interdisciplinary consensus and with the informed consent of the patient and her family, AVM embolization was performed. Complete occlusion of the AVM was achieved by embolization with PHIL (precipitating hydrophobic injectable liquid). The calculated dose in the uterus was less than 1 µSv, which represents a negligible risk of harmful effects on the fetus. She delivered a baby at 37 weeks of gestation by cesarean section without complications. No congenital disorders were diagnosed by standard screening methods until the age of the newborn was two years. The angiography protocol must be optimized to minimize the radiation dose. Adequate shielding protection of the uterus is important. Premature termination of pregnancy is not necessary. Multidisciplinary care of neurologists, neurosurgeons, interventional radiologists, anesthesiologists, neonatologists, and obstetricians is necessary.

Incidence and severity of dysphagia after anterior cervical discectomy and fusion with zero-profile spacer: prospective study with 3-years follow-up

INTRODUCTION

Dysphagia after anterior cervical discectomy and fusion (ACDF) is a regular complication. The aim of this study was to identify risk factors for incidence and severity of dysphagia after ACDF with zero-profile spacer.

METHODS

Incidence and severity of dysphagia was evaluated preoperatively and for time of three years after ACDF (regular outpatient check-ups) ‒ prospective study with 3-years follow-up. Severity of dysphagia was assessed subjectively using Bazaz‒Yoo dysphagia score. Influence of selected factors on the incidence and severity of postoperative dysphagia was evaluated. Following statistical methods were used: Fisher's exact test, unpaired Student's t-test, one-way ANOVA and Spearman's correlation coefficient. Level of significance was defined as p ˂ 0.05. Correlations between paired parameters were evaluated according to Spearman's correlation.

RESULTS

Our study included 133 patients who underwent one-, two- or three-level ACDF with zero-profile spacer in years 2013‒2018. Myelopathy and GERD had significant impact on incidence and severity of pre-existing dysphagia. Risk factors for incidence of dysphagia after ACDF were number of treated segments, myelopathy, pre-existing dysphagia and surgery of C4/5 segment. Age of patients, duration of surgery and pre-existing dysphagia correlated positively very weakly to weakly with severity of dysphagia after ACDF. Number of treated segments, myelopathy, GERD and surgery of the C4/5 segment were risk factors for greater severity of postoperative dysphagia.

CONCLUSION

Risk factors for incidence and severity of pre-existing dysphagia were myelopathy and GERD. Risk factors for dysphagia incidence after ACDF were number of treated segments, pre-existing dysphagia, myelopathy and surgery of C4/5 segment (Tab. 6, Fig. 1, Ref. 30).

Quantitative profiling of genes associated with cancer pathways in brain tumors

BACKGROUND

Brain tumors are a heterogeneous group of malignancies characterized by inter- and intratumoral heterogeneity. Among them, the most aggressive and, despite advances in medicine, still incurable remains glioblastoma. One of the reasons is the high recurrence rate of the disease and resistance to temozolomide, a golden standard in chemotherapy of brain tumors. Therefore, mapping the pathways responsible for tumorigenesis at the transcriptional level may help to determine the causes and aggressive behavior among different glial tumors.

PATIENTS AND METHODS

Biopsies from patients with astrocytoma (N = 6), glioblastoma (N = 22), and meningioma (N = 14) were included in the sample set. A control group consisted of RNA isolated from healthy human brain (N = 3). The reverse-transcribed cDNAs were analyzed using the Human Cancer PathwayFinder™ real-time PCR Array in a 96-well format. The expression of 84 genes belonging to 9 signaling pathways (angiogenesis, apoptosis, cell cycle and senescence, DNA damage and repair, epithelial-to-mesenchymal transition, hypoxia, overall metabolism, and telomere dynamics) was determined for each sample.

RESULTS

By determining the relative expression of selected genes, we characterized the transcriptomic profile of individual brain malignancies in the context of signaling pathways involved in tumorigenesis. We observed deregulation in 50, 52.4 and 53.6% % of the genes in glioblastomas, meningiomas and astrocytomas, respectively. The most pronounced changes with statistical significance compared to control were observed in the genes associated with epithelial-to-mesenchymal transition (CDH2, FOXC2, GSC, SNAI2, and SOX10), cellular senescence (BMI1, ETS2, MAP2K1, and SOD1), DNA repair (DDB2, ERCC3, GADD45G, and LIG4), and dynamic of telomeres (TEP1, TERF2IP, TNKS, and TNKS2).

CONCLUSION

Based on the obtained data, we can conclude that individual diagnoses differ in transcriptomic profile. An individual molecular approach is therefore necessary in order to provide comprehensive and targeted therapy on multiple metabolic pathways in the diagnosis of brain tumors.

Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

BACKGROUND

Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development.

METHODS

We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation.

FINDINGS

Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49).

INTERPRETATION

Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices.

FUNDING

National Institute for Health Research Global Health Research Group.

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

INTRODUCTION

The occurrence of symptomatic spinal epidural hematoma after spine surgery is a rare, but serious major complication whose incidence usually requires urgent surgical intervention. Obesity is currently considered to be one of the most common metabolic diseases.

METHODS

Prospective analysis of patients who underwent surgical treatment of degenerative lumbar spine disease from January 2016 to February 2018 with one-year follow-up. All patients underwent decompression of spinal cord and nerve roots. This study was conducted to determine an association between the incidence of spinal epidural hematoma (SEDH) requiring surgical treatment and obesity/body mass index (BMI).

RESULTS

In our study, data from 371 patients were assessed. SEDH requiring surgical intervention occurred totally in seven patients (1.89 %). An average BMI in patients with presence of SEDH was 30.67 kg/m2. Our work showed a statistically significant difference between BMI in patients with SEDH compared to patients without SEDH (p = 0.0044). This study also showed a significant difference in incidence of symptomatic SEDH in obese patients compared to non-obese patients (p=0.0158).

CONCLUSION

In our study, we found out that obesity is a significant risk factor for the incidence of postoperative SEDH after degenerative lumbar spine surgery (Tab. 1, Fig. 2, Ref. 18).

Analysis of clinical efficiency and early postoperative complications after cranioplasty

INTRODUCTION

Despite of being considered a routine procedure, cranioplasty is associated with a substantial risk of failure, or postoperative complications.

PATIENTS AND METHODS

Postoperative clinical course and rate of complications was assessed in patients undergoing cranioplasty during years 2015-2019 in a retrospective fashion.

RESULTS

The most frequent condition requiring cranioplasty was a presence of bone defect after a decompressive craniectomy for traumatic brain injury (45 patients). Revision was needed in 9 cases (12.68 %), removal of the bone flap was necessary in 5 patients (7.04 %). The most common complication observed was an unintended intraoperative durotomy, occurring in 9 patients (12.68 %), which was, however, not associated with an increased risk of reoperation. Postoperative improvement of motor functions was observed in 7 patients (9.86 %). Improvement of consciousness occurred in 8 patients (11.27 %). Early cranioplasty was associated with significantly higher odds for surgical revision, patients after previous craniectomy for traumatic brain injury had significantly increased odds for the overall occurrence of complications.

CONCLUSIONS

After a cranial reconstruction, complications with a various degree of severity may occur and even the result in need of the implant removal. Postoperative improvement of focal neuro-deficit is possible as well as improvement on the level of patient's consciousness (Tab. 2, Fig. 2, Ref. 61).

Proton magnetic resonance spectroscopy changes in the brainstem in patients after mild traumatic brain injury with loss of consciousness

INTRODUCTION

Loss of consciousness (LOC) is used as a diagnostic feature of mild traumatic brain injury (MTBI). However, only 10% of concussions result in LOC. There are only a limited number of in-vivo studies dealing with unconsciousness and structural and functional integrity of the brainstem in patients with MTBI. The aim of our pilot study was to assess the sensitivity of proton magnetic resonance spectroscopy (¹H-MRS) to detect metabolic changes in the brainstem in patients after MTBI with unconscioussness.

METHODS

Twenty-four patients (12 with LOC, and 12 without LOC) within 3 days of MTBI and 19 healthy controls were examined. All subjects underwent single-voxel ¹H-MRS examination of the upper brainstem. Spectra were evaluated using LCModel software. Ratios of total N-acetylaspartate (tNAA), total choline-containing compounds (tCho) and glutamate plus glutamine (Glx) to total creatine (tCre) were used for calculations.

RESULTS

We found a significant decrease in tNAA/tCre and tCho/tCre ratios in the patient group with LOC when compared with the control group of healthy volunteers (P=0.002 and P=0.041, respectively), and a significant decrease in the tNAA/tCre ratio in the LOC group when compared with patients without LOC (P=0.04). Other metabolite ratios in the brainstem did not show any significant group differences.

CONCLUSION

Our findings indicate that decrease of tNAA/tCre ratio in the upper brainstem using single-voxel ¹H-MRS may provide a potential biomarker for MTBI associated with LOC.

Random Forest-Based Prediction of Outcome and Mortality in Patients with Traumatic Brain Injury Undergoing Primary Decompressive Craniectomy

BACKGROUND

Various prognostic models are used to predict mortality and functional outcome in patients after traumatic brain injury with a trend to incorporate machine learning protocols. None of these models is focused exactly on the subgroup of patients indicated for decompressive craniectomy. Evidence regarding efficiency of this surgery is still incomplete, especially in patients undergoing primary decompressive craniectomy with evacuation of traumatic mass lesions.

METHODS

In a prospective study with a 6-month follow-up period, we assessed postoperative outcome and mortality of 40 patients who underwent primary decompressive craniectomy for traumatic brain injuries during 2018-2019. The results were analyzed in relation to a wide spectrum of preoperatively available demographic, clinical, radiographic, and laboratory data. Random forest algorithms were trained for prediction of both mortality and unfavorable outcome, with their accuracy quantified by area under the receiver operating curves (AUCs) for out-of-bag samples.

RESULTS

At the end of the follow-up period, we observed mortality of 57.5%. Favorable outcome (Glasgow Outcome Scale [GOS] score 4-5) was achieved by 30% of our patients. Random forest-based prediction models constructed for 6-month mortality and outcome reached a moderate predictive ability, with AUC = 0.811 and AUC = 0.873, respectively. Random forest models trained on handpicked variables showed slightly decreased AUC = 0.787 for 6-month mortality and AUC = 0.846 for 6-month outcome and increased out-of-bag error rates.

CONCLUSIONS

Random forest algorithms show promising results in prediction of postoperative outcome and mortality in patients undergoing primary decompressive craniectomy. The best performance was achieved by Classification Random forest for 6-month outcome.

Quantitative analysis of 2-hydroxyglutarate as a controversial oncometabolite in malignant gliomas

There is a great effort to connect the accumulation of 2-hydroxyglutarate (2-HG) oncometabolite with cellular onco-epigenetic status and subsequently predict the prognoses of glioma patients. In this observational study, the concentrations of D- and L- 2-HG were determined in 57 tumor tissue samples of glioma patients (n=57) WHO grade I through IV (astrocytoma, oligodendroglioma, secondary glioblastoma, and glioblastoma multiforme) in vitro. Also, genetic mutation status on isocitrate dehydrogenase 1 and 2 (IDH 1/2) was determined from these samples. The objective of this study was to confirm or to reject the hypothesis of the direct correlation of 2-HG concentration in tumor tissue and the results from IDH 1/IDH 2 point mutation analyses. The concentrations of 2-HG were quantified using high sensitive HPLC and Q-TOF HRMS spectrometer setup. Concurrently, the genetic mutation analyses of both IDH 1 (cytosolic) and IDH 2 (mitochondrial) were performed by the isolation of tumor tissue DNA, PCR amplification, and subsequent Sanger forward sequencing. Our results indicate that there is no definite correlation between the two as we identified cases of glioma tumors with significantly increased concentration of one or both L- and D- 2-HG but no IDH 1/2 mutations (44% 2-HG positive cases).

Incidence and risk factors of early postoperative complications in patients after decompressive craniectomy: a 5-year experience

PURPOSE

Decompressive craniectomy is an effective measure to reduce a pathologically elevated intracranial pressure. Patients' survival and life quality following this surgery have been a subject of several studies and significantly differ according to the primary diagnosis. Since this operation is often associated with a wide spectrum of possibly serious complications, we aimed to describe their incidence and possible associated risk factors.

METHODS

We evaluated 118 patients who underwent decompressive craniectomy at our clinic during years 2013-2017. The indications included traumatic brain injuries, ischaemic or haemorrhagic strokes and postoperative complications of planned neurosurgical procedures. Subsequently, we assessed the incidence of early postoperative complications (occurring during the first 3 postoperative weeks). The results were statistically analysed with relation to a wide selection of possible risk factors.

RESULTS

At least one early surgical postoperative complication occurred in 87 (73.73%) patients, the most frequent being a development of an extraaxial fluid collection in 41 (34.75%) patients. We were able to identify risk factors linked with extraaxial fluid collections, subcutaneous and extradural haematomas, postoperative seizures and meningitis. An overall need for reoperation was 13.56%. Neither the duration of the surgery nor the qualification of the operating surgeon had any effect on the complications' occurrence.

CONCLUSIONS

Decompressive craniectomy is associated with numerous early postoperative complications with a various degree of severity. Most cases of complications can, however, be managed in a conservative way. The risk factors linked with postoperative complications should be taken into account during the indication process in each individual patient.

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease

BACKGROUND

The aim of this study was to verify the relationship between changes in the segmental sagittal profile (SSP) and changes in the global sagittal profile (GSP) after anterior cervical discectomy with anchored cage implantation (ACDF).

STUDY DESIGN

Prospective study with 2-year follow-up.

METHODS

This study includes 104 patients after 1-level or 2-level ACDF operated between the May 2013 and March 2016. SSP was evaluated by Cobb angle measurement of operated motion segment (CobbS) and GSP was evaluated by Cobb angle measurement in C2-C7 segments (CobbG). Both SSP and GSP were measured pre- and postoperatively within a 24 months follow-up period. The influence of factors such as age, gender, number of treated segments and osteoporosis was evaluated using t-tests. The correlation between SSP and GSP changes was assessed by Pearson's correlation coefficient.

RESULTS

In the early postoperative period after 1-level ACDF, there was a significantly greater increase in CobbS compared to that of the 2-level ACDF (P=0.0149). Male patients experienced a significant decrease of CobbG during the first 6 months after surgery as well as patients with osteoporosis within 12 months after ACDF. After ACDF the SSP change weakly correlated with the GSP change.

CONCLUSION

SSP change after 1- or 2-level ACDF correlates mostly weakly with GSP change. Male gender and osteoporosis were identified as risk factors for global lordotisation following ACDF.

Is there an impact of subdural drainage duration and the number of burr holes on the recurrence rate of unilateral chronic subdural haematoma?

INTRODUCTION

Purpose of the study is to evaluate a possible influence of subdural drainage duration and burr hole quantity on a relapse of a unilateral chronic subdural haematoma (CHSH).

METHODS

Sixty - five patients who underwent evacuation of unilateral CHSH via 1 or 2 burr holes and subdural drainage during a period from January 2014 to December 2018 were retrospectively analyzed. Duration of the subdural drainage and the number of burr holes used were assessed in relation to an incidence of CHSH recurrence. According to the subdural drainage duration, we divided the patient cohort into two subgroups: with the subdural drainage duration of 1-3 days and 4-5 days. We also evaluated a possible influence of the subdural drainage duration on risk of postoperative infection.

RESULTS

An overall incidence of CHSH recurrence was 18.5%. In 45 patients treated by means of a single burr hole the haematoma recurrence was observed in 10 patients (22.2%), in 22 patients with two burr holes recurrence occurred in 2 of them (9.1%). The difference was however, not statistically significant (p=0.3214). We did not observe any significant influence of age, gender and subdural drainage duration on the incidence of CHSH recurrence. The duration of subdural drainage had not significant impact on postoperative infection rate (p=0.0950).

CONCLUSION

The number of burr holes used does not affect the rate of unilateral CHSH recurrence. Similarly the duration of subdural drainage affects neither the unilateral CHSH recurrence rate nor the incidence of postoperative infection.

A review of possible complications in patients after decompressive craniectomy

Through the decades of its use in the management of neurosurgical emergencies decompressive craniectomy has found its place as a life-saving procedure capable of a radical reduction of the intracranial pressure. Clinical results and rate of survival after decompressive craniectomy vary according to the primary diagnosis, and they have been a subject of multicentric randomized trials. However,  considerable attention also needs to be kept on complications associated with the craniectomy. They are based not only on the procedures invasivity but also on the pathophysiological changes associated with a conversion of the closed intracranial space to an open one. The complications may further disturb the postoperative care and convalescence in the surviving patients, and therefore in the salvageable patients the indication of decompressive craniectomy should be based on information about the expected outcome and complications rate, at the same moment prevention, early recognition and adequate therapy of the complications should be emphasized. This work describes the most common complications occurring in patients after decompressive craniectomy, their pathophysiological principles and means of treatment and prevention.

Unintended durotomy during degenerative lumbar spine surgery in patients aged 60 years and older - incidence and risk factors

ntroduction: Unintended perioperative dural tear is a common complication in spine surgery. Methods: Retrospective analysis of patients over 60 years of age who underwent surgery for degenerative disease of the lumbar spine at the Department of Neurosurgery (University Hospital in Martin) from January 2016 to December 2017. Incidence of incidental perioperative durotomy was analyzed. We analyzed selected risk factors gender, ASA (American Society of Anesthesiologists), surgical diagnosis, type of surgical performance, range of surgical procedure, revision surgery and comorbidities. The results were statistically evaluated using descriptive statistics and Fisher&#8250;s test. Results with p.

Chronic calcified subdural hematoma - case report of a rare diagnosis

INTRODUCTION

Chronic calcified/ossified subdural hematoma is a rare diagnosis. The incidence of chronic calcified subdural hematoma is 0.3-2.7% of all chronic subdural hematomas. Surgical treatment is indicated in most cases, but there is still some controversy.

MATERIALS AND METHODS

We present a case report of 81-year-old woman with calcified chronic subdural hematoma. Patient underwent an osteoplastic left craniotomy, evacuation of chronic subdural mass with careful dissection andsuccessful removal of inner and outer membrane. Postoperative CT scan showed removal of subdural hematoma, decrease of left shift of median line and good brain re-expansion. Postoperative period was without any serious complications.

RESULTS

Subdural hematoma was successfully removed, resulting in a good recovery with complete resolution of patients symptoms. From our experience, we highly recommend surgical treatment in cases of chronic symptomatic calcified subdural hematomas.

Metabolomic profiling of blood plasma in patients with primary brain tumours: Basal plasma metabolites correlated with tumour grade and plasma biomarker analysis predicts feasibility of the successful statistical discrimination from healthy subjects - a preliminary study

The brain tumours represent a complex tissue that has its own characteristic metabolic features and is interfaced with the whole organism. We investigated changes in basal blood plasma metabolites in the presence of primary brain tumour, their correlation with tumour grade, as well as the feasibility of statistical discrimination based on plasma metabolites. Together 60 plasma samples from patients with clinically defined glioblastoma, meningioma, oligodendrioglioma, astrocytoma, and non-specific glial tumour and plasma samples from 28 healthy volunteers without any cancer history were measured by NMR spectroscopy. In blood plasma of primary brain tumour patients, we found significantly increased levels of glycolytic metabolites glucose and pyruvate, and significantly decreased level of glutamine and also metabolites participating in tricarboxylic acid (TCA) cycle, citrate and succinate, when compared with controls. Further, plasma metabolites levels: tyrosine, phenylalanine, glucose, creatine and creatinine correlated significantly with tumour grade. In general, observed changes are parallel to the biochemistry expected for tumourous tissue and metabolic changes in plasma seem to follow the similar rules in all primary brain tumours, with very subtle variations among tumour types. Only two plasma metabolites tyrosine and phenylalanine were increased exclusively in blood plasma of patients with glioblastoma. Based on metabolite levels, an excellent discrimination between plasma from patient's tumours and controls was attainable. The metabolites creatine, pyruvate, glucose, formate, creatinine and citrate were of the highest discriminatory power.

Secondary (Duret) brainstem haemorrhage may not always represent a fatal event

Background. Secondary brainstem haemorrhage (eponymously called Duret haemorrhage) is a well-known complication of transtentorial brain herniation or of rapid decompression of intracranial space. It is considered to be a consequence of arterial rupture, venous infarction or ischemia-reperfusion injury and it is regarded as a harbinger of an unfavourable outcome for the patient. Despite this, several case reports describing good outcome after Duret haemorrhage preceded by evacuation of an expansive traumatic intracranial mass lesion, an episode of intracranial hypotension or lumbar drainage have been published.Case description. We present four cases of patients with secondary brainstem haemorrhage linked to an episode of intracranial hypertension due to various reasons who were treated at our clinic. The first patient suffered a small brainstem haemorrhage that was described on his initial CT scan presumably as a result of massive intracranial expansion caused by an acute subdural haematoma and this Duret haemorrhage markedly expanded after the subdural haematoma was evacuated by means of a decompressive craniectomy. The next two patients developed Duret haemorrhage after the evacuation of intracranial haematomas. The fourth patient presented with posttraumatic cerebral oedema complicated by a subtle Duret haemorrhage displayed on his initial CT scan and this bleeding remained stable even after a bilateral decompressive craniectomy. One patient passed away, one remained in a persistent coma and two survived with a light neurological deficit.Conclusions. However ominous a newly discovered Duret haemorrhage may be, it alone should not discourage us from the further intensive treatment of our patients as their outcome may considerably vary. The extent of this bleeding, type and severity of underlying brain injury and complete clinical status and history of our patients should all be taken into account when deciding about patients’ prognosis.

Subsidence of anchored cage after anterior cervical discectomy

PURPOSE

Cage subsidence (CS) represents a risk factor for adjacent segment degeneration (ASD) and unfavorable results of anterior cervical discectomy (ACD).

METHODS

Sixty-one patients after level 1 or 2 of ACD with implantation of Zero Profile VA cage were included in the study. CS was assessed with a follow-up period of 12 months after ACD. The impacts of factors such as sex, age, number of operated segments, osteoporosis and extent of peroperative distraction were assessed in relation to the incidence of CS. The influences of CS on clinical results (VAS, NDI, Odom's criteria) and ASD incidence were evaluated.

RESULTS

In 74 % of cases there was the presence of CS into both adjacent vertebral bodies. CS into the ventral part of motion segment was dominant during the entire follow-up period. CS had no influence on clinical results of ACD. Parallel CS into both ventral and dorsal parts of motion segments significantly increased the incidence of proximal ASD (p = 0.0163). Osteoporosis and extent of peroperative distraction were linked to higher incidence of CS into the dorsal part of motion segment (p ˂ 0.05).

CONCLUSIONS

Osteoporosis and the extent of peroperative distraction are risk factors for the subsidence of anchored cage and while increasing the incidence of proximal adjacent segment degeneration it has no significant influence on clinical results of surgery (Tab. 3, Fig. 5, Ref. 32).

Dysphagia after anterior cervical discectomy and interbody fusion - prospective study with 1-year follow-up

INTRODUCTION

Dysphagia is a common finding after anterior cervical discectomy. The incidence and severity of swallowing disorders are variable and depend on many factors.

METHODS

73 patients after 1- or 2-level anterior cervical discectomy and fusion /ACDF/ were enrolled in prospective, single-center study. The severity of dysphagia was evaluated by the Bazaz-Yoo dysphagia score before surgery and 6 weeks, 3, 6 and 12 months after surgery. The impact of factors such as sex, age, number of operated segments, smoking, gastroesophageal reflux disease, hypertension, duration of surgery and pre-existing dysphagia on the incidence of dysphagia after surgery was verified. The correlation between the duration of surgery and severity of postoperative dysphagia, and similarly between the age and severity of preoperative and postoperative dysphagia was studied.

RESULTS

Dysphagia was present in 22% patients within 12 months after surgery. No patient reported severe dysphagia. No significant relationship was demonstrated between sex, age, number of operated segments, pre-existing dysphagia, gastroesophageal reflux disease, hypertension and the incidence of dysphagia after surgery. Smokers showed a significantly lower incidence of dysphagia before surgery and within 12 months after ACDF (p.

Efficiency and Limitations of Decompressive Craniectomy in Patients after Traumatic Brain Injury – Preliminary Results

Introduction: Decompressive craniectomy (DC) has been recently proven effective tier II therapeutic procedure in the treatment of refractory posttraumatic intracranial hypertension. However, its full potential and effectivity is yet to be described and this surgery remains controversial. The goals of our study include analysis of efficiency of DC and description of risk factors associated with unfavourable outcome.

Methods: 24 patients who underwent DC at the Clinic of Neurosurgery, JFM CU in Martin, during years 2015–2016 were prospectively observed. Selected demographic, clinical, and radiographic factors were analysed and compared with patient’s GOS (Glasgow Outcome Scale) at the time of their first ambulatory control (after 3.5 months in average).

Results: We observed mortality of 29.17 %. Good outcome (GOS 4–5) was achieved by 29.17 % of the patients as well. Preoperative GCS ≤ 5 (p = 0.049), intraventricular bleeding (p = 0.0268), midline shift ≥ 15 mm (p = 0.0067), and the volume of intracranial lesion (R = −0.41, p = 0.046), especially its extracerebral component (R = −0.46, p = 0.02), were identified as statistically significant negative prognostic factors.

Conclusion: DC is effective in the management of patients with traumatic brain injury. Good outcome is achieved by 29.17 % of the patients. Described negative prognostic factors (preoperative GCS ≤ 5, intraventricular bleeding, midline shift ≥ 15 mm, and increasing the volume of traumatic mass lesion) could help in targeting this surgery only to patients who are expected to benefit from it.

Surgical site infections after degenerative lumbar spine surgery

Degenerative lumbar spine disease is nowadays considered as a serious health condition, because the number of patients requiring a surgical intervention is in last decades rapidly increasing. At the time of surgery indication, it is important to assess the risk of complications incidence, especially surgical ones, because when they occur, they usually lead to reoperation, prolonged hospitalisation and drug use, economic consequences and a compromised postoperative outcome and benefits. Postoperative infectious complications may occur, even after following aseptic and hygienic epidemiological rules. This article contains an interdisciplinary review of diagnosis, treatment and prevention of postoperative surgical site infections after degenerative lumbar spine surgery. Key words: postoperative complications lumbar spine surgical treatmens - spondylodiscitis.

Adverse effects of orthodontic treatments

Orthodontic therapy, like any other medical intervention, in addition to its benefits carries the risk of potential complications and is associated with adverse effects-including periodontal problems, external root resorptions, pulpal changes, enamel damages (demineralization, discoloration, attrition), temporomandibular disorders, infective endocarditis, soft tissue damages, discomfort, pain and the risk of either aspiration or indigestion of medical instruments and appliances. Usually these effects are multifactorial in origin- most often a result of interactions between the patient, the dental practitioner and the technical aspects of the appliances or techniques. With preventive measurements and care, most of these complications can be either limited or completely avoided. Therefore, every dental practitioner must be fully aware of these effects and associated risk factors in order to maximize the treatment outcome. The present review aims to summarize these effects of orthodontic therapies, and provide a detailed description of factors and preventive measures, in order to minimize these damages.

Arteriovenous malformation of vein of Galen as a rare non-hypoxic cause of changes in fetal heart rate pattern during labor

The aim of this case report is to describe a rare non-hypoxic cause of pathological changes in fetal heart rate pattern during labor, and to determine management, including a description of important prenatal aspects when pathologic cardiotocographic recording is performed during labor. A fetus with rare arteriovenous malformation of the vein of Galen, which represents less than 1% of all intracranial arteriovenous malformations, was monitored by intrapartum external cardiotocography in the 37 + 5 gestational week. The baby was born by cesarean section because of signs of imminent intrauterine hypoxia on cardiotocography. However, metabolic acidosis was not confirmed in umbilical cord blood sampling. Despite intensive neonatal care management, the newborn died 31 h after delivery because of progressive cardiac decompensation, hypotension and multi-organ failure. Precise diagnosis of the abovementioned pathology, a pre-labor plan for delivery and postnatal prognosis assessment can significantly contribute to the avoidance of a misdiagnosis of fetal hypoxia and unnecessary operative delivery with marked medico-legal consequences.

Apoptosis-related gene expression in tumor tissue samples obtained from patients diagnosed with glioblastoma multiforme

Tumors of the brain are very diverse in their biological behavior and are therefore considered a major issue in modern medicine. The heterogeneity of gliomas, their clinical presentation and their responses to treatment makes this type of tumor a challenging area of research. Glioblastoma multiforme (GBM) is the most common, and biologically the most aggressive, primary brain tumor in adults. The standard treatment for patients with newly diagnosed GBM consists of surgical resection, radiotherapy and chemotherapy. However, resistance to chemotherapy is a major obstacle to successful treatment. The aim of this study was to examine the changes occurring in the expression levels of apoptosis-associated genes in tumor tissue biopsy samples from 7 patients diagnosed with GBM and compare our results with a human astrocyte cell line (used as a reference) cultured under basic conditions. For molecular analysis, we used a commercial pre-designed microfluidic array to quantify the expression of 93 apoptosis-associated human genes. Significant changes in the expression levels of genes were observed in the tumor tissue samples obtained from patients with GBM. We determined significant changes in gene expression (n=32) in all apoptotic signaling pathways (BCl-2, TNF, Caspases, NF-κB, IAP and CARD), while the most pronounced deregulation (>5-fold) were observed in 46.9% events. The results of this study underline the importance of apoptosis in heterogenous tumor tissue. The identification of the apoptotic gene panel in tissue biopsies from patients with GBM may help improve the effectiveness of treatments for GBM in clinical practice and may broaden our understanding of brain tumor cell metabolism. Recognizing the changes in the expression of pro-apoptotic and anti-apoptotic genes may aid in the development of novel treatment strategies founded on a molecular basis.

Most frequent molecular and immunohistochemical markers present in selected types of brain tumors

Tumors of brain tissue and meninges create a heterogeneous group with various biological behavior, therapy management and differing prognosis. Some of these do not require treatment, some can be cured by surgery and some are rapidly fatal despite treatment. Despite huge progress in tumor research, innovations in diagnostic tools and therapy, prognosis remains, in case of malignant tumor types, very serious. There has been an increased understanding of molecular abnormalities occurring in primary brain tumors. Genome-wide analyses of tumors have improved the knowledge in tumor biology. The aim of the research is to explain the oncogenesis features thus leading to the use of new therapeutic modalities in order to prolong survival rate of patients and at the same time providing satisfactory life quality. This article offers a short review of the basic genetic alterations present with some histological types of brain tumors.

Changes in heart rate variability in a premature infant with hydrocephalus

Objective To define changes of heart rate variability in premature infant with hydrocephalus before and after drainage procedure. Study Design The authors report a case of a premature infant with hydrocephalus with analysis of heart rate variability before and after drainage procedure. Three subsequent recordings of the electrocardiography and heart rate variability were done: the first at the age of 22 days before insertion of ventriculoperitoneal shunt, the second at the age of 36 days with functional shunt, the third at the age of 71 days (before discharge). Results Before drainage operation, there was reduced heart rate variability in time and spectral domains, and sympathetic activity was dominant. After surgery, an increase in heart rate variability parameters was found, particularly with spectral analysis. The ratio of low-frequency/high-frequency band and relative power of the low-frequency band decreased, reflecting enhanced parasympathetic activity. Conclusion Results of the heart rate variability analysis in a preterm infant with hydrocephalus before and after drainage procedure showed marked improvement in chronotropic cardiac regulation. Evaluation of heart rate variability in premature infants with hydrocephalus with increased intracranial pressure can be an additional method for monitoring of cardiac dysregulation and improvement of the cardiovascular control after successful drainage procedure.

[Urinary incontinence in degenerative spinal disease]

PURPOSE OF THE STUDY

The aim of the study was to evaluate the presence of urinary incontinence in patients with chronic degenerative spinal disease and to identify factors affecting the occurrence and changes in urinary incontinence after surgery.

MATERIAL

The group evaluated comprised 214 patients undergoing surgery for degenerative spinal disease at our department between January 1 and December 31, 2008. The patients were categorised according to the type of their degenerative disease (cervical disc herniation, lumbar disc herniation, spinal stenosis, spinal instability or olisthesis) and the spine level involved (cervical or lumbar spine). The symptoms of urinary incontinence included leakage of urine and non-obstructive chronic urinary retention developing in association with the manifestation of vertebrogenic disorder. Patients with diseases known to increase the risk of incontinence were not included in the study.

METHODS

Based on a retrospective analysis of the patients' clinical notes, the occurrence of urinary incontinence in each type of degenerative spinal disease was assessed. The effect of gender, age, body mass index (BMI), neurological status and spinal disease type on the development of incontinence was statistically evaluated. The efficacy of surgical treatment was assessed on the basis of the patients' subjective complaints at the first follow-up one month after surgery. The data were evaluated by the statistical programme InSTAT (analysis of variance ANOVA, t-test). All tests were two-sided; a 0.05 level of statistical significance was used.

RESULTS

Of the 214 patients with degenerative spinal disease, 27 (12.6%) had urinary incontinence. A higher risk of developing incontinence was found in women (p = 0.008) and in patients with radicular weakness (p = 0.023). The patients with urinary incontinence had their BMI significantly lower than patients without this disorder (p = 0.019). Age had no effect. The differences in the occurrence of urinary incontinence amongst the different types of degenerative disease were regarded as approaching statistical significance (p = 0.09). The surgical treatment resulted in incontinence control in 15 (55.5 %) affected patients.

DISCUSSION

A comparison of the factors leading to the development of urinary incontinence in degenerative spinal disease and those associated with the development of incontinence in the general population suggests that the aetiology in each case is different. The relationship between low back pain and urinary incontinence remains unknown.

CONCLUSIONS

Degenerative spinal disease can result in acute or chronic urinary incontinence. Factors associated with its development include gender, BMI, radicular weakness and the type of degenerative disease. Surgical treatment improved or eliminated the symptoms of urinary incontinence in more than half of the patients affected.

Measurement of the blood flow velocity in the pericallosal artery of children with hydrocephalus by transcranial Doppler ultrasonography--preliminary results

AIM

The goal of this study was to evaluate selected parameters of the Doppler curve of the pericallosal artery at children with hydrocephalus.

METHODS

12 patients with hydrocephalus were divided into two groups. Group 1 comprised children needing cerebrospinal fluid drainage, and group 2 comprised children without any indication for drainage or with an already inserted well-functioning drainage system. Dilatation of the cerebral ventricles was determined by transcranial ultrasonography. Following parameters of a blood flow of the pericallosal branch of the anterior cerebral artery: peak systolic blood flow velocity (PSFV), end-diastolic blood flow velocity (EDFV) and resistive index (RI) were observed by transcranial Doppler ultrasonography. Parameters of The Doppler curve were measured without pressure (baseline parameters) and during compression of the anterior fontanelle (pressure provocation test).

RESULTS

Group 1: baseline parameters: PSFV 68.9 +/- 13.52 cm/s, EDFV 18.26 +/- 10.39 cm/s, RI 0.76 +/- 0.12; parameters during pressure provocation test: PSFV 66.92 +/- 19.75 cm/s, EDFV 10.88 +/- 11.18 cm/s, RI 0.86 +/- 0.14. Group 2: baseline parameters: PSFV 59.95 +/- 19.38 cm/s, EDFV 20.65 +/- 8 cm/s, RI 0.65 +/- 0.04; parameters during the pressure provocation test: PSFV 57.14 +/- 18.91 cm/s, EDFV 17.7 +/- 8.3 cm/s, RI 0.68 +/- 0.05.

CONCLUSION

The results show increased baseline and postcompressive values of RI of pericallosal artery in infants with hydrocephalus before drainage procedure and normal values of RI at children without the need for cerebrospinal fluid drainage or with a well-functioning drainage system.

Assessment of renal circulation in small for gestational age and appropriate for gestational age term newborns: a prospective study

PURPOSE

To compare selected parameters of renal circulation between small for gestational age (SGA) and appropriate for gestational age (AGA) newborns.

METHODS

Fifty-two SGA and 100 AGA term newborns were examined. The size of the kidneys were measured, and renal blood flow in the central and intraparenchymal renal arteries were assessed via Doppler sonography. Peak systolic velocity (PSV), end diastolic velocity (EDV), mean blood flow velocity (V mean), resistance index (RI), and pulsatility index (PI) were determined and compared between the groups.

RESULTS

No statistically significant differences in the velocity parameters were found between SGA and AGA infants in central renal arteries. Slightly higher RIs and PIs were seen in AGA newborns (RI, 0.76 +/- 0.13 versus 0.78 +/- 0.06 [p < 0.05]; PI, 1.65 +/- 0.54 versus 1.84 +/- 0.46 [p < 0.05]). There were statistically significant differences between the groups in all measured parameters in intraparenchymal arteries (RI, 0.57 +/- 0.11 versus 0.63 +/- 0.05 [p < 0.001]; PI, 0.89 +/- 0.26 versus 1.09 +/- 0.16 [p < 0.001]) except PSV (7.11 +/- 1.55 versus 7.14 +/- 0.81 cm/s [p > 0.05]).

CONCLUSION

Based on our findings, we suggest that renal circulation is not negatively influenced by intrauterine growth restriction in SGA neonates compared with AGA newborns.

Early postnatal changes in superior mesenteric artery blood flow velocity in healthy term infants

OBJECTIVES

After birth, the newborn intestinal circulation undergoes physiological changes. The purpose of this work was to characterize the changes in mesenteric blood flow velocity occuring during the first three days of life in healthy term infants.

METHODS

30 healthy term newborns were studied repeatedly at the age of 2, 24 and 70 hours. Blood flow velocity in superior mesenteric artery (SMA) was measured by Doppler ultrasound, peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged mean velocity (TAV) were recorded at each time point. Resistance index (RI) and pulsatility index (PI) were calculated.

RESULTS

SMA EDV increased from 2 h [-5.2+/-6.8 cm/s (mean +/- SD)] to 24 h (12.9+/-3.8 cm/s, p<0.001) with further insignificant increase to 70 h (14.9+/-4.7 cm/s). At 2 h of age the mean EDV was negative in 23 of 30 cases (76.7%). PSV did not change between 2 h (58.0+/-21.8 cm/s) and 24 h (58.5+/-15.0 cm/s) but it increased to 70 h (79.6+/-17.7 cm/s). TAV showed a significant increase with time. RI decreased from 2 h (1.09+/-0.11) to 24 h (0.78+/-0.06, p<0.001) with further insignificant increase to 70 h (0.81+/-0.06).

CONCLUSIONS

The blood flow velocity in SMA increases during the early neonatal period in term infants. The most remarkable changes occur within the first 24 hours of life. At 2 h of age a reversed blood flow is present in majority of infants.