Nevin Manimala

J Neurooncol. 2025 Jun 21. doi: 10.1007/s11060-025-05105-x. Online ahead of print.

ABSTRACT

PURPOSE: In brain gliomas, non-invasive biomarkers reflecting tumor cellularity would be useful to guide supramarginal resections and to plan stereotactic biopsies. We aim to validate a previously-trained machine learning algorithm that generates cellularity prediction maps (CPM) from multiparametric MRI data to an independent, retrospective external cohort of gliomas undergoing image-guided biopsies, and to compare the performance of CPM and diffusion MRI apparent diffusion coefficient (ADC) in predicting cellularity.

METHODS: A cohort of patients with treatment-naïve or recurrent gliomas were prospectively studied. All patients underwent pre-surgical MRI according to the standardized brain tumor imaging protocol. The surgical sampling site was planned based on image-guided biopsy targets and tissue was stained with hematoxylin-eosin for cell density count. The correlation between MRI-derived CPM values and histological cellularity, and between ADC and histological cellularity, was evaluated both assuming independent observations and accounting for non-independent observations.

RESULTS: Sixty-six samples from twenty-seven patients were collected. Thirteen patients had treatment-naïve tumors and fourteen had recurrent lesions. CPM value accurately predicted histological cellularity in treatment-naïve patients (b = 1.4, R² = 0.2, p = 0.009, rho = 0.41, p = 0.016, RMSE = 1503 cell/mm²), but not in the recurrent sub-cohort. Similarly, ADC values showed a significant association with histological cellularity only in treatment-naive patients (b = 1.3, R² = 0.22, p = 0.007; rho = -0.37, p = 0.03), not statistically different from the CPM correlation. These findings were confirmed with statistical tests accounting for non-independent observations.

CONCLUSION: MRI-derived machine learning generated cellularity prediction maps (CPM) enabled a non-invasive evaluation of tumor cellularity in treatment-naïve glioma patients, although CPM did not clearly outperform ADC alone in this cohort.

PMID:40542949 | DOI:10.1007/s11060-025-05105-x

Anat Sci Int. 2025 Jun 21. doi: 10.1007/s12565-025-00855-0. Online ahead of print.

ABSTRACT

The vertebral artery (VA) supplies almost one-third of the blood flow to the brain, contributing mainly to its posterior circulation. This article provides a comprehensive overview of the different anatomical variations related to the origin, course, and termination of the VA and associated clinical implications. Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literature in Health Sciences (LILACS) as of January 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in VA variant rates were assessed. VA variants were identified that could be separated into three categories: variation in origin, course, and terminal branches. A total of 16 studies met the established selection criteria for the current meta-analysis. VA variations were reported at an overall prevalence of 11% (CI: 7%-15%) and a heterogeneity of 77%. Statistically significantly higher rates were revealed in the following subgroups of the sample: imaging examinations versus cadavers (p = 0.032); right side of the body versus left (p = 0.034); and bilaterally versus unilaterally (p = 0.019). Concerns listed in included studies primarily focused on the possibility of iatrogenic damage during surgical procedures. A few studies also indicated higher rates of VA variants in patients who reported symptoms of recurrent headaches, vertigo, dizziness, and/or syncope. The presence of VA variants is high and can occur in various regions. However, the most important clinical consideration is that individuals with this variant must be constantly monitored since their posterior cerebral circulation could be affected. To avoid iatrogenic damage to the VA, clinicians should employ medical imaging to evaluate its course and branches prior to surgical interventions in the region.

PMID:40542940 | DOI:10.1007/s12565-025-00855-0

Neurosurg Rev. 2025 Jun 21;48(1):524. doi: 10.1007/s10143-025-03674-z.

ABSTRACT

The transpedicular screw placement has been the gold standard for over a decade in treating degenerative diseases of the lumbo-sacral spine related to vertebral instability. The evolution of neuronavigation and robotic surgery has mitigated many perioperative complications such as mispositioning, vascular damage, and nerve structure injuries, leading to enhanced postoperative outcomes, reduced blood loss, and decreased intraoperative radiation exposure. Our study proposes a multicenter comparison between robotic surgery and neuronavigation for treating degenerative diseases of the lumbo-sacral spine. We conducted a retrospective analysis at Papardo Hospital in Messina and Garibaldi Hospital in Catania, examining a consecutive series of 76 patients treated for degenerative diseases of the lumbo-sacral spine between March 2024 and December 2024 using the Excelsius GPS Robot and neuronavigation with the O-arm. We evaluated each procedure based on age, sex, body mass index, number of involved metameres, number of screws placed, operative times, estimated blood loss (EBL), radiation exposure, type of anesthesia, accuracy (using the Gertzbein and Robbins scale), and then compared various pre- and postoperative parameters through univariate statistical analysis. Patients were randomly assigned in a 1:1 ratio using a computer-generated sequence with permuted blocks of variable size (4-6). This ensured balanced allocation and minimized selection bias. A detailed statistical plan has been included: continuous variables were assessed using Student’s t-test or Mann-Whitney U test depending on distribution (Shapiro-Wilk test), while categorical variables were evaluated with Chi-square or Fisher’s exact test as appropriate. 48 out of 76 patients (average age 60.47 years) underwent pedicle screw placement via robotic surgery, and 28 patients (average age 65.92 years) via neuronavigation surgery. Robotic surgery showed comparable results to neuronavigation surgery in terms of blood loss. Additionally, functional outcomes, especially those evaluated with the ODI scale and VAS scale, were similar between the two patient groups. Despite a reported mispositioning rate of 2.2% in neuronavigation surgery, no clinical impact was observed in these specific cases. The surgical procedures included both decompression (laminectomy with partial facetectomy) and fusion in all patients. Operative time was recorded as skin-to-skin time, excluding anesthesia induction and positioning. Patients with prior surgeries at the index level, complex spinal deformities (Cobb angle > 30°), or revision surgeries were excluded from this study. The included diagnoses were degenerative disc disease (RS: 56%, NS: 52%), spinal stenosis (RS: 28%, NS: 31%), spondylolisthesis (RS: 12%, NS: 14%), and traumatic pathology (RS: 4%, NS: 3%). While there was a trend towards greater precision in screw placement with robotic technology, no significant difference was observed compared to neuronavigation with the O-arm. Both technological systems used in instrumented spinal surgery appear safe and effective. However, they present a steep learning curve, and various technical aspects of these systems are continuously reassessed to improve operational efficiency and achieve these objectives.

PMID:40542927 | DOI:10.1007/s10143-025-03674-z

Ir J Med Sci. 2025 Jun 21. doi: 10.1007/s11845-025-03988-3. Online ahead of print.

ABSTRACT

INTRODUCTION: ECG is a frequently used and easily accessible diagnostic tool used to evaluate cardiac involvement in hyperkalemia patients.

OBJECTIVE: The present study aimed to investigate the mortality prediction potential of the frontal QRS-T angle in hyperkalemia patients and the effects of the treatment process on this angle.

METHOD: The study was planned as a prospective study. A total of 121 hyperkalemia patients were included in the study. Conditions that caused high potassium were identified and the PR, QRS, QT, QTc, and frontal QRS-T angle were calculated and recorded from the 12-lead ECG recordings of the patients at the time of admission to the emergency room.

RESULTS: The mean age of the patients was 58.5 ± 9.2 years (median: 59), 63 (% 52.1) were female and 58 (% 47.9) were male. The second measurements of the ECG parameters PR, QTc, QRS, T-amplitude, T duration, and frontal QRS-T values were lower than the first measurements (p < 0.001; p = 0.007; p < 0.001; p < 0.001; p < 0.001; p = 0.006, respectively). The ability of the patient’s ECG parameters PR, QT, QTc, QRS, T-amplitude, frontal QRS-T angle, and frontal QRS-T (absolute value) to predict the development of mortality In the ROC Curve analysis, it was found that these parameters did not have a statistically significant effect in predicting mortality.

CONCLUSION: As well as known ECG findings, in cases of hyperkalemia, widening of the frontal QRS-T angle and correction of this widened angle in patients with normokalemia detected with treatment can be used as an important follow-up parameter.

PMID:40542911 | DOI:10.1007/s11845-025-03988-3

Neurosurg Rev. 2025 Jun 21;48(1):522. doi: 10.1007/s10143-025-03611-0.

ABSTRACT

Traumatic brain injury (TBI) is a significant public health issue, with 30% to 50% of patients developing post-traumatic hydrocephalus (PTH). This condition can elevate intracranial pressure, leading to headaches, vomiting, altered consciousness, and potentially coma or death, severely impacting quality of life. This study aims to systematically evaluate risk factors associated with PTH following TBI. The authors searched PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials for studies published from 2000 to 2024. Data extraction was standardized, and statistical analysis was performed using State 14.0 software. We assessed the risk of bias and compared patient characteristics, using fixed or random effects models to summarize PTH risk factors, calculating pooled odds ratios (OR) and 95% confidence intervals (CI). A total of 25 studies involving 1,383,328 TBI patients met the inclusion criteria. Significant factors associated with an increased risk of PTH included decompressive craniectomy (DC) (p < 0.001), intraventricular hemorrhage (IVH) (p = 0.016), lower Glasgow Coma Scale (GCS) scores (p < 0.001), subdural hematoma (p < 0.001), postoperative meningitis (p = 0.027), external ventricular drainage (EVD) (p < 0.001), traumatic subarachnoid hemorrhage (SAH) (p < 0.001), and epidural hematoma (p < 0.001). Age was not significantly correlated with PTH. Identifying these risk factors (DC, IVH, GCS, subdural hematoma, postoperative meningitis, external ventricular drainage, traumatic SAH, and epidural hematoma) highlights the importance of close monitoring in TBI patients. This approach aims to enable early identification of PTH and reduce its incidence, ultimately improving survival outcomes and long-term prognosis for TBI patients.

PMID:40542903 | DOI:10.1007/s10143-025-03611-0

Eur Phys J E Soft Matter. 2025 Jun 21;48(6-7):33. doi: 10.1140/epje/s10189-025-00498-z.

ABSTRACT

The most studies on the stability of foam bubbles investigated the mechanical stability of thin films between bubbles due to the drainage by gravity. In the current work, we take an alternative approach by assuming the rupture of bubbles as a series of random events and by investigating the time evolution of the size distribution of foam bubbles over a long time up to several hours. For this purpose, we first prepared layers of bubbles on Petri dishes by shaking soap solutions of a few different concentrations, and then we monitored the Petri dishes by using a time-lapse video imaging technique. We analyzed the captured images by custom software to count the bubble size distribution with respect to the initial concentration and elapsed time. From the statistics on our data, we find that the total bubble volume decreases exponentially in time, and the exponent, i.e., the mean lifetime, is a function of the bubble size. The mean lifetimes of larger bubbles are observed to be shorter than those of smaller bubbles, by approximately a factor of 2.

PMID:40542902 | DOI:10.1140/epje/s10189-025-00498-z

Vet Res Commun. 2025 Jun 21;49(4):232. doi: 10.1007/s11259-025-10801-0.

ABSTRACT

Avian colibacillosis, caused by avian pathogenic Escherichia coli (APEC), represents a major threat to the poultry industry, leading to significant economic losses. This study aimed to characterize selected biofilm-producing APEC strains isolated from diseased chickens in the Tizi-Ouzou region of Algeria and to explore potential associations between antimicrobial resistance and the presence of virulence factors. Twenty-four confirmed biofilm-producing E. coli isolates were analyzed for serotype distribution, antimicrobial resistance patterns and virulence gene profiles. While none belonged to the O157 serogroup, all isolates demonstrated concerning resistance profiles, with high rates observed for tetracycline (83.3%), ampicillin (75%), and ciprofloxacin (62.5%). Notably, 40% of the strains exhibited biofilm-forming capability, predominantly showing weak to moderate production levels.Virulence gene profiling revealed traT, bcsA, and csgA as nearly ubiquitous (95.8%), with fimH present in 83.3% of isolates. Intermediate prevalence was noted for iutA (62.5%), fliC (45.8%), and agn43 (33.3%), while fyuA (29.2%) and several other virulence markers (kpsMT II, papC, cnf1, ibeA) occurred at lower frequencies (< 10%). Statistical analysis identified significant correlations between virulence gene content and phenotypic characteristics, including a positive association between virulence gene number and biofilm intensity (p < 0.05). Moreover, the fimH gene showed a strong positive correlation with resistance to the antibiotic nalidixic acid. Resistance to β-lactam antibiotics (cefotaxime, cefepime, aztreonam) was positively correlated (p < 0.05) with papC and ibeA, but negatively correlated with csgA. These findings underscore the complex interplay between antimicrobial resistance and virulence in Algerian biofilm-producing APEC strains, highlighting the need for enhanced surveillance programs and tailored intervention strategies. This study provides critical baseline data for developing effective control measures against colibacillosis poultry production systems.

PMID:40542899 | DOI:10.1007/s11259-025-10801-0

Eur J Pediatr. 2025 Jun 21;184(7):432. doi: 10.1007/s00431-025-06247-w.

ABSTRACT

This study investigated the annual incidence rates of spine-related hospital diagnoses in Danish children aged 0-17 years from 2009 to 2021. It aimed to assess trends stratified by diagnostic groups, hospital departments, and residential regions. A nationwide register-based cohort study was conducted using data from the Danish National Patient Register and census data. Spine-related diagnoses were identified through International Classification of Disease (ICD-10) codes and categorized into five groups: critical, whiplash, radiating, structural, and regional. Incidence rates (IR) per 100,000 children were calculated and stratified by diagnostic group, hospital department, and region. Temporal trends were visualized using descriptive statistics. The study identified 43,073 children with 78,304 spine-related diagnoses. The median age was 13 years with interquartile range of 5.3, and 55% were female. IRs remained stable over the 13-year period. Whiplash and structural diagnoses decreased after 2015, while regional diagnoses increased until stabilizing in 2019. Regional disparities were noted, with the capital region having higher IRs than other regions. Most diagnoses were managed within orthopedic departments.

CONCLUSION: This study highlights stable IRs of pediatric spine-related diagnoses despite significant changes in diagnostic practices, reflecting a potential shift toward a biopsychosocial approach in hospital care. Regional disparities and variability in diagnostic coding practices emphasize the need for standardized protocols and equitable care pathways. Further research could validate coding practices, investigate care trajectories, and explore long-term outcomes to optimize pediatric spine care.

WHAT IS KNOWN: • Pediatric spinal pain is increasingly reported in epidemiological surveys, with substantial health burden. • Hospital-based diagnostic patterns in children remain largely unexplored.

WHAT IS NEW: • This is the first national registry-based study of spine-related hospital diagnoses in Danish children. • Marked regional variation and changing departmental patterns suggest a need for standardization.

PMID:40542882 | DOI:10.1007/s00431-025-06247-w

Neurosurg Rev. 2025 Jun 21;48(1):523. doi: 10.1007/s10143-025-03673-0.

ABSTRACT

Decompressive craniectomy is a key treatment for refractory intracranial pressure after severe traumatic brain injury (TBI). Post-traumatic hydrocephalus (PTH) occurs in 7.6-36% of cases, and early diagnosis significantly improves rehabilitation outcomes. This retrospective study analyzed risk factors for shunt-dependent PTH in 126 TBI patients (93 men, 33 women, median age 53 years). Patients were divided into those requiring shunts and those who did not. Clinical and radiological characteristics, including volumetric measurements and surgical techniques, were assessed using SPSS^® Statistics 25. The incidence of shunt-dependent PTH was 27%. Multivariate analysis identified significant risk factors: advanced age at craniectomy (p = 0.008; OR 1.048), traumatic subarachnoid hemorrhage in the basal cisterns (p = 0.015; OR 7.545), post-traumatic ischemic infarcts (p = 0.003; OR 5.319), transcalvarial brain herniation (p = 0.012; OR 5.543), subdural hygroma (p = 0.004; OR 8.131), and progression of contusion hemorrhages (p = 0.013; OR 4.386). Operative parameters did not show statistical significance. Neurological outcomes in shunt patients, assessed via the modified Rankin Scale and Extended Glasgow Outcome Scale, were significantly worse than in non-shunt patients (mRS > 3, GOS-E < 5, p = 0.001-0.011). Our findings suggest that subarachnoid hemorrhage in the cisterns, advanced age, hygromas, ischemic infarcts, transcalvarial herniation, and contusion hemorrhage progression are independent risk factors for shunt-dependent PTH. Additionally, shunt placement was linked to poorer neurological outcomes.

PMID:40542880 | DOI:10.1007/s10143-025-03673-0

Abdom Radiol (NY). 2025 Jun 21. doi: 10.1007/s00261-025-05054-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the utility and complications of urethrosonography (US) in the preoperative assessment of urethral stricture compared to traditional diagnostic methods and its impact on therapeutic decision-making.

METHODS: A prospective observational study was conducted on male patients diagnosed with urethral stricture who were candidates for surgical treatment. Preoperative assessment included flexible urethrocystoscopy, voiding cystourethrography (VCUG), and US. Demographic and epidemiological data were recorded and analyzed. Sensitivity and specificity were calculated. Agreement between diagnostic techniques was assessed using the Cohen’s Kappa coefficient. The impact of findings on surgical decision-making was evaluated, and potential complications associated with each technique were documented.

RESULTS: Thirty-three male patients with a mean age of 59.5 years, diagnosed with urethral stricture who were candidates for surgical treatment, were evaluated. No statistically significant differences were found in the location or severity of the stricture among the different techniques, with good concordance with intraoperative findings. US demonstrated higher sensitivity (60% vs. 44.2%) and specificity (87.8% vs. 84.9%) compared to VCUG in assessing the length of the stricture, and was also more accurate than urethrocystoscopy in determining the degree of spongiofibrosis (77.02% vs. 69.11% for sensitivity, and 81.9% vs. 74.5% for specificity). The choice of preoperative technique influenced the selection of the surgical approach.

CONCLUSIONS: Urethrosonography is more sensitive and specific than traditional techniques in determining the length of the stricture, with similar concordance with intraoperative findings. It may serve as an alternative to conventional diagnostic tests in the preoperative evaluation of urethral stricture, offering several advantages such as the absence of radiation, lower complication rates, and its non-invasive nature.

PMID:40542876 | DOI:10.1007/s00261-025-05054-z