Updates on management of gliomas in the molecular age

Gliomas are primary brain tumors derived from glial cells of the central nervous system,afflicting both adults and children with distinct characteristics and therapeutic challenges.Recent developments have ushered in novel clinical and molecular prognostic factors,reshaping treatment paradigms based on classi-fication and grading,determined by histological attributes and cellular lineage.This review article delves into the diverse treatment modalities tailored to the specific grades and molecular classifications of gliomas that are currently being discussed and used clinically in the year 2023.For adults,the therapeutic triad typically consists of surgical resection,chemotherapy,and radiotherapy.In contrast,pediatric gliomas,due to their diversity,require a more tailored approach.Although complete tumor excision can be curative based on the location and grade of the glioma,certain non-resectable cases demand a chemotherapy approach usually involving,vincristine and carboplatin.Addi-tionally,if surgery or chemotherapy strategies are unsuccessful,Vinblastine can be used.Despite recent advancements in treatment methodologies,there remains a need of exploration in the literature,particularly concerning the efficacy of treatment regimens for isocitrate dehydrogenase type mutant astrocytomas and fine-tuned therapeutic approaches tailored for pediatric cohorts.This review article explores into the therapeutic modalities employed for both adult and pediatric gliomas in the context of their molecular classification.

Soft tissue swelling incidence using demineralized bone matrix in the outpatient setting

AIM To assess use of demineralized bone matrix(DBM) use in anterior cervical discectomy and fusion(ACDF) in outpatient setting.METHODS One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone(PEEK) cages. Two groups created, Group 1(75) outpatients and control Group 2(70) hospital patients. Prevertebral soft tissue swelling(PVSTS) was measured anterior to C2 and C6 on plain lateral cervical radiographs preoperatively and one week postoperatively and fusion assessed at two years. RESULTS There was no intergroup significance between preoperative and postoperative visual analogue scales(VAS)and neck disability index(NDI) scores between Group 1 and 2. Mean preoperative PVSTS in Group 1 was 4.7 ± 0.2 mm at C2 level and 11.1 ± 0.5 at C6 level compared to Group 2 mean PVSTS of 4.5 ± 0.5 mm and 12.8 ± 0.5, P = 0.172 and 0.127 respectively. There was no radiographic or clinical evidence of adverse reaction noted. In Group 1 mean postoperative PVSTS was 5.5 ± 0.4 mm at C2 and 14.9 ± 0.6 mm at C6 compared Group 2 mean PVSTS was 4.9 ± 0.3 mm at C2 and 14.8 ± 0.5 mm at C6, P = 0.212 and 0.946 respectively. No significant increase in prevertebral soft tissue space at C2 and C6 level demonstrated.CONCLUSION ACDF with adjunct DBM packed PEEK cages showed a statistical significant intragroup improvement in VAS neck pain scores and NDI scores(P = 0.001). There were no reported serious patient complications; post-operative radiographs demonstrated no significant difference in prevertebral space. We conclude that ACDF with DBMpacked PEEK cages can be safely done in an ASC with satisfactory outcomes.

Liver transplantation amidst the COVID-19 era:Our center's experience

Coronavirus disease 2019 significantly impacted the liver transplant process worldwide.Consequently,it brought significant challenges and limitations to transplant policies and organ allocation forcing liver transplant centers to adjust their protocols to ensure maximum benefit and avoid harm to their patients.Our center,like many others,was obliged to adapt to the challenges.This paper provided an overview of the effects of coronavirus disease 2019 on liver transplantations and detailed our center’s experience and efforts during this unprecedented pandemic to serve as a guide for future public health crises.

Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Creation and validation of a novel low-cost dry lab for early resident training and assessment of robotic prostatectomy technical proficiency

Purpose:To evaluate the preliminary validity and acceptability of a low-cost low-fidelity robotic surgery dry lab for training and assessing residents’technical proficiency with key robotic radical prostatectomy steps.Materials and methods:Three standardized inanimate tasks were created to simulate the radical prostatectomy steps of posterior dissection,neurovascular bundle release,and urethrovesical anastomosis.Urology trainees and faculty at a single institution completed and evaluated each dry lab task.Construct validity was evaluated by comparing task completion times and Global Evaluative Assessment of Robotic Skills scores across four participant cohorts:medical students(n=5),junior residents(n=5),senior residents(n=5),and attending surgeons(n=7).Content validity,face validity,and acceptabilitywere evaluated through a posttask survey using a 5-point Likert scale.Results:There was a significant difference in the individual and composite task completion times and Global Evaluative Assessment of Robotic Skills scores across all participant cohorts(all p<0.01).The model was rated favorably in terms of its content validity and acceptability for use in residency training.However,model realism,compared with human tissue,was poorly rated.The dry lab production cost was less than US$25.Conclusions:This low-cost procedure-specific dry lab demonstrated evidence of content validity,construct validity,and acceptability for simulating key robotic prostatectomy technical steps and can be used to augment robot-assisted laparoscopic prostatectomy surgical training.

Odontogenic Herpes Zoster Infection: A Case Report and Review

Herpes zoster is a commonly encountered entity of which all clinicians should be aware. The diagnosis is most often considered and made based on a characteristic vesicular rash that presents in a unilateral dermatomal distribution and is usually accompanied by a painful neuritis. Not uncommonly, the pain presents a few days before the rash becomes evident and may even occur without the rash appearing. When this happens patients may be subject to further diagnostic testing seeking alternative diagnoses, as herpes zoster is known to mimic a variety of other non-cutaneous organ system entities. Although the thoracic and lumbar dermatomes are the affected most frequently, in approximately one-fifth of cases the cranial nerves are involved either singularly or in combination. Trigeminal nerve zoster is of particular concern as it poses a risk of developing into zoster ophthalmicus with subsequent keratitis and uveitis resulting in permanent vision impairment. Involvement of the second (maxillary) and third (mandibular) branches of this 5th cranial nerve are less common and may present with signs and symptoms of a primary dental process. The infrequency and unfamiliarity of herpes zoster odontogenic manifestations can lead to unnecessary investigation and treatment. Apropos such a case we review the epidemiology, pathophysiology, signs, and symptoms of odontogenic herpes zoster.

Exercise training improves long-term memory in obese mice

Obesity has been linked to a range of pathologies,including dementia.In contrast,regular physical activity is associated with the prevention or reduced progression of neurodegeneration.Specifically,physical activity can improve memory and spatial cognition,reduce age-related cognitive decline,and preserve brain volume,but the mechanisms are not fully understood.Accordingly,we investigated whether any detrimental effects of high-fat diet(HFD)-induced obesity on cognition,motor behavior,adult hippocampal neurogenesis,and brain-derived neurotrophic factor(BDNF)could be mitigated by voluntary exercise training in male C57Bl/6 mice.HFD-induced impairment of motor function was not reversed by exercise.Importantly,voluntary wheel running improved long-term memory and increased hippocampal neurogenesis,suggesting that regular physical activity may prevent cognitive decline in obesity.