Syndromic Assessment of Degenerative Disorders of the Lumbar Spine in Elderly Patients

Background. The choice of the method and options for surgical treatment of degenerative pathology of the lumbar spine is difficult due to the lack of clear clinical and radiological criteria for diagnosis and a direct correlation between the severity of the radiological manifestations of the disease and clinical symptoms. The aim of this study was to analyze the clinical and neurological characteristics of elderly patients with degenerative disorders of the lumbar spine and to identify the dominant clinical and radiologic syndromes. Methods. Сohort of 1013 patients were operated using MIS technologies (decompression alone, TLIF, LLIF, ALIF) in the period 2013–2017 (367 male/646 female). The age range is 60-89 years (mean 66 years). The criteria for identifying the leading syndromes: leg pain/back pain with a threshold value of 5 points according to VAS, X-ray criteria for clinical instability by A.A. White and M.M. Panjabi (value 5 points), Cobb angle 10°, markers of sagittal imbalance: Index Barrey (II and III), PT increase above target values, L4-S1 and LL deficiency. Results. Symptoms of compression were identified in 97% of patients. Radiculopathy syndrome was detected in 665 (66%) patients with mean leg pain 7 points, neurogenic intermittent claudication — in 319 (31%) patients. Degenerative spondylolisthesis according to radiological criteria was detected in 428 (42%) patients. Degenerative scoliotic deformity had 91 (9%) patients. In accordance with the proposed criteria, the dominant compression syndrome was determined in 624 patients (62%), clinical instability syndrome — in 338 (33%), deformity syndrome with sagittal imbalance — in 51 (5%). Conclusion. Syndromic assessment of clinical, neurological and radiological manifestations of degenerative disorders provides the possibility of identifying the dominant syndrome requiring operative surgical treatment and a differentiated approach to choosing the optimal surgical option

The use of LLIF technology in adult patients with degenerative scoliosis: retrospective cohort analysis and literature review

Introduction Incidence of adult degenerative scoliosis (ADS) among individuals over 50 years old reaches 68%. Surgical interventions aimed at correcting the spinal deformity in patients of the older age group are accompanied by a high risk of complications. The use of LLIF is associated with lower complications as compared with open anterior or posterior fusion. Materials and methods Seventy-one patients with ADS (13 men, 58 women) were operated at the Federal Neurosurgical Center. Their average age was 60.4/60 (average/median) [55;64.5] (1: 3 quartile) years. The follow-up was from 12 to 18 months. X-ray study, SCT, MRI of the lumbar spine were used. Questionnaire surveys were conducted using the visual analog pain scale (VAS), Oswestry Disability Index (ODI) and the Short Form-36 (SF-36). Deformity correction was estimated in the frontal plane with Cobb’s method. Scoliosis was classified according to SRS-Schwab classification. Parameters of sagittal balance were estimated: PI (Pelvic incidence), SS (Sacral slope), PT (Pelvic tilt), LL (Lumbar lordosis). SVA, PT and PILL (PI minus LL) were defined adjusted for the age. Results Back pain according to VAS relieved from 6.1/6 [4;8] to 2.2/2 [2;3] points (p < 0.001) and was statistically significant at 12 months after the surgery. Leg pain according to VAS decreased from 5.4/5 [4;8] to 2.1/2 [1;3] points (p < 0.001) and was statistically significant at 12 months after the surgery. Functional adaptation according to ODI improved from 51.2/52.2 [38.6;64.1] to 31.8/33.3 [26.1;35.9] (p < 0.001). According to SF36, PH before the surgery was 25.7/24.3 [21.8;28.9] on average and at 12 months after the surgery - 38.7/38.7 [35.4;41.2] (p < 0.001). SF-36 MH before surgery was 27.1/26.3 [21.8;31.4] on average and 12 months later – 41.3/40.6 [36.5;43.7] (p < 0.001). PT before the surgery was 23.3/22° [17.5;28], 12 months later it was 17.9/17° [15;20] (p < 0.001). PI-LL was 11.5/10 ° [4;17.5], 12 months later – 8.4/8 ° [5.5;11.5] (p = 0.11). Transient paresis of femur flexors on the ipsilateral side was observed in five (7 %) cases; transient hyposthesia on the anterior thigh surface occurred in eight (11.2 %) cases. There were two cases of medial malposition (0.4 %) of pedicle screws (474 screws), pseudoarthrosis at two levels (1.2 %) (Grade 4 Bridwell) out of 166 levels performed, and seven (4.2 %) cases of damage to cortical endplates. Conclusion Restoration of local sagittal balance in ADS patients by short-segment fixation using LLIF technology leads to a statistically significant improvement in the quality of life and increases functional adaptation. Few early and late postoperative complications, less intraoperative blood loss and shorter hospital stay make LLIF in combination with MIS transpedicular fixation a method of choice in determining the surgical tactics for ADS in elderly and old age patients

The Influence of Radical Prostatectomy on the Expression of Cell-Free MiRNA

MiRNAs of blood and urine have been shown to represent a convenient source of biomarkers for prostate cancer (PCa) diagnosis and assessment of the therapy effectiveness due to their high stability and representation and the low invasiveness of sample collection. Here, we studied the influence of radical prostatectomy (RP) on the expression of 12 cell-free miRNAs previously shown as potential markers of PCa (i.e., miR-19b, miR-22, miR-92a, miR-378, miR-425, miR-30e, miR-31, miR-125b, miR-200b, miR-205, miR-375 and miR-660). The relative expression of the miRNAs combined into 31 paired ratios was evaluated in the urine extracellular vesicles (EVs), clarified urine (CU) and blood plasma of healthy donors, pre- and post-RP samples of PCa patients. Nineteen miRNA ratios based on combinations of ten of the miRNAs (miR-19b, miR-30e, miR-31, miR-125b, miR-200b, miR-205, miR-375, miR-378, miR-425, and miR-660) were altered by RP. The comparative expression analysis of the cell-free miRNA ratios between healthy donors and PCa patients revealed miR-125b/miR-30e and miR-375/miR-30e as potential markers for evaluating therapeutic efficacy. MiR-378/miR-19b, miR-425/miR-19b, miR-200/miR-30e, miR-660/miR-30e, and miR-205/miR-30e had minor prognostic value but could be used to increase the steadiness of the diagnostic system. The urine EVs had the highest potential as a source of markers

Software for brain tumor diagnosis on magnetic resonance imaging

BACKGROUND: The main reason for the development and implementation of artificial intelligence (AI) technologies in neuro-oncology is the high prevalence of brain tumors reaching up to 200 cases per 100,000 population. The incidence of a primary focus in the brain is 5%10%; however, 60%70% of those who die from malignant neoplasms have metastases in the brain. Magnetic resonance imaging (MRI) is the most common method for primary non-invasive diagnosis of brain tumors and monitoring disease progression. One of the challenges is the classification of tumor types and determination of clinical parameters (size and volume) for the conduct, diagnosis, and treatment procedures, including surgery. AIM: To develope a software module for the differential diagnosis of brain neoplasms on MRI images. METHODS: The software module is based on the developed Siberian Brain Tumor Dataset (SBT), which contains information on over 1000 neurosurgical patients with fully verified (histologically and immunohistochemically) postoperative diagnoses. The data for research and development was presented by the Federal Neurosurgical Center (Novosibirsk). The module uses two- and three-dimensional computer vision models with pre-processed MRI sequence data included in the following packages: pre-contrast T1-weighted image (WI), post-contrast T1-WI, T2-WI, and T2-WI with fluid-attenuated inversion-recovery technique. The models allow to detect and recognize with high accuracy 4 types of neoplasms, such as meningioma, neurinoma, glioblastoma, and astrocytoma, and segment and distinguish components and sizes: ET (tumor core absorbing Gd-containing contrast), TC (tumor core) = ET + Necr (necrosis) + NenTu, and WT (whole tumor) = TC + Ed (peritumoral edema). RESULTS: The developed software module shows high segmentation results on SBT by Dice metric for ET 0.846, TC 0.867, WT 0.9174, Sens 0.881, and Spec 1.000 areas. The testing and validation were done at the international BraTS Challenge 2021 competition. The test dataset yielded DiceET 0.86588, DiceTC 0.86932, and DiceWT 0.921 values, placing the developed software module in the top ten. According to the classification, the results demonstrate high accuracy rates of up to 92% in patient analysis (up to 89% in slice analysis), a very high potential, and a perspective for future research in this area. CONCLUSIONS: The developed software module may be used for training specialists and in clinical diagnostics

Searching for the Novel Specific Predictors of Prostate Cancer in Urine: The Analysis of 84 miRNA Expression

The aim of this study was to investigate miRNA profiles of clarified urine supernatant and combined urine vesicle fractions of healthy donors and patients with benign prostatic hyperplasia and prostate cancer (PCa). The comparative analysis of miRNA expression was conducted with a custom miRCURY LNA miRNA qPCR panel. Significant combinations of miRNA pairs were selected by the RandomForest-based feature selection algorithm Boruta; the difference of the medians between the groups and a 95% confidence interval was built using the bootstrap approach. The Asymptotic Wilcoxon-Mann-Whitney Test was performed for miRNA combinations to compare different groups of donors. Benjamini-Hochberg correction was used to adjust the statistical significance for multiple comparisons. The most diagnostically significant miRNAs pairs were miR-107-miR-26b.5p and miR-375.3p-miR-26b.5p in the urine supernatant fraction that discriminated the group of healthy patients and PCa patients, as well as miR-31.5p-miR-16.5p, miR-31.5p-miR-200b, miR-31.5p-miR-30e.3p and miR-31.5p-miR-660.5p in the fraction extracellular vesicles that were different between healthy men and benign prostate hyperplasia patients. Such statistical criteria as the occurrence of individual significant miRNA pairs in the total number of comparisons, median &#916;Ct difference, and confidence interval can be useful tools for determining reliable markers of PCa