Explore the vast range of titles available.

تناول البحث وصف القلم في عيون شعراء الأندلس، وقد جاء في مقدّمة تحدّثت فيها عن أهميَّة البحث وأهدافه والدّراسات السّابقة والمنهج المُتّبع في التّحليل. وخصّصت التّمهيد للحديث عن الاهتمام بالقلم في الجانبين الشّعري والنَّثري، وجعلت مدار البحث في قسمين، وأدرجت في كلّ واحد منهما عنوانات فرعيَّة: اشتمل القسم الأوّل على تبيان فضل القلم، وتهادي الأقلام، وما بين السّيف والقلم من صراع، ومدح الكُتّاب ووصف الأقلام، وأخيرًا الألغاز. أمّا القسم الثّاني فتناولت فيه الحديث عن مصادر الصُّورة لدى الشُّعراء في وصف القلم. وأعقبت ذلك بنتائج البحث وثبت المصادر.

Study design Retrospective single center cohort study. Purpose Spinal instrumentation in combination with antibiotic therapy is a treatment option for acute or chronic pyogenic spondylodiscitis (PSD). This study compares the early fusion outcome for multi-level and single-level PSD after urgent surgical treatment with interbody fusion in combination with fixation. Methods This is a retrospective cohort study. Over a 10 year period at a single institution, all surgically treated patients received surgical debridement, fusion und fixation of the spine to treat PSD. Multi-level cases were either adjacent to each other on the spine or distant. Fusion rates were assessed at 3 and 12 months after surgery. We analyzed demographic data, ASA status, duration of surgery, location and length of spine affected, Charlson comorbidity index (CCI), and early complications. Results A total of 172 patients were included. Of these, 114 patients suffered from single-level and 58 from multi-level PSD. The most frequent location was the lumbar spine (54.0%) followed by the thoracic spine (18.0%). The PSD was adjacent in 19.0% and distant in 81.0% of multi-level cases. Fusion rates at the 3 month follow-up did not differ among the multi-level group ( p  = 0.27 for both adjacent and distant sites). In the single-level group, sufficient fusion was achieved in 70.2% of cases. Pathogen identification was possible 58.5% of the time. Conclusions Surgical treatment of multi-level PSD is a safe option. Our study demonstrates that there was no significant difference in early fusion outcomes between single-level and multi-level PSD, whether adjacent or distant.

Objective: Cerebral cavernous malformations (CCMs) are usually occult but can present with a symptomatic hemorrhage. Treatment recommendations for CCMs are still controversially discussed, as all CCMs have signs of chronic hemorrhage. The distinction of acute hemorrhage can be difficult, especially when patients only present with mild symptoms. Because of emerging evidence supporting inflammatory burden as a main avenue in the disease pathogenesis of CCMs, the aim of the present study was to investigate routine inflammatory parameters to support decision-making in ambiguous cases. Methods: A total of 87 patients who underwent CCM resection at the authors’ institution between 2008 and 2021 were included in this study. Data were recorded retrospectively. Patients were dichotomized into two groups: those with acute hemorrhage and those without, as a control group (e.g., resection for seizure control). Inflammatory parameters included C-reactive Protein (CrP), White Blood Cell Count (WBC), Red Cell Distribution Width (RDW), and Mean Platelet Volume/Platelet Count Ratio (MPV/PC). Results: The receiver operating characteristic curve demonstrated moderate diagnostic accuracy for predicting acute hemorrhage from CCM based on WBC at admission (AUC: 0.74, 95%-CI: 0.63–0.84) with a cut-off of ≥6.595 G/L. The multivariable analysis confirmed that having a WBC > 6.595 G/L is an independent predictor for acute hemorrhage of CCM (adjusted odds ratio: 4.5, 95%-CI: 1.8–11.2, p < 0.001). Conclusions: A white blood cell count >6.595 G/L was significantly associated with acute hemorrhage in CCMs and appears to be a quick-to-use biomarker in controversial cases. Moreover, leukocytosis emphasizes the involvement of neuroinflammation in acute hemorrhage of CCM. Further investigations are needed to analyze the precise role of inflammation in CCM pathogenesis and its impact on treatment strategies.

The aim of this study was to employ artificial intelligence (AI)-based magnetic resonance imaging (MRI) brain volumetry to potentially distinguish between idiopathic normal pressure hydrocephalus (iNPH), Alzheimer’s disease (AD), and age- and sex-matched healthy controls (CG) by evaluating cortical, subcortical, and ventricular volumes. Additionally, correlations between the measured brain and ventricle volumes and two established semi-quantitative radiologic markers for iNPH were examined. An IRB-approved retrospective analysis was conducted on 123 age- and sex-matched subjects (41 iNPH, 41 AD, and 41 controls), with all of the iNPH patients undergoing routine clinical brain MRI prior to ventriculoperitoneal shunt implantation. Automated AI-based determination of different cortical and subcortical brain and ventricular volumes in mL, as well as calculation of population-based normalized percentiles according to an embedded database, was performed; the CE-certified software mdbrain v4.4.1 or above was used with a standardized T1-weighted 3D magnetization-prepared rapid gradient echo (MPRAGE) sequence. Measured brain volumes and percentiles were analyzed for between-group differences and correlated with semi-quantitative measurements of the Evans’ index and corpus callosal angle: iNPH patients exhibited ventricular enlargement and changes in gray and white matter compared to AD patients and controls, with the most significant differences observed in total ventricular volume (+67%) and the lateral (+68%), third (+38%), and fourth (+31%) ventricles compared to controls. Global ventriculomegaly and marked white matter reduction with concomitant preservation of gray matter compared to AD and CG were characteristic of iNPH, whereas global and frontoparietally accentuated gray matter reductions were characteristic of AD. Evans’ index and corpus callosal angle differed significantly between the three groups and moderately correlated with the lateral ventricular volumes in iNPH patients [Evans’ index (r > 0.83, p ≤ 0.001), corpus callosal angle (r < −0.74, p ≤ 0.001)]. AI-based MRI volumetry in iNPH patients revealed global ventricular enlargement and focal brain atrophy, which, in contrast to healthy controls and AD patients, primarily involved the supratentorial white matter and was marked temporomesially and in the midbrain, while largely preserving gray matter. Integrating AI volumetry in conjunction with traditional radiologic measures could enhance iNPH identification and differentiation, potentially improving patient management and therapy response assessment.

Background and aims: Brain metastases are prevalent in the late stages of malignant melanoma. Multimodal therapy remains challenging. Patient-derived organoids (PDOs) represent a valuable pre-clinical model, faithfully recapitulating key aspects of the original tumor, including the heterogeneity and the mutational status. This study aimed to establish PDOs from melanoma brain metastases (MBM-PDOs) and to test the feasibility of using them as a model for in vitro targeted-therapy drug testing. Methods: Surgical resection samples from eight patients with melanoma brain metastases were used to establish MBM-PDOs. The samples were enzymatically dissociated followed by seeding into low-attachment plates to generate floating organoids. The MBM-PDOs were characterized genetically, histologically, and immunohistologically and compared with the parental tissue. The MBM-PDO cultures were exposed to dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor) followed by a cell viability assessment. Results: Seven out of eight cases were successfully cultivated, maintaining the histological, immunohistological phenotype, and the mutational status of the parental tumors. Five out of seven cases harbored BRAF V600E mutations and were responsive to BRAF and MEK inhibitors in vitro. Two out of seven cases were BRAF wild type: one case harboring an NRAS mutation and the other harboring a KIT mutation, and both were resistant to BRAF and MEK inhibitor therapy. Conclusions: We successfully established PDOs from melanoma brain metastases surgical specimens, which exhibited a consistent histological and mutational profile with the parental tissue. Using FDA-approved BRAF and MEK inhibitors, our data demonstrate the feasibility of employing MBM-PDOs for targeted-therapy in vitro testing.

Study designRetrospective single-center cohort study.BackgroundThe spine is the most common anatomic site for osteoporotic fractures. Osteoporotic vertebral fractures play an increasingly important role in geriatric patients and percutaneous vertebroplasty (PVP) constitutes a common treatment option. The aim of this study was to evaluate the safety and efficacy of PVP in geriatric patients with cardiovascular comorbidities at our center.MethodsIn this retrospective single-center study, 49 patients aged ≥ 65 with a total of 88 vertebral fractures underwent vertebroplasty. MRI and CT scans of the spine were performed in all patients prior to surgery. All patients were evaluated 4 weeks after surgery as part of their clinical follow-up. VAS scores were recorded before and after the operation. Postoperative complications within 30 days of the initial surgery were analyzed.ResultsThe mean age of patients was 77 years (± 6.4). Of the 49 patients, 39 (80%) were female, and 36 (76%) had cardiovascular comorbidities. The most frequent postoperative complications were cement leakage with no new neurological postoperative deficits (14.3%). The in-hospital mortality rate was 1 out of 49 patients (2%). VAS scores revealed an overall pain reduction of > 97%. None of the following affected patient safety: ASA, BMI, duration of surgery, or the level or localization of vertebroplasty.ConclusionsOur data demonstrate that vertebroplasty was a feasible and effective treatment for pain reduction in geriatric patients with osteoporotic fractures despite cardiovascular comorbidities.Level of evidence3.

Leksell stereotactic system-based aspiration biopsy is a common procedure in the neurosurgical treatment of deep-seated or multiple brain lesions. This study aimed to evaluate the benefit of frameless biopsy using VarioGuide compared to frame-based biopsy using the Leksell stereotactic system (LSS). We analyzed all brain biopsies using VarioGuide or LSS at our neurooncological Department of Neurosurgery in the University Hospital of Bonn between January 2018 and August 2020. We analyzed demographic data, duration of surgery, size of lesion, localization, and early complications. Uni-variable analyses were carried out on data from both groups. In total, 109 biopsies were compared (40 VarioGuide vs. 69 LSS). Patients with VarioGuide were significant older (74 (62–80) years vs. 67 (57–76) years; p = 0.03) and had a shorter duration of general anesthesia (163 (138–194) min vs. 193 (167–215) min, p < 0.001). We found no significant differences in surgery duration (VarioGuide median 28 min (IQR 20–38); LSS: median 30 min (IQR 25–39); p = 0.1352) or in early complication rates (5% vs. 7%; p = 0.644). A slightly higher false negative biopsy rate was registered in the LSS group (3 vs. 1; p = 0.1347). The size of the lesions also did not differ significantly between the two groups (18.31 ± 26.35 cm3 vs. 12.63 ± 14.62; p = 0.15). Our data showed that biopsies performed using VarioGuide took significantly less time than LSS biopsies and did not differ in complication rates. Both systems offered a high degree of patient safety.

Community-acquired bacterial meningitis conveys significant morbidity and mortality due to intracranial and systemic complications, and sepsis is a major contributor to the latter. While cerebrospinal fluid (CSF) analysis is essential in the diagnosis of bacterial meningitis, its predictive utility for detection of sepsis is unknown. We investigated the diagnostic performance of CSF parameters for sepsis defined by the Sepsis-3 criteria in a retrospective cohort of patients with community-acquired bacterial meningitis. Among 103 patients, 69.5% developed sepsis. CSF lactate was associated with sepsis with an odds ratio of 1.11 (p = 0.022), while CSF cell counts, glucose and protein levels were not (all p > 0.4). Employing the optimal cutoff of 8.2 mmol/L, elevated CSF lactate resulted in a sensitivity of 81.5% and specificity of 61.5% for sepsis. In exploratory analyses, CSF lactate was also associated with in-hospital mortality with an odds ratio of 1.21 (p = 0.011). Elevated CSF lactate might contribute to early diagnosis of sepsis as well as prognostication in patients with community-acquired bacterial meningitis.

Abstract Introduction: Angiogram-negative subarachnoid hemorrhage (AN-SAH) accounts for 5–15% of spontaneous SAH. This study aims to analyze the frequency and characteristics of spinal bleeding sources in patients with AN-SAH. Methods: 140 patients suffering from AN-SAH treated at our institution from 2012 to 2022 were included in this retrospective cohort study. Results: 52.1% were diagnosed with perimesencephalic SAH, 35.0% with non-perimesencephalic, SAH and 12.9% with CT-negative SAH (diagnosed by lumbar puncture). Additional magnetic resonance imaging (MRI) identified a spinal bleeding source in 4 patients (2.86%). These patients presented with local spine pain or neurological deficits (relative risk: 3.9706 [95% confidence interval [CI]: 0.7272–21.6792]; p < 0.001) and were younger (mean difference 14.85 years [95% CI: 0.85–28.85; p = 0.038]) compared to patients without a spinal bleeding source. Conclusions: AN-SAH caused by spinal pathology is rare. This study indicates that craniocervical and holospinal MRI should be considered in AN-SAH, especially for young patients with AN-SAH who present with back pain or neurological deficits.

Chronic subdural hematoma (cSDH) is a common disease in the neurological and neurosurgical world. The recommended treatment for cSDH patients with moderate or severe neurological symptoms is surgical evacuation, but cSDH frequently recurs. The patient’s ABO blood type may influence the outcome. This study aims to evaluate the correlation between cSDH recurrence and blood type O. We performed a retrospective analysis of the data of patients with cSDH who were surgically treated. Recurrence was defined as the need for re-operation within the first 12 weeks after the initial surgery. We analyzed standard demographic data, duration and type of surgery, ABO blood types, and the re-operation rate. Univariate and multivariate analyses were conducted. A total of 229 patients were included. The recurrence of hematoma was identified in 20.5% of patients. Blood type O was found to be significantly associated with cSDH recurrence leading to re-operation within 12 weeks (p = 0.02, OR 1.9, 95% CI 1.1–3.5). Thrombocyte aggregation inhibition and oral anticoagulants were not predictors of cSDH recurrence. Patients with blood type O in our cohort were identified to be at higher risk of cSDH recurrence and may, therefore, be a more vulnerable patient group. This finding needs further evaluation in larger cohorts.