Safety and efficiency of Wharton's Jelly-derived mesenchymal stem cell administration in patients with traumatic brain injury: First results of a phase I study.

BACKGROUND: Traumatic brain injury (TBI) is characterized by a disruption in the normal function of the brain due to an injury following a trauma, which can potentially cause severe physical, cognitive, and emotional impairment. Stem cell transplantation has evolved as a novel treatment modality in the management of TBI, as it has the potential to arrest the degeneration and promote regeneration of new cells in the brain. Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) have recently shown beneficial effects in the functional recovery of neurological deficits. AIM: To evaluate the safety and efficiency of MSC therapy in TBI. METHODS: We present 6 patients, 4 male and 2 female aged between 21 and 27 years who suffered a TBI. These 6 patients underwent 6 doses of intrathecal, intramuscular (i.m.) and intravenous transplantation of WJ-MSCs at a target dose of 1 × 106/kg for each application route. Spasticity was assessed using the Modified Ashworth scale (MAS), motor function according to the Medical Research Council Muscle Strength Scale, quality of life was assessed by the Functional Independence Measure (FIM) scale and Karnofsky Performance Status scale. RESULTS: Our patients showed only early, transient complications, such as subfebrile fever, mild headache, and muscle pain due to i.m. injection, which resolved within 24 h. During the one year follow-up, no other safety issues or adverse events were reported. These 6 patients showed improvements in their cognitive abilities, muscle spasticity, muscle strength, performance scores and fine motor skills when compared before and after the intervention. MAS values, which we used to assess spasticity, were observed to statistically significantly decrease for both left and right sides (P < 0.001). The FIM scale includes both motor scores (P < 0.05) and cognitive scores (P < 0.001) and showed a significant increase in pretest posttest analyses. The difference observed in the participants' Karnofsky Performance Scale values pre and post the intervention was statistically significant (P < 0.001). CONCLUSION: This study showed that cell transplantation has a safe, effective and promising future in the management of TBI.

Allogeneic mesenchymal stem cells may be a viable treatment modality in cerebral palsy.

BACKGROUND: Cerebral palsy (CP) describes a group of disorders affecting movement, balance, and posture. Disturbances in motor functions constitute the main body of CP symptoms. These symptoms surface in early childhood and patients are affected for the rest of their lives. Currently, treatment involves various pharmacotherapies for different types of CP, including antiepileptics for epilepsy and Botox A for focal spasticity. However, none of these methods can provide full symptom relief. This has prompted researchers to look for new treatment modalities, one of which is mesenchymal stem cell therapy (MSCT). Despite being a promising tool and offering a wide array of possibilities, mesenchymal stem cells (MSCs) still need to be investigated for their efficacy and safety. AIM: To analyze the efficacy and safety of MSCT in CP patients. METHODS: Our sample consists of four CP patients who cannot stand or walk without external support. All of these cases received allogeneic MSCT six times as 1 × 106/kg intrathecally, intravenously, and intramuscularly using umbilical cord-derived MSCs (UC-MSC). We monitored and assessed the patients pre- and post-treatment using the Wee Functional Independence Measure (WeeFIM), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification Scale (MACS) instruments. We utilized the Modified Ashworth Scale (MAS) to measure spasticity. RESULTS: We found significant improvements in MAS scores after the intervention on both sides. Two months: Right χ2 = 4000, P = 0.046, left χ2 = 4000, P = 0.046; four months: Right χ2 = 4000, P = 0.046, left χ2 = 4000, P = 0.046; 12 months: Right χ2 = 4000, P = 0.046, left χ2 = 4000, P = 0.046. However, there was no significant difference in motor functions based on WeeFIM results (P > 0.05). GMFCS and MACS scores differed significantly at 12 months after the intervention (P = 0.046, P = 0.046). Finally, there was no significant change in cognitive functions (P > 0.05). CONCLUSION: In light of our findings, we believe that UC-MSC therapy has a positive effect on spasticity, and it partially improves motor functions.

Percutaneous Pain Procedures in Patients Who Underwent Lumbar Disc Herniation Surgery: Is It an Important Tool in the Management of Post-Surgical Ongoing Pain?

AIM: To evaluate the efficacy of percutaneous pain interventions in patients who previously underwent lumbar disc herniation surgery. MATERIAL AND METHODS: We retrospectively analyzed 48 patients with persistent / recurring complaints who underwent lumbar disc surgery (LDS) and were treated with percutaneous interventions. They were grouped into recurrent disc herniations (RDHs) and other discovertebral pathologies (ODVP). Moreover, patients were evaluated as those who received transforaminal injection (TFI) with facet blockage (FB) and who received both caudal injection (CI) and TFI in addition to FB. Patients were evaluated using Oswestry Disability Index (ODI) and visual analog scale (VAS). RESULTS: Between the recurrent and ODVP groups, preoperative, at 1-hour postoperative, and at 6-month postoperative ODI (p=0.867, p=0.055, p=0.892) and VAS (p=0.902, p=0.136, p=0.462) scores did not show a statistically significant difference, respectively. Additionally, in the comparison of patients who underwent FB+TFI+CI and only FB+TFI, there was no statistically significant correlation between preoperative and 6-month postoperative ODI (p = 0.284) and VAS (p=0.248) scores in both recurrent and ODVP groups, respectively. The success rates at the 3rd and 6th months of patients with RDH and ODVP were 47.61% (10/21) and 42.85% (9/21) and 70.37% (19/27) and 63.96% (17/27), respectively. CONCLUSION: There was no statistically significant difference in ODI and VAS scores between recurrent and ODVP groups. The clinical success rate was numerically better in the ODVP group. Thus, we suggest that co-administration of TFI and CI did not significantly contribute to our clinical outcome.

Effectiveness of Burr Hole Sizes on Midline Shift and Hematoma Thickness in the Treatment of Chronic Subdural Hematoma.

BACKGROUND: The aim of our study was to investigate the effect of the burr hole width on the postoperative chronic subdural hematoma (CSH) thickness and midline shift radiologically. METHODS: The medical records of 92 patients who had undergone surgery after a diagnosis of CSH between April 1, 2015 and July 1, 2021 were reviewed retrospectively. Preoperative and postoperative computed tomography (CT) scans were reviewed, and the thickness of the hematoma and midline shift and the diameters of 2 burr holes opened were measured and recorded. The correlation between the burr hole diameter width and CSH thickness on postoperative CT scans and the improvement in midline shift were investigated statistically. RESULTS: When the CT scans performed on the first postoperative day and first postoperative month were examined, we found that the preoperative hematoma thickness and midline shift were significantly reduced postoperatively (P < 0.001). A positive significant correlation was found between the improvement in the midline shift, posterior burr hole diameter, and anteroposterior burr hole arithmetic mean (P < 0.001 and P = 0.029, respectively). CONCLUSIONS: Having examined the current surgical techniques in the treatment of CSH, we found that an increase in the burr hole craniostomy width, especially the posterior burr hole craniostomy width, contributed to the improvement in the midline shift.

Comprehensive natural radioactivity and pollution risk assessments of aquatic media and sediment in Lake Van (Türkiye).

This paper studies the radionuclide (137Cs, 226Ra, 232Th, 40K) activity concentrations and gross radioactivities in waters and sediments of Lake Van, which is the third largest closed lake (with no natural or artificial outlet) within the Earth. The physico-chemical parameters were measured and evaluated in the lake waters. The mean gross α activities in surface, middle and bottom waters are 0.04, 0.03 and 0.03 Bq/L, respectively, and in the same order, the mean gross ß activities are 0.30, 0.23 and 0.33 Bq/L, respectively. In sediment samples, the mean activity concentrations were measured as 1.98 Bq/g for gross-α, 3.46 Bq/g for gross-ß, 48.3 Bq/kg for 226Ra, 32.0 Bq/kg for 232Th, 540.1 Bq/kg for 40K and 25.9 Bq/kg for 137Cs. The radiation hazard parameters values based on the measured activities were calculated and Raeq values are lower than the world average value in all samples, while Dout and AED values are relatively high in some sediment samples.

The Effects of Using Hearing Aids and Hearing Assistive Technologies on Programmable Ventriculoperitoneal Shunt.

BACKGROUND: To investigate interaction between behind-the-ear (BTE) hearing aids, hearing assistive technologies, and programmable shunt valve to understand how use of BTE hearing aids in patients who underwent ventriculoperitoneal shunt (VPS) surgery affects the settings of a programmable shunt valve. METHODS: In this study, we investigated the magnetic field (MF) generation of 3 BTE hearing aids made by different companies, 1 frequency modulated system using telecoil technology, and 1 wireless microphone technology and their interactions with 2 programmable shunt valves. All measurements were made in a silent booth using 2 different models. The influence of MF strength in the distance modeling was investigated based on the distance from source auditory prostheses. The measurements were recorded using a Gauss meter. In the anatomical modeling, the change in the settings and interaction of the valve in a bust mannequin were investigated. RESULTS: No MF created by BTE hearing aids was detected in the distance modeling. The highest value measured was 32.67 µT (<90 dB noise) when BTE hearing aids and frequency modulated systems were used, and this value decreased as the distance increased. No MF generation was observed at measurements done for distances >10 mm. In the anatomical modeling, the settings of both programmable valves did not change under all acoustic conditions. CONCLUSIONS: This is the first study to our knowledge examining the MF created by hearing aids and hearing assistive technologies and its impact on programmable valves and variations in their settings. Our findings showed that it is safe to use BTE hearing aids, frequency modulated systems, and wireless microphone technologies in patients with a programmable VPS.

Metric Evaluation of Reliability and Transparency of the Videos About Carpal Tunnel Syndrome Surgery in the Online Platforms: Assessment of YouTube Videos' Content.

OBJECTIVE: To evaluate the quality and reliability of carpal tunnel syndrome surgery videos on YouTube. METHODS: A keyword set of "carpal tunnel syndrome surgery" was searched on YouTube. The DISCERN scoring system, Journal of the American Medical Association (JAMA) scoring system, and Health on the Net (HON) ranking systems were used to evaluate the quality and reliability of the first 50 videos appeared in the search results. The characteristics of each video, such as the number of likes, dislikes and views, upload days, video length, and the uploader, were collected retrospectively. The relationships between the video quality and these factors were investigated statistically. RESULTS: All of the featured videos sorted were found to be of poor content (mean DISCERN score [n = 1.71 of 5], mean JAMA score [n = 1.76 of 4], mean HON score [n = 5.65 of 16]). Yet, DISCERN scores of the videos uploaded by medical centers were higher than that of the others (p = 0.022). No relationship was detected between the other variables and video quality. CONCLUSION: Healthcare professionals and organizations should be more cautious when recording and uploading a video to the online platforms. As those videos could reach a wide audience, their content should provide more information about possible complications of a treatment and other treatment modalities.

When to Assess: Cognitive Impact of Ventriculoperitoneal Shunt Operation in Elderly Adults with Normal Pressure Hydrocephalus.

OBJECTIVE: Normal pressure hydrocephalus (NPH) has clinical manifestations with different cognitive difficulties. Despite the intense interest, the change in cognitive functions after ventriculoperitoneal shunt (VPS) treatment varies widely. The aims of this study were to monitor the effect of NPH on cognition in elderly and the progress of cognitive abilities after VPS surgery. METHODS: Patients diagnosed with idiopathic NPH (iNPH) who had ventriculomegaly with narrow callosal angle and/or periventricular signal changes not attributable to ischemic changes were included in study. All patients (n = 30) underwent comprehensive neuropsychological assessment and received programmable VPS. After VPS placement, 2 consecutive examinations were performed at approximately 6-month intervals. RESULTS: At the baseline evaluation, patients with iNPH displayed poorer performance in executive functions (EFs) compared with the matched control group (n = 30). Among those patients, significant improvement was observed in semantic fluency (M = 13.94; standard deviation, 4.95) and clock drawing (M = 3.67; standard deviation, 1.57) at the second follow-up evaluation (P = 0.015 and P = 0.024, respectively). The other prominent finding was in memory process: patients with iNPH showed improvement in delayed recall (P = 0.011), recognition (P = 0.033), and learning scores (P = 0.041) at the second follow-up compared with evaluation before VPS placement. CONCLUSIONS: iNPH seems to have a detrimental effect predominantly on EFs. As EFs become corrupted, decline occurs in learning and recall processes of memory. VPS provides an improvement of cognitive deterioration; however, efficacy of this treatment on cognitive abilities is shows in a longer period compared with other iNPH symptoms.

An international bibliometric study of scientific articles on intracranial aneurysms.

OBJECTIVES: The number of original scientific researches on intracranial aneurysms has risen over the last 30 years. Despite the rise in the number of articles, there is no up-to-date exhaustive bibliometric research in the literature. This study aimed to contribute to the literature via a bibliometric analysis of the original scientific researches on intracranial aneurysms published over the last 30 years. METHODS: The literature review was done using the Web of Science. All articles and its citations containing aneurysm keywords were analyzed in the "title" section of articles published in the research areas: Neurosciences Neurology during 1980-2019. Correlation analyses between the number of articles produced by the countries and their economic and development indicators of gross domestic product, and Human Development Index were analyzed using the Spearman correlation coefficient. Linear regression analysis was utilized to estimate the number of articles to be published in the future. RESULTS: There were a total of 21,673 publications on intracranial aneurysms. Of these publications, 13,371 (61.7%) were articles. The three countries that produced the most articles were the USA (4098), Japan (2668), and China (937). A statistically significant correlation was found between the development indicators of world countries and publication productivity (p<0.001). The three journals that produced the most publications were Neurosurgery, Journal of Neurosurgery, and American Journal of Neuroradiology. The most cited article was published in Journal of Neurosurgery. CONCLUSION: This bibliometric study provides a collection of data that will help design future research on intracranial aneurysms more efficiently and make innovations at greater speed.

Multi-Level Anterior Cervical Decompression in Multi-Level Cervical Spondylotic Myelopathy without Extending the Corpus Resection: A Cadaveric Study of a Novel Surgical Technique.

AIM: To perform three-level decompression with a single-level corpectomy by modifying the fusion with anterior cervical corpectomy (ACC-F) method on a cadaver. MATERIAL AND METHODS: The anterior cervical region of four whole-head cadavers was dissected. The corpectomy was performed under a surgical microscope with a MT4-20+ ultrasonic bone dissector (UBD) tip. Superior and inferior decompression were conducted and viewed with a 70° neuroendoscope using two types (vertically and horizontally oriented) of specially designed 23 mm-long, 90°-angled UBD tips. RESULTS: After neck dissection and the removal of the thyroid and cricoid cartilages, C5 corpectomy and adjacent-level discectomies were performed. Following discectomy and corpectomy, superior and inferior decompression were conducted with specially designed UBD tips and viewed with a 70° neuroendoscope. A three-level anterior cervical decompression was provided with a single-level corpectomy. CONCLUSION: This study demonstrated that two more level decompression is possible with a single-level corpectomy in the cervical region using the new technique.

Is it Possible to Distinguish Cervicogenic Headache from Neck Pain with Cervicospinal Posture? A Single-Blind, Prospective Cross-Sectional Trial.

BACKGROUND: Cervicogenic headache (CEH) is a type of headache that is considered to be originated from the upper cervical spine. There are conflicting results in studies showing changes in the cervical spine in patients with CEH. OBJECTIVES: We aimed to compare the cervical radiographs of patients with CEH and nonspecific neck pain. STUDY DESIGN: A single-blind, prospective study. SETTING: The department of neurosurgery and physical medicine and rehabilitation in a university hospital. METHODS: In this cross-sectional study; 45 women with CEH and 45 women with neck pain were involved. The pain assessment of the patients was done by the Visual Analog Scale (VAS), and the disability assessment was tested with the Neck Disability Index (NDI). General cervical lordosis (GCL) and upper cervical lordosis (UCL) angles were calculated on the lateral cervical x-ray. Clinical parameters including age, weight, height, pain (VAS), disability (NDI), and disease duration were recorded. Patients with CEH and neck pain were compared. Correlations between GCL, UCL, and pain assessment were analyzed. RESULTS: Both groups were demographically similar. There was no significant difference at the lateral cervical x-ray measurements between CEH and neck pain groups (CEH group mean GCL = 19.2, UCL = 13.6; neck pain group mean GCL = 19.1, UCL= 14.8). The positive correlation between GCL and UCL in the neck pain group (r = 0.453; P = 0.002) was not found in the CEH group (P > 0.05). LIMITATIONS: Anesthetic blockade was not used for the diagnosis. Also, the whole spinal alignment was not evaluated. CONCLUSIONS: According to cervical lateral x-ray, there was no significant difference in posture in patients with CEH and neck pain.