The purpose was to describe cervical sagittal alignment in adolescent idiopathic scoliosis (AIS) compared to a normal group of adolescents and young adults, seeking for differences by Lenke type. Radiographs of 1779 AIS patients and 1115 controls were analyzed. Lenke types were determined. Spinopelvic parameters, thoracic kyphosis (TK), lumbar lordosis and sagittal vertical axis (SVA) CAM, C2, and C7 were measured. Cervical parameters included McGregor slope, C1–C2 and McGregor–C2 lordosis, C2–C7 lordosis (subdivided into cranial and caudal arches), C7 and T1 slopes. Cervical alignment patterns were classified as lordotic, kyphotic or sigmoid shapes. Lenke 1, 2, 3 and 6 curves showed decreased C2–C7 and caudal arch lordosis associated with decreased C7 and T1 slopes and TK (p < 0.001) compared to normal. Cranial cervical parameters were comparable to the normal group. Lenke 5 patients demonstrated TK, C7 and T1 slopes, and cervical alignment parameters close to the normal group. In AIS, TK correlated with caudal cervical (r = 0.76) and C2-C7 lordosis (r = 0.52), but only weakly with cranial cervical parameters. Cervical sagittal alignment compensatory changes in AIS predominantly involve the caudal cervical segment and are closely related to TK, while cranial alignment remains close to normal, supporting horizontal gaze. As opposed to other AIS types with thoracic deformity, Lenke 5 patients had no cervical compensation, and sagittal alignment was close to normal. Distinguishing normative from pathologic compensation across AIS curve types may help optimize surgical planning and restoration of TK to indirectly improve cervical alignment.
Streptococcus equi subspecies zooepidemicus is an opportunistic pathogen. Human infections are rare and often linked to close contact with horses. Consumption of raw milk cheese has also been incriminated. We present two cases of S. equi ssp. zooepidemicus bacteremia diagnosed within a short space of time in the same hospital.
Inverted follicular keratosis (IFK) is an uncommon benign skin epithelial neoplasm that microscopically consists of a superficial, sharply circumscribed tumor composed of bland keratinocytes associated with squamous eddies. Only a few examples of combined tumors associating IFK and either trichoblastoma or a sebaceous component have been reported in the literature. Herein, we report the clinicopathological and molecular characterization of 12 cases of combined tumor comprising IFK associated with an adnexal neoplasm, including trichoblastoma (n = 7), sebaceoma (n = 4), and tubular adenoma (n = 1). The age at presentation ranged from 26 to 79 years, with a mean of 55 years. The majority of the tumors were located on the head (n = 8) with a median size of 6 mm (Range: 3–14 mm). Microscopically, all cases showed a biphasic appearance with a prominent IFK component superficially, associated either with trichoblastoma, sebaceoma or tubular adenoma at the deeper aspect, with an abrupt transition between the two tumor components. There was no evidence of nevus sebaceus in the surrounding tissue. Molecular investigation revealed pathogenic HRAS or KRAS mutations in 3 of the 4 cases harboring a sebaceous component and also in the specimen with combined IFK and tubular adenoma. No mutations were detected in any of the 5 tested IFK-TB cases. To conclude, our series expands the spectrum of combined tumors associated with IFK. Genetic characterization suggests that pathogenic mutations of RAS might drive a subset of these cases, particularly when associated with sebaceoma, even in the absence of pre-existing nevus sebaceus.
Background: It is unclear if revascularization therapies become less effective at recanalizing occlusions over time. We evaluated the association between time metrics and successful reperfusion in patients treated with thrombolysis for anterior circulation large vessel occlusion (LVO) strokes. Methods: We included LVO patients from the AcT (Alteplase compared to Tenecteplase) trial who underwent digital subtraction angiography. Logistic regression was performed to determine associations between time metrics and reperfusion outcomes: initial successful reperfusion (eTICI score ≥ 2b on first run), initial eTICI score, first pass effect (final eTICI 2b-3 after one thrombectomy pass), and final eTICI score. Models adjusted for age, sex, baseline NIHSS, occlusion location, treatment allocation and needle-to-groin time. Results: Among 471 patients, 46 (9.7%) achieved initial successful reperfusion (initial eTICI ≥2b) post-thrombolysis and prior to thrombectomy. Median age was 73 years, 50.7% were female; M1 occlusions were most common (40.6%). Onset-to-needle (median 110 vs 105 min; p = 0.055), onset-to-groin (157 vs 155 min; p = 0.376), and needle-to-groin times (46 vs 39 min; p = 0.394) did not differ between patients with vs without initial successful reperfusion. Onset-to-needle time was not associated with initial successful reperfusion (aOR 1.00 per 10-min increase; 95% CI 0.96–1.05). Onset-to-groin time was also not associated with first-pass effect (aOR 0.99; 95% CI 0.97–1.02) or final eTICI (aOR 1.00; 95% CI 0.98–1.02). Conclusion: Time from symptom onset was not significantly associated with angiographic reperfusion outcomes among patients with anterior circulation LVO stroke treated within the 4.5 h window. Further studies should explore this relationship across wider time windows, stroke subtypes, and treatments.
Brain frailty measures like atrophy and white matter changes (WMC) are becoming increasingly relevant in stroke outcome prediction but are conventionally thought to be best seen on MRI compared to CT. We assessed agreement between baseline CT vs follow-up MRI ratings for brain atrophy and WMC; and compared their discriminative ability for 90-day functional outcomes in acute ischemic stroke. In this post-hoc, observational analysis of baseline CT and follow-up MRI data from the Alteplase compared to Tenecteplase (AcT) randomised-controlled trial, experts assessed brain atrophy, periventricular and deep WMC using established visual-rating scales. Binary agreement (none-mild vs. moderate-severe) and agreement across the full scores between atrophy and WMC measures on CT and MRI were calculated using Gwet’s agreement coefficient (AC1). Logistic regression estimated discrimination for 90-day modified Rankin Scale (mRS) 0–1. Agreement of AUCs for CT and MRI models were compared using DeLong’s test. Among 1577 AcT participants, 491(31.1
