Kamand Khalaj

BACKGROUND AND OBJECTIVES: Glioblastoma (GBM) isocitrate dehydrogenase-wildtype remains a devastating brain tumor with a poor prognosis despite optimal treatment. Even after supramaximal or complete contrast-enhancing (CE) resection, patient outcomes vary significantly, with some experiencing short-term survival (STS) and others long-term survival (LTS). This study aims to identify clinical and molecular markers predicting the survival of patients with GBM in these high-resection categories. METHODS: We retrospectively analyzed patients with newly diagnosed GBM who underwent supramaximal or complete CE resection, followed by next-generation sequencing at our institution (2009-2025). Patients were categorized as STS (survival ≤12 months), non-STS (survival >12 months), or LTS (survival ≥36 months). We compared clinical, radiological, and molecular features between these groups to identify potential prognostic markers. RESULTS: Among 85 patients who met the inclusion criteria, 24 (28%) were STSs and 61 were non-STS (from which 16 [18.8%] were LTSs), with no significant molecular differences observed between these groups. On comparing STS and LTS patients, CDKN2A/B loss (83.3% vs 43.8%, P = .01) and EGFR amplification (58.3% vs 25%, P = .05) were more frequent in STS patients vs LTS. Tumor location varied, with STS patients having more frontal lobe tumors (45.8%) and LTS patients having more temporal lobe tumors (62.5%). A trend, although not statistically significant, toward increased nonlocal recurrence rates was observed in STS patients (27.2%). CONCLUSION: Despite aggressive extent of resection in GBM, the prevalence of STS patients remains notable at ∼28% and survival beyond 3 years remains limited at ∼18.8%. CDKN2A/B loss and EGFR amplification might correlate with shortened survival after supramaximal or complete CE resection. The impact of nonlocal recurrence remains uncertain among STSs. These findings highlight the need for collaborative studies to advance understanding of the biology of GBM as their behavior differs despite aggressive surgical and medical therapies.

Upper cervical spine trauma (UCST) can lead to severe morbidity and mortality, particularly when associated with craniocervical junction (CCJ) injuries. Previous studies suggest that identifying prevertebral hematomas in patients with cervical trauma may have clinical significance. However, the association between prevertebral hematomas and clinical outcomes in patients with UCST has not yet been firmly established. The purpose of this study is to investigate the association of prevertebral hematomas with the severity of upper cervical spine injury, and clinical outcomes in patients with UCST. This retrospective study analyzed patients with UCST admitted to a level I trauma center in a 3-year period. Inclusion criteria included cervical spine trauma confirmed via imaging and MRI performed within 7 days of admission. Prevertebral hematomas were assessed for size and location and correlated with injury patterns and clinical outcomes. Statistical analysis was performed by using χ² tests and logistic regression models. One hundred sixty-five patients (mean age, 40.6 ± 19.9 years; 103 men) were evaluated. Prevertebral hematomas were identified in 88 of 165 patients (53.3%). Hematomas were significantly associated with CCJ dislocations (17/23 patients; 73.9%, P = .03) and subaxial disco-ligamentous injuries (48/71 patients; 67.6%, P = .001). Surgical intervention was more likely in patients with prevertebral hematomas (39/60 patients; 65%, P = .02), with an OR of 2.08 (95% CI, 1.08-4.01). While 75 of 148 patients with neurologic disability at discharge had prevertebral hematomas (50.6%, P = .06), this association did not reach statistical significance. Prevertebral hematomas were significantly associated with CCJ dislocations, subaxial disco-ligamentous injuries, and an increased likelihood of surgical intervention in patients with UCST. These findings suggest that prevertebral hematomas can serve as a useful marker for identifying patients with more severe injury patterns.

Purpose: Oxygen 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation is associated with better chemotherapy response and prognosis in glioblastoma patients. This study evaluates the prognostic value of routine MRI findings at initial diagnosis to determine MGMT promoter methylation status. Methods: A retrospective study was performed on 85 patients with histologically confirmed IDH wild-type glioblastoma. Patients were divided into two groups based on MGMT promoter status: methylated (33 [38.8%]) and unmethylated (52 [61.1%]). MRI findings were assessed using the Visually Accessible Rembrandt Imaging lexicon, and variables were analyzed using univariate analysis (X ² /Fisher’s test) and logistic regression for independent predictors of MGMT promoter methylation. Results: A thick enhancing tumoral margin (≥3 mm) was present in 67.3% of MGMT unmethylated glioblastomas and 32.7% of MGMT promoter methylated glioblastomas ( p = .05). Tumoral cortical extension was observed in 68.7% of unmethylated cases versus 31.3% in methylated cases ( p = .01). Non-enhancing tumors were predominantly MGMT methylated (83.3%). In multivariate analysis, tumoral cortical involvement and non-enhancing tumors were independent predictors of MGMT promoter methylation. In survival analysis, higher progression-free survival rates were identified in patients with MGMT promoter methylation ( p = .05) and in patients without cortical tumoral extension ( p = .05). Conclusion: Our study suggests that while the predictive power of the assessed parameters is modest, thick enhancing tumoral margins and cortical tumor extension were more frequently identified in MGMT unmethylated glioblastomas. Conversely, 83.3% of non-enhancing tumors showed MGMT promoter methylation. Furthermore, MGMT promoter methylation and cortical extension were associated with progression-free survival.

Background: The amygdala is a key structure involved in memory, emotional processing, and sensory integration. While the cortical connectivity of the amygdala with the frontal and temporal lobes has been extensively studied, its direct connections with the parieto-occipital cortices remain underexplored. This study aims to delineate the direct connectivity between the amygdala and the parietal and occipital cortices via the parahippocampal segment of the cingulum bundle. Methods: High-resolution diffusion-weighted imaging (DWI) tractography was performed on 30 healthy adult brains. Fiber tracking was conducted using three regions of interest (ROIs) placed in the parietal, occipital, and medial temporal lobes. A fractional anisotropy (FA) threshold of 0.25 and an angle threshold of 70° were applied to reconstruct the fiber pathways. Results: A consistent bilateral trajectory of the parahippocampal segment of the cingulum bundle was identified, originating in the posterior parietal and lateral occipital cortices and terminating in the amygdala. This pathway was distinct from adjacent fiber tracts such as the amygdalofugal pathway and fornix. Conclusion: This study confirms the existence of a direct parieto-occipital connection to the amygdala via the parahippocampal cingulum bundle which is an important part of the ventral and dorsal Kamali limbic circuitry. These findings contribute to our understanding of posterior limbic connectivity and may have implications for visuosensory-emotional processing in both health and disease.

Objectives: Glioblastomas (GBM) are the most common primary invasive neoplasms of the brain. Distinguishing between lesion recurrence and different types of treatment related changes in patients with GBM remains challenging using conventional MRI imaging techniques. Therefore, accurate and precise differentiation between true progression or pseudoresponse is crucial in deciding on the appropriate course of treatment. This retrospective study investigated the potential of apparent diffusion coefficient (ADC) map values derived from diffusion-weighted imaging (DWI) as a noninvasive method to increase diagnostic accuracy in treatment response. Methods: A cohort of 21 glioblastoma patients (mean age: 59.2 ± 11.8, 12 Male, 9 Female) that underwent treatment with bevacizumab were selected. The ADC values were calculated from the DWI images obtained from a standardized brain protocol across 1.5-T and 3-T MRI scanners. Ratios were calculated for rADC values. Lesions were classified as bevacizumab-induced cytotoxicity based on characteristic imaging features (well-defined regions of restricted diffusion with persistent diffusion restriction over the course of weeks without tissue volume loss and absence of contrast enhancement). The rADC value was compared to these values in radiation necrosis and recurrent lesions, which were concluded in our prior study. The nonparametric Wilcoxon signed rank test with p < 0.05 was used for significance. Results: The mean ± SD age of the selected patients was 59.2 ± 11.8. ADC values and corresponding mean rADC values for bevacizumab-induced cytotoxicity were 248.1 ± 67.2 and 0.39 ± 0.10, respectively. These results were compared to the ADC values and corresponding mean rADC values of tumor progression and radiation necrosis. Significant differences between rADC values were observed in all three groups (p < 0.001). Bevacizumab-induced cytotoxicity had statistically significant lower ADC values compared to both tumor recurrence and radiation necrosis. Conclusion: The study demonstrates the potential of ADC values as noninvasive imaging biomarkers for differentiating recurrent glioblastoma from radiation necrosis and bevacizumab-induced cytotoxicity.

Background. Patients with β‐thalassemia major depend on lifelong transfusion, resulting in tissue iron overload. This longitudinal retrospective observational study aims to assess myocardial and liver iron overload using magnetic resonance imaging (MRI) and investigate the lag between myocardial and liver iron unloading in β‐thalassemia patients undergoing chelation therapy. Methods. Beta‐thalassemia major patients with at least two MRI studies between 2016 and 2020 were enrolled. Myocardial and liver iron overload were defined as T2^∗ less than 20 and 2.1, respectively. Outcomes included mortality, myocardial and liver T2^∗ changes, and systolic dysfunction assessed by cardiac MRI. Results. Fifty‐five patients with a mean age of 24.62 ± 7.94 years, a mean follow‐up duration of 24.3 ± 12.9 months, and a mean ferritin level of 1475.75 ± 771.12 ng/mL were enrolled. All of the abovementioned patients only took deferoxamine as the iron‐chelating medication. Mortality occurred in three patients (5.5%) during follow‐up. Liver T2^∗ significantly increased (p value ∗ showed a nonsignificant increase. Iron unloading of the myocardium was not significantly different from that of the liver and did not result in a significant lag (56% vs. 44%; p value = 0.419). Baseline myocardial T2^∗ correlated with extramedullary hematopoiesis, weekly number of deferoxamine injections (p value p value Conclusion. Liver T2^∗ reduced during deferoxamine chelation therapy, while myocardial T2^∗ remained unchanged. No significant lag was observed between myocardial and liver iron unloading. Further studies are required to elucidate these findings.

Infantile fibrosarcoma (IF) is a rare malignant fibroblastic tumor that affects infants and young children, occurring most commonly in the extremities. Here, we present a 14-year-old patient with an abdominal mass incidentally detected after a blunt injury to the abdomen. The initial trauma protocol CT revealed a high attenuation mesenteric lesion in the left central abdomen suggestive of mesenteric hematoma. However, the possibility of a solid neoplastic mass lesion could not be excluded. Further evaluation with dynamic contrast-enhanced serial MRI showed a progressive enhancing mass and excluded a hyperacute hematoma with active bleeding. The mass was resected, and histopathological examination and molecular analysis of tumor cells were consistent with a high-grade fibrosarcoma with KMT2D : BCOR fusion.

We aimed to assess the Iranian people’s attitude and confidence in the COVID-19 vaccine, their concerns about the safety of vaccines, and their reasons for accepting or rejecting the COVID-19 vaccine. We conducted a web-based cross-sectional study with a mixed qualitative–quantitative approach from December 2020 to February 2021. Our questionnaire consisted of a COVID-19 vaccine attitude questionnaire, a COVID-19 vaccine confidence inventory, a modified vaccine safety scale, and questions about participants’ decision to accept or refuse the COVID-19 vaccine, and their explanations for their decisions. The research included 1928 people with an average age of 34.88 years with 1236 (64.1%) being female. A total of 1330 participants desired to have the COVID-19 vaccine (69%). Female gender, lower educational levels, following COVID-19 news through sources other than websites and social media, not following COVID-19 news, and loss of a first-degree relative due to COVID-19 were all associated with a more negative attitude toward the COVID-19 vaccine (p < 0.01). To conclude, the acceptance rate of the COVID-19 vaccine among Iranians is comparable to the international average; however, it is still unfavorable. There are serious challenges to the vaccination program in Iran, such as older adults’ lower intention to undergo the COVID-19 vaccine and misinformation.