Luay Şerifoğlu

Background/Objectives: Epidural electrical stimulation (EES) is an investigational, off-label neuromodulation strategy used adjunctively with rehabilitation in chronic spinal cord injury (SCI), but safety and longitudinal functional data specific to traumatic cervical SCI remain limited. This is a descriptive safety-and-feasibility study, not an efficacy study; no efficacy or causal claim is made. Methods: In this single-centre observational cohort, 32 consecutive patients with traumatic cervical SCI underwent EES implantation and were included in baseline and safety analyses, while longitudinal analyses comprised the 26 participants with complete Spinal Cord Independence Measure (SCIM) III data at baseline and 3, 6, 9 and 12 months. Rehabilitation dose was quantified (approximately 1087 prescribed therapy hours over 12 months) and adverse events were classified using ISO 14155:2020 definitions with WHO–UMC causality grading. Prespecified outcomes were device- and procedure-related adverse events and total and domain-specific SCIM III scores; analyses were descriptive. Results: Patients were aged 33.8 ± 10.3 years, 28 (87.5%) were male, and baseline AIS grade was A in 31 and B in 1. Mean total SCIM III increased from 14.81 ± 8.92 at baseline to 21.77 ± 14.60, 25.12 ± 15.90, 28.23 ± 17.68 and 32.42 ± 19.45 at 3, 6, 9 and 12 months (all p < 0.001), with gains across self-care, respiration and sphincter management, and mobility; 10 of 32 patients (31.3%) improved by at least one AIS grade. Adverse events were infrequent: sterile hardware-site inflammation (2, 6.3%), explantation (1, 3.1%) and a first-ever seizure (1, 3.1%), without stimulation-related neurological deterioration. Conclusions: The cohort was highly selected (31/32 baseline AIS A; 87.5% male; injury-to-implant interval 10–339 months), no comparator group was available, stimulation programming was individualised rather than protocolised, and 6 of 32 patients lacked complete 12-month follow-up; these features limit reproducibility and generalisability and preclude any inference about effectiveness. EES with rehabilitation was well tolerated and accompanied by progressive functional gains, although the uncontrolled design precludes causal inference. The contribution of this report is therefore transparent safety, dose and programming data, together with a prespecified protocol framework intended to make a controlled, propensity-matched evaluation of EES in traumatic cervical SCI feasible and reproducible.

Lumbar degenerative disc disease (LDDD) is characterized by persistent inflammation and extracellular matrix degradation. Emerging as main controllers in its pathogenesis are microRNAs (miRNAs) and proinflammatory cytokines. Through the JAK/STAT signalling pathway, HSA-miR-186-5p has been linked to modulating cytokine expression, including interleukin-2 (IL-2). The aim is to find the expression levels of IL-2 and HSA-miR-186-5p in LDDDpatients and investigate their possible correlation with disease degree. 110 LDDD patients and 17 healthy controls wereincluded. ELISA measured serum IL-2 concentrations, and RT-qPCRestimated miR-186-5p levels. The Oswestry Disability Index (ODI) guidedpatients into five subgroups (G1–G5). One-way ANOVA and correlationanalysis were applied in statistical comparisons. LDDD patients had notably higher IL-2 levels than controls ( p p < 0.001), with G1and G5 having the lowest levels found. Across groups, an inverse trend in IL-2 and miR-186-5p expression was noted. Results imply a dysregulated interaction between HSA-miR-186-5p and IL-2 in LDDD. Particularly in early and moderate stages ofdisease, miR-186-5p downregulation could help to explain increased IL-2-mediated inflammation. These biomarkers could provide information ondisease activity and present targets for new treatments.

Background: Intraoperative cytological consultation (IOC) is a practical, rapid, and reliable method for evaluating central nervous system (CNS) tumors, enhancing the neurosurgical oncological approach. While some studies have used Papanicolaou (Pap) staining for diagnosis, its exact contribution in comparison to the rapid hematoxylin and eosin (HE) staining technique and its cytological staining characteristics remains to be fully clarified. Method: During 12 months, this prospective study examined and contrasted the final histopathological section diagnoses of 161 specimens collected from 146 consecutive patients who received intraoperative touch‐imprint cytology (TIC) and squash smear preparation (SP) techniques, using both HE and Pap staining methods. Results: The diagnostic accuracy of TIC, relative to the final integrated histopathological diagnosis, was 85.1%. Although data for frozen sections were not separately quantified, TIC remains a rapid, reliable, and practical method for intraoperative evaluation. The evaluation of CNS lesions is best achieved by histopathology, which is considered the gold standard. The most common neoplasms were glioblastoma IDH‐wild type, metastatic cancers, pituitary neuroendocrine tumor (adenoma), and meningiomas. Kappa statistics between Pap and HE staining demonstrated very good overall agreement (kappa 0.9–1, p < 0.01) across all assessed cytological features, with the highest concordance observed for nuclear details, artifacts, mitotic background, necrosis, and cytoplasmic details. Although the Wilcoxon rank‐sum test indicated small but statistically significant differences in the median scores for nuclear details and artifacts, these differences reflect minor quantitative variations and do not affect the very good overall agreement between the two staining methods. Conclusion: Intracranial TIC and SP specimens stained with both HE and Pap demonstrated excellent diagnostic performance, characterized by high sensitivity and specificity. The combined use of Pap staining alongside HE provides a reliable and effective alternative to traditional cytological staining methods.

Determining Hydrocephalus and V-P Shunt Requirements After Repair of Myelomeningocele Defects in Infants - Medical Journal of Bakirkoy

Background/Objectives: The aim of the study is to investigate the role of microRNA-17 (miRNA-17), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) in the pathogenesis of lumbar degenerative disc disease (LDDD). The goal is to explore how miRNA-17 regulates inflammation and apoptosis within the intervertebral discs, with a particular focus on its involvement in inflammatory pathways via NF-κB signaling. This research seeks to uncover the molecular mechanisms that contribute to LDDD and its associated chronic lower back pain and disability. Methods: A case–control study was conducted, involving 110 patients diagnosed with LDDD and 17 healthy control individuals. Serum levels of miRNA-17, TNF-α, and IL-6 were measured using quantitative real-time PCR and enzyme-linked immunosorbent assays (ELISAs). The patients were further categorized based on the severity of their condition using the Oswestry Disability Index (ODI), which classified them into five subgroups. The correlation between miRNA-17 expression, pro-inflammatory cytokines, and disease severity was analyzed statistically. Results: The results demonstrated a significant downregulation of microRNA-17 in patients with LDDD compared to healthy controls. Inflammatory markers TNF-α and IL-6 were found to be significantly elevated in the patient group. A peak in inflammation and miRNA-17 expression was observed in patients with moderate to severe disability (ODI Grade 3), while inflammation levels decreased in more advanced stages of the disease (ODI Grades 4 and 5), suggesting a possible shift in disease dynamics. Conclusions: This study demonstrates that miRNA-17 plays a regulatory role in inflammation during the progression of LDDD, particularly through the modulation of TNF-α and IL-6 levels. The findings indicate that inflammation is most pronounced in the mid-stages of LDDD, while the later stages are characterized by structural damage rather than ongoing inflammation. These insights could help guide future therapeutic strategies aimed at targeting the molecular mechanisms underlying LDDD, potentially improving patient outcomes.

Study Design: Retrospective clinical study. Objectives: The aim is to assess and contrast the results of full endoscopic lumbar discectomy (FELD) and lumbar microdiscectomy (LMD) for L5–S1 disc herniation, with a specific emphasis on postoperative pain reduction and surgical effectiveness. Background: Although minimally invasive spine operations are becoming more popular, there is still little research on the comparative effectiveness of FELD and LMD. Materials and Methods: The research had a total of 50 patients who received surgical intervention for L5–S1 disc herniation, with 25 patients getting full endoscopic interlaminar discectomy and the other 25 patients undergoing LMD. Clinical outcomes were assessed using the Visual Analog Scale for low back and leg pain, collected preoperatively and at the end of 1 week, 3 months, and 6 months postsurgery. Patient satisfaction was evaluated using Odoms criteria at the same intervals. Results: The study included 50 patients (26 men, 24 women), with a mean age of 51.11 ± 13.76 years. The groups had no significant differences in demographic data. Back and leg pain Visual Analog Scale scores decreased more significantly in the FELD group after 1 week of surgery (P < 0.001), although the declines at 3 months and 6 months were not significantly different between the two groups. According to Odoms criteria, patient satisfaction was favorable in both groups and significantly better in the FELD group than in the LMD group at 1 week postoperatively [excellent in 20 patients (80%) in the FELD group vs 9 patients (36%) in the LMD group (P = 0.025)]. However, patient satisfaction at 3 months and 6 months did not differ between the groups. Conclusion: This study demonstrates that FELD offers significant early postoperative advantages over LMD at the L5–S1 level when compared with pain and satisfaction scales. Level of Evidence: Level III.