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Background: Resistant hypertension (rHTN) is defined as blood pressure (BP) of ≥ 140/90 mmHg despite treatment with at least three antihypertensive medications, including a diuretic. Endovascular ultrasound renal denervation (uRDN) aims to control BP alongside conventional BP treatment with antihypertensive medication. This analysis assesses the cost effectiveness of the addition of the Paradise uRDN System compared with standard of care alone in patients with rHTN from the perspective of the United Kingdom (UK) health care system. Methods: Using RADIANCE-HTN TRIO trial data, we developed a state-transition model. Baseline risk was calculated using Framingham and Prospective Cardiovascular Münster (PROCAM) risk equations to estimate the long-term cardiovascular risks in patients treated with the Paradise uRDN System, based on the observed systolic BP (SBP) reduction following uRDN. Relative risks sourced from a meta-analysis of randomised controlled trials were then used to project cardiovascular events in patients with baseline SBP ('control' patients); utility and mortality inputs and costs were derived from UK data. Costs and outcomes were discounted at 3.5% per annum. Modelled outcomes were validated against trial meta-analyses and the QRISK3 algorithm and real-world evidence of RDN effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs). Results: A mean reduction in office SBP of 8.5 mmHg with uRDN resulted in an average improvement in both absolute life-years (LYs) and quality-adjusted life-years (QALYs) gained compared with standard of care alone (0.73 LYs and 0.67 QALYs). The overall base-case ICER with uRDN was estimated at £5600 (€6500) per QALY gained (95% confidence interval £5463–£5739 [€6341–€6661]); modelling demonstrated > 99% probability that the ICER is below the £20,000–£30,000 (€23,214–€34,821) per QALYs gained willingness-to-pay threshold in the UK. Results were consistent across sensitivity analyses and validation checks. Conclusions: Endovascular ultrasound RDN with the Paradise system offers patients with rHTN, clinicians, and healthcare systems a cost-effective treatment option alongside antihypertensive medication. [ABSTRACT FROM AUTHOR]

Tarlov cysts were thought to be anatomic variants of uncertain etiology and clinical significance when initially described over 80 years ago. They are often detected in routine lumbosacral imaging and generally not reported in a differential diagnosis. There is increasing evidence that at least some Tarlov cysts are symptomatic and can have a significant adverse impact on patients' health and well-being. Women are disproportionately affected with this condition, often presenting with long-standing pain and neurological dysfunctions. Significant gender bias has been a concern in the management of these patients. Unfortunately, there is no consensus on patient selection or management approaches for symptomatic Tarlov cysts. This review article updates information on the prevalence, diagnosis, clinical significance, and treatments of these cysts. Based on these findings and experience with over 1000 patient referrals, a treatment decision algorithm for symptomatic Tarlov cysts was constructed to provide guidance for appropriate management of patients with these complex cysts. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Cost Effectiveness of Endovascular Ultrasound Renal Denervation in Patients with Resistant Hypertension" which appeared in the January 30, 2024 issue.

Introduction: Radiofrequency ablation (RFA) and percutaneous vertebroplasty (PVP) are used independently and in combination to treat metastatically involved vertebrae with the aim of relieving pain, reducing tumour burden and providing bony mechanical stabilization.Purpose: The aim of this work was to characterize the effect of two bone-targeted RFA devices, alone and in combination with PVP, to improve strength and mechanical stability in vertebrae with osteolytic metastatic disease.Methods: Simulated spinal metastases (n = 12) were treated with one of two bone-targeted RFA devices (bipolar cooled or bone coil RF electrodes), followed by PVP. Under axial compressive loading, spinal canal narrowing was measured in the intact specimen, after tumour simulation, post-RFA and post-PVP.Results: RFA alone resulted in successful tumour shrinkage and cavitation, but further increased canal narrowing under loading. RFA combined with PVP significantly reduced posterior wall stability in samples where sufficient tumour shrinkage and cavitation were coupled with a pattern of cement deposition which extended to posterior vertebral body.Conclusions: RFA combined with cement deposition in the posterior vertebral body demonstrates significantly more stable vertebrae under axial loading. [ABSTRACT FROM AUTHOR]

Introduction: Cerebrospinal fluid (CSF) absorption has long been held to predominantly entail drainage into the venous outflow system via the intracranial arachnoid granulations. Newer data suggest pathways involving spinal arachnoid granulations and lymphatic channels may also make substantial contributions to CSF outflow. Methods: The putative major CSF outflow pathways and their proportionate contribution to CSF absorption were reviewed in this article. Results: CSF is absorbed and drained in bulk not just through cerebral arachnoid granulations (CAG) but also through spinal arachnoid granulations (SAG) and a lymphatic pathway involving egress through cranial and spinal nerve sheaths. The proportions of CSF that efflux through each of these major pathways have yet to be determined with any certainty in humans, though existing evidence (the majority of which is derived from animal studies) suggests that lymphatic pathways may account for up to 50 % of CSF outflow-presumably leaving the CAG and SAG to process the balance. Conclusion: Knowledge of the CSF pathways holds implications for our ability to understand, prognose, and even treat diseases related to CSF circulation and so is a matter of considerable relevance to neuroradiology and neurology. [ABSTRACT FROM AUTHOR]

Background 22q11.2 deletion syndrome (22q11DS, velo-cardio-facial syndrome [VCFS]) is a genetic disorder associated with interstitial deletions of chromosome 22q11.2. In addition to high rates of neuropsychiatric disorders, children with 22q11DS have impairments of face processing, as well as IQ-independent deficits in visuoperceptual function and social and abstract reasoning. These face-processing deficits may contribute to the social impairments of 22q11DS. However, their neurobiological basis is poorly understood. Methods We used event-related functional magnetic resonance imaging (fMRI) to examine neural responses when children with 22q11DS (aged 9-17 years) and healthy controls (aged 8-17 years) incidentally processed neutral expressions and mild (50%) and intense (100%) expressions of fear and disgust. We included 28 right-handed children and adolescents: 14 with 22q11DS and 14 healthy (including nine siblings) controls. Results Within groups, contrasts showed that individuals significantly activated 'face responsive' areas when viewing neutral faces, including fusiform-extrastriate cortices. Further, within both groups, there was a significant positive linear trend in activation of fusiform-extrastriate cortices and cerebellum to increasing intensities of fear. There were, however, also between group differences. Children with 22q11DS generally showed reduced activity as compared to controls in brain regions involved in social cognition and emotion processing across emotion types and intensities, including fusiform-extrastriate cortices, anterior cingulate cortex (Brodmann area (BA) 24/32), and superomedial prefrontal cortices (BA 6). Also, an exploratory correlation analysis showed that within 22q11DS children reduced activation was associated with behavioural impairment--social difficulties (measured using the Total Difficulties Score from the Strengths and Difficulties Questionnaire [SDQ]) were significantly negatively correlated with brain activity during fear and disgust processing (respectively) in the left precentral gyrus (BA 4) and in the left fusiform gyrus (FG, BA 19), right lingual gyrus (BA 18), and bilateral cerebellum. Conclusions Regions involved in face processing, including fusiform-extrastriate cortices, anterior cingulate gyri, and superomedial prefrontal cortices (BA 6), are activated by facial expressions of fearful, disgusted, and neutral expressions in children with 22q11DS but generally to a lesser degree than in controls. Hypoactivation in these regions may partly explain the social impairments of children with 22q11DS. [ABSTRACT FROM AUTHOR]

Background Down syndrome (DS), or trisomy 21, is one of the most common autosomal mutations. People with DS have intellectual disability (ID) and are at significantly increased risk of developing Alzheimer's disease (AD). The biological associates of both ID and AD in DS are poorly understood, but glutamate has been proposed to play a key role. In non-DS populations, glutamate is essential to learning and memory and glutamate-mediated excitotoxicity has been implicated in AD. However, the concentration of hippocampal glutamate in DS individuals with and without dementia has not previously been directly investigated. Proton magnetic resonance spectroscopy (1H MRS) can be used to measure in vivo the concentrations of glutamate-glutamine (Glx). The objective of the current study was to examine the hippocampal Glx concentration in non-demented DS (DS-) and demented DS (DS+) individuals. Methods We examined 46 adults with DS (35 without dementia and 11 with dementia) and 39 healthy controls (HC) using 1H MRS and measured their hippocampal Glx concentrations. Results There was no significant difference in the hippocampal Glx concentration between DS+ and DS-, or between either of the DS groups and the healthy controls. Also, within DS, there was no significant correlation between hippocampal Glx concentration and measures of overall cognitive ability. Last, a sample size calculation based on the effect sizes from this study showed that it would have required 6,257 participants to provide 80% power to detect a significant difference between the groups which would indicate that there is a very low likelihood of a type 2 error accounting for the findings in this study. Conclusions Individuals with DS do not have clinically detectable differences in hippocampal Glx concentration. Other pathophysiological processes likely account for ID and AD in people with DS. [ABSTRACT FROM AUTHOR]

Background: Down's syndrome (DS) is the most common genetic cause of intellectual disability. People with DS are at an increased risk of Alzheimer's disease (AD) compared to the general population. Neuroimaging studies of AD have focused on medial temporal structures; however, to our knowledge, no in vivo case-control study exists comparing the anatomy of dementia in DS to people with AD in the general population. We therefore compared the in vivo brain anatomy of people with DS and dementia (DS+) to those with AD in the general population. Method: Using MRI in 192 adults, we compared the volume of whole brain matter, lateral ventricles, temporal lobes and hippocampus in DS subjects with and without dementia (DS+, DS-), to each other and to three non-DS groups. These included one group of individuals with AD and two groups of controls (each age-matched for their respective DS and general population AD cohorts). Results: AD and DS+ subjects showed significant reductions in the volume of the whole brain, hippocampus and temporal lobes and a significant elevation in the volume of the lateral ventricle, compared to their non-demented counterparts. People with DS+ had a smaller reduction in temporal lobe volume compared to individuals with AD. Conclusions: DS+ and AD subjects have a significant reduction in volume of the same brain regions. We found preliminary evidence that DS individuals may be more sensitive to tissue loss than others and have less 'cognitive reserve'. [ABSTRACT FROM AUTHOR]

Social dysfunction is intrinsically involved in severe psychiatric disorders such as depression and psychosis and linked with poor theory of mind. Children with 22q11.2 deletion syndrome (22q11DS, or velo-cardio-facial syndrome) have poor social competence and are also at a particularly high risk of developing mood (40%) and psychotic (up to 30%) disorders in adolescence and young adulthood. However, it is unknown if these problems are associated with theory of mind skills, including underlying social-cognitive and social-perceptual mechanisms. The present cross-sectional study included classic social-cognitive false-belief and mentalising tasks and social-perceptual face processing tasks. The performance of 50 children with 22q11DS was compared with 31 age-matched typically developing sibling controls. Key findings indicated that, while younger children with 22q11DS showed impaired acquisition of social-cognitive skills, older children with 22q11DS were not significantly impaired compared with sibling controls. However, children with 22q11DS were found to have social-perceptual deficits, as demonstrated by difficulties in matching faces on the basis of identity, emotion, facial speech and gaze compared with sibling controls. Furthermore, performance on the tasks was associated with age, language ability and parentally rated social competence and emotional problems. These results are discussed in relation to the importance of a better delineation of social competence in this population. [ABSTRACT FROM AUTHOR]

Young people with 22q11 Deletion Syndrome (22q11DS) are at substantial risk for developing psychosis and have significant differences in white matter (WM) volume. However, there are few in vivo studies of both WM microstructural integrity (as measured using Diffusion Tensor (DT)-MRI) and WM volume in the same individual. We used DT-MRI and structural MRI (sMRI) with voxel based morphometry (VBM) to compare, respectively, the fractional anisotropy (FA) and WM volume of 11 children and adolescents with 22q11DS and 12 controls. Also, within 22q11DS we related differences in WM to severity of schizotypy, and polymorphism of the catechol-O-methyltransferase (COMT) gene. People with 22q11DS had significantly lower FA in inter-hemispheric and brainstem and frontal, parietal and temporal lobe regions after covarying for IQ. Significant WM volumetric increases were found in the internal capsule, anterior brainstem and frontal and occipital lobes. There was a significant negative correlation between increased schizotypy scores and reduced WM FA in the right posterior limb of internal capsule and the right body and left splenium of corpus callosum. Finally, the Val allele of COMT was associated with a significant reduction in both FA and volume of WM in the frontal lobes, cingulum and corpus callosum. Young people with 22q11DS have significant differences in both WM microstructure and volume. Also, there is preliminary evidence that within 22q11DS, some regional differences in FA are associated with allelic variation in COMT and may perhaps also be associated with schizotypy. [ABSTRACT FROM AUTHOR]

22q11.2 deletion syndrome (22q11DS) is a genetic disorder associated with a microdeletion of chromosome 22q11. In addition to high rates of neuropsychiatric disorders such as schizophrenia and attention deficit hyperactivity disorder, children with 22q11DS have a specific neuropsychological profile with particular deficits in visuospatial and working memory. However, the neurobiological substrate underlying these deficits is poorly understood. We investigated brain function during a visuospatial working memory (SWM) task in eight children with 22q11DS and 13 healthy controls, using fMRI. Both groups showed task-related activation in dorsolateral prefrontal cortex (DLPFC) and bilateral parietal association cortices. Controls activated parietal and occipital regions significantly more than those with 22q11DS but there was no significant between-group difference in DLPFC. In addition, while controls had a significant age-related increase in the activation of posterior brain regions and an age-related decrease in anterior regions, the 22q11DS children showed the opposite pattern. Genetically determined differences in the development of specific brain systems may underpin the cognitive deficits in 22q11DS, and may contribute to the later development of neuropsychiatric disorders. [ABSTRACT FROM AUTHOR]

Non-compression osteoporotic vertebral pain (NCOVP) can also cause pain and severe immobilization, such as typical vertebral compression fracture (VCF). The aim of this study was to evaluate whether patients with NCOVP refractory to medical treatment and severely affecting normal daily activities could be offered therapeutic benefit with percutaneous vertebroplasty. We conducted a retrospective review of the records of consecutive percutaneous vertebroplasty procedures performed at our institutions during a 28-month period to define a population of patients who suffered from severe NCOVP. Nine such patients were identified based on physical examination, computed tomography, magnetic resonance (MR) imaging, and bone scans. Initial clinical outcomes were assessed by comparing quantitative measurements of pain (10-point scale) and mobility (5-point scale) 1 day before the operation with those 1 day post-operation. A second follow-up took place between 2 weeks and 1 month after the operation, with a third follow-up between 6 and 10 months post-operative. Biopsy was taken in each case. Each patient demonstrated point tenderness over radiographically normal-shaped vertebra. Every patient showed a low signal on T1W images, and seven cases showed a high signal on T2W images inside the vertebra, indicating bone marrow edema. All patients experienced a reduction in pain and an increase in mobility after percutaneous vertebroplasty, with a mean pain reduction of 7.0 points and an average improved mobility of 2.8 points. Biopsy results indicated necrotic and/or degenerative changes in eight cases. The clinical outcomes of our patients suggest that NCOVP, mainly verified by abnormal MR signals and biopsy results, can be successfully treated by percutaneous vertebroplasty. [ABSTRACT FROM AUTHOR]

We present a novel access for transvenous embolization of a dural arteriovenous fistula of the laterocavernous sinus through the external jugular vein and the pterygoid plexus. The anatomy of the laterocavernous sinus is reviewed, and its clinical implications discussed in light of the case of a patient whose management was modified after identifying this anatomical variation. [ABSTRACT FROM AUTHOR]

Recent advances in multidetector CT imaging (MDCT) provide real-time “fluoroscopic-like” capabilities with excellent spatial resolution. MDCT fluoroscopy expands our ability to perform image-guided interventions in anatomically complex locations. Although MDCT fluoroscopy is currently used at our institution for a variety of procedures ranging from spinal nerve blocks to RFA ablation, we believe these same techniques can be used to navigate within the ventricles of the central nervous system to treat conditions requiring placement of intraventricular catheters, depth electrodes, or potentially stents for the relief of CSF outlet obstruction. Using three fresh, unfrozen human cadavers, we studied the feasibility of using MDCT fluoroscopy for intraventricular catheter placement and to stent the aqueduct of Sylvius. The ventricles were entered via a single needle pass and catheters were placed over the wire. Contrast agent was then injected to visualize the distribution. To stent the aqueduct of Sylvius, a wire was passed into the 4th ventricle and a coronary stent was then inserted over the wire and deployed. Based on our success with these procedures, we believe this technique can be used to limit complications and improve efficacy of a number of neurosurgical procedures. [ABSTRACT FROM AUTHOR]

Introduction: The use of n-butyl cyanoacrylate (NBCA) as an adhesive agent for embolization of high-flow intracranial and extracranial vascular lesions is well established. To be successful, the embolization of arteriovenous malformations and fistulas must achieve obliteration of the arteriovenous shunts themselves rather than simply occlude the feeders proximal to the lesion. However, the feeders cannot always be negotiated over their entire length. This is often the case with dural arteriovenous fistulas (DAVF), which are usually vascularized by long and intricate meningeal networks. In such situations, NBCA may not be able to reach the lesion itself, rendering the embolization ineffective. We present a new technique that improves distal distribution of NBCA glue. Methods: The technique described in this report consists of injecting dextrose 5% through the guiding catheter simultaneously with the superselective injection of NBCA glue into the targeted feeding branch. The technique is illustrated with three cases of posterior fossa DAVF. Results: In the reported cases, flooding the territory of the targeted vessel with non-ionic dextrose 5% allowed deep progression of the glue by delaying contact with ionic substances. Excellent distribution of the NBCA glue reaching the site of the arteriovenous shunts was thus obtained despite suboptimal proximal microcatheter tip positions. Conclusion: Simultaneous perfusion of dextrose 5% through the guiding catheter during NBCA injection dramatically improves the distal progression of glue through small, tortuous arterial feeders. This technique has the potential to increase the therapeutic value of transarterial embolization for DAVFs. [ABSTRACT FROM AUTHOR]

Vein of Galen aneurysmal malformations (VGAM) are rare intracranial vascular anomalies typically found in children. The anatomic landmark of a VGAM is the presence of multiple arteriovenous shunts draining into a dilated median prosencephalic vein, an embryonic vessel normally absent at the adult stage. This article reviews the developmental anatomy, the clinical presentation, and the current management of VGAM.Journal of Perinatology (2005) 25, 542–551. doi:10.1038/sj.jp.7211349; published online 14 July 2005 [ABSTRACT FROM AUTHOR]

There is overwhelming evidence for a significant genetic contribution to the etiology of schizophrenia. Molecular genetic techniques are now sufficiently advanced to be applied to complex genetic disorders with uncertain phenotypes, such as schizophrenia. In this article we first briefly discuss certain pertinent background issues: the evidence that schizophrenia has a heritable basis, the possible modes of inheritance involved, and how best to define schizophrenia in the light of this evidence; we then review the current status of research in the field. Large collaborative studies are currently underway that pave the way for the detection of genes of both major and minor effects. We may now be seeing the first consistently replicated results from chromosome 6 and 22 and from candidate genes, such as the dopamine D3 receptor gene. [ABSTRACT FROM AUTHOR]

Two patients with cervical paragangliomas underwent positron emission tomography (PET) with 2-[F]-fluoro-2-deoxy-D-glucose (FDG). There was marked tumor uptake and retention of FDG. Adjacent salivary gland accumulation of FDG was minimal, though quite prominent with meta-iodobenzylguanidine. FDG PET offers another potentially useful approach to functional imaging of these uncommon tumors, independent of the presence of specific amine uptake mechanisms or cell surface receptors required by other scintigraphic techniques. [ABSTRACT FROM AUTHOR]

Percutaneous vertebroplasty using bone cements is increasingly being used to stabilize osteoporotic spinal compression fractures. Although the scintigraphic appearance of compression fractures has been well-described, the post-vertebroplasty bone scan appearance has not. This case report describes a characteristic cold defect of a vertebral body after percutaneous vertebroplasty. [ABSTRACT FROM AUTHOR]

Biological invasion provides a promising system for studying rapid environmental accommodation and adaptation in the wild. Mounting evidence indicates that epigenetic modifications such as DNA methylation play crucial roles in rapid local accommodation and adaptation. Thus, we hypothesize that different local environments can trigger methylation divergence among marine invasive populations at fine geographical scales. In this study, we examined population methylation patterns in the invasive ascidian, Ciona intestinalis, along the Atlantic coast of Nova Scotia, Canada, where significant temperature differences exist at defined locations along the coast. Using the methylation-sensitive amplification polymorphism (MSAP) technique, we observed a high level of intra- and inter-population diversity, as well as significant population methylation differentiation. We identified a correlation between local environments and methylation patterns, and further consistently recovered 14 temperature-related subepiloci by using multiple analyses. All these results demonstrate a substantial role of temperature in shaping population methylation patterns and an epigenetic response to environmental changes during range expansions. The complex fine-scale methylation structures among populations of C. intestinalis observed in this study suggest that multiple biotic and abiotic factors, as well as their interactions, should be further investigated to reveal epigenetic mechanisms of local accommodation and adaptation during biological invasions in marine ecosystems. [ABSTRACT FROM AUTHOR]

An abstract of the article "Acute on Chronic Cerebral Venous Thrombosis in Patient With Ulcerative Colitis," by Florence M. Aslinia-Hosseini and Kieran Murphy is presented.