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Jariya Waisayarat,1 Phumin Wongsuwan,1 Kiarttiyot Tuntiseranee,2 Phu Waisayarat,3 Charungthai Dejthevaporn,4 Chaiyos Khongkhatithum,5 Sirisucha Soponkanaporn6 1Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand; 3Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand; 4Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Division of Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 6Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Jariya Waisayarat, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Email jariya.wai@mahidol.ac.thBackground: Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases affecting primarily proximal muscles. Major subtypes include dermatomyositis, polymyositis, inclusion body myositis, immune-mediated necrotizing myopathy and antisynthetase syndrome. Overexpression of sarcoplasmic myxovirus-resistance protein A (MxA) has been observed in muscle biopsy specimens of dermatomyositis but is rarely seen in other subtypes of IIM and other myopathies.Objective: We evaluate the expression of sarcoplasmic MxA and its diagnostic value in IIM and other myopathies.Methods: One hundred and thirty-eight muscle biopsy specimens with the diagnosis of IIM and other myopathies from 2011 to 2020 were reviewed and stained for MxA by immunohistochemistry. The difference of the expression of MxA between IIM and other myopathies was analyzed by Fisher’s exact test, and the sensitivity and specificity of MxA immunohistochemistry in the diagnosis of IIM were assessed.Results: MxA protein was positive in 16/138 (11.6%) specimens. All 12 dermatomyositis specimens positive for MxA protein were positive in perifascicular area pattern. Only dermatomyositis specimens had a significantly higher percentage of positive sarcoplasmic MxA expression than specimens of other subtypes of IIM (p< 0.001). Sarcoplasmic MxA expression for dermatomyositis diagnosis had a sensitivity of 46.15% (95% CI 26.59– 66.63%) and a specificity of 94.44% (95% CI 81.34– 99.32%) with the positive and negative likelihood ratio of 8.31 (95% CI 2.03– 34.01) and 0.57 (95% CI 0.40– 0.82), respectively.Conclusion: The MxA immunohistochemistry is highly specific for dermatomyositis and should be added to a routine inflammatory panel of muscle biopsy. MxA expression should be cautiously interpreted to avoid pitfalls.Keywords: dermatomyositis, idiopathic inflammatory myopathies, muscle biopsy, myxovirus resistance protein A

Purpose: The main purpose of this study was to investigate the dimensions of cerebral arteries in the Thai population using digital subtraction angiography (DSA), with a focus on the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). The research aimed to explore anatomical variations in diameters and lengths of these arteries across different sexes and age groups, which are crucial for cerebrovascular interventions., Methods: This retrospective study measured the diameters and lengths of the ACA, MCA, and PCA in 177 Thai patients with an average age of 47.6 years (range: 11-82 years) with normal cerebral angiograms. Digital subtraction angiography (DSA) was used for the measurements., Results: The study found significant sex-based differences in the mean diameters of the left ACA (males: 2.12 ± 0.28 mm, females: 1.92 ± 0.20 mm; p < 0.01), right MCA (males: 2.50 ± 0.25 mm, females: 2.31 ± 0.17 mm; p < 0.01), and left MCA (males: 2.44 ± 0.19 mm, females: 2.30 ± 0.17 mm; p < 0.01) with males exhibiting larger diameters. The right ACA length was significantly longer in males (15.46 ± 1.74 mm) compared to females (13.98 ± 1.92 mm; p < 0.01). While no significant age-related differences were observed in diameters, a significant increase in length with age was noted for the left ACA in the ≥ 60 years group (13.61 ± 1.64 mm) compared to the < 60 years group (12.63 ± 1.36 mm; p < 0.01). Among others, significant correlations were found between the diameters of the left ACA and right MCA (r = 0.699; p < 0.01), and a strong correlation between left ACA length and left PCA diameter (r = 0.975; p < 0.01)., Conclusion: The findings provide invaluable data for tailoring neurosurgical approaches and designing angiographic equipment for the Thai population, emphasizing the importance of considering anatomical variations in clinical practice. These results highlight the necessity for personalized medical care based on anatomical differences to improve cerebrovascular intervention outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

In this report, atlantooccipital assimilation (AS), anterior arch defect (AAD), and posterior arch defect (PAD) of the atlas, and several variations around the craniocervical junction were identified on computed tomography (CT) of a patient of unknown sex and age. Coronal and sagittal CT scans showed AS and bilateral fusion of the atlas and the base of occipital bone. Axial CT scan at the atlas revealed PAD type B on the left side and midline AAD. Morphometric measurements indicated a potential ventral spinal cord compression. In addition, mid-sagittal CT revealed the presence of fossa navicularis magna and incomplete formation of the transverse foramen on the right side. This study reports an extremely rare AS associated with AAD, PAD, and other variations of the clivus and the atlas. To our knowledge, no similar case has been reported in the literature.