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Article ; Online: Ultrasound-guided transforaminal approach for nusinersen delivery in adult spinal muscle atrophy patients with challenging access.

Snoj, Žiga / Salapura, Vladka

2022 Volume 65, Issue 5, Page(s) 585–589

Abstract: Introduction/aims: Previous papers on ultrasound (US)-guided delivery of nusinersen in patients with spinal muscle atrophy (SMA) described good results with translaminar approach. However, this approach is not possible in patients with spinal fusion and ...

Abstract	Introduction/aims: Previous papers on ultrasound (US)-guided delivery of nusinersen in patients with spinal muscle atrophy (SMA) described good results with translaminar approach. However, this approach is not possible in patients with spinal fusion and no visible interlaminar space on pre-procedural computed tomography (CT). US-guided transforaminal nusinersen delivery is a potential option that warrants investigation. Methods: Twenty adult SMA patients with challenging access were treated in our institution under cone beam CT (CBCT) guidance. The patients were already in the maintenance phase of the dosing protocol and were prospectively evaluated for US-guided transforaminal approach. After they completed one injection via US-guided transforaminal approach, success and safety of the approach were analyzed. Patients shared their experience on US-guided in comparison to CBCT-guided injections. Results: US-guided transforaminal puncture was possible in 14 (70.0%) patients, although 2 of them required needle repositioning under fluoroscopy due to inadvertent access of a prominent vein. US-guided transforaminal approach was therefore successful in 60% of patients. Mild adverse events were recorded in four patients. The survey on patients' experience showed that seven reported no difference in the two approaches, six preferred the US-guided procedure, and one preferred the CBCT-guided procedure. Discussion: US-guided transforaminal lumbar approach is an effective and safe method of intrathecal nusinersen delivery in adult SMA patients with challenging spinal access and could be considered the first option in appropriately selected adult SMA patients requiring transforaminal nusinersen delivery.
MeSH term(s)	Adult ; Humans ; Injections, Spinal/methods ; Muscular Atrophy ; Muscular Atrophy, Spinal/diagnostic imaging ; Muscular Atrophy, Spinal/drug therapy ; Oligonucleotides/therapeutic use ; Ultrasonography, Interventional
Chemical Substances	Oligonucleotides ; nusinersen (5Z9SP3X666)
Language	English
Publishing date	2022-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	438353-9
ISSN	1097-4598 ; 0148-639X
ISSN (online)	1097-4598
ISSN	0148-639X
DOI	10.1002/mus.27518
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Article: Sonographic assessment of the tarsal tunnel compared to cadaveric findings: a pictorial study.

Harej, Nežka / Salapura, Vladka / Cvetko, Erika / Snoj, Žiga

Journal of ultrasonography

2023 Volume 23, Issue 94, Page(s) e144–e150

Abstract: Aim of the study: To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination.: Materials and methods: Anatomical dissection was performed on a defrosted cadaveric model to ... ...

Abstract	Aim of the study: To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination. Materials and methods: Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle. Results: Sonographic images were correlated with anatomical structures exposed during cadaveric dissection. Conclusions: We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.
Language	English
Publishing date	2023-09-11
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2843824-3
ISSN	2084-8404
ISSN	2084-8404
DOI	10.15557/jou.2023.0023
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Article ; Online: Subcutaneous chondromyxoid fibroma with a novel PNISR::GRM1 fusion-report of a primary soft tissue tumour without connection to an underlying bone.

Zupan, Andrej / Salapura, Vladka / Šekoranja, Daja / Pižem, Jože

Virchows Archiv : an international journal of pathology

2023 Volume 482, Issue 5, Page(s) 917–921

Abstract: Chondromyxoid fibroma (CMF) is a rare benign bone tumour. While CMF located entirely on the surface of a bone (i.e. juxtacortical CMF) has been well characterised, CMF has not so far been convincingly documented to arise in soft tissues without ... ...

Abstract	Chondromyxoid fibroma (CMF) is a rare benign bone tumour. While CMF located entirely on the surface of a bone (i.e. juxtacortical CMF) has been well characterised, CMF has not so far been convincingly documented to arise in soft tissues without connection to an underlying bone.We report a subcutaneous CMF in a 34-year-old male, located on the distal medial aspect of the right thigh without any connection with the femur. The tumour measured 15 mm, it was well-circumscribed and displayed typical morphological features of a CMF. At the periphery, there was a small area of metaplastic bone. Immunohistochemically, the tumour cells were diffusely positive for smooth muscle actin and GRM1, and negative for S100 protein, desmin and cytokeratin AE1AE3. Whole transcriptome sequencing revealed a novel PNISR::GRM1 gene fusion.Our case indicates that CMF should be included in the differential diagnosis of soft tissue (including subcutaneous) tumours composed of spindle/ovoid cells, with a lobular architecture and chondromyxoid matrix. The diagnosis of CMF arising in soft tissues can be confirmed by identifying a GRM1 gene fusion or GRM1 expression by immunohistochemistry.
MeSH term(s)	Adult ; Humans ; Male ; Bone and Bones ; Bone Neoplasms/genetics ; Bone Neoplasms/pathology ; Fibroma/genetics ; Fibroma/pathology ; S100 Proteins ; Soft Tissue Neoplasms/genetics
Chemical Substances	S100 Proteins ; PNISR protein, human ; GRM1 protein, human
Language	English
Publishing date	2023-02-21
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	1184867-4
ISSN	1432-2307 ; 0945-6317
ISSN (online)	1432-2307
ISSN	0945-6317
DOI	10.1007/s00428-023-03519-4
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Article ; Online: Single centre experience with Excluder® stent graft; 17-year outcome

Snoj Ziga / Tomazin Tjasa / Salapura Vladka / Kuhelj Dimitrij

Radiology and Oncology, Vol 56, Iss 2, Pp 156-

2022 Volume 163

Abstract: Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed. ...

Abstract	Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed.
Keywords	evar ; long-term experience ; excluder® stent graft ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	Sciendo
Document type	Article ; Online
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Article ; Online: Cone-beam computed tomography guided nusinersen administrations in adult spinal muscular atrophy patients with challenging access

Salapura Vladka / Snoj Ziga / Leonardis Lea / Koritnik Blaz / Kostadinova Viktorija

Radiology and Oncology, Vol 56, Iss 3, Pp 319-

a single- center experience

2022 Volume 325

Abstract: The challenging anatomic predispositions in adult patients with spinal muscular atrophy (SMA) preclude the conventional lumbar punctures. Consequently, an introduction of alternative method for intrathecal delivery of nusinersen is required. Cone-beam CT ...

Abstract	The challenging anatomic predispositions in adult patients with spinal muscular atrophy (SMA) preclude the conventional lumbar punctures. Consequently, an introduction of alternative method for intrathecal delivery of nusinersen is required. Cone-beam CT (CBCT) allows volumetric display of the area of interest, pre-procedural planning and real time needle guidance which results in accurate anatomic navigation. The aim of the study was to evaluate technical success, safety, and feasibility of CBCT lumbar intrathecal delivery of nusinersen in the adult SMA patients with challenging anatomical access.
Keywords	nusinersen ; cone-beam ct ; lumbar puncture ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2022-08-01T00:00:00Z
Publisher	Sciendo
Document type	Article ; Online
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Article ; Online: Assessment of short-term effect of platelet-rich plasma treatment of tendinosis using texture analysis of ultrasound images

Pintaric Karlo / Salapura Vladka / Snoj Ziga / Vovk Andrej / Mijovski Mojca Bozic / Vidmar Jernej

Radiology and Oncology, Vol 57, Iss 4, Pp 465-

2023 Volume 472

Abstract: Computer-aided diagnosis (i.e., texture analyses) tools are becoming increasingly beneficial methods to monitor subtle tissue changes. The aim of this pilot study was to investigate short-term effect of platelet rich plasma (PRP) treatment in ... ...

Abstract	Computer-aided diagnosis (i.e., texture analyses) tools are becoming increasingly beneficial methods to monitor subtle tissue changes. The aim of this pilot study was to investigate short-term effect of platelet rich plasma (PRP) treatment in supraspinatus and common extensor of the forearm tendinosis by using texture analysis of ultrasound (US) images as well as by clinical questionnaires.
Keywords	texture analysis ; tendinosis ; platelet-rich plasma ; ultrasonography ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Sciendo
Document type	Article ; Online
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Article ; Online: Single centre experience with Excluder

Snoj, Ziga / Tomazin, Tjasa / Salapura, Vladka / Kuhelj, Dimitrij

Radiology and oncology

2022 Volume 56, Issue 2, Page(s) 156–163

Abstract: Background: Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed.: Patients and methods: This study included 123 patients (104 men; ... ...

Abstract	Background: Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed. Patients and methods: This study included 123 patients (104 men; mean age 73.0 years, range 51-89) with abdominal aorta aneurysm, treated with Excluder Results: The median follow-up was 9.7 years (interquartile range, 4.6-13.8). The primary technical success was 98.4% and the 30-day mortality accounted for 0.8%. Secondary procedures were performed in 29 (23.6%) patients during the follow-up period. The one-, five-, ten-, fifteen- and seventeen-year overall survival accounted for 94.3%, 74.0%, 47.2%, 35.8% and 35.8%, while the aneurysm-related survival was 98.4%, 96.3%, 92.6%, 92.6%, 92.6%. In seven (5.7%) patients, abdominal aortic rupture was found as the primary cause of death during follow-up. Conclusions: Our data showed that EVAR with Excluder
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/surgery ; Aortic Rupture/etiology ; Aortic Rupture/surgery ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/methods ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Humans ; Male ; Middle Aged ; Stents/adverse effects
Language	English
Publishing date	2022-04-13
Publishing country	Poland
Document type	Journal Article
ZDB-ID	1128829-2
ISSN	1581-3207 ; 0485-893X ; 1318-2099
ISSN (online)	1581-3207
ISSN	0485-893X ; 1318-2099
DOI	10.2478/raon-2022-0008
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Article ; Online: Cone-beam computed tomography guided nusinersen administrations in adult spinal muscular atrophy patients with challenging access: a single- center experience.

Salapura, Vladka / Snoj, Ziga / Leonardis, Lea / Koritnik, Blaz / Kostadinova, Viktorija

Radiology and oncology

2022 Volume 56, Issue 3, Page(s) 319–325

Abstract: Background: The challenging anatomic predispositions in adult patients with spinal muscular atrophy (SMA) preclude the conventional lumbar punctures. Consequently, an introduction of alternative method for intrathecal delivery of nusinersen is required. ...

Abstract	Background: The challenging anatomic predispositions in adult patients with spinal muscular atrophy (SMA) preclude the conventional lumbar punctures. Consequently, an introduction of alternative method for intrathecal delivery of nusinersen is required. Cone-beam CT (CBCT) allows volumetric display of the area of interest, pre-procedural planning and real time needle guidance which results in accurate anatomic navigation. The aim of the study was to evaluate technical success, safety, and feasibility of CBCT lumbar intrathecal delivery of nusinersen in the adult SMA patients with challenging anatomical access. Patients and methods: Thirty-eight adult SMA patients were treated in our institution. Patients with challenging access were selected by multidisciplinary board for image guided administration of nusinersen either due to implantation of the posterior fusion instrumentation, severe scoliosis defined as Cobb's angle > 40º or body mass index over 35. Technical success, radiation exposure and occurrence of adverse events were assessed. Results: Twenty patients were selected, and 108 CBCT-guided procedures were performed. Each patient underwent at least 4 administrations. Transforaminal approach was performed in 82% of patients. The technical success was 100%, with primary success of 93.5%. The median radiation effective dose of the administrations was 5 mSv, the mean value equalled 10 mSv. Only mild adverse events were reported in the study. Conclusions: CBCT-guided lumbar intrathecal administrations of nusinersen in an adult SMA population with challenging access was feasible and safe image guided method.
MeSH term(s)	Adult ; Cone-Beam Computed Tomography ; Humans ; Injections, Spinal ; Muscular Atrophy, Spinal/diagnostic imaging ; Muscular Atrophy, Spinal/drug therapy ; Oligonucleotides/therapeutic use
Chemical Substances	Oligonucleotides ; nusinersen (5Z9SP3X666)
Language	English
Publishing date	2022-08-14
Publishing country	Poland
Document type	Journal Article
ZDB-ID	1128829-2
ISSN	1581-3207 ; 0485-893X ; 1318-2099
ISSN (online)	1581-3207
ISSN	0485-893X ; 1318-2099
DOI	10.2478/raon-2022-0033
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Article: MRI Findings of Early Osteoarthritis in Patients Who Sustained Septic Arthritis of the Knee After ACL Reconstruction.

Meglic, Uros / Salapura, Vladka / Zupanc, Oskar

Orthopaedic journal of sports medicine

2021 Volume 9, Issue 11, Page(s) 23259671211052519

Abstract: Background: Although a rare complication, septic arthritis (SA) after anterior cruciate ligament (ACL) reconstruction has potentially devastating consequences for the knee joint.: Purpose: To prospectively analyze, at a mean 4-year follow-up, ... ...

Abstract	Background: Although a rare complication, septic arthritis (SA) after anterior cruciate ligament (ACL) reconstruction has potentially devastating consequences for the knee joint. Purpose: To prospectively analyze, at a mean 4-year follow-up, subjective, clinical, radiographic, and magnetic resonance imaging (MRI) findings between patients with SA and those with no septic complication after ACL reconstruction. Study design: Cohort study; Level of evidence, 2. Methods: Of 2006 ACL reconstructions performed between 2004 and 2014, a total of 20 patients experienced SA. All patients were treated with arthroscopic irrigation and graft-retaining debridement immediately after diagnosis and at least 6 weeks of antibiotic treatment. After the exclusion process, 18 patients were included in the SA group and 20 in the control group. At final follow-up at a mean 48 months, a physical examination, KT-1000 arthrometer laxity test, Lysholm knee score, Tegner activity score, and International Knee Documentation Committee radiographic score were completed and then compared with preoperative data. The Boston-Leeds Osteoarthritis Knee Score was used for MRI evaluation at final follow-up to note chondral changes. Results: No significant differences between the SA and control groups were observed in pre- and perioperative variables that could indicate a higher incidence of early osteoarthritis (OA). Although range of motion and knee stability were not significantly different between the groups at final follow-up, the Lysholm score (mean ± SD, 79.8 ± 13.1 vs 90.9 ± 8.6; Conclusion: MRI evaluation provided signs of worsened chondral state in the SA group, which could be associated with reduced functional outcome and return to sports. In contrast to radiograph analyses, MRI was excellent at distinguishing damage to the cartilage and can be useful in early follow-up evaluation of patients with SA after ACL reconstruction.
Language	English
Publishing date	2021-11-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671211052519
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Article ; Online: Assessment of short-term effect of platelet-rich plasma treatment of tendinosis using texture analysis of ultrasound images.

Pintaric, Karlo / Salapura, Vladka / Snoj, Ziga / Vovk, Andrej / Mijovski, Mojca Bozic / Vidmar, Jernej

Radiology and oncology

2023 Volume 57, Issue 4, Page(s) 465–472

Abstract: Background: Computer-aided diagnosis (: Patients and methods: Thirteen patients (7 male and 6 female, age 36-60 years, mean age 51.2 ± 5.2) were followed after US guided PRP treatment for tendinosis of two tendons (9 patients with lateral ... ...

Abstract	Background: Computer-aided diagnosis ( Patients and methods: Thirteen patients (7 male and 6 female, age 36-60 years, mean age 51.2 ± 5.2) were followed after US guided PRP treatment for tendinosis of two tendons (9 patients with lateral epicondylitis and 4 with supraspinatus tendinosis). Clinical and US assessment was performed prior to as well as 3 months after PRP treatment with validated clinical questionnaires. Tissue response in tendons was assessed by using gray level run length matrix method (GLRLM) of US images. Results: All patients improved of tendinosis symptoms after PRP treatment according to clinical questionnaires. Almost all GLRLM features were statistically improved 3 months after PRP treatment. GLRLM-long run high gray level emphasis (LRLGLE) revealed the best moderate positive and statistically significant correlation after PRP ( Conclusions: Texture analysis of tendinosis US images was a useful quantitative method for the assessment of tendon remodeling after minimally invasive PRP treatment. GLRLM features have the potential to become useful imaging biomarkers to monitor spatial and time limited tissue response after PRP, however larger studies with similar protocols are needed.
MeSH term(s)	Humans ; Male ; Female ; Middle Aged ; Adult ; Treatment Outcome ; Pilot Projects ; Ultrasonography ; Platelet-Rich Plasma/diagnostic imaging ; Tendinopathy/diagnostic imaging ; Tendinopathy/therapy
Language	English
Publishing date	2023-11-30
Publishing country	Poland
Document type	Journal Article
ZDB-ID	1128829-2
ISSN	1581-3207 ; 0485-893X ; 1318-2099
ISSN (online)	1581-3207
ISSN	0485-893X ; 1318-2099
DOI	10.2478/raon-2023-0054
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