Microscopic polyangiitis (MPA) is a rare antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis that poses unique diagnostic and therapeutic challenges in seniors. We describe a 90-year-old female with diabetes, hypertension and heart failure who presented with anasarca and rapid renal failure. Evaluation revealed myeloperoxidase-ANCA positivity, and renal biopsy confirmed pauci-immune crescentic glomerulonephritis. Her course was complicated by anemia and deep vein thrombosis. She was managed with high-dose corticosteroids, rituximab, and supportive hemodialysis, achieving improvement in renal function. This case highlights how comorbidities may obscure recognition of vasculitis and how assessment of frailty and baseline function are essential in weighing risks of immunosuppression in older adults. Clinicians should maintain vigilance for ANCA-associated vasculitis in older adults with unexplained renal decline and tailor therapy to balance disease control with vulnerability to treatment toxicity.

Objective: This study presents an early multicentre experience with an adapted basivertebral nerve ablation (BVNA) technique using bilateral transpedicular access, evaluating its safety, efficacy, and potential for expanded indications. Methods: Participants were recruited from 2 Gold Coast centres based on the presence of chronic, sharp midline axial lower back pain and evidence of type 1 or type 2 Modic changes on imaging. The radiofrequency ablation procedure was performed via transpedicular access under computed tomographic guidance. Satisfaction outcomes were assessed at 2 months using a visual analogue scale and Likert scales. Statistical analyses compared outcomes according to sex and pain indications. Results: Forty patients were included in the study, of whom 33 underwent BVNA for Modic type 1 and type 2 vertebrogenic pain, and 8 underwent the procedure for expanded indications, with no complications reported. Among those treated for expanded indications, 2 had vertebrogenic endplate changes adjacent to a prior fusion, 2 had persistent pain following subacute osteoporotic fractures, and one each presented with a haemangioma, inflammatory endplate osteitis associated with spondyloarthropathy, and a postmyeloma fracture. Overall, 75% of participants reported being satisfied or very satisfied with the treatment of their painful condition. All patients treated for expanded indications expressed satisfaction or high satisfaction, with visual analogue score reductions ranging from 30% to 100%. Conclusion Early experience with BVNA using a bilateral transpedicular access technique suggests that it is a safe and effective procedure. It may also be applicable in selected cases involving expanded indications, particularly where persistent back pain remains refractory to or unsuitable for other therapeutic options.

The Encouraging Novel Amelogenesis Models and Ex vivo cell Lines (ENAMEL) Development workshop was held on 23 June 2017 at the Bethesda headquarters of the National Institute of Dental and Craniofacial Research(NIDCR). Discussion topics included model organisms, stem cells/cell lines, and tissues/3D cell culture/organoids. Scientists from a number of disciplines, representing institutions from across the United States, gathered to discuss advances in our understanding of enamel,as well as future directions for the field.

Pseudoaneurysms of the superficial temporal artery are rare and may be treated by manual compression, surgical intervention, coil embolization, or percutaneous thrombin injection. We present a novel technique of local ultrasound guided low-profile coil embolization of the superficial temporal artery with both satisfactory cosmetic and surgical results.
Aneurysm, False* ; Embolization, Therapeutic ; Temporal Arteries* ; Thrombin ; Ultrasonography*