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Sastry RA, Setty A, Liu DD, Zheng B, Ali R, Weil RJ, Roye GD, Doberstein CE, Oyelese AA, Niu T, Gokaslan ZL, Telfeian AE. Natural language processing augments comorbidity documentation in neurosurgical inpatient admissions. PLoS One 2024; 19:e0303519. [PMID: 38723044 PMCID: PMC11081267 DOI: 10.1371/journal.pone.0303519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/04/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To establish whether or not a natural language processing technique could identify two common inpatient neurosurgical comorbidities using only text reports of inpatient head imaging. MATERIALS AND METHODS A training and testing dataset of reports of 979 CT or MRI scans of the brain for patients admitted to the neurosurgery service of a single hospital in June 2021 or to the Emergency Department between July 1-8, 2021, was identified. A variety of machine learning and deep learning algorithms utilizing natural language processing were trained on the training set (84% of the total cohort) and tested on the remaining images. A subset comparison cohort (n = 76) was then assessed to compare output of the best algorithm against real-life inpatient documentation. RESULTS For "brain compression", a random forest classifier outperformed other candidate algorithms with an accuracy of 0.81 and area under the curve of 0.90 in the testing dataset. For "brain edema", a random forest classifier again outperformed other candidate algorithms with an accuracy of 0.92 and AUC of 0.94 in the testing dataset. In the provider comparison dataset, for "brain compression," the random forest algorithm demonstrated better accuracy (0.76 vs 0.70) and sensitivity (0.73 vs 0.43) than provider documentation. For "brain edema," the algorithm again demonstrated better accuracy (0.92 vs 0.84) and AUC (0.45 vs 0.09) than provider documentation. DISCUSSION A natural language processing-based machine learning algorithm can reliably and reproducibly identify selected common neurosurgical comorbidities from radiology reports. CONCLUSION This result may justify the use of machine learning-based decision support to augment provider documentation.
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Affiliation(s)
- Rahul A. Sastry
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Aayush Setty
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
- Department of Computer Science, Brown University, Providence, RI, United States of America
| | - David D. Liu
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Bryan Zheng
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Rohaid Ali
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Robert J. Weil
- Department of Neurosurgery, Brain & Spine, Southcoast Health, Dartmouth, MA, United States of America
| | - G. Dean Roye
- Department of Surgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Curtis E. Doberstein
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
| | - Albert E. Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, United States of America
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Guo CR, Rivera Perla KM, Leary OP, Sastry RA, Borrelli MR, Liu DD, Khunte M, Gokaslan ZL, Liu PY, Kwan D, Fridley JS, Woo AS. Systematic Review of Prophylactic Plastic Surgery Closure to Prevent Postoperative Wound Complications Following Spine Surgery. World Neurosurg 2024; 184:103-111. [PMID: 38185457 DOI: 10.1016/j.wneu.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
Spinal surgeries are increasingly performed in the United States, but complication rates can be unacceptably high at up to 26%. Consequently, plastic surgeons (PS) are sometimes recruited by spine surgeons (SS) for intraoperative assistance with soft tissue closures. An electronic multidatabase literature search was systematically conducted to determine whether spinal wound closure performed by PS minimizes postoperative wound healing complications when compared to closure by SS (neurosurgical or orthopedic), with the hypothesis that closures by PS minimizes incidence of complications. All published studies involving patients who underwent posterior spinal surgery with closure by PS or SS at index spine surgery were identified. Filtering by exclusion criteria identified 10 studies, 4 of which were comparative in nature and included both closures by PS and SS. Of these 4, none reported significant differences in postoperative outcomes between the groups. Across all studies, PS were involved in cases with higher baseline risk for wound complications and greater comorbidity burden. Closures by PS were significantly more likely to have had prior chemotherapy in 2 of the 4 (50%) studies (P = 0.014, P < 0.001) and radiation in 3 of the 4 (75%) studies (P < 0.001, P < 0.01, P < 0.001). In conclusion, closures by PS are frequently performed in higher risk cases, and use of PS in these closures may normalize the risk of wound complications to that of the normal risk cohort, though the overall level of evidence of the published literature is low.
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Affiliation(s)
- Cynthia R Guo
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island, USA.
| | - Krissia M Rivera Perla
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Owen P Leary
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Mimi R Borrelli
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - David D Liu
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mihir Khunte
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Paul Y Liu
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Daniel Kwan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jared S Fridley
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Albert S Woo
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Jha R, Liu DD, Gerstl JVE, Renauld S, Kilgallon JL, Blitz SE, Medeiros L, Nawabi NLA, Singh H, Chua MMJ, Tobochnik S, Cosgrove GR, Rolston JD. Comparative effectiveness of stereotactic, subdural, or hybrid intracranial EEG monitoring in epilepsy surgery. J Neurosurg 2024:1-9. [PMID: 38457804 DOI: 10.3171/2024.1.jns232560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/04/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Surgical intervention can be curative or palliative for drug-resistant focal epilepsy. However, if the seizure onset zone (SOZ) cannot be adequately localized via noninvasive tests, intracranial EEG (iEEG) recordings are often carried out to develop surgical plans in appropriate candidates. Stereotactic EEG (SEEG), subdural EEG (SDE), and SDE with depth electrodes (hybrid) are major tools used for investigation, but there is no class 1 or 2 evidence comparing the effectiveness of these modalities. METHODS The authors identified an institutional cohort of patients who underwent iEEG monitoring between 2001 and 2022. Demographic data, preoperative clinical features, iEEG intervention, and follow-up data were identified. Primary study endpoints included the following: 1) likelihood of SOZ localization; 2) likelihood of surgical treatment after iEEG; 3) seizure outcomes; and 4) complications. RESULTS A total of 329 patients were identified (176 in the SEEG, 60 in the SDE, and 93 in the hybrid cohort) who were followed for a median of 5.4 (IQR 6.8) years. Baseline characteristics, including demographics, mean age at epilepsy diagnosis, mean age at iEEG investigation, number of preoperative antiseizure medications, and preoperative seizure frequency, were not statistically different across the 3 cohorts. Patients in the SEEG cohort were more likely to have their SOZ localized than were the patients in the SDE group (OR 2.3) and were less likely to undergo subsequent resection (OR 0.3) or to have complications (OR 0.4), although there was no statistical difference with respect to likelihood of undergoing any subsequent neurosurgical treatment, or with respect to favorable seizure outcomes. Patients in the hybrid cohort were more likely to have SOZ localized than were patients in the SDE group (OR 3.1), but were more likely to undergo resection (OR 4.9) or any neurosurgical treatment (OR 2.5) compared to patients in the SEEG group. Patients in the hybrid cohort had better seizure outcomes compared to the SDE (OR 2.3) but not to the SEEG group. CONCLUSIONS Patients in the SEEG group were more likely to have their SOZ localized and patients in the SDE group were more likely to undergo resection, but they did not differ with respect to seizure outcomes.
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Affiliation(s)
| | | | | | - Sophia Renauld
- 1Harvard Medical School, Boston
- 3Harvard MIT MD PhD Program, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Steven Tobochnik
- 4Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston; and
| | - G Rees Cosgrove
- 1Harvard Medical School, Boston
- Departments of2Neurosurgery and
| | - John D Rolston
- 1Harvard Medical School, Boston
- Departments of2Neurosurgery and
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Chua MMJ, Vissani M, Liu DD, Schaper FLWVJ, Warren AEL, Caston R, Dworetzky BA, Bubrick EJ, Sarkis RA, Cosgrove GR, Rolston JD. Initial case series of a novel sensing deep brain stimulation device in drug-resistant epilepsy and consistent identification of alpha/beta oscillatory activity: A feasibility study. Epilepsia 2023; 64:2586-2603. [PMID: 37483140 DOI: 10.1111/epi.17722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Here, we report a retrospective, single-center experience with a novel deep brain stimulation (DBS) device capable of chronic local field potential (LFP) recording in drug-resistant epilepsy (DRE) and explore potential electrophysiological biomarkers that may aid DBS programming and outcome tracking. METHODS Five patients with DRE underwent thalamic DBS, targeting either the bilateral anterior (n = 3) or centromedian (n = 2) nuclei. Postoperative electrode lead localizations were visualized in Lead-DBS software. Local field potentials recorded over 12-18 months were tracked, and changes in power were associated with patient events, medication changes, and stimulation. We utilized a combination of lead localization, in-clinic broadband LFP recordings, real-time LFP response to stimulation, and chronic recordings to guide DBS programming. RESULTS Four patients (80%) experienced a >50% reduction in seizure frequency, whereas one patient had no significant reduction. Peaks in the alpha and/or beta frequency range were observed in the thalamic LFPs of each patient. Stimulation suppressed these LFP peaks in a dose-dependent manner. Chronic timeline data identified changes in LFP amplitude associated with stimulation, seizure occurrences, and medication changes. We also noticed a circadian pattern of LFP amplitudes in all patients. Button-presses during seizure events via a mobile application served as a digital seizure diary and were associated with elevations in LFP power. SIGNIFICANCE We describe an initial cohort of patients with DRE utilizing a novel sensing DBS device to characterize potential LFP biomarkers of epilepsy that may be associated with seizure control after DBS in DRE. We also present a new workflow utilizing the Percept device that may optimize DBS programming using real-time and chronic LFP recording.
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Affiliation(s)
- Melissa M J Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matteo Vissani
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David D Liu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederic L W V J Schaper
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron E L Warren
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rose Caston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen J Bubrick
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rani A Sarkis
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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5
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Zheng B, Abdulrazeq H, Shao B, Liu DD, Leary O, Lauro PM, Bartolini L, Blum AS, Asaad WF. Seizure and anatomical outcomes of repeat laser amygdalohippocampotomy for temporal lobe epilepsy: A single-institution case series. Epilepsy Behav 2023; 146:109365. [PMID: 37523797 DOI: 10.1016/j.yebeh.2023.109365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE In patients with treatment-refractory temporal lobe epilepsy (TLE), a single stereotactic laser interstitial thermotherapy (LITT) procedure is sometimes insufficient to ablate epileptogenic tissue, particularly the medial structures often implicated in TLE. In patients with seizure recurrence after initial ablation, the extent to which a second ablation may achieve improved seizure outcomes is uncertain. The objective of this study was to investigate the feasibility and potential efficacy of repeat LITT amygdalohippocampotomy as a worthwhile strategy for intractable temporal lobe epilepsy by quantifying changes to targeted mesial temporal lobe structures and seizure outcomes. METHODS Patients who underwent two LITT procedures for drug-resistant mesial TLE at our institution were included in the study. Lesion volumes for both procedures were calculated by comparing post-ablation intraoperative sequences to preoperative anatomy. Clinical outcomes after the initial procedure and repeat procedure were classified according to Engel scores. RESULTS Five consecutive patients were included in this retrospective case series: 3 with right- and 2 with left-sided TLE. The median interval between LITT procedures was 294 days (range: 227-1918). After the first LITT, 3 patients experienced class III outcomes, 1 experienced a class IV, and 1 experienced a class IB outcome. All patients achieved increased seizure freedom after a second procedure, with class I outcomes (3 IA, 2 IB). CONCLUSIONS Repeat LITT may be sufficient to achieve satisfactory seizure outcomes in some individuals who might otherwise be considered for more aggressive resection or palliative neuromodulation. A larger study to establish the potential value of repeat LITT amygdalohippocampotomy vs. other re-operation strategies for persistent, intractable temporal lobe epilepsy is worth pursuing.
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Affiliation(s)
- Bryan Zheng
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.
| | - Belinda Shao
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - David D Liu
- Department of Neurosurgery, Brigham and Womens Hospital, Boston, MA, USA
| | - Owen Leary
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter M Lauro
- The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA
| | - Luca Bartolini
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA; Deparment of Neurology, Rhode Island Hospital, Providence, RI, USA; Deparment of Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Andrew S Blum
- Deparment of Neurology, Rhode Island Hospital, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA; The Carney Institute for Brain Science, Brown University, Providence, RI, USA; The Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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Harder TJ, Leary OP, Yang Z, Lucke-Wold B, Liu DD, Still ME, Zhang M, Yeatts SD, Allen JW, Wright DW, Merck D, Merck LH. Early Signs of Elevated Intracranial Pressure on Computed Tomography Correlate With Measured Intracranial Pressure in the Intensive Care Unit and Six-Month Outcome After Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:1603-1613. [PMID: 37082956 PMCID: PMC10458381 DOI: 10.1089/neu.2022.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Early triage and treatment after TBI have been shown to improve outcome. Identifying patients at risk for increased intracranial pressure (ICP) via baseline computed tomography (CT) , however, has not been validated previously in a prospective dataset. We hypothesized that acute CT findings of elevated ICP, combined with direct ICP measurement, hold prognostic value in terms of six-month patient outcome after TBI. Data were obtained from the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECTIII) multi-center clinical trial. Baseline CT scans for 881 participants were individually reviewed by a blinded central neuroradiologist. Five signs of elevated ICP were measured (sulcal obliteration, lateral ventricle compression, third ventricle compression, midline shift, and herniation). Associations between signs of increased ICP and outcomes (six-month functional outcome and death) were assessed. Secondary analyses of 354 patients with recorded ICP monitoring data available explored the relationships between hemorrhage phenotype/anatomic location, sustained ICP ≥20 mm Hg, and surgical intervention(s). Univariate and multi-variate logistic/linear regressions were performed; p < 0.05 is defined as statistically significant. Imaging characteristics associated with ICP in this cohort include sulcal obliteration (p = 0.029) and third ventricular compression (p = 0.039). Univariate regression analyses indicated that increasing combinations of the five defined signs of elevated ICP were associated with death, poor functional outcome, and time to death. There was also an increased likelihood of death if patients required craniotomy (odds ratio [OR] = 4.318, 95% confidence interval [1.330-16.030]) or hemicraniectomy (OR = 2.993 [1.109-8.482]). On multi-variate regression analyses, hemorrhage location was associated with death (posterior fossa, OR = 3.208 [1.120-9.188] and basal ganglia, OR = 3.079 [1.178-8.077]). Volume of hemorrhage >30 cc was also associated with increased death, OR = 3.702 [1.575-8.956]). The proportion of patient hours with sustained ICP ≥20 mm Hg, and maximum ICP ≥20 mm Hg were also directly correlated with increased death (OR = 6 4.99 [7.731-635.51]; and OR = 1.025 [1.004-1.047]), but not with functional outcome. Poor functional outcome was predicted by concurrent presence of all five radiographic signs of elevated ICP (OR = 4.44 [1.514-14.183]) and presence of frontal lobe (OR = 2.951 [1.265-7.067]), subarachnoid (OR = 2.231 [1.067-4.717]), or intraventricular (OR = 2.249 [1.159-4.508]) hemorrhage. Time to death was modulated by total patient days of elevated ICP ≥20 mm Hg (effect size = 3.424 [1.500, 5.439]) in the first two weeks of hospitalization. Sulcal obliteration and third ventricular compression, radiographic signs of elevated ICP, were significantly associated with measurements of ICP ≥20 mm Hg. These radiographic biomarkers were significantly associated with patient outcome. There is potential utility of ICP-related imaging variables in triage and prognostication for patients after moderate-severe TBI.
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Affiliation(s)
- Tyler J. Harder
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA
| | - Owen P. Leary
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Zhihui Yang
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - David D. Liu
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Megan E.H. Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Miao Zhang
- Department of Information Systems and Operation Management, University of Florida, Gainesville, Florida, USA
| | - Sharon D. Yeatts
- Department of Biostatistics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason W. Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Derek Merck
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Lisa H. Merck
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Lauro PM, Lee S, Amaya DE, Liu DD, Akbar U, Asaad WF. Concurrent decoding of distinct neurophysiological fingerprints of tremor and bradykinesia in Parkinson's disease. eLife 2023; 12:e84135. [PMID: 37249217 PMCID: PMC10264071 DOI: 10.7554/elife.84135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/26/2023] [Indexed: 05/31/2023] Open
Abstract
Parkinson's disease (PD) is characterized by distinct motor phenomena that are expressed asynchronously. Understanding the neurophysiological correlates of these motor states could facilitate monitoring of disease progression and allow improved assessments of therapeutic efficacy, as well as enable optimal closed-loop neuromodulation. We examined neural activity in the basal ganglia and cortex of 31 subjects with PD during a quantitative motor task to decode tremor and bradykinesia - two cardinal motor signs of PD - and relatively asymptomatic periods of behavior. Support vector regression analysis of microelectrode and electrocorticography recordings revealed that tremor and bradykinesia had nearly opposite neural signatures, while effective motor control displayed unique, differentiating features. The neurophysiological signatures of these motor states depended on the signal type and location. Cortical decoding generally outperformed subcortical decoding. Within the subthalamic nucleus (STN), tremor and bradykinesia were better decoded from distinct subregions. These results demonstrate how to leverage neurophysiology to more precisely treat PD.
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Affiliation(s)
- Peter M Lauro
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- The Warren Alpert Medical School, Brown UniversityProvidenceUnited States
| | - Shane Lee
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- Norman Prince Neurosciences Institute, Rhode Island HospitalProvidenceUnited States
- Department of Neurosurgery, Rhode Island HospitalProvidenceUnited States
| | - Daniel E Amaya
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
| | - David D Liu
- Department of Neurosurgery, Brigham and Women’s HospitalBostonUnited States
| | - Umer Akbar
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- The Warren Alpert Medical School, Brown UniversityProvidenceUnited States
- Norman Prince Neurosciences Institute, Rhode Island HospitalProvidenceUnited States
- Department of Neurology, Rhode Island HospitalProvidenceUnited States
| | - Wael F Asaad
- Department of Neuroscience, Brown UniversityProvidenceUnited States
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown UniversityProvidenceUnited States
- The Warren Alpert Medical School, Brown UniversityProvidenceUnited States
- Norman Prince Neurosciences Institute, Rhode Island HospitalProvidenceUnited States
- Department of Neurosurgery, Rhode Island HospitalProvidenceUnited States
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8
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Zheng B, Liu DD, Theyel BB, Abdulrazeq H, Kimata AR, Lauro PM, Asaad WF. Thalamic neuromodulation in epilepsy: A primer for emerging circuit-based therapies. Expert Rev Neurother 2023; 23:123-140. [PMID: 36731858 DOI: 10.1080/14737175.2023.2176752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Epilepsy is a common, often debilitating disease of hyperexcitable neural networks. While medically intractable cases may benefit from surgery, there may be no single, well-localized focus for resection or ablation. In such cases, approaching the disease from a network-based perspective may be beneficial. AREAS COVERED Herein, the authors provide a narrative review of normal thalamic anatomy and physiology and propose general strategies for preventing and/or aborting seizures by modulating this structure. Additionally, they make specific recommendations for targeting the thalamus within different contexts, motivated by a more detailed discussion of its distinct nuclei and their respective connectivity. By describing important principles governing thalamic function and its involvement in seizure networks, the authors aim to provide a primer for those now entering this fast-growing field of thalamic neuromodulation for epilepsy. EXPERT OPINION The thalamus is critically involved with the function of many cortical and subcortical areas, suggesting it may serve as a compelling node for preventing or aborting seizures, and so it has increasingly been targeted for the surgical treatment of epilepsy. As various thalamic neuromodulation strategies for seizure control are developed, there is a need to ground such interventions in a mechanistic, circuit-based framework.
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Affiliation(s)
- Bryan Zheng
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian B Theyel
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Anna R Kimata
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Peter M Lauro
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA.,The Carney Institute for Brain Science, Brown University, Providence, RI, USA.,The Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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Zheng B, Leary OP, Beer RA, Liu DD, Nuss S, Barrios-Anderson A, Darveau S, Syed S, Gokaslan ZL, Telfeian AE, Oyelese AA, Fridley JS. Long-Term Motor versus Sensory Lumbar Plexopathy After Lateral Lumbar Interbody Fusion: Single-Center Experience, Intraoperative Neuromonitoring Results, and Multivariate Analysis of Patient-Level Predictors. World Neurosurg 2023; 170:e568-e576. [PMID: 36435383 DOI: 10.1016/j.wneu.2022.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although lateral lumbar interbody fusion (LLIF) is an effective surgical option for lumbar arthrodesis, postoperative plexopathies are a common complication. We characterized post-LLIF plexopathies in a large cohort and analyzed potential risk factors for each. METHODS A single-institutional cohort who underwent LLIF between May 2015 and December 2019 was retrospectively reviewed for postoperative lumbar plexopathies. Plexopathies were divided based on sensory and motor symptoms and duration, as well as by laterality relative to the surgical approach. We assessed these subgroups for associations with patient and surgical characteristics as well as psoas dimensions. We then evaluated risk of developing plexopathies after intraoperative neuromonitoring observations. RESULTS A total of 127 patients were included. The overall rate of LLIF-induced sensory or motor lumbar plexopathy was 37.8% (48/127). Of all cases, 42 were ipsilateral to the surgical approach (33.1%); conversely, 6 patients developed contralateral plexopathies (4.7%). Most (31/48; 64.6%) resolved with a follow-up interval of 402 days in the plexopathy group. Of ipsilateral cases, 24 patients experienced persistent (>90 days) postoperative sensory symptoms (18.9%), whereas 20 experienced persistent weakness (15.7%). More levels fused predicted persistent sensory symptoms (odds ratio, 1.714 [1.246-2.359]; P = 0.0085), whereas surgical duration predicted persistent weakness (odds ratio, 1.004 [1.002-1.006]; P = 0.0382). Psoas anatomic variables were not significantly associated with plexopathy. Nonresolution of intraoperative evoked motor potential alerts was a significant risk factor for developing plexopathies (relative risk, 2.29 [1.17-4.45]). CONCLUSIONS Post-LLIF plexopathies are common but usually resolve. Surgical complexity and unresolved neuromonitoring alerts are possible risk factors for persistent plexopathy.
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Affiliation(s)
- Bryan Zheng
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robert A Beer
- SpecialtyCare, Inc., Southern New England Intraoperative Neuromonitoring, Providence, Rhode Island, USA
| | - David D Liu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sarah Nuss
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adriel Barrios-Anderson
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Spencer Darveau
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Shao B, Zheng B, Liu DD, Anderson MN, Svokos K, Bartolini L, Asaad WF. Seizure freedom after laser amygdalohippocampotomy guided by bilateral responsive neurostimulation in pediatric epilepsy: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22235. [PMID: 36051773 PMCID: PMC9426349 DOI: 10.3171/case22235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
For patients with difficult-to-lateralize temporal lobe epilepsy, the use of chronic recordings as a diagnostic tool to inform subsequent surgical therapy is an emerging paradigm that has been reported in adults but not in children.
OBSERVATIONS
The authors reported the case of a 15-year-old girl with pharmacoresistant temporal lobe epilepsy who was found to have bitemporal epilepsy during a stereoelectroencephalography (sEEG) admission. She underwent placement of a responsive neurostimulator system with bilateral hippocampal depth electrodes. However, over many months, her responsive neurostimulation (RNS) recordings revealed that her typical, chronic seizures were right-sided only. This finding led to a subsequent right-sided laser amygdalohippocampotomy, resulting in seizure freedom.
LESSONS
In this case, RNS chronic recording provided real-world data that enabled more precise seizure localization than inpatient sEEG data, informing surgical decision-making that led to seizure freedom. The use of RNS chronic recordings as a diagnostic adjunct to seizure localization procedures and laser ablation therapies in children is an area with potential for future study.
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Affiliation(s)
| | | | | | | | - Konstantina Svokos
- Departments of Neurosurgery,
- Norman Prince Neurosciences Institute, Rhode Island Hospital & Hasbro Children’s Hospital, Providence, Rhode Island
| | - Luca Bartolini
- Departments of Neurosurgery,
- Neurology, Brown University Alpert Medical School, Providence, Rhode Island
| | - Wael F. Asaad
- Departments of Neurosurgery,
- Department of Neuroscience, Brown University, Providence, Rhode Island
- Norman Prince Neurosciences Institute, Rhode Island Hospital & Hasbro Children’s Hospital, Providence, Rhode Island
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Liu DD, Kurland DB, Ali A, Golfinos JG, Nossek E, Riina HA. Pial brainstem artery arteriovenous malformation with flow-related intracanalicular aneurysm masquerading as vestibular schwannoma: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22208. [PMID: 36046703 PMCID: PMC9301348 DOI: 10.3171/case22208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Lesions of the internal auditory canal presenting with partial hearing loss are almost always vestibular schwannomas (VSs). Intracanalicular anterior inferior cerebellar artery (AICA) aneurysms are extremely rare but can mimic VS based on symptoms and imaging. The authors report the case of a flow-related intracanalicular AICA aneurysm from a pial brainstem arteriovenous malformation (AVM) masquerading as VS. OBSERVATIONS A 57-year-old male with partial left-sided hearing loss and an intracanalicular enhancing lesion was initially diagnosed with VS and managed conservatively at an outside institution with surveillance imaging over 3 years. When he was referred for VS follow-up, new imaging raised radiological suspicion for vascular pathology. Cerebral angiography revealed a small pial AVM located at the trigeminal root entry zone with an associated flow-related intracanalicular AICA aneurysm. The AVM was obliterated with open surgery, during which intraoperative angiography confirmed no AVM filling, preservation of the AICA, and no further aneurysm filling. LESSONS Intracanalicular AICA aneurysms and other lesions, including cavernous malformations, can mimic radiographic features of VS and present with hearing loss or facial weakness. Modern vascular neurosurgical techniques such as endovascular intervention and open surgery in a hybrid operating room allowed definitive management of both lesions without untoward morbidity.
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Affiliation(s)
- David D. Liu
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - David B. Kurland
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Aryan Ali
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - John G. Golfinos
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Erez Nossek
- Department of Neurosurgery, New York University Langone Health, New York, New York
| | - Howard A. Riina
- Department of Neurosurgery, New York University Langone Health, New York, New York
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12
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Zheng B, Leary OP, Liu DD, Nuss S, Barrios-Anderson A, Darveau S, Syed S, Gokaslan ZL, Telfeian AE, Fridley JS, Oyelese AA. Radiographic analysis of neuroforaminal and central canal decompression following lateral lumbar interbody fusion. North American Spine Society Journal (NASSJ) 2022; 10:100110. [PMID: 35345481 PMCID: PMC8957056 DOI: 10.1016/j.xnsj.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/20/2022]
Abstract
Background Lateral lumbar interbody fusion (LLIF) is a minimally invasive surgical option for treating symptomatic degenerative lumbar spinal stenosis (DLSS) in select patients. However, the efficacy of LLIF for indirectly decompressing the lumbar spine in DLSS, as well as the best radiographic metrics for evaluating such changes, are incompletely understood. Methods A single-institutional cohort of patients who underwent LLIF for DLSS between 5/2015 – 12/2019 was retrospectively reviewed. Diameter, area, and stenosis grades were measured for the central canal (CC) and neural foramina (NF) at each LLIF level based on preoperative and postoperative T2-weighted MRI. Baseline facet joint (FJ) space, degree of FJ osteoarthritis, presence of spondylolisthesis, interbody graft position, and posterior disc height were analyzed as potential predictors of radiographic outcomes. Changes to all metrics after LLIF were analyzed and compared across lumbar levels. Preoperative and intraoperative predictors of decompression were then assessed using multivariate linear regression. Results A total of 102 patients comprising 153 fused levels were analyzed. Pairwise linear regression of stenosis grade to diameter and area revealed significant correlations for both the CC and NF. All metrics except CC area were significantly improved after LLIF (p < 0.05, 2-tailed t-test). Worse FJ osteoarthritis ipsilateral to the surgical approach was predictive of greater post-operative CC and NF stenosis grade (p < 0.05, univariate and multivariate ordinary least squares linear regression). Lumbar levels L3-5 had significantly higher absolute postoperative CC stenosis grades while relative change in CC stenosis at the L2-3 was significantly greater than other lumbar levels (p < 0.05, one-way ANOVA). There were no baseline or postoperative differences in NF stenosis grade across lumbar levels. Conclusions Radiographically, LLIF is effective at indirect compression of the CC and NF at all lumbar levels, though worse FJ osteoarthritis predicted higher degrees of post-operative stenosis.
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Liu DD, Lauro P, Leary OP, Zheng B, Phillips R, Roth J, Blum A, Segar DJ, Asaad W. 204 Anatomical Modeling of Two-Trajectory Laser Amygdalohippocampotomy. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Barrios-Anderson A, Liu DD, Snead J, Wu E, Lee DJ, Robbins J, Aguirre J, Tang O, Garcia CM, Pucci F, Anderson MN, Syed S, Shaaya E, Gokaslan Z. In Reply to the Letter to the Editor Regarding "The National Student Neurosurgical Research Conference: A Research Conference for Medical Students". World Neurosurg 2021; 157:259. [PMID: 34929779 DOI: 10.1016/j.wneu.2021.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jameson Snead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Esther Wu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David J Lee
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Robbins
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jesus Aguirre
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Tang
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Catherine M Garcia
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Francesco Pucci
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Matthew N Anderson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Sohail Syed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Elias Shaaya
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Ziya Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
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15
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Barrios-Anderson A, Wu E, Liu DD, Snead J, Lee DJ, Robbins J, Aguirre J, Tang O, Garcia CM, Pucci F, Anderson MN, Syed S, Shaaya E, Gokaslan ZL. A survey study examining the motivations, concerns, and perspectives of medical students engaging in neurosurgical research. Surg Neurol Int 2021; 12:490. [PMID: 34754540 PMCID: PMC8571239 DOI: 10.25259/sni_742_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background In a competitive landscape for neurosurgical residency admission, research productivity is increasingly important. Medical school applicants to neurosurgery report high numbers of "scholarly products" as published by the National Residency Match Program. Despite increased student involvement in research and productivity, to the best of our knowledge, no previous reported studies have examined student perspectives on their involvement in neurosurgical research. Methods For 2 consecutive years (February 2019 and February 2020), medical students (n = 55) from around the United States presented original research at the Student Neurosurgical Research Conference. Participants were administered a mixed-method survey designed to assess experiences and perspectives on engaging in neurosurgical research. Survey responses were analyzed independently by two researchers to assess for common themes and perspectives. Results Medical students engaged in all types of research work across nearly every neurosurgical subfield with "Basic/Bench Lab work" (38.5%) and "Chart Review" (23.1%) representing the majority of projects. Students commonly cited "curiosity/interest," and "residency application competitiveness" as main reasons for participation in research. About 66% of respondents reported experiencing anxiety/concern about research productivity "often" or "very often." Thematic analysis revealed that sources of research-related stress were (1) having enough publications to match into residency, and (2) having enough time in medical school to engage in research. Conclusion Medical students engaging in neurosurgical research are highly motivated students driven by scientific curiosity and pressure to prepare for competitive residency applications. Students experience anxiety due to time constraints in medical curricula and increasing demands for scholarly productivity.
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Affiliation(s)
- Adriel Barrios-Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Esther Wu
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - David D Liu
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Jameson Snead
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - David J Lee
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - James Robbins
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Jesus Aguirre
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Oliver Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Catherine M Garcia
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Francesco Pucci
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Matthew N Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Sohail Syed
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Elias Shaaya
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
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Liu DD, Lauro PM, Phillips RK, Leary OP, Zheng B, Roth JL, Blum AS, Segar DJ, Asaad WF. Two-trajectory laser amygdalohippocampotomy: Anatomic modeling and initial seizure outcomes. Epilepsia 2021; 62:2344-2356. [PMID: 34338302 DOI: 10.1111/epi.17019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) is typically performed with one trajectory to target the medial temporal lobe (MTL). MTL structures such as piriform and entorhinal cortex are epileptogenic, but due to their relative geometry, they are difficult to target with one trajectory while simultaneously maintaining adequate ablation of the amygdala and hippocampus. We hypothesized that a two-trajectory approach could improve ablation of all relevant MTL structures. First, we created large-scale computer simulations to compare idealized one- vs two-trajectory approaches. A two-trajectory approach was then validated in an initial cohort of patients. METHODS We used magnetic resonance imaging (MRI) from the Human Connectome Project (HCP) to create subject-specific target structures consisting of hippocampus, amygdala, and piriform/entorhinal/perirhinal cortex. An algorithm searched for safe potential trajectories along the hippocampal axis (catheter one) and along the amygdala-piriform axis (catheter two) and compared this to a single trajectory optimized over all structures. The proportion of each structure ablated at various burn radii was evaluated. A cohort of 11 consecutive patients with mTLE received two-trajectory LITT; demographic, operative, and outcome data were collected. RESULTS The two-trajectory approach was superior to the one-trajectory approach at nearly all burn radii for all hippocampal subfields and amygdala nuclei (p < .05). Two-laser trajectories achieved full ablation of MTL cortical structures at physiologically realistic burn radii, whereas one-laser trajectories could not. Five patients with at least 1 year of follow-up (mean = 21.8 months) experienced Engel class I outcomes; 6 patients with less than 1 year of follow-up (mean = 6.6 months) are on track for Engel class I outcomes. SIGNIFICANCE Our anatomic analyses and initial clinical results suggest that LITT amygdalohippocampotomy performed via two-laser trajectories may promote excellent seizure outcomes. Future studies are required to validate the long-term clinical efficacy and safety of this approach.
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Affiliation(s)
- David D Liu
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter M Lauro
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Ronald K Phillips
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Owen P Leary
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Bryan Zheng
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Julie L Roth
- Department of Neurology, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew S Blum
- Department of Neurology, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - David J Segar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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Liu DD, Rivera-Lane K, Leary OP, Pertsch NJ, Niu T, Camara-Quintana JQ, Oyelese AA, Fridley JS, Gokaslan ZL. Supplementation of Screw-Rod C1-C2 Fixation With Posterior Arch Femoral Head Allograft Strut. Oper Neurosurg (Hagerstown) 2021; 20:226-231. [PMID: 33269389 DOI: 10.1093/ons/opaa336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous C1-C2 fixation techniques exist for the treatment of atlantoaxial instability. Limitations of screw-rod and sublaminar wiring techniques include C2 nerve root sacrifice and dural injury, respectively. We present a novel technique that utilizes a femoral head allograft cut with a keyhole that rests posteriorly on the arches of C1 and C2 and straddles the C2 spinous process, secured by sutures. OBJECTIVE To offer increased fusion across C1-C2 without the passage of sublaminar wiring or interarticular arthrodesis. METHODS A total of 6 patients with atlantoaxial instability underwent C1-C2 fixation using our method from 2015 to 2016. After placement of a C1-C2 screw/rod construct, a cadaveric frozen femoral head allograft was cut into a half-dome with a keyhole and placed over the already decorticated dorsal C1 arch and C2 spinous process. Notches were created in the graft and sutures were placed in the notches and around the rods to secure it firmly in place. RESULTS The femoral head's shape allowed for creation of a graft that provides excellent surface area for fusion across C1-C2. There were no intraoperative complications, including dural tears. Postoperatively, no patients had sensorimotor deficits, pain, or occipital neuralgia. 5 patients demonstrated clinical resolution of symptoms by 3 mo and radiographic (computed tomography) evidence of fusion at 1 yr. One patient had good follow-up at 1 mo but died due to complications of Alzheimer disease. CONCLUSION The posterior arch femoral head allograft strut technique with securing sutures is a viable option for supplementing screw-rod fixation in the treatment of complex atlantoaxial instability.
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Affiliation(s)
- David D Liu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kendall Rivera-Lane
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Owen P Leary
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nathan J Pertsch
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jared S Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Visco ZR, Liu DD, Leary OP, Oyelese AA, Gokaslan ZL, Camara-Quintana JQ, Galgano MA. A transpedicular approach to complex ventrally situated thoracic intradural extramedullary tumors: technique, indications, and multiinstitutional case series. Neurosurg Focus 2021; 50:E19. [PMID: 33932926 DOI: 10.3171/2021.2.focus20968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ventrally situated thoracic intradural extramedullary tumors are surgically challenging and difficult to access, and they may be complicated by extensive adhesions and calcifications. Selecting an approach for adequate ventral access is key to complete resection and optimization of outcomes. The authors present a case series of patients who underwent resection of ventral thoracic intradural extramedullary tumors and discuss indications and considerations for this technique. Additionally, they describe the use of a posterolateral transpedicular approach for resection of ventral thoracic intradural extramedullary tumors compared with other techniques, and they summarize the literature supporting its application. METHODS From May 2017 to August 2020, 5 patients with ventral thoracic intradural extramedullary tumors underwent resection at one of the two academic institutions. RESULTS Patient ages ranged from 47 to 75 (mean 63.4) years. All tumors were diagnosed as meningiomas or schwannomas by histological examination. Three of the 5 patients had evidence of partial or extensive tumor calcification. Four of the 5 patients underwent an initial posterolateral transpedicular approach for resection, with positive radiographic and clinical outcomes from surgery. One patient initially underwent an unsuccessful traditional direct posterior approach and required additional resection 2 years later after interval disease progression. There were no postoperative wound infections, CSF leaks, or other complications related to the transpedicular approach. CONCLUSIONS Posterolateral transpedicular tumor resection is a safe technique for the treatment of complex ventrally situated thoracic intradural extramedullary tumors compared with the direct posterior approach. Anecdotally, this approach appears to be particularly beneficial in patients with calcified tumors.
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Affiliation(s)
- Zachary R Visco
- 1Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, New York; and
| | - David D Liu
- 2Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Owen P Leary
- 2Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- 2Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- 2Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joaquin Q Camara-Quintana
- 2Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael A Galgano
- 1Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, New York; and
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19
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Liu S, Que LP, Huang K, Fang JP, Wang KM, Zhan LP, Liu DD, Xu HG. [Eltrombopag for thrombocytopenia in 24 children after hematopoietic stem cell transplantation]. Zhonghua Er Ke Za Zhi 2021; 59:311-315. [PMID: 33775051 DOI: 10.3760/cma.j.cn112140-20200715-00727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the efficacy and safety of eltrombopag for children with thrombocytopenia after hematopoietic stem cell transplantation (HSCT). Methods: Clinical data of 24 patients with thrombocytopenia after HSCT,who were treated with eltrombopag in the Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from August 1, 2018 to April 1, 2019 were analyzed retrospectively. The response rate and adverse reactions of eltrombopag were evaluated. Patients were divided into groups by source of hematopoietic stem cells (umbilical cord blood group and peripheral stem cell group) and type of disease (malignant and non-malignant disease group) and the clinical outcomes between groups were compared. Rank Sum test was used for comparisons between groups. Results: Among 24 cases, 15 were males and 9 females, the age of starting eltrombopag was 7.7 (2.6-13.7) years, the time of eltrombopag treatment after HSCT was 27.5 (8.0-125.0) days, the time from treatment to complete response (CR) was 23.5 (6.0-83.0) days, with the treatment course 36.5 (8.0-90.0) days. The total dose of eltrombopag was 1 400(200-5 900) mg. Complete response rate was 92% (22/24),without eltrombopag related adverse reactions. Comparing with peripheral stem cell group (n=8), the course and total dose of eltrombopag in umbilical cord blood group (n=16) were significantly reduced(24.5 (8.0-81.0) vs. 65.5 (35.0-90.0) d, Z=-3.004, P=0.002; 900.0 (200.0-3 850.0) vs. 2 862.5 (1 175.0-5 900.0) mg, Z=-2.604, P=0.007), but no significant differences were found in the time from treatment to complete response, platelet count after 2 weeks of eltrombopag withdrawal or platelet count at the end point of follow-up (all P>0.05). Comparing malignant patients (n=12) and non-malignant patients (n=12), no significant differences were found in the time from treatment to complete response, course, total dose, platelet count after 2 weeks of eltrombopag withdrawal, and platelet count at the end point of follow-up in non-malignant patients (all P>0.05). Conclusion: Eltrombopag is safe and maybe effective for thrombocytopenia after HSCT, especially for umbilical cord blood transplantation.
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Affiliation(s)
- S Liu
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - L P Que
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - K Huang
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - J P Fang
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - K M Wang
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - L P Zhan
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - D D Liu
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
| | - H G Xu
- Department of Pediatrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China
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20
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Leary OP, Merck LH, Yeatts SD, Pan I, Liu DD, Harder TJ, Jung S, Collins S, Braileanu M, Gokaslan ZL, Allen JW, Wright DW, Merck D. Computer-Assisted Measurement of Traumatic Brain Hemorrhage Volume Is More Predictive of Functional Outcome and Mortality than Standard ABC/2 Method: An Analysis of Computed Tomography Imaging Data from the Progesterone for Traumatic Brain Injury Experimental Clinical Treatment Phase-III Trial. J Neurotrauma 2021; 38:604-615. [PMID: 33191851 PMCID: PMC7898408 DOI: 10.1089/neu.2020.7209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hemorrhage volume is an important variable in emergently assessing traumatic brain injury (TBI). The most widely used method for rapid volume estimation is ABC/2, a simple algorithm that approximates lesion geometry as perfectly ellipsoid. The relative prognostic value of volume measurement based on more precise hematoma topology remains unknown. In this study, we compare volume measurements obtained using ABC/2 versus computer-assisted volumetry (CAV) for both intra- and extra-axial traumatic hemorrhages, and then quantify the association of measurements using both methods with patient outcome following moderate to severe TBI. A total of 517 computer tomography (CT) scans acquired during the Progesterone for Traumatic Brain Injury Experimental Clinical Treatment Phase-III (ProTECTIII) multi-center trial were retrospectively reviewed. Lesion volumes were measured using ABC/2 and CAV. Agreement between methods was tested using Bland-Altman analysis. Relationship of volume measurements with 6-month mortality, Extended Glasgow Outcome Scale (GOS-E), and Disability Rating Scale (DRS) were assessed using linear regression and area under the curve (AUC) analysis. In subdural hematoma (SDH) >50cm3, ABC/2 and CAV produce significantly different volume measurements (p < 0.0001), although the difference was not significant for smaller SDH or intra-axial lesions. The disparity between ABC/2 and CAV measurements varied significantly with hematoma size for both intra- and extra-axial lesions (p < 0.0001). Across all lesions, volume was significantly associated with outcome using either method (p < 0.001), but CAV measurement was a significantly better predictor of outcome than ABC/2 estimation for SDH. Among large traumatic SDH, ABC/2 significantly overestimates lesion volume compared with measurement based on precise bleed topology. CAV also offers significantly better prediction of patient functional outcofme and mortality.
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Affiliation(s)
- Owen P. Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Lisa H. Merck
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville Florida, USA
| | - Sharon D. Yeatts
- Department of Health Sciences, Medical University of South Carolina, Charleston South Carolina, USA
| | - Ian Pan
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - David D. Liu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Tyler J. Harder
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Stefan Jung
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Scott Collins
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Maria Braileanu
- Department of Radiology and Emory University School of Medicine, Atlanta Georgia, USA
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
| | - Jason W. Allen
- Department of Radiology and Emory University School of Medicine, Atlanta Georgia, USA
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta Georgia, USA
| | - Derek Merck
- Department of Diagnostic Imaging, and Warren Alpert Medical School of Brown University, Providence Rhode Island, USA
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville Florida, USA
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21
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Pertsch NJ, Leary OP, Camara-Quintana JQ, Liu DD, Niu T, Woo AS, Ng TT, Oyelese AA, Fridley JS, Gokaslan ZL. A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2023. [PMID: 36045932 PMCID: PMC9394173 DOI: 10.3171/case2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervicothoracic junction chordomas are uncommon primary spinal tumors optimally treated with en bloc resection. Although en bloc resection is the gold standard for treatment of mobile spinal chordoma, tumor location, size, and extent of involvement frequently complicate the achievement of negative margins. In particular, chordoma involving the thoracic region can require a challenging anterior access, and en bloc resection can lead to a highly destabilized spine. OBSERVATIONS Modern technological advances make en bloc resection more technically feasible than ever before. In this case, the successful en bloc resection of a particularly complex cervicothoracic junction chordoma was facilitated by a multidisciplinary surgical approach that maximized the use of intraoperative computed tomography–guided spinal navigation and patient-specific three-dimensional–printed modeling. LESSONS The authors review the surgical planning and specific techniques that facilitated the successful en bloc resection of this right-sided chordoma via image-guided parasagittal osteotomy across 2 stages. The integration of emerging visualization technologies into complex spinal column tumor management may help to provide optimal oncological care for patients with challenging primary tumors of the mobile spine.
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Affiliation(s)
- Nathan J. Pertsch
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Owen P. Leary
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Joaquin Q. Camara-Quintana
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - David D. Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Tianyi Niu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Albert S. Woo
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Plastic Surgery, and
| | - Thomas T. Ng
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Thoracic Surgery, Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A. Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Jared S. Fridley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
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22
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Liu DD, Leary OP, Camara-Quintana JQ, Galgano MA. Two-Level Separation Surgery for Thoracic Epidural Metastatic Disease: An Operative Video Demonstration. World Neurosurg 2020; 147:160. [PMID: 33316479 DOI: 10.1016/j.wneu.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
The spinal column is one of the most common regions of cancer metastasis. Spinal metastases typically occur in the vertebral body, and due to direct posterior extension or retropulsed pathological fractures, they often present with signs and symptoms of epidural spinal cord compression. This scenario requires surgical management to relieve compression and stabilize the spine. Separation surgery establishes a corridor to the ventral epidural space via pediculectomy, which allows for circumferential decompression and creation of a tumor-free margin around the thecal sac. Separation surgery is an increasingly popular method for the management of spinal metastases, particularly due to potentially reduced morbidity versus en bloc tumor resection, and its proven effectiveness when combined with spinal radiosurgery. Thus, separation surgery should be considered in patients with high-grade metastatic ventral epidural spinal cord compression. In this video, we present the case of a 61-year-old woman with metastatic hepatocellular carcinoma found to have severe spinal cord compression due to pathological vertebral body fractures at T10-T12, and ventral epidural disease at T10 and T12. The patient received T8-L2 posterior instrumented fusion and T10 and T12 separation surgery, with intraoperative cement embolization. We demonstrate the operative steps required to complete this procedure (Video 1).
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Affiliation(s)
- David D Liu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
| | - Owen P Leary
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Michael A Galgano
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
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23
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Barrios-Anderson A, Liu DD, Snead J, Wu E, Lee D, Robbins J, Aguirre J, Tang OY, Garcia CM, Pucci F, Anderson M, Syed S, Shaaya E, Gokaslan ZL. Examining the Motivations, Concerns, and Perspectives of Medical Students Engaging in Neurological Surgery Research. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Barrios-Anderson A, Liu DD, Snead J, Wu E, Lee DJ, Robbins J, Aguirre J, Tang O, Garcia CM, Pucci F, Anderson MN, Syed S, Shaaya E, Gokaslan ZL. The National Student Neurosurgical Research Conference: A Research Conference for Medical Students. World Neurosurg 2020; 146:e398-e404. [PMID: 33130142 DOI: 10.1016/j.wneu.2020.10.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Medical students interested in neurosurgery are increasingly involved in research, and research conferences have proven valuable for developing medical research experience and exposure. A research conference was designed for medical students interested in neurosurgery to present research. METHODS Our team designed an annual research conference at the Warren Alpert Medical School of Brown University in conjunction with the Neurosurgery and Neurology Departments. In February 2019, we hosted the first Student Neurosurgical and Neurological Research Conference (SNRC), the first national research conference, to our knowledge, designed for medical students to present neurosurgical research in the United States. The conference consisted of student poster/oral presentations, keynote speeches from clinical faculty, and surgical skills workstations. In February 2020, we hosted the second SNRC. After each conference, participants (n = 55) completed a survey to assess student perspectives of the conference. RESULTS Fifty-five medical students from around the nation attended the conferences to present their research. One hundred percent of participants affirmed that the conference fulfilled their primary reason for attending, which for most (54.5%) was the opportunity to present research. Thematic analysis revealed that students especially appreciated the "lower stress environment" and "opportunity to get feedback on their research." Notably, 97.6% of students felt the conference strengthened or increased their interest in neurosurgery. CONCLUSIONS Participants felt that the SNRC was a valuable opportunity to present research in an environment conducive for practice and improvement. Research conferences primarily for medical students may support the development of young researchers while increasing and strengthening interest in the field of neurosurgery.
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Affiliation(s)
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jameson Snead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Esther Wu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David J Lee
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Robbins
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jesus Aguirre
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Tang
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Catherine M Garcia
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Francesco Pucci
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Matthew N Anderson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Sohail Syed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Elias Shaaya
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
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25
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Sanderson JB, Yu JH, Liu DD, Amaya D, Lauro PM, D'Abreu A, Akbar U, Lee S, Asaad WF. Multi-Dimensional, Short-Timescale Quantification of Parkinson's Disease and Essential Tremor Motor Dysfunction. Front Neurol 2020; 11:886. [PMID: 33071924 PMCID: PMC7530842 DOI: 10.3389/fneur.2020.00886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/10/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Parkinson's disease (PD) is a progressive movement disorder characterized by heterogenous motor dysfunction with fluctuations in severity. Objective, short-timescale characterization of this dysfunction is necessary as therapies become increasingly adaptive. Objectives: This study aims to characterize a novel, naturalistic, and goal-directed tablet-based task and complementary analysis protocol designed to characterize the motor features of PD. Methods: A total of 26 patients with PD and without deep brain stimulation (DBS), 20 control subjects, and eight patients with PD and with DBS completed the task. Eight metrics, each designed to capture an aspect of motor dysfunction in PD, were calculated from 1-second, non-overlapping epochs of the raw positional and pressure data captured during task completion. These metrics were used to generate a classifier using a support vector machine (SVM) model to produce a unifying, scalar “motor error score” (MES). The data generated from these patients with PD were compared to same-day standard clinical assessments. Additionally, these data were compared to analogous data generated from a separate group of 12 patients with essential tremor (ET) to assess the task's specificity for different movement disorders. Finally, an SVM model was generated for each of the eight patients with PD and with DBS to differentiate between their motor dysfunction in the “DBS On” and “DBS Off” stimulation states. Results: The eight metrics calculated from the raw positional and force data captured during task completion were non-redundant. MES generated by the SVM analysis protocol showed a strong correlation with MDS-UPDRS-III scores assigned by movement disorder specialists. Analysis of the relative contributions of each of the eight metrics showed a significant difference between the motor dysfunction of PD and ET. Much of this difference was attributable to the homogenous, tremor-dominant phenotype of ET motor dysfunction. Finally, in individual patients with PD with DBS, task performance and subsequent SVM classification effectively differentiated between the “DBS On” and “DBS Off” stimulation states. Conclusion: This tablet-based task and analysis protocol correlated strongly with expert clinical assessments of PD motor dysfunction. Additionally, the task showed specificity for PD when compared to ET, another common movement disorder. This specificity was driven by the relative heterogeneity of motor dysfunction of PD compared to ET. Finally, the task was able to distinguish between the “DBS On” and “DBS Off” states within single patients with PD. This task provides temporally-precise and specific information about motor dysfunction in at least two movement disorders that could feasibly correlate to neural activity.
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Affiliation(s)
- John B Sanderson
- The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - James H Yu
- The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - David D Liu
- The Warren Alpert Medical School, Brown University, Providence, RI, United States.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
| | - Daniel Amaya
- Department of Neuroscience, Brown University, Providence, RI, United States.,Carney Institute for Brain Science, Brown University, Providence, RI, United States.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
| | - Peter M Lauro
- The Warren Alpert Medical School, Brown University, Providence, RI, United States.,Department of Neuroscience, Brown University, Providence, RI, United States.,Carney Institute for Brain Science, Brown University, Providence, RI, United States.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
| | - Anelyssa D'Abreu
- The Warren Alpert Medical School, Brown University, Providence, RI, United States.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States.,Department of Neurology, Rhode Island Hospital, Providence, RI, United States
| | - Umer Akbar
- The Warren Alpert Medical School, Brown University, Providence, RI, United States.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States.,Department of Neurology, Rhode Island Hospital, Providence, RI, United States
| | - Shane Lee
- Department of Neuroscience, Brown University, Providence, RI, United States.,Carney Institute for Brain Science, Brown University, Providence, RI, United States.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
| | - Wael F Asaad
- The Warren Alpert Medical School, Brown University, Providence, RI, United States.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States.,Department of Neuroscience, Brown University, Providence, RI, United States.,Carney Institute for Brain Science, Brown University, Providence, RI, United States.,Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
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26
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Leary OP, Crozier J, Liu DD, Niu T, Pertsch NJ, Camara-Quintana JQ, Svokos KA, Syed S, Telfeian AE, Oyelese AA, Woo AS, Gokaslan ZL, Fridley JS. Three-Dimensional Printed Anatomic Modeling for Surgical Planning and Real-Time Operative Guidance in Complex Primary Spinal Column Tumors: Single-Center Experience and Case Series. World Neurosurg 2020; 145:e116-e126. [PMID: 33010507 DOI: 10.1016/j.wneu.2020.09.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Three-dimensional (3D) printing has emerged as a visualization tool for clinicians and patients. We sought to use patient-specific 3D-printed anatomic modeling for preoperative planning and live intraoperative guidance in a series of complex primary spine tumors. METHODS Over 9 months, patients referred to a single neurosurgical provider for complex primary spinal column tumors were included. Most recent spinal magnetic resonance and computed tomography (CT) imaging were semiautomatically segmented for relevant anatomy and models were printed using polyjet multicolor printing technology. Models were available to surgical teams before and during the operative procedure. Patients also viewed the models preoperatively during surgeon explanation of disease and surgical plan to aid in their understanding. RESULTS Tumor models were prepared for 9 patients, including 4 with chordomas, 2 with schwannomas, 1 with osteosarcoma, 1 with chondrosarcoma, and 1 with Ewing-like sarcoma. Mean age was 50.7 years (range, 15-82 years), including 6 males and 3 females. Mean tumor volume was 129.6 cm3 (range, 3.3-250.0 cm3). Lesions were located at cervical, thoracic, and sacral levels and were treated by various surgical approaches. Models were intraoperatively used as patient-specific anatomic references throughout 7 cases and were found to be technically useful by the surgical teams. CONCLUSIONS We present the largest case series of 3D-printed spine tumor models reported to date. 3D-printed models are broadly useful for operative planning and intraoperative guidance in spinal oncology surgery.
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Affiliation(s)
- Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Joseph Crozier
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David D Liu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nathan J Pertsch
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Konstantina A Svokos
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert S Woo
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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27
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Liu DD, Camara-Quintana JQ, Leary OP, Syed S, Oyelese AA, Telfeian AE, Gokaslan ZL, Fridley JS, Niu T. Traumatic unilateral jumped facet joint in the upper thoracic spine: Case presentation and literature review. Surg Neurol Int 2020; 11:77. [PMID: 32363072 PMCID: PMC7193257 DOI: 10.25259/sni_119_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: A jumped facet joint is defined by when the inferior articular process of the superior vertebra becomes locked anterior to the superior articular process of the inferior vertebra. These typically traumatic lesions are exceedingly rare in the thoracic spine. Here, we present a patient with a unilateral jumped facet joint in the upper thoracic spine treated with open reduction and an instrumented fusion. Case Description: A 45-year-old male presented after a significant motor vehicle accident. In the emergency room, he had a Glasgow Coma Score of 13 without any neurologic deficit. The thoracic computed tomography (CT) showed a significant jumped left facet at the T2-T3 level. Two days later, utilizing intraoperative CT-guided navigation and neuromonitoring, he underwent open reduction of the T2-T3 jumped facet plus an instrumented T1-T5 fusion. X-rays taken 3-month postoperatively showed a stable construct. Six months postoperatively, he remained neurologically intact. Conclusion: A unilateral jumped thoracic facet may be present in patients with fractured ribs. The mechanism of injury is most likely axial rotation. Both CT and magnetic resonance imaging studies allow for early detection of these very rare lesions and warrant open reduction and instrumented fusion.
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28
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Leary OP, Liu DD, Boyajian MK, Syed S, Camara-Quintana JQ, Niu T, Svokos KA, Crozier J, Oyelese AA, Liu PY, Woo AS, Gokaslan ZL, Fridley JS. Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients. J Neurosurg Spine 2020; 33:77-86. [PMID: 32109877 DOI: 10.3171/2019.12.spine191238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wound breakdown and infection are common postoperative complications following resection of spinal neoplasms. Accordingly, it has become common practice at some centers for plastic surgeons to assist with closure of large posterior defects after spine tumor resection. In this study, the authors tested the hypothesis that plastic surgery closure of complex spinal defects improves wound outcomes following resection of spinal neoplastic disease. METHODS Electronic medical records of consecutive patients who underwent resection of a spinal neoplasm between June 2015 and January 2019 were retrospectively reviewed. Patients were separated into two subpopulations based on whether the surgical wound was closed by plastic surgery or neurosurgery. Patient demographics, preoperative risk factors, surgical details, and postoperative outcomes were collected in a central database and summarized using descriptive statistics. Outcomes of interest included rates of wound complication, reoperation, and mortality. Known preoperative risk factors for wound complication in spinal oncology were identified based on literature review and grouped categorically. The presence of each category of risk factors was then compared between groups. Univariate and multivariate linear regressions were applied to define associations between individual risk factors and wound complications. RESULTS One hundred six patients met inclusion criteria, including 60 wounds primarily closed by plastic surgery and 46 by neurosurgery. The plastic surgery population included more patients with systemic metastases (58% vs 37%, p = 0.029), prior radiation (53% vs 17%, p < 0.001), prior chemotherapy (37% vs 15%, p = 0.014), and sacral region tumors (25% vs 7%, p = 0.012), and more patients who underwent procedures requiring larger incisions (7.2 ± 3.6 vs 4.5 ± 2.6 levels, p < 0.001), prolonged operative time (413 ± 161 vs 301 ± 181 minutes, p = 0.001), and greater blood loss (906 ± 1106 vs 283 ± 373 ml, p < 0.001). The average number of risk factor categories present was significantly greater in the plastic surgery group (2.57 vs 1.74, p < 0.001). Despite the higher relative risk, the plastic surgery group did not experience a significantly higher rate of wound complication (28% vs 17%, p = 0.145), reoperation (17% vs 9%, p = 0.234), or all-cause mortality (30% vs 13%, p = 0.076). One patient died from wound-related complications in each group (p = 0.851). Regression analyses identified diabetes, multilevel instrumentation, and BMI as the factors associated with the greatest wound complications. CONCLUSIONS Involving plastic surgery in the closure of spinal wounds after resection of neoplasms may ameliorate expected increases in wound complications among higher-risk patients.
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Affiliation(s)
- Owen P Leary
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | | | | | - Sohail Syed
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Joaquin Q Camara-Quintana
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Tianyi Niu
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Konstantina A Svokos
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Joseph Crozier
- 2Plastic Surgery, Warren Alpert Medical School of Brown University; and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Paul Y Liu
- 2Plastic Surgery, Warren Alpert Medical School of Brown University; and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Albert S Woo
- 2Plastic Surgery, Warren Alpert Medical School of Brown University; and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Ziya L Gokaslan
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Jared S Fridley
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
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Liu DD, Cao XB, Li HL, Lu XC, Shou BQ, Lei MT, Wang CH, Xue H. [Effect of comprehensive AIDS intervention among men aged 50 or over who had non-marital sexual behavior]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 40:1595-1600. [PMID: 32062922 DOI: 10.3760/cma.j.issn.0254-6450.2019.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effectiveness of AIDS intervention programs on men aged 50 or over and having had non-marital sexual behavior. Methods: A community-based intervention/experimental and based on individual level study was adopted. Stratified sampling method was used. 12 townships/streets in Fuyang district of Hangzhou were identified as intervention or control group (six research sites each). All of the subjects in the township (street) were included. The inclusion criteria of study objects would include men aged 50 or older who reported having unmarried sex in the last year. Estimated sample size was 290, with each 145 in the intervention group and the control group. All the intervention group participants were provided with a total of 4 intervention-related items (knowledge and education on AIDS prevention, information radiation and behavioral change, broadcast expert lectures), every 3 months, for 12 month, the main evaluation indicators would include: incidence of non-marital sex and commercial sex in the last year, condom use when having non-marital sex in the last episode. Results: A total of 312 subjects were recruited. 300 of them completed the baseline study while 284 of them completed the follow-up survey. Among the subjects who had undergone the baseline study, the average age was (65.58±7.89), 71.33% were married or cohabiting with someone, 52.00% having had primary school education. After the implementation of intervention programs, the incidence of non-marital sex dropped to 59.42% (82/138) and the incidence of commercial sex dropped from 79.73% (118/148) to 55.07% (76/138). Condom use rate in the last non-marital sexual contact increased from 19.59% (29/148) to 51.22% (42/82). In the control group, the incidence of non-marital sex in the year before dropped to 74.66% (109/146) and the incidence of commercial sex dropped from 91.45% (139/152) to 72.60% (106/146). Rates of condom use during the last non-marital sexual contact dropped from 32.89% (50/152) to 31.19% (34/109). Statistically, there were significant differences appeared between the two groups on the incidence of non-marital sex in the past year (χ(2)=7.48, P=0.008), the incidence of commercial sex in the last year (χ(2)=9.47, P=0.003) and the rate of condom use in the last sex experience (χ(2)=7.83, P=0.007). Conclusions: Results from this intervention study showed that: in the intervention group, both the incidence rates of non-marital or commercial sex had reduced, together with the increase of condom use in non-marital sex in the last sexual experience. Intervention strategies that involving knowledge and education on AIDS prevention, information radiation and behavioral change, broadcasting lectures by experts etc. were all proved effective.
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Affiliation(s)
- D D Liu
- National Center for STD/AIDS Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Fuyang District Center for Disease Control and Prevention of Hangzhou, Hangzhou 311400, China
| | - X B Cao
- National Center for STD/AIDS Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H L Li
- Fuyang District Center for Disease Control and Prevention of Hangzhou, Hangzhou 311400, China
| | - X C Lu
- Fuyang District Center for Disease Control and Prevention of Hangzhou, Hangzhou 311400, China
| | - B Q Shou
- Fuyang District Center for Disease Control and Prevention of Hangzhou, Hangzhou 311400, China
| | - M T Lei
- Fuyang District Center for Disease Control and Prevention of Hangzhou, Hangzhou 311400, China
| | - C H Wang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H Xue
- Beijing Lanchengyouning Health Management Limited Company, Beijing 100022, China
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Wu J, Wen ZH, Liu DD, Wu CF, Zhang Y, Zhang L, Xu YL, Yang G, Jing CX. [Safety evaluation on different ventilation strategies set for neonatal respiratory distress syndrome: a network Meta-analysis]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:249-260. [PMID: 32164138 DOI: 10.3760/cma.j.issn.0254-6450.2020.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To evaluate the relative safety of different ventilation methods regarding mortality and rates of complication, on neonatal respiratory distress syndrome (NRDS). Methods: Network Meta-analysis was used to collect data on randomized controlled trials of pulmonary ventilation strategies in preterm infants with a mean gestational age of less than 32 weeks. Diagnostic criteria on NRDS were published in the PubMed, Cochrane, Web of Science, EBSCO, and Springer Link databases from January 1986 to June 2018. Revman 5.3 software was used to evaluate the quality of studies, based on the Cochrane quality assessment tool. Data were analyzed by Bayesian and frequency methods, using both Win BUGS 1.4.3 and STATA 13.0 software. Safety of different ventilation strategies for NRDS mortality and complications would include intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA) and retinopathy of prematurity (ROP) and were evaluated. Counted data was displayed by OR and 95%CI. Results: A total of 31 RCTs were included in this paper, including 5 827 preterm infants and 11 ventilation strategies. There were no statistically significant differences appearing in 11 ventilation strategies on mortality, PDA or ROP. IVH results were reported in 28 studies. Compared with nasal intermittent positive pressure ventilation (NIPPV), both high- frequency oscillation ventilation (HFOV) (OR=3.33, 95%CI: 1.08-16.67, P<0.05) and synchronized intermittent mechanical ventilation (SIMV) (OR=8.22, 95%CI: 1.25-29.44, P<0.05) schemes seemed to have increased the risk of IVH in preterm infants with NRDS. NIPPV appeared the optimal ventilation strategy in the rankings of cumulative probability. Results on clustering showed that NIPPV was probably the best ventilation strategy for children with NRDS after considering the orders of IVH, PDA and ROP on mortality, respectively. However, HFOV, IMV, and SIMV did not seem to be the ideal ventilated strategies. Conclusions: Most of the clinical decision makers might prefer using NIPPV in the treatment of children with NRDS through mechanical ventilation systems to reduce both the incidence and death caused by IVH, PDA and ROP. It was not recommended to use HFOV, SIMV and IMV in treating NRDS with gestational less than 32 weeks. We suggested that larger numbers of multi-center RCTs ba carried out to make the above conclusions more convincing.
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Affiliation(s)
- J Wu
- Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China; Department of Pathogenic Biology, Jinan University, Guangzhou 510632, China
| | - Z H Wen
- Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China
| | - D D Liu
- Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China
| | - C F Wu
- School of Medicine, Zhongshan University, Guangzhou 510080, China
| | - Y Zhang
- Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan 523000, China
| | - L Zhang
- Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan 523000, China
| | - Y L Xu
- Department of Neonatology, Dongguan Maternal and Child Health Hospital, Dongguan 523000, China
| | - G Yang
- Department of Pathogenic Biology, Jinan University, Guangzhou 510632, China
| | - C X Jing
- Department of Epidemiology and Health Statistics, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China
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Yu JYH, Collins S, Liu DD, Leary OP, Merck D, Konakondla S, Nakhla J, Barber SM, Telfeian AE, Oyelese AA, Gokaslan ZL, Fridley JS. Objective Indirect Assessment of Transverse Ligament Competence Using Quantitative Analysis of 3-Dimensional Segmented Flexion-Extension Computed Tomography Scan. World Neurosurg 2019; 136:e223-e233. [PMID: 31899395 DOI: 10.1016/j.wneu.2019.12.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Assessment of transverse ligament (TL) competence in patients with suspected atlantoaxial instability is performed via indirect radiograph measurements or direct TL visualization on magnetic resonance imaging (MRI). Interpretation of these images can be limited by unique patient anatomy or imaging technique variability. We report a novel technique for evaluating TL competence using flexion-extension computed tomography (feCT) scan with 3-dimensional (3D) segmentation and quantitative analysis. METHODS feCT scans of 11 patients were segmented to create 3D surface models. Six patients with atlantoaxial pathology were evaluated for possible instability based on clinical examination and imaging findings. The other 5 patients had no clinical or imaging evidence of atlantoaxial injury. Dynamic atlantodental interval (ADI) was calculated using point-to-point voxel changes between flexion and extension 3D models. Magnitude and direction of ADI changes were quantified and compared with available cervical spine flexion-extension radiograph and/or MRI findings. RESULTS In the 5 patients without evidence of atlantoaxial injury, 94.3% of ADI vector changes were <3.0 mm. In the 3 patients with atlantoaxial pathology but TL competence, 92.4% of ADI vector changes were <3.0 mm. In the 3 patients with atlantoaxial pathology and TL incompetence, only 49.1% of ADI vector changes were <3.0 mm. In addition to the significant atlantoaxial subluxation in these 3 patients, there was significant rotational motion compared with the patients with an intact TL. CONCLUSIONS 3D segmentation and quantitative analysis of feCT scan allow objective indirect assessment of TL integrity. Results are consistent with MRI findings and offer additional biomechanical information regarding the direction and distribution of atlantoaxial motion.
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Affiliation(s)
- James Y H Yu
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Scott Collins
- Department of Diagnostic Imaging, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - David D Liu
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Derek Merck
- Department of Diagnostic Imaging, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jonathan Nakhla
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Sean M Barber
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
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Shen L, Zhu H, Li XX, Liu DD, Chen XY, Liu H. [The influence factors of quality-of-life in patients with thyroid-associated ophthalmopathy]. Zhonghua Yan Ke Za Zhi 2019; 53:575-582. [PMID: 28851197 DOI: 10.3760/cma.j.issn.0412-4081.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the risk factors associated with decreased quality-of-life in patients with thyroid-associated ophthalmopathy (TAO). Methods: Cross-sectional study. One hundred and twelve patients with TAO and 68 controls were recruited to answer the Graves' ophthalmopathy quality-of-life questionnaire (GO-QOL) from January 2014 to April 2016. The GO-QOL included two subscales: the visual functioning and the psychosocial consequences. The differences in the GO-QOL scores between TAO patients and controls were analyzed. The influences of multiple factors on the GO-QOL scores among TAO patients were explored. Results: Among 112 TAO patients, 63 were male and 49 were female, with an average age of (45.4±13.1) years. Among 68 controls, 36 were male and 32 were female, with an average age of (39.5±10.8) years. Independent sample t test showed that TAO patients had significantly lower scores than controls in the visual functioning subscale and the psychosocial consequences subscale (55.63±29.02 vs 97.48±6.96, t=-14.58, P<0.01; 57.61±29.97 vs100±0.00, t=-14.97, P<0.01). Among TAO patients, smokers were associated with significantly lower psychological subscale scores than non-smokers (t=-2.284, P=0.024). Patients with abnormal primary position of eye scored significantly lower than those with normal alignment in functional (t=-3.979, P<0.001) and psychological subscales (t=-2.154, P=0.034) Patients with abnormal eye movement had significantly lower functional scores than those without (t=-2.975, P=0.004). One-way analysis of variance showed that higher CAS scores were significantly related to lower psychological subscale scores (F=3.178, P=0.018). Patients with upper eyelid retraction had significantly lower psychological subscale scores than those without (F=3.562, P=0.032). Pearson correlation analysis showed that age was negatively correlated with functional subscale scores (r=-0.366; P<0.01). TAO course was negatively correlated with functional (r=-0.235, P<0.05) and psychological subscale scores (r=-0.320, P<0.01). The degree of exophthalmos was negatively correlated with psychological subscale scores (r=-0.209, P<0.01). Multivariable linear regression analysis showed that only primary position of eye (P=0.013) and TAO course (P=0.007) were negatively correlated with functional subscale scores and only CAS scores (P=0.022) and TAO course (P=0.024) were negatively correlated with psychological subscale scores. Conclusion: Risk factors associated with lower quality-of-life among TAO patients included abnormal primary position of eye, higher CAS scores, and longer TAO course.(Chin J Ophthalmol,2017,53: 575-582).
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Affiliation(s)
- L Shen
- Depantment of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
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Li Z, Li J, Liu XL, Liu DD, Li H, Li ZJ, Han RL, Wang YB, Liu XJ, Kang XT, Yan FB, Tian YD. Effects of different starch sources on glucose and fat metabolism in broiler chickens. Br Poult Sci 2019; 60:449-456. [PMID: 30957519 DOI: 10.1080/00071668.2019.1605150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
1. The aim of the present study was to investigate the effects of different starch sources (corn, wheat, and rice) on the blood glucose level, glycogen content of liver and muscle, expression of GSK-3β and FAS mRNA, abdominal fat weight and abdominal fat deposition in broiler chickens. 2. A total of 360, one-day-old AA (Arbor Acres) broiler chickens were randomly assigned to three treatment groups, each with six replicates, consisting of 20 chickens per replicate, and fed either a corn-, wheat- or rice-based diet for 21 days. The chickens were then subdivided into groups A and B, and the chickens in these two subgroups were processed or sampled for 28 days, respectively. 3. The results indicated that post-prandial time significantly affected the glucose concentration, glycogen content in the liver and breast muscle and expression of GSK-3β and FAS mRNAs (P < 0.05). The expression of the GSK-3β gene in the chicken liver of the corn-based diet group was higher (P < 0.05) than that in the wheat-based diet group, and the expression of the FAS gene in the corn-based diet group was lower (P < 0.05) than that in the wheat-based and rice-based diet groups. Abdominal fat weight and deposition in the corn-based diet group were lower than those of the wheat-based and rice-based diet groups, but these differences were not significant (P > 0.05). 4. The results suggested that the efficiency of glucose absorption in animals might have an effect on the fat deposition efficiency in the liver and that diets with different starch sources might affect fat deposition in chickens.
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Affiliation(s)
- Z Li
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - J Li
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - X L Liu
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - D D Liu
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - H Li
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - Z J Li
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - R L Han
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - Y B Wang
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - X J Liu
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - X T Kang
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - F B Yan
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
| | - Y D Tian
- a College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China.,b Henan Innovative Engineering Research Center of Poultry Germplasm Resource, College of Animal Science and Veterinary Medicine , Henan Agricultural University , Zhengzhou , China
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Liu DD, Zhou W, Li PL, Zhang JL, Chen W, Gu WJ, Pei Y, Du J, Zang L, Ba JM, Lü ZH, Mu YM, Shan BC, Zhang YL, Ma L, Dou JT. [Differences of brain functional alterations between subtypes of Cushing's syndrome patients]. Zhonghua Yi Xue Za Zhi 2019; 99:593-598. [PMID: 30818928 DOI: 10.3760/cma.j.issn.0376-2491.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To compare the differences of brain functional damage of subtypes of patients with Cushing's syndrome (CS). Methods: A total of 11 adrenocorticotropic hormone (ACTH)-dependent CS patients and 29 ACTH-independent CS patients were recruited from Chinese PLA General Hospital between September 2015 and March 2017 with confirmed CS. The psychiatric scales and brain task functional magnetic resonance imaging (fMRI) were evaluated. Results: A total of 40 patients (34 females, 6 males) with a mean age of (39.20±12.10) years and a median education level of 12 (9, 16) years were enrolled. ACTH-dependent patients had significantly worse performance than the ACTH-independent patients in response to the depression evaluation (64.6±6.1 vs 56.2±12.8, P=0.008), positive emotion (17.8±4.2 vs 24.3±7.2, P=0.008) and CS life quality [31(29,33) vs 42(29,51), P=0.040]. In the reaction to positive target pictures, ACTH-dependent CS patients showed stronger activation in left superior temporal gyrus compared with patients in ACTH-independent group, while the activation degree of their bilateral dorsal anterior cingulate cortex, bilateralsuperior frontal gyrus and left middle frontal gyrus was much worse. In the reactions to negative target pictures, ACTH-dependent CS patients had weaker activation in bilateral cerebellum, left superior frontal gyrus, left middle frontal gyrus, left precuneus and right postcentral gyrus, compared with patients in the ACTH-independent CS group (P<0.01, AlphaSim corrected). The activation degree of some regions whose brain function was different between the two groups was correlated to the cortisol level, ACTH level, 24 h urinary free cortisol (UFC) level, depression evaluation and negative emotion assessment (all P<0.05). Conclusions: The severity of the depression and the life quality of patients in ACTH-dependent group are worse than ACTH-independent CS patients. The brain function of ACTH-dependent CS patients is much weaker.
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Affiliation(s)
- D D Liu
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China( is working in the Department of Endocrinology, Baoding First Central Hospital, Baoding 071000, China)
| | - W Zhou
- Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China
| | - P L Li
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Beijing 100049, China
| | - J L Zhang
- Department of Pharmacology School of Medicine, Nankai University, Tianjin 300071, China
| | - W Chen
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - W J Gu
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - Y Pei
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - J Du
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - L Zang
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - J M Ba
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - Z H Lü
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - Y M Mu
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
| | - B C Shan
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Beijing 100049, China
| | - Y L Zhang
- Department of Endocrinology, Baoding First Central Hospital, Baoding 071000, China
| | - L Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China
| | - J T Dou
- Department of Endocrinology, Chinese PLA General Hospital, Key Laboratory of Endocrinology and Metabolism of PLA, Beijing 100853, China
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Thomas PS, Patel AB, Contreras A, Liu DD, Lee JJ, Khan S, Vornik LA, Dimond EP, Perloff M, Heckman-Stoddard BM, Brown PH. Abstract OT2-09-02: A phase I dose escalation study of topical bexarotene in women at high risk for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-09-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer prevention with anti-estrogens, including tamoxifen, raloxifene, and exemestane, has been shown to reduce the incidence of hormone receptor-positive breast cancer. However, agents that can reduce the incidence of hormone receptor negative breast cancer are currently lacking. Rexinoids such as bexarotene are vitamin A analogues that have been shown to be involved in cell differentiation, growth, and apoptosis. In preclinical mouse models that develop ER-negative breast cancers, bexarotene showed a significant reduction in mammary tumor development. Oral bexarotene has been evaluated in BRCA mutation carriers and significant decreases in cyclin D1 were noted in breast cells suggesting biological activity of bexarotene on breast tissue. Systemic side effects of hyperlipidemia and hypothyroidism were also found. Data from chemoprevention studies with topical 4-hydroxytamoxifen support the concept of topical agents penetrating into the breast tissue and exhibiting biological activity in the tissue. We hypothesize that topical bexarotene can be applied to the breast as a chemoprevention agent with penetration to the breast tissue without subsequent systemic side effects and toxicity as seen with oral bexarotene.
Trial Design: Women at high risk for breast cancer will be recruited and assigned to one of three different dose levels: 10mg (1ml) every other day, 10mg (1ml) daily, 20mg (2ml) daily to one unaffected breast for 4 weeks. The primary endpoint of the study is to determine the recommended phase II dose of topical bexarotene 1% gel for evaluation in healthy at-risk women. Dose Limiting Toxicity (DLT) is defined as a grade 2 skin adverse event that persists for at least 6 days or any grade 3 or greater adverse event related to the study drug. A grade 2 skin adverse event that recurs and persists for at least 3 days is also a DLT. The Maximum Tolerated Dose (MTD) will be defined as the highest dose level at which no more than 2 participants experience a DLT among 10 participants treated. A conservative modification of the standard “3+3” design will be applied. The first three participants will be assigned to the lowest dose level. New cohorts of 3-4 participants will not be treated until toxicity has been fully evaluated for all current participants through 4 weeks. Once the MTD has been determined, an expansion cohort of an additional 10 patients will be recruited at the MTD to further evaluate safety and toxicity at this dose level as well bexarotene concentration in the breast tissue. Secondary endpoints include serum bexarotene level, tissue bexarotene levels, and changes in thyroid function tests, lipid profile, and calcium. The planned accrual for this study if maximally accrued to all dose levels and the dose expansion cohort will be 40 participants.
Citation Format: Thomas PS, Patel AB, Contreras A, Liu DD, Lee JJ, Khan S, Vornik LA, Dimond EP, Perloff M, Heckman-Stoddard BM, Brown PH. A phase I dose escalation study of topical bexarotene in women at high risk for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-09-02.
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Affiliation(s)
- PS Thomas
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - AB Patel
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - A Contreras
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - DD Liu
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - JJ Lee
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - S Khan
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - LA Vornik
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - EP Dimond
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - M Perloff
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - BM Heckman-Stoddard
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - PH Brown
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
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Al-Awadhi A, Liu DD, Gutierrez-Barrera AM, Strong LC, Arun BK. Abstract P5-09-02: Clinical and pathological characteristics and screening outcome for secondary cancers of women with breast cancer and Li-Fraumeni syndrome. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Germline TP53 mutations predispose to early onset breast cancer in women and are associated with Li-Fraumeni syndrome. Published data on the clinical and pathological characteristics and screening outcome for secondary cancers among women with breast cancer and TP53 mutations is limited. To the best of our knowledge this is the largest cohort of breast cancer associated with Li-Fraumeni syndrome.
Methods: Patients with breast cancer and Li-Fraumeni Syndrome were identified from a prospective research database from 2001 to 2017. Patients had genetic counselling and testing at The University of Texas MD Anderson Cancer Center and confirmed to have TP53 mutations associated with Li-Fraumeni syndrome. We reviewed the patient's charts to identify the clinical and pathological characteristics of their breast cancer. Data for secondary cancers are obtained only for patients with breast cancer as their initial cancer diagnosis and who are followed at The MD Anderson's Li-Fraumeni Education and Early Detection (LEAD) clinic which conducts comprehensive cancer screening for these patient's per the NCCN guidelines, including yearly whole body MRIs.
Results: Fifty-nine patients confirmed to have Li-Fraumeni syndrome and breast cancer (100% female, median age 30 years). 94% of the patients were pre-menopausal at the time of breast cancer diagnosis and 6% were post-menopausal due to bilateral salpingo-oophorectomy. 61% were diagnosed after abnormal self or clinical breast exam and 26% based on abnormal screening mammography or ultrasound. In terms of the histologic subtype of breast cancer: 69% had invasive ductal carcinoma, 5% mucinous carcinoma, 5% mixed ductal and lobular, 5% sarcoma, 3% phylloides tumor and 13% with missing data. Pathologic stage per the 7th edition of AJCC cancer staging system was as follows: 23% stage I, 26% stage II, 23% stage III, 28% remaining with unknown pathologic stage. Pathologic markers include: 70% with positive estrogen receptor expression, 64% with positive progesterone receptor expression, 57% with HER-2 amplification defined per the ASCO-CAP HER-2 test guidelines and 7% with triple negative disease. Forty three patients were followed at LEAD clinic. Of the 43 patients, 40% (N=17) were diagnosed with 1 primary cancer other than breast cancer, 7% (N=7) with 2 primary cancers other than breast cancer and 44% (N=19) with breast cancer only. Out of the 43 patients, 5 were diagnosed with acute myelogenous leukemia, 4 with leiomyosarcoma, 3 osteosarcoma, 4 with other types of sarcoma, 4 with central nervous cell tumors (astrocytoma or glioblastoma multiforme), 3 with papillary thyroid carcinoma, 1 with pancreatic cancer, 1 with renal cell carcinoma, 1 adrenocortical carcinoma, 1 with uterine cancer, 1 with melanoma and 1 with cervical cancer.
Conclusion: This study to our knowledge is the largest cohort of patient's with Li-Fraumeni syndrome and associated breast cancer that is followed in a dedicated clinic for patients with Li Fraumeni Syndrome. This cohort highlights the characteristics of patients with Li-Fraumeni syndrome and associated diagnosis of breast cancer as well as other primary cancers.
Citation Format: Al-Awadhi A, Liu DD, Gutierrez-Barrera AM, Strong LC, Arun BK. Clinical and pathological characteristics and screening outcome for secondary cancers of women with breast cancer and Li-Fraumeni syndrome [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-02.
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Affiliation(s)
- A Al-Awadhi
- Cancer Medicine Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX; Center for Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - DD Liu
- Cancer Medicine Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX; Center for Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - AM Gutierrez-Barrera
- Cancer Medicine Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX; Center for Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - LC Strong
- Cancer Medicine Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX; Center for Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - BK Arun
- Cancer Medicine Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX; Center for Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ueno NT, Tahara RK, Reuben JM, Gao H, Saigal B, Fujii T, Lucci A, Ibrahim NK, Damodaran S, Shen Y, Liu DD, Hortobagyi GN, Tripathy D, Lim B, Chasen BA. Abstract P1-18-04: CTCs and SUV to predict the efficacy of the bone-specific radiopharmaceutical agent radium-223 dichloride combined with hormonal therapy for hormone receptor-positive bone-dominant breast cancer metastasis. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-18-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Radium-223 dichloride (Ra-223) is a targeted alpha particle-based radiotherapeutic that has a localized cytotoxic effect on bone metastases. We sought to determine whether the circulating tumor cell (CTC) count and the presence of CTCs in epithelial-mesenchymal transition (EMT-CTCs) along with the standardized uptake value (SUV) on positron emission tomography-computed tomography (PET/CT) scans predict the efficacy of combined Ra-223 and hormonal therapy in patients with hormone receptor (HR)-positive bone-dominant metastatic breast cancer.
Patients and Methods: In this single-center phase 2 study (NCT02366130), 36 patients received Ra-223 (55 kBq/kg intravenously) on day 1 and then every 4 weeks for six cycles. Patients also received a standard care endocrine monotherapy. One non-bone metastatic site was allowed. The number of prior endocrine therapies was not limited and one prior chemotherapy was allowed for metastasis. Response was evaluated using the PET Response Criteria in Solid Tumors (PERCIST) with PET/CT at baseline, 6 and 9 months (mo) later. The CTC count (CellSearch) and the presence of EMT-CTCs (AdnaTest) was determined at baseline, 6 and 9 mo later. Progression-free survival (PFS) time was calculated to evaluate efficacy.
Results: Seven patients (20%) had a non-bone metastatic site. The median number of prior therapies for metastasis was 1 (range, 0-4). Six patients (17%) received chemotherapy. The median CTC count at baseline was 4 (range, 0-306). Only four patients (11%) were positive for EMT-CTCs at baseline. The median follow-up time was 14.7 mo (95% confidence interval [CI], 13.2 mo-not reached [NR]). The disease control rate at 9 mo was 46% in 33 patients who reached 9 mo or progressed up to 9 mo. The tumor response rate at 6 mo was 52% (complete/partialresponse rate; 22/30 %) in 27 patients whose disease was evaluable using PERCIST. The SUV on PET/CT decreased significantly at 6 and 9 mo after baseline (average decreases of 1.5 (p=0.0004) and 2.5 (p=0.0054), respectively). The median PFS duration was 7.4 mo (95% CI, 4.8 mo-NR). The median bone PFS was 16 mo (95% CI, 7.3 mo-NR). Patients with bone-only metastasis (N=28, 80%) had a significantly longer median PFS duration than did patients with non-bone metastases at baseline (N=7, 20%) (13.8 mo versus 4.5 mo; p=0.017). Patients without prior treatment (N=12, 34%) tended to have longer median PFS durations than did those who underwent prior treatment (N=23, 66%) (16.8 mo versus 4.8 mo; p=0.1865). Also, patients with <5 CTCs at baseline (N=19, 54%) tended to have longer median PFS durations than did those with ≥5 CTCs (N=16, 46%) (13.8 mo versus 4.8 mo; p=0.1277). EMT-CTCs status did not predict efficacy.
Conclusions: Bone-only metastatic breast cancer and SUV suppression by Ra-223 are predictive of efficacy. Patients with baseline <5 CTC count tended to have better outcomes than did those with ≥5 CTCs. Combined treatment with Ra-223 and a hormonal agent is especially effective at controlling bone metastasis in patients with HR-positive breast cancer. Bone-only metastatic disease and CTC count should be factored in future clinical trial designs.
Citation Format: Ueno NT, Tahara RK, Reuben JM, Gao H, Saigal B, Fujii T, Lucci A, Ibrahim NK, Damodaran S, Shen Y, Liu DD, Hortobagyi GN, Tripathy D, Lim B, Chasen BA. CTCs and SUV to predict the efficacy of the bone-specific radiopharmaceutical agent radium-223 dichloride combined with hormonal therapy for hormone receptor-positive bone-dominant breast cancer metastasis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-18-04.
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Affiliation(s)
- NT Ueno
- The University of Texas MD Anderson Cancer Center, Houston
| | - RK Tahara
- The University of Texas MD Anderson Cancer Center, Houston
| | - JM Reuben
- The University of Texas MD Anderson Cancer Center, Houston
| | - H Gao
- The University of Texas MD Anderson Cancer Center, Houston
| | - B Saigal
- The University of Texas MD Anderson Cancer Center, Houston
| | - T Fujii
- The University of Texas MD Anderson Cancer Center, Houston
| | - A Lucci
- The University of Texas MD Anderson Cancer Center, Houston
| | - NK Ibrahim
- The University of Texas MD Anderson Cancer Center, Houston
| | - S Damodaran
- The University of Texas MD Anderson Cancer Center, Houston
| | - Y Shen
- The University of Texas MD Anderson Cancer Center, Houston
| | - DD Liu
- The University of Texas MD Anderson Cancer Center, Houston
| | - GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston
| | - D Tripathy
- The University of Texas MD Anderson Cancer Center, Houston
| | - B Lim
- The University of Texas MD Anderson Cancer Center, Houston
| | - BA Chasen
- The University of Texas MD Anderson Cancer Center, Houston
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Willey JS, Parker CA, Valero V, Lim B, Reuben JM, Krishnamurthy S, Gong Y, Scoggins ME, Dryden MJ, Liu DD, Woodward WA, Ueno NT. Abstract OT1-02-01: A phase II study of anti-PD-1 (MK-3475) therapy in patients with metastatic inflammatory breast cancer (MIBC) or non-IBC triple negative breast cancer (non-IBC TNBC) who have achieved clinical response or stable disease to prior chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Primary Objective: To assess the efficacy of MK-3475 as a single agent in patients with MIBC and non-IBC TNBC. The primary endpoint is disease control rate at the end of 4 months after receiving the treatment. We will also investigate the association between biomarkers in the peripheral blood and tumor tissue, safety and efficacy.
Background: The extensive invasion of lymphatic vessels by tumor emboli in patients with IBC suggests that the host immune surveillance system is suboptimal or that the tumor cells have decreased immunogenicity through immune editing to avoid detection by the host. In the immune-competent host, tumor cells must overcome both innate and adaptive immunologic defenses of the host. The PD-1 receptor-ligand interaction is a major pathway hijacked by tumors to suppress immune control. MK-3475 is a potent and highly selective humanized mAb designed to block the interaction between PD-1 and its ligands, PD-L1 and PD-L2. MK-3475 strongly enhances T lymphocyte immune responses in cultured blood cells from healthy human donors, cancer patients, and primates. Mouse anti-PD-1, as a monotherapy, demonstrated efficacy in several syngeneic mouse tumor models. To date, no specific targeted therapeutic options exist for the treatment of MIBC and TNBC. After patients achieving a clinical response to systemic therapy, the maintenance of disease control is not guaranteed. Further, our recent publication suggests that IBC has immune dysfunction. Chemotherapies can debulk the disease volume but cannot be used for maintenance due to their toxicities. Using an anti PD-1 monoclonal antibody is a promising approach for this patient population.
Study Design and Treatment Plan: This is a single arm phase II study. Up to 35 patients with HER2 negative MIBC or metastatic TN-IBC (MTNBC) who have achieved clinical response or stable disease after receiving any prior systemic therapy for metastatic/recurrent disease, and meet all other criteria will be eligible. Patients will receive MK-3475 200 mg IV every 3 weeks for up to 2 years.
Statistical Considerations: The trial will be conducted using Simon's optimal two-stage design and the rate of disease control will be estimated accordingly. It is assumed that the MK-3475 single agent will have a disease control rate of 30%. A disease control rate of 10% or lower will be considered treatment failure and the regimen will be rejected under this circumstance.
Status of the study:
Activation Date: June 2015. 13 patients have been enrolled. Enrollment continues.
Sponsor: Merck Sharp & Dohme Corp.
State of Texas appropriation for rare and aggressive breast cancer research.
Citation Format: Willey JS, Parker CA, Valero V, Lim B, Reuben JM, Krishnamurthy S, Gong Y, Scoggins ME, Dryden MJ, Liu DD, Woodward WA, Ueno NT. A phase II study of anti-PD-1 (MK-3475) therapy in patients with metastatic inflammatory breast cancer (MIBC) or non-IBC triple negative breast cancer (non-IBC TNBC) who have achieved clinical response or stable disease to prior chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-01.
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Affiliation(s)
- JS Willey
- MD Anderson Cancer Center, Houston, TX
| | - CA Parker
- MD Anderson Cancer Center, Houston, TX
| | - V Valero
- MD Anderson Cancer Center, Houston, TX
| | - B Lim
- MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- MD Anderson Cancer Center, Houston, TX
| | | | - MJ Dryden
- MD Anderson Cancer Center, Houston, TX
| | - DD Liu
- MD Anderson Cancer Center, Houston, TX
| | | | - NT Ueno
- MD Anderson Cancer Center, Houston, TX
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Willey JS, Marx AN, Lim B, Ibrahim NK, Valero V, Mittendorf EA, Reuben JM, Le-Petross HT, Whitman GJ, Krishnamurthy S, Woodward WA, Lucci A, Liu DD, Shen Y, Ueno NT. Abstract OT1-01-05: A phase II study using talimogene laherparepvec as a single agent for inflammatory breast cancer or non-inflammatory breast cancer patients with inoperable local recurrence. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-01-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: The primary purpose of the study is to determine the local and systemic antitumor efficacy of talimogene laherparepvec in locally recurrent breast cancer patients with or without distant metastases, as evidenced by improved overall response rates. This will be the first study to use biopsy of distant disease to demonstrate whether systemic immune modulation has antitumor efficacy in breast cancer patients.
BACKGROUND: Patients with locally recurrent breast disease frequently undergo multimodal treatment at the first occurrence of breast cancer, and because local treatment modalities such as surgical intervention and radiation are difficult to add, they subsequently receive systemic therapy. Talimogene laherparepvec (T-VEC) was developed to eliminate solid tumors and has since been considered as a potential treatment option for body surface tumors. In addition to T-VECinjected area, this agent is capable of modifying the immune response with the potential of inhibiting distant metastases. Hence, locally recurrent breast disease could benefit from T-VECregardless of concomitant distant metastases, and may offer a new local treatment option.
Study Design and Treatment Plan: This is a single agent phase II study. Patients with breast cancer who have recurrence of chest wall disease with or without distant metastasis, have at least 1 injectable lesion ≥5 mm in longest diameter or multiple injectable lesions that in aggregate have a longest diameter of ≥ 5 mm, and meet inclusion and exclusion criteria will be eligible to participate in the study. Patient will receive T-VEC via intra-tumoral injection every 2 weeks after the first initial injection (3 weeks).
STATISTICAL METHODS:
Up to 35 patients will be enrolled in the study. The trial will be conducted using a two-stage design and the overall response rate will be estimated accordingly. It is assumed that the talimogene laherparepvec single agent will have a response rate of 20%. A response rate of 5% or lower will be considered treatment failure and the regimen will be rejected under this circumstance.
Status of the study:
Activation Date: Aug 2016. 6 patients have been treated. Enrollment continues.
Sponsor: Amgen
State of Texas appropriation for rare and aggressive breast cancer research.
Citation Format: Willey JS, Marx AN, Lim B, Ibrahim NK, Valero V, Mittendorf EA, Reuben JM, Le-Petross HT, Whitman GJ, Krishnamurthy S, Woodward WA, Lucci A, Liu DD, Shen Y, Ueno NT. A phase II study using talimogene laherparepvec as a single agent for inflammatory breast cancer or non-inflammatory breast cancer patients with inoperable local recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-01-05.
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Affiliation(s)
- JS Willey
- MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- MD Anderson Cancer Center, Houston, TX
| | - B Lim
- MD Anderson Cancer Center, Houston, TX
| | | | - V Valero
- MD Anderson Cancer Center, Houston, TX
| | | | - JM Reuben
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - A Lucci
- MD Anderson Cancer Center, Houston, TX
| | - DD Liu
- MD Anderson Cancer Center, Houston, TX
| | - Y Shen
- MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- MD Anderson Cancer Center, Houston, TX
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Tahara RK, Fujii T, Saigal B, Ibrahim NK, Damodaran S, Barcenas CH, Murray JL, Chasen BA, Shen Y, Liu DD, Hortobagyi GN, Tripathy D, Ueno NT. Abstract P1-16-02: Phase II study of the feasibility and safety of radium-223 dichloride in combination with hormonal therapy and denosumab for the treatment of patients with hormone receptor-positive breast cancer with bone-dominant metastasis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-16-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Radium-223 dichloride (Ra-223) is a therapeutic alpha particle-emitting radiopharmaceutical compound which have antitumor effect targeted on bone metastases. Alpha particles induces double strand DNA breaks and localized cytotoxic effect to cancer cells with limiting harm on normal tissues. We are conducting a phase II clinical trial of combination of Ra-223, hormonal therapy, and denosumab treatment in patients with hormone receptor (HR)-positive bone-dominant metastatic breast cancer (NCT02366130). In this preliminary analysis of the study, we aimed to evaluate the feasibility and safety of this combination therapy.
Methods
This single-center phase II study seeks to determine the efficacy and safety of Ra-223 in combination with hormonal therapy and denosumab. Major eligibility criteria include HR-positive breast cancer with bone and/or marrow predominant metastases. Patients with two or more visceral metastases were not eligible. There was no limit in the number of prior hormonal therapies in the metastatic setting. Patients received Ra-223 injection (55 kBq/kg intravenously) on day 1 of the study and then every 4 weeks thereafter for 6 cycles. Patients were also administered a single hormonal agent (i.e., tamoxifen, aromatase inhibitor, or fulvestrant at standard doses) daily and denosumab (120 mg subcutaneously) every 4 weeks. For this analysis, adverse events (AEs) were summarized using descriptive statistics.
Results
A total of 25 patients were enrolled and 22 were evaluable between March 2015 and December 2016. Median age was 58.5 years (range 31-79), and 59% of patients were postmenopausal. ECOG performance status was 0 in 16 patients (73%), and 1 in six patients (27%). HER2/neu was positive in only one patient. Four patients (18%) were de novo metastasis, no patients had visceral metastasis, and multiple bone metastases in 20 patients (91%) vs. focal metastasis in 2 (9%). Median time from diagnosis of bone metastasis was 4.8 months (range 0.5-96.6). Prior therapy for metastatic disease consisted of hormonal therapy in 50% of the patients (eight patients with one line and three patients with two lines), chemotherapy (9%), palbociclib (14%), radiation to bone metastasis (50%), and bone-supportive therapy (27% with zoledronic acid, 27% with denosumab). The median number of cycles of Ra-223 administered was 6 (range 4-6).
The median follow-up time was 4 months (range 2-8). There were no grade 3 or 4 AEs. Major non-hematological grade 1 and 2 AEs were bone pain (77%), fatigue (45%), nausea (36%), diarrhea (32%), AST/ALT elevation (23%), hot flashes (23%), and headache (18%). The most common hematological AEs were grade 1 or 2 neutropenia (23%), anemia (14%), and thrombocytopenia (18%). There was no treatment delay or discontinuation due to AEs.
Conclusion
Our results suggest that the addition of Ra-223 to hormonal therapy and denosumab is a feasible and safe combination therapy in patients with HR-positive breast cancer with bone-dominant metastasis. We continue to enroll patients in the phase II trial to evaluate the efficacy of the treatment.
Citation Format: Tahara RK, Fujii T, Saigal B, Ibrahim NK, Damodaran S, Barcenas CH, Murray JL, Chasen BA, Shen Y, Liu DD, Hortobagyi GN, Tripathy D, Ueno NT. Phase II study of the feasibility and safety of radium-223 dichloride in combination with hormonal therapy and denosumab for the treatment of patients with hormone receptor-positive breast cancer with bone-dominant metastasis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-16-02.
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Affiliation(s)
- RK Tahara
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Fujii
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Saigal
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - NK Ibrahim
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Damodaran
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - CH Barcenas
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - JL Murray
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - BA Chasen
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y Shen
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - DD Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Chia CW, Carlson OD, Liu DD, González-Mariscal I, Santa-Cruz Calvo S, Egan JM. Incretin secretion in humans is under the influence of cannabinoid receptors. Am J Physiol Endocrinol Metab 2017; 313:E359-E366. [PMID: 28655715 PMCID: PMC5625085 DOI: 10.1152/ajpendo.00080.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/26/2023]
Abstract
The mechanisms regulating incretin secretion are not fully known. Human obesity is associated with altered incretin secretion and elevated endocannabinoid levels. Since cannabinoid receptors (CBRs) are expressed on incretin-secreting cells in rodents, we hypothesized that endocannabinoids are involved in the regulation of incretin secretion. We compared plasma glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) responses during oral glucose tolerance test (OGTT) in 20 lean and 20 obese participants from the Baltimore Longitudinal Study of Aging (BLSA). Next, we recruited 20 healthy men to evaluate GIP and GLP-1 responses during OGTT after administering placebo or nabilone (CBR agonist) in a randomized, double-blind, crossover fashion. Compared with the BLSA lean group, the BLSA obese group had significantly higher fasting and post-OGTT GIP levels, but similar fasting GLP-1 and significantly lower post-OGTT GLP-1 levels. In the nabilone vs. placebo study, when compared with placebo, nabilone resulted in significantly elevated post-dose fasting GIP levels and post-OGTT GIP levels, but no change in post-dose fasting GLP-1 levels together with significantly lower post-OGTT GLP-1 levels. Glucose levels were not different with both interventions. We conclude that elevated GIP levels in obesity are likely a consequence of increased endocannabinoid levels. CBRs exert tonic control over GIP secretion, which may have a homeostatic effect in suppressing GLP-1 secretion. This raises the possibility that gut hormones are influenced by endocannabinoids.
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Affiliation(s)
- Chee W Chia
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Olga D Carlson
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - David D Liu
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Isabel González-Mariscal
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Sara Santa-Cruz Calvo
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Josephine M Egan
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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Song PP, Qian XY, Zhou H, Shen XH, Liu DD, Feng AN, Gao X. [Expression of E-cadherin, N-cadherin, β-catenin and their clinical significance in laryngeal carcinoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 51:440-5. [PMID: 27345880 DOI: 10.3760/cma.j.issn.1673-0860.2016.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the expression of E-cadherin(E-cad), N-cadherin(N-cad), β-catenin(β-cat), which are the markers of Epithelial-mesenchymal transition and analyze their relationships with the clinicopathological features and the prognosis of the laryngeal squamous cell carcinoma. METHODS The expression levels of E-cad, N-cad, β-cat in 76 tumor tissues and their corresponding adjacent normal laryngeal tissues were determined by immunohistochemistry method. Relationships between the proteins' expression and clinicopathological features were analyzed. Survival curves were calculated using the Kaplan-Meier method. Differences in the survival rates were analyzed by the log-rank test among different expression groups. Cox's regression model was used to examine the independent predictor of the prognosis of the laryngeal cancer. RESULTS The expression levels of E-cad, N-cad, β-cat in tumor tissues and adjacent normal tissues were statistically significant(P<0.001). The expression level of E-cad and β-cat in the laryngeal carcinoma was related to lymph node metastasis, clinical pathological stage and differentiation degree (P<0.05), while N-cad expression level was associated with clinical stage and differentiation degree (P<0.05). The expression of E-cad was correlated with the expression of β-cat (P=0.001), and the expression of N-cad was correlated with β-cat (P=0.02), but the expression of E-cad was not correlated with N-cad. There were four subgroups of patterns of E-cad and N-cad expression: E-cad (+ )/N-cad (-), E-cad (+ ) /N-cad (+ ), E-cad (-) /N-cad (-), E-cad (-) /N-cad (+ ). The expression level of each group was related to the clinical pathological stage and differentiation degree (P<0.05). The expression level of E-cad/β-cat was associated with lymph node metastasis, clinical pathological stage and differentiation degree (P<0.01). Log-rank analysis showed that the prognosis of negative and positive groups was statistically different (P<0.05), and the combined analysis showed that the prognosis of E-cad/N-cad or E-cad/β-cat group was significantly different (P<0.01). Cox's regression model analysis showed that the clinical stage and β-cat were independent predictors of the prognosis of laryngeal carcinoma. CONCLUSIONS The low expression of E-cad, high abnormal expression of N-cad and β-cat played an important role in the occurrence and development of laryngeal carcinoma. It can provide a reference for evaluating clinical prognosis. The clinical pathological stage and β-cat can be used as independent predictors for the prognosis of laryngeal carcinoma.
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Affiliation(s)
- P P Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - X Y Qian
- Department of Otorhinolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - H Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - X H Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - D D Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - A N Feng
- Department of Pathology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
| | - X Gao
- Department of Otorhinolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China
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Qiu SY, Liu DD, Zhong JW, Luo X, Liu SF. [A child with palate fistula after coblation adenotonsillectomy]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 52:113-114. [PMID: 28219172 DOI: 10.3760/cma.j.issn.1673-0860.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- S Y Qiu
- Otorhinolaryngology Department of Guangzhou Women and Children's Medical Center, Guangzhou 510120, China
| | - D D Liu
- Otorhinolaryngology Department of Guangzhou Women and Children's Medical Center, Guangzhou 510120, China
| | - J W Zhong
- Otorhinolaryngology Department of Guangzhou Women and Children's Medical Center, Guangzhou 510120, China
| | - X Luo
- Otorhinolaryngology Department of Guangzhou Women and Children's Medical Center, Guangzhou 510120, China
| | - S F Liu
- Otorhinolaryngology Department of Guangzhou Women and Children's Medical Center, Guangzhou 510120, China
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Chia CW, Shardell M, Tanaka T, Liu DD, Gravenstein KS, Simonsick EM, Egan JM, Ferrucci L. Chronic Low-Calorie Sweetener Use and Risk of Abdominal Obesity among Older Adults: A Cohort Study. PLoS One 2016; 11:e0167241. [PMID: 27880832 PMCID: PMC5120853 DOI: 10.1371/journal.pone.0167241] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/10/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity. Participants and Methods We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0–28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes—body mass index, waist circumference, obesity and abdominal obesity—with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders. Results With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m2 higher body mass index (95% confidence interval [CI], 0.17–1.44), 2.6 cm larger waist circumference (95% CI, 0.71–4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10–1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10–2.12) of abdominal obesity than low-calorie sweetener non-users. Conclusions Low-calorie sweetener use is independently associated with heavier relative weight, a larger waist, and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control.
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Affiliation(s)
- Chee W. Chia
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Michelle Shardell
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Toshiko Tanaka
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - David D. Liu
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Kristofer S. Gravenstein
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Eleanor M. Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Josephine M. Egan
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
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Kovatcheva M, Liu DD, Dickson MA, Klein ME, O'Connor R, Wilder FO, Socci ND, Tap WD, Schwartz GK, Singer S, Crago AM, Koff A. MDM2 turnover and expression of ATRX determine the choice between quiescence and senescence in response to CDK4 inhibition. Oncotarget 2016; 6:8226-43. [PMID: 25803170 PMCID: PMC4480747 DOI: 10.18632/oncotarget.3364] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/15/2015] [Indexed: 12/19/2022] Open
Abstract
CDK4 inhibitors (CDK4i) earned Breakthrough Therapy Designation from the FDA last year and are entering phase III clinical trials in several cancers. However, not all tumors respond favorably to these drugs. CDK4 activity is critical for progression through G1 phase and into the mitotic cell cycle. Inhibiting this kinase induces Rb-positive cells to exit the cell cycle into either a quiescent or senescent state. In this report, using well-differentiated and dedifferentiated liposarcoma (WD/DDLS) cell lines, we show that the proteolytic turnover of MDM2 is required for CDK4i-induced senescence. Failure to reduce MDM2 does not prevent CDK4i-induced withdrawal from the cell cycle but the cells remain in a reversible quiescent state. Reducing MDM2 in these cells drives them into the more stable senescent state. CDK4i-induced senescence associated with loss of MDM2 is also observed in some breast cancer, lung cancer and glioma cell lines indicating that this is not limited to WD/DDLS cells in which MDM2 is overexpressed or in cells that contain wild type p53. MDM2 turnover depends on its E3 ligase activity and expression of ATRX. Interestingly, in seven patients the changes in MDM2 expression were correlated with outcome. These insights identify MDM2 and ATRX as new regulators controlling geroconversion, the process by which quiescent cells become senescent, and this insight may be exploited to improve the activity of CDK4i in cancer therapy.
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Affiliation(s)
- Marta Kovatcheva
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - David D Liu
- The Graduate Program in Biochemistry, Cellular and Molecular Biology, Weill College of Medicine, Cornell University, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Mark A Dickson
- Department of Medicine, Weill College of Medicine, Cornell University, New York, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Mary E Klein
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Rachael O'Connor
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Fatima O Wilder
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Nicholas D Socci
- Program in Computational Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - William D Tap
- Department of Medicine, Weill College of Medicine, Cornell University, New York, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Gary K Schwartz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.,Current address: Columbia University, New York, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Aimee M Crago
- Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA.,Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Andrew Koff
- The Louis V. Gerstner Graduate School of Biomedical Sciences, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, USA.,The Graduate Program in Biochemistry, Cellular and Molecular Biology, Weill College of Medicine, Cornell University, New York, USA.,Program in Molecular Biology, Memorial Sloan-Kettering Cancer Center, New York, USA
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Masuda H, Brewer TM, Liu DD, Iwamoto T, Shen Y, Hsu L, Willey JS, Gonzalez-Angulo AM, Chavez-MacGregor M, Fouad TM, Woodward WA, Reuben JM, Valero V, Alvarez RH, Hortobagyi GN, Ueno NT. Long-term treatment efficacy in primary inflammatory breast cancer by hormonal receptor- and HER2-defined subtypes. Ann Oncol 2013; 25:384-91. [PMID: 24351399 DOI: 10.1093/annonc/mdt525] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subtypes defined by hormonal receptor (HR) and HER2 status have not been well studied in inflammatory breast cancer (IBC). We characterized clinical parameters and long-term outcomes, and compared pathological complete response (pCR) rates by HR/HER2 subtype in a large IBC patient population. We also compared disease-free survival (DFS) and overall survival (OS) between IBC patients who received targeted therapies (anti-hormonal, anti-HER2) and those who did not. PATIENTS AND METHODS We retrospectively reviewed the records of patients diagnosed with IBC and treated at MD Anderson Cancer Center from January 1989 to January 2011. Of those, 527 patients had received neoadjuvant chemotherapy and had available information on estrogen receptor (ER), progesterone receptor (PR), and HER2 status. HR status was considered positive if either ER or PR status was positive. Using the Kaplan-Meier method, we estimated median DFS and OS durations from the time of definitive surgery. Using the Cox proportional hazards regression model, we determined the effect of prognostic factors on DFS and OS. Results were compared by subtype. RESULTS The overall pCR rate in stage III IBC was 15.2%, with the HR-positive/HER2-negative subtype showing the lowest rate (7.5%) and the HR-negative/HER2-positive subtype, the highest (30.6%). The HR-negative, HER2-negative subtype (triple-negative breast cancer, TNBC) had the worst survival rate. HR-positive disease, irrespective of HER2 status, had poor prognosis that did not differ from that of the HR-negative/HER2-positive subtype with regard to OS or DFS. Achieving pCR, no evidence of vascular invasion, non-TNBC, adjuvant hormonal therapy, and radiotherapy were associated with longer DFS and OS. CONCLUSIONS Hormone receptor and HER2 molecular subtypes had limited predictive and prognostic power in our IBC population. All molecular subtypes of IBC had a poor prognosis. HR-positive status did not necessarily confer a good prognosis. For all IBC subtypes, novel, specific treatment strategies are needed in the neoadjuvant and adjuvant settings.
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Affiliation(s)
- H Masuda
- Department of Breast Medical Oncology
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Fouad TM, Kogawa T, Liu DD, Shen Y, Masuda H, El-Zein R, Woodward WA, Arun B, Chavez-Macgregor M, Alvarez RH, Lucci A, Krishnamurthy S, Hortobagyi GN, Valero V, Ueno NT. Abstract P6-12-02: Survival differences between patients with metastatic inflammatory and non-inflammatory breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-12-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Very little is known about the survival of patients with inflammatory breast cancer (IBC) and distant metastasis. Furthermore, the American Joint Committee on Cancer classification of breast cancer does not recognize metastatic IBC as a distinct entity within stage IV. We hypothesized that the survival of patients with IBC and distant metastasis is worse than the survival of patients with stage-matched non-IBC.
Patients and Methods: We retrospectively reviewed 5314 consecutive patients with stage III or IV breast cancer (IBC or non-IBC) who were treated at our institution between 1986 and 2012. A total of 1079 patients presented with IBC (stage III: 861; stage IV: 218) and 4235 non-IBC (stage III: 2781; stage IV: 1454). We compared the time to distant metastasis from initial diagnosis, distant metastasis–free survival (DMFS), and overall survival (OS) in stage-matched patients with IBC or non-IBC.
Results: The median follow-up periods were 3.3 years for patients with stage III disease (range, 0-32.2 years) and 1.8 years for patients with stage IV disease (range, 0-19.9 years). The total number of recorded events (metastasis/death) was 1657 for stage III, while the numbers of deaths for stage III and IV were 1337 and 973, respectively. In patients with stage III, the time to distant metastasis was shorter in IBC than in non-IBC (median 1.3 vs. 1.7 years, P < .001). DMFS and OS were shorter in patients with stage III IBC than in those with stage III non-IBC (2.5 vs. 6.9 years, P < .001; and 4.7 vs. 8.9 years, P < .001; respectively). However, there was no significant difference in OS after development of distant metastasis between stage III IBC and non-IBC (median for both 1.3 years, P = .83). In multivariate analysis, the diagnosis of IBC remained significantly associated with mortality after adjusting for potential confounders. De novo stage IV IBC presented more frequently with multiple sites of metastasis than de novo stage IV non-IBC (P = .02). In patients with de novo stage IV disease, OS was shorter in IBC than in non-IBC (2.3 vs. 3.4 years, P = .004). In the multicovariate Cox model, while ethnicity, tumor grade, hormone receptor status and HER2 status, site of metastasis, number of sites of metastasis, and definitive breast surgery by 1 year were all significant factors in OS for stage IV breast cancer, the diagnosis of IBC conferred a hazard ratio of 1.33 (95% confidence interval: 1.05 - 1.69) in multivariate analysis.
Conclusion: Our findings suggest that IBC patients with metastasis at diagnosis have worse outcomes than stage-matched non-IBC patients. IBC patients presenting with de novo stage IV disease should be considered as a separate subcategory of stage IV in the tumor-node-metastasis classification because their clinical course and prognosis are different from those of patients with stage IV non-IBC.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-12-02.
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Affiliation(s)
- TM Fouad
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - T Kogawa
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - DD Liu
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - Y Shen
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - H Masuda
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - R El-Zein
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - WA Woodward
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - B Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - M Chavez-Macgregor
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - RH Alvarez
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - A Lucci
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - S Krishnamurthy
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - GN Hortobagyi
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - V Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
| | - NT Ueno
- The University of Texas MD Anderson Cancer Center, Houston, TX; The National Cancer Institute, Cairo University, Cairo, Egypt
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Ji XR, Yang ZD, Yang XH, Liu DD, Ni HJ, Li M. Change of selenium in environment and risk of adolescent idiopathic scoliosis: a retrospective cohort study. Eur Rev Med Pharmacol Sci 2013; 17:2499-2503. [PMID: 24089230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Scoliosis is the disease which has a long history over one century. However, the pathogenesis remains unclear at present. To demonstrate the effect of different selenium content in environment on the morbidity of adolescent idiopathic scoliosis (AIS). METHODS Retrospective cohort study (follow-up from 1997 to 2009): compare the difference morbidity between high selenium group and the normal selenium group of AIS. PATIENTS 9998 cases from three areas in China were participated in this study. There is different selenium content in these three areas. RESULTS High selenium levels were significant associated with the AIS morbidity. While low selenium level had no significant correlation with the AIS morbidity. CONCLUSIONS This study confirmed that high selenium content in the environment was one of risk factors for idiopathic scoliosis. We speculated that the excessive growth of the spine and the spinal cord asynchronous growth effect were key factors that high selenium content in the environment leads to scoliosis.
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Affiliation(s)
- X R Ji
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Xu JJ, Ren CZ, Wang SS, Liu DD, Cao LQ, Tao JP. Protection Efficacy of Multivalent Egg Yolk Immunoglobulin against Eimeria tenella Infection in Chickens. Iran J Parasitol 2013; 8:449-58. [PMID: 24454440 PMCID: PMC3887248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/27/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND To control avian coccidiosis with drug-independent strategy effectively and safely, multivalent hyperimmune egg yolk immunoglobulin (IgY) was prepared and its ability to protect against Eimeria tenella infection was evaluated. METHODS Hens were orally immunized with live oocysts of 5 species of Eimeria for six times, antibody titers in serum and yolk were monitored by indirect enzyme-linked immunosorbent assay. The specific IgY was isolated, purified and lyophilized. IgY powder was orally administrated as dietary supplement in newly hatched chicks at various dosages. Birds were orally challenged with 10000 sporulated oocysts of E. tenella at 10 days of age, weighed and killed at 8 days post challenge, and the protective effect was assessed. RESULTS The averge yeid of IgY was 9.2 mg/ml yolk, the antibody titer of IgY reached to 1:163840 per mg with the purity up to 98%. Chickens fed IgY resulted in reduced mortality, increased body weight gain (BWG), reduced oocyst shedding, reduced caecal lesion score and increased anti-coccidial index. In terms of BWG and caecal lesion, IgY significantly enhanced the resistance of bird at ≥ 0.05% of IgY in the diet when compared with the challenged control group (P<0.05). No significant difference was observed at dosage ≥ 0.5% and 1.0% when BWG and caecal lesion were compared with the sodium salinomycin control group, respectively (P>0.05). CONCLUSION Supplementing newly hatched chicks with Eimeria-specific IgY represents a promising strategy to prevent avian coccidiosis.
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Brewer TM, Masuda H, Iwamoto T, Liu P, Shen Y, Liu DD, Kai K, Barnett CM, Woodward WA, Reuben JM, Yang P, Hortobagyi GN, Ueno NT. Abstract PD03-08: Statin use and improved outcome in primary inflammatory breast cancer: retrospective cohort study. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd03-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer. HMG-CoA reductase inhibitors (statins) are cholesterol reducing agents with pleiotropic effects, including antitumorigenic and anti-inflammatory properties. We hypothesized that statins reduce the metastatic potential in primary IBC.
Methods We retrospectively reviewed 724 patients diagnosed with and treated for primary IBC at The University of Texas MD Anderson Cancer Center between Jan. 12, 1995 and Jan. 27, 2011. Patients with records indicating statin use at the time of IBC diagnosis on the electronic medical record were compared with those without. We further compared outcomes stratified by statin type (hydrophilic [H] versus lipophilic [L]). We used the Kaplan-Meier method to estimate the median disease-free survival (DFS) after surgery, overall survival (OS), and disease specific survival (DSS), followed by Cox proportional hazards regression model to test statistical significance of several potential prognostic factors.
Results For primary IBC patients who had information on their statin use status at IBC diagnosis, the median DFS time were 4.88 years, 2.47 years and 1.76 years (P= 0.04); the median OS time 5.05 years, 3.79 years and 4.32 years (P= 0.35); and the median DSS time 5.10 years, 3.79 years and 4.52 years (P= 0.37), for patients who took “ H”, “L” and no statin, respectively. In multivariable Cox model stratified by radiation therapy, ER/PR status and HER2 status, statin “H” use was associated with significantly improved DFS compared to no statin use (HR=0.49; 95% CI: 0.28–0.84; p<0.01), adjusted for lymphatic/vascular invasion. Although there is a trend that patients who used statin “H” had a longer time to death compared to patients who did not take statin, it did not reach statistical significance for OS (HR=0.80; 95% CI: 0.43–1.49; p=0.49) and DSS (HR=0.85; 95% CI: 0.46–1.57, p=0.59) after adjustment for lymphatic/vascular invasion, nuclear grade and surgery status within one year.
Conclusions Hydrophilic statin use was associated with improved DFS. There was a trend for reduced HR in OS and DSS among primary IBC patient who used hydrophilic statins. A prospective randomized study to evaluate the potential survival benefits of statins in primary IBC population is warranted.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD03-08.
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Affiliation(s)
- TM Brewer
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - H Masuda
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - T Iwamoto
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - P Liu
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - Y Shen
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - DD Liu
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - K Kai
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - CM Barnett
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - WA Woodward
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - JM Reuben
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - P Yang
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - GN Hortobagyi
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
| | - NT Ueno
- MD Anderson Cancer Center, Houston, TX; Eastern Virginia Medical School, Norfolk, VA; University of Florida, Gainesville, FL; Okayama University Hospital, Okayama, Japan
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