1
|
Prairie ML, Gencturk M, McClelland CM, Marka NA, Jiang Z, Folkertsma M, Lee MS. Establishing Optic Nerve Diameter Threshold Sensitive and Specific for Optic Atrophy Diagnosis. Clin Neuroradiol 2024:10.1007/s00062-023-01369-w. [PMID: 38172261 DOI: 10.1007/s00062-023-01369-w] [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: 04/13/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To determine a potential threshold optic nerve diameter (OND) that could reliably differentiate healthy nerves from those affected by optic atrophy (OA) and to determine correlations of OND in OA with retinal nerve fiber layer (RNFL) thickness, visual acuity (VA), and visual field mean deviation (VFMD). METHODS This was a retrospective case control study. Magnetic resonance (MR) images were reviewed from individuals with OA aged 18 years or older with vision loss for more than 6 months and an OA diagnosis established by a neuro-ophthalmologist. Individuals without OA who underwent MR imaging of the orbit for other purposes were also collected. OND was measured on coronal T2-weighted images in the midorbital section, 1cm posterior to the optic disc. Measurements of mean RNFL thickness, VA and VFMD were also collected. RESULTS In this study 47 OA subjects (63% women, 78 eyes) and 75 normal subjects (42.7% women, 127 eyes) were assessed. Healthy ONDs (mean 2.73 ± 0.24 mm) were significantly greater than OA nerve diameters (mean 1.94 ± 0.32 mm; P < 0.001). A threshold OND of ≤2.3 mm had a sensitivity of 0.92 and a specificity of 0.93 in predicting OA. Mean RNFL (r = 0.05, p = 0.68), VA (r = 0.17, p = 0.14), and VFMD (r = 0.18, p = 0.16) were not significantly associated with OND. CONCLUSION ONDs are significantly reduced in patients with OA compared with healthy nerves. A threshold OND of ≤2.3 mm is highly sensitive and specific for a diagnosis of OA. OND was not significantly correlated with RNFL thickness, VA, or VFMD.
Collapse
Affiliation(s)
- Michael L Prairie
- Departments of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Mehmet Gencturk
- Department of Neuroradiology, University of Minnesota, Minneapolis, MN, USA
| | - Collin M McClelland
- Departments of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas A Marka
- Department of Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Ziou Jiang
- Department of Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Mark Folkertsma
- Department of Neuroradiology, University of Minnesota, Minneapolis, MN, USA
| | - Michael S Lee
- Departments of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
2
|
Spiekman M, Francia DL, Mossel DM, Brouwer LA, Diercks GFH, Vermeulen KM, Folkertsma M, Ghods M, Kzhyshkowska J, Klüter H, Krenning G, van der Lei B, Harmsen MC. Autologous Lipofilling Improves Clinical Outcome in Patients With Symptomatic Dermal Scars Through Induction of a Pro-Regenerative Immune Response. Aesthet Surg J 2022; 42:NP244-NP256. [PMID: 34270698 PMCID: PMC8922688 DOI: 10.1093/asj/sjab280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Autologous lipofilling is an emerging procedure to treat and possibly reverse dermal scars and to reduce scar-related pain, but its efficacy and mechanisms are poorly understood. OBJECTIVES The aim of this study was to test the hypothesis that repeated lipografts reverse dermal scars by reinitiation of wound healing. METHODS In a prospective, non-placebo-controlled clinical study, 27 adult patients with symptomatic scars were given 2 lipofilling treatments at 3-month intervals. As primary outcome, clinical effects were measured with the Patient and Observer Scar Assessment Scale (POSAS). Scar biopsies were taken before and after treatments to assess scar remodeling at a cellular level. RESULTS Twenty patients completed the study. Patients' scars improved after lipofilling. The total POSAS scores (combined patient and observer scores) decreased from 73.2 [14.7] points (mean [standard deviation]) pretreatment to 46.1 [14.0] and 32.3 [13.2] points after the first and second lipofilling treatment, respectively. Patient POSAS scores decreased from 37.3 [8.8] points to 27.2 [11.3] and 21.1 [11.4] points, whereas observer POSAS scores decreased from 35.9 [9.5] points to 18.9 [6.0] and 11.3 [4.5] points after the first and second treatment, respectively. After each lipofilling treatment, T lymphocytes, mast cells, and M2 macrophages had invaded scar tissue and were associated with increased vascularization. In addition, the scar-associated epidermis showed an increase in epidermal cell proliferation to levels similar to that normal in skin. Moreover, lipofilling treatment caused normalization of the extracellular matrix organization towards that of normal skin. CONCLUSIONS Autologous lipofilling improves the clinical outcome of dermal scars through the induction of a pro-regenerative immune response, increased vascularization, and epidermal proliferation and remodeling of scar tissue extracellular matrix. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Maroesjka Spiekman
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Delia L Francia
- Department of Plastic and Reconstructive and Aesthetic Surgery, Academic Hospital of the Medical University Charité, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Dieuwertje M Mossel
- University of Heidelberg, Medical Faculty Mannheim, Institute of Transfusion Medicine and Immunology, Mannheim, Germany
| | - Linda A Brouwer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gilles F H Diercks
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mark Folkertsma
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mojtaba Ghods
- Department of Plastic and Reconstructive and Aesthetic Surgery, Academic Hospital of the Medical University Charité, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Julia Kzhyshkowska
- Department of Plastic and Reconstructive and Aesthetic Surgery, Academic Hospital of the Medical University Charité, Ernst Von Bergmann Clinic, Potsdam, Germany
| | - Harald Klüter
- Ruprecht Karls Universität Heidelberg Medizinische Fakultät Mannheim, Institute of Transfusion Medicine and Immunology, Mannheim, Germany
| | - Guido Krenning
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin C Harmsen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
3
|
Gessler DJ, Neil EC, Shah R, Levine J, Shanks J, Wilke C, Reynolds M, Zhang S, Özütemiz C, Gencturk M, Folkertsma M, Bell WR, Chen L, Ferreira C, Dusenbery K, Chen CC. GammaTile® brachytherapy in the treatment of recurrent glioblastomas. Neurooncol Adv 2021; 4:vdab185. [PMID: 35088050 PMCID: PMC8788013 DOI: 10.1093/noajnl/vdab185] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background GammaTile® (GT) is a recent U.S. Food and Drug Administration (FDA) cleared brachytherapy platform. Here, we report clinical outcomes for recurrent glioblastoma patients after GT treatment following maximal safe resection. Methods We prospectively followed twenty-two consecutive Isocitrate Dehydrogenase (IDH) wild-type glioblastoma patients (6 O6-Methylguanine-DNA methyltransferase methylated (MGMTm); sixteen MGMT unmethylated (MGMTu)) who underwent maximal safe resection of recurrent tumor followed by GT placement. Results The cohort consisted of 14 second and eight third recurrences. In terms of procedural safety, there was one 30-day re-admission (4.5%) for an incisional cerebrospinal fluid leak, which resolved with lumbar drainage. No other wound complications were observed. Six patients (27.2%) declined in Karnofsky Performance Score (KPS) after surgery due to worsening existing deficits. One patient suffered a new-onset seizure postsurgery (4.5%). There was one (4.5%) 30-day mortality from intracranial hemorrhage secondary to heparinization for an ischemic limb. The mean follow-up was 733 days (range 279–1775) from the time of initial diagnosis. Six-month local control (LC6) and twelve-month local control (LC12) were 86 and 81%, respectively. Median progression-free survival (PFS) was comparable for MGMTu and MGMTm patients (~8.0 months). Median overall survival (OS) was 20.0 months for the MGMTu patients and 37.4 months for MGMTm patients. These outcomes compared favorably to data in the published literature and an independent glioblastoma cohort of comparable patients without GT treatment. Conclusions This clinical experience supports GT brachytherapy as a treatment option in a multi-modality treatment strategy for recurrent glioblastomas.
Collapse
Affiliation(s)
- Dominic J Gessler
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth C Neil
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rena Shah
- Department of Oncology, North Memorial Health, Robbinsdale, Minnesota, USA
| | - Joseph Levine
- Department of Oncology, North Memorial Health, Robbinsdale, Minnesota, USA
| | - James Shanks
- Department of Oncology, Fairview Cancer Care, Minneapolis, Minnesota, USA
| | - Christopher Wilke
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Margaret Reynolds
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shunqing Zhang
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Can Özütemiz
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mehmet Gencturk
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark Folkertsma
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Robert Bell
- Department of Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Liam Chen
- Department of Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clara Ferreira
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|