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Leroy HA, Vaziri S, Assaker R, Wang MY. Digital Tubular-Based Camera-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:481-482. [PMID: 38084946 DOI: 10.1227/ons.0000000000001027] [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: 05/14/2023] [Accepted: 09/19/2023] [Indexed: 03/16/2024] Open
Affiliation(s)
- Henri-Arthur Leroy
- Department of Neurosurgery, CHU Lille, Lille , France
- AO Spine, Educational Officer for France, Davos , Switzerland
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Sasha Vaziri
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Richard Assaker
- Department of Neurosurgery, CHU Lille, Lille , France
- AO Spine, Minimally Invasive Task Force, Davos , Switzerland
| | - Michael Y Wang
- Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, Miami , Florida , USA
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Pierre K, Bardhi O, Laurent D, Vaziri S, Lucke-Wold B, Brennan MM, Dagra A, Olowofela B, Barthélemy E. The AANS Harvey Cushing Medal: a demographic and academic analysis of its recipients. Egypt J Neurosurg 2023; 38:66. [PMID: 38037602 PMCID: PMC10688272 DOI: 10.1186/s41984-023-00243-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Background The Harvey Cushing Medal, awarded by the American Association of Neurological Surgeons, is the premier accolade in neurosurgery. The study's purpose was to examine the qualities and accomplishments of previous winners, emphasizing potential selection biases, with the aim to promote social justice and guide young neurosurgeons in their career paths. Results Predominantly, recipients graduated from top-ranked United States News and World Report institutions and specialized in cerebrovascular and neuro-oncologic/skull base neurosurgery. A significant proportion held roles as department or division chairs and led neurosurgical organizations. All awardees were male, and there was a notable trend of increasing publication counts among more recent recipients. Conclusions Commonalities among Harvey Cushing Medal winners include graduating from top institutions, holding significant leadership roles, and having an extensive publication history. However, the absence of female and underrepresented minority awardees underscores an urgent need for greater diversity in the selection process.
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Affiliation(s)
- Kevin Pierre
- Department of Radiology, University of Florida, 1600 SW Archer Rd, PO Box 100265, Gainesville, FL 32610-0265, USA
| | - Olgert Bardhi
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Sasha Vaziri
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Meghan M. Brennan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Abeer Dagra
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Ernest Barthélemy
- Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Porche K, Vaziri S, Stein A, Awan O, Kubilis PS, Lipori P, Hoh DJ, Polifka A, Fox WC. The effect of myelopathic symptoms on hospital costs, length of stay, and discharge location in anterior cervical discectomy and fusion. Neurosurg Focus 2023; 55:E8. [PMID: 37657101 DOI: 10.3171/2023.6.focus23288] [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: 04/29/2023] [Accepted: 06/13/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is a common clinical degenerative disease treated with anterior cervical discectomy and fusion (ACDF), which seriously impacts quality of life and causes severe disability. The objective of the study was to determine the effect of different characteristics of the neurological deficit found in myelopathic patients undergoing ACDFs on hospital cost, length of stay (LOS), and discharge location. METHODS This is a retrospective review of ACDF cases performed at a single institution by multiple surgeons from 2011 to 2017. Patient symptomatology, complications, comorbidities, demographics, surgical time, LOS, and discharge location were collected. Patients with readmissions or reoperations were excluded. Symptoms evaluated were based on clinical diagnosis, Japanese Orthopaedic Association classification, Ranawat grade, and Cooper scales. Symptoms were further grouped using principal component analysis. Cost was defined as surgical episode hospital stay costs plus outpatient clinic costs plus discharge disposition cost. Multivariate linear regression models were created to evaluate correlations with outcomes. The primary outcome was total 90-day hospital costs. Secondary outcomes were discharge location and LOS. RESULTS A total of 250 patients were included in the analyses. Discharge location, neuromonitoring use, number of surgical vertebral levels, cage use, LOS, surgical time, having a complication, and sex were all found to be predictive of total 90-day costs. Myelopathic symptomatology was not found to be associated with increased 90-day costs (p ≥ 0.131) when correcting for these other factors. Lower-extremity functionality was found to be associated with increased LOS (p < 0.0001). Upper-extremity myelopathy was found to be associated with increased discharge location needs (p < 0.0001). CONCLUSIONS Cervical myelopathy was not found to be predictive of total 90-day costs using symptomatology based on multiple myelopathy grading systems. Lower-extremity functionality was, however, found to predict LOS, while upper-extremity myelopathy was found to predict increased discharge location needs. This implies that preoperative deficits from myelopathy should not be considered in a bundled payment system; however, certain myelopathic symptoms should be considered when determining the cost of care.
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Affiliation(s)
- Ken Porche
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville
| | - Sasha Vaziri
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville
| | - Alan Stein
- 1College of Medicine, University of Florida, Gainesville
- 3Department of General Surgery, University of Florida, Gainesville, Florida
- 4Department of Neurologic Surgery, Westchester Medical Center, Valhalla, New York
| | - Omar Awan
- 1College of Medicine, University of Florida, Gainesville
- 5Department of Neurologic Surgery, Inova Center for Personalized Health, Fairfax, Virginia; and
| | - Paul S Kubilis
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville
| | - Paul Lipori
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville
| | - Daniel J Hoh
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville
| | - Adam Polifka
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville
| | - W Christopher Fox
- 6Department of Neurologic Surgery, Mayo Clinic Florida, Jacksonville, Florida
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Porche K, Yan SC, Mehkri Y, Sriram S, MacNeil A, Melnick K, Garvan C, Vaziri S, Seubert C, Murad G, Decker M, Polifka A, Hoh DJ, Mohamed B. The Enhanced Recovery After Surgery pathway for posterior cervical surgery: a retrospective propensity-matched cohort study. J Neurosurg Spine 2023:1-12. [PMID: 37119104 PMCID: PMC10193465 DOI: 10.3171/2023.2.spine221174] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/28/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE The Enhanced Recovery After Surgery (ERAS) protocol is a comprehensive, multifaceted approach aimed at improving postoperative outcomes. It incorporates a range of strategies to promote early and more effective recovery, including reducing pain, complications, and length of stay, without increasing readmission rate. To date, ERAS for spine surgery patients has been primarily limited to lumbar surgery and anterior cervical decompression and fusion (ACDF). ERAS has not been previously studied for posterior cervical surgery, which may present a greater opportunity for improvement in patient outcomes with ERAS than ACDF. This single-institution, multi-surgeon study assessed the impact of an ERAS protocol in patients undergoing posterior cervical decompression surgery. METHODS This study included a retrospective consecutive patient cohort with controls that were propensity matched for age, body mass index, sex, home opioid use, surgical levels, Nurick grade, and smoking status. In addition, consecutive patients who underwent posterior cervical decompression surgery for degenerative disease from December 2014 to December 2021 were included. ERAS was implemented in December 2018. Demographic, perioperative, clinical, and radiographic information was gathered. Regression models were created to evaluate length of stay, physiological function, pain levels, and opioid use. The primary focus was length of stay, with secondary outcomes including timing of ambulation, bowel movement, and voiding; daily pain scores; opioid consumption; discharge status; 30-day readmission rates; and reoperation rates. RESULTS There were 366 patients included in the study, all of whom were included in multivariate models, and 254 (127 in each cohort) were included on the basis of matching. After propensity matching, patient characteristics, operative procedures, and operative duration were similar between groups. The ERAS cohort had a significantly improved length of stay (3.2 vs 4.7 days, p < 0.0001) and home discharge rate (80% vs 50%, p < 0.001) without an increase in readmission rate. The ERAS cohort had an earlier day of the first ambulation (p = 0.003), bowel movement (p = 0.014), and voiding (p = 0.001). ERAS demonstrated a significantly lower composite complication rate (1.1 vs 1.8, p < 0.0001). ERAS resulted in better maximum pain scores (p = 0.043) and trended toward improved mean pain scores (p = 0.072), although total opioid use was similar. CONCLUSIONS Implementing a novel ERAS protocol significantly improved length of stay, return of physiological function, home discharge, complications, and maximum pain score after posterior cervical surgery.
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Affiliation(s)
- Ken Porche
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Sandra C Yan
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Yusuf Mehkri
- 1College of Medicine, University of Florida, Gainesville
| | - Sai Sriram
- 1College of Medicine, University of Florida, Gainesville
| | - Andrew MacNeil
- 1College of Medicine, University of Florida, Gainesville
| | - Kaitlyn Melnick
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Cynthia Garvan
- 3Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Sasha Vaziri
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Christoph Seubert
- 1College of Medicine, University of Florida, Gainesville
- 3Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Gregory Murad
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Matthew Decker
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Adam Polifka
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Daniel J Hoh
- 1College of Medicine, University of Florida, Gainesville
- 2Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Basma Mohamed
- 1College of Medicine, University of Florida, Gainesville
- 3Department of Anesthesiology, University of Florida, Gainesville, Florida
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Porche K, Yan S, Mohamed B, Garvan C, Samra R, Melnick K, Vaziri S, Seubert C, Decker M, Polifka A, Hoh DJ. Enhanced recovery after surgery (ERAS) improves return of physiological function in frail patients undergoing one- to two-level TLIFs: an observational retrospective cohort study. Spine J 2022; 22:1513-1522. [PMID: 35447326 PMCID: PMC9534035 DOI: 10.1016/j.spinee.2022.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/14/2022] [Accepted: 04/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The enhanced recovery after surgery (ERAS) protocol is a multimodal approach which has been shown to facilitate recovery of physiological function, and reduce early post-operative pain, complications, and length of stay (LOS) in open one- to two-level TLIF. The benefit of ERAS in specifically frail patients undergoing TLIF has not been demonstrated. Frailty is clinically defined as a syndrome of physiological decline that can predispose patients undergoing surgery to poor outcomes. PURPOSE This study primarily evaluated the benefit of an ERAS protocol in frail patients undergoing one- or two-level open TLIF compared to frail patients without ERAS. Secondarily, we assessed whether outcomes in frail patients with ERAS approximated those seen in nonfrail patients with ERAS. STUDY DESIGN Retrospective consecutive patient cohort with controls propensity-matched for age, body mass index, sex, and smoking status. PATIENT SAMPLE Consecutive patients that underwent one- or two-level open TLIF for degenerative disease from August, 2015 to July, 2021 by a single surgeon. ERAS was implemented in December 2018. OUTCOME MEASURES Primary outcome measure was return of postoperative physiological function defined as the summation of first day to ambulate, first day to bowel movement, and first day to void. Additional outcome measures included LOS, daily average pain scores, opioid use, discharge disposition, 30-day readmission rate, and reoperation. METHODS A retrospective analysis of frail patients > 65 years of age undergoing one- to two-level open TLIF post-ERAS were compared to propensity matched frail pre-ERAS patients. Frailty was assessed using the Fried phenotype classification (score >1). Patient demographics, LOS, first-day-to-ambulate (A1), first-day-to-bowel movement (B1), first-day-to-void (V1) were collected. Return of physiological function was defined as A1+B1+V1. Primary analysis was a comparison of frail patients pre-ERAS versus post-ERAS to determine effect of ERAS on return of physiologic function with frailty. Secondary analysis was a comparison of post-ERAS frail versus post-ERAS nonfrail patients to determine if return of physiologic function in frail patients with ERAS approximates that of nonfrail patients. RESULTS In the primary analysis, 32 frail patients were included with mean age ± standard deviation of 72.8±4.4 years, mean BMI 28.8±5.5, 65.6% were male, 15 pre-ERAS and 17 post-ERAS. Patient characteristics were similar between groups. After ERAS implementation, return of physiological function improved by a mean 3.2 days overall (post-ERAS 3.4 vs. pre-ERAS 6.7 days) (p<.0001), indicating a positive effect of ERAS in frail patients. Additionally, length of stay improved by 1 day (4.8±1.6 vs. 3.8±1.9 days, p<.0001). Total daily intravenous morphine milligram equivalent (MME) as well as average daily pain scores were similar between groups. Secondarily, 26 nonfrail patients post ERAS were used as a comparison group with the 17 post-ERAS frail cohort. Mean age of this cohort was 73.4±4.6 years, mean BMI 27.4±4.9, and 61.9% were male. Return of physiologic function was similar between cohorts (post-ERAS nonfrail 3.5 vs. post-ERAS frail 3.4 days) (p=.938), indicating the benefit with ERAS in frail patients approximates that of nonfrail patients. CONCLUSIONS ERAS significantly improves return of physiologic function and length of stay in patients with frailty after one- to two-level TLIF, and approximates improved outcomes seen in non-frail patients.
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Affiliation(s)
- Ken Porche
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608; 1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA.
| | - Sandra Yan
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Basma Mohamed
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1600 SW Archer Road, Department of Anesthesiology, University of Florida, Gainesville, FL, USA 32608
| | - Cynthia Garvan
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1600 SW Archer Road, Department of Anesthesiology, University of Florida, Gainesville, FL, USA 32608
| | - Ronny Samra
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608
| | - Kaitlyn Melnick
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Sasha Vaziri
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Christoph Seubert
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1600 SW Archer Road, Department of Anesthesiology, University of Florida, Gainesville, FL, USA 32608
| | - Matthew Decker
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Adam Polifka
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Daniel J. Hoh
- 1600 SW Archer Rd, College of Medicine, University of Florida, Gainesville, FL, USA 32608,1505 SW Archer Rd, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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Porche K, Samra R, Melnick K, Brennan M, Vaziri S, Seubert C, Polifka A, Hoh DJ, Mohamed B. Enhanced recovery after surgery (ERAS) for open transforaminal lumbar interbody fusion: a retrospective propensity-matched cohort study. Spine J 2022; 22:399-410. [PMID: 34687905 PMCID: PMC9595392 DOI: 10.1016/j.spinee.2021.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) protocol is a multidisciplinary, multimodal approach which has been shown to facilitate recovery of physiological function, and reduce postoperative pain, complication rates, and length of stay without adversely affecting readmission rates. Design and implementation of ERAS protocols in the recent spine surgery literature has primarily focused on patients undergoing minimally invasive lumbar surgery. However, conventional open transforaminal lumbar interbody fusion (TLIF) remains a common procedure and to date there are no studies assessing an ERAS protocol in this patient population. PURPOSE This study presents a single surgeon experience implementing an ERAS protocol in patients undergoing 1- or 2-level open TLIF. STUDY DESIGN/SETTING Retrospective consecutive patient cohort with controls propensity-matched for age, body mass index, sex, and smoking status. PATIENT SAMPLE Consecutive patients that underwent 1- or 2-level open TLIF for degenerative disease from 12/2018 - 02/2021 and controls from 12/2011-12/2017 by a single surgeon. ERAS was implemented in December 2018. OUTCOME MEASURES Primary: length of stay; Secondary: first day to ambulate, first day to bowel movement, first day to void, daily average and maximum pain scores, opioid use, discharge disposition, 30-day readmission rate, and re-operations. METHODS Demographic, perioperative, clinical, radiographic data were collected. Multivariate mixed-linear regression models were developed for length of stay, physiological function, pain scales, and opiate use. RESULTS There were 114 patients included with 57 in each cohort. After propensity matching, patient characteristics were similar between groups. Operative time decreased significantly after institution of ERAS (170±44 vs. 141±37 minutes, p <.0001) as did length of stay (4.6±1.7 vs. 3.6±1.6 days, p<.0001). First day of ambulation, bowel movement, and bladder voiding improved by 0.8 (p<.0001), 0.7 (p=.008), and 0.8 (p<.0001) days, respectively, in the ERAS cohort. Total daily intravenous morphine milligram equivalent (MME) (8±9 vs. 36±38, p<0.0001) and total 72-hour MME consumption (53±33 vs. 68±48, p<.0001) was significantly lower in the ERAS cohort; however, 72-hour MME consumption was not found to be significantly different in a sensitivity analysis controlling for preoperative MME. Average daily pain scores were similar between groups. CONCLUSIONS Consistent with other studies demonstrating benefit of an ERAS protocol for minimally invasive spine procedures, ERAS was associated with decreased operative time, reduced length of stay, decrease in IV opioid consumption, and improved physiological outcomes for open 1- and 2-level TLIF. ERAS can be a potentially effective strategy for improving patient outcome and efficiency of healthcare resources for common conventional spinal surgeries such as open TLIF.
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Affiliation(s)
- Ken Porche
- College of Medicine, University of Florida, Gainesville, FL, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
| | - Ronny Samra
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kaitlyn Melnick
- College of Medicine, University of Florida, Gainesville, FL, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Meghan Brennan
- College of Medicine, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Sasha Vaziri
- College of Medicine, University of Florida, Gainesville, FL, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Christoph Seubert
- College of Medicine, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Adam Polifka
- College of Medicine, University of Florida, Gainesville, FL, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Daniel J Hoh
- College of Medicine, University of Florida, Gainesville, FL, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Basma Mohamed
- College of Medicine, University of Florida, Gainesville, FL, USA; Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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Porche K, Dru A, Moor R, Kubilis P, Vaziri S, Hoh DJ. Preoperative Radiographic Prediction Tool for Early Postoperative Segmental and Lumbar Lordosis Alignment After Transforaminal Lumbar Interbody Fusion. Cureus 2021; 13:e18175. [PMID: 34703700 PMCID: PMC8530555 DOI: 10.7759/cureus.18175] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Transforaminal lumbar interbody fusion (TLIF) is a common approach and results in varying degrees of lordosis correction. The purpose of this study is to determine preoperative radiographic spinopelvic parameters that predict change in postoperative segmental and lumbar lordosis after TLIF. Materials & Methods This study is a single surgeon retrospective review of one-level and two-level TLIFs from L3-S1. All patients underwent bilateral facetectomies, 10 mm TLIF cage (non-lordotic) insertions, and bilateral pedicle screw-rod construct placements. Pre- and post-operative X-rays were assessed for preoperative segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence (PI). Univariate and multi-predictor linear regression analyses were performed to determine the relationships between preoperative radiographic findings and change in early postoperative segmental and lumbar lordosis. Results Ninety-seven patients contributing 128 intervertebral segments were examined. The mean change in SL after TLIF was 7.3 (range: 0.10-28.9°, SD 6.39°). The mean change in LL after TLIF was 5.5˚ (range: -14.8-39.2°, standard deviation (SD) 7.16°). Greater preoperative LL predicted less postoperative LL correction, while greater preoperative PI predicted more postoperative SL and LL correction. Greater anterior disk height was noted to be associated with a decreased change in SL (∆SL). An annular tear on preoperative magnetic resonance imaging (MRI) predicted a 2.7° decrease in ∆SL. A Schmorl's node on preoperative MRI predicted a 4.0° decrease in change in LL (∆LL). Conclusions A greater preoperative lordosis and a lower spinopelvic mismatch lessen the potential for an increase in the postoperative SL and LL after a TLIF, which is likely due to a ‘ceiling’ effect of an otherwise optimized spinal alignment. A greater anterior disk height and the presence of an annular tear are associated with decreased ∆SL.
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Affiliation(s)
- Ken Porche
- Neurosurgery, University of Florida, Gainesville, USA
| | - Alexander Dru
- Neurosurgery, University of Florida, Gainesville, USA
| | - Rachel Moor
- Neurosurgery, University of Florida, Gainesville, USA
| | - Paul Kubilis
- Neurosurgery, University of Florida, Gainesville, USA
| | - Sasha Vaziri
- Neurosurgery, University of Florida, Gainesville, USA
| | - Daniel J Hoh
- Neurosurgery, University of Florida College of Medicine, Gainesville, USA
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Oravec CS, Tschoe C, Fargen KM, Kittel CA, Spiotta A, Almallouhi E, Starke RM, McCarthy DJ, Simon S, Zyck S, Gould GC, De Leacy R, Mocco J, Siddiqui A, Vaziri S, Fox WC, Fraser JF, Chitale R, Zipfel G, Huguenard A, Wolfe SQ. Trends in mechanical thrombectomy and decompressive hemicraniectomy for stroke: A multicenter study. Neuroradiol J 2021; 35:170-176. [PMID: 34269121 DOI: 10.1177/19714009211030526] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke has increasingly become a procedural disease following the demonstrated benefit of mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) on clinical outcomes and tissue salvage in randomized trials. Given these data and anecdotal experience of decreased numbers of decompressive hemicraniectomies (DHCs) performed for malignant cerebral edema, we sought to correlate the numbers of strokes, thrombectomies, and DHCs performed over the timeline of the 2013 failed thrombolysis/thrombectomy trials, to the 2015 modern randomized MT trials, to post-DAWN and DEFUSE 3. MATERIALS AND METHODS This is a multicenter retrospective compilation of patients who presented with ELVO in 11 US high-volume comprehensive stroke centers. Rates of tissue plasminogen activator (tPA), thrombectomy, and DHC were determined by current procedural terminology code, and specificity to acute ischemic stroke confirmed by each institution. Endpoints included the incidence of stroke, thrombectomy, and DHC and rates of change over time. RESULTS Between 2013 and 2018, there were 55,247 stroke admissions across 11 participating centers. Of these, 6145 received tPA, 4122 underwent thrombectomy, and 662 patients underwent hemicraniectomy. The trajectories of procedure rates over time were modeled and there was a significant change in MT rate (p = 0.002) without a concomitant change in the total number of stroke admissions, tPA administration rate, or rate of DHC. CONCLUSIONS This real-world study confirms an increase in thrombectomy performed for ELVO while demonstrating stable rates of stroke admission, tPA administration and DHC. Unlike prior studies, increasing thrombectomy rates were not associated with decreased utilization of hemicraniectomy.
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Affiliation(s)
- Chesney S Oravec
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Christine Tschoe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, USA
| | | | | | | | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, USA
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Laurent D, Bardhi O, Kubilis P, Corliss B, Adamczak S, Geh N, Dodd W, Vaziri S, Busl K, Fox WC. Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage. Surg Neurol Int 2021; 12:277. [PMID: 34221608 PMCID: PMC8247662 DOI: 10.25259/sni_100_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Olgert Bardhi
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Paul Kubilis
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Brian Corliss
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Stephanie Adamczak
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Ndi Geh
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - William Dodd
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Sasha Vaziri
- Department of Neurosurgery, Lillian S. Wells, University of Florida, Florida, United States
| | - Katharina Busl
- Department of Neurology, University of Florida, Gainesville, Florida, United States
| | - W Christopher Fox
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States
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Vaziri S, Mummaneni PV, Wang MY, Hoh DJ. Brief History of Neurosurgical Spine Societies in the United States: Part 2. Neurospine 2021; 18:257-260. [PMID: 34218608 PMCID: PMC8255776 DOI: 10.14245/ns.2142018.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Praveen V Mummaneni
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael Y Wang
- Department of Neurosurgery, University of Miami, Miami, FL, USA
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Sadrameli SS, Davidov V, Sulhan S, Vaziri S, Hartman CJ, Hooten KG, Murad GJA. The utility of routine post-hospitalization CT imaging in patients with non-operative mild to moderate traumatic brain injury. Brain Inj 2021; 35:778-782. [PMID: 33998357 DOI: 10.1080/02699052.2021.1910999] [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: 10/21/2022]
Abstract
Primary Objective: The purpose of this study was to determine the utility of CT imaging in patients with non-operative mild-moderate TBI with respect to changes in management.Methods: We conducted a retrospective analysis for 191 patients over a 5-year interval to examine whether follow-up CT initiated a change in management. We created a logistic regression model to incorporate different variables contributing to change in management.Results: Of 191 patients, 31 (16.2%) underwent a change in management. Change in management was associated with older age (65 yo vs. 55 yo, p = .011), diagnosis of subdural hematoma (p = .041), antiplatelet/anticoagulant therapy (p = .009), imaging performed (p = .16), and increased blood products on CT (p = <0.0001). For patients on antiplatelet/anticoagulant therapy, only those with worsening findings on CT required a change in management (p = .0002, 0.039). Surgical intervention was indicated in two patients.Conclusions: Limited clinical value exists in repeat CT scans for patients with mild TBI. Most patients with traumatic SAH, contusions, or asymptomatic patients should not have repeat imaging, as our study revealed only 2% of patients with positive CT finding and 0.6% requiring surgical intervention.
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Affiliation(s)
- Saeed S Sadrameli
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
| | | | - Suraj Sulhan
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA
| | - Sasha Vaziri
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Cory J Hartman
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kristopher G Hooten
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Neurosurgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Gregory J A Murad
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
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Porche K, Vaziri S, Mehkri Y, Christie C, Laurent D, Wang Y, Rahman M. Patient satisfaction scores with telemedicine in the neurosurgical population. Clin Neurol Neurosurg 2021; 205:106605. [PMID: 33894681 DOI: 10.1016/j.clineuro.2021.106605] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The benefits of telemedicine in neurosurgery have been widely studied, especially as its implementation into clinical practice boomed at the start of the COVID-19 pandemic. However, few studies have investigated telemedicine from the perspective of the patient experience. OBJECTIVE To evaluate patient satisfaction scores of telemedicine outpatient clinic visits in neurosurgery in comparison with in-person visits. METHODS After obtaining Institutional Review Board approval, Press Ganey surveys from 3/1/2019 to 9/15/2020 were evaluated retrospectively from single-institution, academic neurosurgical clinics. Due to the non-normality of our data, stratified Wilcoxon tests were performed with correction for care provider differences. Domain score probability values were corrected for multiple comparisons. Average scores (range 20-100) are documented as mean ± standard deviation. RESULTS The response rates were 20% (97 responders) for telemedicine visits and 19% (589 responders) for in-person visits. Patient overall satisfaction score was slightly higher with telemedicine visits compared to in-person corrected for care provider differences (94.2 ± 12.2 vs 93.1 ± 13.4, p = 0.085). The care provider domain demonstrated no statistically significant difference in telemedicine compared to in-person (94.7 ± 14.4 vs 92.4 ± 16.5, p = 0.096). The access domain (93.7 ± 12.3 vs 93.4 ± 12.4, p = 0.999) and overall domains (94.1 ± 12.1 vs 94.4 ± 13.4, p = 1.000) were not found to be different between visit types. CONCLUSION Telemedicine appears to be a valuable option for neurosurgical patients and is not significantly different to in-person visits in all domains. This study demonstrates that telemedicine visits result in comparable satisfaction scores by neurosurgical patients, and providers should continue offering this option to their patients as we approach the post-COVID era.
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Affiliation(s)
- Ken Porche
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
| | - Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Yusuf Mehkri
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carlton Christie
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Dimitri Laurent
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Yu Wang
- Division of Quantitative Sciences and Biostatistics Shared Resource, University of Florida, Gainesville, FL, USA
| | - Maryam Rahman
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Christie CW, Mehkri Y, Rahman M, Vaziri S. Comprehensive Analysis of Independent Risk Factors Contributing to Hemorrhage and Infection After EVD Placement. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_498] [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: 11/12/2022] Open
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Dewberry LS, Dru A, Gravenstine M, Nguyen B, Anderson J, Vaziri S, Hoh D, Allen K, Otto KJ. Partial high frequency nerve block decreases neuropathic signaling following chronic sciatic nerve constriction injury. J Neural Eng 2020; 18. [PMID: 33027782 DOI: 10.1088/1741-2552/abbf03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/17/2020] [Accepted: 10/07/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE High frequency (HF) block can quickly and reversibly stop nerve conduction. We hypothesized HF block at the sciatic nerve would minimize nociception by preventing neuropathic signals from reaching the central nervous system. APPROACH Lewis rats were implanted with a constriction cuff and a distal cuff electrode around their right sciatic nerve. Tactile sensitivity was evaluated using the 50% paw withdrawal threshold determined using Chaplan's method for von Frey monofilaments. Over the course of 49 days, the 50% paw withdrawal threshold was measured 1) before HF block, 2) during HF block (50 kHz, 3 Vpp), and 3) after HF block. Gait was observed and scored before and during block. At end point, HF block efficacy was directly evaluated using additional cuff electrodes to elicit and record compound neural action potentials across the HF blocking cuff. MAIN RESULTS At days 7 and 14 days post-operation, tactile sensitivity was significantly lower during HF block compared to before and after block (p < 0.005). Additionally, an increase in gait disability was not visually observed during HF block. SIGNIFICANCE HF block can reduce tactile sensitivity in a limb with a neuropthic injury in a rapidly reversible fashion.
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Affiliation(s)
- Lauren Savannah Dewberry
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Biomedical Sciences Building JG56, Gainesville, FL 32611-6131, Gainesville, Florida, 32611-7011, UNITED STATES
| | - Alexander Dru
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, UNITED STATES
| | - Maxwell Gravenstine
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, UNITED STATES
| | - Brian Nguyen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, UNITED STATES
| | - James Anderson
- Department of Microbiology and Cell Science, University of Florida, Gainesville, Florida, UNITED STATES
| | - Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, UNITED STATES
| | - Daniel Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, UNITED STATES
| | - Kyle Allen
- Department of Biomedical Engineering, University of Florida, P.O. Box 116131, USA, Gainesville, Florida, 32611-6131, UNITED STATES
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, 32611-7011, UNITED STATES
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Vaziri S, Christie C, Laurent D, Porche K, Dru AB, Lucke-Wold B, Fox WC. Changes in Neurosurgeon Reimbursement Since Healthcare Reform in the United States. World Neurosurg 2020; 134:650-651. [PMID: 32059267 DOI: 10.1016/j.wneu.2019.12.042] [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] [Indexed: 02/08/2023]
Affiliation(s)
- Sasha Vaziri
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Carlton Christie
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Dimitri Laurent
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Ken Porche
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Alexander B Dru
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - W Christopher Fox
- University of Florida College of Medicine, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Lucke-Wold B, Vaziri S, Scott K, Busl K. Urinary dysfunction in acute brain injury: A narrative review. Clin Neurol Neurosurg 2020; 189:105614. [PMID: 31786429 DOI: 10.1016/j.clineuro.2019.105614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023]
Abstract
The frontal lobe urinary control center is an important regulator of urinary function. Neurologic injury often causes damage or temporary dysfunction of this center and other related urinary control pathways. Little has been reported about this topic in the literature although a majority of neurologic injury patients suffer from some type of urinary dysfunction. In this review, we highlight what is known about urinary dysfunction based on injury type (traumatic brain injury, hemorrhagic stroke, ischemic stroke, subarachnoid hemorrhage, subdural hematoma, and epilepsy). We discuss both clinical and pre-clinical data and pinpoint areas warranting further investigation. In the final section, we provide proposed practice suggestions for managing these patients clinically with the intended goal for refinement in these approaches following further clinical trials.
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Affiliation(s)
- Brandon Lucke-Wold
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Sasha Vaziri
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Kyle Scott
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Katharina Busl
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States; University of Florida, Department of Neurology, Gainesville, FL, United States.
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Vaziri S, Resnick DK, Ames CP, Harrop JS, Shaffrey CI, Singh K, Smith JS, Hoh DJ. Brief History of Spinal Neurosurgical Societies in the United States: Part 1. Neurospine 2019; 16:631-636. [PMID: 31905449 PMCID: PMC6944983 DOI: 10.14245/ns.1938378.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/15/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Daniel K Resnick
- Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Kern Singh
- Department of Orthopedics and Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Dru AB, Lockney DT, Vaziri S, Decker M, Polifka AJ, Fox WC, Hoh DJ. Cervical Spine Deformity Correction Techniques. Neurospine 2019; 16:470-482. [PMID: 31607079 PMCID: PMC6790735 DOI: 10.14245/ns.1938288.144] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 07/31/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022] Open
Abstract
Cervical kyphotic deformity can be a debilitating condition with symptoms ranging from mechanical neck pain, radiculopathy, and myelopathy to impaired swallowing and horizontal gaze. Surgical correction of cervical kyphosis has the potential to halt progression of neurological and clinical deterioration and even restore function. There are various operative approaches and deformity correction techniques. Choosing the optimal strategy is predicated on a fundamental understanding of spine biomechanics. Preoperative characterization of cervical malalignment, assessment of deformity rigidity, and defining postoperative clinical and radiographic objectives are paramount to formulating a surgical plan that balances clinical benefit with morbidity. This review of cervical deformity treatment provides an overview of the biomechanics of cervical kyphosis, radiographic classification, algorithm-based management, surgical techniques, and current surgical outcome studies.
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Affiliation(s)
- Alexander B Dru
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Dennis Timothy Lockney
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Matthew Decker
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Adam J Polifka
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - W Christopher Fox
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Vaziri S, Lockney DT, Dru AB, Polifka AJ, Fox WC, Hoh DJ. Does Ossification of the Posterior Longitudinal Ligament Progress After Fusion? Neurospine 2019; 16:483-491. [PMID: 31607080 PMCID: PMC6790726 DOI: 10.14245/ns.1938286.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/30/2019] [Accepted: 09/19/2019] [Indexed: 12/02/2022] Open
Abstract
Starting in the 1960s, ossification of the posterior longitudinal ligament (OPLL) became more commonly diagnosed in Japan. The disease is characterized by a gradual increase in calcification of the posterior longitudinal ligament with the eventual sequelae of cervical canal stenosis and myelopathy. Surgical interventions to relieve stenosis and neurologic symptoms are performed to decompress the cervical canal. Studies demonstrate continued ossification of the OPLL in both nonsurgical and surgically treated patients. In this review, the authors evaluate the epidemiology, pathophysiology, and literature regarding disease progression in OPLL after cervical fusion.
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Affiliation(s)
- Sasha Vaziri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Dennis Timothy Lockney
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Alexander B Dru
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Adam J Polifka
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - W Christopher Fox
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Awan O, Scott KW, Vaziri S, Porche K, Decker M, Dru AB, Chakraborty S, Khare K, Hoh B, Rahman M. Reimbursement patterns for neurosurgery: Analysis of the NERVES survey results from 2011-2016. Clin Neurol Neurosurg 2019; 184:105406. [PMID: 31302381 DOI: 10.1016/j.clineuro.2019.105406] [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: 05/05/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In response to rising national health expenditures, the Patient Protection and Affordable Care Act (ACA) was passed in 2010, with major provisions implemented in 2014. Due to increasing concerns about workload and compensation among neurosurgeons, we evaluated trends in neurosurgical reimbursement, productivity and compensation before and after the implementation of the major provisions of the ACA. PATIENTS AND METHODS Results from Neurosurgery Executives' Resource Value and Education Society (NERVES) annual surveys were collected, representing data from 2011 to 2016. Responses from different practice settings across the six years were categorized into groups, and inverse variance-weighted averaging was performed within the frameworks of a one-way ANOVA model with year. Data from 2011 to 2013 and 2014-2016 were analyzed similarly for differences among practice setting and region. RESULTS The NERVES survey response rates ranged from 20% to 36%. Median values for compensation decreased by 3.66%, 6.42%, and 10.34% within private, hospital, and academic practices respectively after 2014 although these trends did not reach statistical significance. Median work RVUs had a trend to decrease by 5.67%, 13.08%, and 19.44% within private, hospital, and academic practices respectively after 2014. Academic practices showed statistically significant decreases in annual total RVUs, total gross charges and collections. CONCLUSION These data demonstrate neurosurgical reimbursement and productivity have trended down during a time that increases in productivity and reimbursement were predicted. This phenomenon is most notable in academic practices compared to private or hospital based practices. Prospective analyses of the impact of healthcare policy reform on neurosurgical productivity are urgently needed.
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Affiliation(s)
- Omar Awan
- University of Florida College of Medicine, United States
| | - Kyle W Scott
- University of Florida College of Medicine, United States
| | - Sasha Vaziri
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States.
| | - Ken Porche
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Matthew Decker
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Alexander B Dru
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Saptarshi Chakraborty
- College of Liberal Arts and Sciences: Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Kshitij Khare
- College of Liberal Arts and Sciences: Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Brian Hoh
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Maryam Rahman
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
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Vaziri S, Abbatematteo JM, Fleisher MS, Dru AB, Lockney DT, Kubilis PS, Hoh DJ. Correlation of perioperative risk scores with hospital costs in neurosurgical patients. J Neurosurg 2019; 132:818-824. [PMID: 30771769 DOI: 10.3171/2018.10.jns182041] [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: 07/15/2018] [Accepted: 10/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs. METHODS A single-center retrospective review of 1005 neurosurgical patients treated between September 1, 2011, and December 31, 2014, was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs. RESULTS The Pearson correlation coefficient (R) was used to assess the correlation between 11 types of predicted complication risk scores and 5 types of encounter costs from 1005 health encounters involving neurosurgical procedures. Risk scores in categories such as any complication, serious complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehabilitation facility were obtained. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005). CONCLUSIONS Previous work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.
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Affiliation(s)
- Sasha Vaziri
- 2Department of Neurosurgery, University of Florida, Gainesville, Florida
| | | | | | - Alexander B Dru
- 2Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Dennis T Lockney
- 2Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Paul S Kubilis
- 2Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Daniel J Hoh
- 2Department of Neurosurgery, University of Florida, Gainesville, Florida
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Vaziri S, Wilson J, Abbatematteo J, Kubilis P, Chakraborty S, Kshitij K, Hoh DJ. Predictive performance of the American College of Surgeons universal risk calculator in neurosurgical patients. J Neurosurg 2018; 128:942-947. [DOI: 10.3171/2016.11.jns161377] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) universal Surgical Risk Calculator is an online decision-support tool that uses patient characteristics to estimate the risk of adverse postoperative events. Further validation of this risk calculator in the neurosurgical population is needed; therefore, the object of this study was to assess the predictive performance of the ACS NSQIP Surgical Risk Calculator in neurosurgical patients treated at a tertiary care center.METHODSA single-center retrospective review of 1006 neurosurgical patients treated in the period from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted complications were compared with actual occurrences identified through chart review and administrative quality coding data. Statistical models were used to assess the predictive performance of risk scores. Traditionally, an ideal risk prediction model demonstrates good calibration and strong discrimination when comparing predicted and observed events.RESULTSThe ACS NSQIP risk calculator demonstrated good calibration between predicted and observed risks of death (p = 0.102), surgical site infection (SSI; p = 0.099), and venous thromboembolism (VTE; p = 0.164) Alternatively, the risk calculator demonstrated a statistically significant lack of calibration between predicted and observed risk of pneumonia (p = 0.044), urinary tract infection (UTI; p < 0.001), return to the operating room (p < 0.001), and discharge to a rehabilitation or nursing facility (p < 0.001). The discriminative performance of the risk calculator was assessed using the c-statistic. Death (c-statistic 0.93), UTI (0.846), and pneumonia (0.862) demonstrated strong discriminative performance. Discharge to a rehabilitation facility or nursing home (c-statistic 0.794) and VTE (0.767) showed adequate discrimination. Return to the operating room (c-statistic 0.452) and SSI (0.556) demonstrated poor discriminative performance. The risk prediction model was both well calibrated and discriminative only for 30-day mortality.CONCLUSIONSThis study illustrates the importance of validating universal risk calculators in specialty-specific surgical populations. The ACS NSQIP Surgical Risk Calculator could be used as a decision-support tool for neurosurgical informed consent with respect to predicted mortality but was poorly predictive of other potential adverse events and clinical outcomes.
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Affiliation(s)
- Sasha Vaziri
- 1Department of Neurosurgery,
- 2University of Florida College of Medicine; and
| | | | | | - Paul Kubilis
- 1Department of Neurosurgery,
- 2University of Florida College of Medicine; and
| | - Saptarshi Chakraborty
- 3Department of Statistics, University of Florida College of Liberal Arts and Sciences, Gainesville, Florida
| | - Khare Kshitij
- 3Department of Statistics, University of Florida College of Liberal Arts and Sciences, Gainesville, Florida
| | - Daniel J. Hoh
- 1Department of Neurosurgery,
- 2University of Florida College of Medicine; and
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Lockney DT, Vaziri S, Walch F, Kubilis P, Neal D, Murad GJ, Rahman M. Prophylactic Antiepileptic Drug Use in Patients with Brain Tumors Undergoing Craniotomy. World Neurosurg 2017; 98:28-33. [DOI: 10.1016/j.wneu.2016.10.079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
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Asadi N, Rahimi A, Ghaheri M, Kahrizi D, Bagheri Dehbaghi M, Khederzadeh S, Banabazi MH, Esmaeilkhanian S, Veisi B, Geravandi M, Karim H, Vaziri S, Daneshgar F, Zargooshi J. Genetic diversity of the Dwarf honeybee (Apis florea Fabricius, 1787) populations based on microsatellite markers. Cell Mol Biol (Noisy-le-grand) 2016; 62:51-55. [PMID: 27894400 DOI: 10.14715/cmb/2016.62.12.9] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 11/26/2016] [Indexed: 06/06/2023]
Abstract
Apis florea is one of two species of small, wild honeybee. The present study was conducted to evaluate the genetic diversity of Apis florea honeybee from 48 nests (colonies) using microsatellite markers in the South of Iran. All honeybee samples were analyzed for six microsatellite loci (A88, A107, A7, B124, A113 and A35). The six loci had different numbers of alleles in the sampled colonies ranging from 7 (loci A107) to 3 (loci A7, A35). Gene diversity in Apis florea ranged from 0.491 to 0.595. This range probably reflects the spreading of nests in a large region with a varied climate. Phylogenetic tree showed two distinct clusters including a) Minab region samples and b) Bandar Abbas, Bandar Khamir and Qeshm Island regions. All of these regions are geographically rich, having varied vegetation and climate conditions. Our findings are an important contribution to the methods of studying distribution and conservation of Apis florea.
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Affiliation(s)
- N Asadi
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Razi Street, P.O. Box: 381351551. Khoramabad, Iran
| | - A Rahimi
- Department of Plant Protection, Razi University, Kermanshah, Iran
| | - M Ghaheri
- Department of Agronomy and Plant Breeding, Razi University, Kermanshah, Iran
| | - D Kahrizi
- Department of Agronomy and Plant Breeding, Razi University, Kermanshah, Iran
| | - M Bagheri Dehbaghi
- Zagros Bioidea Co. Razi University Incubator, Razi University, Kermanshah, Iran
| | - S Khederzadeh
- Natural History Museum and Genetic Resources, Department of Environment, Pardisan Eco-Park, Tehran, Iran
| | - M H Banabazi
- College of Agriculture and Natural Resources, University of Tehran, Karaj, Iran
| | - S Esmaeilkhanian
- College of Agriculture and Natural Resources, University of Tehran, Karaj, Iran
| | - B Veisi
- Department of Soil Science, Razi University, Kermanshah, Iran
| | - M Geravandi
- Department of Agronomy and Plant Breeding, Razi University, Kermanshah, Iran
| | - H Karim
- Department of Cardiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Vaziri
- Department of Infectious Diseases. Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - F Daneshgar
- Department of Ophthalmology. Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - J Zargooshi
- Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine; Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Gholami M, Hafezian SH, Rahimi G, Farhadi A, Rahimi Z, Kahrizi D, Kiani S, Karim H, Vaziri S, Muhammadi S, Veisi F, Ghadiri K, Shetabi H, Zargooshi J. Allele specific-PCR and melting curve analysis showed relatively high frequency of β-casein gene A1 allele in Iranian Holstein, Simmental and native cows. Cell Mol Biol (Noisy-le-grand) 2016; 62:138-143. [PMID: 27894411 DOI: 10.14715/cmb/2016.62.12.23] [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] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 11/26/2016] [Indexed: 11/18/2022]
Abstract
There are two allelic forms of A1 and A2 of β-casein gene in dairy cattle. Proteolytic digestion of bovine β-casein A1 type produces bioactive peptide of β-casomorphin-7 known as milk devil. β-casomorphin-7 causes many diseases, including type 1 diabetes, cardiovascular disease syndrome, sudden death and madness. The aim of the present study was to determine the different allelic forms of β-casein gene in Iranian Holstein, Simmental and native cattle in order to identify A1 and A2 variants. The blood samples were collected randomly and DNA was extracted using modified salting out method. An 854 bp fragment including part of exon 7 and part of intron 6 of β-casein gene was amplified by allele specific polymerase chain reaction (AS-PCR). Also, the accuracy of AS-PCR genotyping has been confirmed by melting temperature curve analysis using Real-time PCR machinery. The comparison of observed allele and genotype frequency among the studied breeds was performed using the Fisher exact and Chi-squared test, respectively by SAS program. Obtained results showed the A1 allele frequencies of 50, 51.57, 54.5, 49.4 and 46.6% in Holstein, Simmental, Sistani, Taleshi and Mazandarani cattle populations, respectively. The chi-square test was shown that no any populations were in Hardy-Weinberg equilibrium for studied marker locus. Comparison and analysis of the test results for allelic frequency showed no any significant differences between breeds (P>0.05). The frequency of observed genotypes only differs significantly between Holstein and Taleshi breeds but no any statistically significant differences were found for other breeds (P>0.05). A relatively high frequency of β-casein A1 allele was observed in Iranian native cattle. Therefore, determine the genotypes and preference alleles A2 in these native and commercial cattle is recommended.
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Affiliation(s)
- M Gholami
- Laboratory for Molecular Genetics and Cytogenetics, Department of Animal Sciences, Faculty of Animal Sciences and Fisheries, Sari Agricultural Sciences and Natural Resources University, Sari, Iran
| | - S H Hafezian
- Laboratory for Molecular Genetics and Cytogenetics, Department of Animal Sciences, Faculty of Animal Sciences and Fisheries, Sari Agricultural Sciences and Natural Resources University, Sari, Iran
| | - G Rahimi
- Laboratory for Molecular Genetics and Cytogenetics, Department of Animal Sciences, Faculty of Animal Sciences and Fisheries, Sari Agricultural Sciences and Natural Resources University, Sari, Iran
| | - A Farhadi
- Laboratory for Molecular Genetics and Cytogenetics, Department of Animal Sciences, Faculty of Animal Sciences and Fisheries, Sari Agricultural Sciences and Natural Resources University, Sari, Iran
| | - Z Rahimi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - D Kahrizi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Kiani
- Research Institute of Applied Physics and Astronomy, University of Tabriz, Tabriz, Iran
| | - H Karim
- Department of Cardiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Vaziri
- Department of Infectious Diseases. Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Muhammadi
- Department of Cardiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - F Veisi
- Department of Obstetrics and gynecology. Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - K Ghadiri
- Nosocomial Infections Research Center. Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - H Shetabi
- Department of Anesthesiology. Isfahan University of Medical Sciences, Isfahan, Iran
| | - J Zargooshi
- Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine; Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Darvishi E, Aziziaram Z, Yari K, Bagheri Dehbaghi M, Kahrizi D, Karim H, Vaziri S, Zargooshi J, Ghadiri K, Muhammadi S, Kazemi E, Moradi MT, Shokrinia M, Mohammadi N. Lack of association between the TNF-α-1031genotypes and generalized aggressive periodontitis disease. Cell Mol Biol (Noisy-le-grand) 2016; 62:63-66. [PMID: 27755954] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/13/2016] [Indexed: 06/06/2023]
Abstract
Periodontal disease is one of the most prevalent inflammatory illnesses and is a main cause of tooth loss in human population. Tumor necrosis factor-α (TNF-α) gene is one of pro-inflammatory cytokines which has important role in pathogenesis of periodontal disease. The main purpose of this study is to determine genotype abundance of TNF-α-1031 gene in both groups of patients and controls, and also investigation of relation of single nucleotide polymorphism (SNP) these genotypes with periodontal disease risk. DNA was extracted from blood tissue of 31 patients and 54 controls. The TNF-α-1031 polymorphism was evaluated by polymerase chain reaction- confronting two-pair primer (PCR-CTPP) method. In the GAP group, the frequencies of TT, TC and CC genotypes were 35.48%, 61.29 and 3.23%, respectively. In controls the frequencies of TT, TC and CC genotypes were 22.22%, 72.22%, and 5.56%, respectively. Results of this study showed that there was no significant association between TNF-α (-1031 T/C promoter) gene polymorphisms and the risk of generalized aggressive periodontitis disease.
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Affiliation(s)
- E Darvishi
- Kermanshah University of Medical Sciences Medical Biology Research Center Kermanshah Iran
| | - Z Aziziaram
- Kermanshah University of Medical Sciences Medical Biology Research Center Kermanshah Iran
| | - K Yari
- Kermanshah University of Medical Sciences Medical Biology Research Center Kermanshah Iran
| | | | - D Kahrizi
- Kermanshah University of Medical Sciences Medical Biology Research Center Kermanshah Iran
| | - H Karim
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - S Vaziri
- Kermanshah University of Medical Sciences Department of Infectious Diseases Kermanshah Iran
| | - J Zargooshi
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - K Ghadiri
- Kermanshah University of Medical Sciences Nosocomial Infections Research Center Kermanshah Iran
| | - S Muhammadi
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - E Kazemi
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - M T Moradi
- Kermanshah University of Medical Sciences Medical Biology Research Center Kermanshah Iran
| | - M Shokrinia
- Kermanshah-Based, General Department of Taxation Affairs Kermanshah Iran
| | - N Mohammadi
- Kermanshah-Based, General Department of Taxation Affairs Kermanshah Iran
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Rahman M, Abbatematteo J, De Leo EK, Kubilis PS, Vaziri S, Bova F, Sayour E, Mitchell D, Quinones-Hinojosa A. The effects of new or worsened postoperative neurological deficits on survival of patients with glioblastoma. J Neurosurg 2016; 127:123-131. [PMID: 27689459 DOI: 10.3171/2016.7.jns16396] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [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: 11/06/2022]
Abstract
OBJECTIVE An increased extent of resection (EOR) has been shown to improve overall survival of patients with glioblastoma (GBM) but has the potential for causing a new postoperative neurological deficit. To investigate the impact of surgical neurological morbidity on survival, the authors performed a retrospective analysis of the clinical data from patients with GBM to quantify the impact of a new neurological deficit on the survival benefit achieved with an increased EOR. METHODS The data from all GBM patients who underwent resection at the University of Florida from 2010 to 2015 with postoperative imaging within 72 hours of surgery were included in the study. Retrospective analysis was performed on clinical outcomes and tumor volumes determined on postoperative and follow-up imaging examinations. RESULTS Overall, 115 patients met the inclusion criteria for the study. Tumor volume at the time of presentation was a median of 59 cm3 (enhanced on T1-weighted MRI scans). The mean EOR (± SD) was 94.2% ± 8.7% (range 59.9%-100%). Almost 30% of patients had a new postoperative neurological deficit, including motor weakness, sensory deficits, language difficulty, visual deficits, confusion, and ataxia. The neurological deficits had resolved in 41% of these patients on subsequent follow-up examinations. The median overall survival was 13.1 months (95% CI 10.9-15.2 months). Using a multipredictor Cox model, the authors observed that increased EOR was associated with improved survival except for patients with smaller tumor volumes (≤ 15 cm3). A residual volume of 2.5 cm3 or less predicted a favorable overall survival. Developing a postoperative neurological deficit significantly affected survival (9.2 months compared with 14.7 months, p = 0.02), even if the neurological deficit had resolved by the first follow-up. However, there was a trend of improved survival among patients with resolution of a neurological deficit by the first follow-up compared with patients with a permanent neurological deficit. Any survival benefit from achieving a 95% EOR was abrogated by the development of a new neurological deficit postoperatively. CONCLUSIONS Developing a new neurological deficit after resection of GBM is associated with a decrease in overall survival. A careful balance between EOR and neurological compromise needs to be taken into account to reduce the likelihood of neurological morbidity from surgery.
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Affiliation(s)
- Maryam Rahman
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Joseph Abbatematteo
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Edward K De Leo
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Paul S Kubilis
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Sasha Vaziri
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Frank Bova
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Elias Sayour
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Duane Mitchell
- Department of Neurosurgery, University of Florida, Gainesville, Florida; and
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Corliss B, Gooldy T, Vaziri S, Kubilis P, Murad G, Fargen K. Complications After In Vivo and Ex Vivo Autologous Bone Flap Storage for Cranioplasty: A Comparative Analysis of the Literature. World Neurosurg 2016; 96:510-515. [PMID: 27647038 DOI: 10.1016/j.wneu.2016.09.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 07/24/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The most common bone flap storage strategies after decompressive hemicraniectomy for malignant intracranial hypertension include freezer cryopreservation (CP) and subcutaneous abdominal implantation (AP). Numerous series have reported on patient outcomes after cranioplasty in terms of infection, cosmesis, and resorption. This meta-analysis compares published outcomes of bone flap CP and subcutaneous storage with respect to efficacy and complication risk in patients undergoing cranioplasty after hemicraniectomy. METHODS A systematic review was performed using PubMed-searchable studies that included bone flap storage methods and outcome data for cranioplasties performed between 1975 and 2015. RESULTS A total of 48 studies including 5346 patients were identified that met the inclusion criteria. Of these patients, 4096 underwent cranioplasty with an autologous flap. Mean bone flap storage times for CP and AP flaps were 69.9 and 69.7 days. Mean follow-up time for CP and AP flaps was 16.9 and 16.5 months. No statistically significant differences were found when comparing CP with subcutaneous storage of bone flaps with respect to percentage of patients developing infection (7.3% vs. 7.1%), percentage of patients needing revision surgery (15.9% vs. 7.6%), and percentage of patients experiencing resorption (9.7% vs. 7.7%). CONCLUSIONS This is the largest and most robust review comparing published outcomes of CP and subcutaneous storage of bone flaps in patients who have undergone decompressive hemicraniectomy. This review found no statistically significant differences in clinical outcomes (infection, resorption, reoperation) when comparing storage methods for bone flap preservation. This study suggests that both strategies may be used safely and successfully.
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Affiliation(s)
- Brian Corliss
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Timothy Gooldy
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
| | - Sasha Vaziri
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Paul Kubilis
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Gregory Murad
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Kyle Fargen
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
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Gonzalez A, Jennings E, Vaziri S, Yachnis AT, Kubal A. Second report of a Nocardia beijingensis infection in the United States: nodular scleritis with in vitro imipenem resistance. Digit J Ophthalmol 2016; 22:62-66. [PMID: 28924404 DOI: 10.5693/djo.02.2016.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the case of a 52-year-old woman with scleritis caused by an imipenem-resistant strain of Nocardia beijingensis. The patient presented with pain, redness, and nodules on the sclera of 8 weeks' duration. A Gram stain from a nodule on the superonasal aspect of the globe was initially negative. After empiric treatment for an autoimmune etiology, cytopathology confirmed filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made, and medical management was based on a literature review on treatments for Nocardia infections. Cultures returned confirming Nocardia beijingensis. Antibiotic sensitivity testing confirmed the correct initial management. The patient's scleritis resolved with a good visual outcome.
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Affiliation(s)
| | - Eric Jennings
- Department of Ophthalmology, University of Florida, Gainesville
| | - Sasha Vaziri
- College of Medicine, University of Florida, Gainesville
| | | | - Anup Kubal
- Department of Ophthalmology, University of Florida, Gainesville
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Kazemi N, Kahrizi D, Mansouri M, Karim H, Vaziri S, Zargooshi J, Khanahmadi M, Shokrinia M, Mohammadi N. Induction of linalool as a pharmaceutical and medicinal metabolite via cell suspension culture of cumin (Cuminum cyminum L.). Cell Mol Biol (Noisy-le-grand) 2016; 62:65-68. [PMID: 27262805] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/13/2016] [Indexed: 06/05/2023]
Abstract
Cumin is an important medicinal plant in Iran. Plant cell suspension culture is a method for the production of medicinal and secondary metabolites. The linalool is a plant secondary metabolite that has been recognized as a neuroprotective agent. The purpose of this study was to evaluate the effects of salicylic acid elicitor on induction of linalool in cell suspension culture of cumin. For this purpose, the cumin seeds were prepared, to obtain sterile seedling, were disinfected with sodium hypochlorite and alcohol, and were cultured on MS basal medium. This research was conducted in two separate experiments including callus induction and suspension cultures. Leaf explants were prepared from sterile seedlings and used to produce callus on MS medium supplemented with 1 mg/l NAA and 0.5 mg/l BAP. In order to establish suspension culture, the appropriate calli were transferred to liquid medium. Then cell cultures were treated with elicitors. The effects of elicitor on the production of linalool secondary metabolite and cell viability were assessed by GC-Mass and tetrazolium test respectively. For this purpose, the salicylic acid (at concentrations of 0, 1, 2, 4 and 8 mg/l) was used. The experimental design was a completely randomized design with five treatments and three replications. The results of cell culture and GC-Mass analysis showed that salicylic acid had significant effects on the linalool production (<0.01). At all concentrations of salicylic acid, viability of the cells in suspension culture experiments was lower than control. Increasing the elicitor concentrations lead to reduction in cell survival. In conclusion it is possible to produce linalool as a secondary metabolite and pharmaceutical agent in cell culture of cumin. It is necessary to determine the best combination of medium and elicitor.
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Affiliation(s)
- N Kazemi
- Institute of Higher Education, Jahad-e-Daneshgahi, Kermanshah Unit Department of Medicinal Plants Kermanshah Iran
| | - D Kahrizi
- Razi University Agronomy and Plant Breeding Department Kermanshah Iran
| | - M Mansouri
- Kermanshah University of Medical Sciences Medical Biology Research Center Kermanshah Iran
| | - H Karim
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - S Vaziri
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - J Zargooshi
- Kermanshah University of Medical Sciences Department of Sexual Medicine, The Rhazes Center for Research in Family Health and Sexual Medicine Kermanshah Iran
| | - M Khanahmadi
- Institute of Higher Education, Jahad-e-Daneshgahi, Kermanshah Unit Department of Medicinal Plants Kermanshah Iran
| | - M Shokrinia
- Kermanshah-Based, General Department of Taxation Affairs Kermanshah Iran
| | - N Mohammadi
- Kermanshah—Based, General Department of Taxation Affairs Kermanshah Iran
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Gonzalez A, Vaziri S, Brandt JC, Steffes W, Perbtani Y. Neutrophilic dermatosis of the dorsal hands in an elderly man. Dermatol Online J 2016; 22:13030/qt786522rg. [PMID: 27267194] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 06/06/2023] Open
Abstract
recently diagnosed with stage II lung adenocarcinoma, who presented to the clinic with a 14-day history of painful macules that progressed to bullae on the dorsal surface of his hands; decreased range of motion was noted. Examination revealed bilateral small, tender violaceous vesicopustules admixed with larger tense hemorrhagic pus-filled bullae on the dorsal aspect of his hands. Biopsy demonstrated changes consistent with neutrophilic dermatosis of the dorsal hands. The patient had been diagnosed with ulcerative colitis in the 1970s, although the condition was asymptomatic at the time of presentation. Treatment with prednisone 60 mg daily resulted in significant improvement by the next day. This regimen was continued for two weeks and was followed by a 6-week steroid taper. After a review of the approximate 75 cases currently reported, we also discuss the recurrence rate of NDDH of approximately 10%.
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Gonzalez A, Vaziri S, Brandt JC, Steffes W, Perbtani Y. Neutrophilic dermatosis of the dorsal hands in an elderly man. Dermatol Online J 2016. [DOI: 10.5070/d3222030096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Vaziri S, Belete M, Dentoni Litta E, Smith AD, Lupina G, Lemme MC, Östling M. Bilayer insulator tunnel barriers for graphene-based vertical hot-electron transistors. Nanoscale 2015; 7:13096-13104. [PMID: 26176739 DOI: 10.1039/c5nr03002a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vertical graphene-based device concepts that rely on quantum mechanical tunneling are intensely being discussed in the literature for applications in electronics and optoelectronics. In this work, the carrier transport mechanisms in semiconductor-insulator-graphene (SIG) capacitors are investigated with respect to their suitability as electron emitters in vertical graphene base transistors (GBTs). Several dielectric materials as tunnel barriers are compared, including dielectric double layers. Using bilayer dielectrics, we experimentally demonstrate significant improvements in the electron injection current by promoting Fowler-Nordheim tunneling (FNT) and step tunneling (ST) while suppressing defect mediated carrier transport. High injected tunneling current densities approaching 10(3) A cm(-2) (limited by series resistance), and excellent current-voltage nonlinearity and asymmetry are achieved using a 1 nm thick high quality dielectric, thulium silicate (TmSiO), as the first insulator layer, and titanium dioxide (TiO2) as a high electron affinity second layer insulator. We also confirm the feasibility and effectiveness of our approach in a full GBT structure which shows dramatic improvement in the collector on-state current density with respect to the previously reported GBTs. The device design and the fabrication scheme have been selected with future CMOS process compatibility in mind. This work proposes a bilayer tunnel barrier approach as a promising candidate to be used in high performance vertical graphene-based tunneling devices.
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Affiliation(s)
- S Vaziri
- KTH Royal Institute of Technology, School of Information and Communication Technology, Isafjordsgatan 22, 16440 Kista, Sweden.
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Sayad B, Vazirian A, Vaziri S, Mansouri F, Afsharian M, Janbakhsh A. Effects of oral levamisole as an adjuvant to hepatitis B vaccine in health-care workers non-responders to previous vaccinations: A randomised controlled trial. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.06.058] [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: 11/16/2022]
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Vaziri S, Lafontaine M, Olson B, Crane JC, Chang S, Lupo J, Nelson SJ. NI-79 * RAPID ASSESSMENT OF LESION VOLUMES FOR PATIENTS WITH GLIOMA USING THE SMARTBRUSH SOFTWARE PACKAGE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou264.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lockney D, Walch F, Vaziri S, Rahman M, Murad G. SM-04 * PROPHYLACTIC ANTIEPILEPTIC DRUGS DO NOT REDUCE SEIZURE RATES IN SURGICAL BRAIN TUMOR PATIENTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou277.4] [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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King B, Vaziri S, Singla A, Fargen KM, Mocco J. Clinical and angiographic outcomes after stent-assisted coiling of cerebral aneurysms with Enterprise and Neuroform stents: a comparative analysis of the literature. J Neurointerv Surg 2014; 7:905-9. [PMID: 25352581 DOI: 10.1136/neurintsurg-2014-011457] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [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: 09/06/2014] [Accepted: 10/08/2014] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The most widely used intracranial stents for stent-assisted coiling are Neuroform (NEU) and Enterprise stents (ENT). This study compares published outcomes between the ENT and NEU coil-assist systems and comments on the published safety and efficacy of stent-assisted coiling in general. METHODS A literature search was performed through PubMed for all published series of ENT or NEU stent-assisted coiling of cerebral aneurysms from 2004 to 2014. All studies including 10 or more published cases of stent-assisted coiling with ENT or NEU were included. RESULTS 47 studies met the inclusion criteria, containing 4238 aneurysms in 4039 patients. 2111 aneurysms were treated with NEU and 2127 were treated with ENT. Mean follow-up was 14.1 months. Overall, thromboembolic events occurred in 6.4% of aneurysms, intracranial hemorrhage (ICH) in 2.6%, permanent morbidity in 3.9%, and mortality in 2.3%. Initial and final 100% angiographic occlusion was seen in 53% and 69% of patients, respectively. Deployment failures (p<0.001), ICH (p=0.001), mortality among all patients (p=0.03), and recanalization (p=0.02) were more commonly reported in NEU treated aneurysms. The ENT system was also associated with higher reported complete occlusion at follow-up (p<0.001). CONCLUSIONS This literature review represents the largest and most robust comparison of stent-assisted coiling devices to date, containing over 4200 aneurysms in more than 4000 patients. Comparative analyses demonstrate that both devices are reported to be safe and effective with comparable permanent morbidity.
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Affiliation(s)
- Brent King
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Sasha Vaziri
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Amit Singla
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Kyle M Fargen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - J Mocco
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
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Smith AD, Niklaus F, Paussa A, Vaziri S, Fischer AC, Sterner M, Forsberg F, Delin A, Esseni D, Palestri P, Östling M, Lemme MC. Electromechanical piezoresistive sensing in suspended graphene membranes. Nano Lett 2013; 13:3237-42. [PMID: 23786215 DOI: 10.1021/nl401352k] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Monolayer graphene exhibits exceptional electronic and mechanical properties, making it a very promising material for nanoelectromechanical devices. Here, we conclusively demonstrate the piezoresistive effect in graphene in a nanoelectromechanical membrane configuration that provides direct electrical readout of pressure to strain transduction. This makes it highly relevant for an important class of nanoelectromechanical system (NEMS) transducers. This demonstration is consistent with our simulations and previously reported gauge factors and simulation values. The membrane in our experiment acts as a strain gauge independent of crystallographic orientation and allows for aggressive size scalability. When compared with conventional pressure sensors, the sensors have orders of magnitude higher sensitivity per unit area.
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Affiliation(s)
- A D Smith
- KTH Royal Institute of Technology , Isafjordsgatan 22, 16440 Kista, Sweden
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Sayyad B, Alavian SM, Najafi F, Mokhtari Azad T, Ari Tabarestani MH, Shirvani M, Behnava B, Afshrian M, Vaziri S, Janbakhsh AR, Mansouri F, Kaviani S. Efficacy of influenza vaccination in patients with cirrhosis and inactive carriers of hepatitis B virus infection. Iran Red Crescent Med J 2012; 14:623-30. [PMID: 23285414 PMCID: PMC3518979] [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] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 02/20/2012] [Indexed: 12/03/2022]
Abstract
BACKGROUND Influenza can causes morbidity and mortality that are greatly enhanced in patients with underlying chronic diseases such as Cirrhotic patients. This study was performed to assess the immunogenicity of Influenza vaccination in patients with cirrhosis and inactive carriers of Hepatitis B virus infection. METHODS In this clinical study 93 enrolled subjects divided into 3 groups: Cirrhotic (N=28), Inactive carriers of Hepatitis B (N=31) and subjects (N=34). All the participants were vaccinated by Influenza vaccine (Influvac®). Serum samples were taken before and 4 weeks after vaccination and the Humoral Immunogenicity was assessed by the Hemagglutination Inhibition (HI) test. RESULTS Four weeks after vaccination, seroconversion rates of vaccine strains ranged between 71.4% and 100% in Group 1, 70.6% and 94.1% in Group 2, and 58.1% and 80.7% in Group 3. No significant differences were seen in the rates of Seroconversion and antibody Geometric Mean Titers (GMTs) against Influenza A (H1N1 and H3N2) vaccine components in the three groups (P>0.05).The rates of Seroconversion and antibody GMTs against Influenza B vaccine component were significantly higher in Cirrhotic and inactive carriers of Hepatitis B than healthy subjects (P<0.005). No significant (P>0.05) differences in the rates of Seroprotection were observed within the three groups. Antibody GMTs against all three strains of Influenza vaccine increased significantly (P<0.001) after vaccination in three groups. CONCLUSION Influenza vaccination is effective in Cirrhotic patients and inactive carriers of Hepatitis B as well as healthy individuals. It means that vaccination should be considered in such patients in order to reduce the morbidity and mortality of Influenza.
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Affiliation(s)
- B Sayyad
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - S M Alavian
- Baqyatallah Research Center for Gastroenterology and Liver Disease, Tehran, Iran
| | - F Najafi
- Kermanshah Health Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - T Mokhtari Azad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - M H Ari Tabarestani
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - M Shirvani
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - B Behnava
- Baqyatallah Research Center for Gastroenterology and Liver Disease, Tehran, Iran
| | - M Afshrian
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - S Vaziri
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - A R Janbakhsh
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - F Mansouri
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
| | - Sh Kaviani
- Kermanshah Liver Diseases and Hepatitis Research Center, Kermanshah University of medical Sciences, Kermanshah, Iran
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Park H, Shults C, Shyqyriu E, Vaziri S, Felsenstein K, Ceballos‐Diaz C, Ladd T, Jung J, Kim S, Golde T. P4‐003: Corticotropin‐releasing hormone alters Aβ42 production via gamma‐secretase. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hyo‐Jin Park
- University of FloridaGainesvilleFloridaUnited States
| | - Cody Shults
- University of FloridaGainesvilleFloridaUnited States
| | - Eva Shyqyriu
- University of FloridaGainesvilleFloridaUnited States
| | - Sasha Vaziri
- University of FloridaGainesvilleFloridaUnited States
| | - Kevin Felsenstein
- University of Florida College of MedicineGainesvilleFloridaUnited States
| | | | - Thomas Ladd
- University of FloridaGainesvilleFloridaUnited States
| | - Joo‐In Jung
- University of FloridaGainesvilleFloridaUnited States
| | - Seong‐Hun Kim
- University of FloridaGainesvilleFloridaUnited States
| | - Todd Golde
- University of FloridaGainesvilleFloridaUnited States
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Abstract
INTRODUCTION Semiconstrained total elbow replacement is now a well recognised and reliable surgical option for advanced elbow disease, mainly rheumatoid arthritis. METHODS We report a retrospective analysis of 31 primary total elbow replacements in 28 patients with a mean follow-up duration of 55 months. The mean age of the patients was 65 years. The indications included 27 cases of rheumatoid arthritis, 3 fractures and 1 case of osteoarthritis. Twenty-one elbows in nineteen patients were assessed using the Mayo elbow performance score (MEPS) in a special follow-up clinic. In the other nine patients (ten elbows), the assessment was carried out with case notes and x-rays. RESULTS The mean pre-operative MEPS in the 21 elbows recalled was 40. This improved to 89 post-operatively (range: 55-100). Sixteen of the twenty-one elbows were considered excellent, two good, two fair and one poor. The range of movement was recorded in eight of the other ten elbows and the mean was 98°. At the last follow-up visit, x-rays were normal in 23 elbows although the ulnar component was loose in 3, the humeral component loose in 2. There were also two cases of non-union of the medial epicondyle and one patient had mild heterotopic ossification. Complications included one infection, which needed irrigation and debridement with a satisfactory final result, and two cases of ulnar nerve palsy/neurapraxia. Two elbows were considered failures due to severe pain caused by prosthetic loosening. These were referred for revision surgery. CONCLUSIONS Excellent pain relief and good function can be achieved in the medium and long term with the Coonrad-Morrey-semiconstrained total elbow replacement prosthesis in patients with severe destructive elbow arthropathy.
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Affiliation(s)
- R Maheshwari
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust, UK.
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Hamkar R, Yahyapour Y, Noroozi M, Nourijelyani K, Jalilvand S, Adibi L, Vaziri S, Poor-Babaei AA, Pakfetrat A, Savad-Koohi R. Prevalence of Rotavirus, Adenovirus, and Astrovirus Infections among Patients with Acute Gastroenteritis in, Northern Iran. Iran J Public Health 2010; 39:45-51. [PMID: 23113006 PMCID: PMC3481758] [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] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the study was to determine the incidence of non-bacterial acute gastroenteritis associated with diarrheal diseases in Mazandaran Province, northern Iran. METHODS A total of 400 symptomatic cases from patients with acute gastroenteritis from Mazandaran Province in Iran were screened using EIA method for the presence of rotavirus, adenovirus and astrovirus during 2005-2006. Chi-square tests were used for testing relationships between different variables. RESULTS Rotavirus, adenovirus and astrovirus were detected in 62%, 2.3%, and 3% of samples, respectively. The maximum rate of rotaviruses was detected in the <1-year-old age group, while minimum rate was found in the 10 years and older age group. Astrovirus and adenovirus were detected predominantly in the 2-5-year-old age group of children, with a prevalence of 8.3% and 3.5% respectively. All studied viral gastroenteritis peaked in the winter, and minimum rate were found in summer. CONCLUSION Our statistical analyzes indicated that viral gastroenteritis, especially Rota-viral, had the highest number of occurrences in colder seasons notably in winter and more frequently were observed among younger children.
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Affiliation(s)
- R Hamkar
- Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Y Yahyapour
- Dept. of Microbiology, School of Medicine, Babol University of Medical Sciences, Iran
| | - M Noroozi
- Dept. of Microbiology, School of Science, Islamic Azad University/Qom, Iran
| | - K Nourijelyani
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran
| | - S Jalilvand
- Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - L Adibi
- Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - S Vaziri
- Dept. of Microbiology, School of Science, Islamic Azad University/Qom, Iran
| | - AA Poor-Babaei
- Dept. of Microbiology, School of Science, Islamic Azad University/Qom, Iran
| | - A Pakfetrat
- Dept. of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Iran
| | - R Savad-Koohi
- Dept. of Infectious Diseases, Microbiology, School of Medicine, Babol University of Medical Sciences, Iran
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Abstract
It is widely accepted that axillary malodour is attributable to the microbial biotransformation of odourless, natural secretions into volatile odorous products. Consequently, there is a need to understand the microbial ecology of the axilla in order that deodorant products, which control microbial action in this region, can be developed in the appropriate manner. A detailed characterization of the axillary microflora of a group of human volunteers has been performed. The axillary microflora is composed of four principal groups of bacteria (staphylococci, aerobic coryneforms, micrococci and propionibacteria), and the yeast genus Malassezia. Results indicated that the axillary microflora was dominated by either staphylococcal or aerobic coryneform species. Comparisons between axillary bacterial numbers and levels of axillary odour demonstrated the greatest association between odour levels and the presence of aerobic coryneforms in the under-arm. As the taxonomy of cutaneous aerobic coryneforms is poorly understood, a further study was conducted to characterize selected axillary aerobic coryneform isolates. Using the molecular technique of 16S rDNA sequencing, selected genomic sequences of a number of axillary aerobic coryneform isolates were obtained. Comparisons with sequence databases indicated the likely presence of a range of Corynebacterium species on axillary skin, although the majority of isolates were most similar to either Corynebacterium G-2 CDC G5840 or C. mucifaciens DMMZ 2278. Although for a panel of individuals differences in the carriage of Corynebacterium species were noted, similar species were carried by a number of panellists. All isolates examined in this limited evaluation failed to demonstrate the capability to metabolize long-chain fatty acids (LCFAs) to shorter chain, more volatile products. The application of this modern molecular phylogenetic technique has increased understanding of the diversity of aerobic coryneform carriage in the axilla, and on human skin. The application of this technique in other studies to assess the ethnic differences in cutaneous bacterial ecology, or the effects on the microflora of specific product use, will assist in the future development of novel deodorant systems.
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Affiliation(s)
- D Taylor
- Unilever Research & Development Port Sunlight, Wirral, UK.
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Tanimura Y, Vaziri S, Lewis MH. Indirect basal ganglia pathway mediation of repetitive behavior: attenuation by adenosine receptor agonists. Behav Brain Res 2010; 210:116-22. [PMID: 20178817 DOI: 10.1016/j.bbr.2010.02.030] [Citation(s) in RCA: 62] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/11/2010] [Accepted: 02/15/2010] [Indexed: 11/18/2022]
Abstract
Repetitive behaviors are diagnostic for autism and common in related neurodevelopmental disorders. Despite their clinical importance, underlying mechanisms associated with the expression of these behaviors remain poorly understood. Our lab has previously shown that the rates of spontaneous stereotypy in deer mice (Peromyscus maniculatus) were negatively correlated with enkephalin content, a marker of striatopallidal but not striatonigral neurons. To investigate further the role of the indirect basal ganglia pathway, we examined neuronal activation of the subthalamic nucleus (STN) using cytochrome oxidase (CO) histochemistry in high- and low-stereotypy mice. CO activity in STN was significantly lower in high-stereotypy mice and negatively correlated with the frequency of stereotypy. In addition, exposure to environmental enrichment, which attenuated stereotypy, normalized the activity of STN. Co-administration of the adenosine A(2A) receptor agonist CGS21680 and the A(1) receptor agonist CPA attenuated stereotypy dose-dependently. The significant reduction associated with the lowest dose of the drug combination tested was due to its effects on mice with lower baseline levels of stereotypy. Higher doses of the drug combination were required to show robust behavioral effects, and presumably requisite activation of the indirect pathway, in high-stereotypy mice. These findings support that decreased indirect pathway activity is linked to the expression of high levels of stereotypy in deer mice and that striatal A(1) and A(2A) receptors may provide promising therapeutic targets for the treatment of repetitive behaviors in neurodevelopmental disorders.
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Affiliation(s)
- Yoko Tanimura
- Departments of Psychiatry and Psychology, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
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Janbakhsh A, Mansouri F, Vaziri S, Sayyad B, Afsharian M, Meigouni S. Prevalence and Co-Existance of Diabetes with HIV and Hcv Infection in Kermanshah-Iran. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.1346] [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: 10/21/2022] Open
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Taherkhani H, Fallah M, Jadidian K, Vaziri S. A Study on the Prevalence of Cryptosporidium in HIV Positive Patients. J Res Health Sci 2007; 7:20-24. [PMID: 23343920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 11/26/2007] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND AIDS is acquired by infection with HIV (human immuno-deficiency virus). It leaves the host susceptible to malignant and unusual infections especially opportunistic ones. Most of AIDS patients infected with opportunistic parasitic infections die because of chronic diarrhea and deaths due to Cryptosporidium diarrhea in AIDS patients are considerable in the recent two decades. The aim of this study is to find Cryptosporidium parasite in AIDS patients referring to the center of Diseases consultation in Kermanshah province and to determine the frequency of infection in those patients. METHODS In this study stool and blood samples were collected from 75 AIDS patients referring regularly to the Center of Diseases Consultation in Kermanshah and the gathered information were filled in the questionnaires together with their personal information regarding their names, sex and etc. Stool samples were tested using direct and formalin ether methods and then the smears that were dyed using modified acid fast staining were examined. Peripheral blood samples were used to determine the CD4 counts. RESULTS The results showed that the frequency of infection with Cryptosporidium in AIDS patients was 26.7% (20 cases). CONCLUSION According to the study, as the number of CD4 decreased in the patients, the probability of infection with opportunistic parasites increased and increase in the number CD4 that is normally accompanied with strengthening the body immune system resulted in the decrease in the frequency of infection with Cryptosporidium.
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Affiliation(s)
- H Taherkhani
- Dept. of Medical Parasitology, School of Medicine, University of Medical Sciences, Golestan, Iran
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Ganapathi M, Chikamori K, Hill J, Grabowski D, Zarkhin E, Grozav A, Vaziri S, Bukowski R, Yen A, Ganapathi R. 493 POSTER Down regulation of topoisomerase IIβ in myeloid leukemia cell lines leads to activation of apoptosis following all-trans retinoic acid-induced differentiation/growth arrest. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70498-0] [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: 11/16/2022] Open
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Ganapathi R, Al-Hazzouri A, Vaziri S, Grabowski D, Ganapathi M, Bukowski R. 48 POSTER Distinct gene expression profiles and cell death pathways in clear-cell renal cell carcinoma (CCRCC) and colorectal carcinoma (CRC) cells:r elationship to hypoxia, von Hippel Lindau protein (pVHL) expression and anti-tumor activity of sorafenib. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70054-4] [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: 10/23/2022] Open
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