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Naeem B, Ayub A, Coss-Bu J, Mian MUM, Hernaez R, Fogarty TP, Deshotels K, Kennedy C, Goss J, Desai MS. Postoperative outcomes of acute-on-chronic liver failure in infants and children with biliary atresia. Pediatr Transplant 2024; 28:e14736. [PMID: 38602219 DOI: 10.1111/petr.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Acute-on-chronic liver failure (ACLF) is associated with increased mortality and morbidity in patients with biliary atresia (BA). Data on impact of ACLF on postoperative outcomes, however, are sparse. METHOD We performed a retrospective analysis of patients with BA aged <18 years who underwent LT between 2011 and 2021 at our institution. ACLF was defined using the pediatric ACLF criteria: ≥1 extra-hepatic organ failure in children with decompensated cirrhosis. RESULTS Of 107 patients (65% female; median age 14 [9-31] months) who received a LT, 13 (12%) had ACLF during the index admission prior to LT. Two (15%) had Grade 1; 4 (30%) had Grade 2; and 7 (55%) had Grade ≥3 ACLF. ACLF cohort was younger at time of listing (5 [4-8] vs. 9 [6-24] months; p < .001) and at LT (8 [8-11] vs. 16 [10-40] months, p < .001) compared to no-ACLF group. Intraoperatively, ACLF patients had higher blood loss (40 [20-53] vs. 10 [6-19] mL/kg; p < .001) and blood transfusion requirements (33 [21-69] vs. 18 [7-25] mL/kg; p = .004). Postoperatively, they needed higher vasopressor support (31% vs. 10.6%; p = .04) and had higher total hospital length of stay (106 [45-151] vs. 13 [7-30] days; p = .023). Rate of return to the operating room, hospital readmission rates, and 1-year post-LT survival rates were comparable between the groups. CONCLUSION Despite higher perioperative complications, survival outcomes for ACLF in BA after LT are favorable and comparable to those without ACLF. These encouraging data reiterate prioritization during organ allocation of these critically ill children for LT.
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Affiliation(s)
- Buria Naeem
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adil Ayub
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jorge Coss-Bu
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Muhammad Umair M Mian
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine, Houston, Texas, USA
| | - Thomas P Fogarty
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Kirby Deshotels
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Curt Kennedy
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John Goss
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Moreshwar S Desai
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Cobelo-Gómez S, Sánchez-Iglesias S, Rábano A, Senra A, Aguiar P, Gómez-Lado N, García-Varela L, Burgueño-García I, Lampón-Fernández L, Fernández-Pombo A, Díaz-López EJ, Prado-Moraña T, San Millán B, Araújo-Vilar D. A murine model of BSCL2-associated Celia's encephalopathy. Neurobiol Dis 2023; 187:106300. [PMID: 37717662 DOI: 10.1016/j.nbd.2023.106300] [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: 06/03/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/19/2023] Open
Abstract
Celia's encephalopathy or progressive encephalopathy with/without lipodystrophy is a neurodegenerative disease with a fatal prognosis in childhood. It is generally caused by the c.985C > T variant in the BSCL2 gene, leading to the skipping of exon 7 and resulting in an aberrant seipin protein (Celia-seipin). To precisely define the temporal evolution and the mechanisms involved in neurodegeneration, lipodystrophy and fatty liver in Celia's encephalopathy, our group has generated the first global knock-in murine model for the aberrant human transcript of BSCL2 (Bscl2Celia/Celia) using a strategy based on the Cre/loxP recombination system. In order to carry out a characterization at the neurological, adipose tissue and hepatic level, behavioral studies, brain PET, metabolic, histological and molecular studies were performed. Around 12% of homozygous and 5.4% of heterozygous knock-in mice showed severe neurological symptoms early in life, and their life expectancy was dramatically reduced. Severe generalized lipodystrophy and mild hepatic steatosis were present in these affected animals, while serum triglycerides and glucose metabolism were normal, with no insulin resistance. Furthermore, the study revealed a reduction in brain glucose uptake, along with patchy loss of Purkinje cells and the presence of intranuclear inclusions in cerebellar cortex cells. Homozygous, non-severely-affected knock-in mice showed a decrease in locomotor activity and greater anxiety compared with their wild type littermates. Bscl2Celia/Celia is the first murine model of Celia's encephalopathy which partially recapitulates the phenotype and severe neurodegenerative picture suffered by these patients. This model will provide a helpful tool to investigate both the progressive encephalopathy with/without lipodystrophy and congenital generalized lipodystrophy.
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Affiliation(s)
- Silvia Cobelo-Gómez
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain
| | - Sofía Sánchez-Iglesias
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain
| | - Alberto Rábano
- Alzheimer's Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center, Madrid, Spain
| | - Ana Senra
- Department of Physiology, CIMUS, University of Santiago de Compostela, Spain
| | - Pablo Aguiar
- Molecular Imaging and Medical Physics, University of Santiago de Compostela-IDIS, Spain; Nuclear Medicine and Molecular Imaging Group, IDIS, University Clinical Hospital of Santiago de Compostela, Spain
| | - Noemí Gómez-Lado
- Molecular Imaging and Medical Physics, University of Santiago de Compostela-IDIS, Spain; Nuclear Medicine and Molecular Imaging Group, IDIS, University Clinical Hospital of Santiago de Compostela, Spain
| | - Lara García-Varela
- Molecular Imaging and Medical Physics, University of Santiago de Compostela-IDIS, Spain; Nuclear Medicine and Molecular Imaging Group, IDIS, University Clinical Hospital of Santiago de Compostela, Spain
| | - Iván Burgueño-García
- Alzheimer's Disease Research Unit, CIEN Foundation, Queen Sofia Foundation Alzheimer Center, Madrid, Spain
| | - Laura Lampón-Fernández
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain
| | - Antía Fernández-Pombo
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain; Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Spain
| | - Everardo Josué Díaz-López
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain; Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Spain
| | - Teresa Prado-Moraña
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain; Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Spain
| | - Beatriz San Millán
- Grupo de Enfermedades Raras y Medicina Pediátrica, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain; Pathology Department, Alvaro Cunqueiro Hospital, Vigo, Spain
| | - David Araújo-Vilar
- UETeM-Molecular Pathology Group. Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CIMUS, University of Santiago de Compostela, Spain; Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, Spain.
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Su CY, Huang GS, Chang WC, Wang CC, Chen CW, Hsu YC. The Value of 18F-FDG PET/MRI in Detecting Lumbar Radiculopathy for Selective Percutaneous Endoscopic Discectomy: a Case Report. Nucl Med Mol Imaging 2023; 57:247-250. [PMID: 37720881 PMCID: PMC10504134 DOI: 10.1007/s13139-023-00797-3] [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: 11/08/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the most popular imaging modality for investigating intervertebral disc herniation. However, it has a high chance for identifying incidental findings that are morphologically or structurally abnormal but not responsible for patients' symptoms. Although a previous study suggested that 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) may help identify neuroinflammation in lumbar radiculopathy, there is currently no direct evidence obtained from surgery. Here, we describe the case of a 32-year-old man with low back pain and right leg paresthesia for 7 months. MRI demonstrated disc herniation at the L3-L4, L4-L5 and L5-S1 levels, causing bilateral L5 and left S1 root compression. 18F-FDG PET/MRI demonstrated increased 18F-FDG uptake at the right L5 root, which was compatible with the patient's symptoms. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) was performed. Intraoperative images revealed a swollen nerve root at the right L5 after removal of the herniated disc. After surgery, the patient experienced immediate pain relief and had no recurrence at the 6-month follow-up. When performing PELD in patients with multilevel radiculopathy identified on MRI, the use of 18F-FDG PET/MRI can help in accurate localization of the symptomatic roots and minimize surgical incision and soft-tissue injury.
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Affiliation(s)
- Chih-Ying Su
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
| | - Chih-Chien Wang
- Department of Orthopedic, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Wen Chen
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung City, Taiwan, Republic of China
- Department of Radiology, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
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Luo M, Wang Z, Zhou B, Yang G, Shi Y, Chen J, Tang S, Huang J, Xiao Z. Risk factors for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a meta-analysis of 58 cohort studies. Neurosurg Rev 2023; 46:159. [PMID: 37392260 DOI: 10.1007/s10143-023-02041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/27/2023] [Indexed: 07/03/2023]
Abstract
Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic lumbar discectomy (PELD). There are reports in the literature on the identification of risk factors associated with rLDH; however, the results are controversial. Therefore, we conducted a meta-analysis to identify risk factors for rLDH among patients following spinal surgery. PubMed, EMBASE, and the Cochrane Library were searched without language restrictions from inception to April 2018 for studies reporting risk factors for LDH recurrence after PELD. MOOSE guidelines were followed in this meta-analysis. We used a random effects model to aggregate odds ratios (ORs) with 95% confidence intervals (CIs). The evidence of observational studies was classified into high quality (class I), medium quality (class II/III), and low quality (class IV) based on the P value of the total sample size and heterogeneity between studies. Fifty-eight studies were identified with a mean follow-up of 38.8 months. Studies with high-quality (class I) evidence showed that postoperative LDH recurrence after PELD was significantly correlated with diabetes (OR, 1.64; 95% CI, 1.14 to 2.31), the protrusion type LDH (OR, 1.62; 95% CI, 1.02 to 2.61), and less experienced surgeons (OR, 1.54; 95% CI, 1.10 to 2.16). Studies with medium-quality (class II or III) evidence showed that postoperative LDH recurrence was significantly correlated with advanced age (OR, 1.11; 95% CI, 1.05 to 1.19), Modic changes (OR, 2.23; 95% CI, 1.53 to 2.29), smoking (OR, 1.31; 95% CI, 1.00 to 1.71), no college education (OR, 1.56; 95% CI, 1.05 to 2.31), obesity (BMI ≥ 25 kg/m2) (OR, 1.66; 95% CI, 1.11 to 2.47), and inappropriate manual labor (OR, 2.18; 95% CI, 1.33 to 3.59). Based on the current literature, eight patient-related and one surgery-related risk factor are predictors of postoperative LDH recurrence after PELD. These findings may help clinicians raise awareness of early intervention for patients at high risk of LDH recurrence after PELD.
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Affiliation(s)
- Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Zhongze Wang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Beijun Zhou
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Gaigai Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi, 830054, China
| | - Jiang Chen
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Siliang Tang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Jingshan Huang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China.
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Lokhande PV. Full endoscopic spine surgery. J Orthop 2023; 40:74-82. [PMID: 37197373 PMCID: PMC10183645 DOI: 10.1016/j.jor.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Background With a dramatic increase in elderly population worldwide, the prevalence of degenerative spine disease is steadily rising. Even though the entire spinal column is affected the problem is more commonly seen in the lumbar, cervical spine and to some extent the thoracic spine. The treatment of symptomatic lumbar disc or stenosis is primarily conservative with analgesics, epidural steroids and physiotherapy. Surgery is advised only if conservative treatment is ineffective. Conventional open microscopic procedures even though are still a gold standard, have the disadvantages of excessive muscle damage and bone resection, epidural scarring along with prolonged hospital stay and increased need of postoperative analgesics. Minimal access spine surgeries minimize surgical access related injury by minimizing soft tissue and muscle damage and also bony resection thus preventing iatrogenic instability and unnecessary fusions. This leads to good functional preservation of the spine and enhances early postoperative recovery and early return to work. Full endoscopic spine surgeries are one of the more sophisticated and advanced form of MIS surgeries. Purpose Full endoscopy has definitive benefits over conventional microsurgical techniques. These include better and clear vision of the pathology due to presence of irrigation fluid channel, minimal soft tissue and bone trauma, better and relatively easy approach to deep seated pathologies like thoracic disc herniations and a possibility to avoid fusion surgeries. The purpose of this article is to describe these benefits, give an overview of the two main approaches - transforaminal and interlaminar, their indications, contraindications and their limitations. The article also describes about the challenges in overcoming the learning curve and its future prospectives. Conclusion Full endoscopic spine surgery is one of the fastest growing technique in the field of modern spine surgery. Better intraoperative visualization of the pathology, lesser incidence of complications, faster recovery time, less postoperative pain, better relief of symptoms and early return to activity are the main reasons behind this rapid growth. With better patient outcomes and reduced medical costs, the procedure is going to be more accepted, relevant and popular procedure in future.
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Jitpakdee K, Liu Y, Kotheeranurak V, Kim JS. Transforaminal Versus Interlaminar Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:575-587. [PMID: 35993298 PMCID: PMC9972290 DOI: 10.1177/21925682221120530] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Meta-analysis and systematic review. OBJECTIVE This study aims to investigate and compare patient-reported outcomes, perioperative data, and complications between 2 common endoscopic approaches for lumbar disc herniation: transforaminal and interlaminar endoscopic lumbar discectomy, by published high-quality evidence. METHODS Electronic databases were searched for reported outcomes following TELD and IELD. Oswestry Disability Index (ODI), visual analog scale of back (VASB) and leg pain (VASL), and MacNab criteria were evaluated. Operative time, hospital stays, blood loss, radiation exposure, and complications were investigated. Odds ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random and fixed-effect models. RESULTS Total of 1948 patients from 18 studies were included, consisting of 1006 patients (51.6%) in TELD group and 942 (48.4%) patients in IELD group. TELD had better improvement of postoperative ODI (MD = 1.26; 95% CI: .07-2.16; P = .04), postoperative VASB (MD = -.23; 95% CI: -.40 to -.05; P = .01) and last follow-up VASB (MD = -.25; 95% CI: -.41 to -.09; P = .002), but with longer operative time (MD = 10.1 min; 95% CI: 1.925-18.77; P < .00001) and more fluoroscopic time (SMD = 4.12; 95% CI: 3.22-5.03; P < .00001), especially in L5-S1 operation. Bed rest time was significantly longer following IELD, with no difference in VASL, hospital stays, or complication. CONCLUSION We found comparable clinical outcomes in terms of ODI, VAS, patient satisfaction, hospital stays, and complication between both techniques. TELD required more radiation exposure and longer operative time at L5-S1 level than IELD. Our study provided results to help consider appropriate approaches for selected patients and informed consent of benefits from each approach.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopedics, Thai Red Cross
Society, Queen Savang Vadhana Memorial
Hospital, Sriracha, Thailand
| | - Yanting Liu
- Department of Neurosurgery, College of
Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of
Medicine, Chulalongkorn University, Bangkok, Thailand,Center of Excellence in Biomechanics and
Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, College of
Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, South Korea,Jin-Sung Kim, MD, PhD, Department of Neurosurgery,
College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seocho
gu, Seoul 06591, South Korea. Emails: ;
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Sun M, Chu F, Zhang L, Zhao R, Liu X, Yu H, Pan B, Wu J, Yuan F. Effect of medium with moderate temperature on patient's body temperature during percutaneous endoscopic lumbar discectomy. J Orthop Surg Res 2022; 17:336. [PMID: 35765022 PMCID: PMC9237985 DOI: 10.1186/s13018-022-03226-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To explore the influence of irrigating fluid at different temperatures on patients' body temperature and local inflammatory mediators during spinal endoscopy. METHODS 110 cases of intervertebral foramen surgery in our hospital from January 2019 to October 2021 were randomly divided into control group and observation group. Operations of both groups were performed by the same experienced chief physician. The observation group was irrigated with 37 °C constant temperature saline, while the control group was irrigated at room temperature. The effect was evaluated by monitoring the intraoperative temperature, postoperative VAS score and the levels of inflammatory factors, such as TNF-α, IL-1, IL-6 and IL-10 in drainage fluid. RESULTS After 30 min of operation, overall temperature of the control group dropped significantly, and 50 cases (90.9%) had hypothermia, P < 0.05. There was no significant difference in preoperative VAS score between the two groups P > 0.05. The VAS score of observation group was significantly lower than that of control group at 6 h and 1 month after operation, P < 0.05. At 0, 3 and 6 h after operation, the values of TNF-α, IL-1, IL-6 and IL-10 in the observation group were significantly lower than those in the control group (P < 0.05). CONCLUSIONS Isothermal flushing solution can reduce the incidence of hypothermia and effectively alleviate local inflammatory reaction.
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Affiliation(s)
- Maji Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Fuchao Chu
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Lidong Zhang
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Rui Zhao
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Xiaona Liu
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Huilin Yu
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Bin Pan
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Jibin Wu
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Feng Yuan
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.
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Li Y, Yang X, Peng L, Xia Q, Zhang Y, Huang W, Liu T, Jia D. Role of Seipin in Human Diseases and Experimental Animal Models. Biomolecules 2022; 12:biom12060840. [PMID: 35740965 PMCID: PMC9221541 DOI: 10.3390/biom12060840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023] Open
Abstract
Seipin, a protein encoded by the Berardinelli-Seip congenital lipodystrophy type 2 (BSCL2) gene, is famous for its key role in the biogenesis of lipid droplets and type 2 congenital generalised lipodystrophy (CGL2). BSCL2 gene mutations result in genetic diseases including CGL2, progressive encephalopathy with or without lipodystrophy (also called Celia’s encephalopathy), and BSCL2-associated motor neuron diseases. Abnormal expression of seipin has also been found in hepatic steatosis, neurodegenerative diseases, glioblastoma stroke, cardiac hypertrophy, and other diseases. In the current study, we comprehensively summarise phenotypes, underlying mechanisms, and treatment of human diseases caused by BSCL2 gene mutations, paralleled by animal studies including systemic or specific Bscl2 gene knockout, or Bscl2 gene overexpression. In various animal models representing diseases that are not related to Bscl2 mutations, differential expression patterns and functional roles of seipin are also described. Furthermore, we highlight the potential therapeutic approaches by targeting seipin or its upstream and downstream signalling pathways. Taken together, restoring adipose tissue function and targeting seipin-related pathways are effective strategies for CGL2 treatment. Meanwhile, seipin-related pathways are also considered to have potential therapeutic value in diseases that are not caused by BSCL2 gene mutations.
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Affiliation(s)
- Yuying Li
- West China Pancreatitis Centre, Centre for Integrated Traditional Chinese Medicine and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (X.Y.); (Q.X.)
| | - Xinmin Yang
- West China Pancreatitis Centre, Centre for Integrated Traditional Chinese Medicine and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (X.Y.); (Q.X.)
| | - Linrui Peng
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu 610041, China; (L.P.); (Y.Z.)
| | - Qing Xia
- West China Pancreatitis Centre, Centre for Integrated Traditional Chinese Medicine and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (X.Y.); (Q.X.)
| | - Yuwei Zhang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu 610041, China; (L.P.); (Y.Z.)
| | - Wei Huang
- West China Pancreatitis Centre, Centre for Integrated Traditional Chinese Medicine and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (X.Y.); (Q.X.)
- Institutes for Systems Genetics & Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence: (W.H.); (T.L.)
| | - Tingting Liu
- West China Pancreatitis Centre, Centre for Integrated Traditional Chinese Medicine and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (X.Y.); (Q.X.)
- Correspondence: (W.H.); (T.L.)
| | - Da Jia
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Paediatrics, West China Second University Hospital, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu 610041, China;
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Arif S, Brady Z, Enchev Y, Peev N, Encheva E. Minimising radiation exposure to the surgeon in minimally invasive spine surgeries: A systematic review of 15 studies. Orthop Traumatol Surg Res 2021; 107:102795. [PMID: 33333283 DOI: 10.1016/j.otsr.2020.102795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/30/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health hazards including malignancy. In this study, the authors conducted a systematic review to evaluate the efficacy of navigation assisted fluoroscopy methods on radiation exposure to the surgeon in minimally invasive spine surgeries, percutaneous endoscopic lumbar discectomy/percutaneous endoscopic transforaminal discectomy versus minimally invasive spine transforaminal lumbar interbody fusion (PELD/PETD versus MIS-TLIF). METHODS A systematic literature search was conducted using PUBMED/MEDLINE on 20th July, 2020. Inclusion criteria were applied according to study design, surgical technique, spinal region, and language. Data extracted included lumbar segment, average operation time (min), fluoroscopic time (s), and radiation dose (μSV), efficacy of modified navigation versus conventional techniques; on reducing operation, fluoroscopy times and effective radiation dose. RESULTS Fifteen studies (ten prospectives, and five retrospectives) were included for quantitative analysis. PELD recorded a shorter operation time (by 126.3min, p<0.001) and fluoroscopic time (by 22.9s, p=0.3) than MIS-TLIF. The highest radiation dose/case (μSV) for both techniques were recorded at the surgeon's: finger, chest, neck and eye. The effective dose for MIS-TLIF was 30μSV higher than PELD. Modified navigation techniques recorded a shorter operation time (by 15.9min, p=0.3); fluoroscopy time (by 289.8s, p=0.3); effective radiation dose (by 169.5μSV, p=0.3) than conventional fluoroscopy methods. DISCUSSION This systematic literature review showed that although navigation assisted fluoroscopy techniques are superior to conventional methods in minimising radiation exposure, lack of statistical significance warrants future randomised controlled trials, to solidify their efficacy in reducing radiation related hazards.
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Affiliation(s)
- Shahswar Arif
- Medical university of Varna, ul. "Professor Marin Drinov" 55, 9002 Center Varna, Bulgaria
| | - Zarina Brady
- Medical university of Varna, ul. "Professor Marin Drinov" 55, 9002 Center Varna, Bulgaria.
| | - Yavor Enchev
- Medical university of Varna, ul. "Professor Marin Drinov" 55, 9002 Center Varna, Bulgaria; Department of neurosurgery, medical university of Varna, university hospital "St. Marina", Varna, Bulgaria
| | - Nikolay Peev
- Department of neurosurgery, Royal Victoria hospital, Belfast health and social care trust, Belfast, Northern Ireland, United Kingdom
| | - Elitsa Encheva
- Medical university of Varna, ul. "Professor Marin Drinov" 55, 9002 Center Varna, Bulgaria
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Sánchez-Iglesias S, Fernández-Pombo A, Cobelo-Gómez S, Hermida-Ameijeiras Á, Alarcón-Martínez H, Domingo-Jiménez R, Ruíz Riquelme AI, Requena JR, Araújo-Vilar D. Celia's Encephalopathy ( BSCL2-Gene-Related): Current Understanding. J Clin Med 2021; 10:1435. [PMID: 33916074 DOI: 10.3390/jcm10071435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022] Open
Abstract
Seipin, encoded by the BSCL2 gene, is a protein that in humans is expressed mainly in the central nervous system. Uniquely, certain variants in BSCL2 can cause both generalized congenital lipodystrophy type 2, upper and/or lower motor neuron diseases, or progressive encephalopathy, with a poor prognosis during childhood. The latter, Celia's encephalopathy, which may or may not be associated with generalized lipodystrophy, is caused by the c.985C >T variant. This cytosine to thymine transition creates a cryptic splicing zone that leads to intronization of exon 7, resulting in an aberrant form of seipin, Celia seipin. It has been proposed that the accumulation of this protein, both in the endoplasmic reticulum and in the nucleus of neurons, might be the pathogenetic mechanism of this neurodegenerative condition. In recent years, other variants in BSCL2 associated with generalized lipodystrophy and progressive epileptic encephalopathy have been reported. Interestingly, most of these variants could also lead to the loss of exon 7. In this review, we analyzed the molecular bases of Celia's encephalopathy and its pathogenic mechanisms, the clinical features of the different variants, and a therapeutic approach in order to slow down the progression of this fatal neurological disorder.
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Covarrubias K, Luo X, Massie A, Schwarz KB, Garonzik-Wang J, Segev DL, Mogul DB. Determinants of length of stay after pediatric liver transplantation. Pediatr Transplant 2020; 24:e13702. [PMID: 32212292 PMCID: PMC7260078 DOI: 10.1111/petr.13702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/07/2020] [Accepted: 03/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND We sought to identify factors that are associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. METHODS We identified 2726 infants (≤24 months) and 3210 children (>24 months) who underwent pediatric liver-only transplantation from 2002-2017 using the Scientific Registry of Transplant Recipients. We used multilevel multivariable negative binomial regression to analyze associations between LOS and recipient and donor characteristics and calculated the MLOSR to quantify heterogeneity in LOS across centers. RESULTS In infants, the median LOS (IQR) was 19 (13-32) days. Hospitalization prior to transplant (ICU ratio:1.46 1.591.70 ; non-ICU ratio:1.08 1.161.23 ), public insurance (ratio:1.03 1.091.15 ), and a segmental graft (ratio:1.08 1.151.22 ) were associated with a longer LOS; thus, we would expect a 1.59-fold longer LOS in an infant admitted to the ICU compared to a non-hospitalized infant with similar characteristics. In children, the median LOS (IQR) was 13 (9-21) days. Hospitalization prior to transplant (ICU ratio:1.49 1.621.77 ; non-ICU ratio:1.34 1.441.56 ), public insurance (ratio:1.02 1.071.13 ), a segmental graft (ratio:1.20 1.271.35 ), a living donor graft (ratio:1.27 1.381.51 ), and obesity (ratio:1.03 1.101.17 ) were associated with a longer LOS. The MLOSR was 1.25 in infants and 1.26 in children, meaning if an infant received a transplant at another center with a longer LOS, we would expect a 1.25-fold difference in LOS driven by center practices alone. CONCLUSIONS While center-level practices account for substantial variation in LOS, consideration of donor and recipient factors can help clinicians provide more personalized counseling for families of pediatric liver transplant candidates.
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Affiliation(s)
- Karina Covarrubias
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Kathleen B. Schwarz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Douglas B. Mogul
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the effect of time to first ambulation on recurrence after percutaneous endoscopic lumbar discectomy (PELD). METHODS From July 2017 to August 2018, 90 patients with lumbar intervertebral disc herniation underwent PELD surgery. According to the initial walking time, i.e., the time until the patient could walk after the operation, the operations were divided into three groups: early stage, middle stage, and late stage. The follow-up period was 3 months, and complete follow-up data were obtained. The visual analog scale (VAS) and Oswestry disability index (ODI) scores before the operation, at first ambulation, 1 month after the operation, and 3 months after the operation and the recurrence and incidence rates of high magnetic resonance imaging (MRI) signal in the vertebral endplate area were recorded after the operation. RESULTS The success rate was 100% for these 90 cases. The VAS and ODI scores at the first ambulation after the operation significantly improved compared with those before the operation, and the difference was statistically significant. The improvements in the lumbar VAS and ODI scores of the middle- and late-stage groups were better than that of the early-stage group at 1 and 3 months after the operation, and the differences were statistically significant; however, there was no significant difference between the middle- and late-stage groups. The postoperative recurrence rate and rate of high MRI signal in the vertebral endplate area were significantly higher in the early-stage group than in the other two groups, and the difference was statistically significant. CONCLUSION The time to first ambulation after PELD is an important factor affecting the curative effect of the operation. Early ambulation may be one of the factors affecting recurrence after PELD.
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Affiliation(s)
- Fengwei Qin
- Department of Orthopedics, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Avenue, Huadu District, Guangzhou City, Guangdong Province People’s Republic of China
| | - Zhaofei Zhang
- Department of Orthopedics, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Avenue, Huadu District, Guangzhou City, Guangdong Province People’s Republic of China
| | - Caixia Zhang
- Department of Surgery, Xinhua Community Health Service Center, No. 8, Nongxin Road, Huadu District, Guangzhou City, Guangdong Province People’s Republic of China
| | - Yonghui Feng
- Department of Orthopedics, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Avenue, Huadu District, Guangzhou City, Guangdong Province People’s Republic of China
| | - Sineng Zhang
- Department of Orthopedics, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Avenue, Huadu District, Guangzhou City, Guangdong Province People’s Republic of China
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Lv Z, Jin L, Wang K, Chen Z, Li F, Zhang Y, Lao L, Zhou C, Li X, Shen H. Comparison of Effects of PELD and Fenestration in the Treatment of Geriatric Lumbar Lateral Recess Stenosis. Clin Interv Aging 2019; 14:2187-2194. [PMID: 31908429 PMCID: PMC6924588 DOI: 10.2147/cia.s226295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/07/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Although degenerative lumbar spinal stenosis (LSS) is increasingly being diagnosed in older people, there is much uncertainty about the appropriate operative treatment options. The objective of this study was to compare the outcome of percutaneous endoscopic lumbar decompression (PELD) versus fenestration for lumbar lateral recess stenosis (LRS) in geriatric patients over 75 years old. Materials and methods This prospective controlled study was performed on 46 consecutive over aged patients with lateral recess stenosis who underwent either PELD or fenestration. Clinical data were recorded before, 1 week, 3 months and 1.5 years after surgery using visual analog scale (VAS), Japanese Orthopaedic Association Score (JOA), The Short-Form-36 (SF-36), and the modified Macnab evaluation criteria. Results The patients’ mean age was 82.7 years (aged 75–93 years) in PELD group and 79.1 years (aged 75–88 years) in fenestration group. No statistical difference was found between PELD group and fenestration group with regards to VAS-back pain, VAS-leg pain, JOA and at 3 months and 1.5-year follow-up. However, the PELD group had a lower mean VAS for back pain at 1 week postoperatively (P<0.05). The quality of life in PELD group achieved the same remarkable improvement as fenestration group (P>0.05). Operative time (min) was similar between two groups (p>0.05), while the PELD techniques brought advantages in blood loss (mL) (48.3 vs 128.2, p<0.05), early ambulation (h) (5.5 vs 25.2, p<0.05), and anesthesia-related complications. Conclusion Both PELD and fenestration showed favorable clinical outcomes for the treatment of lumbar lateral recess stenosis. In addition, PELD had advantages such as reduced traumatization and less anesthesia-related complications. In terms of quality of life and complications after operation, PELD under local anesthesia could be an efficient supplement to conventional decompression surgery in geriatric patients with lumbar lateral recess stenosis.
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Affiliation(s)
- Zhendong Lv
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Linyu Jin
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Kun Wang
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhi Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Fengning Li
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yuhui Zhang
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Lifeng Lao
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Chun Zhou
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xinfeng Li
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Hongxing Shen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Raices M, Czerwonko ME, Ardiles V, Boldrini G, D'Agostino D, Marcó Del Pont J, Pekolj J, Mattera J, Brandi C, Ciardullo M, de Santibañes E, de Santibañes M. Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients. J Gastrointest Surg 2019; 23:2411-20. [PMID: 30887299 DOI: 10.1007/s11605-019-04188-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/26/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate short- and long-term outcomes after live-donor liver transplantation (LT) with hyper-reduced grafts in low-weight pediatric recipients. LT is an established curative therapy for children with end-stage chronic liver disease or acute liver failure. A major problem in pediatric LT has been the lack of size-matched donor organs. The disadvantage of the use of large-for-size grafts is the insufficient tissue oxygenation and graft compression, which result in poor outcomes. The shortage of suitable donors is most notable in children under 10 kg. To overcome such obstacle, in situ hyper-reduced live-donor liver grafts have been introduced. Available articles in the literature are based on small samples and are deficient in long-term follow-up. METHODS A single-cohort, retrospective analysis was conducted including 59 pediatric patients under 10 kg who underwent hyper-reduced (in situ "a la carte" left lateral segment reduction) live-donor LT (LDLT) between February 1994 and February 2018. RESULTS The most frequent cause of liver failure was biliary atresia (70%). Median recipient weight was 8 kg. Vascular complications were confirmed in 15% of the sample, while 45% presented biliary complications. Median follow-up time was 40.3 months. Ten-year overall survival rate was 74%. Pediatric end-stage liver disease score > 23 was associated with a higher risk of post-operative complications. CONCLUSION LDLT can be undertaken in children with body weight < 10 kg achieving good results in high-volume centers by experienced surgeons.
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Sharma SB, Lin GX, Jabri H, Sidappa ND, Song MS, Choi KC, Kim JS. Radiographic and clinical outcomes of huge lumbar disc herniations treated by transforaminal endoscopic discectomy. Clin Neurol Neurosurg 2019; 185:105485. [PMID: 31421587 DOI: 10.1016/j.clineuro.2019.105485] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/02/2019] [Accepted: 08/08/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Large Central disc herniations (occupying more than 50% of canal area) are notorious as they are generally associated with worse outcomes and are technically difficult to manage. Transforaminal endoscopy (TELD) has evolved to become an interesting alternative for lumbar disc herniations. The aim of the paper is to review our technique of transforaminal endoscopy in large central disc herniations and describe the clinical and radiographic results. We also describe an innovative technique of intraoperative epidurography to assess the adequacy of decompression in some cases with severe canal compromise. PATIENTS AND METHODS We performed a retrospective analysis of all the patients undergoing TELD from December 2012 to October 2018 for huge central lumbar disc herniations. The procedure was done under local anaesthesia and required a more horizontal approach angle, undercutting of superior articular process and posterior annular release to reach the herniated fragment in the epidural space. In severe cases, a radiopaque dye was introduced via trans-sacral catheter to check the adequacy of decompression. The disc height, lumbar lordosis, segmental lordotic angle on standing radiographs and Canal cross sectional area(CSA) on MRI were evaluated preoperatively and compared with postoperative images at the end of 1 year/final follow-up. The Visual analogue scale(VAS) for Back and Leg pain and Oswestry disability index (ODI), MacNab criteria, return to daily activities, return to work, patient satisfaction rate and recommendation to others were the clinical outcomes evaluated. The percentage of patients achieving the Minimal clinically important difference (MCID) of 3 points for VAS and 12 points for ODI was calculated. RESULTS A total of 18 patients, with an average age of 35.1years (range 20-61), were operated. The mean VAS back improved from 5.7(±1.77) to 1(±0.77) and VAS leg improved from 7.3(±1.37) to 1.1(±1.09). The ODI improved from 49.88(±11.42) to 13.88(±7.28) at final follow-up. According to MacNab criteria, 17 patients had excellent and 1 had good outcome at final follow-up. The patient satisfaction rate was 90.5%, with 94% patient recommendation rate. All the patients returned to daily activities and work/modified work within a median of 5 weeks. There was 1 patient who required conversion to open surgery due to incidental dural tear, 1 patient who had a remnant disc required a revision tubular discectomy and 1 patient who had recurrence at 6 weeks and again at 2 years which was treated by repeat TELD. Five patients had impending cauda equina. All the patients achieved the MCID for VAS and ODI within a median period of 6 weeks and 3 months, respectively. The recovery rate was 90.1%. Five patients had grade 4 weakness of great toe/ankle dorsiflexion, one also had ankle flexion weakness preoperatively which improved after surgery. The CSA improved from a preoperative mean of 62.26(±30.3)mm2 to 122.16(±56.5)mm2 postoperatively. The CSA improved to 141.05(±63.86)mm2 at 1 year followup. The average disc height which was 9.71 mm(±2.4) was maintained at follow-up of one year which was 9.21 mm(±2.4). The lumbar lordosis and segmental lordotic angle changed from 27.08°(±15.9) and 2.82°(±5.7) to 35.8°(±8.56) and 4.85°(±4.39) respectively. CONCLUSION TELD may be considered as an alternative to microdiscectomy or fusion procedures for huge central disc herniations with favourable outcomes. However, sufficient expertise with the procedure is necessary. Intraoperative decompression may be confirmed with intraoperative epidurography. The patient acceptability of the procedure is good and causes minimal disruption of the normal anatomy.
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Affiliation(s)
- Sagar B Sharma
- Spine Fellow, Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Guang-Xun Lin
- Spine Fellow, Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Hussam Jabri
- Spine Fellow, Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Naveen D Sidappa
- Spine Fellow, Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Myung Soo Song
- Spine Fellow, Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Kyung Chul Choi
- Consultant Spine Surgeon, Department of Neurosurgery, Wiltse Memorial Hospital, Anyang-si, South Korea.
| | - Jin-Sung Kim
- Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, South Korea.
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Sánchez-Iglesias S, Crocker M, O'Callaghan M, Darling A, García-Cazorla A, Domingo-Jiménez R, Castro A, Fernández-Pombo A, Ruibal Á, Aguiar P, Garrido-Pumar M, Rodríguez-Núñez A, Álvarez-Escudero J, Brown RJ, Araújo-Vilar D. Celia's encephalopathy and c.974dupG in BSCL2 gene: a hidden change in a known variant. Neurogenetics 2019; 20:73-82. [PMID: 30903322 DOI: 10.1007/s10048-019-00574-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/17/2019] [Indexed: 12/11/2022]
Abstract
Celia's encephalopathy (progressive encephalopathy with/without lipodystrophy (PELD)) is a childhood neurodegenerative disorder with a fatal prognosis before the age of 10, due to the variant c.985C>T in the BSCL2 gene that causes a cryptic splicing site leading to skipping of exon 7. For years, different authors have reported cases of congenital generalized lipodystrophy due to the variant c.974dupG in BSCL2 associated with neurological manifestations of variable severity, although some of them clearly superimposable to PELD. To identify the molecular mechanisms responsible for these neurological alterations in two patients with c.974dupG. Clinical characterization, biochemistry, and neuroimaging studies of two girls carrying this variant. In silico analysis, PCR amplification, and BSCL2 cDNA sequencing. BSCL2-201 transcript expression, which lacks exon 7, by qPCR in fibroblasts from the index case, from a healthy child as a control and from two patients with PELD, and in leukocytes from the index case and her parents. One with a severe encephalopathy including a picture of intellectual deficiency, severe language impairment, myoclonic epilepsy, and lipodystrophy as described in PELD, dying at 9 years and 9 months of age. The other 2-year-old patient showed incipient signs of neurological involvement. In silico and cDNA sequencing studies showed that variant c.974dupG gives rise to skipping of exon 7. The expression of BSCL2-201 in fibroblasts was significantly higher in the index case than in the healthy child, although less than in the case with homozygous PELD due to c.985C>T variant. The expression of this transcript was approximately half in the healthy carrier parents of this patient. The c.974dupG variant leads to the skipping of exon 7 of the BSCL2 gene and is responsible for a variant of Celia's encephalopathy, with variable phenotypic expression.
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Keorochana G, Pairuchvej S, Setrkraising K, Arirachakaran A, Kongtharvonskul J. Comparative Outcomes of Perioperative Epidural Steroids After Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Randomized Placebo-Controlled Trial. World Neurosurg 2018; 119:e244-e249. [PMID: 30059778 DOI: 10.1016/j.wneu.2018.07.122] [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: 05/14/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess postoperative outcomes and complications after percutaneous endoscopic lumbar discectomy (PELD) with or without epidural steroids (ES) administration in lumbar disc herniation. METHODS In a double-blind randomized, placebo-controlled trial at Ramathibodi Hospital, Mahidol University, from May 2014 to May 2015, 30 patients were randomly allocated to receive ES or placebo (saline) after PELD. The primary outcome was 24-hour morphine consumption. Secondary outcomes were visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index score, Roland-Morris Disability Questionnaire score, and complications at 6-month follow-up. RESULTS Mean patient age was 60.0 years, and 0.57% of patients were male. Mean VAS back pain, VAS leg pain, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores at baseline were 4.7, 6.1, 24.9, 17.5 in the ES group and 5.1, 5.5, 24.7, 16.7 in the placebo group, respectively. Mean morphine requirements measured at 8, 16, and 24 hours were 3.47, 2.67, and <0.001 in the ES group and 3.13, 1.67, and 0.40 in the placebo group. The mean VAS scores measured at 4, 8, 12, 16, 20, and 24 hours were 2.99, 2.70, 2.56, 3.30, 3.05, and 2.05 the ES group and 3.13, 1.13, 1.26, 1.65, 1.22, and 1.08 in placebo group. The difference was not statistically significant (P > 0.05 for all). CONCLUSIONS Administration of ES with PELD for lumbar disc herniation does not improve postoperative pain, morphine requirements, or disability scores in the short-term and midterm periods.
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Affiliation(s)
- Gun Keorochana
- Orthopedics Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Saran Pairuchvej
- Orthopedics Department, Queen Savang Vadhana Memorial Hospital, Chon Buri, Thailand
| | | | | | - Jatupon Kongtharvonskul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Eun SS, Lee SH, Liu WC, Erken HY. A novel preoperative trajectory evaluation method for L5-S1 transforaminal percutaneous endoscopic lumbar discectomy. Spine J 2018; 18:1286-1291. [PMID: 29501748 DOI: 10.1016/j.spinee.2018.02.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 10/25/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT L5-S1 transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a demanding procedure because of structures such as iliac crest, L5 transverse process, hypertrophic L5-S1 facet joint, and sacral ala. There has been no definite preoperative evaluation method to evaluate the surgical validity of L5-S1 transforaminal PELD. PURPOSE The authors report a new preoperative trajectory evaluation method for L5-S1 transforaminal PELD using magnetic resonance imaging (MRI) or computed tomography (CT) examinations. STUDY DESIGN/SETTING This is a technical report study. PATIENT SAMPLE Patients who were diagnosed L5-S1 soft disc herniation were included in the present study. OUTCOME MEASURES Success rate of transforaminal PELD according to height of iliac crest was measured. METHODS Twelve patients who were diagnosed L5-S1 disc herniation were preoperatively evaluated with this new method. A skin marker is attached to patient's back as a tentative skin entry point, which was determined by usual preoperative MRI or CT. A new tilted axial and coronal MRI or CT scan is performed according to axis of L5-S1 transforaminal working channel. The images show good relationship between working channel and iliac crest. RESULTS Six patients underwent a transforaminal PELD, and the results were successful. The other six patients were considered to be "unsuitable" for transforaminal PELD because of the probable blockade by iliac crest. CONCLUSIONS The tilted MRI or CT provides precise evaluation for L5-S1 transforaminal PELD trajectory and may achieve good outcome.
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Affiliation(s)
- Sang Soo Eun
- Department of Orthopedic Surgery, Spine Health Wooridul Hospital (Gangnam), 445, Hakdong-ro, Gangnam-gu, Seoul 135-951, Republic of Korea
| | - Sang-Ho Lee
- Department of Neurosurgery, Spine Health Wooridul Hospital (Gangnam), 445, Hakdong-ro, Gangnam-gu, Seoul 135-951, Republic of Korea
| | - Wei Chiang Liu
- Department of Radiology, Spine Health Wooridul Hospital(Gangnam), 445, Hakdong-ro, Gangnam-gu, Seoul 135-951, Republic of Korea
| | - H Yener Erken
- Spine Health Wooridul Hospital (Gangnam), 445, Hakdong-ro, Gangnam-gu, Seoul 135-951, Republic of Korea.
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Gilbert Pérez JJ, Jordano Moreno B, Rodríguez Salas M. [Aetiology, outcomes and prognostic indicators of paediatric acute liver failure]. An Pediatr (Barc) 2017; 88:63-68. [PMID: 28395968 DOI: 10.1016/j.anpedi.2017.02.017] [Citation(s) in RCA: 7] [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: 01/13/2017] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Acute liver failure (ALF) is a multisystem disease with severe impairment of liver function of acute onset. The Paediatric End-stage Liver Disease (PELD) score is used as a predictor of mortality in chronic liver disease, however experience is limited in ALF. OBJECTIVES To evaluate the aetiology and outcomes of children with ALF in a Children's Liver Transplant Centre, and to investigate the validity of PELD as a prognostic indicator. PATIENTS AND METHODS A retrospective study was conducted on patients diagnosed with ALF in our hospital from 2000 to 2013 using the criteria of the Paediatric ALF Study Group. RESULTS The study included 49 patients with an age range 0-14years. The most frequent aetiologies were: indeterminate (36.7%) and metabolic (26.5%). Liver transplant (LT) was required by 42.8%, and there were 16.3% deaths. Patients with higher levels of bilirubin, INR, or encephalopathy were more likely to require a liver transplant, yielding an OR for INR 1.93. A cut-off of 27 in the PELD score according to the ROC curve showed a sensitivity of 86% and a specificity of 85%, predicting a worse outcome (AUC: 0.90; P<.001). The survival of patients with ALF without transplantation seems more likely in those who have low values of PELD and absence of encephalopathy, with a RR of 0.326. CONCLUSIONS ALF patients with a high PELD score and the presence of encephalopathy had worse outcomes. The PELD score could be a useful tool to establish the optimum time for inclusion in the transplant list, however further studies are still needed.
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Affiliation(s)
- Juan José Gilbert Pérez
- Unidad de Gastroenterología, Hepatología, Nutrición y Trasplante Hepático Pediátrico, Unidad de Gestión Clínica, Críticos y Urgencias Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España
| | - Belén Jordano Moreno
- Unidad de Gastroenterología, Hepatología, Nutrición y Trasplante Hepático Pediátrico, Unidad de Gestión Clínica, Críticos y Urgencias Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España.
| | - Mónica Rodríguez Salas
- Unidad de Gastroenterología, Hepatología, Nutrición y Trasplante Hepático Pediátrico, Unidad de Gestión Clínica, Críticos y Urgencias Pediátricas, Hospital Universitario Reina Sofía, Córdoba, España
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Magnusson M, Sten-Linder M, Bergquist A, Rajani R, Kechagias S, Fischler B, Németh A, Lindahl TL. The international normalized ratio according to Owren in liver disease: interlaboratory assessment and determination of international sensitivity index. Thromb Res 2013; 132:346-51. [PMID: 23993902 DOI: 10.1016/j.thromres.2013.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/09/2012] [Revised: 04/28/2013] [Accepted: 05/07/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The international normalized ratio (INR) is used to prioritize liver disease patients for transplantation. Previous studies have shown high interlaboratory variability in Quick-based INR determinations in samples of patients with liver disease. We assessed Owren-based INR reagents for analyzing INR in patients with liver disease. Further, we determined the difference between international sensitivity index (ISI) for patients on vitamin K antagonists (ISIVKA) and ISI for patients with liver disease (ISIliver). PATIENTS AND METHODS Twenty patients with liver disease were included, 10 with INR 1.8-3.6 (group A1) and 10 with INR 1.2-1.5 (group C1). Plasma from these patients was analyzed for Owren-based INR in eight Swedish laboratories using either of following reagents: SPA+, Owrens PT or Nycotest PT. To determine ISI liver, the reference thromboplastin RBT/05 and additional 41 patients with liver disease and 20 normal controls were included. ISIVKA was determined according to the WHO procedure. The difference between the ISIVKA and ISIliver was calculated. RESULTS The coefficients of variance for the Owren based INR methods were 6.2% in group A1, 3.9 % in group C1 and 5.3% for all patients. The difference between ISIVKA and ISIliver were -0.4%, -0.7% and -0.2% for SPA+, Owrens PT and Nycotest PT respectively. CONCLUSIONS Interlaboratory variation in INR analyses according to Owren in patients with liver disease is low and the difference between ISIVKA and ISIliver is below 10% with this method. ISIVKA can therefore be used in the INR calibration, for the Owren reagents studied, when analyzing plasma from patients with liver disease.
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Affiliation(s)
- Maria Magnusson
- CLINTEC, Karolinska Institutet, Division of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
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