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Alexander H, Claus CF, Tong D, McCabe R, Garmo L, Gabrail J, Kelkar P, Griauzde J, Soo TM, Richards B. Safety and functional outcomes of early antiplatelet therapy within 24 hours following mechanical thrombectomy for secondary prevention in emergent large-vessel occlusion strokes: a registry study. Neurosurg Focus 2023; 55:E19. [PMID: 37778039 DOI: 10.3171/2023.7.focus23335] [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: 05/31/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The aim of this study was to demonstrate the safety and functional outcomes of antiplatelet use within 24 hours following mechanical thrombectomy (MT). METHODS A retrospective review of prospectively collected data for consecutive patients who underwent MT for acute ischemic stroke (AIS) between 2016 and 2020 was performed. Patient demographics, comorbidities, Alberta Stroke Program Early CT Score (ASPECTS), antiplatelet use, neurological status, and tissue plasminogen activator use were collected. Patients were stratified into two groups, early (< 24 hours) or late (> 24 hours), based on when antiplatelet therapy was initiated post-MT. The primary outcome was safety, determined based on the rate of symptomatic intracranial hemorrhage (sICH) and inpatient mortality. The secondary outcome was functional independence (defined as modified Rankin Scale [mRS] score ≤ 2) at discharge and 30 days and 90 days postoperatively. The two cohorts were compared using univariate analysis. Multiple imputations were used to create complete data sets for missing data. Multivariable analysis was used to identify predictors for sICH and functional outcomes. RESULTS A total of 190 patients met inclusion criteria (95 per group). Significant differences between the early and late groups included sex, preoperative intravenous thrombolysis, angioplasty, stent placement, and thrombectomy site. ICH (symptomatic and asymptomatic) and inpatient mortality were not significantly different between the groups. The mRS score was significantly lower at discharge (p < 0.001), 30 days (p = 0.011), and 90 days (p = 0.024) following MT in the early group. Functional independence was significantly higher in the early antiplatelet group at discharge (p = 0.015) and at 30 days (p = 0.006). Early antiplatelet use was independently associated with significantly increased odds of achieving functional independence at discharge (OR 3.07, p = 0.007) and 30 days (OR 5.78, p = 0.004). Early antiplatelet therapy was not independently associated with increased odds of sICH. CONCLUSIONS Early antiplatelet initiation after MT in patients with AIS was independently associated with significantly increased odds of improved postoperative functional outcomes without increased odds of developing sICH.
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Affiliation(s)
- Hepzibha Alexander
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Chad F Claus
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Doris Tong
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Robert McCabe
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Lucas Garmo
- 2Central Michigan University College of Medicine, Mount Pleasant, Michigan; and
| | - Joseph Gabrail
- 3Des Moines University College of Osteopathic Medicine, Des Moines, Iowa
| | - Prashant Kelkar
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Julius Griauzde
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Teck M Soo
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
| | - Boyd Richards
- 1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan
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2
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Findlay MC, Bauer SZ, Khan M, Kim RB, Park S, Alexander H, Karsy M. Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study. Neurosurgery 2023; 93:176-185. [PMID: 36762909 DOI: 10.1227/neu.0000000000002397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/07/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Race-based health care outcomes remain to be described in anterior cranial fossa (ACF) surgery. OBJECTIVE To determine whether race predicts worse outcomes after ACF surgery. METHODS A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program data for 2005 to 2020. Current Procedural Terminology and International Classification of Diseases-9 codes were used to identify ACF tumor cases. Propensity score matching was performed to compare White and minority patients to assess the robustness of unmatched findings. A subanalysis of pituitary adenoma (PA) resections was also performed. RESULTS In an unmatched analysis of 1370 patients who underwent ACF surgery (67.9% White, 17.4% Black, 6.6% Asian/Pacific Islander, and 6.3% Hispanic), minority groups had higher rates of comorbidities. Unmatched multivariate analysis found Hispanic patients bore a 1.86 odds ratio (OR) of minor complications, Black and Asian and Pacific Islander patients bore 1.49 and 1.71 ORs, respectively, for extended length of stay, and Black patients bore a 3.78 OR for urinary tract infection (UTI). Matched analysis found that minority patients had higher UTI rates ( P = .02) and a 4.11 OR of UTI. In PA cases specifically, minority groups had higher comorbidities and length of stay in addition to extended length of stay odds (1.84 OR). CONCLUSION Although most ACF surgery outcomes were unaffected by race, minority groups had more minor postoperative complications than White patients, particularly UTI. Similar disparities were observed among PA cases. Higher rates of comorbidities may also have led to longer hospital stays. Further study is needed to understand what actions might be necessary to address any race-associated health disparities in ACF surgery.
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Affiliation(s)
| | - Sawyer Z Bauer
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Majid Khan
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Robert B Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Seojin Park
- New York University, New York, New York, USA
| | - Hepzibha Alexander
- Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Michael Karsy
- School of Medicine, University of Nevada, Reno, Nevada, USA
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Alexander H, Manning J. 951 SETTING UP A GERIATRIC LIAISON SERVICE WITHIN UROLOGY IN A DISTRICT GENERAL HOSPITAL. Age Ageing 2022. [PMCID: PMC9384282 DOI: 10.1093/ageing/afac126.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction One might refer to urologists as the ‘hidden providers’ of geriatric care, ultimately sought out by many geriatric patients. POPS, the Peri-Operative care of Older People’s Service started at Guys Hospital in London is often quoted as the gold standard for liaison services. Having set up liaison services in Orthopaedics and General Surgery in my previous job, an exciting opportunity arose after the first COVID—19 wave when I found my new office directly under the Urology Assessment Unit. Method A Geriatric Urology liaison service was set up by a Consultant Geriatrician with SpR support. One hour per week was agreed within the department to pilot the service. By May 2021 the service had been running for 8 months. During this period 30 patients had been seen (36 patient visits). Results The patient’s mean age was 82 years. The advice given included: O Stopping medication (7 cases) O Recommending iron infusions instead of tablets (5 cases) O Adjusting analgesia (4 cases) O Ordering brain imaging (3 cases) Commonly there was the recognition of the need for palliative care in this frail population. There have been complex cases: O A gentleman with a large perinephric bleed. O A young man with seizures and cognitive issues following renal stones. O A patient with post-operative rhabdomyolysis following nephrectomy. Pre-operative assessments have now been started as part of enhanced care: O Two cystectomy patients (one ward/one telephone) O Two TURBT patients (one with low sodium). Conclusion Staff feedback has been excellent especially linking to the Palliative Care Team. We presented our data at the Urology governance meeting in September 2021 and again received excellent feedback. The urology staff have felt increasingly supported. Data collection has helped build a business case for two Consultant posts in surgical liaison.
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Affiliation(s)
| | - J Manning
- Ashford and St Peter’s Hospital NHS Foundation Trust
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Budihal D, Andrews S, Settle S, Alexander H, Haslam S. 969 ACUTE FRAILTY MODEL: A DISTRICT GENERAL HOSPITAL EXPERIENCE OF DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Under the NHS Long Term Plan1, every hospital with a Type 1 Emergency Department (ED) has been asked to provide Acute Frailty Services for at least 70 hours a week. We have adopted a liaison model to ensure Comprehensive Geriatric Assessment at the front door. The Frailty Team now includes two Frailty Practitioners, a Specialist Registrar based in ED and the Acute Medical Unit (AMU) with Consultant Physician of the Week support.
Method
The team attend multi-disciplinary meetings in ED and AMU on a daily basis. Frail patients are reviewed and Comprehensive Geriatric Assessments are undertaken together with appropriate signposting. The aim being, to enhance the care of frail patients at the earliest opportunity.
Results
High bed utilisation comes at a cost and a longer length of stay (LOS) is associated with an increased risk of deconditioning. Since introducing incremental changes to our working model, the average LOS of patients on AMU has been reduced from a mean of 1.33 days to 0.82 days. This represents a 38.3% reduction from September 2020 to August 2021. This reduction has been sustained, while 30-day readmission rates have not increased. Feedback has been very positive from all the other teams involved.
Conclusion
Our service has established a more positive working culture to efficiently manage frail patients. The AMU team now feel empowered to make patient-centric decisions regarding patient flow and discharges. Since this data was analysed we have implemented a further change to help enhance the care of frail patients. A list of appropriate patients is emailed to the hospital site team every afternoon to aid getting the right patients into the right beds. The impact of LOS on the frailty wards will then be reviewed following this introduction.
Reference
1. nhs-long-term-plan-june-2019.pdf (longtermplan.nhs.uk).
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Affiliation(s)
- D Budihal
- Department of Geriatrics; Eastbourne District General Hospital
| | - S Andrews
- Department of Geriatrics; Eastbourne District General Hospital
| | - S Settle
- Department of Geriatrics; Eastbourne District General Hospital
| | - H Alexander
- Department of Geriatrics; Eastbourne District General Hospital
| | - S Haslam
- Department of Geriatrics; Eastbourne District General Hospital
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Mortazavi A, Mualem W, Dowlati E, Alexander H, Rotter J, Withington C, Margolis M, Voyadzis JM. Anterior lumbar interbody fusion: single institutional review of complications and associated variables. Spine J 2022; 22:454-462. [PMID: 34600108 DOI: 10.1016/j.spinee.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT As more patients undergo anterior lumbar interbody fusion (ALIF) procedures and more devices are created for that purpose, it is important to understand the complications that can arise and the variables that mitigate risk for major and minor complications. PURPOSE To assess complication rates after ALIF with or without posterior instrumentation and variables associated with increased likelihood of postoperative complications. We aim to provide this data as benchmarking to improve patient safety and surgical care. STUDY DESIGN A single-center retrospective cohort study. PATIENT SAMPLE All adult patients who underwent ALIF between 2017 and 2019 was performed OUTCOME MEASURES: Post-operative major and minor complications were evaluated. METHODS Complications were recorded and presented as percentages. Patient demographics, perioperative, and postoperative data were also collected and analyzed between patients who had no complications and those that had any complication. Subgroup analysis of surgical complications were performed by nonparametric Chi-square tests. Continuous variables were compared using Mann-Whitney U tests. RESULTS Ninty-five of three hundred sixty-two (26.2%) of patients experienced a minor or major complication. Among the most common complications found were surgical site infections (5.8%), neurological complications (4.1%), vascular complications (3.6%), and urinary tract infections (3.3%). Patients undergoing ALIF alone with post-operative complications had higher mean age, higher BMI, higher ASA status, and experienced higher estimated blood loss. Patients undergoing ALIF and posterior instrumentation with post-operative complications were more likely to have diabetes and had a higher ASA status. Patients with any complications from both groups had longer length of stay, discharge to a non-home setting and were more likely to be readmitted or return to the operating room. CONCLUSION Our study reveals variables associated with complications at our institution, including age of the patient, BMI, and ASA status leading to higher complications and greater LOS, higher readmission rates, and disposition to skilled facilities.
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Affiliation(s)
- Armin Mortazavi
- Georgetown University School of Medicine, 3900 Reservoir Rd, Washington, DC, USA
| | - William Mualem
- Georgetown University School of Medicine, 3900 Reservoir Rd, Washington, DC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, 3800 Reservoir Rd, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Hepzibha Alexander
- Division of Neurosurgery, 16001 W Nine Mile Rd, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI, USA
| | - Juliana Rotter
- Department of Neurological Surgery, 200 1st St NW, Mayo Clinic, Rochester, MN, USA
| | - Charles Withington
- Georgetown University School of Medicine, 3900 Reservoir Rd, Washington, DC, USA
| | - Marc Margolis
- Division of Thoracic Surgery, 3800 Reservoir Rd, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, 3800 Reservoir Rd, MedStar Georgetown University Hospital, Washington, DC, USA.
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Alexander H, Govindan RB, Anwar T, Chirumamilla VC, Fayed I, Keating RF, Gaillard WD, Oluigbo CO. Global and intertuberal epileptic networks in tuberous sclerosis based on stereoelectroencephalographic (sEEG) findings: a quantitative EEG analysis in pediatric subjects and surgical implications. Childs Nerv Syst 2022; 38:407-419. [PMID: 34455445 DOI: 10.1007/s00381-021-05342-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Recent evidence favors a network concept in tuberous sclerosis (TSC) with seizure generation and propagation related to changes in global and regional connectivity between multiple, anatomically distant tubers. Direct exploration of network dynamics in TSC has been made possible through intracranial sampling with stereoelectroencephalography (sEEG). The objective of this study is to define epileptic networks in TSC using quantitative analysis of sEEG recordings. We also discuss the impact of the definition of these epileptic networks on surgical decision-making. METHODS Intracranial sEEG recordings were obtained from four pediatric patients who presented with medically refractory epilepsy secondary to TSC and subjected to quantitative signal analysis methods. Cortical connectivity was quantified by calculating pairwise coherence between all contacts and constructing an association matrix. The global coherence, defined as the ratio of the largest eigenvalue to the sum of all the eigenvalues, was calculated for each frequency band (delta, theta, alpha, beta, gamma). Spatial distribution of the connectivity was identified by plotting the leading principal component (product of the largest eigenvalue and its corresponding eigenvector). RESULTS Four pediatric subjects with TSC underwent invasive intracranial monitoring with sEEG, comprising 31 depth electrodes and 250 contacts, for localization of the epileptogenic focus and guidance of subsequent surgical intervention. Quantitative connectivity analysis revealed a change in global coherence during the ictal period in the beta/low gamma (14-30 Hz) and high gamma (31-80 Hz) bands. Our results corroborate findings from existing literature, which implicate higher frequencies as a driver of synchrony and desynchrony. CONCLUSIONS Coordinated high-frequency activity in the beta/low gamma and high gamma bands among spatially distant sEEG define the ictal period in TSC. This time-dependent change in global coherence demonstrates evidence for intra-tuberal and inter-tuberal connectivity in TSC. This observation has surgical implications. It suggests that targeting multiple tubers has a higher chance of seizure control as there is a higher chance of disrupting the epileptic network. The use of laser interstitial thermal therapy (LITT) allowed us to target multiple disparately located tubers in a minimally invasive manner with good seizure control outcomes.
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Affiliation(s)
- H Alexander
- Division of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.,Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA
| | - R B Govindan
- Division of Fetal and Transitional Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - T Anwar
- Division of Neurology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - V C Chirumamilla
- Division of Fetal and Transitional Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - I Fayed
- Division of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.,MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - R F Keating
- Division of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - W D Gaillard
- George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.,Division of Neurology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - C O Oluigbo
- Division of Neurosurgery, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA. .,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
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Dowlati E, Alexander H, Voyadzis JM. Vulnerability of the L5 nerve root during anterior lumbar interbody fusion at L5-S1: case series and review of the literature. Neurosurg Focus 2021; 49:E7. [PMID: 32871560 DOI: 10.3171/2020.6.focus20315] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/15/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nerve root injuries associated with anterior lumbar interbody fusion (ALIF) are uncommonly reported in the literature. This case series and review aims to describe the etiology of L5 nerve root injury following ALIF at L5-S1. METHODS The authors performed a single-center retrospective review of prospectively collected data of patients who underwent surgery between 2017 and 2019 who had postoperative L5 nerve root injuries after stand-alone L5-S1 ALIF. They also reviewed the literature with regard to nerve root injuries after ALIF procedures. RESULTS The authors report on 3 patients with postoperative L5 radiculopathy. All 3 patients had pain that improved. Two of the 3 patients had a neurological deficit, one of which improved. CONCLUSIONS Stretch neuropraxia from overdistraction is an important cause of postoperative L5 radiculopathy after L5-S1 ALIF. Judicious use of implants and careful preoperative planning to determine optimal implant sizes are paramount.
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Affiliation(s)
- Ehsan Dowlati
- 1Department of Neurosurgery, MedStar Georgetown University Hospital; and
| | | | - Jean-Marc Voyadzis
- 1Department of Neurosurgery, MedStar Georgetown University Hospital; and
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Cobourn KD, Qadir I, Fayed I, Alexander H, Oluigbo CO. Does the Modified Arrhenius Model Reliably Predict Area of Tissue Ablation After Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Pediatric Lesional Epilepsy? Oper Neurosurg (Hagerstown) 2021; 21:265-269. [PMID: 34270761 DOI: 10.1093/ons/opab225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Commercial magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) systems utilize a generalized Arrhenius model to estimate the area of tissue damage based on the power and time of ablation. However, the reliability of these estimates in Vivo remains unclear. OBJECTIVE To determine the accuracy and precision of the thermal damage estimate (TDE) calculated by commercially available MRgLITT systems using the generalized Arrhenius model. METHODS A single-center retrospective review of pediatric patients undergoing MRgLITT for lesional epilepsy was performed. The area of each lesion was measured on both TDE and intraoperative postablation, postcontrast T1 magnetic resonance images using ImageJ. Lesions requiring multiple ablations were excluded. The strength of the correlation between TDE and postlesioning measurements was assessed via linear regression. RESULTS A total of 32 lesions were identified in 19 patients. After exclusion, 13 pairs were available for analysis. Linear regression demonstrated a strong correlation between estimated and actual ablation areas (R2 = .97, P < .00001). The TDE underestimated the area of ablation by an average of 3.92% overall (standard error (SE) = 4.57%), but this varied depending on the type of pathologic tissue involved. TDE accuracy and precision were highest in tubers (n = 3), with average underestimation of 2.33% (SE = 0.33%). TDE underestimated the lesioning of the single hypothalamic hamartoma in our series by 52%. In periventricular nodular heterotopias, TDE overestimated ablation areas by an average of 13% (n = 2). CONCLUSION TDE reliability is variably consistent across tissue types, particularly in smaller or periventricular lesions. Further investigation is needed to understand the accuracy of this emerging minimally invasive technique.
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Affiliation(s)
- Kelsey D Cobourn
- Division of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Imazul Qadir
- Division of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Howard University College of Medicine, Washington, District of Columbia, USA
| | - Islam Fayed
- Division of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Hepzibha Alexander
- Division of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Division of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Ruswa N, Mavhunga F, Roscoe JC, Beukes A, Shipiki E, van Gorkom J, Sawadogo S, Agolory S, Menzies H, Tiruneh D, Makumbi B, Bayer B, Zezai A, Campbell P, Alexander H, Kalisvaart N, Forster N. Second nationwide anti-tuberculosis drug resistance survey in Namibia. Int J Tuberc Lung Dis 2020; 23:858-864. [PMID: 31439119 DOI: 10.5588/ijtld.18.0526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Namibia ranks among the 30 high TB burden countries worldwide. Here, we report results of the second nationwide anti-TB drug resistance survey.OBJECTIVE: To assess the prevalence and trends of multidrug-resistant TB (MDR-TB) in Namibia.METHODS: From 2014 to 2015, patients with presumptive TB in all regions of Namibia had sputum subjected to mycobacterial culture and phenotypic drug susceptibility testing (DST) for rifampicin, isoniazid, ethambutol and streptomycin if positive on smear microscopy and/or Xpert MTB/RIF.RESULTS: Of the 4124 eligible for culture, 3279 (79.5%) had Mycobacterium tuberculosis isolated. 3126 (95%) had a first-line DST completed (2392 new patients, 699 previously treated patients, 35 with unknown treatment history). MDR-TB was detected in 4.5% (95%CI 3.7-5.4) of new patients, and 7.9% (95%CI 6.0-10.1) of individuals treated previously. MDR-TB was significantly associated with previous treatment (OR 1.8, 95%CI 1.3-2.5) but not with HIV infection, sex, age or other demographic factors. Prior treatment failure demonstrated the strongest association with MDR-TB (OR 17.6, 95%CI 5.3-58.7).CONCLUSION: The prevalence of MDR-TB among new TB patients in Namibia is high and, compared with the first drug resistance survey, has decreased significantly among those treated previously. Namibia should implement routine screening of drug resistance among all TB patients.
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Affiliation(s)
- N Ruswa
- Ministry of Health and Social Services, Windhoek, Namibia, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - F Mavhunga
- Ministry of Health and Social Services, Windhoek, Namibia
| | - J C Roscoe
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Beukes
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Shipiki
- Namibia Institute of Pathology, Windhoek, Namibia
| | - J van Gorkom
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - S Sawadogo
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Agolory
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Menzies
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Tiruneh
- World Health Organization, Geneva, Switzerland
| | - B Makumbi
- Namibia Institute of Pathology, Windhoek, Namibia
| | - B Bayer
- Ministry of Health and Social Services, Windhoek, Namibia
| | - A Zezai
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - P Campbell
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Alexander
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Kalisvaart
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - N Forster
- Ministry of Health and Social Services, Windhoek, Namibia, International Training & Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA
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Alexander H, Cobourn K, Fayed I, Oluigbo CO. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for the Treatment of Nonlesional Insular Epilepsy in Pediatric Patients: Technical Considerations. Pediatr Neurosurg 2020; 55:155-162. [PMID: 32750699 DOI: 10.1159/000509006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The insula presents anatomic challenges to surgical exploration and intervention. Open neurosurgical intervention is associated with high rates of complications despite improved seizure control. Minimally invasive techniques using novel energy delivery methods have gained popularity due to their relative safety and ability to overcome access-related barriers. The goal of this paper is to present an operative technical report and methodological considerations on the application of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for the treatment of nonlesional, medically refractory, insular epilepsy in pediatric patients. METHODS Visualase laser probe(s) were implanted using ROSA robotic stereotactic guidance into the insula using a parasagittal trajectory. After confirmation of placement using intraoperative MRI, thermal energy was delivered under real-time MR guidance. Laser wire pullback was performed when the initial dose of thermal energy was insufficient to ablate the target in its entirety. Thermal ablation within the intended target was confirmed using gadolinium-enhanced brain MRI. Following removal of laser wires, a final T1-weighted axial brain MRI was performed to confirm no evidence of hemorrhage. RESULTS Three patients underwent MRgLITT of nonlesional insular epilepsy over an 11-month period. The epileptogenic focus was localized to the insula using stereoelectroencephalography. The anterior and middle portions of the insula were accessed using a parasagittal trajectory. Laser ablation was performed for up to 3 min using an output of 10.5 W. No complications were encountered, and all patients were discharged within 24 h after the surgery. At the most recent follow-up, all patients had an Engel I outcome without any new neurologic deficits. CONCLUSION This small cohort shows that insular ablation can be achieved safely with promising seizure outcomes in the short term.
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Affiliation(s)
- Hepzibha Alexander
- Division of Neurosurgery, Children's National Medical Center, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Kelsey Cobourn
- Division of Neurosurgery, Children's National Medical Center, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Islam Fayed
- Division of Neurosurgery, Children's National Medical Center, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA,
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Sacino M, Huang SS, Alexander H, Fayed I, Keating RF, Oluigbo CO. An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery. Pediatr Neurosurg 2020; 55:141-148. [PMID: 32829333 DOI: 10.1159/000509329] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/15/2019] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy. METHODS We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase® thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results. RESULTS Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be cost--effective. CONCLUSION Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery.
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Affiliation(s)
- Matthew Sacino
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA
| | - Sean S Huang
- Department of Health Systems Administration, Georgetown University, Washington, District of Columbia, USA
| | - Hepzibha Alexander
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Islam Fayed
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Robert F Keating
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA.,Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Chima O Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, District of Columbia, USA, .,Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA,
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12
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Alexander H, Paller AS, Traidl-Hoffmann C, Beck LA, De Benedetto A, Dhar S, Girolomoni G, Irvine AD, Spuls P, Su J, Thyssen JP, Vestergaard C, Werfel T, Wollenberg A, Deleuran M, Flohr C. The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group. Br J Dermatol 2019; 182:1331-1342. [PMID: 31677162 PMCID: PMC7317931 DOI: 10.1111/bjd.18643] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey‐coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD – cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy – overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site‐ and skin‐type‐specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.
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Affiliation(s)
- H Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany.,CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - A De Benedetto
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | - S Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - A D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,Dermatology, Children's Health Ireland, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Su
- Departments of Dermatology and Paediatrics, Murdoch Children's Research Institute, University of Melbourne and Monash University, Eastern Health, Melbourne, VIC, Australia
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
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13
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Alexander H, Tsering D, Myseros JS, Magge SN, Oluigbo C, Sanchez CE, Keating RF. Management of Chiari I malformations: a paradigm in evolution. Childs Nerv Syst 2019; 35:1809-1826. [PMID: 31352576 DOI: 10.1007/s00381-019-04265-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/30/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Despite decades of experience and research, the etiology and management of Chiari I malformations (CM-I) continue to raise more questions than answers. Controversy abounds in every aspect of management, including the indications, timing, and type of surgery, as well as clinical and radiographic outcomes. This review aims to outline past experiences, consolidate current evidence, and recommend directions for the future management of the Chiari I malformation. METHODS A review of recent literature on the management of CM-I in pediatric patients is presented, along with our experience in managing 1073 patients who were diagnosed with CM-I over the past two decades (1998-2018) at Children's National Medical Center (CNMC) in Washington DC. RESULTS The general trend reveals an increase in the diagnosis of CM-I at younger ages with a significant proportion of these being incidental findings (0.5-3.6%) in asymptomatic patients as well as a rise in the number of patients undergoing Chiari posterior fossa decompression surgery (PFD). The type of surgical intervention varies widely. At our institution, 104 (37%) Chiari surgeries were bone-only PFD with/without outer leaf durectomy, whereas 177 (63%) were PFD with duraplasty. We did not find a significant difference in outcomes between the PFD and PFDD groups (p = 0.59). An analysis of failures revealed a significant difference between patients who underwent tonsillar coagulation versus those whose tonsils were not manipulated (p = 0.02). CONCLUSION While the optimal surgical intervention continues to remain elusive, there is a shift away from intradural techniques in favor of a simple, extradural approach (including dural delamination) in pediatric patients due to high rates of clinical and radiographic success, along with a lower complication rate. The efficacy, safety, and necessity of tonsillar manipulation continue to be heavily contested, as evidence increasingly supports the efficacy and safety of less tonsillar manipulation, including our own experience.
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Affiliation(s)
- H Alexander
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - D Tsering
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA
| | - J S Myseros
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA.,Department of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, 20010, USA
| | - S N Magge
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA.,Department of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, 20010, USA
| | - C Oluigbo
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA.,Department of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, 20010, USA
| | - C E Sanchez
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA.,Department of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, 20010, USA
| | - Robert F Keating
- Division of Neurosurgery, Children's National Medical Center, Washington, DC, USA. .,Department of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, 20010, USA.
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14
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Alexander H, Govindan RB, Garrett CT, Anwar T, Fayed I, Keating RF, Gaillard W, Oluigbo C. Global and Intertuberal Epileptic Networks in Tuberous Sclerosis Based on Stereoelectroencephalographic (sEEG) Findings: A Quantitative EEG Analysis in Pediatric Subjects and Surgical Implications. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_656] [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: 11/13/2022] Open
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15
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Alexander H, Tsering D, Myseros JS, Magge SN, Oluigbo C, Sanchez CE, Keating RF. When Does an Incidental Chiari I Malformation Require Surgery? A 10-Year Prospective Study on the Evolution and Natural History. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_201] [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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16
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Alexander H, Fayed I, Oluigbo CO. Rigid Cranial Fixation for Robot-Assisted Stereoelectroencephalography in Toddlers: Technical Considerations. Oper Neurosurg (Hagerstown) 2019; 18:614-620. [DOI: 10.1093/ons/opz247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children because of inadequate cranial bone thickness.
OBJECTIVE
To describe a rigid cranial fixation technique involving the integrated Gel Head Ring from the DORO QR3 multipurpose skull clamp set (Pro Med Instruments) with superimposed pin fixation in children below the age of 36 mo undergoing sEEG.
METHODS
Patients were placed in the supine position and the head was fixed using a DORO skull clamp with 3 pediatric cranial pins. The head was supported on the integrated Gel Head Ring, and a pin pressure of 20 pounds was applied. The DORO skull clamp set was then attached to the ROSA neurosurgical robot support telescopic arm for stereotactic navigation.
RESULTS
We present an illustrative series of 2 patients below the age of 3 yr with medically refractory epilepsy who underwent sEEG using our modified cranial fixation technique. Head position and reference registration were stable throughout the surgeries. Postoperative volumetric computed tomography scans of the head showed accurate placement of sEEG depth electrodes and did not reveal any fractures or epidural hematoma. No other complications related to cranial fixation were noted.
CONCLUSION
Concurrent use of rigid and nonrigid cranial fixation using the DORO skull clamp set provides safe and effective cranial fixation in infants and toddlers undergoing sEEG.
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Affiliation(s)
- Hepzibha Alexander
- Children's National Medical Center, Department of Neurosurgery, School of Medicine, Georgetown University, Washington, District of Columbia
| | - Islam Fayed
- Children's National Medical Center, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Chima O Oluigbo
- Children's National Medical Center, Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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17
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Alexander H, Cobourn K, Fayed I, Depositario-Cabacar D, Keating RF, Gaillard WD, Oluigbo CO. Magnetic resonance-guided laser interstitial thermal therapy for the treatment of non-lesional insular epilepsy in pediatric patients: thermal dynamic and volumetric factors influencing seizure outcomes. Childs Nerv Syst 2019; 35:453-461. [PMID: 30627771 DOI: 10.1007/s00381-019-04051-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/11/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the safety and efficacy of stereoelectroencephalography (sEEG) directed magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in medically refractory insular epilepsy in pediatric patients, define the relationship between ablation volumes and seizure control, and analyze the relationship between thermal energy and ablation volumes. METHODS A single-institution, retrospective review of pediatric patients with insular epilepsy who underwent sEEG directed MRgLITT over a 10-month period was performed. Perioperative, imaging, and outcome data were analyzed. Seizure outcomes were determined based on Engel score (Engel I versus Engel II-IV). Insula and ablation volumes were measured, and the proportion of insula volume ablated was calculated. Thermal energy was calculated in joules. RESULTS Four patients underwent sEEG directed MRgLITT of insular epileptogenic foci. The ablation volume was higher in patients with Engel I outcome (3.93 cm3) compared to Engel II-IV outcome (1.02 cm3). The proportion of ablation to insula volume was lowest in patients with Engel II-IV outcome (25.09%). The mean energy requirement to create a unit volume of ablation in the insula is 1205.86 J. A linear trend was noted between thermal ablation energy and ablation volume (R2 = 0.884). Over a mean follow-up period of 104 days, three patients were seizure-free (Engel I), and one patient saw significant improvement in seizure frequency (Engel III). CONCLUSIONS The proportion of insula ablated, as well as the volume of ablation, are related to seizure outcome with increasing ablation volumes corresponding to improved seizure control. Further analysis of insula laser ablation thermal dynamics and volumes is needed.
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Affiliation(s)
- Hepzibha Alexander
- Division of Neurosurgery, Children's National Medical Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Kelsey Cobourn
- Division of Neurosurgery, Children's National Medical Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Islam Fayed
- Division of Neurosurgery, Children's National Medical Center, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Dewi Depositario-Cabacar
- Division of Neurology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Robert F Keating
- Division of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - William D Gaillard
- Division of Neurology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Chima O Oluigbo
- Division of Neurosurgery, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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18
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Alexander H, Dowlati E, McGowan JE, Mason RB, Anaizi A. C2-C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management. Spinal Cord Ser Cases 2019; 5:4. [PMID: 30675388 DOI: 10.1038/s41394-019-0150-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions. Case presentation We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries. Discussion Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.
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Affiliation(s)
- Hepzibha Alexander
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
| | - Ehsan Dowlati
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
| | - Jason E McGowan
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
| | - Robert B Mason
- 2Department of Neurosurgery, Medstar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010 USA
| | - Amjad Anaizi
- 1Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd., PHC 7, Washington, DC 20007 USA
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Regidor PA, Alexander H. Identifizierung und Vorhersage des fertilen Fensters des weiblichen Zyklus mit einem neuen web basierten Medizinprodukt (OvulaRing®). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671278] [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: 10/28/2022] Open
Affiliation(s)
| | - H Alexander
- Universitätsfrauenklinik Leipzig, Klinik für Frauenheilkunde und Geburtshilfe, Leipzig, Deutschland
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20
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Click ES, Murithi W, Ouma GS, McCarthy K, Willby M, Musau S, Alexander H, Pevzner E, Posey J, Cain KP. Detection of Apparent Cell-free M. tuberculosis DNA from Plasma. Sci Rep 2018; 8:645. [PMID: 29330384 PMCID: PMC5766485 DOI: 10.1038/s41598-017-17683-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022] Open
Abstract
New diagnostics are needed to improve clinicians’ ability to detect tuberculosis (TB) disease in key populations such as children and persons living with HIV and to rapidly detect drug resistance. Circulating cell-free DNA (ccfDNA) in plasma is a diagnostic target in new obstetric and oncologic applications, but its utility for diagnosing TB is not known. Here we show that Mycobacterium tuberculosis complex DNA can be detected in plasma of persons with sputum smear-positive TB, even in the absence of mycobacteremia. Among 40 participants with bacteriologically-confirmed smear-positive TB disease who had plasma tested by quantitative PCR (qPCR), 18/40 (45%) had a positive result on at least one triplicate reaction. Our results suggest that plasma DNA may be a useful target for improving clinicians’ ability to diagnose TB. We anticipate these findings to be the starting point for optimized methods of TB ccfDNA testing and sequence-based diagnostic applications such as molecular detection of drug resistance.
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Affiliation(s)
- E S Click
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - W Murithi
- Kenya Medical Research Institute, Kisumu, Kenya
| | - G S Ouma
- Kenya Medical Research Institute, Kisumu, Kenya
| | - K McCarthy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M Willby
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Musau
- Kenya Medical Research Institute, Kisumu, Kenya
| | - H Alexander
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Pevzner
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Posey
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K P Cain
- Centers for Disease Control and Prevention, Kisumu, Kenya
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21
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Ekhart D, Wicht H, Kersken T, Ackermann H, Kaczmarczyk M, Pretzsch G, Alexander H, Korf HW. Dynamics of core body temperature cycles in long-term measurements under real life conditions in women. Chronobiol Int 2017; 35:8-23. [DOI: 10.1080/07420528.2017.1375942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- D Ekhart
- Dr. Senckenbergisches Chronomedizinisches Institut, Fachbereich Medizin der Goethe-Universität, Frankfurt am Main, Germany
| | - H Wicht
- Dr. Senckenbergische Anatomie, Fachbereich Medizin der Goethe-Universität, Frankfurt am Main, Germany
| | | | - H Ackermann
- Institut für Biostatistik und mathematische Modellierung, Fachbereich Medizin der Goethe-Universität, Frankfurt am Main, Germany
| | - M Kaczmarczyk
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany
| | - G Pretzsch
- Universitätsfrauenklinik Leipzig, Medizinische Fakultät der Universität Leipzig, Leipzig, Germany
| | - H Alexander
- Universitätsfrauenklinik Leipzig, Medizinische Fakultät der Universität Leipzig, Leipzig, Germany
| | - HW Korf
- Dr. Senckenbergisches Chronomedizinisches Institut, Fachbereich Medizin der Goethe-Universität, Frankfurt am Main, Germany
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Zareen N, Shinozaki M, Ryan D, Alexander H, Amer A, Truong DQ, Khadka N, Sarkar A, Naeem S, Bikson M, Martin JH. Motor cortex and spinal cord neuromodulation promote corticospinal tract axonal outgrowth and motor recovery after cervical contusion spinal cord injury. Exp Neurol 2017; 297:179-189. [PMID: 28803750 DOI: 10.1016/j.expneurol.2017.08.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/04/2017] [Accepted: 08/09/2017] [Indexed: 01/15/2023]
Abstract
Cervical injuries are the most common form of SCI. In this study, we used a neuromodulatory approach to promote skilled movement recovery and repair of the corticospinal tract (CST) after a moderately severe C4 midline contusion in adult rats. We used bilateral epidural intermittent theta burst (iTBS) electrical stimulation of motor cortex to promote CST axonal sprouting and cathodal trans-spinal direct current stimulation (tsDCS) to enhance spinal cord activation to motor cortex stimulation after injury. We used Finite Element Method (FEM) modeling to direct tsDCS to the cervical enlargement. Combined iTBS-tsDCS was delivered for 30min daily for 10days. We compared the effect of stimulation on performance in the horizontal ladder and the Irvine Beattie and Bresnahan forepaw manipulation tasks and CST axonal sprouting in injury-only and injury+stimulation animals. The contusion eliminated the dorsal CST in all animals. tsDCS significantly enhanced motor cortex evoked responses after C4 injury. Using this combined spinal-M1 neuromodulatory approach, we found significant recovery of skilled locomotion and forepaw manipulation skills compared with injury-only controls. The spared CST axons caudal to the lesion in both animal groups derived mostly from lateral CST axons that populated the contralateral intermediate zone. Stimulation enhanced injury-dependent CST axonal outgrowth below and above the level of the injury. This dual neuromodulatory approach produced partial recovery of skilled motor behaviors that normally require integration of posture, upper limb sensory information, and intent for performance. We propose that the motor systems use these new CST projections to control movements better after injury.
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Affiliation(s)
- N Zareen
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - M Shinozaki
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - D Ryan
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - H Alexander
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - A Amer
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA; CUNY Graduate Center, New York, NY 10031, USA
| | - D Q Truong
- Department of Biomedical Engineering, City College of NY, 10031, USA
| | - N Khadka
- Department of Biomedical Engineering, City College of NY, 10031, USA
| | - A Sarkar
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - S Naeem
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA
| | - M Bikson
- Department of Biomedical Engineering, City College of NY, 10031, USA
| | - J H Martin
- Department of Molecular, Cellular, and Biomedical Sciences, City University of NY School of Medicine, New York, NY 10031, USA; CUNY Graduate Center, New York, NY 10031, USA.
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Francis N, Rose T, Parrott A, Birtles P, Archer J, Alexander H. 4DOES A WEEKLY COMMUNITY GERIATRIC CLINIC IN PEACEHAVEN REDUCE HOSPITAL ATTENDANCES? Age Ageing 2017. [DOI: 10.1093/ageing/afx115.4] [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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Okumu A, McCarthy K, Orwa J, Williamson J, Musau S, Alexander H, Cavanaugh S, Modi S, Cain K. Comparison of Mycobacterium tuberculosis complex Yield and Contamination Rates using Lowenstein-Jensen with and without Antibiotics in Western Kenya. J Med Sci Clin Res 2017; 5:10.18535/jmscr/v5i8.86. [PMID: 35979512 PMCID: PMC9380436 DOI: 10.18535/jmscr/v5i8.86] [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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND While molecular methods have been recently endorsed for diagnosis of tuberculosis (TB), mycobacterial culture remains the gold standard. Lowenstein-Jensen (LJ) is often used for the cultivation of Mycobacterium tuberculosis complex (MTBC); however contamination often renders a subset of cultures useless. We compared the MTBC yield and contamination rate of processed sputum inoculated on LJ with antibiotics (LJ PACT) to LJ without antibiotics (LJ). METHODOLOGY Sputum samples were obtained from people living with HIV enrolled in a TB screening study in western Kenya, processed using NALC/NaOH-Na citrate, then inoculated on LJ PACT and LJ media. Cultures were evaluated weekly with growth identified as acid-fast bacilli by Ziehl-Neelsen bright-field microscopy. MTBC and nontuberculous mycobacteria (NTM) were identified by immunochromatographic and line probe assays. RESULTS A total of 700 sputum samples were cultured on both LJ PACT and LJ between March and June 2012. Of those cultured on LJ PACT, 29 (4.1%) grew MTBC, 613 (87.6%) were negative, 12 (1.7%) grew NTM, and 46 (6.6%) were contaminated; on LJ, 28 (4%) grew MTBC, 553 (79%) were negative, 9 (1.3%) grew NTM, and 110 (15.7%) were contaminated. The difference in contamination on LJ PACT and LJ was statistically significant (p<0.0001), while the difference in MTBC growth was not (p=0.566).
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Affiliation(s)
- A Okumu
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - K McCarthy
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
| | - J Orwa
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - J Williamson
- Division of Parasitic Diseases and Malaria (DPDM), CDC, Atlanta, GA
| | - S Musau
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - H Alexander
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
| | - S Cavanaugh
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
| | - S Modi
- Division of Global HIV/AIDS (DGHA), Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - K Cain
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
- Division of Tuberculosis Elimination (DTBE), CDC, Atlanta, GA
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Rawlins SC, Tiwari T, Chadee DD, Validum L, Alexander H, Nazeer R, Rawlins SRS. American cutaneous leishmaniasis in Guyana, South America. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.2001.11813636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Burmen B, Modi S, Cavanaugh JS, Muttai H, McCarthy KD, Alexander H, Cain K. Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009. Int J Tuberc Lung Dis 2016; 20:79-84. [PMID: 26688532 DOI: 10.5588/ijtld.15.0053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Fifteen human immunodeficiency virus (HIV) clinics in Nyanza Region, Western Kenya. OBJECTIVE To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding. DESIGN Retrospective chart abstraction of PLHIV aged ⩾7 years who were newly enrolled in HIV care in July and August 2009, and who had not received antiretroviral treatment in the preceding 2 years or been diagnosed with TB in the previous year. Factors associated with evidence of TB diagnostic evaluation among symptomatic PLHIV were assessed. RESULTS Of 1020 patients included in the analysis, 995 (98%) were screened for TB at enrolment and 613 (62%) reported TB symptoms. Ninety-six (16%) patients with symptoms had evidence of referral for TB diagnostic evaluation, including patients at large clinics, those with advanced HIV disease and those reporting multiple TB symptoms. Among the 43 (45%) with documented evaluation results, 26 (60%) were diagnosed with TB. CONCLUSION Although most PLHIV were screened for TB, very few underwent an evaluation, and the proportion diagnosed with TB was very low. Efforts to improve TB screening should focus on standardizing the intensified case finding algorithm and linkage to, and adequate infrastructure for, TB diagnostic evaluation.
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Affiliation(s)
- B Burmen
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya; KEMRI/Centers for Disease Control and Prevention (CDC) Research and Public Health Collaboration, Kisumu, Kenya
| | - S Modi
- US CDC, Atlanta, Georgia, USA
| | | | | | | | | | - K Cain
- KEMRI/Centers for Disease Control and Prevention (CDC) Research and Public Health Collaboration, Kisumu, Kenya; US CDC, Kisumu, Kenya
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Seifert H, Georgiou A, Alexander H, Bodla S, Kaye S, Nobbenhuis M, Gore M, Banerjee S. 2763 Poor performance status (PS) is an indication for an aggressive approach to neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer (EOC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31529-5] [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: 11/28/2022]
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Gracie R, Randall E, Alexander H. 10 * A RETROSPECTIVE SURVEY OF ELDERLY PATIENTS' DISCHARGE SUMMARIES: ARE INPATIENT MEDICATION CHANGES COMMUNICATED TO GPS? Age Ageing 2014. [DOI: 10.1093/ageing/afu124.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Gwilliam JC, CVitan A, Watson N, Falkenberg L, Yousefi N, Alexander H, Morin A, Wiest JS, DeCicco-Skinner KL. Abstract 3609: Fibroblast influence on keratinocyte tumorigenic and metastatic potential in cutaneous squamous cell carcinoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Skin cancer is the most common form of cancer in the United States, with an estimated two million cases diagnosed annually. Tpl2 (Map3k8) is a serine threonine protein kinase in the mitogen-activated protein kinase (MAPK) signal transduction cascade. Tpl2 was identified by our laboratory as having a tumor suppressive function in skin carcinogenesis, with Tpl2 knockout mice developing significantly more tumors than matched wildtype controls and Tpl2 knockout keratinocytes having greater angiogenic and metastatic potential. However, the microenvironmental contributions of underlying fibroblasts to the cancerous behavior seen in Tpl2 knockout keratinocytes has yet to be characterized. Therefore, we compared the tumorigenic, invasive, and metastatic potential of H-ras infected keratinocytes from wildtype and Tpl2 knockout mice with H-ras infected keratinocytes co-cultured with fibroblasts from wildtype and Tpl2 knockout mice. Using various techniques, including protein microarray, real-time polymerase chain reaction and Western blotting we found that fibroblasts in the microenvironment of H-ras-infected Tpl2 knockout keratinocytes contribute to an up-regulation of markers involved in growth and progression of squamous cell carcinoma. Additionally, Tpl2 knockout keratinocytes cultured in fibroblast conditioned media (FCM) have higher malignant conversion rates, colony formation and increased angiogenesis compared to co-cultured wildtype keratinocytes. In summary, our studies demonstrate that fibroblasts in the tumor microenvironment of Tpl2 knockout mice play a major role in the more aggressive,invasive, and metastatic character of knockout tumors than is seen in control animals.
Citation Format: J Curtis Gwilliam, Alexander CVitan, Nicholas Watson, Lauren Falkenberg, Nyousha Yousefi, Hepzibha Alexander, Adam Morin, Jonathan S. Wiest, Katie L. DeCicco-Skinner. Fibroblast influence on keratinocyte tumorigenic and metastatic potential in cutaneous squamous cell carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3609. doi:10.1158/1538-7445.AM2014-3609
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Alexander H, Kaczmarczyk M, Pretzsch G, Kersken T, Puschmann D, Schiwek E, Goeckenjan M. Fertilitätsmonitoring mit vaginalem Biosensor (OvulaRing©). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388603] [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: 10/24/2022] Open
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Schiwek E, Haussmann J, Alexander H, Goeckenjan M. Diagnostik der Lutealinsuffizienz mithilfe der kontinuierlichen Temperaturmessung in der Kinderwunschsprechstunde. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388017] [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: 10/24/2022] Open
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Snider J, Francis M, Hanna N, Alexander H, Sausville E, Amin P, Regine W. Use of “Virtual” High-Dose-Rate (HDR) Brachytherapy via Spatially Fractionated GRID Radiation Therapy (SFGRT) as Part of Neoadjuvant Therapy in Poor Prognosis, Bulky Sarcomas. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2220] [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: 10/24/2022]
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Chuong M, Bhooshan N, Moeslein F, Horiba N, Hanna N, Alexander H, Hausner P, Regine W, Kudryasheva S, Sharma N. Radiographic Tumor Volume Change as a Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer Patients Who Received Selective Internal Radiation Therapy to the Liver Using Yttrium-90 Resin Microspheres. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1220] [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: 10/24/2022]
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Chuong M, Bhooshan N, Sharma N, Moeslein F, Horiba N, Alexander H, Hausner P, Regine W, Kudryasheva S, Yi B. Radiation Dose Versus Activity as a Prognostic Factor in Metastatic Colorectal Cancer Patients Who Received Selective Internal Radiation Therapy to the Liver Using Yttrium-90 Resin Microspheres. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1225] [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: 10/24/2022]
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Layden J, Connelly M, Sandeman K, Hekerem D, Alexander H, McLoughlin P, Tyrrell P. UNDERSTANDING PALLIATIVE AND END OF LIFE CARE THROUGH STAKEHOLDER AND COMMUNITY ENGAGEMENT. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.39] [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: 11/04/2022]
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Böttcher D, Gräfe H, Zimmermann G, Alexander H, Ellenberger C, Schoon HA. Transcription of equine chorionic gonadotropin/luteinizing hormone b subunit gene in the endometrium of non-pregnant mares. PFERDEHEILKUNDE 2014. [DOI: 10.21836/pem20140103] [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: 11/27/2022]
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Sharma N, Chaudhry H, Horiba M, Hanna N, Alexander H, Hausner P, Regine W, Amin P, Kudryasheva S, Moeslein F. Association Between K-Ras Mutation Status and Survival in mCRC Patients Undergoing Selective Internal Radiation Therapy (SIRT) to the Liver Using Yttrium-90 Coated Resin Microspheres. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.861] [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: 10/26/2022]
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Chaudhry H, Ellison T, Maidment B, Regine W, Alexander H, Hanna N, Wolfgang C, Morris C, Herman J, Sharma N. Radiation Therapy in Pancreatic Neuroendocrine Tumors: Favorable Outcomes and Low Toxicity in a Multi-institutional Experience. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.809] [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: 10/26/2022]
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Decicco-Skinner KL, Jung SA, Tabib T, Gwilliam JC, Alexander H, Goodheart SE, Merchant AS, Shan M, Garber C, Wiest JS. Tpl2 knockout keratinocytes have increased biomarkers for invasion and metastasis. Carcinogenesis 2013; 34:2789-98. [PMID: 24067898 DOI: 10.1093/carcin/bgt319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Skin cancer is the most common form of cancer in the USA, with an estimated two million cases diagnosed annually. Tumor progression locus 2 (Tpl2), also known as MAP3K8, is a serine/threonine protein kinase in the mitogen-activated protein kinase signal transduction cascade. Tpl2 was identified by our laboratory as having a tumor suppressor function in skin carcinogenesis, with the absence of this gene contributing to heightened inflammation and increased skin carcinogenesis. In this study, we used gene expression profiling to compare expression levels between Tpl2 (+/+) and Tpl2 (-) (/-) keratinocytes. We identified over 2000 genes as being differentially expressed between genotypes. Functional annotation analysis identified cancer, cell growth/proliferation, cell death, cell development, cell movement and cell signaling as the top biological processes to be differentially regulated between genotypes. Further microarray analysis identified several candidate genes, including Mmp1b, Mmp2, Mmp9 and Mmp13, involved in migration and invasion to be upregulated in Tpl2 (-) (/-) keratinocytes. Moreover, Tpl2 (-/-) keratinocytes had a significant downregulation in the matrix metalloproteinase (MMP) inhibitor Timp3. Real-time PCR validated the upregulation of the MMPs in Tpl2 (-/-) keratinocytes and zymography confirmed that MMP2 and MMP9 activity was higher in conditioned media from Tpl2 (-/-) keratinocytes. Immunohistochemistry confirmed higher MMP9 staining in 12-O-tetradecanoylphorbol-13-acetate-treated skin from Tpl2 (-/-) mice and grafted tumors formed from v-ras(Ha) retrovirus-infected Tpl2 (-/-) keratinocytes. Additionally, Tpl2 (-/-) keratinocytes had significantly higher invasion, malignant conversion rates and increased endothelial cell tube formation when compared with Tpl2 (+/+) keratinocytes. In summary, our studies reveal that keratinocytes from Tpl2 (-/-) mice demonstrate a higher potential to be invasive and metastatic.
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Böttcher D, Gräfe H, Zimmermann G, Alexander H, Ellenberger C, Schoon HA. Equine chorionic gonadotropin in the uterus of non-pregnant mares? Reprod Biol 2013. [DOI: 10.1016/j.repbio.2013.01.041] [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: 11/26/2022]
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Tedman RA, Alexander H, Massa H, Moses D. Student perception of a new integrated anatomy practical program: does students' prior learning make a difference? Clin Anat 2011; 24:664-70. [PMID: 21438022 DOI: 10.1002/ca.21180] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 01/31/2011] [Accepted: 02/20/2011] [Indexed: 11/10/2022]
Abstract
While there is evidence that science and non-science background students display small differences in performance in basic and clinical sciences, early in a 4-year, graduate entry medical program, this lessens with time. With respect to anatomy knowledge, there are no comparable data as to the impact previous anatomy experience has on the student perception of the anatomy practical learning environment. A study survey was designed to evaluate student perception of the anatomy practical program and its impact on student learning, for the initial cohort of a new medical school. The survey comprised 19 statements requiring a response using a 5-point Likert scale, in addition to a free text opportunity to provide opinion of the perceived educational value of the anatomy practical program. The response rate for a total cohort of 82 students was 89%. The anatomy practical program was highly valued by the students in aiding their learning of anatomy, as indicated by the high mean scores for all statements (range: 4.04-4.7). There was a significant difference between the students who had and had not studied a science course prior to entering medicine, with respect to statements that addressed aspects of the course related to its structure, organization, variety of resources, linkage to problem-based learning cases, and fairness of assessment. Nonscience students were more positive compared to those who had studied science before (P levels ranging from 0.004 to 0.035). Students less experienced in anatomy were more challenged in prioritizing core curricular knowledge. Clin. Anat. 24:664-670, 2011. © 2011 Wiley-Liss, Inc.
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Affiliation(s)
- R A Tedman
- School of Medicine, Griffith University, Gold Coast Campus, Queensland, Australia.
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Abstract
Fibroblast growth factor (FGF) is a polypeptide found in two forms: basic and acidic. The basic form is produced by many more types of cells than the acidic form, although both bind to the same receptor. These proteins act on a variety of mesodermally and ectodermally derived cells, including chondrocytes, glial cells, myoblasts, endothelial cells, cornea and lens epithelia, adrenal cortical cells, ovarian granulosa cells, periosteal fibroblasts, and osteoblasts. Basic FGF was chosen for the present study for a variety of reasons. First, it has significant cross-species homology, with 98.7% correlation between human and both bovine and avian FGF. Less conservation has been observed in the acidic form. In addition, the basic form has been shown to be 30- to 100-fold more potent, depending on the target tissue.
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Abstract
ABSTRACTBioabsorbable synthetic polymers have been studied for their possible application in absorbable internal fracture fixation devices. The current study examines the biological response of intramedullary bone to PLLA (poly-L-lactic acid). PLLA degrades at a rate sufficiently slow to be useful for fracture fixation and undergoes hydrolytic deesterification to form metabolites normally found in the body. Nevertheless, the lactic-acid-rich degradation products have the potential to significantly lower the local pH in a closed space surrounded by bone. It is hypothesized that this acidity may tend to cause abnormal bone resorption and/or demineralization.
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Schwalenberg T, Neuhaus J, Horn LC, Alexander H, Zimmermann G, Ho Thi P, Mallock T, Stolzenburg JU. [New insights in the differential diagnosis of bladder pain syndrome]. Aktuelle Urol 2010; 41:107-18. [PMID: 20309783 DOI: 10.1055/s-0030-1247272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is challenging, since pathogenetic mechanisms and the definition of clinical relevant parameters are still under lively discussion. The criteria recently proposed by the European Society for the Study of Interstitial Cystitis (ESSIC) define a collective of patients based on the cardinal symptom of bladder pain which is heterogeneous, and therefore cannot receive standardised consistent therapy. Thus an extended diagnosis based on molecular markers seems to be indicated to render individual pharmacotherapy possible, and to contribute to elucidation of BPS/IC pathogenesis. For this purpose we feel the vital need for taking a bladder biopsy. The diagnosis of BPS/IC should rely on 3 "columns": (1) clinical diagnostics; (2) histopathology; (3) molecular diagnostics/protein expression. Since a significant contribution of the 3 functional units of the bladder to the pathophysiology is most evident, the examinations should ideally include urothelium, lamina propria, and detrusor musculature. Generation of receptor profiles of the detrusor muscle represents a first attempt to define a diagnostic tool for the individualisation of BPS/IC pharmacotherapy. Other factors, e.g., beta-hCG expression in the urothelium, need further evaluation. Extended BPS/IC diagnostics could be realistically integrated into routine patient care within a clinic/laboratory network.
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Levy E, Chang R, Neeman Z, Abi-Jaoudeh N, Hughes M, Kammula U, Avital I, Royal R, Libutti S, Alexander H, Pingpank J, Wood B. Abstract No. 114: Percutaneous hepatic perfusion: Single institution review of technical considerations. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.266] [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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Beaglehole R, Dobson A, Hobbs M, Jackson R, Jamrozik K, Alexander H, Stewart A. Comparison of event rates among three MONICA centres. Acta Med Scand Suppl 2009; 728:53-9. [PMID: 3202032 DOI: 10.1111/j.0954-6820.1988.tb05553.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Data from three MONICA centres in Auckland (New Zealand) and Newcastle and Perth (Australia) are used to explore some of the issues involved in comparing event rates and case fatality among MONICA centres. Auckland and Newcastle follow the "hot pursuit" method of identifying and interviewing patients while they are still in hospital. Perth follows the "cold pursuit" method, in which patients are identified by search of computerized hospital records after discharge and all data are abstracted retrospectively from case notes. Fatal cases are identified by the same method in the three centres. The distribution of events by MONICA diagnostic classification varied among centres, with Perth having the highest proportion of definite myocardial infarction events and the lowest proportion of possible myocardial infarction events. These differences appear to be due to the different methods of event ascertainment and data collection, and to variations in post mortem rates between centres. For comparisons among these three centres, the categories of non-fatal definite myocardial infarction and of all coronary heart disease deaths (that is those in the MONICA categories fatal definite myocardial infarction, fatal possible myocardial infarction, and fatal cases with insufficient data) appear to be the most useful.
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Affiliation(s)
- R Beaglehole
- Department of Community Health, School of Medicine, University of Auckland, New Zealand
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Alexander H. Die Nachbehandlung beim extrapleuralen Pneumothorax. Respiration 2008. [DOI: 10.1159/000191135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Meinel A, Leo C, Zimmermann G, Alexander H, Horn LC. COX–2 is overesxpressed in ovarian endometriosis and might represent a therapeutic target. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088624] [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: 10/19/2022] Open
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Buchbinder S, Kratzsch J, Fiedler GM, Yar V, Brügel M, Leichtle A, Weber W, Alexander H, Matthes G, Thiery J. Body weight and oral contraceptives are the most important modulators of serum CRP levels. Scand J Clin Lab Invest 2007; 68:140-4. [PMID: 17852819 DOI: 10.1080/00365510701487727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND C-reactive protein (CRP) levels are modulated by endogenous and exogenous factors independently of inflammation. The present study investigated the impact of oral contraceptives, endogenous oestrogens, age, gender, smoking, body mass index (BMI) and lipid levels on CRP concentrations in a healthy collective. METHODS Highly sensitive CRP, total cholesterol, HDL-cholesterol and LDL-cholesterol levels were measured in 850 blood donors (438 M, 412 F); 227 women in this group used oral contraceptive formulations (OC). Additionally, serum samples from 58 women undergoing in vitro fertilization cycles (IVF) were tested for CRP. Results. The 97.5th percentile of CRP levels of the blood donors was 4.91 mg/L in men, 7.52 mg/L in OC non-users and 11.95 mg/L in OC users. Overweight gives a 2-fold increase of median CRP levels in men and women. The combination of overweight and OC use in women resulted in 6-fold median CRP levels. Age, smoking and lipid levels were influencing factors of lower significance. In IVF patients the elevated oestradiol levels had no influence on CRP concentrations in multivariance analysis. CONCLUSION The diagnostic and predictive value of CRP levels is most affected by BMI and oral contraceptive use, which suggests the need for further investigations into the role of CRP modulating factors in monitoring infectious diseases.
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Affiliation(s)
- S Buchbinder
- Central laboratory, University Hospital of Heidelberg, Im Neueneimer Feld 410, D-69120 Heidelberg, Germany.
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