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Abdel-Alim T, Kurniawan M, Mathijssen I, Dremmen M, Dirven C, Niessen W, Roshchupkin G, van Veelen ML. Sagittal Craniosynostosis: Comparing Surgical Techniques Using 3D Photogrammetry. Plast Reconstr Surg 2023; 152:675e-688e. [PMID: 36946583 PMCID: PMC10521803 DOI: 10.1097/prs.0000000000010441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/10/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND The aim of this study was to compare three surgical interventions for correction of sagittal synostosis-frontobiparietal remodeling (FBR), extended strip craniotomy (ESC), and spring-assisted correction (SAC)-based on three-dimensional (3D) photogrammetry and operation characteristics. METHODS Patients who were born between 1991 and 2019 and diagnosed with nonsyndromic sagittal synostosis who underwent FBR, ESC, or SAC and had at least one postoperative 3D photogrammetry image taken during one of six follow-up appointments until age 6 were considered for this study. Operative characteristics, postoperative complications, reinterventions, and presence of intracranial hypertension were collected. To assess cranial growth, orthogonal cranial slices and 3D photocephalometric measurements were extracted automatically and evaluated from 3D photogrammetry images. RESULTS A total of 322 postoperative 3D images from 218 patients were included. After correcting for age and sex, no significant differences were observed in 3D photocephalometric measurements. Mean cranial shapes suggested that postoperative growth and shape gradually normalized with higher occipitofrontal head circumference and intracranial volume values compared with normal values, regardless of type of surgery. Flattening of the vertex seems to persist after surgical correction. The authors' cranial 3D mesh processing tool has been made publicly available as a part of this study. CONCLUSIONS The findings suggest that until age 6, there are no significant differences among the FBR, ESC, and SAC in their ability to correct sagittal synostosis with regard to 3D photocephalometric measurements. Therefore, efforts should be made to ensure early diagnosis so that minimally invasive surgery is a viable treatment option. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Tareq Abdel-Alim
- From the Departments of Neurosurgery
- Radiology and Nuclear Medicine
| | | | | | | | | | | | | | - Marie-Lise van Veelen
- From the Departments of Neurosurgery
- the Pediatric Brain Center, Erasmus MC, University Medical Center
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The utility and post-operative evolution of head circumference in nonsyndromic single-suture craniosynostosis: a prospective study in Vietnamese children. Childs Nerv Syst 2023; 39:471-479. [PMID: 35804268 DOI: 10.1007/s00381-022-05580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Head circumference (HC) is an important clinical tool for following head growth in children with craniosynostosis (CS). The purpose of this study is to quantify the usefulness of HC along continuum of CS care, from diagnosis to pre- and post-operative (pre-op, post-op) follow-up in Vietnamese children. METHODS A prospective cohort of 54 nonsyndromic single-suture CS patients undergoing open surgery from January 2015 to January 2020 was collected at Children's Hospital 2, Vietnam. HC z-score on admission was compared with World Health Organization (WHO) standards to evaluate for utility in initial diagnosis. Pre-op and post-op HC were compared to demonstrate the evolution of head growth following reconstruction. RESULTS Nonsyndromic single-suture CS was more predominant in males (79.6%) than in females (20.4%). The mean HC z-score was - 0.38 [Formula: see text] 1.29 similar to normal WHO standards regardless of which sutural involvement. The HC z-score increased above + 1 standard deviation (SD) significantly at 3 months of follow-up (p < 0.001); however, the trajectory gradually decreased after the first year of surgery. One patient (1.8%, 1/54) demonstrated restenosis and delayed intracranial hypertension (DIH) 4 years after reconstruction. CONCLUSIONS The HC in nonsyndromic single-suture CS children presents similarly to the values of healthy children. Additionally, HC reliably increased after reconstruction and gradually normalized over subsequent years. This indicator is consistent in Southeast Asian populations and should be used to follow all patients to assess the normal progression of post-op head growth and as a useful indicator of suspected recurrent synostosis.
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Intracranial Volumes of Healthy Children in the First 3 Years of Life: An Analysis of 270 Magnetic Resonance Imaging Scans. Plast Reconstr Surg 2022; 150:136e-144e. [PMID: 35575631 DOI: 10.1097/prs.0000000000009188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of data on normal intracranial volumes for healthy children during the first few years of life, when cranial growth velocity is greatest. The aim of this study was to generate a normative predictive model of intracranial volumes based on brain magnetic resonance imaging from a large sample of healthy children to serve as a reference tool for future studies on craniosynostosis. METHODS Structural magnetic resonance imaging data for healthy children up to 3 years of age was acquired from the National Institutes of Health Pediatric MRI Data Repository. Intracranial volumes were calculated using T1-weighted scans with FreeSurfer (version 6.0.0). Mean intracranial volumes were calculated and best-fit logarithmic curves were generated. Results were compared to previously published intracranial volume curves. RESULTS Two-hundred seventy magnetic resonance imaging scans were available: 118 were collected in the first year of life, 97 were collected between years 1 and 2, and 55 were collected between years 2 and 3. A best-fit logarithmic growth curve was generated for male and female patients. The authors' regression models showed that male patients had significantly greater intracranial volumes than female patients after 1 month of age. Predicted intracranial volumes were also greater in male and female patients in the first 6 months of life as compared to previously published intracranial volume curves. CONCLUSIONS To the authors' knowledge, this is the largest series of demographically representative magnetic resonance imaging-based intracranial volumes for children aged 3 years and younger. The model generated in this study can be used by investigators as a reference for evaluating craniosynostosis patients.
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Riesel JN, Riordan CP, Hughes CD, Karsten MB, Staffa SJ, Meara JG, Proctor MR. Endoscopic strip craniectomy with orthotic helmeting for safe improvement of head growth in children with Apert syndrome. J Neurosurg Pediatr 2022:1-8. [PMID: 35364592 DOI: 10.3171/2022.2.peds21340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Bilateral coronal craniosynostosis in Apert syndrome is traditionally managed with open cranial vault remodeling procedures like fronto-orbital advancement (FOA). However, as minimally invasive procedures gain popularity, limited data exist to determine their efficacy in this syndromic population. This study examines whether endoscopic strip craniectomy (ESC) is inferior to FOA in correcting head growth in patients with Apert syndrome. METHODS The authors conducted a retrospective review of children with Apert syndrome over a 23-year period. Postoperative head circumferences until 24 months of age were compared for patients treated with ESC versus FOA by using normative growth curves. Intraoperative and postoperative morbidity was compared between groups. RESULTS The median postoperative follow-up for the FOA (n = 14) and ESC (n = 16) groups was 40 and 28.5 months, the median age at operation was 12.8 and 2.7 months, and the median operative time was 285 and 65 minutes, respectively (p < 0.001). The FOA group had significantly higher rates of blood transfusion, ICU admission, and longer hospital length of stay (p < 0.01). There were no statistically significant differences in premature reossification rates, complications, need for further procedures, or complaints of asymmetry. Compared to normative growth curves, all patients in both groups had head circumferences comparable to or above the 85th percentile at last follow-up. CONCLUSIONS Children with Apert syndrome and bilateral coronal craniosynostosis treated with ESC experience early normalization of head growth and cephalic index that is not inferior to those treated with FOA. Longer-term assessments are needed to determine long-term aesthetic results and the correlation between head growth and neurocognitive development in this population.
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Affiliation(s)
- Johanna N Riesel
- 1Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Coleman P Riordan
- 2Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.,3University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christopher D Hughes
- 4Division of Plastic and Craniofacial Surgery, Connecticut Children's, Hartford, Connecticut
| | - Madeline B Karsten
- 2Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- 5Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital; and
| | - John G Meara
- 6Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Mark R Proctor
- 2Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
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Wilson AT, Den Ottelander BK, Van Veelen MC, Dremmen MHG, Persing JA, Vrooman HA, Mathijssen IMJ, Tasker RC. Cerebral cortex maldevelopment in syndromic craniosynostosis. Dev Med Child Neurol 2022; 64:118-124. [PMID: 34265076 PMCID: PMC9290542 DOI: 10.1111/dmcn.14984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/04/2022]
Abstract
AIM To assess the relationship of surface area of the cerebral cortex to intracranial volume (ICV) in syndromic craniosynostosis. METHOD Records of 140 patients (64 males, 76 females; mean age 8y 6mo [SD 5y 6mo], range 1y 2mo-24y 2mo) with syndromic craniosynostosis were reviewed to include clinical and imaging data. Two hundred and three total magnetic resonance imaging (MRI) scans were evaluated in this study (148 patients with fibroblast growth factor receptor [FGFR], 19 patients with TWIST1, and 36 controls). MRIs were processed via FreeSurfer pipeline to determine total ICV and cortical surface area (CSA). Scaling coefficients were calculated from log-transformed data via mixed regression to account for multiple measurements, sex, syndrome, and age. Educational outcomes were reported by syndrome. RESULTS Mean ICV was greater in patients with FGFR (1519cm3 , SD 269cm3 , p=0.016) than in patients with TWIST1 (1304cm3 , SD 145cm3 ) or controls (1405cm3 , SD 158cm3 ). CSA was related to ICV by a scaling law with an exponent of 0.68 (95% confidence interval [CI] 0.61-0.76) in patients with FGFR compared to 0.81 (95% CI 0.50-1.12) in patients with TWIST1 and 0.77 (95% CI 0.61-0.93) in controls. Lobar analysis revealed reduced scaling in the parietal (0.50, 95% CI 0.42-0.59) and occipital (0.67, 95% CI 0.54-0.80) lobes of patients with FGFR compared with controls. Modified learning environments were needed more often in patients with FGFR. INTERPRETATION Despite adequate ICV in FGFR-mediated craniosynostosis, CSA development is reduced, indicating maldevelopment, particularly in parietal and occipital lobes. Modified education is also more common in patients with FGFR.
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Affiliation(s)
- Alexander T Wilson
- Department of Plastic and Reconstructive and Hand SurgeryErasmus University Medical CenterRotterdamthe Netherlands,Section of Plastic SurgeryYale School of MedicineNew HavenCTUSA
| | - Bianca K Den Ottelander
- Department of Plastic and Reconstructive and Hand SurgeryErasmus University Medical CenterRotterdamthe Netherlands
| | | | - Marjolein HG Dremmen
- Department of Radiology and Nuclear MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - John A Persing
- Section of Plastic SurgeryYale School of MedicineNew HavenCTUSA
| | - Henri A Vrooman
- Department of Radiology and Nuclear MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - Irene MJ Mathijssen
- Department of Plastic and Reconstructive and Hand SurgeryErasmus University Medical CenterRotterdamthe Netherlands
| | - Robert C Tasker
- Department of AnesthesiologyCritical Care and Pain MedicineHarvard Medical SchoolBoston Children’s HospitalBostonMAUSA
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Chen YJ, Lin TL, Cai Z, Yan CH, Gou SR, Zhuang YD. Assessment of acute pancreatitis severity via determination of serum levels of hsa-miR-126-5p and IL-6. Exp Ther Med 2020; 21:26. [PMID: 33262812 PMCID: PMC7690249 DOI: 10.3892/etm.2020.9458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
Early assessment of acute pancreatitis (AP) severity is key to its treatment. The present study aimed to explore the role of microRNAs (miRNAs/miRs) combined with inflammatory factors in determining AP severity. For this, serum pro-inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, IL-8 and IL-10)] and miRNAs [Homo sapiens (hsa)-miR-548d-5p, hsa-miR-126-5p and hsa-miR-130b-5p] were detected in patients with mild AP (MAP), severe AP (SAP) and recurrent AP (RAP). High expression of IL-10, TNF-α, hsa-miR-126-5p, hsa-miR-548d-5p and hsa-miR-130b-5p was able to distinguish SAP from MAP and RAP (P<0.05). Multifactorial binary logistic regression analysis indicated that IL-1/IL-6 combined with hsa-miR-126-5p/hsa-miR-548d-5p had a significant influence on AP and AP severity (P<0.05). Receiver operating characteristic analysis revealed that IL-1 combined with hsa-miR-126-5p [area under the curve (AUC), 0.926; sensitivity, 90.0%; specificity, 86.7%, P<0.001] and IL-6 combined with hsa-miR-126-5p (AUC, 0.952; sensitivity, 93.3%; specificity, 90.0%; P<0.001) were able to better distinguish MAP from SAP than IL-1/IL-6 combined with hsa-miR-548d-5p, lipase, and amylase. IL-1 or IL-6 combined with hsa-miR-548d-5p (AUC, 0.924; sensitivity, 83.3%; specificity, 93.3%; P<0.001) were able to better distinguish SAP from RAP than IL-1/IL-6 combined with hsa-miR-126-5p, lipase, and amylase. IL-1 combined with hsa-miR-126-5p (AUC, 0.926; sensitivity, 90.0%; specificity, 86.7%; P<0.001) and IL-6 combined with hsa-miR-126-5p (AUC, 0.952; sensitivity, 93.3%; specificity, 90.0%; P<0.001) were able to better differentiate between MAP and RAP than IL-1/IL-6 combined with hsa-miR-548d-5p, lipase, and amylase. These results demonstrated that the combined detection of serum IL-6 and hsa-miR-126-5p may be useful for the early prediction of AP classification.
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Affiliation(s)
- Ying-Jie Chen
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, Fujian 362200, P.R. China
| | - Tian-Lai Lin
- Department of Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medicine University, Quanzhou, Fujian 362000, P.R. China
| | - Zhe Cai
- Department of Emergency Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, Fujian 362200, P.R. China
| | - Chang-Hu Yan
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, Fujian 362200, P.R. China
| | - Sen-Ren Gou
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, Fujian 362200, P.R. China
| | - Yao-Dong Zhuang
- Department of Critical Care Medicine, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang, Fujian 362200, P.R. China
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Li R, Tang H, Bao T, Yang H, Jin T. Correlation between prostate-specific antigen and four renal function-associated parameters in different ethnicities in southwest China. Exp Ther Med 2020; 20:143. [PMID: 33093881 DOI: 10.3892/etm.2020.9272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
A limited number of studies have investigated the significance of cystatin C, creatinine, uric acid and urea in prostate cancer. The present study aimed to explore the correlation between these molecules and total prostate-specific antigen (tPSA) levels using big data from patients of different Chinese ethnicities. Patients undergoing physical examination at the Medical Examination Center of West China Hospital (Chengdu, China) between January 2010 and May 2019 were retrospectively included. A χ2 test or Fisher's test and Kruskal-Wallis rank-sum test were used to compare categorical and continuous variables. Pearson's correlation coefficients (r) with 95% CI were also determined to assess the correlation between tPSA and cystatin, uric acid, creatinine and urea in the entire patient population and in different ethnicities. A total of 253,281 male patients were included and their mean age was 47.83±14.28 years. The mean tPSA level of these patients was 1.15±1.88 ng/ml. The mean levels of the renal function-associated parameters cystatin C, uric acid, creatinine and urea were 0.91±0.19, 388.02±77.37, 83.94±55.89 and 5.23±1.23 ng/ml, respectively. In the total patient population, urea (r=0.0774, P<0.0001), creatinine (r=0.0219, P<0.0001) and cystatin (r=0.1513, P<0.0001) were slightly positively correlated with tPSA, whereas uric acid was negatively correlated with tPSA (r=-0.0307, P<0.0001). Subgroup analyses generally yielded consistent results; however, a stronger correlation was noted between cystatin C and tPSA for the Mongolian ethnicity (r=0.6572, P<0.0001) and between creatinine and tPSA for the Yi ethnicity (r=0.6125, P<0.0001). In conclusion, the present study used data from a large population to reveal a generally significant and slightly positive correlation between tPSA and cystatin C levels among the 10 most common ethnicities in China. Subgroup analyses indicated that the tPSA level was moderately positively correlated with the creatinine level for the Mongolian and Yi ethnicities and the cystatin C level was moderately positively correlated with tPSA for the Mongolian ethnicity. Future studies are required to confirm and expand the present results.
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Affiliation(s)
- Ruicen Li
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Huairong Tang
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ting Bao
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hanwei Yang
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Tao Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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