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Anandhan A, Nguyen N, Syal A, Dreher LA, Dodson M, Zhang DD, Madhavan L. Erratum to "NRF2 Loss Accentuates Parkinsonian Pathology and Behavioral Dysfunction in Human α-Synuclein Overexpressing Mice". Aging Dis 2024; 15:951-952. [PMID: 37728584 PMCID: PMC11081150 DOI: 10.14336/ad.2023.10917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/21/2023] Open
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2
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Abi-Aad KR, Rahme RJ, Syal A, De La Peña NM, Turcotte EL, Patra DP, Jones B, Chong B, Krishna C, Bendok BR. Predictive Model Evaluating Risk of Hemorrhage in Intracranial Aneurysms: Analysis from Prospectively Collected HEAT Trial Database. World Neurosurg 2023; 178:e315-e322. [PMID: 37479031 DOI: 10.1016/j.wneu.2023.07.057] [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: 04/30/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE We analyzed the data of patients enrolled in the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to develop and validate a model to predict the risk of aneurysmal hemorrhage. METHODS Analysis included data from 600 patients enrolled for the HEAT trial and included single saccular aneurysms of 3-14 mm size. Baseline characteristics were compared between patients with ruptured and unruptured aneurysms. Regression analysis was performed in the training set to identify significant risk factors and was validated in the validation dataset. The complete dataset was used to formulate a scoring model in which positive and negative predictors were assigned 1 and -1 points, respectively. RESULTS Data from 593 patients were analyzed in which 169 (28.5%) patients had ruptured aneurysms. The training (n = 297) and validation dataset (n = 296) had a comparable proportion of ruptured aneurysms (29.3% and 27.7%). Dome-to-neck ratio >2.5 (odds ratio [OR] 3.66), irregular shape (OR 3.79), daughter sac (OR 5.89), and anterior and posterior communicating artery locations (OR 3.32 and 3.56, respectively) had a higher rupture rate. Use of aspirin was associated with lower risk of hemorrhage (OR 0.16). The area under the curve from the receiver operating curve analysis was 0.88, 0.87, and 0.87 in the training, validation, and combined data set, respectively. The scoring model created a score of -1 to 2, yielding an of aneurysmal hemorrhage probability from 1.5% (score -1) to 70% (score 2). CONCLUSIONS This prospective study identifies dome-to-neck ratio >2.5, irregular shape, presence of daughter sac, absence of aspirin use, and aneurysm location at anterior communicating and posterior communicating artery as factors associated with increased risk of hemorrhagic presentation in small- to medium-sized intracranial aneurysms. Our model provides an estimate of rupture risk based on the presence or absence of these factors.
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Affiliation(s)
- Karl R Abi-Aad
- Department of Neurosurgery, SUNY Upstate University, New York, New York, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA
| | - Rudy J Rahme
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Global Neurosciences Institute, Pennington, New Jersey, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, New York Medical College, Valhalla, New York, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Nicole M De La Peña
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Evelyn L Turcotte
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Devi P Patra
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Breck Jones
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Chong
- Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurosurgery, Southern Illinois University, Springfield, Illinois, USA; Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.
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3
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Stuebe C, Jones BA, Syal A, Rahme RJ, Turcotte EL, Toussaint LG, Ross JS, Bendok BR. Cerebrospinal Venous Fistula Presenting with Cognitive Decline: Systematic Literature Review and Report of Two Cases. World Neurosurg 2023; 176:74-80. [PMID: 36934870 DOI: 10.1016/j.wneu.2023.03.056] [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: 02/24/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE A cerebrospinal fluid (CSF) venous fistula (CVF) is an aberrant connection between the subarachnoid space and a vein resulting in CSF loss. The presentation and management of CVF with cognitive decline is incompletely understood. METHODS A systematic review was completed following the PRISMA guidelines. Articles that included at least 1 case of imaging-confirmed CVF with details on patient treatment were included. A separate review of cases of patients with spontaneous intracranial hypotension (SIH) with frontotemporal dementia (FTD) or dementia symptoms was also completed. RESULTS Ten CVF articles (69 patients; average age, 51.5 years) and 5 SIH with FTD or dementia articles (n = 41; average age, 55.9 years) were identified. Only 1 patients with CVF with cognitive abnormalities was identified. The most common symptom was headache in both reviews. Brain sag was identified in all patients, whereas CSF leak was identified in only 2 patients with SIH with FTD or dementia (4.9%). An epidural blood or fibrin glue patch was used in all patients with CVF and in 33 patients with SIH with FTD or dementia. Fifty-five patients with CVF (79.7%) and 27 patients with SIH with FTD or dementia (65.9%) had surgery. CONCLUSIONS The 2 cases and literature reviews show the difficulty in diagnosis and treatment of CVF with cognitive decline. Novel imaging techniques should be used in patients with cognitive decline in whom a CSF leak is suspected. Transvenous embolization or surgery should be considered before patching for treatment of CVF-induced brain sag and resulting dementia.
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Affiliation(s)
- Caren Stuebe
- Texas A&M College of Medicine, Bryan, Texas, USA
| | - Breck A Jones
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- New York Medical College, Valhalla, New York, USA
| | - Rudy J Rahme
- Department of Neurosurgery, Global Neuroscience Institute, Philadelphia, Pennsylvania, USA
| | - Evelyn L Turcotte
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - L Gerard Toussaint
- Texas A&M College of Medicine, Bryan, Texas, USA; Texas Brain and Spine Institute, Bryan, Texas, USA
| | - Jeffrey S Ross
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-Therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA.
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Syal A, Cozzi FM, Vazquez S, Spirollari E, Naftchi AF, Das A, Ng C, Akinleye O, Gagliardi T, Dominguez JF, Wang A, Kinon MD. Dural Closure Techniques and Cerebrospinal Fluid Leak Incidence After Resection of Primary Intradural Spinal Tumors: A Systematic Review. Clin Spine Surg 2023:01933606-990000000-00184. [PMID: 37482628 DOI: 10.1097/bsd.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
STUDY DESIGN This is a systematic review of primary intradural spinal tumors (PIDSTs) and the frequency of postoperative cerebrospinal fluid (CSF) leaks. OBJECTIVE This study aimed to compare CSF leak rates among techniques for dural watertight closure (WTC) after the resection of PIDSTs. SUMMARY OF BACKGROUND DATA Resection of PIDSTs may result in persistent CSF leak. This complication is associated with infection, wound dehiscence, increased length of stay, and morbidity. Dural closure techniques have been developed to decrease the CSF leak rate. METHODS A PubMed search was performed in 2022 with these inclusion criteria: written in English, describe PIDST patients, specify the method of dural closure, report rates of CSF leak, and be published between 2015 and 2020. Articles were excluded if they had <5 patients. We used standardized toolkits to assess the risk of bias. We assessed patient baseline characteristics, tumor pathology, CSF leak rate, and dural closure techniques; analysis of variance and a 1-way Fisher exact test were used. RESULTS A total of 4 studies (201 patients) satisfied the inclusion criteria. One study utilized artificial dura (AD) and fibrin glue to perform WTC and CSF diversion, with lumbar drainage as needed. The rate of CSF leak was different among the 4 studies (P=0.017). The study using AD with dural closure adjunct (DCA) for WTC was associated with higher CSF leak rates than those using native dura (ND) with DCA. There was no difference in CSF leak rate between ND-WTC and AD-DCA, or with any of the ND-DCA studies. CONCLUSIONS After resection of PIDSTs, the use of autologous fat grafts with ND resulted in lower rates of CSF leak, while use of fibrin glue and AD resulted in the highest rates. These characteristics suggest that a component of hydrophobic scaffolding may be required for WTC. A limitation included articles with low levels of evidence. Continued investigation to understand mechanisms for WTC is warranted. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | | | | | | | | | - Christina Ng
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA
| | | | | | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Arthur Wang
- Department of Neurosurgery, Tulane Medical Center, New Orleans, LA
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY
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Seshan N, Hanft S, Goswami G, Syal A. Primary Sellar Neuroblastoma Masquerading as a Pituitary Macroadenoma. JCEM Case Rep 2023; 1:luad081. [PMID: 37908997 PMCID: PMC10580437 DOI: 10.1210/jcemcr/luad081] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 11/02/2023]
Abstract
Olfactory neuroblastomas, or esthesioneuroblastomas, are rare and aggressive malignant tumors that typically arise from the olfactory neuroepithelium in the upper nasal cavity. In rare instances, they can be ectopic originating from areas outside the upper nasal cavity such as the sellar region. These tumors, also known as primary sellar neuroblastomas, may be mistaken for pituitary macroadenomas. We present a rare case of a primary sellar neuroblastoma in a 30-year-old woman with a prior diagnosis of presumed prolactinoma, status post transsphenoidal resection, with residual visual deficits, who presented with worsening vision and headaches. Pituitary magnetic resonance imaging showed a large sellar mass causing compression of the optic chiasm, and invasion of the right cavernous sinus and bilateral cavernous internal carotid arteries. The patient underwent a second transsphenoidal resection. Postoperatively, she developed central adrenal insufficiency, central hypothyroidism, central hypogonadism, and transient syndrome of inappropriate antidiuretic hormone secretion. Owing to rapid tumor regrowth, she underwent a craniotomy with plans for radiation treatment. This condition is challenging to diagnose and has poorly defined clinical management guidelines. An early, aggressive approach with surgical intervention is recommended.
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Affiliation(s)
- Nandini Seshan
- Department of Endocrinology, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Simon Hanft
- Department of Endocrinology, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Gayotri Goswami
- Department of Endocrinology, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Arjun Syal
- Department of Endocrinology, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595, USA
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Elgar G, Smiley A, Syal A, Latifi R. Hospital Length of Stay Independently Predicts Mortality in Patients Emergently Admitted for Esophageal Hemorrhage: Sex, Frailty, and Age as Additional Mortality Factors. Surg Technol Int 2023; 42:sti42/1666. [PMID: 37053368 DOI: 10.52198/23.sti.42.gs1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Upper gastrointestinal bleeding results in greater than $7.6 billion of in-hospital economic burden in the United States yearly. With a worldwide incidence between 40-100/100,000 individuals and a mortality rate of approximately 2-10%, upper gastrointestinal bleeding represents a major source of mortality and morbidity. The goal of this study was to describe mortality risk factors in patients emergently admitted with esophageal hemorrhage, the second most common etiology of upper gastrointestinal bleeding. MATERIALS AND METHODS Patients emergently admitted with esophageal hemorrhage between 2005-2014 were evaluated using the National Inpatient Sample database. Patient characteristics, clinical outcomes, and therapeutic trends were obtained. Relationships between morality and all other variables were determined via univariable and multivariable logistic regression analyses. RESULTS In total, 4,607 patients were included, of which 2,045 (44.4%) were adults, 2,562 (55.6%) were elderly, 2,761 (59.9%) were males, and 1,846 (40.1%) were females. The average age of adult and elderly patients were 50.1 and 78.7 years, respectively. The multivariable logistic regression analysis revealed, for every additional day of hospitalization, the odds of mortality for nonoperatively treated adult and elderly patients increased by 7.5% (p=<0.001) and 6.6% (p=<0.001), respectively. Every additional year of age was associated with a 5.4% (p=0.012) increase in mortality odds for nonoperatively managed adult patients. Frailty increased the odds of mortality by 31.1% (p=0.009) in nonoperatively treated elderly patients. Undergoing invasive diagnostic procedures in conservatively treated adults reduced mortality significantly (odds ratio=0.400, p=0.021). Frailty, age, and hospital length of stay demonstrated no significant association with mortality in surgically managed adult and elderly patients. CONCLUSION Nonoperatively managed patients emergently admitted for esophageal hemorrhage with longer hospital length of stay and higher modified frailty index exhibited higher odds of mortality. Invasive diagnostic procedures were negatively correlated with mortality in nonoperatively treated adult patients. Age is only associated with higher mortality rates in adults, while elderly patients revealed no association between age and mortality.
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Affiliation(s)
- Guy Elgar
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, New York
| | - Abbas Smiley
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, New York
| | - Arjun Syal
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, New York
| | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, Arizona
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Salik I, Vazquez S, Syal A, Das A, Sacknovitz A, Spirollari E, Dominguez JF, Wecksell M, Stewart D, Pisapia JM. Risk factors for posttraumatic hydrocephalus after decompressive hemicraniectomy in pediatric patients with traumatic brain injury. J Neurosurg Pediatr 2023; 31:417-422. [PMID: 36787133 DOI: 10.3171/2023.1.peds22525] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Traumatic brain injuries (TBIs) play a significant role in pediatric mortality and morbidity. Decompressive hemicraniectomy (DHC) is a treatment option for severe pediatric TBI (pTBI) not amenable to medical management of intracranial pressure. Posttraumatic hydrocephalus (PTH) is a known sequela of DHC that may lead to further injury and decreased capacity for recovery if not identified and treated. The goal of this study was to characterize risk factors for PTH after DHC in patients with pTBI by using the Kids' Inpatient Database (KID). METHODS The records collected in the KID from 2016 to 2019 were queried for patients with TBI using International Classification of Diseases, 10th Revision codes. Data defining demographics, complications, procedures, and outcomes were extracted. Multivariate regression was used to identify risk factors associated with PTH. The authors also investigated length of stay and hospital charges. RESULTS Of 68,793 patients with pTBI, 848 (1.2%) patients underwent DHC. Prolonged mechanical ventilation (PMV) was required in 475 (56.0%) patients with pTBI undergoing DHC. Three hundred (35.4%) patients received an external ventricular drain (EVD) prior to DHC. PTH was seen in 105 (12.4%), and 50 (5.9%) received a ventriculoperitoneal shunt. DHC before hospital day 2 was negatively associated with PTH (OR 0.464, 95% CI 0.267-0.804; p = 0.006), whereas PMV (OR 2.204, 95% CI 1.344-3.615; p = 0.002) and EVD placement prior to DHC (OR 6.362, 95% CI 3.667-11.037; p < 0.001) were positively associated with PTH. PMV (OR 7.919, 95% CI 2.793-22.454; p < 0.001), TBI with subdural hematoma (OR 2.606, 95% CI 1.119-6.072; p = 0.026), and EVD placement prior to DHC (OR 4.575, 95% CI 2.253-9.291; p < 0.001) were independent predictors of ventriculoperitoneal shunt insertion. The mean length of stay and total hospital charges were significantly increased in patients with PMV and in those with PTH. CONCLUSIONS PMV, presence of subdural hematoma, and EVD placement prior to DHC are risk factors for PTH in patients with pTBI who underwent DHC. Higher healthcare resource utilization was seen in patients with PTH. Identifying risk factors for PTH may improve early diagnosis and efficient resource utilization.
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Affiliation(s)
| | - Sima Vazquez
- 2School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - Arjun Syal
- 2School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - Ankita Das
- 2School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - Ariel Sacknovitz
- 2School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - Eris Spirollari
- 2School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York
| | | | | | | | - Jared M Pisapia
- 2School of Medicine, New York Medical College, Westchester Medical Center, Valhalla, New York.,3Neurosurgery, and
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8
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Patra DP, Syal A, Rahme RJ, Abi-Aad KR, Singh R, Turcotte EL, Jones BA, Meyer J, Hudson M, Chong BW, Dabus G, James RF, Krishna C, Bendok BR. A comparison of treating physician versus independent core lab assessments of post-aneurysm treatment imaging outcomes: an analysis of prospectively collected data from a randomized trial. J Neurosurg 2022:1-9. [PMID: 36681980 DOI: 10.3171/2022.10.jns22841] [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: 05/18/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Aneurysm occlusion has been used as surrogate marker of aneurysm treatment efficacy. Aneurysm occlusion scales are used to evaluate the outcome of endovascular aneurysm treatment and to monitor recurrence. These scales, however, require subjective interpretation of imaging data, which can reduce the utility and reliability of these scales and the validity of clinical studies regarding aneurysm occlusion rates. Use of a core lab with independent blinded reviewers has been implemented to enhance the validity of occlusion rate assessments in clinical trials. The degree of agreement between core labs and treating physicians has not been well studied with prospectively collected data. METHODS In this study, the authors analyzed data from the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to assess the interrater agreement between the treating physician and the blinded core lab. The HEAT trial included 600 patients across 46 sites with intracranial aneurysms treated with coiling. The treating site and the core lab independently reviewed immediate postoperative and follow-up imaging (3-12 and 18-24 months, respectively) using the Raymond-Roy occlusion classification (RROC) scale, Meyer scale, and recanalization survey. A post hoc analysis was performed to calculate interrater reliability using Cohen's kappa. Further analysis was performed to assess whether degree of agreement varied on the basis of various factors, including scale used, timing of imaging, size of the aneurysm, imaging modality, location of the aneurysm, dome-to-neck ratio, and rupture status. RESULTS Minimal interrater agreement was noted between the core lab reviewers and the treating physicians for assessing aneurysm occlusion using the RROC grading scale (k = 0.39, 95% CI 0.38-0.40) and Meyer scale (k = 0.23, 95% CI 0.14-0.38). The degree of agreement between groups was slightly better but still weak for assessing recanalization (k = 0.45, 95% CI 0.38-0.52). Factors that significantly improved degree of agreement were scales with fewer variables, greater time to follow-up, imaging modality (digital subtraction angiography), and wide-neck aneurysms. CONCLUSIONS Assessment of aneurysm treatment outcome with commonly used aneurysm occlusion scales suffers from risk of poor interrater agreement. This supports the use of independent core labs for validation of outcome data to minimize reporting bias. Use of outcome tools with fewer point categories is likely to provide better interrater reliability. Therefore, the outcome assessment tools are ideal for clinical outcome assessment provided that they are sensitive enough to detect a clinically significant change.
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Affiliation(s)
- Devi P Patra
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Arjun Syal
- 4New York Medical College, Valhalla, New York
| | - Rudy J Rahme
- 5Department of Neurosurgery, Global Neuroscience Institute, Philadelphia, Pennsylvania
| | | | - Rohin Singh
- 7Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Evelyn L Turcotte
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Breck A Jones
- 3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,8Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jenna Meyer
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Miles Hudson
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Brian W Chong
- 12Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Guilherme Dabus
- 9Department of Neuroradiology, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
| | - Robert F James
- 10Department of Neurosurgery, IU Health Physicians Neurosurgery, Indianapolis, Indiana
| | - Chandan Krishna
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona
| | - Bernard R Bendok
- 1Department of Neurological Surgery, Mayo Clinic, Phoenix.,2Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix.,3Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona.,11Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix.,12Department of Radiology, Mayo Clinic, Phoenix, Arizona
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9
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Patra DP, Welz ME, Turcotte EL, Pandey R, Vij K, Daly M, Rabon M, Korszen S, Zhou Y, Halpin B, Marchese ML, Syal A, Krishna C, Bendok BR. Real-Time MRI-Guided Stereotactic Aspiration of Spontaneous Intracerebral Hematoma: A Preclinical Feasibility Study. Oper Neurosurg (Hagerstown) 2022; 22:80-86. [PMID: 35007273 DOI: 10.1227/ons.0000000000000005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Minimally invasive surgical techniques have reinvigorated the role of surgical options for spontaneous intracranial hematomas; however, they are limited by the lack of real-time feedback on the extent of hematoma evacuation. OBJECTIVE To describe the development of a MRI-guided catheter-based aspiration system, the ClearPoint Pursuit Neuroaspiration Device (ClearPoint Neuro) and validation in phantom models. METHODS In this preclinical experimental trial, 8 phantom brains with skull models were created to simulate an intracranial hematoma with 2 clot sizes, 30 cc (small clot) and 60 cc (large clot). After registration, the aspiration catheter (Pursuit device) was aligned to the desired planned trajectory. The aspiration of the clot was performed under real-time MRI scan in 3 orthogonal views. The primary end point was reduction of the clot volume to less than 15 cc or 70% of the original clot volume. RESULTS Successful completion of clot evacuation was achieved in all models. The average postaspiration clot volume was 9.5 cc (8.7 cc for small clots and 10.2 cc for large clots). The average percentage reduction of clot volume was 76.3% (range 58.7%-85.2%). The average total procedure time (from frame registration to final postaspiration clot assessment) was 50 min. The average aspiration time was 6.9 min. CONCLUSION This preclinical trial confirms the feasibility and efficacy of MRI-guided aspiration under real-time image guidance in simulation models for intracranial hematoma. Clinical use of the system in patients would further validate its efficacy and safety.
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Affiliation(s)
- Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn L Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Kamal Vij
- ClearPoint Neuro, Inc., Irvine, California, USA
| | - Max Daly
- ClearPoint Neuro, Inc., Irvine, California, USA
| | | | | | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Brooke Halpin
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | | | - Arjun Syal
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Precision Neurotherapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
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Anandhan A, Nguyen N, Syal A, Dreher LA, Dodson M, Zhang DD, Madhavan L. NRF2 Loss Accentuates Parkinsonian Pathology and Behavioral Dysfunction in Human α-Synuclein Overexpressing Mice. Aging Dis 2021; 12:964-982. [PMID: 34221542 PMCID: PMC8219498 DOI: 10.14336/ad.2021.0511] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
Nuclear factor (erythroid-derived 2)-like 2 (NRF2) is a central regulator of cellular stress responses and its transcriptional activation promotes multiple cellular defense and survival mechanisms. The loss of NRF2 has been shown to increase oxidative and proteotoxic stress, two key pathological features of neurodegenerative disorders such as Parkinson's disease (PD). Moreover, compromised redox homeostasis and protein quality control can cause the accumulation of pathogenic proteins, including alpha-synuclein (α-Syn) which plays a key role in PD. However, despite this link, the precise mechanisms by which NRF2 may regulate PD pathology is not clear. In this study, we generated a humanized mouse model to study the importance of NRF2 in the context of α-Syn-driven neuropathology in PD. Specifically, we developed NRF2 knockout and wild-type mice that overexpress human α-Syn (hα-Syn+/Nrf2-/- and hα-Syn+/Nrf2+/+ respectively) and tested changes in their behavior through nest building, challenging beam, and open field tests at three months of age. Cellular and molecular alterations in α-Syn, including phosphorylation and subsequent oligomerization, as well as changes in oxidative stress, inflammation, and autophagy were also assessed across multiple brain regions. It was observed that although monomeric α-Syn levels did not change, compared to their wild-type counterparts, hα-Syn+/Nrf2-/- mice exhibited increased phosphorylation and oligomerization of α-Syn. This was associated with a loss of tyrosine hydroxylase expressing dopaminergic neurons in the substantia nigra, and more pronounced behavioral deficits reminiscent of early-stage PD, in the hα-Syn+/Nrf2-/- mice. Furthermore, hα-Syn+/Nrf2-/- mice showed significantly amplified oxidative stress, greater expression of inflammatory markers, and signs of increased autophagic burden, especially in the midbrain, striatum and cortical brain regions. These results support an important role for NRF2, early in PD progression. More broadly, it indicates NRF2 biology as fundamental to PD pathogenesis and suggests that targeting NRF2 activation may delay the onset and progression of PD.
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Affiliation(s)
- Annadurai Anandhan
- Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA.
- Department of Neurology, University of Arizona, Tucson, AZ, USA.
| | - Nhat Nguyen
- Physiology Undergraduate Program, Tucson, AZ, USA.
| | - Arjun Syal
- Neuroscience and Cognitive Science Undergraduate Program, Tucson, AZ, USA.
| | - Luke A Dreher
- Ecology and Evolutionary Biology Undergraduate Program, Tucson, AZ, USA.
| | - Matthew Dodson
- Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA.
| | - Donna D Zhang
- Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA.
| | - Lalitha Madhavan
- Department of Neurology, University of Arizona, Tucson, AZ, USA.
- Evelyn F McKnight Brain Institute and Bio5 Institute, University of Arizona, Tucson, AZ, USA.
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Abi-Aad KR, Rahme RJ, Syal A, Patra DP, Hudson M, Richter KR, Ward JD, Knis J, Nak Y, Turcotte E, Welz ME, Winter J, Krishna C, Chong B, Bendok BR. Quality of Life of Patients with Unruptured Intracranial Aneurysms Before and After Endovascular Coiling: A HEAT Trial Secondary Study and Systematic Review of the Literature. World Neurosurg 2020; 146:e492-e500. [PMID: 33127571 DOI: 10.1016/j.wneu.2020.10.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The study of quality of life (QOL) in patients with asymptomatic diseases receiving interventional treatment provides an essential metric for the assessment of procedural benefits in the surgical patient population. In this study, we analyzed QOL data collected from patients with unruptured intracranial aneurysms (UIAs) before and after endovascular coiling in the HEAT Trial, alongside a systematic review on QOL in unruptured brain aneurysms. METHODS HEAT was a randomized controlled trial comparing recurrence rates in aneurysms treated with either bare platinum coils or hydrogel coils. Patients enrolled in this trial completed a short form-36 (SF-36) QOL questionnaire before treatment and at the 3- to 12- and 18- to 24-month follow-ups. The change in QOL before and after treatment was assessed. Regression analysis evaluated the effect of select baseline characteristics on QOL change. RESULTS A total of 270 patients were eligible for analysis. There was an increase in the role physical (P = 0.043), vitality (P = 0.022), and emotional well-being (P < 0.001) QOL components at the 18- to 24-month follow-up compared with baseline scores. Regression analysis showed that age younger than 60 and absence of serious adverse events were associated with improved social functioning and vitality. The literature review showed a mixed effect of intervention on QOL in patients with UIAs. CONCLUSIONS Our analysis has revealed that patients with 3- to 14-mm UIAs had improvements in some physical and emotional components of QOL at 18-24 months following aneurysm coiling in the HEAT study. The literature remains indeterminate on this issue. Further studies are needed to better understand the effects of the diagnosis of UIAs and their treatment on QOL.
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Affiliation(s)
- Karl R Abi-Aad
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Rudy J Rahme
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Arjun Syal
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Miles Hudson
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Kent R Richter
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Jennifer D Ward
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Jason Knis
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Yak Nak
- Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn Turcotte
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - JoDee Winter
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Chong
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA.
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Syal A, Kalen B, Patra DP, Rahme RJ, Turcotte E, Bendok B. Blood Pressure Management After Embolectomy for Cerebral Large Vessel Occlusion: Toward Evidence-Based Guidelines. World Neurosurg 2020; 138:551-552. [PMID: 32544991 DOI: 10.1016/j.wneu.2020.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Arjun Syal
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Brian Kalen
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rudy J Rahme
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Evelyn Turcotte
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard Bendok
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA
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Syal A, Okawa T, Vedernikov Y, Chwalisz K, Saade GR, Garfield RE. Effect of placental tissue on inhibition of uterine contraction by nitric oxide donors. Am J Obstet Gynecol 1999; 181:415-8. [PMID: 10454693 DOI: 10.1016/s0002-9378(99)70571-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 10/25/2022]
Abstract
OBJECTIVE Our purpose was to test the hypothesis that placental tissue modulates the effect of nitric oxide on spontaneous uterine contractility in pregnant rats. STUDY DESIGN Rings (approximately 4 mm) of uterus taken from rats on day 14 (midpregnancy, n = 6), day 18 (late pregnancy, n = 4), and day 22 (term, n = 4) of gestation were placed in organ chambers filled with Krebs-bicarbonate buffer bubbled with 5% carbon dioxide in air (37 degrees C, pH approximately 7.4) for isometric tension recording. In some rings a piece of placenta was left attached to the uterine wall. In the other rings the fetuses, placentas, and membranes were removed completely. Change of spontaneous contractions of the rings (percentage change of basal integral activity for 10 minutes) in response to cumulative concentrations of the nitric oxide donors diethylamine-nitric oxide and nitroglycerin (10(-6) mol/L to 10(-4) mol/L) were compared between rings with and without placenta. RESULTS Diethylamine-nitric oxide and nitroglycerin inhibited spontaneous uterine contractions in rings from midpregnancy, in both the absence and the presence of placenta. In rings from midpregnancy, the maximal inhibition of contractions by diethylamine-nitric oxide but not by nitroglycerin was significantly (P <.05) higher in the presence (26.7% +/- 3.5% of basal activity) than in the absence (39. 6% +/- 3.3%) of placenta. Inhibition of contraction by nitric oxide donors in rings from late and term pregnancy was less than in midpregnancy, and the presence of placental tissue did not influence the responses. CONCLUSIONS The presence of placental tissue enhances inhibition of uterine contractility by agents that spontaneously release nitric oxide, such as diethylamine-nitric oxide, but not by nitroglycerin, which requires metabolic transformation for nitric oxide to be released. Refractoriness to nitric oxide near or at term does not depend on the presence or absence of placental tissue.
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Affiliation(s)
- A Syal
- Department of Obstetrics and Gynecology, The University of Texas Medical branch, Glaveston, USA
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Okawa T, Syal A, Vedernikov Y, Saade G, Chwalisz K, Garfield R. Effects of a nitric oxide donor and a scavenger on isolated uterine and aortic rings from pregnant rats. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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