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Chen TN, Kuo KL, Lin CL, Su YF. Middle Cerebral Artery Compromise Associated With Post-traumatic Hydrocephalus: A Case Report. Korean J Neurotrauma 2023; 19:466-470. [PMID: 38222833 PMCID: PMC10782109 DOI: 10.13004/kjnt.2023.19.e57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/13/2023] [Accepted: 09/22/2023] [Indexed: 01/16/2024] Open
Abstract
Post-traumatic hydrocephalus (PTH) is a commonly encountered complication following decompressive craniectomy, and is usually characterized by symptoms including headache, nausea, vomiting, and papilledema. Extracranial herniation accompanied by hemiplegia is a rare complication in patients with PTH who underwent craniectomy after subdural hematoma removal. We report a case of PTH that presented with extracranial herniation within one month of decompressive craniectomy. Following ventriculoperitoneal shunt implantation, left hemiplegia improved dramatically with restoration of the left middle cerebral artery blood flow, which was evident on serial imaging. Vascular compromise is often overshadowed by increased intracranial pressure when clinicians are dealing with traumatic brain injury patients. Delicate neurological and radiological examinations and prompt early interventions could lead to optimal outcomes in patients receiving decompressive craniectomy.
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Affiliation(s)
- Tzu-Ning Chen
- Department of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Keng-Liang Kuo
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Su
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Su YF, Tsai TH, Kuo KL, Wu CH, Tsai CY, Lu YM, Hwang SL, Lin PC, Lieu AS, Lin CL, Chang CH. Potential Roles of Teamwork and Unmet Needs on Surgical Learning Curves of Spinal Robotic Screw Placement. J Multidiscip Healthc 2022; 15:1971-1978. [PMID: 36105672 PMCID: PMC9464635 DOI: 10.2147/jmdh.s380707] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to investigate the learning curve of robotic spine surgery quantitatively with the well-described power law of practice. Methods Kaohsiung Medical University Hospital set up a robotic spine surgery team by the neurosurgery department in 2013 and the orthopedic department joined the well-established team in 2014. A total of consecutive 150 cases received robotic assisted spinal surgery. The 150 cases, with 841 transpedicular screws were enrolled into 3 groups: the first 50 cases performed by neurosurgeons, the first 50 cases by orthopedic surgeons, and 50 cases by neurosurgeons after the orthopedic surgeons joined the team. The time per screw and accuracy by each group and individual surgeon were analyzed. Results The time per screw for each group was 9.56 ± 4.19, 7.29 ± 3.64, and 8.74 ± 5.77 minutes, respectively, with p-value 0.0017. The accuracy was 99.6% (253/254), 99.5% (361/363), and 99.1% (222/224), respectively, with p-value 0.77. Though the first group took time significantly more on per screw placement but without significance on the nonlinear parallelism F-test. Analysis of 5 surgeons and their first 10 cases of short segment surgery showed the time per screw by each surgeon was 12.28 ± 5.21, 6.38 ± 1.54, 8.68 ± 3.10, 6.33 ± 1.90, and 6.73 ± 1.81 minutes. The first surgeon who initiated the robotic spine surgery took significantly more time per screw, and the nonlinear parallelism test also revealed only the first surgeon had a steeper learning curve. Conclusion This is the first study to demonstrate that differences of learning curves between individual surgeons and teams. The roles of teamwork and the unmet needs due to lack of active perception are discussed.
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Affiliation(s)
- Yu-Feng Su
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Tai-Hsin Tsai
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Keng-Liang Kuo
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yen-Mou Lu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shiuh-Lin Hwang
- Department of Spinal Surgery, Chi-Hsien Spine Hospital, Kaohsiung, Taiwan
| | - Pei-Chen Lin
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ann-Shung Lieu
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hui Chang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tsai CY, Su YF, Kuo KL, Ko HJ, Su HY, Wu CH, Chou YL, Lin CL, Tsai TH. Minimally Invasive Transforaminal Lumbar Interbody Fusion for 2-Level Degenerative Lumbar Disease in Patients With Osteoporosis: Long-Term Clinical and Radiographic Outcomes. Oper Neurosurg (Hagerstown) 2021; 20:535-540. [PMID: 33550407 DOI: 10.1093/ons/opab009] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Spine fusion surgery in osteoporosis remains controversial because it is related to a high incidence of osteoporosis-related complications, such as cage nonfusion, pedicle screw loosening, and new vertebral compression fractures (VCFs). OBJECTIVE To treat 2-level degenerative lumbar disease in osteoporosis patients as an effective and safe surgical treatment for long-term results using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS We retrospectively assessed 12 patients with osteoporosis who underwent MIS-TLIF on L4 and L5 between 2011 and 2012 to assess the clinical and radiographic results for 2-level lumbar degenerative spine disease. All patients were followed-up for at least 2 yr after surgery and assessed by using X-ray. Basic patient data and clinical and radiological outcomes were collected and analyzed. RESULTS Of all 12 patients, 11/12 (91.6%) and 1/12 (8.3%) demonstrated cage fusion and cage subsidence, respectively. Pedicle screw loosening was found in 1/12 (8.3%) patients. The P-values calculated using the F-test for changes in the vertebral body height pre- and postoperation in L3, L4, and L5 were .69, .87, and .39, respectively. The data revealed no significant variants of new VCFs. CONCLUSION MIS-TLIF provided a high cage fusion rate and low pedicle screw loosening rate in patients with osteoporosis with 2-level degenerative spine disease. Furthermore, no new VCFs were found in long-term follow-up. The clinical outcomes also demonstrated no significant difference compared with traditional open spine fusion surgery. Therefore, MIS-TLIF could be considered an effective and safe surgical treatment modality for 2-level degenerative spine disease in osteoporosis.
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Affiliation(s)
- Cheng-Yu Tsai
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Su
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Keng-Liang Kuo
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Huey-Jiun Ko
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Yuan Su
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Lin Chou
- Division of Spine Surgery, Chi Hsien Spine Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Hsin Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Wu CH, Tsai YC, Tsai TH, Kuo KL, Su YF, Chang CH, Lin CL. Valproic Acid Reduces Vasospasm through Modulation of Akt Phosphorylation and Attenuates Neuronal Apoptosis in Subarachnoid Hemorrhage Rats. Int J Mol Sci 2021; 22:ijms22115975. [PMID: 34205883 PMCID: PMC8198375 DOI: 10.3390/ijms22115975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a devastating emergent event associated with high mortality and morbidity. Survivors usually experience functional neurological sequelae caused by vasospasm-related delayed ischemia. In this study, male Sprague-Dawley rats were randomly assigned to five groups: sham (non-SAH) group, SAH group, and three groups with SAH treated with different doses of valproic acid (VPA) (10, 20, 40 mg/kg, once-daily, for 7 days). The severity of vasospasm was determined by the ratio of cross-sectional areas to intima-media thickness of the basilar arteries (BA) on the seventh day after SAH. The BA showed decreased expression of phospho-Akt proteins. The dentate gyrus showed increased expression of cleaved caspase-3 and Bax proteins and decreased expression of Bcl-2, phospho-ERK 1/2, phospho-Akt and acetyl-histone H3 proteins. The incidence of SAH-induced vasospasm was significantly lower in the SAH group treated with VPA 40 mg/kg (p < 0.001). Moreover, all groups treated with VPA showed reversal of the above-mentioned protein expression in BA and the dentate gyrus. Treatment with VPA upregulated histone H3 acetylation and conferred anti-vasospastic and neuro-protective effects by enhancing Akt and/or ERK phosphorylation. This study demonstrated that VPA could alleviate delayed cerebral vasospasm induced neuro-apoptosis after SAH.
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Affiliation(s)
- Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (T.-H.T.); (K.-L.K.); (Y.-F.S.); (C.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Yi-Cheng Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
| | - Tai-Hsin Tsai
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (T.-H.T.); (K.-L.K.); (Y.-F.S.); (C.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
| | - Keng-Liang Kuo
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (T.-H.T.); (K.-L.K.); (Y.-F.S.); (C.-H.C.)
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
| | - Yu-Feng Su
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (T.-H.T.); (K.-L.K.); (Y.-F.S.); (C.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Chih-Hui Chang
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (T.-H.T.); (K.-L.K.); (Y.-F.S.); (C.-H.C.)
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
| | - Chih-Lung Lin
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (T.-H.T.); (K.-L.K.); (Y.-F.S.); (C.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
- Correspondence: ; Tel.: +886-7-3121101
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Huang YK, Su YF, Lieu AS, Loh JK, Li CY, Wu CH, Kuo KL, Lin CL. MiR-1271 regulates glioblastoma cell proliferation and invasion by directly targeting the CAMKK2 gene. Neurosci Lett 2020; 737:135289. [PMID: 32791096 DOI: 10.1016/j.neulet.2020.135289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
This study explored the regulatory role of microRNA-1271 (miR-1271) in glioblastoma multiforme (GBM) proliferation and invasion via calcium/calmodulin-dependent protein kinase 2 (CaMKK2). MiR-1271 and CaMKK2 expression were quantified in normal human astrocyte cells, GBM cell lines, and low- and high-grade glioma tissues. MKI67 expression in GBM cells was measured using quantitative real-time polymerase chain reaction. The target relationship between miR-1271 and the CAMKK2 gene was confirmed using the luciferase reporter assay. MTT and Transwell assays were used to analyze the role of miR-1271 and CAMKK2 in cell proliferation and invasion. Finally, CaMKK2 expression and AKT phosphorylation were detected by western blotting. MiR-1271 was significantly downregulated in high-grade glioma tissues and GBM cell lines. Conversely, CAMKK2 mRNA expression was upregulated in high-grade glioma tissues and GBM cell lines. We observed that miR-1271 directly targeted the 3'-untranslated region of CAMKK2, indicating an inverse relationship with miR-1271. Overexpressing miR-1271 inhibited GBM cell proliferation and invasion, whereas inhibiting miR-1271 increased cell proliferation and invasion. Silencing CAMKK2 expression also inhibited GBM cell proliferation and invasion. Furthermore, overexpressing miR-1271 inhibited AKT phosphorylation and MKI67 mRNA expression by targeting CAMKK2. These results indicate that miR-1271 regulates GBM cell proliferation and invasion, and that these effects involve directly targeting the CAMKK2 gene. Therefore, miR-1271 may serve as a new therapeutic target for developing GBM treatments.
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Affiliation(s)
- Yu-Kai Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, 80145, Taiwan.
| | - Yu-Feng Su
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan; Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, 80145, Taiwan
| | - Ann-Shung Lieu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Joon-Khim Loh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Chia-Yang Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Chieh-Hsin Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Keng-Liang Kuo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Chih-Lung Lin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
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Kuo KL, Tsai FJ, Liu YJ, Huang YK, Lieu AS. Unusual location of developmental venous anomaly within fourth ventricle causing obstructive hydrocephalus - A case report. Neurol Neurochir Pol 2017; 52:112-115. [PMID: 29248318 DOI: 10.1016/j.pjnns.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 11/30/2022]
Abstract
Developmental venous anomaly (DVA) is now considered common and benign disease within the field of cerebral vascular malformation. Though symptomatic DVA is uncommon, further management is necessary to alleviate the symptoms and signs induced by symptomatic DVA, such as parenchymal hemorrhage, venous infarction, brain edema, obstructive hydrocephalus, and nerve root compression. From the viewpoint of obstructive hydrocephalus, mostly resulted from obstruction of aqueduct of Sylvius. Herein, we reported a case with presentation of obstructive hydrocephalus caused by DVA induced fourth ventricle outlet obstruction.
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Affiliation(s)
- Keng-Liang Kuo
- Department of Neurosurgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Ji Tsai
- Department of Neurosurgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Ju Liu
- Department of Neurosurgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Kai Huang
- Department of Neurosurgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ann-Shung Lieu
- Department of Neurosurgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Kuo KL, Su YF, Wu CH, Tsai CY, Chang CH, Lin CL, Tsai TH. Assessing the Intraoperative Accuracy of Pedicle Screw Placement by Using a Bone-Mounted Miniature Robot System through Secondary Registration. PLoS One 2016; 11:e0153235. [PMID: 27054360 PMCID: PMC4824416 DOI: 10.1371/journal.pone.0153235] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/27/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Pedicle screws are commonly employed to restore spinal stability and correct deformities. The Renaissance robotic system was developed to improve the accuracy of pedicle screw placement. Purpose In this study, we developed an intraoperative classification system for evaluating the accuracy of pedicle screw placements through secondary registration. Furthermore, we evaluated the benefits of using the Renaissance robotic system in pedicle screw placement and postoperative evaluations. Finally, we examined the factors affecting the accuracy of pedicle screw implantation. Results Through use of the Renaissance robotic system, the accuracy of Kirschner-wire (K-wire) placements deviating <3 mm from the planned trajectory was determined to be 98.74%. According to our classification system, the robot-guided pedicle screw implantation attained an accuracy of 94.00% before repositioning and 98.74% after repositioning. However, the malposition rate before repositioning was 5.99%; among these placements, 4.73% were immediately repositioned using the robot system and 1.26% were manually repositioned after a failed robot repositioning attempt. Most K-wire entry points deviated caudally and laterally. Conclusion The Renaissance robotic system offers high accuracy in pedicle screw placement. Secondary registration improves the accuracy through increasing the precision of the positioning; moreover, intraoperative evaluation enables immediate repositioning. Furthermore, the K-wire tends to deviate caudally and laterally from the entry point because of skiving, which is characteristic of robot-assisted pedicle screw placement.
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Affiliation(s)
- Keng-Liang Kuo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Su
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Yu Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hui Chang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- * E-mail: (THT); (CLL)
| | - Tai-Hsin Tsai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- * E-mail: (THT); (CLL)
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Wu CH, Tung YC, Chai CY, Lu YY, Su YF, Tsai TH, Kuo KL, Lin CL. Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease: A Nationwide Population-Based Study. Medicine (Baltimore) 2016; 95:e3309. [PMID: 27100415 PMCID: PMC4845819 DOI: 10.1097/md.0000000000003309] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To investigate osteoporosis risk in patients with peptic ulcer disease (PUD) using a nationwide population-based dataset. This Taiwan National Health Insurance Research Database (NHIRD) analysis included 27,132 patients aged 18 years and older who had been diagnosed with PUD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 531-534) during 1996 to 2010. The control group consisted of 27,132 randomly selected (age- and gender)-matched patients without PUD. The association between PUD and the risk of developing osteoporosis was estimated using a Cox proportional hazard regression model. During the follow-up period, osteoporosis was diagnosed in 2538 (9.35 %) patients in the PUD group and in 2259 (8.33 %) participants in the non-PUD group. After adjusting for covariates, osteoporosis risk was 1.85 times greater in the PUD group compared to the non-PUD group (13.99 vs 5.80 per 1000 person-years, respectively). Osteoporosis developed 1 year after PUD diagnosis. The 1-year follow-up period exhibited the highest significance between the 2 groups (hazard ratio [HR] = 63.44, 95% confidence interval [CI] = 28.19-142.74, P < 0.001). Osteoporosis risk was significantly higher in PUD patients with proton-pump-inhibitors (PPIs) use (HR = 1.17, 95% CI = 1.03-1.34) compared to PUD patients without PPIs use. This study revealed a significant association between PUD and subsequent risk of osteoporosis. Therefore, PUD patients, especially those treated with PPIs, should be evaluated for subsequent risk of osteoporosis to minimize the occurrence of adverse events.
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Affiliation(s)
- Chieh-Hsin Wu
- From the Graduate Institute of Medicine (C-HW, C-YC, Y-YL, C-LL), Department of Public Health and Environmental Medicine (Y-CT), Department of Pathology (C-YC), Department of Neurosurgery, Faculty of Medicine, College of Medicine (C-LL), Department of Neurosurgery (C-HW, Y-FS, T-HT, K-LK, C-LL), Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University (C-YC), Institute of Biomedical Sciences, National Sun Yat-Sen University (C-YC), Department of Dermatology, Kaohsiung Veterans General Hospital (Y-YL), and Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan (Y-YL)
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Kuo KL, Lin CL, Su YF. Meningioma with cystic change mimicking hemangioblastoma. Formosan Journal of Surgery 2015. [DOI: 10.1016/j.fjs.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kuo KL, Lieu AS, Tsai FJ, Chen YT, Liang PI. Intramedullary spinal glioblastoma metastasis from anaplastic astrocytoma of cerebellum: A case report and review of the literature. Asian J Neurosurg 2015; 10:268-71. [PMID: 26396627 PMCID: PMC4553752 DOI: 10.4103/1793-5482.161170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cerebellar anaplastic astrocytoma is infrequently encountered even nowadays, and drop metastasis with progression into spinal glioblastoma is not reported in the English literature. We report a case of cerebellar anaplastic astrocytoma receiving operation and subsequent concurrent chemoradiotherapy. One year later, progressive weakness of both lower limbs and unsteady gait occurred. Spine magnetic resonance imaging showed cervical and thoracic spine intramedullary tumor. We then performed laminectomy and tumor biopsy. The histopathological report demonstrated primary spinal cord glioblastoma multiforme with positive glial fibrillary acidic protein, high MIB-1 labeling index and negative staining of isocitrate dehydrogenase-1 mutation. After reviewing the English literature to date, most metastatic spinal glioblastoma resulted from previous intracranial glioblastoma, and there are few studies mentioning spinal glioblastoma originating from intracranial low-grade gliomas. Over time, improvement in local control of the primary tumor has raised patient risk of the possibility of spinal metastasis, and clinical physicians should be aware of this aspect so that quicker diagnosis and management will be accomplished, even in patients with lower grade of intracranial gliomas.
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Affiliation(s)
- Keng-Liang Kuo
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ann-Shung Lieu
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Ji Tsai
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Rochau U, Kluibenschaedl M, Stenehjem D, Kuo KL, Oderda G, Brixner D, Siebert U. Decision Analysis on the Cost-Effectiveness of Sequential Treatment Strategies for Patients with Chronic Myeloid Leukemia in the United States. Value Health 2014; 17:A639. [PMID: 27202283 DOI: 10.1016/j.jval.2014.08.2302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- U Rochau
- UMIT - University for Health Sciences, Medical Informatics and Technology/ ONCOTYROL - Center for Personalized Cancer Medicine, Hall in Tyrol/ Innsbruck, Austria
| | - M Kluibenschaedl
- UMIT - University for Health Sciences, Medical Informatics and Technology/ ONCOTYROL - Center for Personalized Cancer Medicine, Hall in Tyrol/ Innsbruck, Austria
| | | | - K L Kuo
- University of Utah, Salt Lake City, UT, USA
| | - G Oderda
- University of Utah, Salt Lake City, UT, USA
| | - D Brixner
- UMIT - University for Health Sciences, Medical Informatics and Technology/ ONCOTYROL - Center for Personalized Cancer Medicine/ University of Utah, Hall in Tyrol/ Salt Lake City, UT, Austria
| | - U Siebert
- Medical Informatics and Technology, and Director of the Division for Health Technology Assessment and Bioinformatics, ONCOTYROL, Hall i. T, Austria
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Abstract
Renal anemia is mainly caused by inadequate synthesis of erythropoietin from diseased kidneys. At the present time, recombinant human erythropoietin (rHuEPO) is used to correct anemia successfully in most patients with end-stage renal diseases. Nevertheless, poor response to rHuEPO still exists in some hemodialysis patients and its mechanism in some cases remains obscure. Herein, we describe a rare case of rHuEPO hyporesponsiveness due to mechanical hemolysis induced by a traumatic carotid-jugular arteriovenous fistula (AVF) in the presence of subclinical aluminum intoxication. Following surgical resection of the traumatic AVF and 8 months of desferrioxamine treatment, the responsiveness to rHuEPO was restored and the rHuEPO dose requirements reduced.
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Affiliation(s)
- K L Kuo
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Affiliation(s)
- K L Kuo
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan
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Abstract
This study presents a high-performance capillary electrophoresis (CE) method to analyze five constituents of Puerariae radix, an important crude herb used in Chinese medicine. Puerarin, daidzin, daidzein, genistein and biochanin A are the bioactive constituents of Puerariae radix. Herein, those analytes were successfully separated within 6 min using a pH 10.1 borax-NaOH buffer. The effects of pH value and concentration of the running buffer on the separation of the five analytes were also examined. The relative standard deviations of the analytes' migration times were less than 0.38% under the optimized separation conditions. Notably, the correlation coefficients of the analytes' linear calibration graphs exceeded 0.998. Moreover, the amounts of the five constituents in three different Puerariae radix samples were determined by the CE method with a relatively simple extraction procedure.
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Affiliation(s)
- C Y Wang
- Department of Applied Chemistry, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
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Abstract
This paper presents a rapid and reliable micellar electrokinetic capillary chromatography (MEKC) method to separate major prostaglandins and thromboxane B2. The running buffer was modified with sodium dodecyl sulfate (SDS). The effects of the SDS concentration on the migration behavior of analytes was also examined. Moreover, the influences of electrolyte concentration and capillary temperature on the separation were investigated. In optimum conditions, seven major prostaglandins and thromboxane B2 could be separated within 8 min. The relative standard deviations of the migration times (reproducibility) of the analytes were less than 0.82%.
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Affiliation(s)
- Y Z Hsieh
- Department of Applied Chemistry, National Chiao Tung University, Hsinchu, Taiwan
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