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Peterson D, Van Poppel M, Boling W, Santos P, Schwalb J, Eisenberg H, Mehta A, Spader H, Botros J, Vrionis FD, Ko A, Adelson PD, Lega B, Konrad P, Calle G, Vale FL, Bucholz R, Richardson RM. Clinical safety and feasibility of a novel implantable neuroimmune modulation device for the treatment of rheumatoid arthritis: initial results from the randomized, double-blind, sham-controlled RESET-RA study. Bioelectron Med 2024; 10:8. [PMID: 38475923 PMCID: PMC10935935 DOI: 10.1186/s42234-023-00138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/12/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes persistent synovitis, bone damage, and progressive joint destruction. Neuroimmune modulation through electrical stimulation of the vagus nerve activates the inflammatory reflex and has been shown to inhibit the production and release of inflammatory cytokines and decrease clinical signs and symptoms in RA. The RESET-RA study was designed to determine the safety and efficacy of an active implantable device for treating RA. METHODS The RESET-RA study is a randomized, double-blind, sham-controlled, multi-center, two-stage pivotal trial that enrolled patients with moderate-to-severe RA who were incomplete responders or intolerant to at least one biologic or targeted synthetic disease-modifying anti-rheumatic drug. A neuroimmune modulation device (SetPoint Medical, Valencia, CA) was implanted on the left cervical vagus nerve within the carotid sheath in all patients. Following post-surgical clearance, patients were randomly assigned (1:1) to active stimulation or non-active (control) stimulation for 1 min once per day. A predefined blinded interim analysis was performed in patients enrolled in the study's initial stage (Stage 1) that included demographics, enrollment rates, device implantation rates, and safety of the surgical procedure, device, and stimulation over 12 weeks of treatment. RESULTS Sixty patients were implanted during Stage 1 of the study. All device implant procedures were completed without intraoperative complications, infections, or surgical revisions. No unanticipated adverse events were reported during the perioperative period and at the end of 12 weeks of follow-up. No study discontinuations were due to adverse events, and no serious adverse events were related to the device or stimulation. Two serious adverse events were related to the implantation procedure: vocal cord paresis and prolonged hoarseness. These were reported in two patients and are known complications of surgical implantation procedures with vagus nerve stimulation devices. The adverse event of vocal cord paresis resolved after vocal cord augmentation injections with filler and speech therapy. The prolonged hoarseness had improved with speech therapy, but mild hoarseness persists. CONCLUSIONS The surgical procedures for implantation of the novel neuroimmune modulation device for the treatment of RA were safe, and the device and its use were well tolerated. TRIAL REGISTRATION NCT04539964; August 31, 2020.
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Affiliation(s)
- Daniel Peterson
- Neurosurgery, Austin Neurosurgeons (Arise Medical Center), Austin, TX, USA
| | - Mark Van Poppel
- Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
| | - Warren Boling
- Neurosurgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Perry Santos
- Integris Health Baptist Medical Center, Head and Neck Surgery, Oklahoma City, OK, USA
| | - Jason Schwalb
- Neurosurgery, Henry Ford Medical Group, Detroit, MI, USA
| | - Howard Eisenberg
- Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ashesh Mehta
- The Feinstein Institutes for Medical Research, Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Heather Spader
- Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - James Botros
- Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Frank D Vrionis
- Neurosurgery, Marcus Neuroscience Institute, Boca Raton, FL, USA
| | - Andrew Ko
- Neurosurgery, University of Washington, Seattle, WA, USA
| | - P David Adelson
- Neurosurgery, Phoenix Children's Hospital, Phoenix, AZ, USA
- Rockefeller Neuroscience Institute, Neurosurgery, West Virginia University Medicine, Morgantown, WV, USA
| | - Bradley Lega
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Konrad
- Rockefeller Neuroscience Institute, Neurosurgery, West Virginia University Medicine, Morgantown, WV, USA
| | | | - Fernando L Vale
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Richard Bucholz
- Division of Neurological Surgery, St. Louis University, St. Louis, MO, USA
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Abstract
Parkinson's Disease (PD) is the second most common neurodegenerative disease, characterized by progressive motor (such as resting tremor, hypokinesia, postural instability) and non-motor symptoms (such as neuropsychiatric decline and autonomic dysfunction). Since its introduction in the late 1980s, deep brain stimulation (DBS) has revolutionized the treatment of PD. Initially used in patients' with advanced PD with either medically refractory motor symptoms or medication intolerance, DBS typically provides excellent improvement in motor symptoms. Indications for DBS have continued to expand, with demonstrated efficacy in early PD and essential tremor, and promising preliminary results in the treatment of epilepsy, psychiatric disease, and depression. Advancements in DBS hardware, programming, neuroimaging, and surgical techniques have led to progressive improvement in efficacy and safety profiles. Thanks to ongoing research into remote programming, adaptive DBS, new targets, and alternative interventions, such as transcranial magnetic stimulation, the opportunities for further improvements in DBS and neuromodulation are bright.
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Affiliation(s)
- Ryan T Cleary
- Department of Neurosurgery, 25213Saint Louis University Hospital, Saint Louis, MO, USA
| | - Richard Bucholz
- Department of Neurosurgery, 25213Saint Louis University Hospital, Saint Louis, MO, USA
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Tewari M, Khan M, Verma M, Coppens J, Kemp JM, Bucholz R, Mercier P, Egan TM. Physiology of Cultured Human Microglia Maintained in a Defined Culture Medium. Immunohorizons 2021; 5:257-272. [PMID: 33931497 DOI: 10.4049/immunohorizons.2000101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Microglia are the primary immune cell of the CNS, comprising 5-20% of the ∼60 billion neuroglia in the human brain. In the developing and adult CNS, they preferentially target active neurons to guide synapse maturation and remodeling. At the same time, they are the first line of defense against bacterial, fungal, and viral CNS infections. Although an extensive literature details their roles in rodents, less is known about how they function in humans because of the difficulty in obtaining tissue samples and the understandable inability to extensively study human microglia in situ. In this study, we use recent advances in the study of brain microenvironments to establish cultures of primary human microglia in a serum-free medium. Postsurgical samples of human brain were enzymatically and mechanically dissociated into single cells, and microglia were isolated at high purity by positive selection using CD11b Ab-coated microbeads. The CD11b+ cells were plated on poly-l-lysine-coated surfaces and bathed in serum-free DMEM/F12 supplemented with three essential components (TGF-β, IL-34, and cholesterol). Under these conditions, microglia assumed a ramified morphology, showed limited proliferation, actively surveyed their surroundings, and phagocytosed bacterial microparticles. In the presence of LPS, they assumed a more compact shape and began production of proinflammatory cytokines and reactive oxygen species. LPS on its own triggered release of TNF-α, whereas release of IL-1β required costimulation by ATP. Thus, human microglia maintained in a defined medium replicate many of the characteristics expected of native cells in the brain and provide an accessible preparation for investigations of human microglial physiology, pharmacology, and pathophysiology.
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Affiliation(s)
- Manju Tewari
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO.,The Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University School of Medicine, St. Louis, MO; and
| | - Maheen Khan
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Megha Verma
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Joanna M Kemp
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Richard Bucholz
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Philippe Mercier
- The Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University School of Medicine, St. Louis, MO; and.,Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Terrance M Egan
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO; .,The Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University School of Medicine, St. Louis, MO; and
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Zane KL, Gfeller JD, Roskos PT, Stout J, Buchanan TW, Malone TM, Bucholz R. Diffusion tensor imaging findings and neuropsychological performance in adults with TBI across the spectrum of severity in the chronic-phase. Brain Inj 2021; 35:536-546. [PMID: 33593218 DOI: 10.1080/02699052.2021.1887521] [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] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To examine associations between neuroimaging indicators of cerebral tract integrity and neurocognitive functioning in traumatic brain injury (TBI). RESEARCH DESIGN Between-Groups design with two TBI groups and controls. METHOD AND PROCEDURES Forty-four participants with TBI and 27 matched controls completed diffusion tensor imaging and neuropsychological measures of processing speed, attention, memory, and executive function. Multivariate analyses were conducted to examine group differences in white matter integrity (fractional anisotropy) for 11 regions of interest and cognitive performance among adult males with chronic phase, mild, moderate, or severe TBI. Correlational analyses investigated associations between white matter integrity, brain injury severity, and cognitive status. MAIN OUTCOMES AND RESULTS Participants with moderate or severe TBI exhibited reduced white matter integrity in 8 of 11 ROIs and worse performance on most cognitive measures, relative to control participants. Persons with mild TBI did not differ from controls on white matter integrity values and differed on one measure of processing speed. Significant correlations were found between injury severity ratings and 10 ROIs, most notably between ROIs and measures of processing speed or memory. CONCLUSIONS These findings provide nuanced information regarding white matter connectivity as it relates to neurocognitive abilities across the TBI severity spectrum.
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Affiliation(s)
| | - Jeffrey D Gfeller
- Department of Psychology Saint Louis University, St. Louis, Missouri, USA
| | - P Tyler Roskos
- Department of Physical Medicine and Rehabilitation Beaumont Health, Dearborn, Michigan, USA
| | - Jeff Stout
- National Institute of Mental Health, MEG Core Facility, Bethesda, Maryland, USA
| | - Tony W Buchanan
- Department of Psychology Saint Louis University, St. Louis, Missouri, USA
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Alexopoulos G, Quadri N, Khan M, Bazai H, Formoso Pico C, Fraser C, Kulkarni N, Kemp J, Coppens J, Bucholz R, Mercier P. Ballistic lobar trajectory outcomes in civilian firearm penetrating brain injury. J Neurosurg 2020:1-10. [PMID: 33157538 DOI: 10.3171/2020.6.jns201837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Penetrating brain injury (PBI) is the most lethal of all firearm injuries, with reported survival rates of less than 20%. The projectile trajectory (PT) has been shown to impact mortality, but the significant lobar tracks have not been defined. The aim of this retrospective case-control study was to test for associations between distinct ballistic trajectories, missile types, and patient outcomes. METHODS A total of 243 patients who presented with a PBI to the Saint Louis University emergency department from 2008 through 2019 were identified from the hospital registry. Conventional CT scans combined with 3D CT reconstructions and medical records were reviewed for each patient to identify distinct PTs. RESULTS A total of 65 ballistic lobar trajectories were identified. Multivariable regression models were used, and the results were compared with those in the literature. Penetrating and perforating types of PBI associated with bitemporal (t-statistic = -2.283, p = 0.023) or frontal-to-contralateral parietal (t-statistic = -2.311, p = 0.025) projectile paths were universally found to be fatal. In the group in which the Glasgow Coma Scale (GCS) score at presentation was lower than 8, a favorable penetrating missile trajectory was one that involved a single frontal lobe (adjusted OR 0.02 [95% CI 0.00-0.38], p = 0.022) or parietal lobe (adjusted OR 0.15 [95% CI 0.02-0.97], p = 0.048). Expanding or fragmenting types of projectiles carry higher mortality rates (OR 2.53 [95% CI 1.32-4.83], p < 0.001) than do nondeformable missiles. Patient age was not associated with worse outcomes when controlled by other significant predictive factors. CONCLUSIONS Patients with penetrating or perforating types of PBI associated with bitemporal or frontal-to-contralateral parietal PTs should be considered as potential donor candidates. Trauma patients with penetrating missile trajectories involving a single frontal or parietal lobe should be considered for early neurosurgical intervention, especially in the circumstances of a low GCS score (< 8). Surgeons should not base their decision-making solely on advanced patient age to defer further treatment. Patients with PBIs caused by nondeformable types of projectiles can survive multiple simultaneous intracranial missile trajectories.
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Affiliation(s)
- Georgios Alexopoulos
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Nabiha Quadri
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Maheen Khan
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Henna Bazai
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | | | - Connor Fraser
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Neha Kulkarni
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Joanna Kemp
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Jeroen Coppens
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Richard Bucholz
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Philippe Mercier
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
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Alexopoulos G, Sappington J, Mercier P, Bucholz R, Coppens J. Glomus jugulare tumor presenting as mastoiditis in a patient with familial paraganglioma syndrome: A case report and review of the literature. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2019.100657] [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: 10/25/2022] Open
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Alexopoulos G, Cikla U, El Tecle N, Kulkarni N, Pierson M, Mercier P, Kemp J, Coppens J, Mahmoud S, Sehi M, Bucholz R, Abdulrauf S. The Value of White Matter Tractography by Diffusion Tensor Imaging in Altering a Neurosurgeon's Operative Plan. World Neurosurg 2019; 132:e305-e313. [PMID: 31494311 DOI: 10.1016/j.wneu.2019.08.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/01/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate if the implementation of white matter (WM) fiber tractography by diffusion tensor imaging in presurgical planning for supratentorial tumors proximal to eloquent WM tracts can alter a neurosurgeon's operative strategy. METHODS A retrospective review was conducted of patients with supratentorial brain tumors within eloquent WM tracts who underwent diffusion tensor imaging (DTI) tractography as part of their preoperative assessment. These patients were classified into 3 different DTI groups per the radiology reports: group 1, intact WM tracts; group 2, deviated and/or displaced WM bundles; and group 3, patients with an established WM injury (interrupted and/or destroyed tracts). A blinded prospective behavioral study followed, in which 4 neurosurgeons reviewed the preoperative images at 2 different times (magnetic resonance imaging without DTI, followed by a review of the DTI). They provided estimations about the DTI group of each individual eloquent WM category in every patient, and their planned surgical approach. RESULTS Fifteen patients (mean age, 58.3 years) were included in the study. The neurosurgeons provided a correct DTI group estimation in 53%, 60%, and 57% of the cases that involved motor/sensory pathway tracts, optic tracts, and language tracts, respectively. The neurosurgeons underestimated DTI group 3 in the motor category and in the optic category 75% of the time. DTI did not alter the planned surgical approach. CONCLUSIONS DTI WM tractography helped neurosurgeons to correctly identify patients with interrupted motor and optic pathway tracts so they could be more aggressive with the extent of tumor resection, despite its inability to alter the operative approach.
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Affiliation(s)
- Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA.
| | - Ulas Cikla
- Department of Neurosurgery, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Najib El Tecle
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Neha Kulkarni
- School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Matthew Pierson
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Philippe Mercier
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Joanna Kemp
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Shamseldeen Mahmoud
- Department of Radiology, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Mehrdad Sehi
- Department of Radiology, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Richard Bucholz
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Saleem Abdulrauf
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
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Michael AP, Stout J, Roskos PT, Bolzenius J, Gfeller J, Mogul D, Bucholz R. Evaluation of Cortical Thickness after Traumatic Brain Injury in Military Veterans. J Neurotrauma 2015; 32:1751-8. [DOI: 10.1089/neu.2015.3918] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alex P. Michael
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jeffrey Stout
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - P. Tyler Roskos
- Department of Physical Medicine and Rehabilitation, Oakwood, Wayne State University, School of Medicine, Dearborn, Michigan
| | | | - Jeffrey Gfeller
- Department of Psychology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - David Mogul
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Richard Bucholz
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri
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Mahadevan A, Bucholz R, Gaya AM, Kresl JJ, Mantz C, Minnich DJ, Muacevic A, Medbery C, Yang J, Caglar HB, Davis JN. Best of the Radiosurgery Society® Scientific Meeting 2014: stereotactic radiosurgery/stereotactic body radiotherapy treatment of extracranial and intracranial lesions. Future Oncol 2014; 10:2307-10. [DOI: 10.2217/fon.14.168] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The SRS/SBRT Scientific Meeting 2014, Minneapolis, MN, USA, 7–10 May 2014 The Radiosurgery Society®, a professional medical society dedicated to advancing the field of stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT), held the international Radiosurgery Society Scientific Meeting, from 7–10 May 2014 in Minneapolis (MN, USA). This year's conference attracted over 400 attendants from around the world and featured over 100 presentations (46 oral) describing the role of SRS/SBRT for the treatment of intracranial and extracranial malignant and nonmalignant lesions. This article summarizes the meeting highlights for SRS/SBRT treatments, both intracranial and extracranial, in a concise review.
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Affiliation(s)
- Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard Bucholz
- Department of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | | | - John J Kresl
- Phoenix CyberKnife & Radiation Oncology Center, Phoenix, AZ, USA
| | | | - Douglas J Minnich
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Muacevic
- Department of Neurosurgery, European Cyberknife Center Munich-Grosshadern, Munich, Germany
| | - Clinton Medbery
- Department of Radiation Oncology, St Anthony Hospital, Oklahoma City, OK, USA
| | - Jun Yang
- Department of Medical Physics, Philadelphia CyberKnife, Philadelphia, PA, USA
| | - Hale Basak Caglar
- Department of Radiation Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Joanne N Davis
- The Radiosurgery Society, 1350 Dell Avenue, Suite 150, Campbell, CA, USA
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Van Essen DC, Ugurbil K, Auerbach E, Barch D, Behrens TEJ, Bucholz R, Chang A, Chen L, Corbetta M, Curtiss SW, Della Penna S, Feinberg D, Glasser MF, Harel N, Heath AC, Larson-Prior L, Marcus D, Michalareas G, Moeller S, Oostenveld R, Petersen SE, Prior F, Schlaggar BL, Smith SM, Snyder AZ, Xu J, Yacoub E. The Human Connectome Project: a data acquisition perspective. Neuroimage 2012; 62:2222-31. [PMID: 22366334 DOI: 10.1016/j.neuroimage.2012.02.018] [Citation(s) in RCA: 1309] [Impact Index Per Article: 109.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 10/24/2011] [Accepted: 02/08/2012] [Indexed: 11/28/2022] Open
Abstract
The Human Connectome Project (HCP) is an ambitious 5-year effort to characterize brain connectivity and function and their variability in healthy adults. This review summarizes the data acquisition plans being implemented by a consortium of HCP investigators who will study a population of 1200 subjects (twins and their non-twin siblings) using multiple imaging modalities along with extensive behavioral and genetic data. The imaging modalities will include diffusion imaging (dMRI), resting-state fMRI (R-fMRI), task-evoked fMRI (T-fMRI), T1- and T2-weighted MRI for structural and myelin mapping, plus combined magnetoencephalography and electroencephalography (MEG/EEG). Given the importance of obtaining the best possible data quality, we discuss the efforts underway during the first two years of the grant (Phase I) to refine and optimize many aspects of HCP data acquisition, including a new 7T scanner, a customized 3T scanner, and improved MR pulse sequences.
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Affiliation(s)
- D C Van Essen
- Department of Anatomy & Neurobiology, Washington University, St. Louis, MO, USA.
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Sweeney J, Lebovitz J, Eller J, Coppens J, Bucholz R, Abdulrauf S. Management of Non-Missile Penetrating Brain Injuries: A Description of Three Cases and Review of the Literature. Skull Base 2011. [DOI: 10.1055/s-2011-1274390] [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: 10/18/2022]
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Dombrowski J, Oliver D, Osman M, Nguyen N, Dawson J, Walz B, Logie M, Naunheim K, Bucholz R. PET/CT Target Delineation with Respiratory Motion Tracking for Early Stage Lung Cancer Radiosurgery. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bucholz R, Lippert J. Von der Einzelzelle zum Organismus, vom Computermodell zum Bioreaktor – Verfahrenstechnik in der medizinischen Forschung. CHEM-ING-TECH 2007. [DOI: 10.1002/cite.200750293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mamelak AN, Rosenfeld S, Bucholz R, Raubitschek A, Nabors LB, Fiveash JB, Shen S, Khazaeli MB, Colcher D, Liu A, Osman M, Guthrie B, Schade-Bijur S, Hablitz DM, Alvarez VL, Gonda MA. Phase I Single-Dose Study of Intracavitary-Administered Iodine-131-TM-601 in Adults With Recurrent High-Grade Glioma. J Clin Oncol 2006; 24:3644-50. [PMID: 16877732 DOI: 10.1200/jco.2005.05.4569] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [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: 11/20/2022] Open
Abstract
Purpose TM-601 binds to malignant brain tumor cells with high affinity and does not seem to bind to normal brain tissue. Preclinical studies suggest that iodine-131 (131I) –TM-601 may be an effective targeted therapy for the treatment of glioma. We evaluated the safety, biodistribution, and dosimetry of intracavitary-administered 131I-TM-601 in patients with recurrent glioma. Patients and Methods Eighteen adult patients (17 with glioblastoma multiforme and one with anaplastic astrocytoma) with histologically documented recurrent glioma and a Karnofsky performance status of ≥ 60% who were eligible for cytoreductive craniotomy were enrolled. An intracavitary catheter with subcutaneous reservoir was placed in the tumor cavity during surgery. Two weeks after surgery, patients received a single dose of 131I-TM-601 from one of three dosing panels (0.25, 0.50, or 1.0 mg of TM-601), each labeled with 10 mCi of 131I. Results Intracavitary administration was well tolerated, with no dose-limiting toxicities observed. 131I-TM-601 bound to the tumor periphery and demonstrated long-term retention at the tumor with minimal uptake in any other organ system. Nonbound peptide was eliminated from the body within 24 to 48 hours. Only minor adverse events were reported during the 22 days after administration. At day 180, four patients had radiographic stable disease, and one had a partial response. Two of these patients further improved and were without evidence of disease for more than 30 months. Conclusion A single dose of 10 mCi 131I-TM-601 was well tolerated for 0.25 to 1.0 mg TM-601 and may have an antitumoral effect. Dosimetry and biodistribution from this first trial suggest that phase II studies of 131I-TM-601 are indicated.
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Affiliation(s)
- Adam N Mamelak
- Maxine Dunitz Neurosurgical Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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Bucholz R, MacNeil W, McDurmont L. The operating room of the future. Clin Neurosurg 2004; 51:228-37. [PMID: 15571148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Richard Bucholz
- Division of Neurosurgery, Saint Louis University Health Science Center, Missouri, USA
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Weber F, Asher A, Bucholz R, Berger M, Prados M, Chang S, Bruce J, Hall W, Rainov NG, Westphal M, Warnick RE, Rand RW, Floeth F, Rommel F, Pan H, Hingorani VN, Puri RK. Safety, tolerability, and tumor response of IL4-Pseudomonas exotoxin (NBI-3001) in patients with recurrent malignant glioma. J Neurooncol 2003; 64:125-37. [PMID: 12952293 DOI: 10.1007/bf02700027] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [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: 11/28/2022]
Abstract
PURPOSE This was an open-label, dose-escalation trial of intratumoral administration of IL-4 Pseudomonas exotoxin (NBI-3001) in patients with recurrent malignant glioma. PATIENTS AND METHODS A total of 31 patients with histologically verified supratentorial grades 3 and 4 astrocytoma were studied. Of these, 25 patients were diagnosed with glioblastoma multiforme (GBM) while six were diagnosed with anaplastic astrocytoma. Patients were over 18 years of age and had Karnofsky performance scores > or = 60. Patients were assigned to one of four dose groups in a dose-escalation fashion: 6 microg/ml x 40 ml, 9 microg/ml x 40 ml, 15 microg/ml x 40 ml, or 9 microg/ml x 100 ml of NBI-3001 administered via convection-enhanced delivery intratumorally using stereotactically placed catheters. Patients were followed with serial MRI scans and clinical assessments every four weeks for the first 16 weeks and then every eight weeks until week 26. RESULTS No drug-related systemic toxicity, as evident by lack of hematological or serum chemical changes, was apparent in any patients; treatment-related adverse effects were limited to the central nervous system. No deaths were attributable to treatment. Drug-related grade 3 or 4 toxicity was seen in 39% of patients in all dose groups and 22% of patients at the maximum tolerated dose of 6 microg/ml x 40 ml. The overall median survival was 8.2 months with a median survival of 5.8 months for the GBM patients. Six-month survival was 52% and 48%, respectively. Gadolinium-enhanced magnetic resonance imaging of the brain showed areas of decreased signal intensity within the tumor consistent with tumor necrosis following treatment in many patients. CONCLUSIONS NBI-3001 appears to have an acceptable safety and toxicity profile when administered intratumorally in patients with recurrent malignant glioma.
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Affiliation(s)
- Friedrich Weber
- Department of Neurological Surgery, Heinrich Heine University, Düsseldorf, Germany
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Weber FW, Floeth F, Asher A, Bucholz R, Berger M, Prados M, Chang S, Bruce J, Hall W, Rainov NG, Westphal M, Warnick RE, Rand RW, Rommell F, Pan H, Hingorani VN, Puri RK. Local convection enhanced delivery of IL4-Pseudomonas exotoxin (NBI-3001) for treatment of patients with recurrent malignant glioma. Acta Neurochir Suppl 2003; 88:93-103. [PMID: 14531567 DOI: 10.1007/978-3-7091-6090-9_15] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE This was an open-label, dose-escalation trial of intratumoral administration of IL-4 Pseudomonas Exotoxin (NBI-3001) in patients with recurrent malignant glioma. PATIENTS AND METHODS A total of 31 patients with histologically verified supratentorial grade 3 and 4 astrocytoma were studied. Of these, twenty-five patients were diagnosed with glioblastoma multiforme (GBM) while six were diagnosed with anaplastic astrocytoma (AA). Patients were over 18 years of age and had Karnofsky performance scores > or = 60. Patients were assigned to one of four dose groups in a dose-escalation fashion: 6 microg/ml x 40 ml, 9 microg/ml x 40 ml, 15 microg/ml x 40 ml, or 9 microg/ml x 100 ml of NBI-3001 administered intratumorally via stereotactically placed catheters. Patients were followed with serial MRI scans and clinical assessments every four weeks for the first 16 weeks and then every eight weeks until week 26. RESULTS No drug-related systemic toxicity, as evident by lack of hematological or serum chemical changes, was apparent in any patients; treatment-related adverse effects were limited to the central nervous system. No deaths were attributable to treatment. Drug-related Grade 3 or 4 toxicity was seen in 39% of patients in all dose groups and 22% of patients at the maximum tolerated dose of 6 microg/ml x 40 ml. The overall median survival was 8.2 months with a median survival of 5.8 months for the GBM patients. Six-month survival was 52% and 48%, respectively. Gadolinium-enhanced magnetic resonance imaging of the brain showed areas of decreased signal intensity within the tumor consistent with tumor necrosis following treatment in many patients. CONCLUSIONS NBI-3001 appears to have an acceptable safety and toxicity profile when administered intratumorally in patients with recurrent malignant glioma.
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Affiliation(s)
- F W Weber
- Department of Neurological Surgery, Heinrich Heine University, Düsseldorf, Germany.
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Weber F, Asher A, Bucholz R, Berger M, Prados M, Chang S, Bruce J, Hall W, Rainov NG, Westphal M, Warnick RE, Rand RW, Floeth F, Rommel F, Pan H, Hingorani VN, Puri RK. J Neurooncol 2003; 64:125-137. [DOI: 10.1023/a:1024901501173] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The four species of microalgae (Dunaliella bardawil, Chlorella minutissima, Pavlova lutheri and Haematococcus pluvialis) were immobilized in Ca-alginate capsules as a basic study for the development of the economic cultivation process. Under the batch culture of aerobic conditions, the thickness of the capsule membrane and CO2 supply did not affect the growth of the immobilized microalgae, Dunaliella bardawil. Cell concentration of immobilized microalgae in the capsule was higher than those of immobilized microalgae in beads and free cells. The cell concentrations of microencapsulated Dunaliella bardawil and Haematococcus pluvialis were five times greater than that of free cells. Based on these results, microencapsulation for the culture of microalgae was an effective method for the high-density cultivation. In comparison to the immobilized cultivation on the bioreactor type, it was more effective for the cultivation in the bubble column bioreactor than that in the stirrer tank bioreactor.
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Affiliation(s)
- D S Joo
- East Coastal Marine Bioresources Research Center, Kangnung National University, Korea
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Asher AL, Weber F, Bucholz R, Berger M, Prados M, Bruce J, Hall W, Rainov NG, Westphal M, Warnick R, Williams RL, Hingorani VN, Puri RK. 763 Safety, Tolerability and Tumor Response of IL4-toxin (NBI-3001) in Patients with Recurrent Malignant Glioma. Neurosurgery 2001. [DOI: 10.1227/00006123-200108000-00127] [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: 11/19/2022] Open
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Bucholz R, Macneil W, Fewings P, Ravindra A, McDurmont L, Baumann C. Automated rejection of contaminated surface measurements for improved surface registration in image guided neurosurgery. Stud Health Technol Inform 2000; 70:39-45. [PMID: 10977579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Most image guided Neurosurgery employs adhesively mounted external fiducials for registration of medical images to the surgical workspace. Due to high logistical costs associated with these artificial landmarks, we strive to eliminate the need for these markers. At our institution, we developed a handheld laser stripe triangulation device to capture the surface contours of the patient's head while oriented for surgery. Anatomical surface registration algorithms rely on the assumption that the patient's anatomy bears the same geometry as the 3D model of the patient constructed from the imaging modality employed. During the time interval from which the patient is imaged and placed in the Mayfield head clamp in the operating room, the skin of the head bulges at the pinsite and the skull fixation equipment itself optically interferes with the image capture laser. We have developed software to reject points belonging to objects of known geometry while calculating the registration. During the course of development of the laser scanning unit, we have acquired surface contours of 13 patients and 2 cadavers. Initial analysis revealed that this automated rejection of points improved the registrations in all cases, but the accuracy of the fiducial method was not surpassed. Only points belonging to the offending instrument are removed. Skin bulges caused by the clamps and instruments remain in the data. We anticipate that careful removal of the points in these skin bulges will yield registrations that at least match the accuracy of the fiducial method.
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Affiliation(s)
- R Bucholz
- CRNFA Jean H. Bakewell Section of Image Guided Surgery, Department of Surgery, Saint Louis University School of Medicine, MO 63104, USA
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Abstract
A prospective, randomized clinical trial was conducted concurrently at eighteen medical centers in order to compare the safety and efficacy of two types of graft material for the treatment of fractures of long bones: autogenous bone graft obtained from the iliac crest, and a composite material composed of purified bovine collagen, a biphasic calcium-phosphate ceramic, and autogenous marrow. Two hundred and thirteen patients (249 fractures) were followed for a minimum of twenty-four months to monitor healing and the occurrence of complications. We observed no significant differences between the two treatment groups with respect to rates of union (p = 0.94, power = 88 per cent) or functional measures (use of analgesics, pain with activities of daily living, and impairment in activities of daily living; p > 0.10). The prevalence of complications did not differ between the treatment groups except for the rate of infection, which was higher in the patients who were managed with an autogenous graft. Twelve patients who were managed with a synthetic graft had a positive antibody titer to bovine collagen; seven of them agreed to have intradermal challenge with bovine collagen. One patient had a positive skin response to the challenge but had no complications with regard to healing of the fracture. We concluded that, for traumatic defects of long bones that necessitate grafting, use of the composite graft material appears to be justified on the grounds of safety, efficacy, and elimination of the increased operative time and risk involved in obtaining an autogenous graft from the iliac crest.
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Affiliation(s)
- M W Chapman
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento 95817, USA
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Blasier RD, Bucholz R, Cole W, Johnson LL, Mäkelä EA. Bioresorbable implants: applications in orthopaedic surgery. Instr Course Lect 1997; 46:531-46. [PMID: 9143997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There are several new and potential uses for absorbable implants. Some will provide exciting options in the future. Ongoing animal and clinical studies will help focus future areas of development.
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Affiliation(s)
- R D Blasier
- Division of Pediatric Orthopaedics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, USA
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Abstract
Neurosurgery on eloquent cortex entails important risks of functional deficits complicating aggressive lesion resection. In this study, advanced biomagnetic functional imaging of somatosensory and motor cortex combined with surface rendered magnetic resonance imaging displays including vascular anatomy were used in conjunction with a new nonintrusive intraoperative guided instrumentation system to resect a tumor in eloquent cortex. Intraoperative verification of the accuracy of pre-operative motor localization demonstrated highly accurate results comparing direct stimulation and noninvasive presurgical mapping. The applicability of surface rendered combined functional and anatomic maps of cortex is directly evident on comparison of preoperative computer images and intraoperative pictures. This combination of new technologies has a significant potential for reduced risk and improved outcome in neurosurgery of eloquent cortex.
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Affiliation(s)
- C C Gallen
- Department of Neuropharmacology, Scripps Research Institute, La Jolla, California 92037
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Affiliation(s)
- J A Herzog
- Department of Otolaryngology, Washington University School of Medicine
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Pittman T, Bucholz R, Williams D. Efficacy of barbiturates in the treatment of resistant intracranial hypertension in severely head-injured children. Pediatr Neurosci 1989; 15:13-7. [PMID: 2635769 DOI: 10.1159/000120433] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cerebral perfusion pressures (CPP) of less than 50 torr are associated with marginal cerebral blood flow and poor outcome. We report our experience with a group of 7 children who survived long period with CPP of less than 50 torr during treatment with pentobarbital. The study group was identified through a retrospective review of all head-injured patients admitted to Cardinal Glennon Memorial Hospital for Children between 1984 and 1986. All of the patients presented had sustained intracranial pressure of greater than 20 torr which was resistant to conventional therapy. All patients received pentobarbital for at least 24 h and all had documented CPP of less than 50 torr for more than 30 min during that time. Of these 7 children: 3 made good recoveries; 2 are moderately disabled, and 2 are vegetative. Neither the CPP nor the length of pentobarbital coma was an accurate predictor of outcome. It seems likely that these children are a subset of those previously defined as having resistant intracranial hypertension and that, as a group, they may have benefited from pentobarbital administration. It is also apparent that, in this group, low CPP was not indicative of irreversible brain damage or brain death.
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Affiliation(s)
- T Pittman
- Division of Neurosurgery, St. Louis University Hospital, Mo
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Bone L, Bucholz R. The management of fractures in the patient with multiple trauma. J Bone Joint Surg Am 1986; 68:945-9. [PMID: 3733787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Holmes R, Mooney V, Bucholz R, Tencer A. A coralline hydroxyapatite bone graft substitute. Preliminary report. Clin Orthop Relat Res 1984:252-62. [PMID: 6147218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Experimental histologic and biomechanical studies were performed in 52 dogs by use of a bone substitute composed of hydroxyapatite converted from sea coral calcite. The results demonstrate some potentially useful practical applications. The material was totally incorporated in bone. Although initially too weak to tolerate physiologic stresses, once incorporated it becomes almost as strong as the native bone. Clinical experience with internal fixation of fractures with hydroxyapatite in 18 patients is encouraging.
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Montgomery J, Bucholz R, Gordon M, Ellman B, Jordan D. Case report 187. Congenital intraosseous arteriovenous macrofistulous anomaly (malformation). Skeletal Radiol 1982; 8:71-3. [PMID: 7079790 DOI: 10.1007/bf00361375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
This study was undertaken to identify the normal somatosensory evoked potential pattern from stimulation of the common peroneal nerve in order to provide basic data for clinical use in diagnosis and management of patients with spinal cord lesions. Thirty-four adult volunteers, free of neurological disease, and 12 patients were tested. The recording technique is described and is similar to that reported by Perot. The primary evoked response (P1) was easily visualized in 88% of the recordings from normal subjects. The peak latency of the primary response was 38.9 msec, and the deflection was positive. A vertex potential (P4) was a relatively consistent peak that appeared at approximately 240 msec in 78% of the subjects. Additional components of the waveform are also described and are compared to previous studies. Clinically, the presence of primary response seems to correlate with a favorable neurological outcome, and recovery of the primary response may precede major clinical improvement. The literature is reviewed and results compared to the current study.
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Bucholz R, Mauldin D. Prenatal diagnosis of intrauterine fetal fracture. A case report. J Bone Joint Surg Am 1978; 60:712-3. [PMID: 681399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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32
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Bucholz R. Sarcoid tumor in skeletal muscle. A case report. Clin Orthop Relat Res 1978:224-6. [PMID: 657627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 3 patterns of sarcoid involvement of skeletal muscle are microscopic infiltration, progressive myopathy and tumor formation. This is a case report and review of investigations of a 25-year-old man with the unusual tumorous form.
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