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Yang E, Mummaneni PV, Chou D, Izima C, Fu KM, Bydon M, Bisson EF, Shaffrey CI, Gottfried ON, Asher AL, Coric D, Potts E, Foley KT, Wang MY, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Uribe JS, Tumialán LM, Turner J, Haid RW, Chan AK. Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort. Clin Spine Surg 2024; 37:188-197. [PMID: 38706113 DOI: 10.1097/bsd.0000000000001613] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/28/2024] [Indexed: 05/07/2024]
Abstract
STUDY DESIGN Retrospective analysis of a prospective, multicenter registry. OBJECTIVE To assess whether upper or lower limb mJOA improvement more strongly associates with patient satisfaction after surgery for cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA The modified Japanese Orthopaedic Association (mJOA) is commonly used to assess functional status in patients with CSM. Patients present with upper and/or lower extremity dysfunction, and it is unclear whether improvement in one and/or both symptoms drives postoperative patient satisfaction. METHODS This study utilizes the prospective Quality Outcomes Database (QOD) CSM data set. Clinical outcomes included mJOA and North American Spine Society (NASS) satisfaction. The upper limb mJOA score was defined as upper motor plus sensory mJOA, and the lower limb mJOA as lower motor plus sensory mJOA. Ordered logistic regression was used to determine whether upper or lower limb mJOA was more closely associated with NASS satisfaction, adjusting for other covariates. RESULTS Overall, 1141 patients were enrolled in the QOD CSM cohort. In all, 780 had both preoperative and 24-month mJOA scores, met inclusion criteria, and were included for analysis. The baseline mJOA was 12.1±2.7, and postoperatively, 85.6% would undergo surgery again (NASS 1 or 2, satisfied). Patients exhibited mean improvement in both upper (baseline:3.9±1.4 vs. 24 mo:5.0±1.1, P<0.001) and lower limb mJOA (baseline:3.9±1.4 vs. 24 mon:4.5±1.5, P<0.001); however, the 24-month change in the upper limb mJOA was greater (upper:1.1±1.6 vs. lower:0.6±1.6, P<0.001). Across 24-month NASS satisfaction, the baseline upper and lower limb mJOA scores were similar (pupper=0.28, plower=0.092). However, as satisfaction decreased, the 24-month change in upper and lower limb mJOA decreased as well (pupper<0.001, plower<0.001). Patients with NASS scores of 4 (lowest satisfaction) did not demonstrate significant differences from baseline in upper or lower limb mJOA (P>0.05). In ordered logistic regression, NASS satisfaction was independently associated with upper limb mJOA improvement (OR=0.81; 95% CI: 0.68-0.97; P=0.019) but not lower limb mJOA improvement (OR=0.84; 95% CI: 0.70-1.0; P=0.054). CONCLUSIONS As the magnitude of upper and lower mJOA improvement decreased postoperatively, so too did patient satisfaction with surgical intervention. Upper limb mJOA improvement was a significant independent predictor of patient satisfaction, whereas lower limb mJOA improvement was not. These findings may aid preoperative counseling, stratified by patients' upper and lower extremity treatment expectations. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Eunice Yang
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, NY
| | | | - Dean Chou
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, NY
| | - Chiemela Izima
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, NY
| | - Kai-Ming Fu
- Department of Neurosurgery, Weill Cornell Medical Center, New York, NY
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | | | | | - Anthony L Asher
- Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, NC
| | - Domagoj Coric
- Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, NC
| | - Eric Potts
- Goodman Campbell Brain and Spine, Indianapolis, IN
| | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee; Semmes-Murphey Neurologic and Spine Institute, Memphis, TN
| | - Michael Y Wang
- Department of Neurosurgery, University of Miami, Miami, FL
| | - Michael S Virk
- Department of Neurosurgery, University of Miami, Miami, FL
| | | | - Scott Meyer
- Atlantic Neurosurgical Specialists, Morristown, NJ
| | - Paul Park
- Department of Neurosurgery, University of Tennessee; Semmes-Murphey Neurologic and Spine Institute, Memphis, TN
| | | | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | | | | | - Jay Turner
- Barrow Neurological Institute, Phoenix, AZ
| | | | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, NY
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Chan AK, Park C, Shaffrey CI, Gottfried ON, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos G, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study. J Neurosurg Spine 2024; 40:453-464. [PMID: 38181405 DOI: 10.3171/2023.11.spine23222] [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: 03/07/2023] [Accepted: 11/09/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The aim of this study was to identify predictors of the best 24-month improvements in patients undergoing surgery for cervical spondylotic myelopathy (CSM). For this purpose, the authors leveraged a large prospective cohort of surgically treated patients with CSM to identify factors predicting the best outcomes for disability, quality of life, and functional status following surgery. METHODS This was a retrospective analysis of prospectively collected data. The Quality Outcomes Database (QOD) CSM dataset (1141 patients) at 14 top enrolling sites was used. Baseline and surgical characteristics were compared for those reporting the top and bottom 20th percentile 24-month Neck Disability Index (NDI), EuroQol-5D (EQ-5D), and modified Japanese Orthopaedic Association (mJOA) change scores. A multivariable logistic model was constructed and included candidate variables reaching p ≤ 0.20 on univariate analyses. Least important variables were removed in a stepwise manner to determine the significant predictors of the best outcomes (top 20th percentile) for 24-month NDI, EQ-5D, and mJOA change. RESULTS A total of 948 (83.1%) patients with 24-month follow-up were included in this study. For NDI, 204 (17.9%) had the best NDI outcome and 200 (17.5%) had the worst NDI outcome. Factors predicting the best NDI outcomes included symptom duration less than 12 months (OR 1.5, 95% CI 1.1-1.9; p = 0.01); procedure other than posterior fusion (OR 1.5, 95% CI 1.03-2.1; p = 0.03); higher preoperative visual analog scale neck pain score (OR 1.2, 95% CI 1.1-1.3; p < 0.001); and higher baseline NDI (OR 1.06, 95% CI 1.05-1.07; p < 0.001). For EQ-5D, 163 (14.3%) had the best EQ-5D outcome and 169 (14.8%) had the worst EQ-5D outcome. Factors predicting the best EQ-5D outcomes included arm pain-only complaints (compared to neck pain) (OR 1.9, 95% CI 1.3-2.9; p = 0.002) and lower baseline EQ-5D (OR 167.7 per unit lower, 95% CI 85.0-339.4; p < 0.001). For mJOA, 222 (19.5%) had the best mJOA outcome and 238 (20.9%) had the worst mJOA outcome. Factors predicting the best mJOA outcomes included lower BMI (OR 1.03 per unit lower, 95% CI 1.004-1.05; p = 0.02; cutoff value of ≤ 29.5 kg/m2); arm pain-only complaints (compared to neck pain) (OR 1.7, 95% CI 1.1-2.5; p = 0.02); and lower baseline mJOA (OR 1.6 per unit lower, 95% CI 1.5-1.7; p < 0.001). CONCLUSIONS Compared to the worst outcomes for EQ-5D, the best outcomes were associated with patients with arm pain-only complaints. For mJOA, lower BMI and arm pain-only complaints portended the best outcomes. For NDI, those with the best outcomes had shorter symptom durations, higher preoperative neck pain scores, and less often underwent posterior spinal fusions. Given the positive impact of shorter symptom duration on outcomes, these data suggest that early surgery may be beneficial for patients with CSM.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York; The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Christine Park
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Oren N Gottfried
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee; Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York; The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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Eylon S, Kornitzer E, Wever C, Rigbi A, Weiss PL, Meyer S. Reducing fracture incidence in children with osteogenesis imperfecta: contribution of orthotics to bisphosphonates treatment. Disabil Rehabil 2024; 46:1416-1421. [PMID: 37067232 DOI: 10.1080/09638288.2023.2198259] [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: 09/21/2022] [Accepted: 03/25/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To determine whether there was a reduction in fracture incidence amongst children with OI who were treated with both bisphosphonates and orthoses. OBJECTIVE Was there an additional reduction in fracture incidence amongst children with Osteogenesis Imperfecta (OI) treated with both bisphosphonates and Hip-Knee-Ankle-Foot-Orthosis (HKAFO)? MATERIALS AND METHODS Of the 129 OI patients treated from 1990 to 2017, retrospective data from 48 patients who participated in the bisphosphonates-orthosis regime were analyzed including the incidence of fractures and modalities of fracture treatment. RESULTS Bisphosphonates usage was more frequent than bracing and there were more positive changes (smaller or equal number of fractures each year) than negative changes (more fractures each year); negative changes were scarce, explained by non-compliance with the use of bracing. Poisson regression models were significant for positive changes, whereas the interaction between them was borderline significant. The main finding is that the association between bisphosphonates usage and the number of positive changes was stronger among the patients who used braces more frequently and weaker among patients who used bracing less frequently. CONCLUSIONS Bracing of OI patients has an additive effect on bisphosphonate treatment in fracture prevention which should lead to the reconsideration of a hybrid approach to OI management.
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Affiliation(s)
- S Eylon
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - E Kornitzer
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - C Wever
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | - A Rigbi
- Beit Berl College, Faculty of Education, Kfar-Saba, Israel
| | - P L Weiss
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - S Meyer
- ALYN Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
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Park C, Shaffrey CI, Than KD, Bisson EF, Sherrod BA, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Agarwal N, Chan AK, Chou D, Chaudhry NS, Haid RW, Mummaneni PV, Michalopoulos GD, Bydon M, Gottfried ON. Does the number of social factors affect long-term patient-reported outcomes and satisfaction in those with cervical myelopathy? A QOD study. J Neurosurg Spine 2024; 40:428-438. [PMID: 38241683 DOI: 10.3171/2023.11.spine23127] [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: 02/01/2023] [Accepted: 11/16/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE It is not clear whether there is an additive effect of social factors in keeping patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery. The aim of this study was to explore the effect of multiple social factors on postoperative outcomes and satisfaction. METHODS This was a multiinstitutional, retrospective study of the prospective Quality Outcomes Database (QOD) CSM cohort, which included patients aged 18 years or older who were diagnosed with primary CSM and underwent operative management. Social factors included race (White vs non-White), education (high school or below vs above), employment (employed vs not), and insurance (private vs nonprivate). Patients were considered to have improved from surgery if the following criteria were met: 1) they reported a score of 1 or 2 on the North American Spine Society index, and 2) they met the MCID in patient-reported outcomes (i.e., visual analog scale [VAS] neck and arm pain, Neck Disability Index [NDI], and EuroQol-5D [EQ-5D]). RESULTS Of the 1141 patients included in the study, 205 (18.0%) had 0, 347 (30.4%) had 1, 334 (29.3%) had 2, and 255 (22.3%) had 3 social factors. The 24-month follow-up rate was > 80% for all patient-reported outcomes. After adjusting for all relevant covariates (p < 0.02), patients with 1 or more social factors were less likely to improve from surgery in all measured outcomes including VAS neck pain (OR 0.90, 95% CI 0.83-0.99) and arm pain (OR 0.88, 95% CI 0.80-0.96); NDI (OR 0.90, 95% CI 0.83-0.98); and EQ-5D (OR 0.90, 95% CI 0.83-0.97) (all p < 0.05) compared to those without any social factors. Patients with 2 social factors (outcomes: neck pain OR 0.86, arm pain OR 0.81, NDI OR 0.84, EQ-5D OR 0.81; all p < 0.05) or 3 social factors (outcomes: neck pain OR 0.84, arm pain OR 0.84, NDI OR 0.84, EQ-5D OR 0.84; all p < 0.05) were more likely to fare worse in all outcomes compared to those with only 1 social factor. CONCLUSIONS Compared to those without any social factors, patients who had at least 1 social factor were less likely to achieve MCID and feel satisfied after surgery. The effect of social factors is additive in that patients with a higher number of factors are less likely to improve compared to those with only 1 social factor.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 3Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 3Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 4Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 5Department of Neurosurgery, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 6Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | - Scott Meyer
- 8Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 9Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 10Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 12Barrow Neurological Institute, Phoenix, Arizona
| | - Nitin Agarwal
- 13Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Andrew K Chan
- 14Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Dean Chou
- 14Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nauman S Chaudhry
- 15Department of Neurosurgery, University of South Florida, Tampa, Florida
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 17Department of Neurosurgery, University of California, San Francisco, California; and
| | | | - Mohamad Bydon
- 18Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
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Degitz SJ, Degoey PP, Haselman JT, Olker JH, Stacy EH, Blanksma C, Meyer S, Mattingly KZ, Blackwell B, Opseth AS, Hornung MW. Evaluating potential developmental toxicity of perfluoroalkyl and polyfluoroalkyl substances in Xenopus laevis embryos and larvae. J Appl Toxicol 2024. [PMID: 38531109 DOI: 10.1002/jat.4599] [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: 12/11/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
As part of the US Environmental Protection Agency's perfluoroalkyl and polyfluoroalkyl substances (PFAS) Action Plan, the agency is committed to increasing our understanding of the potential ecological effects of PFAS. The objective of these studies was to examine the developmental toxicity of PFAS using the laboratory model amphibian species Xenopus laevis. We had two primary aims: (1) to understand the developmental toxicity of a structurally diverse set of PFAS compounds in developing embryos and (2) to characterize the potential impacts of perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA), and hexafluoropropylene oxide-dimer acid (HFPO-DA a.k.a. GenX), on growth and thyroid hormone-controlled metamorphosis. We employed a combination of static renewal and flow-through exposure designs. Embryos were exposed to 17 structurally diverse PFAS starting at the midblastula stage through the completion of organogenesis (96 h). To investigate impacts on PFOS, PFOA, PFHxS, and HFPO-DA on development and metamorphosis, larvae were exposed from premetamorphosis (Nieuwkoop Faber stage 51 or 54) through pro metamorphosis. Of the PFAS tested in embryos, only 1H,1H,10H,10H-perfluorodecane-1,10-diol (FC10-diol) and perfluorohexanesulfonamide (FHxSA) exposure resulted in clear concentration-dependent developmental toxicity. For both of these PFAS, a significant increase in mortality was observed at 2.5 and 5 mg/L. For FC10-diol, 100% of the surviving embryos were malformed at 1.25 and 2.5 mg/L, while for FHxSA, a significant increase in malformations (100%) was observed at 2.5 and 5 mg/L. Developmental stage achieved was the most sensitive endpoint with significant effects observed at 1.25 and 0.625 mg/L for FC10-diol and FHxSA, respectively. In larval studies, we observed impacts on growth following exposure to PFHxS and PFOS at concentrations of 100 and 2.5 mg/L, respectively, while no impacts were observed in larvae when exposed to PFOA and HFPO-DA at concentration of 100 mg/L. Further, we did not observe impacts on thyroid endpoints in exposed larvae. These experiments have broadened our understanding of the impact of PFAS on anuran development.
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Affiliation(s)
- Sigmund J Degitz
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
| | - Philip P Degoey
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
| | - Jonathan T Haselman
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
| | - Jennifer H Olker
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
| | - Emma H Stacy
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
| | - Chad Blanksma
- SpecPro Professional Services, c/o US EPA, Great Lakes Toxicology and Ecology Division, Duluth, Minnesota, USA
| | - Scott Meyer
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
- California Department of Water Resources, West Sacramento, California, USA
| | - Kali Z Mattingly
- SpecPro Professional Services, c/o US EPA, Great Lakes Toxicology and Ecology Division, Duluth, Minnesota, USA
| | - Brett Blackwell
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
- Biochemistry and Biotechnology Group, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Anne S Opseth
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
| | - Michael W Hornung
- US Environmental Protection Agency, Office of Research and Development, Center for Computational Toxicology and Exposure (CCTE), Great Lakes Toxicology and Ecology Division (GLTED), Duluth, Minnesota, USA
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Park C, Shaffrey CI, Than KD, Michalopoulos GD, El Sammak S, Chan AK, Bisson EF, Sherrod BA, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner J, Agarwal N, Chou D, Chaudhry NS, Haid RW, Mummaneni PV, Bydon M, Gottfried ON. What factors influence surgical decision-making in anterior versus posterior surgery for cervical myelopathy? A QOD analysis. J Neurosurg Spine 2024; 40:206-215. [PMID: 37948703 DOI: 10.3171/2023.8.spine23194] [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: 02/16/2023] [Accepted: 08/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim of this study was to explore the preoperative patient characteristics that affect surgical decision-making when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM). METHODS This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected. RESULTS Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean 64.8 ± 10.6 vs 58.5 ± 11.1 years, p < 0.001) and those with a higher American Society of Anesthesiologists class (class III or IV: 52.4% vs 46.3%, p = 0.003), a higher rate of motor deficit (67.0% vs 58.7%, p = 0.014), worse myelopathy (mean modified Japanese Orthopaedic Association score 11.4 ± 3.1 vs 12.4 ± 2.6, p < 0.001), and more levels treated (4.3 ± 1.3 vs 2.4 ± 0.6, p < 0.001). On the other hand, surgeons more frequently performed an anterior surgical approach when patients were employed (47.2% vs 23.2%, p < 0.001) and had intervertebral disc herniation as an underlying pathology (30.7% vs 9.2%, p < 0.001). CONCLUSIONS The selection of approach for patients with CSM depends on patient demographics and symptomology. Posterior surgery was performed in patients who were older and had worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and had intervertebral disc herniation.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Sally El Sammak
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | - Nitin Agarwal
- 15Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nauman S Chaudhry
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Praveen V Mummaneni
- 17Department of Neurosurgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
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7
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Yang E, Mummaneni PV, Chou D, Bydon M, Bisson EF, Shaffrey CI, Gottfried ON, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Haid RW, Chan AK. Cervical laminoplasty versus laminectomy and posterior cervical fusion for cervical myelopathy: propensity-matched analysis of 24-month outcomes from the Quality Outcomes Database. J Neurosurg Spine 2023; 39:671-681. [PMID: 37728378 DOI: 10.3171/2023.6.spine23345] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Compared with laminectomy with posterior cervical fusion (PCF), cervical laminoplasty (CL) may result in different outcomes for those operated on for cervical spondylotic myelopathy (CSM). The aim of this study was to compare 24-month patient-reported outcomes (PROs) for laminoplasty versus PCF by using the Quality Outcomes Database (QOD) CSM data set. METHODS This was a retrospective study using an augmented data set from the prospectively collected QOD Registry Cervical Module. Patients undergoing laminoplasty or PCF for CSM were included. Using the nearest-neighbor method, the authors performed 1:1 propensity matching based on age, operated levels, and baseline modified Japanese Orthopaedic Association (mJOA) and visual analog scale (VAS) neck pain scores. The 24-month PROs, i.e., mJOA, Neck Disability Index (NDI), VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and North American Spine Society (NASS) satisfaction scores, were compared. Only cases in the subaxial cervical region were included; those that crossed the cervicothoracic junction were excluded. RESULTS From the 1141 patients included in the QOD CSM data set who underwent anterior or posterior surgery for cervical myelopathy, 946 (82.9%) had 24 months of follow-up. Of these, 43 patients who underwent laminoplasty and 191 who underwent PCF met the inclusion criteria. After matching, the groups were similar for baseline characteristics, including operative levels (CL group: 4.0 ± 0.9 vs PCF group: 4.2 ± 1.1, p = 0.337) and baseline PROs (p > 0.05), except for a higher percentage involved in activities outside the home in the CL group (95.3% vs 81.4%, p = 0.044). The 24-month follow-up for the matched cohorts was similar (CL group: 88.4% vs PCF group: 83.7%, p = 0.534). Patients undergoing laminoplasty had significantly lower estimated blood loss (99.3 ± 91.7 mL vs 186.7 ± 142.7 mL, p = 0.003), decreased length of stay (3.0 ± 1.6 days vs 4.5 ± 3.3 days, p = 0.012), and a higher rate of routine discharge (88.4% vs 62.8%, p = 0.006). The CL cohort also demonstrated a higher rate of return to activities (47.2% vs 21.2%, p = 0.023) after 3 months. Laminoplasty was associated with a larger improvement in 24-month NDI score (-19.6 ± 18.9 vs -9.1 ± 21.9, p = 0.031). Otherwise, there were no 3- or 24-month differences in mJOA, mean NDI, VAS neck pain, VAS arm pain, EQ-5D, EQ-VAS, and distribution of NASS satisfaction scores (p > 0.05) between the cohorts. CONCLUSIONS Compared with PCF, laminoplasty was associated with decreased blood loss, decreased length of hospitalization, and higher rates of home discharge. At 3 months, laminoplasty was associated with a higher rate of return to baseline activities. At 24 months, laminoplasty was associated with greater improvements in neck disability. Otherwise, laminoplasty and PCF shared similar outcomes for functional status, pain, quality of life, and satisfaction. Laminoplasty and PCF achieved similar neck pain scores, suggesting that moderate preoperative neck pain may not necessarily be a contraindication for laminoplasty.
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Affiliation(s)
- Eunice Yang
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | | | - Oren N Gottfried
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 12Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 13Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 14Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 15Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 16Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
| | - Regis W Haid
- 17Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Andrew K Chan
- 1Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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8
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Patel A, Kondapavulur S, Umbach G, Chan AK, Le VP, Bisson EF, Bydon M, Chou D, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin J, Asher AL, Virk MS, Haid RW, Gottfried O, Meyer S, Upadhyaya CD, Tumialán LM, Turner JD, Mummaneni PV. Greater improvement in Neck Disability Index scores in women after surgery for cervical myelopathy: an analysis of the Quality Outcomes Database. Neurosurg Focus 2023; 55:E7. [PMID: 37913530 DOI: 10.3171/2023.8.focus23423] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE There is a high prevalence of cervical myelopathy that requires surgery; as such, it is important to identify how different groups benefit from surgery. The American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry, that includes demographic, clinical, and patient-reported outcome data to measure the safety and quality of neurosurgical procedures. In this study, the authors assessed the impact of gender on patient-reported outcomes in patients who underwent surgery for cervical myelopathy. METHODS The authors analyzed 1152 patients who underwent surgery for cervical myelopathy and were included in the QOD cervical module. Univariate comparison of baseline patient characteristics between males and females who underwent surgery for cervical spondylotic myelopathy was performed. Baseline characteristics that significantly differed between males and females were included in a multivariate generalized linear model comparing baseline and 1-year postoperative Neck Disability Index (NDI) scores. RESULTS This study included 546 females and 604 males. Females demonstrated significantly greater improvement in NDI score 1 year after surgery (p = 0.036). In addition to gender, the presence of axial neck pain and insurance status were also significantly predictive of improvement in NDI score after surgery (p = 0.0013 and p = 0.0058, respectively). CONCLUSIONS Females were more likely to benefit from surgery for cervical myelopathy compared with males. It is important to identify gender differences in postoperative outcomes after surgery in order to deliver more personalized and patient-centric care.
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Affiliation(s)
- Arati Patel
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Sravani Kondapavulur
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Gray Umbach
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 2Department of Neurosurgery, Columbia University, New York, New York
| | - Vivian P Le
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 3Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 4Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Dean Chou
- 2Department of Neurosurgery, Columbia University, New York, New York
| | | | - Kevin T Foley
- 6Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | | | - Eric A Potts
- 8Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Mark E Shaffrey
- 9Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- 10Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 6Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 12Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 13Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Anthony L Asher
- 10Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Michael S Virk
- 13Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Oren Gottfried
- 7Department of Neurosurgery, Duke University Medical Center, Raleigh, North Carolina
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Cheerag D Upadhyaya
- 16Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina; and
| | - Luis M Tumialán
- 17Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona
| | - Jay D Turner
- 17Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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9
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Ambati VS, Macki M, Chan AK, Michalopoulos GD, Le VP, Jamieson AB, Chou D, Shaffrey CI, Gottfried ON, Bisson EF, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Sherrod BA, Haid RW, Bydon M, Mummaneni PV. Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? An analysis of the Quality Outcomes Database cervical spondylotic myelopathy cohort. Neurosurg Focus 2023; 55:E2. [PMID: 37657103 DOI: 10.3171/2023.6.focus23295] [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: 05/01/2023] [Accepted: 06/16/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The authors sought to compare 3-level anterior with posterior fusion surgical procedures for the treatment of multilevel cervical spondylotic myelopathy (CSM). METHODS The authors analyzed prospective data from the 14 highest enrolling sites of the Quality Outcomes Database CSM module. They compared 3-level anterior cervical discectomy and fusion (ACDF) and posterior cervical laminectomy and fusion (PCF) surgical procedures, excluding surgical procedures crossing the cervicothoracic junction. Rates of reaching the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) were compared at 24 months postoperatively. Multivariable analyses adjusted for potential confounders elucidated in univariable analysis. RESULTS Overall, 199 patients met the inclusion criteria: 123 ACDF (61.8%) and 76 PCF (38.2%) patients. The 24-month follow-up rates were similar (ACDF 90.2% vs PCF 92.1%, p = 0.67). Preoperatively, ACDF patients were younger (60.8 ± 10.2 vs 65.0 ± 10.3 years, p < 0.01), and greater proportions were privately insured (56.1% vs 36.8%, p = 0.02), actively employed (39.8% vs 22.8%, p = 0.04), and independently ambulatory (14.6% vs 31.6%, p < 0.01). Otherwise, the cohorts had equivalent baseline modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), numeric rating scale (NRS)-arm pain, NRS-neck pain, and EQ-5D scores (p > 0.05). ACDF patients had reduced hospitalization length (1.6 vs 3.9 days, p < 0.01) and a greater proportion had nonroutine discharge (7.3% vs 22.8%, p < 0.01), but they had a higher rate of postoperative dysphagia (13.5% vs 3.5%, p = 0.049). Compared with baseline values, both groups demonstrated improvements in all outcomes at 24 months (p < 0.05). In multivariable analyses, after controlling for age, insurance payor, employment status, ambulation status, and other potential clinically relevant confounders, ACDF was associated with a greater proportion of patients with maximum satisfaction on the North American Spine Society Patient Satisfaction Index (NASS) (NASS score of 1) at 24 months (69.4% vs 53.7%, OR 2.44, 95% CI 1.17-5.09, adjusted p = 0.02). Otherwise, the cohorts shared similar 24-month outcomes in terms of reaching the MCID for mJOA, NDI, NRS-arm pain, NRS-neck pain, and EQ-5D score (adjusted p > 0.05). There were no differences in the 3-month readmission (ACDF 4.1% vs PCF 3.9%, p = 0.97) and 24-month reoperation (ACDF 13.5% vs PCF 18.6%, p = 0.36) rates. CONCLUSIONS In a cohort limited to 3-level fusion surgical procedures, ACDF was associated with reduced blood loss, shorter hospitalization length, and higher routine home discharge rates; however, PCF resulted in lower rates of postoperative dysphagia. The procedures yielded comparably significant improvements in functional status (mJOA score), neck and arm pain, neck pain-related disability, and quality of life at 3, 12, and 24 months. ACDF patients had significantly higher odds of maximum satisfaction (NASS score 1). Given comparable outcomes, patients should be counseled on each approach's complication profile to aid in surgical decision-making.
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Affiliation(s)
- Vardhaan S Ambati
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamed Macki
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Vivian P Le
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Alysha B Jamieson
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 2Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | | | - Oren N Gottfried
- 4Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 6Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 7Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 9Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 10Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 8Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona; and
| | - Brandon A Sherrod
- 5Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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10
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Chan AK, Shaffrey CI, Park C, Gottfried ON, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya CD, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Do comorbid self-reported depression and anxiety influence outcomes following surgery for cervical spondylotic myelopathy? J Neurosurg Spine 2023; 39:11-27. [PMID: 37021762 DOI: 10.3171/2023.2.spine22685] [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: 06/17/2022] [Accepted: 02/20/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Depression and anxiety are associated with inferior outcomes following spine surgery. In this study, the authors examined whether patients with cervical spondylotic myelopathy (CSM) who have both self-reported depression (SRD) and self-reported anxiety (SRA) have worse postoperative patient-reported outcomes (PROs) compared with patients who have only one or none of these comorbidities. METHODS This study is a retrospective analysis of prospectively collected data from the Quality Outcomes Database CSM cohort. Comparisons were made among patients who reported the following: 1) either SRD or SRA, 2) both SRD and SRA, or 3) neither comorbidity at baseline. PROs at 3, 12, and 24 months (scores for the visual analog scale [VAS] for neck pain and arm pain, Neck Disability Index [NDI], modified Japanese Orthopaedic Association [mJOA] scale, EQ-5D, EuroQol VAS [EQ-VAS], and North American Spine Society [NASS] patient satisfaction index) and achievement of respective PRO minimal clinically important differences (MCIDs) were compared. RESULTS Of the 1141 included patients, 199 (17.4%) had either SRD or SRA alone, 132 (11.6%) had both SRD and SRA, and 810 (71.0%) had neither. Preoperatively, patients with either SRD or SRA alone had worse scores for VAS neck pain (5.6 ± 3.1 vs 5.1 ± 3.3, p = 0.03), NDI (41.0 ± 19.3 vs 36.8 ± 20.8, p = 0.007), EQ-VAS (57.0 ± 21.0 vs 60.7 ± 21.7, p = 0.03), and EQ-5D (0.53 ± 0.23 vs 0.58 ± 0.21, p = 0.008) than patients without such disorders. Postoperatively, in multivariable adjusted analyses, baseline SRD or SRA alone was associated with inferior improvement in the VAS neck pain score and a lower rate of achieving the MCID for VAS neck pain score at 3 and 12 months, but not at 24 months. At 24 months, patients with SRD or SRA alone experienced less change in EQ-5D scores and were less likely to meet the MCID for EQ-5D than patients without SRD or SRA. Furthermore, patient self-reporting of both psychological comorbidities did not impact PROs at all measured time points compared with self-reporting of only one psychological comorbidity alone. Each cohort (SRD or SRA alone, both SRD and SRA, and neither SRD nor SRA) experienced significant improvements in mean PROs at all measured time points compared with baseline (p < 0.05). CONCLUSIONS Approximately 12% of patients who underwent surgery for CSM presented with both SRD and SRA, and 29% presented with at least one symptom. The presence of either SRD or SRA was independently associated with inferior scores for 3- and 12-month neck pain following surgery, but this difference was not significant at 24 months. However, at long-term follow-up, patients with SRD or SRA experienced lower quality of life than patients without SRD or SRA. The comorbid presence of both depression and anxiety was not associated with worse patient outcomes than either diagnosis alone.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork/Presbyterian, New York, New York
| | | | - Christine Park
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- 11Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 3Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 1Department of Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork/Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 15Department of Neurological Surgery, University of California, San Francisco, California; and
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11
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Park C, Mummaneni PV, Gottfried ON, Shaffrey CI, Tang AJ, Bisson EF, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Sherrod BA, Agarwal N, Chou D, Haid RW, Bydon M, Chan AK. Which supervised machine learning algorithm can best predict achievement of minimum clinically important difference in neck pain after surgery in patients with cervical myelopathy? A QOD study. Neurosurg Focus 2023; 54:E5. [PMID: 37283449 DOI: 10.3171/2023.3.focus2372] [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: 01/31/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of different supervised machine learning algorithms to predict achievement of minimum clinically important difference (MCID) in neck pain after surgery in patients with cervical spondylotic myelopathy (CSM). METHODS This was a retrospective analysis of the prospective Quality Outcomes Database CSM cohort. The data set was divided into an 80% training and a 20% test set. Various supervised learning algorithms (including logistic regression, support vector machine, decision tree, random forest, extra trees, gaussian naïve Bayes, k-nearest neighbors, multilayer perceptron, and extreme gradient boosted trees) were evaluated on their performance to predict achievement of MCID in neck pain at 3 and 24 months after surgery, given a set of predicting baseline features. Model performance was assessed with accuracy, F1 score, area under the receiver operating characteristic curve, precision, recall/sensitivity, and specificity. RESULTS In total, 535 patients (46.9%) achieved MCID for neck pain at 3 months and 569 patients (49.9%) achieved it at 24 months. In each follow-up cohort, 501 patients (93.6%) were satisfied at 3 months after surgery and 569 patients (100%) were satisfied at 24 months after surgery. Of the supervised machine learning algorithms tested, logistic regression demonstrated the best accuracy (3 months: 0.76 ± 0.031, 24 months: 0.773 ± 0.044), followed by F1 score (3 months: 0.759 ± 0.019, 24 months: 0.777 ± 0.039) and area under the receiver operating characteristic curve (3 months: 0.762 ± 0.027, 24 months: 0.773 ± 0.043) at predicting achievement of MCID for neck pain at both follow-up time points, with fair performance. The best precision was also demonstrated by logistic regression at 3 (0.724 ± 0.058) and 24 (0.780 ± 0.097) months. The best recall/sensitivity was demonstrated by multilayer perceptron at 3 months (0.841 ± 0.094) and by extra trees at 24 months (0.817 ± 0.115). Highest specificity was shown by support vector machine at 3 months (0.952 ± 0.013) and by logistic regression at 24 months (0.747 ± 0.18). CONCLUSIONS Appropriate selection of models for studies should be based on the strengths of each model and the aims of the studies. For maximally predicting true achievement of MCID in neck pain, of all the predictions in this balanced data set the appropriate metric for the authors' study was precision. For both short- and long-term follow-ups, logistic regression demonstrated the highest precision of all models tested. Logistic regression performed consistently the best of all models tested and remains a powerful model for clinical classification tasks.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Praveen V Mummaneni
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Anthony J Tang
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 5Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 6Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 8Department of Neurosurgery, University of Miami, Florida
| | - Kai-Ming Fu
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 9Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - John J Knightly
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Scott Meyer
- 10Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 11Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 12Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 14Barrow Neurological Institute, Phoenix, Arizona
| | - Brandon A Sherrod
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 15Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Regis W Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia; and
| | - Mohamad Bydon
- 17Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York
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Welch WC, Coric D, Nassr A, Steinmetz MP, Whiting DM, Groff M, Chi J, Whitmore RG, Meyer S, Arnold PM. 499 Prospective, Randomized and Controlled Multicenter Study of Posterior Lumbar Facet Arthroplasty for the Treatment of Spondylolisthesis. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_499] [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: 03/18/2023] Open
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13
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Pinter ZW, Freedman BA, Nassr A, Sebastian AS, Coric D, Welch WC, Steinmetz MP, Robbins SE, Ament J, Anand N, Arnold P, Baron E, Huang J, Whitmore R, Whiting D, Tahernia D, Sandhu F, Chahlavi A, Cheng J, Chi J, Pirris S, Groff M, Fabi A, Meyer S, Kushwaha V, Kent R, DeLuca S, Smorgick Y, Anekstein Y. A Prospective Study of Lumbar Facet Arthroplasty in the Treatment of Degenerative Spondylolisthesis and Stenosis: Results from the Total Posterior Spine System (TOPS) IDE Study. Clin Spine Surg 2023; 36:E59-E69. [PMID: 36191093 PMCID: PMC9949521 DOI: 10.1097/bsd.0000000000001365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective randomized Food and Drug Administration investigational device exemption clinical trial. OBJECTIVE The purpose of the present study is to report the 1-year clinical and radiographic outcomes and safety profile of patients who underwent lumbar facet arthroplasty through implantation of the Total Posterior Spine System (TOPS) device. SUMMARY OF BACKGROUND DATA Lumbar facet arthroplasty is one proposed method of dynamic stabilization to treat grade-1 spondylolisthesis with stenosis; however, there are currently no Food and Drug Administration-approved devices for facet arthroplasty. METHODS Standard demographic information was collected for each patient. Radiographic parameters and patient-reported outcome measures were assessed preoperatively and at regular postoperative intervals. Complication and reoperation data were also collected for each patient. RESULTS At the time of this study, 153 patients had undergone implantation of the TOPS device. The mean surgical time was 187.8 minutes and the mean estimated blood loss was 205.7cc. The mean length of hospital stay was 3.0 days. Mean Oswestry Disability Index, Visual Analog Score leg and back, and Zurich Claudication Questionnaire scores improved significantly at all postoperative time points ( P >0.001). There were no clinically significant changes in radiographic parameters, and all operative segments remained mobile at 1-year follow-up. Postoperative complications occurred in 11 patients out of the 153 patients (7.2%) who underwent implantation of the TOPS device. Nine patients (5.9%) underwent a total of 13 reoperations, 1 (0.6%) of which was for device-related failure owing to bilateral L5 pedicle screw loosening. CONCLUSIONS Lumbar facet arthroplasty with the TOPS device demonstrated a statistically significant improvement in all patient-reported outcome measures and the ability to maintain motion at the index level while limiting sagittal translation with a low complication rate.
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Affiliation(s)
| | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Domagoj Coric
- Carolinas Neurosurgery & Spine Associates, Charlotte, NC
| | - William C. Welch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Neel Anand
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Eli Baron
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | - Faheem Sandhu
- MedStar Georgetown University Hospital, District of Columbia, WA
| | - Ali Chahlavi
- Ascension St. Vincent’s Southside, Jacksonville, FL
| | | | - John Chi
- Brigham and Women’s Hospital, Boston, MA
| | | | | | - Alain Fabi
- Bronson Methodist Hospital, Kalamazoo, MI
| | | | | | | | - Steven DeLuca
- Orthopedic Institute of Pennsylvania, Harrisburg, PA
| | - Yossi Smorgick
- Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
| | - Yoram Anekstein
- Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
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14
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Zaki MM, Joshi RS, Ibrahim S, Michalopoulos GD, Linzey JR, Saadeh YS, Upadhyaya C, Coric D, Potts EA, Bisson EF, Turner JD, Knightly JJ, Fu KM, Foley KT, Tumialan L, Shaffrey ME, Bydon M, Mummaneni PV, Chou D, Chan AK, Meyer S, Asher AL, Shaffrey CI, Gottfried ON, Than KD, Wang M, Haid R, Slotkin JR, Glassman SD, Park P. How closely are outcome questionnaires correlated to patient satisfaction after cervical spine surgery for myelopathy? J Neurosurg Spine 2023; 38:521-529. [PMID: 36805998 DOI: 10.3171/2023.1.spine22888] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Patient-reported outcomes (PROs) have become the standard means to measure surgical outcomes. Insurers and policy makers are also increasingly utilizing PROs to assess the value of care and measure different aspects of a patient's condition. For cervical myelopathy, it is currently unclear which outcome measure best reflects patient satisfaction. In this investigation, the authors evaluated patients treated for cervical myelopathy to determine which outcome questionnaires best correlate with patient satisfaction. METHODS The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to retrospectively analyze patients undergoing surgery for cervical myelopathy. The North American Spine Society (NASS) satisfaction index, Neck Disability Index (NDI), numeric rating scales for neck pain (NP-NRS) and arm pain (AP-NRS), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale were evaluated. RESULTS The analysis included 1141 patients diagnosed with myelopathy, of whom 1099 had an NASS satisfaction index recorded at any of the follow-up time points. Concomitant radiculopathy was an indication for surgery in 368 (33.5%) patients, and severe neck pain (NP-NRS ≥ 7) was present in 471 (42.8%) patients. At the 3-month follow-up, NASS patient satisfaction index scores were positively correlated with scores for the NP-NRS (r = 0.30), AP-NRS (r = 0.32), and NDI (r = 0.36) and negatively correlated with EQ-5D (r = -0.38) and mJOA (r = -0.29) scores (all p < 0.001). At the 12-month follow-up, scores for the NASS index were positively correlated with scores for the NP-NRS (r = 0.44), AP-NRS (r = 0.38), and NDI (r = 0.46) and negatively correlated with scores for the EQ-5D (r = -0.40) and mJOA (r = -0.36) (all p < 0.001). At the 24-month follow-up, NASS index scores were positively correlated with NP-NRS (r = 0.49), AP-NRS (r = 0.36), and NDI (r = 0.49) scores and negatively correlated with EQ-5D (r = -0.44) and mJOA (r = -0.38) scores (all p < 0.001). CONCLUSIONS Neck pain was highly prevalent in patients with myelopathy. Notably, improvement in neck pain-associated disability rather than improvement in myelopathy was the most prominent PRO factor for patients. This finding may reflect greater patient concern for active pain symptoms than for neurological symptoms caused by myelopathy. As commercial payers begin to examine novel remuneration strategies for surgical interventions, thoughtful analysis of PRO measurements will have increasing relevance.
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Affiliation(s)
- Mark M Zaki
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Rushikesh S Joshi
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Sufyan Ibrahim
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph R Linzey
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Yamaan S Saadeh
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Domagoj Coric
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 5Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 6Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Jay D Turner
- 7Barrow Neurological Institute, Phoenix, Arizona
| | | | - Kai-Ming Fu
- 9Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Kevin T Foley
- 10Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee
| | | | - Mark E Shaffrey
- 11Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 12Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 12Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 12Department of Neurological Surgery, University of California, San Francisco, California
| | - Scott Meyer
- 8Altair Health Spine and Wellness, Morristown, New Jersey
| | - Anthony L Asher
- 4Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | | | - Oren N Gottfried
- 13Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 13Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Michael Wang
- 14Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Regis Haid
- 15Atlanta Brain and Spine, Atlanta, Georgia
| | | | | | - Paul Park
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.,10Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee
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15
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Do DH, O’Meara K, Lee J, Meyer S, Hanna P, Mori S, Fishbein MC, Boyle NG, Elizari MV, Bradfield JS, Shivkumar K. Ventricular Parasystole in Cardiomyopathy Patients. JACC Clin Electrophysiol 2023. [DOI: 10.1016/j.jacep.2022.11.014] [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: 02/24/2023]
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16
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Chan AK, Shaffrey CI, Gottfried ON, Park C, Than KD, Bisson EF, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Shaffrey ME, Buchholz AL, Tumialán LM, Turner JD, Michalopoulos GD, Sherrod BA, Agarwal N, Chou D, Haid RW, Mummaneni PV. Cervical spondylotic myelopathy with severe axial neck pain: is anterior or posterior approach better? J Neurosurg Spine 2023; 38:42-55. [PMID: 36029264 DOI: 10.3171/2022.6.spine22110] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/24/2022] [Accepted: 06/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether multilevel anterior cervical discectomy and fusion (ACDF) or posterior cervical laminectomy and fusion (PCLF) is superior for patients with cervical spondylotic myelopathy (CSM) and high preoperative neck pain. METHODS This was a retrospective study of prospectively collected data using the Quality Outcomes Database (QOD) CSM module. Patients who received a subaxial fusion of 3 or 4 segments and had a visual analog scale (VAS) neck pain score of 7 or greater at baseline were included. The 3-, 12-, and 24-month outcomes were compared for patients undergoing ACDF with those undergoing PCLF. RESULTS Overall, 1141 patients with CSM were included in the database. Of these, 495 (43.4%) presented with severe neck pain (VAS score > 6). After applying inclusion and exclusion criteria, we compared 65 patients (54.6%) undergoing 3- and 4-level ACDF and 54 patients (45.4%) undergoing 3- and 4-level PCLF. Patients undergoing ACDF had worse Neck Disability Index scores at baseline (52.5 ± 15.9 vs 45.9 ± 16.8, p = 0.03) but similar neck pain (p > 0.05). Otherwise, the groups were well matched for the remaining baseline patient-reported outcomes. The rates of 24-month follow-up for ACDF and PCLF were similar (86.2% and 83.3%, respectively). At the 24-month follow-up, both groups demonstrated mean improvements in all outcomes, including neck pain (p < 0.05). In multivariable analyses, there was no significant difference in the degree of neck pain change, rate of neck pain improvement, rate of pain-free achievement, and rate of reaching minimal clinically important difference (MCID) in neck pain between the two groups (adjusted p > 0.05). However, ACDF was associated with a higher 24-month modified Japanese Orthopaedic Association scale (mJOA) score (β = 1.5 [95% CI 0.5-2.6], adjusted p = 0.01), higher EQ-5D score (β = 0.1 [95% CI 0.01-0.2], adjusted p = 0.04), and higher likelihood for return to baseline activities (OR 1.2 [95% CI 1.1-1.4], adjusted p = 0.002). CONCLUSIONS Severe neck pain is prevalent among patients undergoing surgery for CSM, affecting more than 40% of patients. Both ACDF and PCLF achieved comparable postoperative neck pain improvement 3, 12, and 24 months following 3- or 4-segment surgery for patients with CSM and severe neck pain. However, multilevel ACDF was associated with superior functional status, quality of life, and return to baseline activities at 24 months in multivariable adjusted analyses.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Christine Park
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 1Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Domagoj Coric
- 4Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 5Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Kevin T Foley
- 6Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Michael Y Wang
- 7Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Michael S Virk
- 8Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | | | - Scott Meyer
- 9Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Paul Park
- 10Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag Upadhyaya
- 11Marion Bloch Neuroscience Institute, Saint Luke's Health System, Kansas City, Missouri
| | - Mark E Shaffrey
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Avery L Buchholz
- 12Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Jay D Turner
- 13Barrow Neurological Institute, Phoenix, Arizona
| | | | - Brandon A Sherrod
- 2Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Nitin Agarwal
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Dean Chou
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Regis W Haid
- 15Atlanta Brain and Spine Care, Atlanta, Georgia
| | - Praveen V Mummaneni
- 14Department of Neurological Surgery, University of California, San Francisco, California; and
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17
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Yee TJ, Upadhyaya C, Coric D, Potts EA, Bisson EF, Turner J, Knightly JJ, Fu KM, Foley KT, Tumialan L, Shaffrey ME, Bydon M, Mummaneni P, Chou D, Chan A, Meyer S, Asher AL, Shaffrey C, Gottfried ON, Than KD, Wang MY, Buchholz AL, Haid R, Park P. Correlation of the Modified Japanese Orthopedic Association With Functional and Quality-of-Life Outcomes After Surgery for Degenerative Cervical Myelopathy: A Quality Outcomes Database Study. Neurosurgery 2022; 91:952-960. [PMID: 36149088 DOI: 10.1227/neu.0000000000002161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 07/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The modified Japanese Orthopedic Association (mJOA) score is a widely used and validated metric for assessing severity of myelopathy. Its relationship to functional and quality-of-life outcomes after surgery has not been fully described. OBJECTIVE To quantify the association of the mJOA with the Neck Disability Index (NDI) and EuroQol-5 Dimension (EQ-5D) after surgery for degenerative cervical myelopathy. METHODS The cervical module of the prospectively enrolled Quality Outcomes Database was queried retrospectively for adult patients who underwent single-stage degenerative cervical myelopathy surgery. The mJOA score, NDI, and EQ-5D were assessed preoperatively and 3 and 12 months postoperatively. Improvement in mJOA was used as the independent variable in univariate and multivariable linear and logistic regression models. RESULTS Across 14 centers, 1121 patients were identified, mean age 60.6 ± 11.8 years, and 52.5% male. Anterior-only operations were performed in 772 patients (68.9%). By univariate linear regression, improvements in mJOA were associated with improvements in NDI and EQ-5D at 3 and 12 months postoperatively (all P < .0001) and with improvements in the 10 NDI items individually. These findings were similar in multivariable regression incorporating potential confounders. The Pearson correlation coefficients for changes in mJOA with changes in NDI were -0.31 and -0.38 at 3 and 12 months postoperatively. The Pearson correlation coefficients for changes in mJOA with changes in EQ-5D were 0.29 and 0.34 at 3 and 12 months. CONCLUSION Improvements in mJOA correlated weakly with improvements in NDI and EQ-5D, suggesting that changes in mJOA may not be a suitable proxy for functional and quality-of-life outcomes.
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Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheerag Upadhyaya
- Saint Luke's Neurological and Spine Surgery, Kansas City, Missouri, USA
| | - Domagoj Coric
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | - Eric A Potts
- Goodman Campbell Brain and Spine, Carmel, Indiana, USA
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jay Turner
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jack J Knightly
- Altair Health Spine and Wellness, Morristown, New Jersey, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA
| | - Luis Tumialan
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Andrew Chan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Scott Meyer
- Altair Health Spine and Wellness, Morristown, New Jersey, USA
| | - Anthony L Asher
- Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | - Christopher Shaffrey
- Department of Neurological Surgery, Duke University, Raleigh, North Carolina, USA
| | - Oren N Gottfried
- Department of Neurological Surgery, Duke University, Raleigh, North Carolina, USA
| | - Khoi D Than
- Department of Neurological Surgery, Duke University, Raleigh, North Carolina, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Avery L Buchholz
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Regis Haid
- Atlanta Brain and Spine, Atlanta, Georgia, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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18
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Alam S, Meyer S, Kuo L, Hu Y, Lu W, Yorke E, Rimner A, Cervino L, Zhang P. Patient-Specific Quality Assurance of Deformable Image Registrations Using Atlas for Adaptive Radiotherapy of Lung Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2253] [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: 11/17/2022]
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19
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Kates R, Sprecher B, Meyer S, Tonk C, Schinköthe T, Harbeck N, Schmidt A. Trained Artificial Intelligence (AI) for Predicting Therapy Discontinuation Based on Patient Observations in Advanced Breast Cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Wada Y, Jensen C, Meyer S, Yamamoto Y, Honda H. Effects of interleukin-6 inhibition with ziltivekimab in patients at high risk of atherosclerotic events in Japan: results from the phase 2 RESCUE-2 trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In the US phase 2 RESCUE trial, ziltivekimab, a fully human monoclonal antibody against the ligand of the pro-inflammatory cytokine interleukin-6, was shown to reduce biomarkers of inflammation in patients with chronic kidney disease (CKD) and elevated levels of high-sensitivity C-reactive protein (hsCRP), a marker of inflammation and cardiac risk.1 Here, we present outcomes from the phase 2 RESCUE-2 trial of ziltivekimab in a patient population from Japan.
Purpose
To evaluate the efficacy and safety of ziltivekimab 15 mg and 30 mg compared with placebo in Japanese patients with non-dialysis-dependent CKD (NDD-CKD).
Methods
We conducted a randomized, double-blind, placebo-controlled trial in 36 patients aged ≥20 years with stage 3–5 NDD-CKD and hsCRP ≥2 mg/L. Patients were randomly assigned to receive subcutaneous ziltivekimab 15 mg (n=11) or 30 mg (n=12), or placebo (n=13) at weeks 0, 4 and 8. The primary endpoint was percentage change in hsCRP levels from baseline to end of treatment (EOT) (average of week 10 and week 12 values); secondary endpoints included percentage change from baseline to EOT in levels of fibrinogen, serum amyloid A (SAA), N-terminal pro B-type natriuretic peptide (NT-proBNP) and lipids. Analysis of endpoints was performed using Wilcoxon two-sample test; differences between treatment groups were calculated using the Hodges–Lehmann estimator.
Results
Baseline characteristics are shown in the Table. At EOT, median hsCRP levels were reduced by 96% and 93% in the ziltivekimab 15 mg and 30 mg groups, respectively, compared with 27% for placebo (both p<0.001 vs placebo). At both doses, ziltivekimab provided rapid and sustained suppression of hsCRP over the 12-week treatment period (Figure). Statistically significant reductions in levels of the inflammatory markers SAA (15 mg: 71%; 30 mg: 58%; placebo: 30%; both p<0.01 vs placebo) and fibrinogen (38%; 34%; 2%; both p<0.0001 vs placebo) were also observed. Ziltivekimab was well tolerated, did not result in persistent neutropenia or thrombocytopenia, and had minimal effect on liver enzyme levels. There was a non-significant increase in low-density lipoprotein levels and a neutral effect on high-density lipoprotein levels. There was a limited, but statistically significant (p<0.05 vs placebo) increase in triglycerides, whereby levels increased in some patients and decreased in others.
Conclusion
Ziltivekimab effectively reduced inflammatory biomarkers associated with atherosclerosis in patients from Japan with CKD and residual inflammatory risk as measured by hsCRP. A significant reduction of more than 90% in hsCRP levels for both doses of ziltivekimab was demonstrated, with a safety profile similar to placebo. Overall, the results of the RESCUE-2 trial in Japan are consistent with the efficacy and safety results of the US-based RESCUE trial.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was funded by Novo Nordisk A/S. Medical writing support was provided by Johanna Scheinost PhD, PharmaGenesis Oxford Central, Oxford, UK, with funding from Novo Nordisk A/S.
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Affiliation(s)
- Y Wada
- Showa University School of Medicine , Tokyo , Japan
| | - C Jensen
- Novo Nordisk A/S , Søborg , Denmark
| | - S Meyer
- Novo Nordisk A/S , Søborg , Denmark
| | | | - H Honda
- Showa University School of Medicine , Tokyo , Japan
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21
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Adelung S, Dietrich RU, Habermeyer F, Meyer S, Raab M, Weyand J. Techno‐Economic and Environmental Assessment of Multiple Energy Transition Options – Methodology and Results. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255114] [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: 11/07/2022]
Affiliation(s)
- S. Adelung
- German Aerospace Center (DLR e.V.) Institute of Engineering Thermodynamics (TT) Pfaffenwaldring 38–40 70569 Stuttgart Germany
| | - R.-U. Dietrich
- German Aerospace Center (DLR e.V.) Institute of Engineering Thermodynamics (TT) Pfaffenwaldring 38–40 70569 Stuttgart Germany
| | - F. Habermeyer
- German Aerospace Center (DLR e.V.) Institute of Engineering Thermodynamics (TT) Pfaffenwaldring 38–40 70569 Stuttgart Germany
| | - S. Meyer
- German Aerospace Center (DLR e.V.) Institute of Engineering Thermodynamics (TT) Pfaffenwaldring 38–40 70569 Stuttgart Germany
| | - M. Raab
- German Aerospace Center (DLR e.V.) Institute of Engineering Thermodynamics (TT) Pfaffenwaldring 38–40 70569 Stuttgart Germany
| | - J. Weyand
- German Aerospace Center (DLR e.V.) Institute of Engineering Thermodynamics (TT) Pfaffenwaldring 38–40 70569 Stuttgart Germany
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22
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Berlin C, Marino AC, Mummaneni PV, Uribe J, Tumialán LM, Turner J, Wang MY, Park P, Bisson EF, Shaffrey M, Gottfried O, Than KD, Fu KM, Foley K, Chan AK, Bydon M, Alvi MA, Upadhyaya C, Coric D, Asher A, Potts EA, Knightly J, Meyer S, Buchholz A. Determining the time frame of maximum clinical improvement in surgical decompression for cervical spondylotic myelopathy when stratified by preoperative myelopathy severity: a cervical Quality Outcomes Database study. J Neurosurg Spine 2022; 37:1-9. [PMID: 35901760 DOI: 10.3171/2022.5.spine211425] [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: 11/08/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While surgical decompression is an important treatment modality for cervical spondylotic myelopathy (CSM), it remains unclear if the severity of preoperative myelopathy status affects potential benefit from surgical intervention and when maximum postoperative improvement is expected. This investigation sought to determine if retrospective analysis of prospectively collected patient-reported outcomes (PROs) following surgery for CSM differed when stratified by preoperative myelopathy status. Secondary objectives included assessment of the minimal clinically important difference (MCID). METHODS A total of 1151 patients with CSM were prospectively enrolled from the Quality Outcomes Database at 14 US hospitals. Baseline demographics and PROs at baseline and 3 and 12 months were measured. These included the modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), quality-adjusted life-years (QALYs) from the EQ-5D, and visual analog scale from the EQ-5D (EQ-VAS). Patients were stratified by preoperative myelopathy severity using criteria established by the AO Spine study group: mild (mJOA score 15-17), moderate (mJOA score 12-14), or severe (mJOA score < 12). Univariate analysis was used to identify demographic variables that significantly varied between myelopathy groups. Then, multivariate linear regression and linear mixed regression were used to model the effect of severity and time on PROs, respectively. RESULTS For NDI, EQ-VAS, and QALY, patients in all myelopathy cohorts achieved significant, maximal improvement at 3 months without further improvement at 12 months. For mJOA, moderate and severe myelopathy groups demonstrated significant, maximal improvement at 3 months, without further improvement at 12 months. The mild myelopathy group did not demonstrate significant change in mJOA score but did maintain and achieve higher PRO scores overall when compared with more advanced myelopathy cohorts. The MCID threshold was reached in all myelopathy cohorts at 3 months for mJOA, NDI, EQ-VAS, and QALY, with the only exception being mild myelopathy QALY at 3 months. CONCLUSIONS As assessed by statistical regression and MCID analysis, patients with cervical myelopathy experience maximal improvement in their quality of life, neck disability, myelopathy score, and overall health by 3 months after surgical decompression, regardless of their baseline myelopathy severity. An exception was seen for the mJOA score in the mild myelopathy cohort, improvement of which may have been limited by ceiling effect. The data presented here will aid surgeons in patient selection, preoperative counseling, and expected postoperative time courses.
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Affiliation(s)
- Connor Berlin
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Alexandria C Marino
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Praveen V Mummaneni
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Juan Uribe
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Luis M Tumialán
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay Turner
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael Y Wang
- 4Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Paul Park
- 5Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erica F Bisson
- 6Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Mark Shaffrey
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Oren Gottfried
- 7Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Khoi D Than
- 7Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Kai-Ming Fu
- 8Department of Neurological Surgery, Weill Cornell Medicine, New York City, New York
| | - Kevin Foley
- 9Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Andrew K Chan
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 10Department of Neurosurgery, Mayo Clinic Neuro-Informatics Lab, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 10Department of Neurosurgery, Mayo Clinic Neuro-Informatics Lab, Mayo Clinic, Rochester, Minnesota
| | - Cheerag Upadhyaya
- 11Marion Bloch Neuroscience Institute's Spine Program, Saint Luke Health System, Kansas City, Missouri
| | - Domagoj Coric
- 12Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina
| | - Anthony Asher
- 12Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina
| | - Eric A Potts
- 13Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | - John Knightly
- 14Atlantic Neurosurgical Specialists, Altair Health Spine & Wellness Center, Morristown, New Jersey
| | - Scott Meyer
- 14Atlantic Neurosurgical Specialists, Altair Health Spine & Wellness Center, Morristown, New Jersey
| | - Avery Buchholz
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Rethorn ZD, Cook CE, Park C, Somers T, Mummaneni PV, Chan AK, Pennicooke BH, Bisson EF, Asher AL, Buchholz AL, Bydon M, Alvi MA, Coric D, Foley KT, Fu KM, Knightly JJ, Meyer S, Park P, Potts EA, Shaffrey CI, Shaffrey M, Than KD, Tumialan L, Turner JD, Upadhyaya CD, Wang MY, Gottfried O. Social risk factors predicting outcomes of cervical myelopathy surgery. J Neurosurg Spine 2022; 37:1-8. [PMID: 35090132 DOI: 10.3171/2021.12.spine21874] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/27/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Combinations of certain social risk factors of race, sex, education, socioeconomic status (SES), insurance, education, employment, and one's housing situation have been associated with poorer pain and disability outcomes after lumbar spine surgery. To date, an exploration of such factors in patients with cervical spine surgery has not been conducted. The objective of the current work was to 1) define the social risk phenotypes of individuals who have undergone cervical spine surgery for myelopathy and 2) analyze their predictive capacity toward disability, pain, quality of life, and patient satisfaction-based outcomes. METHODS The Cervical Myelopathy Quality Outcomes Database was queried for the period from January 2016 to December 2018. Race/ethnicity, educational attainment, SES, insurance payer, and employment status were modeled into unique social phenotypes using latent class analyses. Proportions of social groups were analyzed for demonstrating a minimal clinically important difference (MCID) of 30% from baseline for disability, neck and arm pain, quality of life, and patient satisfaction at the 3-month and 1-year follow-ups. RESULTS A total of 730 individuals who had undergone cervical myelopathy surgery were included in the final cohort. Latent class analysis identified 2 subgroups: 1) high risk (non-White race and ethnicity, lower educational attainment, not working, poor insurance, and predominantly lower SES), n = 268, 36.7% (class 1); and 2) low risk (White, employed with good insurance, and higher education and SES), n = 462, 63.3% (class 2). For both 3-month and 1-year outcomes, the high-risk group (class 1) had decreased odds (all p < 0.05) of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Being in the low-risk group (class 2) resulted in an increased odds of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Neither group had increased or decreased odds of being satisfied with surgery. CONCLUSIONS Although 2 groups underwent similar surgical approaches, the social phenotype involving non-White race/ethnicity, poor insurance, lower SES, and poor employment did not meet MCIDs for a variety of outcome measures. This finding should prompt surgeons to proactively incorporate socially conscience care pathways within healthcare systems, as well as to optimize community-based resources to improve outcomes and personalize care for populations at social risk.
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Affiliation(s)
- Zachary D Rethorn
- 1Department of Orthopaedics, Duke University, Durham
- 19Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Chad E Cook
- 1Department of Orthopaedics, Duke University, Durham
- 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine Park
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Tamara Somers
- 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Praveen V Mummaneni
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Erica F Bisson
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Avery L Buchholz
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohamad Bydon
- 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Domagoj Coric
- 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin T Foley
- 10Department of Neurosurgery, University of Tennessee and Semmes-Murphey Clinic, Memphis, Tennessee
| | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | | | - Scott Meyer
- 12Altair Health Spine and Wellness, Morristown, New Jersey
| | - Paul Park
- 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Eric A Potts
- 14Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Christopher I Shaffrey
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Mark Shaffrey
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Khoi D Than
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jay D Turner
- 16Barrow Neurological Institute, Phoenix, Arizona
| | | | - Michael Y Wang
- 18Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Oren Gottfried
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
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Schnürle K, Bortfeldt J, Englbrecht F, Gianoli C, Hartmann J, Hofverberg P, Meyer S, Vidal M, Hérault J, Schreiber J, Parodi K, Würl M. Development of integration mode proton imaging with a single CMOS detector for a small animal irradiation platform. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00094-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Asuzu DT, Yun JJ, Alvi MA, Chan AK, Upadhyaya CD, Coric D, Potts EA, Bisson EF, Turner JD, Knightly JJ, Fu KM, Foley KT, Tumialan L, Shaffrey M, Bydon M, Mummaneni PV, Park P, Meyer S, Asher AL, Gottfried ON, Than KD, Wang MY, Buchholz AL. Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database. J Neurosurg Spine 2021; 36:568-574. [PMID: 34740180 DOI: 10.3171/2021.7.spine21590] [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: 04/24/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors' objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes. METHODS Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes. RESULTS In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05). CONCLUSIONS Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.
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Affiliation(s)
- David T Asuzu
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,2Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jonathan J Yun
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Andrew K Chan
- 5Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | | | - Domagoj Coric
- 7Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 8Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Jay D Turner
- 9Barrow Neurological Institute, Phoenix, Arizona
| | | | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Kevin T Foley
- 12Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Mark Shaffrey
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Mohamad Bydon
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 5Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Paul Park
- 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Scott Meyer
- 10Altair Health Spine and Wellness, Morristown, New Jersey
| | - Anthony L Asher
- 7Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Oren N Gottfried
- 14Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Khoi D Than
- 14Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Michael Y Wang
- 15Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Avery L Buchholz
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Opdensteinen P, Meyer S, Buyel JF. Nicotiana spp. for the Expression and Purification of Functional IgG3 Antibodies Directed Against the Staphylococcus aureus Alpha Toxin. Front Chem Eng 2021. [DOI: 10.3389/fceng.2021.737010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Immunoglobulin subclass IgG1 is bound and neutralized effectively by Staphylococcus aureus protein A, allowing the bacterium to evade the host’s adaptive immune response. In contrast, the IgG3 subclass is not bound by protein A and can be used to treat S. aureus infections, including drug-resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA). However, the yields of recombinant IgG3 are generally low because this subclass is prone to degradation, and recovery is hindered by the inability to use protein A as an affinity ligand for antibody purification. Here, we investigated plants (Nicotiana spp.) as an alternative to microbes and mammalian cell cultures for the production of an IgG3 antibody specific for the S. aureus alpha toxin. We targeted recombinant IgG3 to different subcellular compartments and tested different chromatography conditions to improve recovery and purification. Finally, we tested the antigen-binding capacity of the purified antibodies. The highest IgG3 levels in planta (>130 mg kg−1 wet biomass) were achieved by targeting the endoplasmic reticulum or apoplast. Although the purity of IgG3 exceeded 95% following protein G chromatography, product recovery requires further improvement. Importantly, the binding affinity of the purified antibodies was in the nanomolar range and thus comparable to previous studies using murine hybridoma cells as the production system.
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27
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Meyer S, Wagner G, Cepni A, Ledoux T, Walsh D, Johnston C, Arlinghaus K. Lunch Skipping Behaviors Among Black and Hispanic Adolescents Who Receive Free School Meals. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.08.089] [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: 10/20/2022]
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Do DH, Meyer S, Bradfield J, Shivkumar K, Boyle NG, Khakpour H. Masked premature ventricular contractions and intradevice interaction causing ventricular fibrillation. HeartRhythm Case Rep 2021; 7:69-73. [PMID: 33665104 PMCID: PMC7897743 DOI: 10.1016/j.hrcr.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott Meyer
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Houman Khakpour
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
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Chang CC, Chu A, Meyer S, Ding Y, Sun MM, Abiri P, Baek KI, Gudapati V, Ding X, Guihard P, Bostrom KI, Li S, Gordon LK, Zheng JJ, Hsiai TK. Three-dimensional Imaging Coupled with Topological Quantification Uncovers Retinal Vascular Plexuses Undergoing Obliteration. Theranostics 2021; 11:1162-1175. [PMID: 33391527 PMCID: PMC7738897 DOI: 10.7150/thno.53073] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction: Murine models provide microvascular insights into the 3-D network disarray seen in retinopathy and cardiovascular diseases. Light-sheet fluorescence microscopy (LSFM) has emerged to capture retinal vasculature in 3-D, allowing for assessment of the progression of retinopathy and the potential to screen new therapeutic targets in mice. We hereby coupled LSFM, also known as selective plane illumination microscopy, with topological quantification, to characterize the retinal vascular plexuses undergoing preferential obliteration. Method and Result: In postnatal mice, we revealed the 3-D retinal microvascular network in which the vertical sprouts bridge the primary (inner) and secondary (outer) plexuses, whereas, in an oxygen-induced retinopathy (OIR) mouse model, we demonstrated preferential obliteration of the secondary plexus and bridging vessels with a relatively unscathed primary plexus. Using clustering coefficients and Euler numbers, we computed the local versus global vascular connectivity. While local connectivity was preserved (p > 0.05, n = 5 vs. normoxia), the global vascular connectivity in hyperoxia-exposed retinas was significantly reduced (p < 0.05, n = 5 vs. normoxia). Applying principal component analysis (PCA) for auto-segmentation of the vertical sprouts, we corroborated the obliteration of the vertical sprouts bridging the secondary plexuses, as evidenced by impaired vascular branching and connectivity, and reduction in vessel volumes and lengths (p < 0.05, n = 5 vs. normoxia). Conclusion: Coupling 3-D LSFM with topological quantification uncovered the retinal vasculature undergoing hyperoxia-induced obliteration from the secondary (outer) plexus to the vertical sprouts. The use of clustering coefficients, Euler's number, and PCA provided new network insights into OIR-associated vascular obliteration, with translational significance for investigating therapeutic interventions to prevent visual impairment.
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Affiliation(s)
- Chih-Chiang Chang
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Scott Meyer
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Yichen Ding
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michel M. Sun
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Parinaz Abiri
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kyung In Baek
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Varun Gudapati
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Xili Ding
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
| | - Pierre Guihard
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kristina I. Bostrom
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Greater Los Angeles VA Healthcare System, Los Angeles, CA
| | - Song Li
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
| | - Lynn K. Gordon
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jie J. Zheng
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tzung K. Hsiai
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Greater Los Angeles VA Healthcare System, Los Angeles, CA
- Medical Engineering, California Institute of Technology, Pasadena, CA
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30
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Affiliation(s)
- O. De Witte
- Departments of Neurosurgery, Hôpital Erasme-Ulb, Brussels, Belgium
| | - N. Massager
- Departments of Neurosurgery, Hôpital Erasme-Ulb, Brussels, Belgium
| | - I. Salmon
- Departments of Neuro-Pathology, Hôpital Erasme-Ulb, Brussels, Belgium
| | - S. Meyer
- Department of Oncology, Hôpital de la Ville, Esch-sur-Alzette
| | - G. Dooms
- Department of Radiology, Centre Hospitalier de Luxembourg, Grand Duché de Luxembourg
| | - J. Brotchi
- Departments of Neurosurgery, Hôpital Erasme-Ulb, Brussels, Belgium
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Wienbergen H, Fach A, Meyer S, Schmucker J, Osteresch R, Michel S, Retzlaff T, Steckenborn M, Elsaesser A, Langer H, Hambrecht R. Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after >24 months (“prevention boost”) is effective.
Methods
In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control.
In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention.
Results
At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p<0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p<0.05, Figure 1).
A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p<0.05 between the groups, Figure 1).
Conclusions
IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after >24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)
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Affiliation(s)
- H Wienbergen
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | - A Fach
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | - S Meyer
- Heart Center Oldenburg, Oldenburg, Germany
| | - J Schmucker
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | - R Osteresch
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | - S Michel
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | - T Retzlaff
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | - M Steckenborn
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
| | | | - H Langer
- University Heart Center, Luebeck, Germany
| | - R Hambrecht
- Hospital Links der Weser, Bremen Institute for Heart and Circulation Research, Bremen, Germany
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Meyer S, Esber A, Runnebaum I, Mothes A. Laser in der Urogynäkologie – Vorläufige Daten einer prospektive Beobachtungsstudie zum dualen Er:YAG thermisch – ablativen Laser Protokoll. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - A. Esber
- St. Georg Klinikum Eisenach, Frauenklinik
| | | | - A.R. Mothes
- Universitätsfrauenklinik
- St. Georg Klinikum Eisenach, Frauenklinik
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Fisher J, Barbor N, Coughlin K, McLaughlin K, Meyer S, Melnick L, Gallant E, Dubiel B, Synek C, Evers L, DeChicco R. Dietetic Interns Competency to Diagnosing Malnutrition. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.212] [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: 11/30/2022]
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Meyer S, Zimmer A, Hamza A, Poryo M. Is there a role for cerebral ultrasonography in near-term/term neonates following assisted vaginal delivery? A prospective, single-center study. Early Hum Dev 2020; 147:105101. [PMID: 32518027 DOI: 10.1016/j.earlhumdev.2020.105101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Meyer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany.
| | - A Zimmer
- Medical School, Saarland University Medical Center, Homburg, Germany
| | - A Hamza
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - M Poryo
- Department of Gynecology and Obstetrics, Saarland University Medical Center, Homburg, Germany
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Seemüller F, Riedel M, Obermeier M, Schennach-Wolff R, Spellmann I, Meyer S, Bauer M, Adli M, Kronmüller K, Ising M, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Möller HJ. The validity of self-rated psychotic symptoms in depressed inpatients. Eur Psychiatry 2020; 27:547-52. [DOI: 10.1016/j.eurpsy.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 12/22/2022] Open
Abstract
AbstractBackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P<0.001) and with the BDI total score (0.64, P<0.001). Moderate correlations were found for the MADRS (0.34, P<0.001), HAMD (0.37, P<0.001) and AMDP depression score (0.33, P<0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P<0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P<0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.
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Abstract
Background and aimsValid assessments require sufficient effort from the part of the testee. Motivation may be compromised, particularly in psychiatric conditions. We examined associations between response bias on free recall and self-reported symptoms in depressed and PTSD patients.Participants and methodsThis is a cross-sectional study. Patients had depression (n = 48), or PTSD or other anxiety disorders (n = 37). A control group (n = 47%) had chronic pain disorder, fibromyalgia or chronic fatigue. The Green Word Memory Test (GWMT) was administered to all subjects. The Structured Inventory of Malingered. Symptomatology (SIMS), and the Beck Depression Inventory (BDI-II) were administered in subsamples. Study outcome was self-reported depressive symptoms in Symptom Validity Test (SVT) negative cases.ResultsAverage age of the participants was 45.1 years (SD 9.5), 48.5% were female. GWMT was positive in 52.3% of all cases, GWMT and SIMS were positive in 33.8%, and GWMT and SIMS were negative in 37.7%. No significant group effects on GWMT were found. Average BDI-II scores were 32.8 (SD 13.9) for depressed patients, 28.3 (15.5) for those with anxiety disorders, and 27.6 (14.1) for controls (P = 0.43). Seventy-eight percent of depressed GWMT negative cases reported at least moderate depressive symptoms (BDI-II > 18), and 44.4% severe symptoms (BDI-II > 29). Approximately half of the GWMT negative cases with anxiety disorders and controls scored BDI-II > 18.ConclusionsNon credible test performance is prevalent in disability claimants with affective, mood disorders. However, depressive symptoms per se do not explain poor effort on cognitive tasks.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Magallanes L, Meyer S, Gianoli C, Kopp B, Voss B, Jakel O, Brons S, Gordon J, Parodi K. Upgrading an Integrating Carbon-Ion Transmission Imaging System With Active Scanning Beam Delivery Toward Low Dose Ion Imaging. IEEE Trans Radiat Plasma Med Sci 2020. [DOI: 10.1109/trpms.2019.2948584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Weingaertner O, Luetjohann D, Meyer S, Seiler-Mussler S, Fuhrmann A, Schoett HF, Kerksiek A, Friedrichs S, Zawada A, Laufs U, Scheller B, Fliser D, Boehm M, Sijbrands E, Heine GH. P6434Low serum lathosterol levels predict fatal cardiovascular disease and all cause mortality: a prospective cohort study in patients admitted for coronary angiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6434] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- O Weingaertner
- Universitätsklinikum Jena, Klinik für Innere Medizin 1, Jena, Germany
| | - D Luetjohann
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - S Meyer
- Klinikum Oldenburg, Abteilung für Kardiologie, Oldenburg, Germany
| | - S Seiler-Mussler
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - A Fuhrmann
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - H F Schoett
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - A Kerksiek
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - S Friedrichs
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - A Zawada
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - U Laufs
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - B Scheller
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homurg, Germany
| | - D Fliser
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - M Boehm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homurg, Germany
| | - E Sijbrands
- Erasmus University Rotterdam, Department of Internal Medicine, Rotterdam, Netherlands
| | - G H Heine
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
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Backhaus T, Michel S, Meyer S, Fach A, Schmucker J, Osteresch R, Stehmeier J, Wettwer T, Haase H, Elsaesser A, Hambrecht R, Wienbergen H. P1228Which role plays the school degree in effectiveness of prevention after myocardial infarction? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Backhaus
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - S Michel
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - S Meyer
- Oldenburg Hospital, Oldenburg, Germany
| | - A Fach
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - J Schmucker
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - R Osteresch
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - J Stehmeier
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - T Wettwer
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - H Haase
- RehaZentrum, Bremen, Germany
| | | | - R Hambrecht
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
| | - H Wienbergen
- Hospital Links der Weser, Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen, Germany
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Michel S, Backhaus T, Meyer S, Fach A, Schmucker J, Osteresch R, Stehmeier J, Wettwer T, Haase H, Elsaesser A, Hambrecht R, Wienbergen H. P1229Intensive prevention program after myocardial infarction: how can LDL cholesterol be reduced and how long are intensive prevention efforts needed? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1229] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Michel
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - T Backhaus
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - S Meyer
- Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - A Fach
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - J Schmucker
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - R Osteresch
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - J Stehmeier
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - T Wettwer
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - H Haase
- RehaZentrum Bremen, Bremen, Germany
| | - A Elsaesser
- Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - R Hambrecht
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - H Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
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Fuhrmann A, Weingaertner O, Meyer S, Cremers B, Seiler-Mussler S, Schoett HF, Kerksiek A, Ulbricht U, Zawada A, Laufs U, Scheller B, Fliser D, Boehm M, Heine GH, Luetjohann D. P1544No associations of plasma oxyphytosterol levels and cardiovascular events in patients admitted for coronary angiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1544] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Fuhrmann
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - O Weingaertner
- Universitätsklinikum Jena, Klinik für Innere Medizin 1, Jena, Germany
| | - S Meyer
- Klinikum Oldenburg, Abteilung für Kardiologie, Oldenburg, Germany
| | - B Cremers
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homurg, Germany
| | - S Seiler-Mussler
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - H F Schoett
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - A Kerksiek
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
| | - U Ulbricht
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - A Zawada
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - U Laufs
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - B Scheller
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homurg, Germany
| | - D Fliser
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - M Boehm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homurg, Germany
| | - G H Heine
- Universitätsklinikum des Saarlandes, Abteilung für Nieren- und Hochdruckkrankheiten, Homburg/Saar, Germany
| | - D Luetjohann
- Universitätsklinikum Bonn, Institut für Klinische Pharmakologie und Klinische Chemie, Bonn, Germany
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Solaro C, Meyer S, Fisher K, DePalatis MV, Drewsen M. Direct Frequency-Comb-Driven Raman Transitions in the Terahertz Range. Phys Rev Lett 2018; 120:253601. [PMID: 29979052 DOI: 10.1103/physrevlett.120.253601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 06/08/2023]
Abstract
We demonstrate the use of a femtosecond frequency comb to coherently drive stimulated Raman transitions between terahertz-spaced atomic energy levels. More specifically, we address the 3d ^{2}D_{3/2} and 3d ^{2}D_{5/2} fine structure levels of a single trapped ^{40}Ca^{+} ion and spectroscopically resolve the transition frequency to be ν_{D}=1,819,599,021,534±8 Hz. The achieved accuracy is nearly a factor of five better than the previous best Raman spectroscopy, and is currently limited by the stability of our atomic clock reference. Furthermore, the population dynamics of frequency-comb-driven Raman transitions can be fully predicted from the spectral properties of the frequency comb, and Rabi oscillations with a contrast of 99.3(6)% and millisecond coherence time have been achieved. Importantly, the technique can be easily generalized to transitions in the sub-kHz to tens of THz range and should be applicable for driving, e.g., spin-resolved rovibrational transitions in molecules and hyperfine transitions in highly charged ions.
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Affiliation(s)
- C Solaro
- Department of Physics and Astronomy, Aarhus University, DK-8000 Aarhus C, Denmark
| | - S Meyer
- Department of Physics and Astronomy, Aarhus University, DK-8000 Aarhus C, Denmark
| | - K Fisher
- Department of Physics and Astronomy, Aarhus University, DK-8000 Aarhus C, Denmark
| | - M V DePalatis
- Department of Physics and Astronomy, Aarhus University, DK-8000 Aarhus C, Denmark
| | - M Drewsen
- Department of Physics and Astronomy, Aarhus University, DK-8000 Aarhus C, Denmark
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Hogan C, Speiser E, Chandola S, Suchkova S, Aulbach J, Schäfer J, Meyer S, Claessen R, Esser N. Controlling the Local Electronic Properties of Si(553)-Au through Hydrogen Doping. Phys Rev Lett 2018; 120:166801. [PMID: 29756924 DOI: 10.1103/physrevlett.120.166801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/12/2017] [Indexed: 06/08/2023]
Abstract
We propose a quantitative and reversible method for tuning the charge localization of Au-stabilized stepped Si surfaces by site-specific hydrogenation. This is demonstrated for Si(553)-Au as a model system by combining density functional theory simulations and reflectance anisotropy spectroscopy experiments. We find that controlled H passivation is a two-step process: step-edge adsorption drives excess charge into the conducting metal chain "reservoir" and renders it insulating, while surplus H recovers metallic behavior. Our approach illustrates a route towards microscopic manipulation of the local surface charge distribution and establishes a reversible switch of site-specific chemical reactivity and magnetic properties on vicinal surfaces.
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Affiliation(s)
- C Hogan
- Istituto di Struttura della Materia-CNR (ISM-CNR), via Fosso del Cavaliere 100, 00133 Rome, Italy
- Dipartimento di Fisica, Università di Roma "Tor Vergata", Via della Ricerca Scientifica 1, 00133 Roma, Italy
| | - E Speiser
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Schwarzschildstraße 8, 12489 Berlin, Germany
| | - S Chandola
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Schwarzschildstraße 8, 12489 Berlin, Germany
| | - S Suchkova
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Schwarzschildstraße 8, 12489 Berlin, Germany
| | - J Aulbach
- Physikalisches Institut and Röntgen Center for Complex Material Systems (RCCM), Universität Würzburg, Am Hubland, D-97074 Würzburg, Germany
| | - J Schäfer
- Physikalisches Institut and Röntgen Center for Complex Material Systems (RCCM), Universität Würzburg, Am Hubland, D-97074 Würzburg, Germany
| | - S Meyer
- Physikalisches Institut and Röntgen Center for Complex Material Systems (RCCM), Universität Würzburg, Am Hubland, D-97074 Würzburg, Germany
| | - R Claessen
- Physikalisches Institut and Röntgen Center for Complex Material Systems (RCCM), Universität Würzburg, Am Hubland, D-97074 Würzburg, Germany
| | - N Esser
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Schwarzschildstraße 8, 12489 Berlin, Germany
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Bernabé KJ, Nokoff NJ, Galan D, Felsen D, Aston CE, Austin P, Baskin L, Chan YM, Cheng EY, Diamond DA, Ellens R, Fried A, Greenfield S, Kolon T, Kropp B, Lakshmanan Y, Meyer S, Meyer T, Delozier AM, Mullins LL, Palmer B, Paradis A, Reddy P, Reyes KJS, Schulte M, Swartz JM, Yerkes E, Wolfe-Christensen C, Wisniewski AB, Poppas DP. Preliminary report: Surgical outcomes following genitoplasty in children with moderate to severe genital atypia. J Pediatr Urol 2018; 14:157.e1-157.e8. [PMID: 29398588 PMCID: PMC5970022 DOI: 10.1016/j.jpurol.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Prior studies of outcomes following genitoplasty have reported high rates of surgical complications among children with atypical genitalia. Few studies have prospectively assessed outcomes after contemporary surgical approaches. OBJECTIVE The current study reported the occurrence of early postoperative complications and of cosmetic outcomes (as rated by surgeons and parents) at 12 months following contemporary genitoplasty procedures in children born with atypical genitalia. STUDY DESIGN This 11-site, prospective study included children aged ≤2 years, with Prader 3-5 or Quigley 3-6 external genitalia, with no prior genitoplasty and non-urogenital malformations at the time of enrollment. Genital appearance was rated on a 4-point Likert scale. Paired t-tests evaluated differences in cosmesis ratings. RESULTS Out of 27 children, 10 were 46,XY patients with the following diagnoses: gonadal dysgenesis, PAIS or testosterone biosynthetic defect, severe hypospadias and microphallus, who were reared male. Sixteen 46,XX congenital adrenal hyperplasia patients were reared female and one child with sex chromosome mosaicism was reared male. Eleven children had masculinizing genitoplasty for penoscrotal or perineal hypospadias (one-stage, three; two-stage, eight). Among one-stage surgeries, one child had meatal stenosis (minor) and one developed both urinary retention (minor) and urethrocutaneous fistula (major) (Summary Figure). Among two-stage surgeries, three children developed a major complication: penoscrotal fistula, glans dehiscence or urethral dehiscence. Among 16 children who had feminizing genitoplasty, vaginoplasty was performed in all, clitoroplasty in nine, external genitoplasty in 13, urethroplasty in four, perineoplasty in five, and total urogenital sinus mobilization in two. Two children had minor complications: one had a UTI, and one had both a mucosal skin tag and vaginal mucosal polyp. Two additional children developed a major complication: vaginal stenosis. Cosmesis scores revealed sustained improvements from 6 months post-genitoplasty, as previously reported, with all scores reported as good or satisfied. DISCUSSION In these preliminary data from a multi-site, observational study, parents and surgeons were equally satisfied with the cosmetic outcomes 12 months after genitoplasty. A small number of patients had major complications in both feminizing and masculinizing surgeries; two-stage hypospadias repair had the most major complications. Long-term follow-up of patients at post-puberty will provide a better assessment of outcomes in this population. CONCLUSION In this cohort of children with moderate to severe atypical genitalia, preliminary data on both surgical and cosmetic outcomes were presented. Findings from this study, and from following these children in long-term studies, will help guide practitioners in their discussions with families about surgical management.
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Affiliation(s)
- K J Bernabé
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - N J Nokoff
- Children's Hospital Colorado, Aurora, CO, USA
| | - D Galan
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - D Felsen
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - C E Aston
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, OK, USA
| | - P Austin
- St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - L Baskin
- University of California San Francisco, San Francisco, CA, USA
| | - Y-M Chan
- Children's Hospital Boston, Department of Urology, Boston, MA, USA
| | - E Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - D A Diamond
- Children's Hospital Boston, Department of Urology, Boston, MA, USA
| | - R Ellens
- Children's Hospital of Michigan, Detroit, MI, USA
| | - A Fried
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - S Greenfield
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - T Kolon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Kropp
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - Y Lakshmanan
- Children's Hospital of Michigan, Detroit, MI, USA
| | - S Meyer
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - T Meyer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - A M Delozier
- Oklahoma State University, College of Arts and Sciences, Stillwater, OK, USA
| | - L L Mullins
- Oklahoma State University, College of Arts and Sciences, Stillwater, OK, USA
| | - B Palmer
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - A Paradis
- St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - P Reddy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - K J Scott Reyes
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - M Schulte
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J M Swartz
- Children's Hospital Boston, Department of Urology, Boston, MA, USA
| | - E Yerkes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - C Wolfe-Christensen
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA; Children's Hospital of Michigan, Detroit, MI, USA
| | - A B Wisniewski
- Genitourinary Institute, Cook Children's Hospital, Fort Worth, TX, USA
| | - D P Poppas
- The Comprehensive Center for Congenital Adrenal Hyperplasia, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
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Schell M, Meyer S, Rath M, Schwerdtle T, Kleinridders A. Extracellular citrate impacts hypothalamic mitochondrial function and activates AMPK. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Schell
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Central Regulation of Metabolism, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - S Meyer
- University of Potsdam, Institute of Nutritional Science, Nuthetal, Germany
| | - M Rath
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Central Regulation of Metabolism, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - T Schwerdtle
- University of Potsdam, Institute of Nutritional Science, Nuthetal, Germany
| | - A Kleinridders
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Central Regulation of Metabolism, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Graves C, Meyer S, Knightly J, Glassman S. Quality in Spine Surgery. Neurosurgery 2018; 82:136-141. [DOI: 10.1093/neuros/nyx476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/29/2017] [Indexed: 01/22/2023] Open
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Donath E, Vardanyan I, Meyer S, Murray RA, Moya SE, Navoyan Z, Arakelyan V. A typical diffusion monitored by flow cytometry: slow diffusion of small molecules in polyelectrolyte multilayers. Nanoscale 2018; 10:765-772. [PMID: 29256567 DOI: 10.1039/c7nr08405f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An innovative approach has been developed to measure small molecule diffusion in polyelectrolyte multilayers (PEMs) assembled on colloidal particles by means of flow cytometry (FACS). FACS allows changes in fluorescence emission as a function of time to be recorded per particle in a colloidal dispersion. Dithionite, S2O42-, diffusion in PEMs composed of polyallylamine hydrochloride (PAH) and poly styrene sulfonate (PSS) assembled on silica particles has been studied by recording the quenching of (7-nitrobenz-2-oxa-1,3-diazol-4yl)amino (NBD) labelled PAH layers by FACS. NBD is reduced when it encounters dithionite, and is therefore no longer fluorescent. The decay in fluorescence will be used to follow the kinetics of dithionite diffusion. The fluorescence decay curves show slow diffusion that does not follow classical Fickean law. However, by assuming that the diffusion coefficient is time dependent and follows an inverse power law in an atypical diffusion case, it was possible to obtain an excellent fit for the decay curves.
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Affiliation(s)
- E Donath
- Institute of Medical and Biophysics, University of Leipzig, Haertelstrasse 16-18, Leipzig, Germany
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Meyer S, López-Serrano A, Mitze H, Jakubowski N, Schwerdtle T. Single-cell analysis by ICP-MS/MS as a fast tool for cellular bioavailability studies of arsenite. Metallomics 2018; 10:73-76. [DOI: 10.1039/c7mt00285h] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A fast and reliable single-cell ICP-MS/MS method is presented to determine the bioavailability of metal species as well as sulfur and phosphorus as internal control after re-suspension of cells in water.
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Affiliation(s)
- S. Meyer
- Institute of Nutritional Science
- University of Potsdam
- 14558 Nuthetal
- Germany
- NutriAct – Competence Cluster Nutrition Research Berlin-Potsdam
| | - A. López-Serrano
- Bundesanstalt für Materialforschung und – prüfung (BAM)
- 12489 Berlin
- Germany
| | - H. Mitze
- Institute of Nutritional Science
- University of Potsdam
- 14558 Nuthetal
- Germany
| | - N. Jakubowski
- Bundesanstalt für Materialforschung und – prüfung (BAM)
- 12489 Berlin
- Germany
| | - T. Schwerdtle
- Institute of Nutritional Science
- University of Potsdam
- 14558 Nuthetal
- Germany
- NutriAct – Competence Cluster Nutrition Research Berlin-Potsdam
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Poryo M, Shatat M, Gortner L, Abdul-Khaliq H, Meyer S. The Role of EEG Recordings in Children undergoing Cardiac Surgery for Congenital Heart Disease. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Poryo
- Clinic for Pediatric Cardiology, Saarland University Hospital, Homburg, Germany
| | - M. Shatat
- Clinic for Pediatric Cardiology, Saarland University Hospital, Homburg, Germany
| | - L. Gortner
- Clinic für Pediatrics and Neurology, Saarland University Hospital, Homburg, Germany
| | - H. Abdul-Khaliq
- Clinic for Pediatric Cardiology, Saarland University Hospital, Homburg, Germany
| | - S. Meyer
- Clinic für Pediatrics and Neurology, Saarland University Hospital, Homburg, Germany
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Lüker J, Sultan A, Plenge T, van den Bruck J, Heeger CH, Meyer S, Mischke K, Tilz RR, Vollmann D, Nölker G, Schäffer B, Willems S, Steven D. Electrical cardioversion of patients with implanted pacemaker or cardioverter-defibrillator: results of a survey of german centers and systematic review of the literature. Clin Res Cardiol 2017; 107:249-258. [PMID: 29151182 DOI: 10.1007/s00392-017-1178-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/05/2017] [Accepted: 11/06/2017] [Indexed: 01/08/2023]
Abstract
AIMS A relevant number of patients presenting for electrical cardioversion carry a pacemaker (PM) or ICD. Case reports suggest a potential hazard of external cardioversion/defibrillation. The incidence of shock related device complications is unknown. No guidelines or recommendations by international medical societies for a cardioversion protocol of cardiovascular implantable electronic device (CIED) patients exist. We conducted a nationwide survey to gather real-world clinical data on the current clinical approach towards these patients during electrical cardioversion and to estimate the incidence of shock-related complications. METHODS AND RESULTS Ninety hospitals with > 380 ECV in 2014 were identified from mandatory hospital quality reports and 60 were randomly selected. All centers were provided with a standardized questionnaire on the general proceedings and complications during electrical cardioversion of pacemaker, ICD and CRT patients (CIED patients). Thirty-two centers (53%) participated in the survey. In total, 16,554 ECV were reported (534 ± 314 per center). Biphasic cardioversion with a first shock energy of ≥ 150 J via adhesive patches in antero-posterior orientation was preferred by most centers (78%). Eleven percent (n = 1809) of pts were reported to carry a PM/ICD. The ECV protocol was heterogeneous among centers. Complications associated with electrical cardioversion were reported in 11/1809 patients (0.6%), all were transitory elevations of pacing thresholds. CONCLUSIONS In this nationwide snapshot survey of cardioversion procedures in Germany, approximately 11% of patients presenting for elective electrical cardioversion were pacemaker or ICD carriers. Cardioversion protocols in these patients are heterogeneous throughout centers and mostly not in accordance with recommendation of the German Cardiac Society. Complications associated with external electrical cardioversion are rare. Controlled trials and large registries are necessary to provide evidence for future recommendations.
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Affiliation(s)
- J Lüker
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany.
| | - A Sultan
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - T Plenge
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - J van den Bruck
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - C-H Heeger
- Department of Cardiology, Asklepios Klinik St.Georg, Hamburg, Germany
| | - S Meyer
- Department of Cardiology, Hospital Oldenburg, Oldenburg, Germany
| | - K Mischke
- Department of Cardiology, University Hospital Aachen, Aachen, Germany
| | - R R Tilz
- Department of Cardiology, University Hospital Lübeck, Lübeck, Germany
| | - D Vollmann
- Herz- & Gefäßzentrum Göttingen, Göttingen, Germany
| | - G Nölker
- Clinic for Cardiology, Heart and Diabetes Center North-Rhine Westphalia, Bad Oeynhausen, Germany
| | - B Schäffer
- Department of Electrophysiology, University Heart Center, Hamburg, Germany
| | - S Willems
- Department of Electrophysiology, University Heart Center, Hamburg, Germany
| | - D Steven
- Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
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