1
|
Yi SH, Xiong WJ, Cao XX, Sun CY, Du J, Wang HH, Wang L, Niu T, Jiang ZX, Wei YQ, Xue H, Chu HL, Qiu LG, Li J. [Diagnosis and treatment understanding of Waldenström macroglobulinemia in China: a cross-sectional study]. Zhonghua Xue Ye Xue Za Zhi 2024; 45:148-155. [PMID: 38604791 DOI: 10.3760/cma.j.cn121090-20231017-00212] [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] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Objective: To conduct a nationwide physician survey to better understand clinicians' disease awareness, treatment patterns, and experience of Waldenström macroglobulinemia (WM) in China. Methods: This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews. Results: The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-naïve and relapsed/refractory patients (94% for all patients, 95% for treatment-naïve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions: This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors' and patients' understanding of WM is one of the most urgent issues that must be addressed right now.
Collapse
Affiliation(s)
- S H Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - W J Xiong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - X X Cao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - C Y Sun
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Du
- The Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai 200003, China
| | - H H Wang
- Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - L Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - T Niu
- West China Hospital of Sichuan University, Chengdu 610044, China
| | - Z X Jiang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y Q Wei
- Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - H Xue
- The Affiliated Hospital of Hebei University, Baoding 071030, China
| | - H L Chu
- Peking University Third Hospital, Beijing 100083, China
| | - L G Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - J Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
2
|
Pham J, Shaaya E, Rhee B, Kimata A, Ozcan EE, Pham KM, Niu T, Sullivan P, Gokaslan ZL. Gross total resection and survival outcomes in elderly patients with spinal chordoma: a SEER-based analysis. Front Oncol 2024; 13:1327330. [PMID: 38352297 PMCID: PMC10862492 DOI: 10.3389/fonc.2023.1327330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objective The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups. Methods The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality. Results There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762). Conclusion GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.
Collapse
Affiliation(s)
- John Pham
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Ganga A, Kim EJ, Lee JY, Leary OP, Sastry RA, Fridley JS, Chang KE, Niu T, Sullivan PZ, Somasundar PS, Gokaslan ZL. Disparities in Primary Spinal Osseous Malignant Bone Tumor Survival by Medicaid Status: A National Population-Based Risk Analysis. World Neurosurg 2024; 181:e192-e202. [PMID: 37777175 DOI: 10.1016/j.wneu.2023.09.103] [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: 07/18/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. METHODS Using the SEER-Medicaid database, adults diagnosed between 2006 and 2013 with sPMBT including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, or malignant giant cell tumor (GCT) were studied. Five-year survival analysis was performed using the Kaplan-Meier method. Adjusted survival analysis was performed using Cox proportional-hazards regression controlling for age, sex, marital status, cancer stage, poverty level, vertebral versus sacral location, geography, rurality, tumor diameter, tumor grade, tumor histology, and therapy. RESULTS A total of 572 patients with sPMBT (Medicaid: 59, non-Medicaid: 513) were identified. Medicaid patients were more likely to be younger (P < 0.001), Black (P < 0.001), live in high poverty neighborhoods (P = 0.006), have distant metastases at diagnosis (P < 0.001), and less likely to receive surgery (P = 0.006). The 5-year survival rate was 65.7% (chondrosarcoma: 70.0%, chordoma: 91.5%, Ewing sarcoma: 44.6%, GCT: 90.0%, osteosarcoma: 34.2%). Medicaid patients had significantly worse 5-year survival than non-Medicaid patients (52.0% vs. 67.2%, P = 0.02). Minority individuals on Medicaid were associated with an increased risk of cancer-specific mortality compared with White non-Medicaid patients (adjusted hazard ratio [aHR] = 2.51, [95% CI 1.18-5.35], P = 0.017). Among Medicaid patients, those who received surgery had significantly better survival than those who did not (64.5% vs. 30.6%, P = 0.001). For all patients, not receiving surgery (aHR = 1.90 [1.23-2.95], P = 0.004) and tumor diameter >50 mm (aHR=1.89 [1.10-3.25], P = 0.023) were associated with an increased risk of mortality. CONCLUSIONS Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.
Collapse
Affiliation(s)
- Arjun Ganga
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric J Kim
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Y Lee
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ki-Eun Chang
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Patricia Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ponnandai S Somasundar
- Department of Surgical Oncology, Roger Williams Medical Center, Providence, Rhode Island, USA; Department of Surgery, Boston University, Boston, Massachusetts, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| |
Collapse
|
4
|
Ganga A, Leary OP, Setty A, Xi K, Telfeian AE, Oyelese AA, Niu T, Camara-Quintana JQ, Gokaslan ZL, Zadnik Sullivan P, Fridley JS. Optimizing surgical management of facet cysts of the lumbar spine: systematic review, meta-analysis, and local case series of 1251 patients. J Neurosurg Spine 2023; 39:793-806. [PMID: 37728373 DOI: 10.3171/2023.6.spine23404] [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: 04/17/2023] [Accepted: 06/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Lumbar facet cysts (LFCs) can cause neurological dysfunction and intractable pain. Surgery is the current standard of care for patients in whom conservative therapy fails, those with neurological deficits, and those with evidence of spinal instability. No study to date has comprehensively examined surgical outcomes comparing the multiple surgical treatment options for LFCs. Therefore, the authors aimed to perform a combined analysis of cases both in the literature and of patients at a single institution to compare the outcomes of various surgical treatment options for LFC. METHODS The authors performed a literature review in accordance with PRISMA guidelines and meta-analysis of the PubMed, Embase, and Cochrane Library databases and reviewed all studies from database inception published until February 3, 2023. Studies that did not contain 3 or more cases, clearly specify follow-up durations longer than 6 months, or present new cases were excluded. Bias was evaluated using Cochrane Collaboration's Risk of Bias in Nonrandomised Studies-of Interventions (ROBINS-I). The authors also reviewed their own local institutional case series from 2015 to 2020. Primary outcomes were same-level cyst recurrence, same-level revision surgery, and perioperative complications. ANOVA, common and random-effects modeling, and Wald testing were used to compare treatment groups. RESULTS A total of 1251 patients were identified from both the published literature (29 articles, n = 1143) and the authors' institution (n = 108). Patients were sorted into 5 treatment groups: open cyst resection (OCR; n = 720), tubular cyst resection (TCR; n = 166), cyst resection with arthrodesis (CRA; n = 165), endoscopic cyst resection (ECR; n = 113), and percutaneous cyst rupture (PCR; n = 87), with OCR being the analysis reference group. The PCR group had significantly lower complication rates (p = 0.004), higher recurrence rates (p < 0.001), and higher revision surgery rates (p = 0.001) compared with the OCR group. Patients receiving TCR (3.01%, p = 0.021) and CRA (0.0%, p < 0.001) had significantly lower recurrence rates compared with those undergoing OCR (6.36%). The CRA group (6.67%) also had significantly lower rates of revision surgery compared with the OCR group (11.3%, p = 0.037). CONCLUSIONS While PCR is less invasive, it may have high rates of same-level recurrence and revision surgery. Recurrence and revision rates for modalities such as ECR were not significantly different from those of OCR. While concomitant arthrodesis is more invasive, it might lead to lower recurrence rates and lower rates of subsequent revision surgery. Given the limitations of our case series and literature review, prospective, randomized studies are needed.
Collapse
Affiliation(s)
- Arjun Ganga
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Owen P Leary
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Aayush Setty
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Kevin Xi
- 2Brown University School of Public Health, Providence, Rhode Island
| | - Albert E Telfeian
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Adetokunbo A Oyelese
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Tianyi Niu
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | | | - Ziya L Gokaslan
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Patricia Zadnik Sullivan
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| | - Jared S Fridley
- 1Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence; and
| |
Collapse
|
5
|
Liu S, Niu T, Wang Y. Beaklike ossification in ankylosing spondylitis. QJM 2023; 116:949. [PMID: 37335876 DOI: 10.1093/qjmed/hcad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- S Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - T Niu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - Y Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| |
Collapse
|
6
|
Su S, Niu T, Vogt T, Eckert S. In-Bulk Temperature Profile Mapping Using Fiber Bragg Grating in Fluids. Sensors (Basel) 2023; 23:8539. [PMID: 37896632 PMCID: PMC10610706 DOI: 10.3390/s23208539] [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] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
The capabilities of Fiber Bragg Grating (FBG) sensors to measure temperature variations in the bulk of liquid flows were considered. In the first step of our research project, reported in this paper, we investigated to what extent the use of thin glass fibers without encapsulation, which only minimally disturb a flow, can fulfill the requirements for robustness and measurement accuracy. Experimental tests were performed in a benchmark setup containing 24 FBG measuring positions, which were instrumented in parallel with thermocouples for validation. We suggest a special assembly procedure in which the fiber is placed under a defined tension to improve its stiffness and immobility for certain flow conditions. This approach uses a single FBG sensor as a reference that measures the strain effect in real time, allowing accurate relative temperature measurements to be made at the other FBG sensor points, taking into account an appropriate correction term. Absolute temperature readings can be obtained by installing another well-calibrated, strain-independent thermometer on the reference FBG. We demonstrated this method in two test cases: (i) a temperature gradient with stable density stratification in the liquid metal GaInSn and (ii) the heating of a water column using a local heat source. In these measurements, we succeeded in recording both spatial and temporal changes in the linear temperature distribution along the fiber. We present the corresponding results from the tests and, against this background, we discuss the capabilities and limitations of this measurement technique with respect to the detection of temperature fields in liquid flows.
Collapse
Affiliation(s)
- Sylvie Su
- Helmholtz-Zentrum Dresden–Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
| | - Tianyi Niu
- Helmholtz-Zentrum Dresden–Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
- Faculty of Electrical and Computer Engineering, Technische Universität Dresden, 01062 Dresden, Germany
| | - Tobias Vogt
- Helmholtz-Zentrum Dresden–Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
| | - Sven Eckert
- Helmholtz-Zentrum Dresden–Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
| |
Collapse
|
7
|
Xu XS, Ding H, Zhang X, Liao Y, Li H, Liu QY, Liu JZ, Zhang L, Huang J, Gong YP, Ma HB, Xiang B, Dai Y, Hou L, Shuai X, Niu T, Wu Y. [Clinical characteristics and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia arising from malignant tumors]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:742-748. [PMID: 38049318 PMCID: PMC10630571 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.007] [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] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Indexed: 12/06/2023]
Abstract
Objective: To investigate the clinical characteristics, cytogenetics, molecular biology, treatment, and prognosis of patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia (t-MDS/AML) secondary to malignancies. Methods: The clinical data of 86 patients with t-MDS/AML in West China Hospital of Sichuan University between January 2010 and April 2023 were retrospectively analyzed. The clinical characteristics, primary tumor types, and tumor-related therapies were analyzed. Results: The study enrolled a total of 86 patients with t-MDS/AML, including 67 patients with t-AML, including 1 patient with M(0), 6 with M(1), 27 with M(2), 9 with M(3), 12 with M(4), 10 with M(5), 1 with M(6), and 1 with M(7). Sixty-two patients could be genetically stratified, with a median overall survival (OS) of 36 (95% CI 22-52) months for 20 (29.9%) patients in the low-risk group and 6 (95% CI 3-9) months for 10 (14.9%) in the intermediate-risk group. The median OS time was 8 (95% CI 1-15) months in 32 (47.8%) patients in the high-risk group. For patients with non-acute promyelocytic leukemia (APL) and AML, the median OS of the low-risk group was 27 (95% CI 18-36) months, which was significantly longer than that of the non-low-risk group (χ(2)=5.534, P=0.019). All 9 APL cases were treated according to the initial treatment, and the median OS was not reached, and the 1-, 2-, and 3-year OS rates were 100.0%, (75.0±6.2) %, and (75.0±6.2) % respectively. Of the 58 patients with non-APL t-AML (89.7%), 52 received chemotherapy, and 16 achieved complete remission (30.8%) after the first induction chemotherapy. The 1-, 2-, and 3-year OS rates of the non-APL t-AML group were (42.0 ± 6.6) %, (22.9±5.7) %, and (13.4±4.7) %, respectively. The median OS of patients who achieved remission was 24 (95% CI 18-30) months, and the median OS of those who did not achieve remission was 6 (95% CI 3-9) months (χ(2)=10.170, P=0.001). Bone marrow CR was achieved in 7 (53.8%) of 13 patients treated with vineclar-containing chemotherapy, with a median OS of 12 (95% CI 9-15) months, which was not significantly different from that of vineclar-containing chemotherapy (χ(2)=0.600, P=0.437). In 19 patients with t-MDS, the 1-, 2-, and 3-year OS rates were (46.8±11.6) %, (17.5±9.1) %, and (11.7±9.1) % with a median OS of 12 (95% CI 7-17) months, which was not significantly different from that in t-AML (χ(2)=0.232, P=0.630) . Conclusions: Breast cancer, bowel cancer, and other primary tumors are common in patients with t-MDS/AML, which have a higher risk of adverse genetics. Patients with APL had a high induction remission rate and a good long-term prognosis, whereas patients without APL had a low remission rate and a poor long-term prognosis.
Collapse
Affiliation(s)
- X S Xu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China Department of Hematology, Jiujiang First People's Hospital, Jiujiang 332000, China
| | - H Ding
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - X Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Liao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - H Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Q Y Liu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Z Liu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - L Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Huang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y P Gong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - H B Ma
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - B Xiang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Dai
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - L Hou
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - X Shuai
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - T Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Wu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
8
|
Sastry RA, Chen JS, Shao B, Weil RJ, Chang KE, Maynard K, Syed SH, Zadnik Sullivan PL, Camara JQ, Niu T, Sampath P, Telfeian AE, Oyelese AA, Fridley JS, Gokaslan ZL. Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019. JAMA Netw Open 2023; 6:e2326357. [PMID: 37523184 PMCID: PMC10391306 DOI: 10.1001/jamanetworkopen.2023.26357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/01/2023] Open
Abstract
Importance Use of lumbar fusion has increased substantially over the last 2 decades. For patients with lumbar stenosis and degenerative spondylolisthesis, 2 landmark prospective randomized clinical trials (RCTs) published in the New England Journal of Medicine in 2016 did not find clear evidence in favor of decompression with fusion over decompression alone in this population. Objective To assess the national use of decompression with fusion vs decompression alone for the surgical treatment of lumbar stenosis and degenerative spondylolisthesis from 2016 to 2019. Design, Setting, and Participants This retrospective cohort study included 121 745 hospitalized adult patients (aged ≥18 years) undergoing 1-level decompression alone or decompression with fusion for the management of lumbar stenosis and degenerative spondylolisthesis from January 1, 2016, to December 31, 2019. All data were obtained from the National Inpatient Sample (NIS). Analyses were conducted, reviewed, or updated on June 9, 2023. Main Outcome and Measure The primary outcome of this study was the use of decompression with fusion vs decompression alone. For the secondary outcome, multivariable logistic regression analysis was used to evaluate factors associated with the decision to perform decompression with fusion vs decompression alone. Results Among 121 745 eligible hospitalized patients (mean age, 65.2 years [95% CI, 65.0-65.4 years]; 96 645 of 117 640 [82.2%] non-Hispanic White) with lumbar stenosis and degenerative spondylolisthesis, 21 230 (17.4%) underwent decompression alone, and 100 515 (82.6%) underwent decompression with fusion. The proportion of patients undergoing decompression alone decreased from 2016 (7625 of 23 405 [32.6%]) to 2019 (3560 of 37 215 [9.6%]), whereas the proportion of patients undergoing decompression with fusion increased over the same period (from 15 780 of 23 405 [67.4%] in 2016 to 33 655 of 37 215 [90.4%] in 2019). In univariable analysis, patients undergoing decompression alone differed significantly from those undergoing decompression with fusion with regard to age (mean, 68.6 years [95% CI, 68.2-68.9 years] vs 64.5 years [95% CI, 64.3-64.7 years]; P < .001), insurance status (eg, Medicare: 13 725 of 21 205 [64.7%] vs 53 320 of 100 420 [53.1%]; P < .001), All Patient Refined Diagnosis Related Group risk of death (eg, minor risk: 16 900 [79.6%] vs 83 730 [83.3%]; P < .001), and hospital region of the country (eg, South: 7030 [33.1%] vs 38 905 [38.7%]; Midwest: 4470 [21.1%] vs 23 360 [23.2%]; P < .001 for both comparisons). In multivariable logistic regression analysis, older age (adjusted odds ratio [AOR], 0.96 per year; 95% CI, 0.95-0.96 per year), year after 2016 (AOR, 1.76 per year; 95% CI, 1.69-1.85 per year), self-pay insurance status (AOR, 0.59; 95% CI, 0.36-0.95), medium hospital size (AOR, 0.77; 95% CI, 0.67-0.89), large hospital size (AOR, 0.76; 95% CI, 0.67-0.86), and highest median income quartile by patient residence zip code (AOR, 0.79; 95% CI, 0.70-0.89) were associated with lower odds of undergoing decompression with fusion. Conversely, hospital region in the Midwest (AOR, 1.34; 95% CI, 1.14-1.57) or South (AOR, 1.32; 95% CI, 1.14-1.54) was associated with higher odds of undergoing decompression with fusion. Decompression with fusion vs decompression alone was associated with longer length of stay (mean, 2.96 days [95% CI, 2.92-3.01 days] vs 2.55 days [95% CI, 2.49-2.62 days]; P < .001), higher total admission costs (mean, $30 288 [95% CI, $29 386-$31 189] vs $16 190 [95% CI, $15 189-$17 191]; P < .001), and higher total admission charges (mean, $121 892 [95% CI, $119 566-$124 219] vs $82 197 [95% CI, $79 745-$84 648]; P < .001). Conclusions and Relevance In this cohort study, despite 2 prospective RCTs that demonstrated the noninferiority of decompression alone compared with decompression with fusion, use of decompression with fusion relative to decompression alone increased from 2016 to 2019. A variety of patient- and hospital-level factors were associated with surgical procedure choice. These results suggest the findings of 2 major RCTs have not yet produced changes in surgical practice patterns and deserve renewed focus.
Collapse
Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Jia-Shu Chen
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Robert J Weil
- Department of Neurosurgery, Brain and Spine, Southcoast Health, Dartmouth, Massachusetts
| | - Ki-Eun Chang
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Ken Maynard
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sohail H Syed
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Joaquin Q Camara
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Prakash Sampath
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
9
|
Xu W, Yi SH, Feng R, Wang X, Jin J, Mi JQ, Ding KY, Yang W, Niu T, Wang SY, Zhou KS, Peng HL, Huang L, Liu LH, Ma J, Luo J, Su LP, Bai O, Liu L, Li F, He PC, Zeng Y, Gao D, Jiang M, Wang JS, Yao HX, Qiu LG, Li JY. [Current status of diagnosis and treatment of chronic lymphocytic leukemia in China: A national multicenter survey research]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:380-387. [PMID: 37550187 PMCID: PMC10440613 DOI: 10.3760/cma.j.issn.0253-2727.2023.05.005] [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] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Indexed: 08/09/2023]
Abstract
Objective: To understand the current status of diagnosis and treatment of chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL) among hematologists, oncologists, and lymphoma physicians from hospitals of different levels in China. Methods: This multicenter questionnaire survey was conducted from March 2021 to July 2021 and included 1,000 eligible physicians. A combination of face-to-face interviews and online questionnaire surveys was used. A standardized questionnaire regarding the composition of patients treated for CLL/SLL, disease diagnosis and prognosis evaluation, concomitant diseases, organ function evaluation, treatment selection, and Bruton tyrosine kinase (BTK) inhibitor was used. Results: ①The interviewed physicians stated that the proportion of male patients treated for CLL/SLL is higher than that of females, and the age is mainly concentrated in 61-70 years old. ②Most of the interviewed physicians conducted tests, such as bone marrow biopsies and immunohistochemistry, for patient diagnosis, in addition to the blood test. ③Only 13.7% of the interviewed physicians fully grasped the initial treatment indications recommended by the existing guidelines. ④In terms of cognition of high-risk prognostic factors, physicians' knowledge of unmutated immunoglobulin heavy-chain variable and 11q- is far inferior to that of TP53 mutation and complex karyotype, which are two high-risk prognostic factors, and only 17.1% of the interviewed physicians fully mastered CLL International Prognostic Index scoring system. ⑤Among the first-line treatment strategy, BTK inhibitors are used for different types of patients, and physicians have formed a certain understanding that BTK inhibitors should be preferentially used in patients with high-risk factors and elderly patients, but the actual use of BTK inhibitors in different types of patients is not high (31.6%-46.0%). ⑥BTK inhibitors at a reduced dose in actual clinical treatment were used by 69.0% of the physicians, and 66.8% of the physicians had interrupted the BTK inhibitor for >12 days in actual clinical treatment. The use of BTK inhibitors is reduced or interrupted mainly because of adverse reactions, such as atrial fibrillation, severe bone marrow suppression, hemorrhage, and pulmonary infection, as well as patients' payment capacity and effective disease progression control. ⑦Some differences were found in the perceptions and behaviors of hematologists and oncologists regarding the prognostic assessment of CLL/SLL, the choice of treatment options, the clinical use of BTK inhibitors, etc. Conclusion: At present, a gap remains between the diagnosis and treatment of CLL/SLL among Chinese physicians compared with the recommendations in the guidelines regarding the diagnostic criteria, treatment indications, prognosis assessment, accompanying disease assessment, treatment strategy selection, and rational BTK inhibitor use, especially the proportion of dose reduction or BTK inhibitor discontinuation due to high adverse events.
Collapse
Affiliation(s)
- W Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - S H Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - R Feng
- Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - X Wang
- Shandong Provincial Hospital, Jinan 250021, China
| | - J Jin
- The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou 310003, China
| | - J Q Mi
- Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China
| | - K Y Ding
- Anhui Province Cancer Hospital, Hefei 230031, China
| | - W Yang
- Shengjing Hospital Affiliated to China Medical University, Shenyang 117004, China
| | - T Niu
- West China Hospital of Sichuan University, Chengdu 610044, China
| | - S Y Wang
- Union Hospital Affiliated to Fujian Medical University, Fuzhou 350001, China
| | - K S Zhou
- Henan Cancer Hospital (Affiliated Cancer Hospital of Zhengzhou University), Zhengzhou 450003, China
| | - H L Peng
- Xiangya Second Hospital of Central South University, Changsha 410008, China
| | - L Huang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - L H Liu
- The Fourth Hospital of Hebei Medical University (Hebei Tumor Hospital), Shijiazhuang 050011, China
| | - J Ma
- Harbin Institute of hematological oncology, Harbin 150001, China
| | - J Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanchang 530021, China
| | - L P Su
- Shanxi Cancer Hospital, Taiyuan 030013, China
| | - O Bai
- The first hospital of Jilin University, Changchun 130061, China
| | - L Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - F Li
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - P C He
- The First Affiliated Hospital of Xi' an Jiaotong University, Xi' an 710061, China
| | - Y Zeng
- The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - D Gao
- Affiliated Hospital of Inner Mongolia Medical University, Hohhot 750306, China
| | - M Jiang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - J S Wang
- Affiliated hospital of Guizhou Medical University, Guiyang 550004, China
| | - H X Yao
- Hainan Provincial People's Hospital, Haikou 570311, China
| | - L G Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - J Y Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| |
Collapse
|
10
|
Sastry RA, Hagan M, Feler J, Abdulrazeq H, Walek K, Sullivan PZ, Abinader JF, Camara JQ, Niu T, Fridley JS, Oyelese AA, Sampath P, Telfeian AE, Gokaslan ZL, Toms SA, Weil RJ. Time of Discharge and 30-Day Re-Presentation to an Acute Care Setting After Elective Lumbar Decompression Surgery. Neurosurgery 2023; 92:507-514. [PMID: 36700671 DOI: 10.1227/neu.0000000000002233] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Evidence regarding the consequence of efforts to increase patient throughput and decrease length of stay in the context of elective spine surgery is limited. OBJECTIVE To evaluate whether early time of discharge results in increased rates of hospital readmission or return to emergency department for patients admitted after elective, posterior, lumbar decompression surgery. METHODS We conducted a retrospective cohort study of 779 patients admitted to hospital after undergoing elective, posterior, lumbar decompression surgery. Multiple logistic regression evaluated the relationship between time of discharge and the primary outcome of return to acute care within 30 days, while controlling for sociodemographic, procedural, and discharge characteristics. RESULTS In multiple logistic regression, time of discharge earlier in the day was not associated with increased odds of return to acute care within 30 days (odds ratio [OR] 1.18, 95% CI 0.92-1.52, P = .19). Weekend discharge (OR 1.99, 95% CI 1.04-3.79, P = .04) increased the likelihood of return to acute care. Surgeon experience (<1 year of attending practice, OR 0.43, 95% CI 0.19-1.00, P = .05 and 2-5 years of attending practice, OR 0.50, 95% CI 0.25-1.01, P = .054), weekend discharge (OR 0.49, 95% CI 0.27-0.89, P = .02), and physical therapy evaluation (OR 0.20, 95% CI 0.12-0.33, P < .001) decreased the likelihood of discharge before noon. CONCLUSION Time of discharge is not associated with risk of readmission or presentation to the emergency department after elective lumbar decompression. Weekend discharge is independently associated with increased risk of readmission and decreased likelihood of prenoon discharge.
Collapse
Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Matthew Hagan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Joshua Feler
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Konrad Walek
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Patricia Z Sullivan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jose Fernandez Abinader
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Joaquin Q Camara
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Prakash Sampath
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Steven A Toms
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Robert J Weil
- Department of Neurosurgery, Southcoast Health Brain & Spine, Dartmouth, Massachusetts, USA
| |
Collapse
|
11
|
Niu T, Xu Y, Chen J, Qin L, Li Z, Yang Y, Liang J. Bacterial taxonomic and functional profiles from Bohai Sea to northern Yellow Sea. Front Microbiol 2023; 14:1139950. [PMID: 36910186 PMCID: PMC9995391 DOI: 10.3389/fmicb.2023.1139950] [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: 01/08/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Microbial distribution patterns are the result of a combination of biotic and abiotic factors, which are the core issues in microbial ecology research. To better understand the biogeographic pattern of bacteria in water environments from the Bohai Sea to the northern Yellow Sea, the effects of environmental factors, and spatial distance on the structure of bacterial communities in marine water were investigated using high-throughput sequencing technology based on 16S rRNA genes. The results showed that Proteobacteria, Bacteroidetes, Actinobacteri, Desulfobacterota, and Bdellovibrionota were the dominant phyla in the study area. A clear spatial pattern in the bacterial community was observed, and environmental factors, including salinity, nutrient concentration, carbon content, total phosphorus, dissolved oxygen, and seawater turbidity emerged as the central environmental factors regulating the variation in bacterial communities. In addition, the study provides direct evidence of the existence of dispersal limitation in this strongly connected marine ecological system. Therefore, these results revealed that the variation in bacterial community characteristics was attributed to environmental selection, accompanied by the regulation of stochastic diffusion. The network analysis demonstrated a nonrandom co-occurrence pattern in the microbial communities with distinct spatial distribution characteristics. It is implied that the biogeography patterns of bacterial community may also be associated with the characteristics of co-occurrence characterize among bacterial species. Furthermore, the PICRUSt analysis indicated a clear spatial distribution of functional characteristics in bacterial communities. This functional variation was significantly modulated by the environmental characteristics of seawater but uncoupled from the taxonomic characteristics of bacterial communities (e.g., diversity characteristics, community structure, and co-occurrence relationships). Together, this findings represent a significant advance in linking seawater to the mechanisms underlying bacterial biogeographic patterns and community assembly, co-occurrence patterns, and ecological functions, providing new insights for identifying the microbial ecology as well as the biogeochemical cycle in the marine environment.
Collapse
Affiliation(s)
- Tianyi Niu
- School of Marine Sciences, Guangxi University, Nanning, China
| | - Yongqian Xu
- School of Marine Sciences, Guangxi University, Nanning, China
| | - Jinni Chen
- School of Marine Sciences, Guangxi University, Nanning, China
| | - Liangyun Qin
- School of Marine Sciences, Guangxi University, Nanning, China
| | - Zhicong Li
- School of Marine Sciences, Guangxi University, Nanning, China
| | - Yating Yang
- School of Marine Sciences, Guangxi University, Nanning, China
| | - Jiayuan Liang
- School of Marine Sciences, Guangxi University, Nanning, China.,Coral Reef Research Center of China, Guangxi University, Nanning, China.,Guangxi Laboratory on the Study of Coral Reefs in the South China Sea, Nanning, China
| |
Collapse
|
12
|
Hagan MJ, Pertsch NJ, Leary OP, Ganga A, Sastry R, Xi K, Zheng B, Behar M, Camara-Quintana JQ, Niu T, Sullivan PZ, Abinader JF, Telfeian AE, Gokaslan ZL, Oyelese AA, Fridley JS. Influence of socioeconomic factors on discharge disposition following traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States. N Am Spine Soc J 2022; 12:100186. [PMID: 36479003 PMCID: PMC9720595 DOI: 10.1016/j.xnsj.2022.100186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/04/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Discharge to acute rehabilitation is strongly correlated with functional recovery after traumatic injury, including spinal cord injury (SCI). However, services such as acute care rehabilitation and Skilled Nursing Facilities (SNF) are expensive. Our objective was to understand if high-cost, resource-intensive post-discharge rehabilitation or alternative care facilities are utilized at disparate rates across socioeconomic groups after SCI. METHODS We performed a cohort analysis using the National Trauma Data Bank® tabulated from 2012-2016. Eligible patients had a diagnosis of cervical or thoracic spine fracture with spinal cord injury (SCI) and were treated surgically. We evaluated associations of sociodemographic and psychosocial variables with non-home discharge (e.g., discharge to SNF, other healthcare facility, or intermediate care facility) via multivariable logistic regression while correcting for injury severity and hospital characteristics. RESULTS We identified 3933 eligible patients. Patients who were older, male (OR=1.29 95% Confidence Interval [1.07-1.56], p=.007), insured by Medicare (OR=1.45 [1.08-1.96], p=.015), diagnosed with a major psychiatric disorder (OR=1.40 [1.03-1.90], p=.034), had a higher Injury Severity Score (OR=5.21 [2.96-9.18], p<.001) or a lower Glasgow Coma Score (3-8 points, OR=2.78 [1.81-4.27], p<.001) had a higher chance of a non-home discharge. The only sociodemographic variable associated with lower likelihood of utilizing additional healthcare facilities following discharge was uninsured status (OR=0.47 [0.37-0.60], p<.001). CONCLUSIONS Uninsured patients are less likely to be discharged to acute rehabilitation or alternative healthcare facilities following surgical management of SCI. High out-of-pocket costs for uninsured patients in the United States may deter utilization of these services.
Collapse
Affiliation(s)
- Matthew J. Hagan
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Nathan J. Pertsch
- Department of Neurosurgery, Rush University Medical Center, 600 S. Paulina St, Chicago, IL 60612, USA
| | - Owen P. Leary
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Arjun Ganga
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Rahul Sastry
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Kevin Xi
- Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
| | - Bryan Zheng
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Mark Behar
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Joaquin Q. Camara-Quintana
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Tianyi Niu
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Patricia Zadnik Sullivan
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Jose Fernandez Abinader
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Albert E. Telfeian
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Ziya L. Gokaslan
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Adetokunbo A. Oyelese
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| | - Jared S. Fridley
- The Warren Alpert School of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, USA
- Department of Neurosurgery, Rhode Island Hospital, 593 Eddy Street, APC6, Providence, RI 02903, USA
| |
Collapse
|
13
|
Zhao AL, Tang WJ, Li Y, Liao Y, Li H, Wang J, Shen K, Yang YF, Xu J, Zhang L, Zheng YH, Niu T. [Efficacy and safety of daratumumab in patients with relapsed/refractory multiple myeloma]. Zhonghua Yi Xue Za Zhi 2022; 102:3304-3311. [PMID: 36319183 DOI: 10.3760/cma.j.cn112137-20220311-00498] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the efficacy and safety of daratumumab in relapsed/refractory multiple myeloma (RRMM) patients. Methods: Fifty-two RRMM patients treated with daratumumab from September 2019 to November 2021 in West China Hospital were retrospectively enrolled, including 31 males and 21 females. The mean age of these patients at the first diagnosis of multiple myeloma was (58±10) years. According to the dosage of daratumumab, patients were divided into low dosage group (n=10) and high dosage group (n=42). Overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse event rates were investigated. Univariate and multivariate analysis of potential factors were conducted. Results: Of the 52 patients, 8 received daratumumab monotherapy, 27 received daratumumab plus immuno-modulatory drug (IMiD) treatment, 4 received daratumumab plus proteosome inhibitor (PI) treatment, and 11 received daratumumab plus dexamethasone treatment. The diagnosis age of high dosage group patients was (57±9) years, which was significantly younger than that of low dosage group [(66±10) years] (P=0.009). The baseline creatinine level of high dosage group patients [M (Q1, Q3)] was 91 (68, 196) μmol/L, which was significantly higher than that of low dosage group [66 (51, 76) μmol/L] (P=0.021). There was no significant difference in other baseline clinical characteristics, previous treatment regimens, previous lines of treatment, and regimen and cycles of daratumumab between the high dosage group and low dosage group (all P>0.05). The ORR for the 52 patients was 71.2% (37/52). The ORR for daratumumab plus IMiD group was 81.5% (22/27), which was significantly higher than that in monotherapy or dexamethasone group [ORR: 52.6% (10/19), P=0.036). With a median follow-up [M (Q1, Q3)] of 7 (5, 26) months, the median PFS for overall cohort was 17 (95%CI: 9.6-24.4) months. The median PFS for daratumumab plus IMiD group was 26 (95%CI: 6.0-46.0) months, which was significantly better than that in monotherapy or dexamethasone group [12 (95%CI: 3.5-20.5) months] (HR=0.231, 95%CI: 0.075-0.715, P=0.011). Higher diagnosis age was the risk factor of progression (HR=1.085, 95%CI: 1.016-1.158, P=0.014), while more cycles of daratumumab treatment was the protective factor of progression (HR=0.669, 95%CI: 0.495-0.904, P=0.009). There was no significant influence of daratumumab dosage on progression (high dosage vs low dosage, HR=1.016, 95%CI: 0.221-4.668, P=0.984). The median OS for overall cohort was 26 (95%CI: 13.1-38.9) months. Higher serum calcium was the independent risk factor of death (HR=12.190, 95%CI: 1.170-127.048, P=0.037). There was no significant influence of daratumumab dosage on death (high dosage vs low dosage, HR=0.818, 95%CI: 0.171-3.917, P=0.802). Adverse events included infections (43.2%, 16/37), infusion-associated reactions (29.7%, 11/37), and thrombocytopenia (27.0%, 10/37). Conclusions: Daratumumab is effective to treat RRMM. The dosage of daratumumab has no significant influence on prognosis when used in combined treatment. The incidence of adverse events is relatively low, with a favorable safety profile.
Collapse
Affiliation(s)
- A L Zhao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - W J Tang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y Liao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - H Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - K Shen
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y F Yang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Xu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - L Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y H Zheng
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - T Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
14
|
Yu N, Wan Y, Zuo L, Cao Y, Qu D, Liu W, Deng L, Zhang T, Wang W, Wang J, Feng Q, Zhou Z, Xiao Z, BI N, Niu T, Wang X. MRI and CT Radiomics Features to Predict Overall Survival of Locally Advanced Esophageal Cancer after Definite Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1051] [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: 10/31/2022]
|
15
|
Hagan MJ, Pertsch NJ, Leary OP, Sastry R, Ganga A, Xi K, Zheng B, Kondamuri NS, Camara-Quintana JQ, Niu T, Sullivan PZ, Abinader JF, Telfeian AE, Gokaslan ZL, Oyelese AA, Fridley JS. Influence of Sociodemographic and Psychosocial Factors on Length of Stay After Surgical Management of Traumatic Spine Fracture with Spinal Cord Injury. World Neurosurg 2022; 166:e859-e871. [PMID: 35940503 DOI: 10.1016/j.wneu.2022.07.128] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Identifying patients at risk of increased health care resource utilization is a valuable opportunity to develop targeted preoperative and perioperative interventions. In the present investigation, we sought to examine patient sociodemographic factors that predict prolonged length of stay (LOS) after traumatic spine fracture. METHODS We performed a cohort analysis using the National Trauma Data Bank tabulated during 2012-2016. Eligible patients were those who were diagnosed with cervical or thoracic spine fracture with spinal cord injury and who were treated surgically. We evaluated the effects of sociodemographic as well as psychosocial variables on LOS by negative binomial regression and adjusted for injury severity, injury mechanism, and hospital characteristics. RESULTS We identified 3856 eligible patients with a median LOS of 9 days (interquartile range, 6-15 days). Patients in older age categories, who were male (incidence rate ratio (IRR), 1.05; 95% confidence interval [CI], 1.01-1.09), black (IRR, 1.12; CI, 1.05-1.19) or Hispanic (IRR, 1.09; CI, 1.03-1.16), insured by Medicaid (IRR, 1.24; CI, 1.17-1.31), or had a diagnosis of alcohol use disorder (IRR, 1.12; CI, 1.06-1.18) were significantly more likely to have a longer LOS. In addition, patients with severe injury on Injury Severity Score (IRR, 1.32; CI, 1.14-1.53) and lower Glasgow Coma Scale (GCS) scores (GCS score 3-8, IRR, 1.44; CI, 1.35-1.55; GCS score 9-11, IRR, 1.40; CI, 1.25-1.58) on admission had a significantly lengthier LOS. Patients admitted to a hospital in the Southern United States (IRR, 1.09; CI, 1.05-1.14) had longer LOS. CONCLUSIONS Socioeconomic factors such as race, insurance status, and alcohol use disorder were associated with a prolonged LOS after surgical management of traumatic spine fracture with spinal cord injury.
Collapse
Affiliation(s)
- Matthew J Hagan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Nathan J Pertsch
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Owen P Leary
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Rahul Sastry
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Arjun Ganga
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kevin Xi
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Bryan Zheng
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | | | - Joaquin Q Camara-Quintana
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Tianyi Niu
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Patricia Zadnik Sullivan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jose Fernandez Abinader
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Albert E Telfeian
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jared S Fridley
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA.
| |
Collapse
|
16
|
Zhao AL, Li M, Li LF, Gan XA, Wang J, Li H, Shen K, Yang YF, Niu T. [Clinical characteristics and prognosis of lymphoma-associated hemophagocytic syndrome]. Zhonghua Yi Xue Za Zhi 2022; 102:2173-2180. [PMID: 35872581 DOI: 10.3760/cma.j.cn112137-20220221-00349] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Subjective To investigate clinical characteristics, treatment, and prognosis of lymphoma-associated hemophagocytic syndrome (LAHS) patients. Methods: The clinical data of patients diagnosed with LAHS from January 2010 to October 2021 in West China Hospital were retrospectively analyzed. Clinical characteristics, treatment, overall response rate (ORR), and overall survival (OS) were investigated. Univariate and multivariate analysis of potential factors were conducted. Results: Of all 94 patients included, 59 were male and 35 were female. The age at hemophagocytic lymphohistiocytosis (HLH) diagnosis was (40.5±17.3) years. Seventy-four cases were T/NK cell lymphoma; 15 were B cell lymphoma; 5 were Hodgkin lymphoma. The age at HLH diagnosis of T/NK cell LAHS patients was (37.9±16.2) years, while that of B cell LAHS patients was (55.9±14.0) years. T/NK cell LAHS patients were significantly younger than B cell LAHS patients (P<0.001). Baseline fibrinogen of T/NK cell LAHS patients was 1.34 (0.86, 2.44) g/L, while that of B cell LAHS patients was 2.20 (1.75, 4.25) g/L. T/NK cell LAHS patients showed significantly lower fibrinogen levels than B cell LAHS patients (P=0.008). Combined treatment of anti-HLH and anti-lymphoma treatment was conducted in 35 patients; anti-HLH treatment was conducted in 31 patients; anti-lymphoma treatment was conducted in 8 patients; glucocorticoid treatment was conducted in 7 patients. ORR was 49.4%, and the median OS was 61 days for overall patients. Patients who received anti-HLH treatment and turned to anti-lymphoma treatment early displayed the best ORR and OS, significantly higher than those of anti-HLH patients (69.0 vs 38.7%, P=0.019, and 192.0 vs 24.5 days, P=0.028, respectively), which were also insignificantly higher than those of anti-lymphoma patients. Extranodal NK/T-cell lymphoma or aggressive natural killer cell leukemia was the risk factor of LAHS prognosis (HR=0.113, 95%CI: 0.018-0.728, P=0.022). Conclusions: Prognosis of LAHS patients is poor. Anti-lymphoma treatment should be initiated as soon as HLH is rapidly controlled.
Collapse
Affiliation(s)
- A L Zhao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - M Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - L F Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - X A Gan
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - H Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - K Shen
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y F Yang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - T Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
17
|
Telfeian AE, Sastry R, Ali R, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T, Lewandrowski KU, Gokaslan ZL. Awake, Transforaminal Endoscopic Lumbar Decompression Surgery to Treat L5-S1 Adjacent Segment Disease: A Case Series. Pain Physician 2022; 25:E649-E656. [PMID: 35793189] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lumbar radiculopathy secondary to L5-S1 degenerative changes adjacent to a lumbar fusion usually requires extending the fusion to include the degenerative L5-S1 level; this revision surgery can often be a very invasive procedure. OBJECTIVE To describe outcomes of awake, transforaminal endoscopic decompression surgery for patients presenting with lumbar radiculopathy as a result of L5-S1 degenerative disc disease below lumbar fusions. STUDY DESIGN Retrospective chart review. METHODS Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period from 2014 through 2019 by a single surgeon at a single institution. The records of 18 consecutive patients who underwent transforaminal lumbar endoscopic decompression surgery to treat radiculopathy secondary to L5-S1 adjacent segment disease were retrospectively reviewed. All included patients were followed for at least 2 years after surgery. All patients were treated at L5-S1 and had fusion constructs that ended at L5. RESULTS Thirteen men and 5 women patients ranging in age from 38 to 83 (average age of 68.9 ± 11.5) were treated for symptomatic adjacent segment disease at L5-S1 during the 5-year time period. Surgery was successful in all cases, except 2 patients (11%) at 2 years follow-up had recurrent symptomatic pathology at L5-S1 and required additional surgical treatment. The average preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were 7.5(± 1.3) and 45.3 (± 12.3) respectively. The average 2-year postoperative VAS and ODI scores were 2.4 (± 1.5) and 22.5 (± 9.6) respectively, excluding the 2 patients with recurrent pathology. The average body mass index (BMI) and L5-S1 disc height in the 2-year successful group (n = 16) were 30.6 (± 7.4) and 8.7 mm (± 3.5 mm) respectively; the average BMI and L5-S1 disc height in the 2-year failure group (n = 2) were 25.8 (± 5.9) and 7.9 (± 2.6) respectively. LIMITATIONS This was a retrospective case series. CONCLUSIONS Endoscopic spine surgery offers patients with fusions that terminate at L5 a safe and effective option for treatment of lumbar degenerative spine disease at L5-S1 below their fusion constructs. A longer follow-up and a larger prospective study would be necessary to consider the utility of endoscopic compression versus extending the fusion construct.
Collapse
Affiliation(s)
- Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahul Sastry
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rohaid Ali
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jared Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kai-Uwe Lewandrowski
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
18
|
Telfeian AE, Bajaj A, Sastry R, Ali R, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T, Lewandrowski KU, Gokaslan ZL. Foraminal Access Strategies in Patients with Lumbar Posterolateral Fusions in Transforaminal Endoscopic Spine Surgery: Case Series and Technical Note. Pain Physician 2022; 25:E449-E455. [PMID: 35652774] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The treatment of post-laminectomy lumbar radiculopathy in the setting of a large posterolateral fusion mass presents an anatomic challenge to the spine interventionalist. OBJECTIVE To describe outcomes of awake, transforaminal endoscopic surgical treatment for patients presenting with lumbar radiculopathy after instrumented posterolateral lumbar fusions. STUDY DESIGN Retrospective chart review. SETTING This study took place in a single-center, academic hospital. METHODS The records of 538 patients who underwent awake transforaminal lumbar endoscopic decompression surgery performed by a single surgeon at a single institution between 2014 and 2019 were retrospectively reviewed. Fifteen consecutive patients who required drilling through their posterolateral fusion masses to access the post-fusion foraminal stenosis were included in this study. All included patients were followed for at least one year after surgery. RESULTS Fifteen patients (7 male and 8 female) with an average age of 68.1 years (range 38-89, standard deviation 13.4 years) underwent awake transforaminal foraminal decompression surgeries that utilized special techniques to drill through large posterolateral fusion masses to access their foraminal stenosis. One patient (7%) required repeat surgery in the postoperative period due to lack of surgical improvement. For the remaining 14 patients, at one year follow up, the preoperative visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) improved from 7.0 (± 1.7) and 40.7% (± 12.9) to 1.7 (± 1.6) and 12.1% (± 11.3). There were no complications such as infection, durotomy, or neurologic injury. LIMITATIONS Retrospective case series. CONCLUSION Transforaminal endoscopic spine surgery offers a unique approach to post-laminectomy and post-fusion foraminal compression because it avoids scar tissue resulting from previous posterior approaches. Large posterolateral fusion masses associated with some posterior fusions can be a sizeable bony barrier to transforaminal access. The authors share their techniques and success for navigating large posterior, bony fusion masses in transforaminal post-fusion foraminal decompression.
Collapse
Affiliation(s)
- Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Ankush Bajaj
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahul Sastry
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rohaid Ali
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jared Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Kai-Uwe Lewandrowski
- Dept. of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
19
|
Sastry RA, Hagan MJ, Feler J, Shaaya EA, Sullivan PZ, Abinader JF, Camara JQ, Niu T, Fridley JS, Oyelese AA, Sampath P, Telfeian AE, Gokaslan ZL, Toms SA, Weil RJ. Influence of Time of Discharge and Length of Stay on 30-Day Outcomes After Elective Anterior Cervical Spine Surgery. Neurosurgery 2022; 90:734-742. [PMID: 35383699 DOI: 10.1227/neu.0000000000001893] [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] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Encouraging early time of discharge (TOD) for medical inpatients is commonplace and may potentially improve patient throughput. It is unclear, however, whether early TOD after elective spine surgery achieves this goal without a consequent increase in re-presentations to the hospital. OBJECTIVE To evaluate whether early TOD results in increased rates of hospital readmission or return to the emergency department after elective anterior cervical spine surgery. METHODS We analyzed 686 patients who underwent elective uncomplicated anterior cervical spine surgery at a single institution. Logistic regression was used to evaluate the relationship between sociodemographic, procedural, and discharge characteristics, and the outcomes of readmission or return to the emergency department and TOD. RESULTS In multiple logistic regression, TOD was not associated with increased risk of readmission or return to the emergency department within 30 days of surgery. Weekend discharge (odds ratio [OR] 0.33, 95% CI 0.21-0.53), physical therapy evaluation (OR 0.44, 95% CI 0.28-0.71), and occupational therapy evaluation (OR 0.32, 95% CI 0.17-0.63) were all significantly associated with decreased odds of discharge before noon. Disadvantaged status, as measured by area of deprivation index, was associated with increased odds of readmission or re-presentation (OR 1.86, 95% CI 0.95-3.66), although this result did not achieve statistical significance. CONCLUSION There does not appear to be an association between readmission or return to the emergency department and early TOD after elective spine surgery. Overuse of inpatient physical and occupational therapy consultations may contribute to decreased patient throughput in surgical admissions.
Collapse
Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Matthew J Hagan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Joshua Feler
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Elias A Shaaya
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Patricia Z Sullivan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jose Fernandez Abinader
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Joaquin Q Camara
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Prakash Sampath
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Steven A Toms
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Robert J Weil
- Southcoast Health Brain & Spine, Dartmouth, Massachusetts, USA
| |
Collapse
|
20
|
Sullivan PZ, Niu T, Abinader JF, Syed S, Sampath P, Telfeian A, Fridley J, Klinge P, Camara J, Oyelese A, Gokaslan ZL. Evolution of surgical treatment of metastatic spine tumors. J Neurooncol 2022; 157:277-283. [PMID: 35306618 DOI: 10.1007/s11060-022-03982-0] [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: 12/31/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The treatment of cancer has transformed over the past 40 years, with medical oncologists, radiation oncologists and surgeons working together to prolong survival times and minimize treatment related morbidity. With each advancement, the risk-benefit scale has been calibrated to provide an accurate assessment of surgical hazard. The goal of this review is to look back at how the role of surgery has evolved with each new medical advance, and to explore the role of surgeons in the future of cancer care. METHODS A literature review was conducted, highlighting the key papers guiding surgical management of spinal metastatic lesions. CONCLUSION The roles of surgery, medical therapy, and radiation have evolved over the past 40 years, with new advances requiring complex multidisciplinary care.
Collapse
Affiliation(s)
- Patricia Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA.
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Jose Fernandez Abinader
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Prakash Sampath
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Albert Telfeian
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Jared Fridley
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Petra Klinge
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Joaquin Camara
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital, 593 Eddy St, APC 6, Providence, RI, 02903, USA
| |
Collapse
|
21
|
Telfeian AE, Sastry R, Oyelese A, Fridley J, Camara-Quintana JQ, Niu T, Sampath P, Lewandrowski KU, Mueller K, Gokaslan ZL. Awake, Transforaminal Endoscopic Lumbar Spine Surgery in Octogenarians: Case Series. Pain Physician 2022; 25:E255-E262. [PMID: 35322980] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Optimal approaches for treating surgical spine pathology in very geriatric patients, such as those over the age of 80, remain unclear. OBJECTIVE To describe outcomes of awake, transforaminal endoscopic surgical treatment for patients 80 years old and older presenting with lumbar radiculopathy. STUDY DESIGN Retrospective case review. METHODS The records of 52 consecutive patients who underwent awake transforaminal lumbar endoscopic decompression surgery performed by a single surgeon at a single institution between 2014 and 2019 were retrospectively reviewed. All included patients were followed for at least one year after surgery. RESULTS Transforaminal surgeries performed were discectomies (21), foraminotomies (7), redo foraminotomies post-laminectomy (5), fusion explorations (13), facet cyst resections (3), spondylolisthesis decompressions (2), and a decompression for metastatic disease (1). Seven patients (13.5%) required repeat surgery at the treated level during the one-year follow-up. For the remaining 45 patients, at one-year follow-up, preoperative visual analog scale (VAS) for leg pain and Oswestry disability index (ODI) improved from 6.9 (± 1.4) and 40.5% (± 11.5) to 1.8 (± 1.4) and 12.0% (± 10.8), respectively. The only complication of the procedure was a single durotomy (2%). LIMITATIONS Single-center, retrospective case review with a relatively small number of cases with diverse clinical pathology. A multi-center case study with a larger number of patients with a more homogeneous case pathology would be more revealing. CONCLUSIONS Endoscopic spine surgery offers octogenarians a safe and effective option for the treatment of lumbar degenerative spine disease and may represent a valuable treatment strategy in a growing patient population.
Collapse
Affiliation(s)
- Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Rahul Sastry
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jared Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Prakash Sampath
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Kyle Mueller
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
22
|
Hagan MJ, Pertsch NJ, Leary OP, Zheng B, Camara-Quintana JQ, Niu T, Mueller K, Boghani Z, Telfeian AE, Gokaslan ZL, Oyelese AA, Fridley JS. Influence of psychosocial and sociodemographic factors in the surgical management of traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States. J Spine Surg 2021; 7:277-288. [PMID: 34734132 DOI: 10.21037/jss-21-37] [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] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
Background Socioeconomic factors can bias clinician decision-making in many areas of medicine. Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, and major psychiatric disorder are emerging as potential sources of conscious and unconscious bias. We hypothesized that these psychosocial factors, in addition to socioeconomic factors, may impact the decision to operate on patients with a traumatic cervicothoracic fracture and associated spinal cord injury (SCI). Methods We performed a cohort analysis using clinical data from 2012-2016 in the American College of Surgeons (ACS) National Trauma Data Bank at academic level I and II trauma centers. Patients were eligible if they had a diagnosis of cervicothoracic fracture with SCI. Using ICD codes, we evaluated baseline characteristics including race; insurance status; diagnosis of alcoholism, substance abuse, or major psychiatric disorder; admission drug screen and blood alcohol level; injury characteristics and severity; and hospital characteristics including geographic region, non-profit status, university affiliation, and trauma level. Factors significantly associated with surgical intervention in univariate analysis were eligible for inclusion in multivariate logistic regression. Results We identified 6,655 eligible patients, of whom 62% underwent surgical treatment (n=4,137). Patients treated non-operatively were more likely to be older; be female; be Black or Hispanic; have Medicare, Medicaid, or no insurance; have been assaulted; have been injured by a firearm; have thoracic fracture; have less severe injuries; have severe TBI; be treated at non-profit hospitals; and be in the Northeast or Western U.S. (all P<0.01). After adjusting for confounders in multivariate analysis, only insurance status remained associated with operative treatment. Medicaid patients (OR=0.81; P=0.021) and uninsured patients (OR=0.63; P<0.001) had lower odds of surgery relative to patients with private insurance. Injury severity and facility characteristics also remained significantly associated with surgical management following multivariate regression. Conclusions Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, or psychiatric illness do not appear to bias the decision to operate after traumatic cervicothoracic fracture with SCI. Baseline sociodemographic imbalances were explained largely by insurance status, injury, and facility characteristics in multivariate analysis.
Collapse
Affiliation(s)
- Matthew J Hagan
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Nathan J Pertsch
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Owen P Leary
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Bryan Zheng
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Joaquin Q Camara-Quintana
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Tianyi Niu
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Kyle Mueller
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Zain Boghani
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Albert E Telfeian
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Ziya L Gokaslan
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Adetokunbo A Oyelese
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Jared S Fridley
- The Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
23
|
Ali R, Syed S, Sastry RA, Abdulrazeq H, Shao B, Roye GD, Doberstein CE, Oyelese A, Niu T, Gokaslan ZL, Telfeian A. Toward more accurate documentation in neurosurgical care. Neurosurg Focus 2021; 51:E11. [PMID: 34724645 DOI: 10.3171/2021.8.focus21387] [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: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Accurate clinical documentation is foundational to any quality improvement endeavor as it is ultimately the medical record that is measured in assessing change. Literature on high-yield interventions to improve the accuracy and completeness of clinical documentation by neurosurgical providers is limited. Therefore, the authors sought to share a single-institution experience of a two-part intervention to enhance clinical documentation by a neurosurgery inpatient service. METHODS At an urban, level I trauma, academic teaching hospital, a two-part intervention was implemented to enhance the accuracy of clinical documentation of neurosurgery inpatients by residents and advanced practice providers (APPs). Residents and APPs were instructed on the most common neurosurgical complications or comorbidities (CCs) and major complications or comorbidities (MCCs), as defined by Medicare. Additionally, a "system-based" progress note template was changed to a "problem-based" progress note template. Prepost analysis was performed to compare the CC/MCC capture rates for the 12 months prior to the intervention with those for the 3 months after the intervention. RESULTS The CC/MCC capture rate for the neurosurgery service line rose from 62% in the 12 months preintervention to 74% in the 3 months after intervention, representing a significant change (p = 0.00002). CONCLUSIONS Existing clinical documentation habits by neurosurgical residents and APPs may fail to capture the extent of neurosurgical inpatients with CC/MCCs. An intervention that focuses on the most common CC/MCCs and utilizes a problem-based progress note template may lead to more accurate appraisals of neurosurgical patient acuity.
Collapse
Affiliation(s)
- Rohaid Ali
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Sohail Syed
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Rahul A Sastry
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Hael Abdulrazeq
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Belinda Shao
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - G Dean Roye
- 2Department of Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Curtis E Doberstein
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Adetokunbo Oyelese
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Tianyi Niu
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| | - Albert Telfeian
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University; and
| |
Collapse
|
24
|
Sastry RA, Yu J, Niu T, Camara J, Svokos K, Fridley J, Telfeian A, Gokaslan Z, Oyelese AA. Hardware failure and reoperation after hybrid anterior cervical corpectomy and discectomy for multilevel spondylotic disease: A retrospective single-institution cohort study. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101234] [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: 11/29/2022] Open
|
25
|
Peeters SM, Nagasawa D, Gaonkar B, Niu T, Tucker A, Attiah M, Babayan D, Moreland N, Yang I, Press MC, Macyszyn L. Perioperative dual antiplatelet therapy for patients undergoing spine surgery soon after drug eluting stent placement. Surg Neurol Int 2021; 12:302. [PMID: 34345443 PMCID: PMC8326059 DOI: 10.25259/sni_337_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/06/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Performing emergent spinal surgery within 6 months of percutaneous placement of drug-eluting coronary stent (DES) is complex. The risks of spinal bleeding in a “closed space” must be compared with the risks of stent thrombosis or major cardiac event from dual antiplatelet therapy (DAPT) interruption. Methods: Eighty relevant English language papers published in PubMed were reviewed in detail. Results: Variables considered regarding surgery in patients on DAPT for DES included: (1) surgical indications, (2) percutaneous cardiac intervention (PCI) type (balloon angioplasty vs. stenting), (3) stent type (drug-eluting vs. balloon mechanical stent), and (4) PCI to noncardiac surgery interval. The highest complication rate was observed within 6 weeks of stent placement, this corresponds to the endothelialization phase. Few studies document how to manage patients with critical spinal disease warranting operative intervention within 6 months of their PCI for DES placement. Conclusion: The treatment of patients requiring urgent or emergent spinal surgery within 6 months of undergoing a PCI for DES placement is challenging. As early interruption of DAPT may have catastrophic consequences, we hereby proposed a novel protocol involving stopping clopidogrel 5 days before and aspirin 3 days before spinal surgery, and bridging the interval with a reversible P2Y12 inhibitor until surgery. Moreover, postoperatively, aspirin could be started on postoperative day 1 and clopidogrel on day 2. Nevertheless, this treatment strategy may not be appropriate for all patients, and multidisciplinary approval of perioperative antiplatelet therapy management protocols is essential.
Collapse
Affiliation(s)
- Sophie M Peeters
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, United States
| | - Daniel Nagasawa
- Department of Neurosurgery, Providence Saint John's Health Center, Santa Monica, California, United States
| | - Bilwaj Gaonkar
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, United States
| | - Tianyi Niu
- Department of Neurosurgery, Brown University, Providence, Rhode Island, United States
| | - Alexander Tucker
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Mark Attiah
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, United States
| | - Diana Babayan
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, United States
| | - Natalie Moreland
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, California, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, United States
| | - Marcela Calfon Press
- Department of Cardiology, University of California Los Angeles, Los Angeles, California, United States
| | - Luke Macyszyn
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, United States
| |
Collapse
|
26
|
Say I, Niu T, Thum JA, Archie MM, Chen DC, Lu DC. A novel endoscope-assisted technique for lateral lumbar interbody fusion: feasibility study, technical note, and operative video. J Neurosurg Spine 2021:1-7. [PMID: 34171832 DOI: 10.3171/2020.12.spine201326] [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: 07/17/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
The lateral approach to the spine is generally well tolerated, but reports of debilitating injury to the lumbar plexus, iliac vessels, ureter, and abdominal viscera are increasingly recognized, likely related to the lack of direct visualization of these nearby structures. To minimize this complication profile, the authors describe here a novel, minimally invasive, endoscope-assisted technique for the LLIF and evaluate its clinical feasibility. Seven consecutive endoscope-assisted lateral lumbar interbody fusion (LLIF) procedures by the senior authors were reviewed for the incidence of approach-related complications. One patient had a postoperative approach-related complication. This patient developed transient ipsilateral thigh hip flexion weakness that resolved spontaneously by the 3-month follow-up. No patient experienced visceral, urological, or vascular injury, and no patient sustained a permanent neurological injury related to the procedure. The authors' preliminary experience suggests that this endoscope-assisted LLIF technique may be clinically feasible to mitigate vascular, urological, and visceral injury, especially in patients with previous abdominal surgery, anomalous anatomy, and revision operations. It provides direct visualization of at-risk structures without significant additional operative time. A larger series is needed to determine whether it reduces the incidence of lumbar plexopathy or visceral injury compared with traditional lateral approaches.
Collapse
Affiliation(s)
| | | | | | | | | | - Daniel C Lu
- 1Department of Neurosurgery.,3Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, and.,4Brain Research Institute, University of California, Los Angeles, California
| |
Collapse
|
27
|
Liu DD, Rivera-Lane K, Leary OP, Pertsch NJ, Niu T, Camara-Quintana JQ, Oyelese AA, Fridley JS, Gokaslan ZL. Supplementation of Screw-Rod C1-C2 Fixation With Posterior Arch Femoral Head Allograft Strut. Oper Neurosurg (Hagerstown) 2021; 20:226-231. [PMID: 33269389 DOI: 10.1093/ons/opaa336] [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: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Numerous C1-C2 fixation techniques exist for the treatment of atlantoaxial instability. Limitations of screw-rod and sublaminar wiring techniques include C2 nerve root sacrifice and dural injury, respectively. We present a novel technique that utilizes a femoral head allograft cut with a keyhole that rests posteriorly on the arches of C1 and C2 and straddles the C2 spinous process, secured by sutures. OBJECTIVE To offer increased fusion across C1-C2 without the passage of sublaminar wiring or interarticular arthrodesis. METHODS A total of 6 patients with atlantoaxial instability underwent C1-C2 fixation using our method from 2015 to 2016. After placement of a C1-C2 screw/rod construct, a cadaveric frozen femoral head allograft was cut into a half-dome with a keyhole and placed over the already decorticated dorsal C1 arch and C2 spinous process. Notches were created in the graft and sutures were placed in the notches and around the rods to secure it firmly in place. RESULTS The femoral head's shape allowed for creation of a graft that provides excellent surface area for fusion across C1-C2. There were no intraoperative complications, including dural tears. Postoperatively, no patients had sensorimotor deficits, pain, or occipital neuralgia. 5 patients demonstrated clinical resolution of symptoms by 3 mo and radiographic (computed tomography) evidence of fusion at 1 yr. One patient had good follow-up at 1 mo but died due to complications of Alzheimer disease. CONCLUSION The posterior arch femoral head allograft strut technique with securing sutures is a viable option for supplementing screw-rod fixation in the treatment of complex atlantoaxial instability.
Collapse
Affiliation(s)
- David D Liu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kendall Rivera-Lane
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Owen P Leary
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nathan J Pertsch
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jared S Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
28
|
Zhong H, Cheng S, Zhang X, Xu B, Chen J, Jiang X, Hu Y, Cui G, Wei J, Qian W, Huang X, Hou M, Yan F, Wang X, Song Y, Hu J, Liu Y, Ma X, Li F, Wu C, Chen J, Yu L, Bai O, Xu J, Zhu Z, Liu L, Zhou X, Huang L, Tong Y, Niu T, Wu D, Xiong J, Zhang H, Wang C, Ouyang B, Yi H, Cai G, Li B, Liu J, Li Z, Xiao R, Wang L, Jiang Y, Liu Y, Zheng X, Xu P, Huang H, Wang L, Chen S, Zhao W. ESA VERSUS MESA WITH SANDWICHED RADIOTHERAPY IN PATIENTS WITH EARLY‐STAGE NATURAL KILLER/T‐CELL LYMPHOMA: A MULTICENTRE, RANDOMISED, PHASE 3, NON‐INFERIORITY TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.52_2879] [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: 02/05/2023]
|
29
|
Darveau SC, Leary OP, Persad-Paisley EM, Shaaya EA, Oyelese AA, Fridley JS, Sampath P, Camara-Quintana JQ, Gokaslan ZL, Niu T. Existing clinical evidence on the use of cellular bone matrix grafts in spinal fusion: updated systematic review of the literature. Neurosurg Focus 2021; 50:E12. [PMID: 34062506 DOI: 10.3171/2021.3.focus2173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal fusion surgery is increasingly common; however, pseudarthrosis remains a common complication affecting as much as 15% of some patient populations. Currently, no clear consensus on the best bone graft materials to use exists. Recent advances have led to the development of cell-infused cellular bone matrices (CBMs), which contain living components such as mesenchymal stem cells (MSCs). Relatively few clinical outcome studies on the use of these grafts exist, although the number of such studies has increased in the last 5 years. In this study, the authors aimed to summarize and critically evaluate the existing clinical evidence on commercially available CBMs in spinal fusion and reported clinical outcomes. METHODS The authors performed a systematic search of the MEDLINE and PubMed electronic databases for peer-reviewed, English-language original articles (1970-2020) in which the articles' authors studied the clinical outcomes of CBMs in spinal fusion. The US National Library of Medicine electronic clinical trials database (www.ClinicalTrials.gov) was also searched for relevant ongoing clinical trials. RESULTS Twelve published studies of 6 different CBM products met inclusion criteria: 5 studies of Osteocel Plus/Osteocel (n = 354 unique patients), 3 of Trinity Evolution (n = 114), 2 of ViviGen (n = 171), 1 of map3 (n = 41), and 1 of VIA Graft (n = 75). All studies reported high radiographic fusion success rates (range 87%-100%) using these CBMs. However, this literature was overwhelmingly limited to single-center, noncomparative studies. Seven studies disclosed industry funding or conflicts of interest (COIs). There are 4 known trials of ViviGen (3 trials) and Bio4 (1 trial) that are ongoing. CONCLUSIONS CBMs are a promising technology with the potential of improving outcome after spinal fusion. However, while the number of studies conducted in humans has tripled since 2014, there is still insufficient evidence in the literature to recommend for or against CBMs relative to cheaper alternative materials. Comparative, multicenter trials and outcome registries free from industry COIs are indicated.
Collapse
|
30
|
Pertsch NJ, Leary OP, Camara-Quintana JQ, Liu DD, Niu T, Woo AS, Ng TT, Oyelese AA, Fridley JS, Gokaslan ZL. A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2023. [PMID: 36045932 PMCID: PMC9394173 DOI: 10.3171/case2023] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervicothoracic junction chordomas are uncommon primary spinal tumors optimally treated with en bloc resection. Although en bloc resection is the gold standard for treatment of mobile spinal chordoma, tumor location, size, and extent of involvement frequently complicate the achievement of negative margins. In particular, chordoma involving the thoracic region can require a challenging anterior access, and en bloc resection can lead to a highly destabilized spine. OBSERVATIONS Modern technological advances make en bloc resection more technically feasible than ever before. In this case, the successful en bloc resection of a particularly complex cervicothoracic junction chordoma was facilitated by a multidisciplinary surgical approach that maximized the use of intraoperative computed tomography–guided spinal navigation and patient-specific three-dimensional–printed modeling. LESSONS The authors review the surgical planning and specific techniques that facilitated the successful en bloc resection of this right-sided chordoma via image-guided parasagittal osteotomy across 2 stages. The integration of emerging visualization technologies into complex spinal column tumor management may help to provide optimal oncological care for patients with challenging primary tumors of the mobile spine.
Collapse
Affiliation(s)
- Nathan J. Pertsch
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Owen P. Leary
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Joaquin Q. Camara-Quintana
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - David D. Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Tianyi Niu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Albert S. Woo
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Plastic Surgery, and
| | - Thomas T. Ng
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Thoracic Surgery, Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A. Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Jared S. Fridley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| |
Collapse
|
31
|
Wang R, Sun J, Li G, Zhang M, Niu T, Kang X, Zhao H, Chen J, Sun E, Li Y. Effect of Bifidobacterium animalis subsp. lactis MN-Gup on constipation and the composition of gut microbiota. Benef Microbes 2020; 12:31-42. [PMID: 33308038 DOI: 10.3920/bm2020.0023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Probiotics have been reported to be associated with the alleviation of constipation. The aim of this study was to detect and determine the effect of Bifidobacterium animalis subsp. lactis MN-Gup (MN-Gup) on the alleviation of constipation in BALB/c mice and humans, and to elucidate the mechanisms underlying its effect by measuring changes in the concentration of short-chain fatty acids and the composition of microbes in human faeces. BALB/c mice were given MN-Gup by gavage for 14 days. On the 8th day of this treatment, constipation was induced by the application of diphenoxylate via gavage. The results showed that MN-Gup significantly decreased the first black stool defecation time, and significantly increased black faecal wet weight, black faecal number and the gastric-intestinal transit rate (P<0.05), thereby relieving constipation. In humans, a randomised, double-blind, placebo-controlled trial was performed to investigate the effect of MN-Gup in adults with functional constipation. After 4 weeks of intervention with placebo or MN-Gup yogurt, constipation-related symptoms (including defecation frequency, stool consistency, straining and incomplete feeling during defecation) in the constipated subjects were significantly improved in the two groups, but not different between the groups at the end of the intervention. The concentration of acetate increased significantly in the MN-Gup group compared to the placebo group and before ingestion. Significant changes in the composition of gut microbiota were found after intake of MN-Gup yogurt when compared to placebo. The relative abundances of acetate-producing Bifidobacterium, Ruminoccaceae_UCG-002 and Ruminoccaceae_UCG-005 were significantly increased after intake of MN-Gup yogurt. These results showed that MN-Gup could relieve constipation related to increased acetate-producing Bifidobacterium, Ruminoccaceae_UCG-002 and Ruminoccaceae_UCG-005.
Collapse
Affiliation(s)
- R Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China P.R
| | - J Sun
- Mengniu Hi-tech Dairy Product Beijing Co., Ltd., Beijing 101100, China P.R
| | - G Li
- Key Laboratory of Functional Dairy, Co-constructed by Ministry of Education and Beijing Government, and Beijing Laboratory of Food Quality and Safety, China Agricultural University, Beijing 100083, China P.R
| | - M Zhang
- School of Food and Chemical Engineering, Beijing Technology and Business University, Beijing 100048, China P.R
| | - T Niu
- Mengniu Hi-tech Dairy Product Beijing Co., Ltd., Beijing 101100, China P.R
| | - X Kang
- Mengniu Hi-tech Dairy Product Beijing Co., Ltd., Beijing 101100, China P.R
| | - H Zhao
- Mengniu Hi-tech Dairy Product Beijing Co., Ltd., Beijing 101100, China P.R
| | - J Chen
- Mengniu Hi-tech Dairy Product Beijing Co., Ltd., Beijing 101100, China P.R
| | - E Sun
- Mengniu Hi-tech Dairy Product Beijing Co., Ltd., Beijing 101100, China P.R
| | - Y Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China P.R
| |
Collapse
|
32
|
Sastry R, Moldovan K, Niu T. Headache, Confusion, and Somnolence in a 27-Year-Old Woman. JAMA 2020; 324:2097-2098. [PMID: 33034624 DOI: 10.1001/jama.2020.10167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rahul Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Krisztina Moldovan
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| |
Collapse
|
33
|
Fridley JS, Syed S, Niu T, Leary OP, Gokaslan ZL. Presentation of spinal cord and column tumors. Neurooncol Pract 2020; 7:i18-i24. [PMID: 33299570 DOI: 10.1093/nop/npaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Metastatic spine disease occurs in more than 10% of all cancer patients. Advances in systemic treatment for cancer has led to improved overall survival for many types of cancer, which has increased the overall incidence of spinal metastases. The most common presenting complaint of patients with spinal metastases is pain. Pain originating from spinal metastases can be oncological, mechanical, and/or neurological in nature. Early recognition of these symptoms is helpful to guide treatment and accurately gauge patient prognosis. Unfortunately, the prevalence of degenerative back pain in the general population can complicate early clinical recognition of patients with metastatic spine disease. Therefore, back pain in any patient with a history of malignancy should prompt clinicians to perform an expedited workup for metastatic disease of the spine. Diagnostic imaging and laboratory studies are part of the initial work up. Obtaining pathology via biopsy to establish tumor histology is essential to determine the appropriate treatment.
Collapse
Affiliation(s)
- Jared S Fridley
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
34
|
Leary OP, Crozier J, Liu DD, Niu T, Pertsch NJ, Camara-Quintana JQ, Svokos KA, Syed S, Telfeian AE, Oyelese AA, Woo AS, Gokaslan ZL, Fridley JS. Three-Dimensional Printed Anatomic Modeling for Surgical Planning and Real-Time Operative Guidance in Complex Primary Spinal Column Tumors: Single-Center Experience and Case Series. World Neurosurg 2020; 145:e116-e126. [PMID: 33010507 DOI: 10.1016/j.wneu.2020.09.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Three-dimensional (3D) printing has emerged as a visualization tool for clinicians and patients. We sought to use patient-specific 3D-printed anatomic modeling for preoperative planning and live intraoperative guidance in a series of complex primary spine tumors. METHODS Over 9 months, patients referred to a single neurosurgical provider for complex primary spinal column tumors were included. Most recent spinal magnetic resonance and computed tomography (CT) imaging were semiautomatically segmented for relevant anatomy and models were printed using polyjet multicolor printing technology. Models were available to surgical teams before and during the operative procedure. Patients also viewed the models preoperatively during surgeon explanation of disease and surgical plan to aid in their understanding. RESULTS Tumor models were prepared for 9 patients, including 4 with chordomas, 2 with schwannomas, 1 with osteosarcoma, 1 with chondrosarcoma, and 1 with Ewing-like sarcoma. Mean age was 50.7 years (range, 15-82 years), including 6 males and 3 females. Mean tumor volume was 129.6 cm3 (range, 3.3-250.0 cm3). Lesions were located at cervical, thoracic, and sacral levels and were treated by various surgical approaches. Models were intraoperatively used as patient-specific anatomic references throughout 7 cases and were found to be technically useful by the surgical teams. CONCLUSIONS We present the largest case series of 3D-printed spine tumor models reported to date. 3D-printed models are broadly useful for operative planning and intraoperative guidance in spinal oncology surgery.
Collapse
Affiliation(s)
- Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Joseph Crozier
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David D Liu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Nathan J Pertsch
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joaquin Q Camara-Quintana
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Konstantina A Svokos
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert S Woo
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
35
|
Lagman C, Nagasawa DT, Azzam D, Sheppard JP, Chen CHJ, Ong V, Nguyen T, Prashant GN, Niu T, Tucker AM, Kim W, Kaldas FM, Pouratian N, Busuttil RW, Yang I. Survival Outcomes After Intracranial Hemorrhage in Liver Disease. Oper Neurosurg (Hagerstown) 2020; 16:138-146. [PMID: 29767779 DOI: 10.1093/ons/opy096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survival outcomes for patients with liver disease who suffer an intracranial hemorrhage (ICH) have not been thoroughly investigated. OBJECTIVE To understand survival outcomes for 3 groups: (1) patients with an admission diagnosis of liver disease (end-stage liver disease [ESLD] or non-ESLD) who developed an ICH in the hospital, (2) patients with ESLD who undergo either operative vs nonoperative management, and (3) patients with ESLD on the liver transplant waitlist who developed an ICH in the hospital. METHODS We retrospectively reviewed hospital charts from March 2006 through February 2017 of patients with liver disease and an ICH evaluated by the neurosurgery service at a single academic medical center. The primary outcome was survival. RESULTS We included a total of 53 patients in this study. The overall survival for patients with an admission diagnosis of liver disease who developed an ICH (n = 29, 55%) in the hospital was 22%. Of those patients with an admission diagnosis of liver disease, 27 patients also had ESLD. Kaplan-Meier analysis found no significant difference in survival for ESLD patients (n = 33, 62%) according to operative status. There were 11 ESLD patients on the liver transplant waitlist. The overall survival for patients with ESLD on the liver transplant waitlist who suffered an in-hospital ICH (n = 7, 13%) was 14%. CONCLUSION ICH in the setting of liver disease carries a grave prognosis. Also, a survival advantage for surgical hematoma evacuation in ESLD patients is not clear.
Collapse
Affiliation(s)
- Carlito Lagman
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Daniel T Nagasawa
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Daniel Azzam
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - John P Sheppard
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Cheng Hao Jacky Chen
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Vera Ong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Thien Nguyen
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Giyarpuram N Prashant
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Tianyi Niu
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Alexander M Tucker
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Won Kim
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Fady M Kaldas
- Department of Surgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Nader Pouratian
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Ronald W Busuttil
- Department of Surgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California.,Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California.,Department of Radiation Oncology, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California.,UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center at the University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
36
|
Liu DD, Camara-Quintana JQ, Leary OP, Syed S, Oyelese AA, Telfeian AE, Gokaslan ZL, Fridley JS, Niu T. Traumatic unilateral jumped facet joint in the upper thoracic spine: Case presentation and literature review. Surg Neurol Int 2020; 11:77. [PMID: 32363072 PMCID: PMC7193257 DOI: 10.25259/sni_119_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: A jumped facet joint is defined by when the inferior articular process of the superior vertebra becomes locked anterior to the superior articular process of the inferior vertebra. These typically traumatic lesions are exceedingly rare in the thoracic spine. Here, we present a patient with a unilateral jumped facet joint in the upper thoracic spine treated with open reduction and an instrumented fusion. Case Description: A 45-year-old male presented after a significant motor vehicle accident. In the emergency room, he had a Glasgow Coma Score of 13 without any neurologic deficit. The thoracic computed tomography (CT) showed a significant jumped left facet at the T2-T3 level. Two days later, utilizing intraoperative CT-guided navigation and neuromonitoring, he underwent open reduction of the T2-T3 jumped facet plus an instrumented T1-T5 fusion. X-rays taken 3-month postoperatively showed a stable construct. Six months postoperatively, he remained neurologically intact. Conclusion: A unilateral jumped thoracic facet may be present in patients with fractured ribs. The mechanism of injury is most likely axial rotation. Both CT and magnetic resonance imaging studies allow for early detection of these very rare lesions and warrant open reduction and instrumented fusion.
Collapse
|
37
|
Leary OP, Liu DD, Boyajian MK, Syed S, Camara-Quintana JQ, Niu T, Svokos KA, Crozier J, Oyelese AA, Liu PY, Woo AS, Gokaslan ZL, Fridley JS. Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients. J Neurosurg Spine 2020; 33:1-10. [PMID: 32109877 DOI: 10.3171/2019.12.spine191238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wound breakdown and infection are common postoperative complications following resection of spinal neoplasms. Accordingly, it has become common practice at some centers for plastic surgeons to assist with closure of large posterior defects after spine tumor resection. In this study, the authors tested the hypothesis that plastic surgery closure of complex spinal defects improves wound outcomes following resection of spinal neoplastic disease. METHODS Electronic medical records of consecutive patients who underwent resection of a spinal neoplasm between June 2015 and January 2019 were retrospectively reviewed. Patients were separated into two subpopulations based on whether the surgical wound was closed by plastic surgery or neurosurgery. Patient demographics, preoperative risk factors, surgical details, and postoperative outcomes were collected in a central database and summarized using descriptive statistics. Outcomes of interest included rates of wound complication, reoperation, and mortality. Known preoperative risk factors for wound complication in spinal oncology were identified based on literature review and grouped categorically. The presence of each category of risk factors was then compared between groups. Univariate and multivariate linear regressions were applied to define associations between individual risk factors and wound complications. RESULTS One hundred six patients met inclusion criteria, including 60 wounds primarily closed by plastic surgery and 46 by neurosurgery. The plastic surgery population included more patients with systemic metastases (58% vs 37%, p = 0.029), prior radiation (53% vs 17%, p < 0.001), prior chemotherapy (37% vs 15%, p = 0.014), and sacral region tumors (25% vs 7%, p = 0.012), and more patients who underwent procedures requiring larger incisions (7.2 ± 3.6 vs 4.5 ± 2.6 levels, p < 0.001), prolonged operative time (413 ± 161 vs 301 ± 181 minutes, p = 0.001), and greater blood loss (906 ± 1106 vs 283 ± 373 ml, p < 0.001). The average number of risk factor categories present was significantly greater in the plastic surgery group (2.57 vs 1.74, p < 0.001). Despite the higher relative risk, the plastic surgery group did not experience a significantly higher rate of wound complication (28% vs 17%, p = 0.145), reoperation (17% vs 9%, p = 0.234), or all-cause mortality (30% vs 13%, p = 0.076). One patient died from wound-related complications in each group (p = 0.851). Regression analyses identified diabetes, multilevel instrumentation, and BMI as the factors associated with the greatest wound complications. CONCLUSIONS Involving plastic surgery in the closure of spinal wounds after resection of neoplasms may ameliorate expected increases in wound complications among higher-risk patients.
Collapse
Affiliation(s)
- Owen P Leary
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | | | | | - Sohail Syed
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Joaquin Q Camara-Quintana
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Tianyi Niu
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Konstantina A Svokos
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Joseph Crozier
- 2Plastic Surgery, Warren Alpert Medical School of Brown University; and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Paul Y Liu
- 2Plastic Surgery, Warren Alpert Medical School of Brown University; and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Albert S Woo
- 2Plastic Surgery, Warren Alpert Medical School of Brown University; and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Ziya L Gokaslan
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| | - Jared S Fridley
- Departments of1Neurosurgery and
- 3Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
38
|
Jin CR, Hou QB, Ma LY, Wang JY, Guo CY, Niu T, Bai XQ, Li SJ. Association between arterial intima response before and after high fat load and progression of arteriosclerosis. J BIOL REG HOMEOS AG 2020; 34:16. [PMID: 32106927 DOI: 10.23812/19-199-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C R Jin
- Department of Cardiology, the First Hospital of Shanxi Medical University, Taiyuan PR China
| | - Q B Hou
- Department of First Clinical Medicine, Shanxi Medical University, Taiyuan, PR China
| | - L Y Ma
- Department of Critical Care Medicine, Shanxi Cardiovascular Hospital, Taiyuan, PR China
| | - J Y Wang
- Department of Basic Medicine, Shanxi Medical University, Taiyuan, PR China
| | - C Y Guo
- Department of First Clinical Medicine, Shanxi Medical University, Taiyuan, PR China
| | - T Niu
- Department of First Clinical Medicine, Shanxi Medical University, Taiyuan, PR China
| | - X Q Bai
- Department of First Clinical Medicine, Shanxi Medical University, Taiyuan, PR China
| | - S J Li
- Department of Nuclear Medicine, the First Hospital of Shanxi Medical University, Taiyuan, PR China
| |
Collapse
|
39
|
Mckay K, Attiah M, Niu T, Nagasawa D, Patel K, Gaonkar B, Van de Wiele B, Moreland N, Tucker A, Churchman P, Batzdorf U, Macyszyn L. Clinical and surgical management of holocervical spinal cord ependymomas. Surg Neurol Int 2019; 10:223. [PMID: 31819817 PMCID: PMC6884946 DOI: 10.25259/sni_374_2019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Spinal ependymomas are rare tumors of the central nervous system, and those spanning the entire cervical spine are atypical. Here, we present two unusual cases of holocervical (C1-C7) spinal ependymomas. Case Description: Two patients, a 32-year-old female and a 24-year-old male presented with neck pain, motor, and sensory deficits. Sagittal MRI confirmed hypointense lesions on T1 and hyperintense regions on T2 spanning the entire cervical spine. These were accompanied by cystic cavities extending caudally into the thoracic spine and rostrally to the cervicomedullary junction. Both patients underwent gross total resection of these lesions and sustained excellent recoveries. Conclusion: Two holocervical cord intramedullary ependymomas were safely and effectively surgically resected without incurring significant perioperative morbidity.
Collapse
Affiliation(s)
- Kevin Mckay
- Departments of Neurosurgery, University of California, Los Angeles
| | - Mark Attiah
- Departments of Neurosurgery, University of California, Los Angeles
| | - Tianyi Niu
- Departments of Neurosurgery, University of California, Los Angeles
| | - Daniel Nagasawa
- Departments of Neurosurgery, University of California, Los Angeles
| | - Kunal Patel
- Departments of Neurosurgery, University of California, Los Angeles
| | - Bilwaj Gaonkar
- Departments of Neurosurgery, University of California, Los Angeles
| | | | - Natalie Moreland
- Departments of Anesthesiology, University of California, Los Angeles
| | - Alexander Tucker
- Departments of Neurosurgery, University of California, Los Angeles
| | - Pedro Churchman
- Departments of Anesthesiology, University of California, Los Angeles
| | - Ulrich Batzdorf
- Departments of Neurosurgery, University of California, Los Angeles
| | - Luke Macyszyn
- Departments of Neurosurgery, University of California, Los Angeles
| |
Collapse
|
40
|
Qin YZ, Zhu LW, Lin S, Geng SX, Liu SW, Cheng H, Wu CY, Xiao M, Li XQ, Hu RP, Wang LL, Liu HY, Ma DX, Guan T, Ye YX, Niu T, Cen JN, Lu LS, Sun L, Yang TH, Wang YG, Li T, Wang Y, Li QH, Zhao XS, Li LD, Chen WM, Long LY, Huang XJ. [An interlaboratory comparison study on the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels]. Zhonghua Xue Ye Xue Za Zhi 2019; 40:889-894. [PMID: 31856435 PMCID: PMC7342382 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.001] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the current status and real performance of the detection of RUNX1-RUNX1T1 fusion transcript levels and WT1 transcript levels in China through interlaboratory comparison. Methods: Peking University People's Hospital (PKUPH) prepared the samples for comparison. That is, the fresh RUNX1-RUNX1T1 positive (+) bone morrow nucleated cells were serially diluted with RUNX1-RUNX1T1 negative (-) nucleated cells from different patients. Totally 23 sets with 14 different samples per set were prepared. TRIzol reagent was added in each tube and thoroughly mixed with cells for homogenization. Each laboratory simultaneously tested RUNX1-RUNX1T1 and WT1 transcript levels of one set of samples by real-time quantitative PCR method. All transcript levels were reported as the percentage of RUNX1-RUNX1T1 or WT1 transcript copies/ABL copies. Spearman correlation coefficient between the reported transcript levels of each participated laboratory and those of PKUPH was calculated. Results: ①RUNX1-RUNX1T1 comparison: 9 samples were (+) and 5 were (-) , the false negative and positive rates of the 20 participated laboratories were 0 (0/180) and 5% (5/100) , respectively. The reported transcript levels of all 9 positive samples were different among laboratories. The median reported transcript levels of 9 positive samples were from 0.060% to 176.7%, which covered 3.5-log. The ratios of each sample's highest to the lowest reported transcript levels were from 5.5 to 12.3 (one result which obviously deviated from other laboratories' results was not included) , 85% (17/20) of the laboratories had correlation coefficient ≥0.98. ②WT1 comparison: The median reported transcript levels of all 14 samples were from 0.17% to 67.6%, which covered 2.6-log. The ratios of each sample's highest to the lowest reported transcript levels were from 5.3-13.7, 62% (13/21) of the laboratories had correlation coefficient ≥0.98. ③ The relative relationship of the reported RUNX1-RUNX1T1 transcript levels between the participants and PKUPH was not always consistent with that of WT1 transcript levels. Both RUNX1-RUNX1T1 and WT1 transcript levels from 2 and 7 laboratories were individually lower than and higher than those of PKUPH, whereas for the rest 11 laboratories, one transcript level was higher than and the other was lower than that of PKUPH. Conclusion: The reported RUNX1-RUNX1T1 and WT1 transcript levels were different among laboratories for the same sample. Most of the participated laboratories reported highly consistent result with that of PKUPH. The relationship between laboratories of the different transcript levels may not be the same.
Collapse
Affiliation(s)
- Y Z Qin
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - L W Zhu
- Beijing Hightrust Diagnostics Co., Ltd, Beijing 100176, China
| | - S Lin
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - S X Geng
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - S W Liu
- Harbin Institute of Hematology and Oncology, Harbin 150010, China
| | - H Cheng
- Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - C Y Wu
- Institute of Hematology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - M Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030
| | - X Q Li
- Center for Stem Cell Research and Application, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022
| | - R P Hu
- Department of Hematology, Bethune First Affiliated Hospital of Jilin University, Changchun 130021
| | - L L Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China
| | - H Y Liu
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - D X Ma
- Department of Hematology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - T Guan
- Department of Hematology, Shanxi Provincial Cancer Hospital, Taiyuan 030000, China
| | - Y X Ye
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - T Niu
- Department of Hematology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - J N Cen
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Disease, Suzhou 215006, China
| | - L S Lu
- Tianjin Sino-us Diagnostics Co., Ltd, Tianjin 301617, China
| | - L Sun
- Wuhan Kindstar Diagnostics Co., Ltd, Wuhan 430075, China
| | - T H Yang
- Department of Hematology, The First People's Hospital of Yunnan Province, Kunming 650034, China
| | - Y G Wang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - T Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y Wang
- The First Hospital of China Medical University, Shenyang 110001, China
| | - Q H Li
- Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Hematologic Disease, Tianjin 300020, China
| | - X S Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - L D Li
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - W M Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - L Y Long
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - X J Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| |
Collapse
|
41
|
Attiah M, Gaonkar B, Alkhalid Y, Villaroman D, Medina R, Ahn C, Niu T, Beckett J, Ames C, Macyszyn L. Natural history of the aging spine: a cross-sectional analysis of spinopelvic parameters in the asymptomatic population. J Neurosurg Spine 2019; 32:1-6. [PMID: 31561232 DOI: 10.3171/2019.7.spine181164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There have been numerous studies demonstrating increased pain and disability when patients' spinopelvic parameters fall outside of certain accepted ranges. However, these values were established based on patients suffering from spinal deformities. It remains unknown how these parameters change over a lifetime in asymptomatic individuals. The goal of this study was to define a range of spinopelvic parameters from asymptomatic individuals. METHODS Sagittal scoliosis radiographs of 210 asymptomatic patients were evaluated. All measurements were reviewed by 2 trained observers, supervised by a trained clinician. The following parameters and relationships were measured or calculated: cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sagittal vertical axis (SVA), cervical SVA (cSVA), and T1 slope, TK/LL, truncal inclination, pelvic tilt (PT), LL-PI, LL/PI, and T1 slope/PI. Patients were stratified by decade of life, and regression analysis was performed to delineate the relationship between each consecutive age group and the aforementioned parameters. RESULTS Cervical lordosis (R2 = 0.61), thoracic kyphosis (R2 = 0.84), SVA (R2 = 0.88), cSVA (R2 = 0.51), and T1 slope (R2 = 0.77) all increase with age. Truncal inclination (R2 = 0.36) and T1 slope/CL remain stable over all decades (R2 = 0.01). LL starts greater than PI, but in the 6th decade of life, LL becomes equal to PI and in the 7th decade becomes smaller than PI (R2 = 0.96). The ratio of TK/LL is stable until the 7th decade of life (R2 = 0.81), whereas PT is stable until the 6th decade (R2 = 0.92). CONCLUSIONS This study further refines the generally accepted LL = PI + 10° by showing that patients under the age of 50 years should have more LL compared to PI, whereas after the 5th decade the relationship is reversed. SVA was not as sensitive across age groups, exhibiting a marked increase only in the 7th decade of life. Given the reliable increase of CL with age, and the stability of T1 slope/CL, this represents another important relationship that should be maintained when performing cervical deformity/fusion surgery. This study has important implications for evaluating adult patients with spinal deformities and for establishing corrective surgical goals.
Collapse
Affiliation(s)
- Mark Attiah
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Bilwaj Gaonkar
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Yasmine Alkhalid
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Diane Villaroman
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Rogelio Medina
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Christine Ahn
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Tianyi Niu
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Joel Beckett
- 1Department of Neurosurgery, University of California, Los Angeles; and
| | - Christopher Ames
- 2Department of Neurosurgery, University of California, San Francisco, California
| | - Luke Macyszyn
- 1Department of Neurosurgery, University of California, Los Angeles; and
| |
Collapse
|
42
|
Xu L, Yang P, Liang W, Xing L, Niu T, Huang M. A Machine Learning Approach with Support Vector Machine (SVM) for Prediction of Preoperative Lymph Node Status with MR Images and clinical features for Intrahepatic Cholangiocarcinoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.203] [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: 10/26/2022]
|
43
|
Denis DJ, Champagne PO, Hoffman H, Niu T, Lu DC. Catheter-based Minimally Invasive Evacuation of Extensive Spinal Epidural Abscess: A Technical Report. Cureus 2019; 11:e4649. [PMID: 31312574 PMCID: PMC6624161 DOI: 10.7759/cureus.4649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Surgical treatment of extensive spinal epidural abscess (SEA) usually involves multilevel exposure of the dural sac with subsequent risk for iatrogenic instability. A minimally invasive technique using an epidural catheter inserted through a limited approach for distant irrigation and drainage of the abscess represents an interesting alternative. Most described techniques involve blind placement of the catheters, with the potential risk of damage to the spinal cord and incomplete abscess drainage. We present and analyze a new technique used in two cases of SEA. Those were successfully treated using a minimally invasive approach supplemented with fluoroscopically-guided catheter drainage. We suggest that fluoroscopic placement of the catheter is a safe and effective method that offers a more focused and potentially safer way to proceed to this technique.
Collapse
|
44
|
Li X, Yang P, Lu Y, Wang X, Jing Z, Yang L, Zhang H, Xia B, Ding L, Niu T, Wu S, Kuang Y. A Radiogenomics Framework to Improve Prediction of Clinical Outcomes in Patients with Esophageal Cancer Treated with Concurrent Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.133] [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: 11/16/2022]
|
45
|
Ausman JI, Liebeskind DS, Gonzalez N, Saver J, Martin N, Villablanca JP, Vespa P, Duckwiler G, Jahan R, Niu T, Salamon N, Yoo B, Tateshima S, Buitrago Blanco MM, Starkman S. A review of the diagnosis and management of vertebral basilar (posterior) circulation disease. Surg Neurol Int 2018; 9:106. [PMID: 29930872 PMCID: PMC5991286 DOI: 10.4103/sni.sni_373_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/26/2017] [Indexed: 12/28/2022] Open
Abstract
We have reviewed the English literature published in the last 70 years on Diseases of the Vertebral Basilar Circulation, or Posterior Circulation Disease (PCD). We have found that errors have been made in the conduct and interpretation of these studies that have led to incorrect approaches to the management of PCD. Because of the difficulty in evaluating the PC, the management of PCD has been incorrectly applied from anterior circulation disease (ACD) experience to PCD. PCD is a common form of stroke affecting 20-40% patients with stroke. Yet, the evidence is strong that the Anterior Circulation (AC) and Posterior Circulations (PC) differ in their pathology, in their clinical presentations, in the rapidity of development of symptoms, in optimal imaging methods, and in available treatments. There appears to be two categories of patients who present with PCD. The first, acute basilar artery occlusion has a more rapid onset. The diagnosis must be made quickly and if imaging proves a diagnosis of Basilar Artery Occlusion (BAO), the treatment of choice is Interventional removal of the basilar artery thrombosis or embolus. The second category of PCD and the most commonly seen PCD disease process presents with non-specific symptoms and early warnings of PCD that now can be related to ischemic events in the entire PC vessels. These warning symptoms and signs occur much earlier than those in the AC. IA angiography is still the gold standard of diagnosis and is superior in definition to MR and CT angiography which are commonly used as a convenient screening imaging tool to evaluate PCD but are both inferior to IA angiography in definition for lesions below 3-4 mm. In at least two reported studies 7T MR angiography appears superior to other imaging modalities and will become the gold standard of imaging of PCD in the future. Medical treatments applied to the ACD have not been proven of value in specific forms of PCD. Interventional therapy was promising but of unproven value in Randomized Controlled Trials (RCT) except for the treatment of Basilar Artery Occlusion (BAO). Surgical revascularization has been proved to be highly successful in patients, who are refractory to medical therapy. These studies have been ignored by the scientific community basically because of an incorrect interpretation of the flawed EC-IC Bypass Trial in 1985 as applying to all stroke patients. Moreover, the EC-IC Bypass Study did not include PCD patients in their study population, but the study results were extrapolated to patients with PCD without any scientific basis. This experience led clinicians to an incorrect bias that surgical treatments are of no value in PCD. Thus, incorrectly, surgical treatments of PCD have not been considered among the therapeutic possibilities for PCD. QMRA is a new quantitative MR technique that measures specific blood flow in extra and intracranial vessels. QMRA has been used to select those patients who may benefit from medical, or interventional, or surgical treatment for PCD based on flow determinations with a high success rate. QMRA accurately predicts the flows in many large and small vessels in the PC and AC and clearly indicates that both circulations are intimately related. From medical and surgical studies, the longer one waits for surgical treatment the higher the risk of a poor outcome results. This observation becomes obvious when the rapidity of development of PCD is compared with ACD. Recent advances in endovascular therapy in the treatment of acute basilar thrombosis is a clear sign that early diagnosis and treatment of PCD will reduce the morbidity and mortality of these diseases. In this review it is evident that there are multiple medical and surgical treatments for PCD depending upon the location of the lesion(s) and the collateral circulation demonstrated. It is clear that the AC and PC have significant differences. With the exception of the large population studies from Oxford England, the reported studies on the management of PCD in the literature represent small selected subsets of the universe of PC diseases, the information from which is not generalizable to the universe of PCD patients. At this point in the history of PCD, there are not large enough databases of similar patients to provide a basis for valid randomized studies, with the exception of the surgical studies. Thus, a high index of suspicion of the early warning symptoms of PCD should lead to a rapid individual clinical assessment of patients selecting those with PCD. Medical, interventional, and/or surgical treatments should be chosen based on knowledge presented in this review. Recording the results in a national Registry on a continuing basis will provide the data that may help advance the management of PCD based on larger data bases of well documented patient information to guide the selection of future therapies for PCD treatments. It is also clear that the management of patients within the complex of diseases that comprise PCD should be performed in centers with expertise in the imaging, medical, interventional and surgical approaches to diseases of the PCD.
Collapse
Affiliation(s)
- James I. Ausman
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David S. Liebeskind
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Neurovascular Imaging Research Core, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Nestor Gonzalez
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeffrey Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Neil Martin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - J. Pablo Villablanca
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Paul Vespa
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gary Duckwiler
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Tianyi Niu
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Noriko Salamon
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Bryan Yoo
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Manuel M. Buitrago Blanco
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sidney Starkman
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
46
|
Lagman C, Nagasawa DT, Sheppard JP, Jacky Chen CH, Nguyen T, Prashant GN, Niu T, Tucker AM, Kim W, Pouratian N, Kaldas FM, Busuttil RW, Yang I. End-Stage Liver Disease in Patients with Intracranial Hemorrhage Is Associated with Increased Mortality: A Cohort Study. World Neurosurg 2018; 113:e320-e327. [DOI: 10.1016/j.wneu.2018.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 12/15/2022]
|
47
|
Diaz-Aguilar D, Niu T, Terterov S, Scharnweber R, Tucker A, Woodard J, Brara H, Merna C, Shah H, Wang S, Rahman S. Neurenteric cyst of the conus medullaris. Surg Neurol Int 2018. [PMID: 29527391 PMCID: PMC5838830 DOI: 10.4103/sni.sni_315_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Neurenteric cysts (NECs) are rare developmental malformations of the central nervous system (CNS) which originate as benign congenital lesions. They originate from developmental foregut precursors, and are presumed to be the result of abnormal partitioning of the embryonic notochord plate. Such NECs predominantly arise in the cervical region in patients around 6 years of age or in their twenties or thirties. Notably, NECs of the conus medullaris are exceedingly rare, especially in patients of advanced age. Case Description: A 70-year-old male presented with bilateral upper thigh and leg pain of over 20 years duration. His pain worsened over the past 3 years, and he sought surgical management. Although his neurological exam was normal, the lumbar magnetic resonance imaging revealed an intradural, nonenhancing, thin-walled, cystic lesion at L1/conus medullaris. The lesion was successfully resected without any adverse sequelae. Conclusions: NECs are rare congenital legions that involve the spine. Here, an L1 intradural extramedullay neuroenteric cyst of the conus medullaris was resected without complications.
Collapse
|
48
|
Terterov S, Diaz-Aguilar D, Scharnweber R, Tucker A, Niu T, Woodard J, Brara H, Poh M, Merna C, Wang S, Rahman S. Surgical nuances of partial sacrectomy for chordoma. Surg Neurol Int 2017; 8:277. [PMID: 29279794 PMCID: PMC5705930 DOI: 10.4103/sni.sni_230_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/19/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Sacral chordomas are rare, slow growing, locally aggressive tumors. Unfortunately, aggressive surgical resection is often associated with increased neurological morbidity. Methods: This technical note focuses on the utilization of partial sacrectomy for the resection of complex spinal chordomas. Results: The case presented documents the potential range of postoperative morbidity seen in patients undergoing partial sacrectomy for chordomas. Despite iatrogenic morbidity and tumor recurrence, with the cooperation of medical and surgical spine specialists, majority of patients can achieve good long-term outcomes. Conclusions: Sacral chordomas are rare lesions and pose a therapeutic challenge for spinal surgeons and oncologists. En-bloc surgical resection (e.g., partial sacrectomy) is the treatment of choice for these lesions, and the cooperation between subspecialists can lead to good neurologic outcomes, particularly if gross total resection is achieved.
Collapse
Affiliation(s)
- Sergei Terterov
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Daniel Diaz-Aguilar
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Rudi Scharnweber
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Alex Tucker
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Tianyi Niu
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Jos'lyn Woodard
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Harsimran Brara
- Department of Neurosurgery, Kaiser Permanente, Los Angeles, California, USA
| | - Melissa Poh
- Department of Plastic Surgery, Kaiser Permanente, Los Angeles, California, USA
| | - Catherine Merna
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Stephanie Wang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Shayan Rahman
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, USA
| |
Collapse
|
49
|
Li X, Gu J, Wang C, Deng Q, Ma S, Ren Y, Xing L, Niu T. P1.14-001 The Feasibility of Predicting Radiation Pneumonitis Using Lung Equivalent Uniform Dose (LEUD) in Volumetric-Modulated Arc. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1019] [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: 11/16/2022]
|
50
|
Niu T, Tucker AM, Nagasawa DT, Bergsneider M. Solitary Aggregatibacter aphrophilus tectal abscess in an immunocompetent patient. Surg Neurol Int 2017; 8:257. [PMID: 29184708 PMCID: PMC5680667 DOI: 10.4103/sni.sni_211_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/15/2017] [Indexed: 11/04/2022] Open
Abstract
Background: A solitary abscess involving the tectum, specifically by Aggregatibacter aphrophilus, is an extremely rare condition with no known reported cases to date. Case Description: Here, we present a case of isolated solitary midbrain tectum abscess in an immunocompetent 28-year-old male who was empirically diagnosed as a primary tectal tumor at an outside hospital where he also underwent placement of a ventriculoperitoneal shunt (VPS) for obstructive hydrocephalus. Eight weeks later he was readmitted with a VPS infection. He was transferred to our institution where the VPS was removed and he was started on broad-spectrum antibiotics. Cerebrospinal fluid (CSF) culture revealed A. aphrophilus. All other workup was negative for infectious etiologies. The tectal lesion completely resolved after 15 weeks of intravenous ceftriaxone without surgical aspiration. Conclusion: We suggest that an empiric diagnosis of tectal glioma should be made with caution for a ring-enhancing mass. CSF should be routinely cultured at the time of operative diversion if abscess is a possibility.
Collapse
Affiliation(s)
- Tianyi Niu
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Alexander M Tucker
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Daniel T Nagasawa
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|