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Gilyadova AV, Ishchenko AA, Samoilova SV, Shiryaev AA, Novruzaliyeva MF, Efendiev KT, Alekseeva PM, Loschenov VB, Reshetov IV. Comparative study of treatment efficacy in severe intraepithelial squamous cell lesions and preinvasive cervical cancer by conization and chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy. Photodiagnosis Photodyn Ther 2024:104060. [PMID: 38521149 DOI: 10.1016/j.pdpdt.2024.104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Cervical cancer (CC) occupies a leading position in incidence among young women of reproductive age. In this connection, it is urgent to search for the most effective approaches to the diagnosis and treatment of this pathology. The purpose of the study was to evaluate the effectiveness of the PDT method using Cе6 with the control of the photobleaching using video and spectral fluorescence diagnostic methods, to develop the method of fluorescence-assisted systemic photodynamic therapy mediated with chlorin e6 for treatment CIN 3 and CIS. MATERIALS AND METHODS A randomized comparative clinical study was conducted involving 94 women aged 18 to 49 years with histologically verified severe intraepithelial squamous cell lesions of the cervix or preinvasive cervical cancer. The patients were included in 2 groups: in the first group conization of the cervix was performed with curettage of the remaining part of the cervical canal; patients in the second group underwent the chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy. RESULTS The absolute majority of patients in the main group after the first course of chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy showed normalization of cytological parameters and colposcopic picture, while women from the comparison group showed signs of cervical lesions statistically significantly more often. These changes corresponded to the dynamics of the proliferation markers expression in the cells of intraepithelial squamous cell lesions. Also, patients of the second group who were planning a pregnancy had better reproductive outcomes after treatment compared to those of the first group. CONCLUSION In general, higher clinical efficacy and safety of the use of the chlorin e6-mediated fluorescence-assisted systemic photodynamic therapy in the treatment of intraepithelial squamous cell lesions and preinvasive cervical cancer have been established compared to the use of standard treatment methods.
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Affiliation(s)
- A V Gilyadova
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;; National Medical Research Center Treatment and Rehabilitation Center, Ministry of Health of the Russian Federation, Ivankovskoe highway 3, Moscow, 125367 Russia.
| | - A A Ishchenko
- National Medical Research Center Treatment and Rehabilitation Center, Ministry of Health of the Russian Federation, Ivankovskoe highway 3, Moscow, 125367 Russia.
| | - S V Samoilova
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - A A Shiryaev
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - M F Novruzaliyeva
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
| | - K T Efendiev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - P M Alekseeva
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - V B Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, ul. Vavilova 38, Moscow, 119991 Russia;; National Research Nuclear University MEPhI (Moscow Engineering Physics Institute MEPhI), Kashirskoye shosse 31, Moscow, 115409 Russia.
| | - I V Reshetov
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, ul. Bolshaya Pirogovskaya 6, Moscow, 119435, Russia;.
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Ma JX, Han XZ, Wang XY. Comparison of single versus double door posterior cervical laminoplasty for patients with cervical spondylotic myelopathy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20538. [PMID: 32569174 PMCID: PMC7310850 DOI: 10.1097/md.0000000000020538] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We undertook a meta-analysis to compare the efficacy and safety of single versus double door posterior cervical laminoplasty for cervical spondylotic myelopathy. METHODS PubMed, Embase, and Cochrane Central Register of controlled trials were searched for randomized controlled trials investigating single and double door posterior cervical laminoplasty for cervical spondylotic myelopathy. The Mantel-Haenszel method with the fixed-effects or random-effects model was used to calculate relative risks and 95% confidence intervals (CIs). RESULTS Seven studies with 224 patients met the eligibility criteria and were included. There was a significant difference in Japanese Orthopedic Association score (MD = 0.79, 95%CI [0.09, 1.49], P = .03; P for heterogeneity = .09, I = 45%), and adverse events (OR = 0.32, 95%CI [0.11, 0.95], P = .04; P for heterogeneity = 1.00, I = 0%) between the double door posterior cervical laminoplasty group and the single door posterior cervical laminoplasty group. There was no significance in operative time (MD = 0.56, 95%CI [-11.86, 12.98], P = .93; P for heterogeneity = 0.001, I = 73%) and length of hospital stay (OR = -0.75, 95%CI [-1.78, 0.27], P = .15; P for heterogeneity = 1.00, I = 0%) between the 2 groups. CONCLUSION Double door posterior cervical laminoplasty is more effective and safer than single door laminoplasty in the treatment of cervical spondylotic myelopathy.
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Affiliation(s)
| | | | - Xiang-Yan Wang
- Clothing Center, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, Shandong, China
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Kumar A, Sahu S, Sethi S, Ratre S, Parihar V, Swamy N, Yadav YR. Computerized Tomography-Based Morphometric Analysis of Cervical Spinal Canal in Central Indian Population. J Neurosci Rural Pract 2020; 11:274-277. [PMID: 32367983 PMCID: PMC7195959 DOI: 10.1055/s-0040-1703962] [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] [Indexed: 11/30/2022] Open
Abstract
Objective
Normal cervical spine canal morphometry is critical for understanding the pathology of certain diseases and for proper preoperative planning. Computerized tomography (CT) scan can replace older conventional radiography techniques by providing more accurate morphometric measurements. This study was aimed to find out various dimensions of the cervical spinal canal of central Indian population.
Materials and Methods
A prospective study was conducted including 100 consecutive cervical spine CT scan of asymptomatic adult subjects. The anteroposterior sagittal canal diameter (SCD), transverse canal diameter (TCD), canal surface area (CSA), and Pavlov-Torg Ratio (PTR) from C2 to C7 were calculated.
Statistical Analysis
Data were entered in Microsoft Excel Sheet 2007 and statistical analysis was performed by IBM SPSS statistics 2.0 version.
p
-Value < 0.05 was considered as significant.
Results
Age ranged from 18 years to 77 years with mean age 39.5 years. There was no significant difference in all the dimensions (SCD, TCD, CSA) in male and female except at C2 level, where SCD, TCD, and CSA were significant larger in male. The mean SCD, TCD, and CSA is largest at C2 level (14.4 ± 1.63 mm, 21.57 ± 1.59 mm, and 156.20 ± 24.98 mm
2
, respectively) and smallest at C4 level (12.77 ± 1.48 mm, 20.37 ± 1.72 mm, and 130.42 ± 21.20 mm
2
). PTR showed very little variation.
Conclusion
Normal values of cervical spinal canal could serve as a future reference. CT scan provides more accurate measurement. More studies are needed as there could be variations in dimensions in different regions in India.
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Affiliation(s)
- Ambuj Kumar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Subhash Sahu
- Department of Plastic Surgery, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India
| | - Shivank Sethi
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Shailendra Ratre
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vijay Parihar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Narayan Swamy
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Gembruch O, Jabbarli R, Rashidi A, Chihi M, El Hindy N, Wetter A, Hütter BO, Sure U, Dammann P, Özkan N. Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery? J Clin Med 2019; 9:jcm9010062. [PMID: 31888031 PMCID: PMC7019793 DOI: 10.3390/jcm9010062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/20/2019] [Revised: 12/17/2019] [Accepted: 12/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Correspondence: ; Tel.: +49-(0)201-723-1201; Fax: +49-(0)201-723-5909
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ali Rashidi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Spine-Center Werne, Katholisches Klinikum Lünen/Werne GmbH, St. Christophorus-Krankenhaus, Am See 1, 59368 Werne, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Neriman Özkan
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
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Waheed H, Khan MS, Muneeb A, Jahanzeb S, Ahmad MN. Radiologic Assessment of Cervical Canal Stenosis Using Kang MRI Grading System: Do Clinical Symptoms Correlate with Imaging Findings? Cureus 2019; 11:e5073. [PMID: 31511807 PMCID: PMC6726420 DOI: 10.7759/cureus.5073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Magnetic resonance imaging (MRI) is widely used in the evaluation of cervical canal stenosis and spinal cord compression. Kang et al. formulated a new MRI grading system for assessing canal stenosis which takes cord signal change into account. The purpose of the study was to determine the agreement between Kang's grading system and neurological symptoms. Methods A cross-sectional study was conducted at Aga Khan University Hospital between April 2014 and December 2015. Patients meeting inclusion criteria were enrolled. T2 sagittal and T2 axial MRI images were acquired and reported by a consultant neuroradiologist, in accordance with the MRI grading system suggested by Kang et al. Neurologic clinical symptoms were acquired by the history taken by the principal investigator. More than one neurologic symptoms and Kang MRI grade 2 or 3 were taken as positive evidence of cord compression resulting from canal stenosis. Results Amongst 126 subjects, 54% were females. Mean age of patients was 50.3 ± 14.3 years (range 19-83 years). Average disease duration was 4.61 ± 3.73 (range 1-24 months). In the majority of the patients, the findings were found at the C5-C6 level. 65.1% of patients were identified positive for cervical canal stenosis by Kang grading system. Most common neurological symptoms were pain (99%) and numbness (56%). Cohen’s Kappa was run to evaluate the agreement between neurological symptoms and Kang grading system. There was a strong agreement between the two methods, K = 0.81 (95% CI 0.70-0.92), p < 0.001. Conclusion There was a substantial agreement between Kang's grading system and the presence of clinical symptoms. The agreement was greatest in females, older patients, and those with longer duration of symptoms.
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Affiliation(s)
- Hira Waheed
- Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Aeman Muneeb
- Internal Medicine, Lincoln Medical Center, New York, USA
| | - Syed Jahanzeb
- Orthopedics, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
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