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Wu EM, Khan NR, Sun MZ, Morcos JJ. Approaches to the Middle Cerebellar Peduncle for Resection of Pontine Cavernomas. Oper Neurosurg (Hagerstown) 2024; 26:468. [PMID: 37909754 DOI: 10.1227/ons.0000000000000968] [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: 03/12/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE The expanded retrosigmoid approach with splitting of the horizontal cerebellar fissure provides a more direct and shorter route for central and dorsolateral pontine lesions while minimizing retraction of tracts, nuclei, and cerebellum. 1-4. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT The middle cerebellar peduncle is partially covered by the petrosal surface of the cerebellum. The horizontal cerebellar fissure (petrosal fissure) divides the petrosal surface of the cerebellar hemisphere into superior and inferior parts. Splitting the petrosal fissure separates the superior and inferior petrosal surfaces and exposes the posterolateral middle cerebellar peduncle (posterior and lateral to the root entry zone of CN5). 1-4. ESSENTIALS STEPS OF THE PROCEDURE Expanded retrosigmoid craniotomy is performed, including unroofing of the sigmoid sinus; petrosal fissure is split to expose the posterolateral middle cerebellar peduncle; entry point for resection of the cavernoma is identified; nims stimulator stimulator is used to confirm the absence of tracts and nuclei; myelotomy is performed; and cavernoma and its draining vein (but not the developmental venous anomaly) are removed using a combination of traction and countertraction against gliotic plane. PITFALLS/AVOIDANCE OF COMPLICATIONS Wide splitting of the horizontal cerebellar fissure minimizes retraction or resection of the cerebellum and offers the best angle of attack. Knowledge of brainstem anatomy and use of intraoperative navigation are critical to avoid complications. VARIANTS AND INDICATIONS FOR THEIR USE Far lateral through the middle cerebellar peduncle is a variant that can be used to resect pontine cavernomas if a caudocranial trajectory is preferred.The patient consented to the procedure and to the publication of her image.
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Affiliation(s)
- Eva M Wu
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
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Sun MZ, Wu EM, Starke RM, Morcos JJ. Clipping of Recurrent Right Middle Cerebral Artery Trifurcation Aneurysm With Extracranial-Intracranial and Intracranial-Intracranial Bypass Using a Radial Artery Graft: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:233. [PMID: 37819073 DOI: 10.1227/ons.0000000000000933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Matthew Z Sun
- Department of Neurological Surgery, University of Miami, Miami , Florida , USA
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Dong XS, Sun MZ, Gu JH, Han F. [Attention should be paid to sleep disorders in critically ill patients and its recognition and intervention]. Zhonghua Yi Xue Za Zhi 2023; 103:3879-3884. [PMID: 38129164 DOI: 10.3760/cma.j.cn112137-20231024-00878] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The sleep deficiency and sleep disturbance of critically ill patients may result in adverse outcomes, negative effects on early rehabilitation, and may persist well beyond the intensive care unit (ICU). It has been paid more and more attention in clinical practice. The sleep problems of critically ill patients are associated with suffered critical illness, ICU environments, and coexisting sleep disorders before critical illness. Poor sleep quality, insufficient sleep duration, severe sleep fragmentation and irregular circadian rhythms during critical care illness have been extensively described. In addition, ICU patients have been specifically shown to experience atypical sleep and pathologic wakefulness. So the sleep in critical ill patients should be evaluated. Sleep can be evaluated by both subjective assessment and objective measurements, including polysomnography and actigraphy. According to individual situation, comprehensive, interdisciplinary, and personalized interventions, which include treating critical illness, improving ICU environment to reduce interference to sleep, nonpharmacological treatment to relax and stabilize sleep, and treating coexisting sleep disorders, should be taken to improve the patient's sleep and then to promote the early rehabilitation of critically ill patients.
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Affiliation(s)
- X S Dong
- Department of Respiratory Sleep Medicine, Peking University People's Hospital, Beijing 100044, China
| | - M Z Sun
- Department of Respiratory Sleep Medicine, Peking University People's Hospital, Beijing 100044, China
| | - J H Gu
- Department of Respiratory Sleep Medicine, Peking University People's Hospital, Beijing 100044, China
| | - F Han
- Department of Respiratory Sleep Medicine, Peking University People's Hospital, Beijing 100044, China
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Zhu SN, Sun MZ, Wang YH, Sun ZJ, Chen YD, Hu SY. [Association between digestive tract cancer and severity of coronary artery disease]. Zhonghua Yi Xue Za Zhi 2023; 103:3410-3415. [PMID: 37963739 DOI: 10.3760/cma.j.cn112137-20230906-00399] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Objective: To evaluate the association between digestive tract cancer and anatomical severity of coronary artery disease. Methods: This study enrolled 142 patients with digestive tract cancer who underwent coronary angiography in the Department of Cardiology of the First Medical Center of Chinese PLA General Hospital from 2009 to 2020 as the cancer group. The patients in cancer group were matched with 426 non-cancer patients who underwent coronary angiography at our hospital during the same period in a 1∶3 ratio based on gender and age. All enrolled patients had no previous history of percutaneous coronary intervention or coronary artery bypass grafting surgery. The severity of coronary artery disease was documented and assessed using the SYNTAX score based on angiogram. High SYNTAX score (SXhigh) was defined as SYNTAX score≥22 (upper quartile), while low SYNTAX score (SXlow) was SYNTAX score<22. High NLR (NLRhigh) was NLR≥2.287 (median), while low NLR (NLRlow) was NLR<2.287. The association between digestive tract cancer and severity of coronary artery disease was analyzed using logistic regression analysis. Results: This study included a total of 568 patients, with a mean age of (66.6±8.7) years. Among them, 430 patients (75.7%) were male. The cancer group consisted of 142 patients with digestive tract cancers, with a mean age of (66.5±8.4) years. The non-cancer group consisted of 426 patients, with a mean age of (66.7±8.8) years. The proportion of SXhigh in patients with digestive tract cancers (33.1%, 47 patients) was higher than that in non-cancer patients (23.9%, 102 patients) (P=0.032). Compared to non-cancer patients, SXhigh in patients with digestive tract cancers was higher (OR: 1.614, 95%CI: 1.051-2.481, P=0.029). Subgroup analysis stratified by NLR levels revealed that in the NLRhigh group, patients with digestive tract cancers exhibited a higher severity of coronary artery disease compared to non-cancer patients, with an OR of 1.948 (95%CI: 1.005-3.779, P=0.048). In the NLRlow group, there was no significant relationship between digestive tract cancers and the severity of coronary artery disease, with an OR of 1.277 (95%CI: 0.586-2.781, P=0.538). Conclusions: Digestive tract cancer is associated with the severity of coronary artery disease, and patients with digestive tract cancers have a higher risk of severe coronary artery disease than non-cancer patients. Additionally, there is an association between digestive tract cancers and the severity of coronary artery disease under conditions of high levels of inflammation.
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Affiliation(s)
- S N Zhu
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - M Z Sun
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Y H Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Z J Sun
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Y D Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - S Y Hu
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
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Wu EM, Sun MZ, Starke RM, Morcos JJ. "Stump Patch Rescue" Reclipping Using Divided Origin of Temporal M2 in a Recurrent Reruptured Bilobed Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e163. [PMID: 37195051 DOI: 10.1227/ons.0000000000000769] [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] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/22/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Eva M Wu
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Wu EM, Sun MZ, Khan NR, Benjamin CG, Morcos JJ. Combined Transcavernous and Anterior Petrosectomy [Kawase] Approach to a Trigeminal Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e150. [PMID: 37306965 DOI: 10.1227/ons.0000000000000776] [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] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/13/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Eva M Wu
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Sun MZ, Wu EM, Costello MC, Abdelsalam A, Starke RM, Morcos JJ. Contralateral transfalcine approach for resection of right medial frontal AVM. Clin Neurol Neurosurg 2023; 232:107843. [PMID: 37423088 DOI: 10.1016/j.clineuro.2023.107843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023]
Abstract
Brain arteriovenous malformations (AVMs) are high flow vascular lesions that can cause significant morbidity and mortality [1-6]. We present a case of a 23-year-old woman who initially presented to an outside institution with a ruptured right medial frontal Spetzler Martin grade II AVM. An EVD was placed and a diagnostic angiogram with partial embolization was performed. She was then transferred to our institution two months post rupture for further care. On arrival, she was trached with eyes opening to voice and localizing in bilateral upper extremities and withdrawing in bilateral lower extremities. Diagnostic angiogram demonstrated arterial supply from the right pericallosal and callosomarginal artery, right posterior cerebral artery callosomarginal branch, distal left anterior cerebral artery (ACA) branches with venous drainage via a cortical vein to the superior sagittal sinus. The patient underwent preoperative embolization of the ACA feeders followed by a contralateral interhemispheric transfalcine approach. An interhemispheric dissection was performed down to the corpus callosum and AVM feeders and draining veins were identified. The falx was then incised to expose the right medial frontal lobe. The AVM was circumferentially dissected and resected. Postoperative imaging demonstrated complete resection of the AVM. She remained at her neurological baseline immediately postoperatively and was discharged to inpatient rehab. The patient made a remarkable recovery and at three months follow up, she no longer required a tracheostomy and was neurologically intact with no complaints except for mild memory difficulties. In this video, we demonstrate the step-by-step surgical technique and review the benefits of the contralateral transfalcine approach for resection of a ruptured right medial frontal Spetzler Martin grade II AVM. The patient consented to the procedure and to the publication of her imaging in this surgical video.
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Affiliation(s)
- Matthew Z Sun
- University of Miami, Department of Neurological Surgery, Miami, FL, USA
| | - Eva M Wu
- University of Miami, Department of Neurological Surgery, Miami, FL, USA
| | | | - Ahmed Abdelsalam
- University of Miami, Department of Neurological Surgery, Miami, FL, USA
| | - Robert M Starke
- University of Miami, Department of Neurological Surgery, Miami, FL, USA
| | - Jacques J Morcos
- University of Miami, Department of Neurological Surgery, Miami, FL, USA.
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Wu EM, Sun MZ, Khan NR, Morcos JJ. Kawase Approach for "Macrovascular" Decompression of Dolichoectatic Basilar Artery Causing Hemifacial Spasm Using Gore-tex Sling: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e84. [PMID: 37040124 DOI: 10.1227/ons.0000000000000716] [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] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/13/2023] [Indexed: 04/12/2023] Open
Affiliation(s)
- Eva M Wu
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Matthew Z Sun
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jacques J Morcos
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Sun MZ, Wu EM, Morcos JJ. Hakuba-Dolenc Approach for Resection of a Large Cavernous Sinus Dermoid Cyst: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e88. [PMID: 37104864 DOI: 10.1227/ons.0000000000000733] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/24/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Matthew Z Sun
- University of Miami, Department of Neurological Surgery, Miami, Florida, USA
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Wang M, Zhang YH, Zhou X, Zhou XH, Xu HS, Liu ML, Li JG, Niu YF, Huang WJ, Yuan Q, Zhang S, Xu FR, Litvinov YA, Blaum K, Meisel Z, Casten RF, Cakirli RB, Chen RJ, Deng HY, Fu CY, Ge WW, Li HF, Liao T, Litvinov SA, Shuai P, Shi JY, Song YN, Sun MZ, Wang Q, Xing YM, Xu X, Yan XL, Yang JC, Yuan YJ, Zeng Q, Zhang M. Mass Measurement of Upper fp-Shell N=Z-2 and N=Z-1 Nuclei and the Importance of Three-Nucleon Force along the N=Z Line. Phys Rev Lett 2023; 130:192501. [PMID: 37243656 DOI: 10.1103/physrevlett.130.192501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/17/2023] [Indexed: 05/29/2023]
Abstract
Using a novel method of isochronous mass spectrometry, the masses of ^{62}Ge, ^{64}As, ^{66}Se, and ^{70}Kr are measured for the first time, and the masses of ^{58}Zn, ^{61}Ga, ^{63}Ge, ^{65}As, ^{67}Se, ^{71}Kr, and ^{75}Sr are redetermined with improved accuracy. The new masses allow us to derive residual proton-neutron interactions (δV_{pn}) in the N=Z nuclei, which are found to decrease (increase) with increasing mass A for even-even (odd-odd) nuclei beyond Z=28. This bifurcation of δV_{pn} cannot be reproduced by the available mass models, nor is it consistent with expectations of a pseudo-SU(4) symmetry restoration in the fp shell. We performed ab initio calculations with a chiral three-nucleon force (3NF) included, which indicate the enhancement of the T=1 pn pairing over the T=0 pn pairing in this mass region, leading to the opposite evolving trends of δV_{pn} in even-even and odd-odd nuclei.
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Affiliation(s)
- M Wang
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Y H Zhang
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - X Zhou
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - X H Zhou
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - H S Xu
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - M L Liu
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - J G Li
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Y F Niu
- School of Nuclear Science and Technology, Lanzhou University, Lanzhou 730000, China
- Frontiers Science Center for Rare isotope, Lanzhou University, Lanzhou 730000, China
| | - W J Huang
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- Advanced Energy Science and Technology Guangdong Laboratory, Huizhou, 516007, China
| | - Q Yuan
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, People's Republic of China
| | - S Zhang
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, People's Republic of China
| | - F R Xu
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, People's Republic of China
| | - Yu A Litvinov
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - K Blaum
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - Z Meisel
- Institute of Nuclear and Particle Physics, Department of Physics and Astronomy, Ohio University, Athens, Ohio 45701, USA
| | - R F Casten
- Wright Nuclear Structure Laboratory, Yale University, New Haven, Connecticut 06520-8124, USA
| | - R B Cakirli
- Department of Physics, Istanbul University, Istanbul 34134, Turkey
| | - R J Chen
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - H Y Deng
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - C Y Fu
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - W W Ge
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - H F Li
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - T Liao
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - S A Litvinov
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - P Shuai
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - J Y Shi
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Y N Song
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - M Z Sun
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Q Wang
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Y M Xing
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - X Xu
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - X L Yan
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - J C Yang
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Y J Yuan
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Q Zeng
- School of Nuclear Science and Engineering, East China University of Technology, Nanchang 330013, China
| | - M Zhang
- CAS Key Laboratory of High Precision Nuclear Spectroscopy, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
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Uy BR, Sun MZ, Muftuoglu Y, Cheng M, Kim WJ, Magaki S, Yoo BY, Salehi B, Beckett JS, Macyszyn L. Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases. J Neurosurg Case Lessons 2023; 5:CASE22552. [PMID: 37014005 PMCID: PMC10555549 DOI: 10.3171/case22552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Migratory disc herniations can mimic neoplasms clinically and on imaging. Far lateral lumbar disc herniations usually compress the exiting nerve root and can be challenging to distinguish from a nerve sheath tumor due to the proximity of the nerve and characteristics on magnetic resonance imaging (MRI). These lesions can occasionally present in the upper lumbar spine region at the L1-2 and L2-3 levels. OBSERVATIONS The authors describe 2 extraforaminal lesions in the far lateral space at the L1-2 and L2-3 levels, respectively. On MRI, both lesions tracked along the corresponding exiting nerve roots with avid postcontrast rim enhancement and edema in the adjacent muscle tissue. Thus, they were initially concerning for peripheral nerve sheath tumors. One patient underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) screening and demonstrated moderate FDG uptake on PET-CT scan. In both cases, intraoperative and postoperative pathology revealed fibrocartilage disc fragments. LESSONS Differential diagnosis for lumbar far lateral lesions that are peripherally enhancing on MRI should include migratory disc herniation, regardless of the level of the disc herniations. Accurate preoperative diagnosis can aid in decision making for management, surgical approach, and resection.
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12
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Say I, Chen YE, Sun MZ, Li JJ, Lu DC. Machine learning predicts improvement of functional outcomes in traumatic brain injury patients after inpatient rehabilitation. Front Rehabil Sci 2022; 3:1005168. [PMID: 36211830 PMCID: PMC9535093 DOI: 10.3389/fresc.2022.1005168] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Survivors of traumatic brain injury (TBI) have an unpredictable clinical course. This unpredictability makes clinical resource allocation for clinicians and anticipatory guidance for patients difficult. Historically, experienced clinicians and traditional statistical models have insufficiently considered all available clinical information to predict functional outcomes for a TBI patient. Here, we harness artificial intelligence and apply machine learning and statistical models to predict the Functional Independence Measure (FIM) scores after rehabilitation for traumatic brain injury (TBI) patients. Tree-based algorithmic analysis of 629 TBI patients admitted to a large acute rehabilitation facility showed statistically significant improvement in motor and cognitive FIM scores at discharge.
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Affiliation(s)
- Irene Say
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Yiling Elaine Chen
- Department of Statistics, University of California, Los Angeles, CA, United States
| | - Matthew Z. Sun
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Jingyi Jessica Li
- Department of Statistics, University of California, Los Angeles, CA, United States
| | - Daniel C. Lu
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
- Brain Research Institute, University of California, Los Angeles, CA, United States
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Sun MZ, Babayan D, Chen JS, Wang MM, Naik PK, Reitz K, Li JJ, Pouratian N, Kim W. Postoperative Admission of Adult Craniotomy Patients to the Neuroscience Ward Reduces Length of Stay and Cost. Neurosurgery 2021. [DOI: 10.1093/neuros/nyab089_s135] [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: 11/13/2022] Open
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14
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Wang S, Sun MZ, Abecassis IJ, Weil AG, Ibrahim GM, Fallah A, Ene C, Leary SES, Cole BL, Lockwood CM, Olson JM, Geyer JR, Ellenbogen RG, Ojemann JG, Wang AC. Predictors of mortality and tumor recurrence in desmoplastic infantile ganglioglioma and astrocytoma-and individual participant data meta-analysis (IPDMA). J Neurooncol 2021; 155:155-163. [PMID: 34613581 PMCID: PMC9448015 DOI: 10.1007/s11060-021-03860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Desmoplastic infantile astrocytoma (DIA) and desmoplastic infantile ganglioglioma (DIG) are classified together as grade I neuronal and mixed neuronal-glial tumor of the central nervous system by the World Health Organization (WHO). These tumors are rare and have not been well characterized in terms of clinical outcomes. We aimed to identify clinical predictors of mortality and tumor recurrence/progression by performing an individual patient data meta-analysis (IPDMA) of the literature. METHODS A systematic literature review from 1970 to 2020 was performed, and individualized clinical data for patients diagnosed with DIA/DIG were extracted. Aggregated data were excluded from collection. Outcome measures of interest were mortality and tumor recurrence/progression, as well as time-to-event (TTE) for each of these. Participants without information on these outcome measures were excluded. Cox regression survival analyses were performed to determine predictors of mortality and tumor recurrence / progression. RESULTS We identified 98 articles and extracted individual patient data from 188 patients. The cohort consisted of 58.9% males with a median age of 7 months. The majority (68.1%) were DIGs, while 24.5% were DIAs and 7.5% were non-specific desmoplastic infantile tumors; DIAs presented more commonly in deep locations (p = 0.001), with leptomeningeal metastasis (p = 0.001), and was associated with decreased probability of gross total resection (GTR; p = 0.001). Gender, age, and tumor pathology were not statistically significant predictors of either mortality or tumor recurrence/progression. On multivariate survival analysis, GTR was a predictor of survival (HR = 0.058; p = 0.007) while leptomeningeal metastasis at presentation was a predictor of mortality (HR = 3.27; p = 0.025). Deep tumor location (HR = 2.93; p = 0.001) and chemotherapy administration (HR = 2.02; p = 0.017) were associated with tumor recurrence/progression. CONCLUSION Our IPDMA of DIA/DIG cases reported in the literature revealed that GTR was a predictor of survival while leptomeningeal metastasis at presentation was associated with mortality. Deep tumor location and chemotherapy were associated with tumor recurrence / progression.
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Affiliation(s)
- Shelly Wang
- Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, FL, USA
- Department of Neurosurgery, University of Miami, Miami, FL, USA
| | - Matthew Z Sun
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - I Joshua Abecassis
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Alexander G Weil
- Department of Surgery, Université de Montréal, Montreal, QC, Canada
| | - George M Ibrahim
- Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto, Toronto, ON, Canada
| | - Aria Fallah
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Chibawanye Ene
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah E S Leary
- Division of Hematology Oncology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Bonnie L Cole
- Department of Anatomic Pathology, Seattle Children's Hospital, University of Washington and Laboratories, Seattle, WA, USA
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - James M Olson
- Division of Hematology Oncology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - J Russell Geyer
- Division of Hematology Oncology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Anthony C Wang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
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Patel KS, Sun MZ, Willis SL, Alemnew M, De Jong R, Evans AS, Duong C, Gopen Q, Yang I. Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series. J Clin Neurosci 2021; 93:183-187. [PMID: 34656245 DOI: 10.1016/j.jocn.2021.09.010] [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: 03/31/2021] [Revised: 07/12/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
There is no consensus on the management of post-craniotomy pain. Several randomized controlled trials have examined the use of a regional scalp block for post-craniotomy pain. We aim to investigate whether scalp block affected short or long-term pain levels and opioid use after craniotomy. This study prospectively administered selective scalp blocks (lesser occipital, preauricular nerve block + pin site block) in 20 consecutive patients undergoing craniotomy for semicircular canal dehiscence. Anesthesia, pain, and opioid outcomes in these patients were compared to 40 consecutive historic controls. There was no significant difference in patient demographics between the two groups and no complications related to selective scalp block. The time between the end of procedure and end of anesthesia decreased in the scalp block group (16 vs 21 min, P = 0.047). Pain scores were significantly less in the scalp block group for the first 4 h, after which there was no statistically significant difference. Time to opioid rescue was longer in the scalp block group (3.6 vs 1.8 h, HR 0.487, P = 0.0361) and opioid use in the first 7 h was significantly less in the scalp block group. Total opioid use, outpatient opioid use, and length of stay did not differ. Selective scalp block is a safe and effective tool for short-term management of postoperative pain after craniotomy and decreases the medication requirement during emergence and recovery. Selective scalp block can speed up OR turnover but is not efficacious in the treatment of postoperative pain beyond this point.
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Affiliation(s)
- Kunal S Patel
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Matthew Z Sun
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Shelby L Willis
- Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Mahlet Alemnew
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Russell De Jong
- Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Audree S Evans
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Courtney Duong
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Quinton Gopen
- Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, United States; Department of Head & Neck Surgery, University of California Los Angeles, Los Angeles, CA, United States; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, United States; Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, United States; Department of Surgery, Harbor-UCLA Los Angeles, Los Angeles, CA, United States; Los Angeles Biomedical Research Center, Harbor-UCLA Los Angeles, Los Angeles, CA, United States.
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Mozaffari K, Ghodrati F, Pradhan A, Ng E, Ding K, Rana S, Duong C, Anderson RN, Enomoto A, Sheppard JP, Sun MZ, Phillips HW, Yang I, Gopen Q. Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience. World Neurosurg 2021; 156:e408-e414. [PMID: 34583007 DOI: 10.1016/j.wneu.2021.09.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is an abnormality of the otic capsule, which normally overlies the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. Given the complexity of the disease, there are patients who experience less favorable surgical outcomes and require revision surgery. The purpose of this study was to report to the rate of postoperative symptomatic improvement in patients who required revision surgery. METHODS A retrospective analysis of patients undergoing SSCD surgical repair at a single institution was performed. Information on patient demographics, primary and secondary surgical approaches, surgical outcomes, and follow-up length was collected. RESULTS Seventeen patients underwent 20 revision surgeries. There were eleven (65%) females and six (35%) males. Mean age of the cohorts was 50 years (range 30-68 years), and mean follow-up length was 6.8 months (range 0.1-31.1 months). Cerebrospinal fluid leak was noted in 67% of cases. The greatest postoperative symptomatic resolution was reported in oscillopsia (100%), headache (100%), and internal sound amplification (71%), while the least postoperative symptomatic resolution was reported in tinnitus (42%), aural fullness (40%), and dizziness (29%). CONCLUSIONS Revision surgery can provide symptomatic improvement in select SSCD patients; however, patients should be cautioned about the possibility of less favorable outcomes than in index surgery. Revision surgeries are associated with a considerably higher rate of perioperative cerebrospinal fluid leak.
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Affiliation(s)
- Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Farinaz Ghodrati
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Anjali Pradhan
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Edwin Ng
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Kevin Ding
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Shivam Rana
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Courtney Duong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Roan N Anderson
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Adam Enomoto
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - John P Sheppard
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - H Westley Phillips
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA.
| | - Quinton Gopen
- Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
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Preet K, Udawatta M, Mozaffari K, Ong V, Franks A, Ng E, Gaonkar B, Sun MZ, Salamon N, Gopen Q, Yang I. Relationship Between Superior Semicircular Canal Dehiscence Volume with Clinical Symptoms: Case Series. World Neurosurg 2021; 156:e345-e350. [PMID: 34562630 DOI: 10.1016/j.wneu.2021.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is an osseous defect of the arcuate eminence of the petrosal temporal bone. Patients typically present with auditory and vestibular symptoms, such as hearing loss and disequilibrium. Using advanced imaging segmentation techniques, we evaluated whether the volume of SSCD correlated with preoperative symptoms and postoperative outcomes. METHODS Our laboratory previously described a novel method of quantifying the size of an SSCD via manual segmentation. High-resolution computed tomography images of the temporal bones were imported into a specialized segmentation software. The volume of the dehiscence was outlined on consecutive slices of the coronal and axial planes via a single-pixel-thick paintbrush tool and was then calculated according to the number of nonzero image voxels. RESULTS This study included 111 patients (70 women and 41 men; mean age, 55.1 years; age range, 24-87 years) with a total of 164 SSCDs. Mean postoperative follow-up time was 5.2 months (range, 0.03-59.5 months). The most common preoperative and postoperative symptoms were tinnitus (n = 85) and dizziness (n = 45), respectively. Surgery resulted in improvement of symptoms in most patients. The average volume of 164 SSCDs was 1.3 mm3. SSCD volume was not significantly associated with either preoperative symptoms or postoperative outcomes. CONCLUSIONS Advances in imaging techniques have allowed increased visualization of SSCD. Further research will be necessary to evaluate the potential correlation of volume of the dehiscence with clinical variables.
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Affiliation(s)
- Komal Preet
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Methma Udawatta
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Vera Ong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Alyssa Franks
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Edwin Ng
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Bilwaj Gaonkar
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Noriko Salamon
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Quinton Gopen
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA.
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Sun MZ, Babayan D, Chen JS, Wang MM, Naik PK, Reitz K, Li JJ, Pouratian N, Kim W. Postoperative Admission of Adult Craniotomy Patients to the Neuroscience Ward Reduces Length of Stay and Cost. Neurosurgery 2021; 89:85-93. [PMID: 33862627 DOI: 10.1093/neuros/nyab089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 12/13/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The neurointensive care unit (NICU) has traditionally been the default recovery unit after elective craniotomies. OBJECTIVE To assess whether admitting adult patients without significant comorbidities to the neuroscience ward (NW) instead of NICU for recovery resulted in similar clinical outcome while reducing length of stay (LOS) and hospitalization cost. METHODS We retrospectively analyzed the clinical and cost data of adult patients undergoing supratentorial craniotomy at a university hospital within a 5-yr period who had a LOS less than 7 d. We compared those admitted to the NICU for 1 night of recovery versus those directly admitted to the NW. RESULTS The NICU and NW groups included 340 and 209 patients, respectively, and were comparable in terms of age, ethnicity, overall health, and expected LOS. NW admissions had shorter LOS (3.046 vs 3.586 d, P < .001), and independently predicted shorter LOS in multivariate analysis. While the NICU group had longer surgeries (6.8 vs 6.4 h), there was no statistically significant difference in the cost of surgery. The NW group was associated with reduced hospitalization cost by $3193 per admission on average (P < .001). Clinically, there were no statistically significant differences in the rate of return to Operating Room, Emergency Department readmission, or hospital readmission within 30 d. CONCLUSION Admitting adult craniotomy patients without significant comorbidities, who are expected to have short LOS, to NW was associated with reduced LOS and total cost of admission, without significant differences in postoperative clinical outcome.
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Affiliation(s)
- Matthew Z Sun
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Diana Babayan
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jia-Shu Chen
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Maxwell M Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Priyanka K Naik
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kara Reitz
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jingyi Jessica Li
- Department of Statistics, University of California Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Won Kim
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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19
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Peeters S, Owens G, Sun MZ, Lee A, Kienzler JC, Orpilla J, Contreras E, Treger J, Odesa S, Everson RG, Becher O, Holland EC, Nathanson D, Xing Y, Liau LM, Prins RM, Wang AC. Dendritic Cell Vaccination is Effective Against H3.3G34R Mutant Glioblastoma in a Novel Syngeneic Genetically Engineered Mouse Model. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_795] [Citation(s) in RCA: 1] [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] [Indexed: 11/14/2022] Open
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20
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Wang AC, Owens G, Lee A, Sun MZ, Peeters S, Kienzler JC, Orpilla J, Contreras E, Treger J, Odesa SK, Everson RG, Holland EC, Becher O, Nathanson D, Xing Y, Liau LM, Prins RM. Engineering T Cell Receptors to Target H3.3G34 Mutant Glioblastoma. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_794] [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: 11/13/2022] Open
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21
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Ding K, Romiyo P, Ng E, Udawatta M, Dejam D, Phillips HW, Sun MZ, Yang I. A systematic analysis of stereotactic radiosurgery surveys for residents in neurosurgery training programs. J Neurol Sci 2020; 417:116867. [PMID: 32423574 DOI: 10.1016/j.jns.2020.116867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECT The use of stereotactic radiosurgery (SRS) has increased. SRS training has not risen congruently. Neurosurgeons have conducted surveys and advocated implementation of widespread, standardized radiosurgery training. Here we analyze the SRS surveys conducted throughout the past decade. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. A broad search of the literature was conducted in October 2018 through the PubMed, Scopus, Embase, and Web of Science databases. This study included surveys evaluating SRS training in neurosurgery and excluded those regarding other specialties. RESULTS An overview of surveys showed that neurosurgery residents possess gaps in SRS knowledge and procedural competency that have persisted through the past decade. There is an overwhelming sentiment that current radiosurgery training is not adequate to prepare residents for future practice. Our recommendation is for residency programs to integrate formal SRS training electives, with a movement towards creating more options for extended SRS fellowships post-residency. CONCLUSIONS We present data from SRS competency and current training surveys. Although resident SRS training still lags behind other subspecialties, we see indications for growth. To keep up with the role of SRS in neurosurgery, residencies need more formalized SRS rotations.
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Affiliation(s)
- Kevin Ding
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Prasanth Romiyo
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Edwin Ng
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Methma Udawatta
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Dillon Dejam
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - H Westley Phillips
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew Z Sun
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Isaac Yang
- Departments of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Office of the Patient Experience, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA; Department of Neurosurgery at Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, Torrance, CA, USA.
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22
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Peeters SM, Colby GP, Guivatchian E, Sun MZ, Tateshima S, Wang AC. Spontaneous Resolution of Dural and Pial Arteriovenous Fistulae Arising After Superficial Temporal Artery to Middle Cerebral Artery Bypass for Moyamoya Disease. World Neurosurg 2020; 142:404-407. [DOI: 10.1016/j.wneu.2020.07.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
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Sheppard JP, Duong C, Lagman C, Patel K, Sun MZ, Prashant GN, Yang I. In Reply: Systemic Antimicrobial Prophylaxis and Antimicrobial-Coated External Ventricular Drain Catheters for Preventing Ventriculostomy-Related Infections: A Meta-Analysis of 5242 Cases. Neurosurgery 2020; 86:E240-E243. [PMID: 31702004 DOI: 10.1093/neuros/nyz494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John P Sheppard
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
| | - Courtney Duong
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
| | - Carlito Lagman
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
| | - Kunal Patel
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
| | - Matthew Z Sun
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
| | - Giyarpuram N Prashant
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
| | - Isaac Yang
- Department of Neurosurgery David Geffen School of Medicine University of California, Los Angeles Los Angeles, California
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Antonios JP, Everson RG, Mochizuki A, Khattab S, Soto H, Romiyo P, Sun MZ, Moughon D, Billingslea-Yoon E, Odesa S, Li G, Kawaguchi E, Salazar A, Yong W, Schlossman J, Ellingson B, Wang AC, Cloughesy T, Prins RM, Liau LM. Abstract PR13: Adjuvant TLR-3 administration enhances proinflammatory immune responses and is associated with extended survival in glioblastoma patients treated with dendritic cell vaccination. Cancer Immunol Res 2020. [DOI: 10.1158/2326-6074.tumimm19-pr13] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Malignant glioma, associated with a poor prognosis, is the most common primary malignant brain tumor in adults. We and others have documented immune responses following dendritic cell (DC) vaccination as an active immunotherapeutic treatment for these patients. In this phase II clinical trial, we randomized malignant glioma patients to receive autologous tumor lysate pulsed DC vaccination with and without adjuvant Toll-like receptor (TLR) agonists. TLRs are present on dendritic cells and serve to modulate immune responses. Twenty-three patients with WHO grade III or IV glioma were treated with three intradermal injections of autologous tumor lysate-pulsed DC on days 0, 14, and 28 followed by an adjuvant placebo, TLR-7 agonist (resiquimod), or TLR-3 agonist (Poly ICLC). Mass cytometry (CyTOF) was used to analyze immune cell populations of patient peripheral blood mononuclear cells (PBMC) before and following treatment. DC-vaccinated patients who received adjuvant Poly ICLC treatment had a significantly improved median survival of 54 months over placebo (11 months) and adjuvant resiquimod (17 months) groups (P<0.01). CyTOF and single-cell RNA sequencing (scRNseq) gene expression analysis of systemic PBMCs from patients demonstrated increased immune cell activation and expression of proinflammatory genes. Notably, the expansion of a heterogenous myeloid cell population was noted to correlate with increased survival, corroborating preclinical evidence that these cells modulate adaptive immunity in the tumor microenvironment. Overall, these findings suggest that adjuvant Poly ICLC treatment improves outcomes with autologous lysate-pulsed DC vaccine treatment via modulation of proinflammatory pathways.
This abstract is also being presented as Poster B27.
Citation Format: Joseph P. Antonios, Richard G. Everson, Aaron Mochizuki, Sara Khattab, Horacio Soto, Prashant Romiyo, Matthew Z. Sun, Diana Moughon, Emma Billingslea-Yoon, Sylvia Odesa, Gang Li, Eric Kawaguchi, Alex Salazar, William Yong, Jason Schlossman, Benjamin Ellingson, Anthony C. Wang, Timothy Cloughesy, Robert M. Prins, Linda M. Liau. Adjuvant TLR-3 administration enhances proinflammatory immune responses and is associated with extended survival in glioblastoma patients treated with dendritic cell vaccination [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2019 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(3 Suppl):Abstract nr PR13.
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Guo CM, Liu SQ, Sun MZ. miR-429 as biomarker for diagnosis, treatment and prognosis of cancers and its potential action mechanisms: A systematic literature review. Neoplasma 2019; 67:215-228. [PMID: 31884798 DOI: 10.4149/neo_2019_190401n282] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/01/2019] [Indexed: 11/08/2022]
Abstract
miR-429 is a member of miR-200 family. Accumulated evidence has indicated that miR-429 dysregulation is involved in the epithelial-mesenchymal transition (EMT), progression, development, invasion, metastasis, apoptosis and drug resistance of a variety of cancers. miR-429 might specifically function either as a tumor suppressor or promoter candidate for certain cancers depending on the particular types of tumor cells/tissues. miR-429 appears to have a tumor-suppression role in renal cell carcinoma (RCC), breast cancer (BC), gastric carcinoma (GC), glioblastoma (GBM), esophageal cancer (EC), osteosarcoma, oral squamous cell carcinoma (OSCC), cervical cancer (CC), pancreatic cancer, tongue squamous cell carcinoma (TSCC), nephroblastoma, nasopharyngeal carcinoma (NPC) and soft tissue sarcomas. On the other hand, miR-429 has a tumor-promotion role in endometrial cancer (EmCa), prostate cancer (CaP) and lung cancer (LC). However, miR-429 shows paradoxical role in colorectal cancer (CRC), hepatocellular carcinoma (HCC), bladder cancer and ovarian cancer (OC). This article summarizes the associations between miR-429 and malignant tumors as well as potential action mechanisms. miR-429 has a potential to be used in the future as a biomarker for the diagnosis, treatment and prognosis of certain cancers.
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Affiliation(s)
- C M Guo
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - S Q Liu
- Department of Biochemistry, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - M Z Sun
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
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Sheppard JP, Duong C, Romiyo P, Azzam D, Alkhalid Y, Nguyen T, Babayan D, Lagman C, Sun MZ, Prashant GN, Beckett JS, Yang I. Patient Safety Analysis in Radiation Burden of Head Computed Tomography Imaging in 1185 Neurosurgical Inpatients. World Neurosurg 2019; 133:e308-e319. [PMID: 31520752 DOI: 10.1016/j.wneu.2019.09.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We performed a retrospective analysis in a cohort of 1185 patients at our institution who were identified as undergoing ≥1 head computed tomography (CT) examinations during their inpatient stay on the neurosurgery service, to quantify the number, type, and associated radiation burden of head CT procedures performed by the neurosurgery service. METHODS CT procedure records and radiology reports were obtained via database search and directly validated against records retrieved from manual chart review. Next, dosimetry data from the head CT procedures were extracted via automated text mining of electronic radiology reports. RESULTS Among 4510 identified adult head CT procedures, 88% were standard head CT examinations. A total of 3.65 ± 3.60 head CT scans were performed during an average adult admission. The most common primary diagnoses were neoplasms, trauma, and other hemorrhage. The median cumulative effective dose per admission was 5.66 mSv (range, 1.06-84.5 mSv; mean, 8.56 ± 8.95 mSv). The median cumulative effective dose per patient was 6.4 mSv (range, 1.1-127 mSv; mean, 9.26 ± 10.0 mSv). CONCLUSIONS The median cumulative radiation burden from head CT imaging in our cohort equates approximately to a single chest CT scan, well within accepted limits for safe CT imaging in adults. Refined methods are needed to characterize the safety profile of the few pediatric patients identified in our study.
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Affiliation(s)
- John P Sheppard
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Courtney Duong
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Prasanth Romiyo
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Daniel Azzam
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Yasmine Alkhalid
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Thien Nguyen
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Diana Babayan
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Carlito Lagman
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Matthew Z Sun
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Giyarpuram N Prashant
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Joel S Beckett
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Department of Radiation Safety, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Department of Physics & Biology in Medicine Graduate Program, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Department of Radiological Sciences-Section of Neuroradiology, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Department of Head and Neck Surgery, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Department of Radiation Oncology, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Los Angeles Biomedical Research Institute, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA; Harbor-UCLA Medical Center, David Geffen School of Medicine of the University of California, Los Angeles (UCLA), Los Angeles, California, USA.
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Ding K, Ng E, Romiyo P, Dejam D, Duong C, Sun MZ, Gopen Q, Yang I. Tumor Control Rates in Patients Undergoing Stereotactic Radiosurgery for Cystic Vestibular Schwannomas: A Systematic Review and Meta-Analysis. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_648] [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: 11/14/2022] Open
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Sun MZ, Babayan D, Chen JS, Wang M, Naik P, Reitz K, Kim W. Postoperative Admission of Adult Craniotomy Patients to Neuroscience Floor Unit Reduces Cost and Length of Stay. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_712] [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: 11/12/2022] Open
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Sun MZ, Chen HM, Zhou ZW, Jin H, Ji YQ, Ji JW, Fu QP, Zhang LZ, Wu QQ, Ju HX. Neutrophil gelatinase-associated apolipoprotein in patients with iodine-contrast nephropathy. J BIOL REG HOMEOS AG 2019; 33:1171-1176. [PMID: 31332985] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- M Z Sun
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - H M Chen
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - Z W Zhou
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - H Jin
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - Y Q Ji
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - J W Ji
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - Q P Fu
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - L Z Zhang
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - Q Q Wu
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
| | - H X Ju
- Department of Clinical Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, People's Republic of China
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Kaur T, Johanis M, Miao T, Romiyo P, Duong C, Sun MZ, Ferraro R, Salamon N, McArthur D, Yang I, Gopen Q. CT evaluation of normal bone thickness overlying the superior semicircular canal. J Clin Neurosci 2019; 66:128-132. [PMID: 31103254 DOI: 10.1016/j.jocn.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/24/2019] [Revised: 04/07/2019] [Accepted: 05/07/2019] [Indexed: 11/24/2022]
Abstract
Superior semicircular canal dehiscence (SSCD) is a rare inner ear disorder with variable amounts of auditory and vestibular dysfunction. In addition to the absence of bone overlying the superior semicircular canal, thinning of bone in this area can also initiate the vestibulocochlear symptoms of SSCD. We evaluated normal bone thickness overlying the course of the semicircular canal using computed tomography (CT) scans and assessed correlations between bone thickness and age, gender, and location of the thinnest bone. A single-institution retrospective chart review was conducted on 133 high-resolution CT scans from 76 healthy, asymptomatic patients between ages 9 and 96 years. These CT scans of the temporal bone were obtained between January 2012 and August 2017. The superior semicircular canal dome thickness at the apex was reported with a mean of 1.25 mm for all 76 patients; the 10th percentile was 0.60 mm, and the 90th percentile was 2.08 mm. The thinnest area of bone at any location yielded a mean of 0.86 mm. The normal bone thickness overlying the superior semicircular canal does not depend on gender or age. The thinnest location was evenly distributed across the superior semicircular canal. A bone thickness of 0.40 mm or greater was present in 90% of normal patients based on CT scan measurements at the thinnest location.
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Affiliation(s)
- Taranjit Kaur
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michael Johanis
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Tyler Miao
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Prasanth Romiyo
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Courtney Duong
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew Z Sun
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Regan Ferraro
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Noriko Salamon
- Department of Radiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - David McArthur
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States; UCLA Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States; Office of the Patient Experience, University of California, Los Angeles, Los Angeles, CA, United States
| | - Quinton Gopen
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, United States; UCLA Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States; Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States.
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Xu X, Zhang P, Shuai P, Chen RJ, Yan XL, Zhang YH, Wang M, Litvinov YA, Xu HS, Bao T, Chen XC, Chen H, Fu CY, Kubono S, Lam YH, Liu DW, Mao RS, Ma XW, Sun MZ, Tu XL, Xing YM, Yang JC, Yuan YJ, Zeng Q, Zhou X, Zhou XH, Zhan WL, Litvinov S, Blaum K, Audi G, Uesaka T, Yamaguchi Y, Yamaguchi T, Ozawa A, Sun BH, Sun Y, Dai AC, Xu FR. Identification of the Lowest T=2, J^{π}=0^{+} Isobaric Analog State in ^{52}Co and Its Impact on the Understanding of β-Decay Properties of ^{52}Ni. Phys Rev Lett 2016; 117:182503. [PMID: 27835000 DOI: 10.1103/physrevlett.117.182503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Indexed: 06/06/2023]
Abstract
Masses of ^{52g,52m}Co were measured for the first time with an accuracy of ∼10 keV, an unprecedented precision reached for short-lived nuclei in the isochronous mass spectrometry. Combining our results with the previous β-γ measurements of ^{52}Ni, the T=2, J^{π}=0^{+} isobaric analog state (IAS) in ^{52}Co was newly assigned, questioning the conventional identification of IASs from the β-delayed proton emissions. Using our energy of the IAS in ^{52}Co, the masses of the T=2 multiplet fit well into the isobaric multiplet mass equation. We find that the IAS in ^{52}Co decays predominantly via γ transitions while the proton emission is negligibly small. According to our large-scale shell model calculations, this phenomenon has been interpreted to be due to very low isospin mixing in the IAS.
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Affiliation(s)
- X Xu
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - P Zhang
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - P Shuai
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - R J Chen
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - X L Yan
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - Y H Zhang
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - M Wang
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - Yu A Litvinov
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - H S Xu
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - T Bao
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - X C Chen
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - H Chen
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - C Y Fu
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - S Kubono
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - Y H Lam
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - D W Liu
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - R S Mao
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - X W Ma
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - M Z Sun
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - X L Tu
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - Y M Xing
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - J C Yang
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - Y J Yuan
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - Q Zeng
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Research Center for Hadron Physics, National Laboratory of Heavy Ion Accelerator Facility in Lanzhou and University of Science and Technology of China, Hefei 230026, People's Republic of China
| | - X Zhou
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
- Graduate University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - X H Zhou
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - W L Zhan
- Key Laboratory of High Precision Nuclear Spectroscopy and Center for Nuclear Matter Science, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, People's Republic of China
| | - S Litvinov
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - K Blaum
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - G Audi
- CSNSM, Univ Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, 91405 Orsay, France
| | - T Uesaka
- RIKEN Nishina Center, RIKEN, Saitama 351-0198, Japan
| | - Y Yamaguchi
- RIKEN Nishina Center, RIKEN, Saitama 351-0198, Japan
| | - T Yamaguchi
- Department of Physics, Saitama University, Saitama 338-8570, Japan
| | - A Ozawa
- Insititute of Physics, University of Tsukuba, Ibaraki 305-8571, Japan
| | - B H Sun
- School of Physics and Nuclear Energy Engineering, Beihang University, Beijing 100191, People's Republic of China
| | - Y Sun
- Department of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China
| | - A C Dai
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, People's Republic of China
| | - F R Xu
- State Key Laboratory of Nuclear Physics and Technology, School of Physics, Peking University, Beijing 100871, People's Republic of China
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Zygourakis CC, Oh T, Sun MZ, Barani I, Kahn JG, Parsa AT. Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation. Neurosurg Focus 2016. [PMID: 26218621 DOI: 10.3171/2014.8.focus14435] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Vestibular schwannomas (VSs) are managed in 3 ways: observation ("wait and scan"); Gamma Knife surgery (GKS); or microsurgery. Whereas there is considerable literature regarding which management approach is superior, there are only a few studies addressing the cost of treating VSs, and there are no cost-utility analyses in the US to date. METHODS In this study, the authors used the University of California at San Francisco medical record and hospital accounting databases to determine total hospital charges and costs for 33 patients who underwent open surgery, 42 patients who had GKS, and 12 patients who were observed between 2010 and 2013. The authors then performed decision-tree analysis to determine which treatment paradigm produces the highest quality-adjusted life years and to calculate the incremental cost-effectiveness ratio, depending on the patient's age at VS diagnosis. RESULTS The average total hospital cost over a 3-year period for surgically treated patients was $80,074 (± $49,678) versus $9737 (± $5522) for patients receiving radiosurgery and $1746 (± $2792) for patients who were observed. When modeling the most debilitating symptoms and worst outcomes of VSs (vertigo and death) at different ages at diagnosis, radiation is dominant to observation at all ages up to 70 years. Surgery is cost-effective when compared with radiation (incremental cost-effectiveness ratio < $150,000) at younger ages at diagnosis (< 45 years old). CONCLUSIONS In this model, surgery is a cost-effective alternative to radiation when VS is diagnosed in patients at < 45 years. For patients ≥ 45 years, radiation is the most cost-effective treatment option.
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Affiliation(s)
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | | | - Igor Barani
- Radiation Oncology, University of California at San Francisco
| | - James G Kahn
- Department of Epidemiology and Biostatistics, Philip R Lee Institute for Health Policy Studies, University of California at San Francisco, California; and
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
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Han SJ, Rolston JD, Zygourakis CC, Sun MZ, McDermott MW, Lau CY, Aghi MK. Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution. J Surg Educ 2016; 73:291-295. [PMID: 26774935 DOI: 10.1016/j.jsurg.2015.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time. DESIGN AND SETTING In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases. RESULTS In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays. CONCLUSIONS Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect.
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Affiliation(s)
- Seunggu J Han
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
| | - John D Rolston
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Corinna C Zygourakis
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Matthew Z Sun
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Michael W McDermott
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Catherine Y Lau
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Sun MZ, Oh T, Ivan ME, Clark AJ, Safaee M, Sayegh ET, Kaur G, Parsa AT, Bloch O. Survival impact of time to initiation of chemoradiotherapy after resection of newly diagnosed glioblastoma. J Neurosurg 2015; 122:1144-50. [DOI: 10.3171/2014.9.jns14193] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
There are few and conflicting reports on the effects of delayed initiation of chemoradiotherapy on the survival of patients with glioblastoma. The standard of care for newly diagnosed glioblastoma is concurrent radiotherapy and temozolomide chemotherapy after maximal safe resection; however, the optimal timing of such therapy is poorly defined. Given the lack of consensus in the literature, the authors performed a retrospective analysis of The Cancer Genome Atlas (TCGA) database to investigate the effect of time from surgery to initiation of therapy on survival in newly diagnosed glioblastoma.
METHODS
Patients with primary glioblastoma diagnosed since 2005 and treated according to the standard of care were identified from TCGA database. Kaplan-Meier and multivariate Cox regression analyses were used to compare overall survival (OS) and progression-free survival (PFS) between groups stratified by postoperative delay to initiation of radiation treatment.
RESULTS
There were 218 patients with newly diagnosed glioblastoma with known time to initiation of radiotherapy identified in the database. The median duration until therapy was 27 days. Delay to radiotherapy longer than the median was not associated with worse PFS (HR = 0.918, p = 0.680) or OS (HR = 1.135, p = 0.595) in multivariate analysis when controlling for age, sex, KPS score, and adjuvant chemotherapy. Patients in the highest and lowest quartiles for delay to therapy (≤ 20 days vs ≥ 36 days) did not statistically differ in PFS (p = 0.667) or OS (p = 0.124). The small subset of patients with particularly long delays (> 42 days) demonstrated worse OS (HR = 1.835, p = 0.019), but not PFS (p = 0.74).
CONCLUSIONS
Modest delay in initiation of postoperative chemotherapy and radiation does not appear to be associated with worse PFS or OS in patients with newly diagnosed glioblastoma, while significant delay longer than 6 weeks may be associated with worse OS.
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Affiliation(s)
- Matthew Z. Sun
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Taemin Oh
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael E. Ivan
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Aaron J. Clark
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Michael Safaee
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Eli T. Sayegh
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gurvinder Kaur
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew T. Parsa
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Orin Bloch
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Oh T, Ivan ME, Sun MZ, Safaee M, Fakurnejad S, Clark AJ, Sayegh ET, Bloch O, Parsa AT. PI3K pathway inhibitors: potential prospects as adjuncts to vaccine immunotherapy for glioblastoma. Immunotherapy 2015; 6:737-53. [PMID: 25186604 DOI: 10.2217/imt.14.35] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Constitutive activation of the PI3K pathway has been implicated in glioblastoma (GBM) pathogenesis. Pharmacologic inhibition can both inhibit tumor survival and downregulate expression of programmed death ligand-1, a protein highly expressed on glioma cells that strongly contributes to cancer immunosuppression. In that manner, PI3K pathway inhibitors can help optimize GBM vaccine immunotherapy. In this review, we describe and assess the potential integration of various classes of PI3K pathway inhibitors into GBM immunotherapy. While early-generation inhibitors have a wide range of immunosuppressive effects that could negate their antitumor potency, further work should better characterize how contemporary inhibitors affect the immune response. This will help determine if these inhibitors are truly a therapeutic avenue with a strong future in GBM immunotherapy.
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Affiliation(s)
- Taemin Oh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Feinberg School of Medicine, 676 N St Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
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Oh T, Rutkowski MJ, Safaee M, Sun MZ, Sayegh ET, Bloch O, Tihan T, Parsa AT. Survival outcomes of giant cell glioblastoma: Institutional experience in the management of 20 patients. J Clin Neurosci 2014; 21:2129-34. [DOI: 10.1016/j.jocn.2014.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Sun MZ, Ivan ME, Oh MC, Delance AR, Clark AJ, Safaee M, Oh T, Kaur G, Molinaro A, Gupta N, Parsa AT. Effects of adjuvant chemotherapy and radiation on overall survival in children with choroid plexus carcinoma. J Neurooncol 2014; 120:353-60. [DOI: 10.1007/s11060-014-1559-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/11/2014] [Indexed: 01/21/2023]
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38
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Safaee M, Oh T, Sun MZ, Parsa AT, McDermott MW, El-Sayed IH, Bloch O. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review. Head Neck 2014; 37:1213-24. [PMID: 24764167 DOI: 10.1002/hed.23717] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 08/28/2013] [Revised: 01/15/2014] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review. METHODS Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases. RESULTS Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence. CONCLUSION PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Z Sun
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Michael W McDermott
- Department of Neurological Surgery, University of California - San Francisco, San Francisco, California
| | - Ivan H El-Sayed
- Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Kaur G, Sayegh ET, Larson A, Bloch O, Madden M, Sun MZ, Barani IJ, James CD, Parsa AT. Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review. Neuro Oncol 2014; 16:628-36. [PMID: 24696499 DOI: 10.1093/neuonc/nou025] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [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: 12/20/2022] Open
Abstract
Atypical meningiomas (AMs) and malignant meningiomas (MMs) are tumors with a lower incidence and poorer prognosis than benign meningiomas. The role of radiotherapy as an adjuvant to surgical resection, especially for AMs, is incompletely defined. In this study, the English-language literature was systematically reviewed for studies that reported tumor characteristics, treatment parameters, and clinical outcomes after adjuvant radiotherapy for AM and MM, including overall survival, progression-free survival, and/or time to recurrence or mortality. Clinical outcomes were further assessed in the context of resection status, timing of administration, and radiation dose. Outcomes after stereotactic radiosurgery were also examined. Treatment toxicity and other potential prognostic or confounding factors were appraised. Ten and 11 studies for AM and MM, respectively, met the inclusion criteria. The median 5-year progression-free survival and overall survival after adjuvant radiotherapy were 54.2% and 67.5%, respectively, for AM and 48% and 55.6% for MM. The complication rates were 11.1% for AM and 5.1% for MM. Incomplete resection and radiation dose <50 Gy conferred significantly poorer 5-year progression-free survival. Most studies were unable to demonstrate a statistically significant prognostic benefit for adjuvant radiotherapy in AM. In conclusion, adjuvant radiotherapy significantly improved local control of AMs and MMs, especially after subtotal resection. Study limitations, including inadequate statistical power, may underlie the studies' inability to demonstrate a statistically significant benefit for adjuvant radiotherapy in AM. Because these tumors preferentially recur within 5 years of surgical resection, future studies should define whether early adjuvant therapy should become part of the standard treatment paradigm for completely excised tumors.
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Affiliation(s)
- Gurvinder Kaur
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois (G.K., E.T.S., O.B., A.T.P.); Department of Pathology, University of California, San Francisco, California (M.M.); Department of Neurological Surgery, University of California, San Francisco, California (A.L., M.Z.S., C.D.J.); Department of Radiation Oncology, University of California, San Francisco, California (I.J.B.)
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Safaee M, Ivan ME, Oh MC, Oh T, Sayegh ET, Kaur G, Sun MZ, Bloch O, Parsa AT. The role of epidermal growth factor-like module containing mucin-like hormone receptor 2 in human cancers. Oncol Rev 2014; 8:242. [PMID: 25992231 PMCID: PMC4419612 DOI: 10.4081/oncol.2014.242] [Citation(s) in RCA: 4] [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: 12/31/2013] [Revised: 03/14/2014] [Accepted: 03/24/2014] [Indexed: 02/04/2023] Open
Abstract
G-protein coupled receptors (GPCRs) are among the most diverse and ubiquitous proteins in all of biology. The epidermal growth factor-seven span transmembrane (EGF-TM7) subfamily of adhesion GPCRs is a small subset whose members are mainly expressed on the surface of leukocytes. The EGF domains on the N-terminus add significant size to these receptors and they are considered to be among the largest members of the TM7 family. Although not all of their ligands or downstream targets have been identified, there is evidence implicating the EGF-TM7 family diverse processes such as cell adhesion, migration, inflammation, and autoimmune disease. Recent studies have identified expression of EGF-TM7 family members on human neoplasms including those of the thyroid, stomach, colon, and brain. Their presence on these tissues is not surprising given the ubiquity of GPCRs, but because their functional significance and pathways are not completely understood, they are of tremendous clinical and scientific interest. Current evidence suggests that expression of certain EGF-TM7 receptors is correlated with tumor grade, confers a more invasive phenotype, and increases the likelihood of metastatic disease. In this review, we will discuss the structure, function, and regulation of these receptors. We also describe the expression of these receptors in human cancers and explore their potential mechanistic significance.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, University of California , San Francisco, CA, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of California , San Francisco, CA, USA
| | - Michael C Oh
- Department of Neurological Surgery, University of California , San Francisco, CA, USA
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Eli T Sayegh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Matthew Z Sun
- Department of Neurological Surgery, University of California , San Francisco, CA, USA
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
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Safaee M, Sun MZ, Oh T, Aghi MK, Berger MS, McDermott MW, Parsa AT, Bloch O. Use of thrombin-based hemostatic matrix during meningioma resection: A potential risk factor for perioperative thromboembolic events. Clin Neurol Neurosurg 2014; 119:116-20. [DOI: 10.1016/j.clineuro.2014.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/10/2013] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
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DeLance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, Bollen AW, Phillips JJ, Parsa AT. Tuberculoma of the central nervous system. J Clin Neurosci 2013; 20:1333-41. [DOI: 10.1016/j.jocn.2013.01.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/20/2013] [Accepted: 01/27/2013] [Indexed: 01/01/2023]
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Sun MZ, Oh MC, Ivan ME, Kaur G, Safaee M, Kim JM, Phillips JJ, Auguste KI, Parsa AT. Current management of choroid plexus carcinomas. Neurosurg Rev 2013; 37:179-92; discussion 192. [PMID: 24068529 DOI: 10.1007/s10143-013-0499-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/12/2012] [Accepted: 03/10/2013] [Indexed: 12/26/2022]
Abstract
Choroid plexus carcinoma (CPC) is a World Health Organization (WHO) grade III brain tumor with a poor prognosis that occurs mainly in children. Gross total resection of CPC is highly recommended and is associated with improved overall survival, although it is often associated with increased morbidity. The use of adjuvant therapies has yet to be standardized, although evidence suggests that for patients with incompletely resected CPCs, a combination of chemotherapy and radiation therapy may be beneficial. The use of radiation therapy for younger children (<3 years old) with CPC, however, is not recommended, due to the potential negative neurological sequelae associated with radiation to the developing brain. Given that the majority of CPC patients are young children, questions regarding optimal radiation dose, chemotherapy agents, and how to combine these two adjuvant treatment modalities to achieve the best outcomes remain unanswered. In this paper we summarize the current management of CPC in the literature. Further studies are needed to standardize the treatment paradigm for this malignant brain tumor.
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Affiliation(s)
- Matthew Z Sun
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA, 94117, USA
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Safaee M, Clark AJ, Ivan ME, Oh MC, Bloch O, Sun MZ, Oh T, Parsa AT. CD97 is a multifunctional leukocyte receptor with distinct roles in human cancers (Review). Int J Oncol 2013; 43:1343-50. [PMID: 23969601 DOI: 10.3892/ijo.2013.2075] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/24/2013] [Indexed: 11/06/2022] Open
Abstract
G-protein coupled receptors (GPCRs) represent the most diverse and biologically ubiquitous protein receptors. The epidermal growth factor seven-span transmembrane (EGF-TM7) family consists of adhesion GPCRs with a diverse functional repertoire. CD97 is the most broadly expressed member with roles in cell adhesion, migration and regulation of intercellular junctions. CD97 is also expressed in a variety of human malignancies including those of the thyroid, stomach, colon and brain. CD97 confers an invasive phenotype and has been shown to correlate with tumor grade, lymph node invasion, metastatic spread and overall prognosis. More recently, CD97 was found to signal through Gα12/13, resulting in increased RHO-GTP levels. Proven roles in tumor invasion and signaling make CD97 an exciting novel therapeutic target. In this review, we will discuss the structure and function of this receptor, with a specific focus on its mechanistic significance in neoplastic diseases.
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Affiliation(s)
- Michael Safaee
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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45
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Sun MZ, Kim JM, Oh MC, Safaee M, Kaur G, Clark AJ, Bloch O, Ivan ME, Kaur R, Oh T, Fouse SD, Phillips JJ, Berger MS, Parsa AT. Na⁺/K⁺-ATPase β2-subunit (AMOG) expression abrogates invasion of glioblastoma-derived brain tumor-initiating cells. Neuro Oncol 2013; 15:1518-31. [PMID: 23887941 DOI: 10.1093/neuonc/not099] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mechanisms of glioma invasion remain to be fully elucidated. Glioma cells within glioblastoma multiforme (GBM) range from well-differentiated tumor cells to less-differentiated brain tumor-initiating cells (BTICs). The β2-subunit of Na(+)/K(+)-ATPase, called the adhesion molecule on glia (AMOG), is highly expressed in normal glia but is thought to be universally downregulated in GBM. To test our hypothesis that expression of AMOG is heterogeneous in GBM and confers a less invasive phenotype, we compared it between BTICs and differentiated cells from patient-matched GBM and then tested GBM invasion in vitro after AMOG overexpression. METHODS Immunohistochemistry, immunoblotting, and real-time PCR were used to characterize AMOG protein and mRNA expression in tumor samples, BTICs, and differentiated cells. Matrigel invasion assay, scratch assay, and direct cell counting were used for testing in vitro invasion, migration, and proliferation, respectively. RESULTS While AMOG expression is heterogeneous in astrocytomas of grades II-IV, it is lost in most GBM. BTICs express higher levels of AMOG mRNA and protein compared with patient-matched differentiated tumor cells. Overexpression of AMOG decreased GBM cell and BTIC invasion without affecting migration or proliferation. Knockdown of AMOG expression in normal human astrocytes increased invasion. CONCLUSIONS AMOG expression inhibits GBM invasion. Its downregulation increases invasion in glial cells and may also represent an important step in BTIC differentiation. These data provide compelling evidence implicating the role of AMOG in glioma invasion and provide impetus for further investigation.
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Affiliation(s)
- Matthew Z Sun
- Corresponding Author: Andrew T. Parsa, MD, PhD, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94117.
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Oh MC, Tarapore PE, Kim JM, Sun MZ, Safaee M, Kaur G, Aranda DM, Parsa AT. Spinal ependymomas: benefits of extent of resection for different histological grades. J Clin Neurosci 2013; 20:1390-7. [PMID: 23768966 DOI: 10.1016/j.jocn.2012.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 11/28/2012] [Accepted: 12/08/2012] [Indexed: 11/26/2022]
Abstract
Although the World Health Organization (WHO) categorizes spinal ependymomas into three histological grades, difference in surgical outcomes between WHO grades I and II tumors are unclear. For these benign tumors, prognosis may be best determined by factors other than tumor grade alone, such as extent of resection. To analyze the effects of the extent of resection on different grades of spinal ependymomas, we performed a comprehensive literature review to identify adult spinal ependymoma patients who received surgical resection with a clearly identifiable WHO grade. A total of 175 patients were identified. While grade III tumors carried the worst prognosis as expected (p<0.001), grade I and II tumors did not differ significantly in outcomes following surgery. Overall, gross total resection (GTR, 68.7%, 114/166) provided significantly improved progression-free survival (PFS, p<0.001) and overall survival (OS, p=0.022) compared to the subtotal resection group. Surprisingly, the highest GTR rate was achieved for grade II tumors (78.8%, 78/99; p<0.001) followed by grade I (58.9%, 33/56) and grade III tumors (27.3%, 3/11). Interestingly, PFS was significantly improved by GTR for grade II tumors (p<0.001), but not for grade I (p=0.705). Similar trends, although not statistically significant, were found for OS. Our results show that while GTR provides the best overall outcomes, GTR is most effective for classic grade II ependymomas, but not for grade I ependymomas. Despite having a lower WHO grade, myxopapillary ependymomas have a lower GTR rate, and benefit less from GTR.
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Affiliation(s)
- Michael C Oh
- Department of Neurological Surgery, University of California San Fransisco, 505 Parnassus Avenue, San Francisco, CA 94117, USA
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Bloch O, Safaee M, Sun MZ, Butowski NA, McDermott MW, Berger MS, Aghi MK, Parsa AT. Disseminated progression of glioblastoma after treatment with bevacizumab. Clin Neurol Neurosurg 2013; 115:1795-801. [PMID: 23706614 DOI: 10.1016/j.clineuro.2013.04.017] [Citation(s) in RCA: 17] [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: 03/21/2013] [Revised: 04/17/2013] [Accepted: 04/27/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Reports of glioblastoma (GBM) progression following treatment with bevacizumab indicate that a subset of patients develop disseminated, often minimally enhancing tumors that differ from the typical pattern of focal recurrence. We have reviewed our institutional experience with bevacizumab for GBM to evaluate the prognostic factors and outcomes of patients with disseminated progression. PATIENTS AND METHODS Medical records of patients treated for GBM at the University of California San Francisco from 2005 to 2009 were reviewed. Patients receiving bevacizumab for focal disease were evaluated and imaging was reviewed to identify patients who progressed in a disseminated pattern. Tumor and treatment factors were compared between focal and disseminated progressors to identify predictive factors for dissemination. Clinical outcomes were compared between progression groups. RESULTS Seventy-one patients received adjuvant bevacizumab at some point in their disease course in addition to surgical resection and standard chemoradiotherapy. Of these, 12 patients (17%) had disseminated progression after bevacizumab. There were no differences in patient demographics, surgical treatment, or bevacizumab administration between disseminated and focal progressors. Length of bevacizumab treatment for disseminated progressors trended toward increased time (7.4 vs. 5.4 months) but was not statistically significant (p=0.1). Although progression-free survival and overall survival did not differ significantly between progression groups (median survival from progression was 3.8 vs. 4.6 months, p=0.5), over 30% of focal progressors had a subsequent resection and enrollment in a surgically based clinical trial, whereas none of the disseminated progressors had further surgical intervention. Compared to previously published reports of GBM dissemination with and without prior bevacizumab treatment, our patients had a rate of disease dissemination similar to the baseline rate observed in patients treated without bevacizumab. CONCLUSION The risk of dissemination does not appear to be considerably increased due to the use of bevacizumab, and the pattern of disease at progression does not affect subsequent survival. Therefore, the risk of dissemination should not influence the decision to treat with bevacizumab, especially for recurrent disease.
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Affiliation(s)
- Orin Bloch
- Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, CA 94143-0112, USA
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Kaur G, Kim J, Kaur R, Tan I, Bloch O, Sun MZ, Safaee M, Oh MC, Sughrue M, Phillips J, Parsa AT. G-protein coupled receptor kinase (GRK)-5 regulates proliferation of glioblastoma-derived stem cells. J Clin Neurosci 2013; 20:1014-8. [PMID: 23693024 DOI: 10.1016/j.jocn.2012.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/10/2012] [Indexed: 12/19/2022]
Abstract
Glioblastoma multiforme (GBM) is a grade IV malignant brain tumor with high mortality and has been well known to involve many molecular pathways, including G-protein coupled receptor (GPCR)-mediated signaling (such as epithelial growth factor receptor [EGFR] and platelet derived growth factor receptor [PDGFR]). G protein-coupled receptor kinases (GRK) directly regulate GPCR activity by phosphorylating activated agonist-bound receptors to desensitize signaling and internalize receptors through beta-arrestins. Recent studies in various cancers, including prostate and breast cancer, have highlighted the role of change in GRK expression to oncogenesis and tumor proliferation. In this study, we evaluated the expression of GRK5 in grade II to grade IV glioma specimens using immunohistochemistry and found that GRK5 expression levels are highly correlated with aggressiveness of glioma. We used culture conditions to selectively promote the growth of either glioblastoma cells with stem cell markers (GSC) or differentiated glioblastoma cells (DGC) from fresh GBM specimens. GSC are known to be highly invasive and mobile, and have the capacity to self-renew and are more resistant to chemotherapy and radiation compared to differentiated populations of GBM. We examined the expression of GRK5 in these two sets of culturing conditions for GBM cells and found that GRK5 expression is upregulated in GSC compared to differentiated GBM cells. To better understand the role of GRK5 in GBM-derived stem cells, we created stable GRK5 knockdown and evaluated the proliferation rate. Using an ATP chemiluminescence assay, we show, for the first time, that knocking down the expression of GRK5 decreased the proliferation rate of GSC in contrast to control.
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Affiliation(s)
- Gurvinder Kaur
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA 94143, USA
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Oh MC, Sayegh ET, Safaee M, Sun MZ, Kaur G, Kim JM, Aranda D, Molinaro AM, Gupta N, Parsa AT. Prognosis by tumor location for pediatric spinal cord ependymomas. J Neurosurg Pediatr 2013; 11:282-8. [PMID: 23259510 DOI: 10.3171/2012.11.peds12292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Ependymoma is a common CNS tumor in children, with spinal cord ependymomas making up 13.1% of all ependymomas in this age group. The clinical features that affect prognosis in pediatric spinal cord ependymomas are not well understood. A comprehensive literature review was performed to determine whether a tumor location along the spinal cord is prognostically significant in children undergoing surgery for spinal cord ependymomas. METHODS A PubMed search was performed to identify all papers that contained data on patients with spinal cord ependymomas. Only pediatric patients (age < 18 years) who underwent resection with a clearly reported tumor location were included in the analysis. Myxopapillary tumors were excluded from study. Tumor location was subdivided into 6 regions: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus medullaris. Kaplan-Meier survival and Cox regression analyses were performed to determine the effects of tumor location on progression-free survival (PFS) and overall survival (OS). RESULTS Fifty-eight patients who underwent resection of spinal cord ependymomas were identified. Ependymomas were located all along the spinal cord but occurred with the highest frequency in the cervical region (29.3%). Progression-free survival was significantly better in patients with tumors arising in the upper portion of the spinal cord (p = 0.031), which remained significant in the multivariate Cox regression analysis (p < 0.05). Moreover, OS was significantly better in patients with upper spinal cord ependymomas than in those harboring ependymomas in the lower spinal cord (p = 0.048). CONCLUSIONS Although more common in adults, spinal ependymomas can occur anywhere along the spinal cord in the pediatric population; however, tumors occurring in the lower half of the spinal cord carry a worse prognosis with shorter PFS and OS. By comparison, ependymomas in the upper spinal cord recur later and less frequently, with little or no mortality in this patient group.
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Affiliation(s)
- Michael C Oh
- Departments of Neurological Surgery, University of California, San Francisco, CA 94117, USA
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Oh MC, Kim JM, Kaur G, Safaee M, Sun MZ, Singh A, Aranda D, Molinaro AM, Parsa AT. Prognosis by tumor location in adults with spinal ependymomas. J Neurosurg Spine 2013; 18:226-35. [PMID: 23311515 DOI: 10.3171/2012.12.spine12591] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECT Ependymomas are primary central nervous system tumors that occur more frequently in the spines of adults than they do there in children. Previous studies consist mainly of retrospective single-institutional experiences or case studies. In this study, a comprehensive literature review was performed on reported cases of spinal ependymoma treated with resection to determine whether tumor location along the spinal axis conveys important prognostic information. METHODS A PubMed search was performed to identify all papers that included data on patients with spinal ependymoma. Only cases involving adult patients who underwent ependymoma resection with a clearly reported tumor location were included for analysis. Tumor locations were separated into 6 groups: cervicomedullary, cervical, cervicothoracic, thoracic, thoracolumbar, and conus + cauda equina. Kaplan-Meier survival and Cox regression analyses were performed to determine the effect of tumor location on progression-free survival (PFS) and overall survival (OS). RESULTS A total of 447 patients who underwent resection of spinal ependymomas with clearly indicated location of tumor were identified. The most common locations of spinal ependymomas were the cervical (32.0%) and conus + cauda equina (26.8%) regions. The thoracolumbar and cervicomedullary regions had the fewest tumors (accounting for, respectively, 5.1% and 3.4% of the total number of cases). The conus + cauda equina and thoracolumbar regions had the highest percentage of WHO Grade I tumors, while tumors located above these regions consisted of mostly WHO Grade II tumors. Despite the tendency for benign grades in the lower spinal regions, PFS for patients with spinal ependymomas in the lower 3 regions (thoracic, thoracolumbar, conus + cauda equina) was significantly shorter (p < 0.001) than for those with tumors in the upper regions (cervicomedullary, cervical, cervicothoracic), but the difference in OS did not achieve statistical significance (p = 0.131). CONCLUSIONS Spinal ependymomas along different regions of spinal axis have different characteristics and clinical behaviors. Tumor grade, extent of resection, and PFS varied by tumor location (upper vs lower spinal regions), while OS did not. Recurrence rates were higher for the lower spinal cord tumors, despite a greater prevalence of lower WHO grade lesions, compared with upper spinal cord tumors, suggesting that tumor location along the spinal axis is an important prognostic factor.
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Affiliation(s)
- Michael C Oh
- Departments of Neurological Surgery, University of California, SanFrancisco, CA 94117 USA
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