Symptomatic ischemic complications following endovascular treatment of vertebral artery dissecting aneurysms.

PURPOSE: The aim of this study is to investigate the clinical and radiological features related to the symptomatic ischemic complications of vertebral artery dissecting aneurysm (VADA) following endovascular treatment (EVT). METHODS: The clinical and radiological features of 127 VADAs, which were treated in a single tertiary institute between September 2008 and December 2020, were retrospectively reviewed. We defined a thrombosed aneurysm as being one which the thrombus was in the aneurysm in magnetic resonance imaging (MRI). Symptomatic ischemic complication was defined as a case in which acute infarction was confirmed on diffusion weighted image after EVT with associated clinical symptoms. Univariate and multivariate analyses were executed to demonstrate the associations between symptomatic ischemic complication and characteristics of VADA. RESULTS: The rate of symptomatic ischemic complication was 13.4% (17 of 127). The thrombosed aneurysms were observed in 24.4% (31 of 127) and posterior inferior cerebellar artery (PICA) involvement was shown in 38.6% (49 of 127). Multivariate logistic regression analysis demonstrated that thrombosed aneurysms (odds ratio [OR] = 8.54, 95% confidence interval [CI] 1.98-36.87, p = 0.004) and PICA involvement (OR = 4.26, 95% CI 1.03-17.68, p = 0.046) were significantly associated with symptomatic ischemic complications following EVT. CONCLUSION: This study showed that the VADAs with intra-aneurysmal thrombose and PICA involvement may be independent risk factors for symptomatic ischemic complications following EVT. Therefore, when the thrombosed VADAs with PICA involvement are observed, practitioners may consider close postoperative monitoring for early detection of ischemic complications.

Risk Factors for the Recurrence of Posterior Communicating Artery Aneurysm: The Significance of Fetal-Type Posterior Cerebral artery.

OBJECTIVES: The purpose of this study was to investigate the risk factors associated with recurrence of posterior communicating artery aneurysms after treatment and to evaluate the significance of fetal-type posterior cerebral artery as an independent risk factor for recurrence of posterior communicating artery aneurysms. MATERIALS AND METHODS: The clinical and radiological findings of 220 posterior communicating artery aneurysms treated between January 2009 and December 2016 in a single tertiary institute were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the association between clinical and radiological variables and recurrence. RESULTS: Of 220 posterior communicating artery aneurysms, 148 aneurysms were unruptured and 82 aneurysms were treated with surgery. Forty-six out of 220 aneurysms (20.9%) were associated with fetal-type posterior cerebral artery. Overall recurrence rate was 19% (42 out of 220 aneurysms) during mean 54.6 ± 29.8 months follow-up. Multivariate logistic regression analysis showed that size (OR=1.238; 95% CI, 1.087-1.409, p = 0.001), ruptured status (OR=2.699; 95% CI, 1.179-6.117, p = 0.019), endovascular treatment (OR=3.803; 95% CI, 1.330-10.875, p = 0.013), incomplete occlusion (OR=4.699; 95% CI, 1.999-11.048, p = <0.001) and fetal-type posterior cerebral artery (OR=3.533; 95% CI, 1.373-9.089, p = 0.009) were significantly associated with recurrence after treatment. CONCLUSIONS: The results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion.

Multimodal treatment including tandem high-dose chemotherapy and autologous stem cell transplantation in children with anaplastic ependymomas.

In this study, we evaluated the results of multimodal treatment that included tandem HDCT/auto-SCT in children with anaplastic ependymomas. Fourteen patients with anaplastic ependymomas were enrolled from 2006 to 2014. Six cycles of induction chemotherapy were administered to all patients before they underwent tandem HDCT/auto-SCT. Patients who were older than 3 years of age were administered RT after two cycles of induction chemotherapy. In patients under 3 years of age, RT was either omitted or delayed until they reached 3 years of age, if the patients experienced CR after tandem HDCT/auto-SCT. All patients, including two who experienced disease progression during induction treatment, underwent the first HDCT/auto-SCT, and 13 subsequently underwent the second HDCT/auto-SCT. One patient died from hepatic VOD during the second HDCT/auto-SCT; other toxicities occurring during tandem HDCT/auto-SCT were manageable. Relapses or progression occurred in seven patients, and five of seven of them remain alive till date after salvage treatment, including surgery and RT. The 5-year overall and event-free survival rates were 85.1% ± 9.7% and 50.0% ± 13.4%, respectively. These findings suggest that multimodal treatment including tandem HDCT/auto-SCT could be a feasible option for improving survival in children with anaplastic ependymomas.

Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for High-Grade Gliomas in Children and Adolescents.

With the aim to investigate the outcome of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) for high-grade gliomas (HGGs), we retrospectively reviewed the medical records of 30 patients with HGGs (16 glioblastomas, 7 anaplastic astrocytomas, and 7 other HGGs) between 2006 and 2015. Gross or near total resection was possible in 11 patients. Front-line treatment after surgery was radiotherapy (RT) in 14 patients and chemotherapy in the remaining 16 patients including 3 patients less than 3 years of age. Eight of 12 patients who remained progression free and 5 of the remaining 18 patients who experienced progression during induction treatment underwent the first HDCT/auto-SCT with carboplatin + thiotepa + etoposide (CTE) regimen and 11 of them proceeded to the second HDCT/auto-SCT with cyclophosphamide + melphalan (CyM) regimen. One patient died from hepatic veno-occlusive disease (VOD) during the second HDCT/auto-SCT; otherwise, toxicities were manageable. Four patients in complete response (CR) and 3 of 7 patients in partial response (PR) or second PR at the first HDCT/auto-SCT remained event free: however, 2 patients with progressive tumor experienced progression again. The probabilities of 3-year overall survival (OS) after the first HDCT/auto-SCT in 11 patients in CR, PR, or second PR was 58.2% ± 16.9%. Tumor status at the first HDCT/auto-SCT was the only significant factor for outcome after HDCT/auto-SCT. There was no difference in survival between glioblastoma and other HGGs. This study suggests that the outcome of HGGs in children and adolescents after HDCT/auto-SCT is encouraging if the patient could achieve CR or PR before HDCT/auto-SCT.

Dual Volume Image Fusion Technique for Anatomical Evaluation of Cavernous Sinus Dural Arteriovenous Fistula: Usefulness for Transvenous Target Segment Embolization.

OBJECTIVE: In this preliminary study, we investigated the value of fusion techniques by flat detector computed tomography based dual volume rotational angiography (DVRA) for the evaluation of the anatomical relationship of cavernous sinus dural arteriovenous fistula (CSDAVF) and assessed the possibility of transvenous target segment embolization. METHODS: Twenty-six patients with CSDAVF supplied by multiple feeders underwent DVRA for each feeding large vessel separately. We assessed the anatomical relationship of feeders, fistula points, and venous drainage with 3 dual volume image fusion techniques. Transvenous embolization was targeted to the segment of fistulous point for preserving those not involved and reducing coil mass effect. RESULTS: Dual vessel multi-planar reconstruction fusion technique could show which segment of the cavernous sinus supplied by feeding arteries. In the dual vessel volume rendering fusion technique, the association between feeding arteries, fistula points, and draining veins of 2 different vessels could be accurately identified in 3 dimensions. In addition, we could visualize the exact anatomical relationship between the components of CSDAVF and skull anatomy with the single vessel fusion technique. Based on various fusion images, target segment embolization was successfully performed in 8 patients. In this group, we achieved complete or near complete occlusion without complications, including cranial nerve palsy. CONCLUSIONS: Detailed anatomical information including accurate fistula point, specific feeding arteries, and draining veins could be obtained with various dual volume image fusion techniques. In addition, the target segment embolization of CSDAVF could be possible with understanding of the precise CSDAVF architectures.

Clinical and Radiological Outcomes of Vertebral Artery Dissecting Aneurysms Treated with Endovascular Treatments: A 12-year Single-Center Experience.

OBJECTIVE: We aimed to compare the clinical and radiological outcomes of vertebral artery dissecting aneurysms (VADAs) stratified using different endovascular treatment methods. METHODS: We retrospectively reviewed 116 patients with VADAs treated at a single tertiary institute between September 2008 and December 2020. We analyzed and compared the clinical and radiological parameters according to different treatment methods. RESULTS: In total, 127 endovascular procedures were performed in 116 patients. We initially treated 46 patients with parent artery occlusion, 9 with coil embolization without stent, 43 with single stent with or without coil, 16 with multiple stents with or without coils, and 13 with flow-diverting stent. At the last follow-up (mean 37.8 ± 30.9 months), the complete occlusion rate (85.7%) was higher in the multiple-stent group than in the groups that received other reconstructive treatment methods. Moreover, the recurrence (0%) and retreatment (0%) rates were significantly lower in the multiple stent group (P < 0.001). The coil embolization-only group showed the highest recurrence (n = 5, 62.5%) and incomplete occlusion (n = 1, 12.5%) rates. The single-stent group showed higher recurrence (n = 9, 22.5%) and retreatment (n = 3, 7%) rates. Multivariate logistic regression analyses showed that coil embolization without stent placement (odds ratio = 172.76, 95% confidence interval = 6.83-4366.85; P = 0.002) was significantly associated with recurrence. At the last follow-up (mean, 42.1 ± 37.7 months), we achieved favorable clinical outcomes (modified Rankin Scale ≤2) in 106 of 127 patients. CONCLUSION: When treating VADAs, multiple stent placements may play a key role in achieving favorable long-term radiological outcomes.

Eosinophilic meningitis following suboccipital craniotomy without bovine dural graft: illustrative case.

BACKGROUND: Eosinophilic meningitis is a rare known complication after brain surgery associated with duraplasty using artificial bovine graft. However, eosinophilic meningitis after craniotomy without bovine dural graft has not been reported. OBSERVATIONS: A 48-year-old female presented with lateral medullary infarction caused by a vertebral artery dissecting aneurysm incorporating the posterior inferior cerebellar artery (PICA). The authors performed occipital artery-PICA anastomosis and repaired the dura by primary suture without bovine graft. Thereafter, endovascular internal trapping using coils was conducted. Severe headache developed at postoperative day 17, and the patient was diagnosed with eosinophilic meningitis. After administration of a high-dose corticosteroid for 2 weeks, her symptoms and laboratory findings were improved. LESSONS: Postoperative eosinophilic meningitis is rarely related to craniotomy without using bovine graft. Neurosurgeons should consider the possibility of eosinophilic meningitis after craniotomy without a xenogeneic dural material.

Comparison of Parent Artery Occlusion and Stent-Assisted Treatments in Ruptured Vertebral Artery Dissecting Aneurysms.

OBJECTIVE: To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. METHODS: This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications. RESULTS: Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications. CONCLUSIONS: Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.

Polycaprolactone scaffolds fabricated with an advanced electrohydrodynamic direct-printing method for bone tissue regeneration.

Electrohydrodynamic (EHD) direct writing has been used in diverse microelectromechanical systems and various supplemental methods for biotechnology and electronics. In this work, we expanded the use of EHD-induced direct writing to fabricate 3D biomedical scaffolds designed as porous structures for bone tissue engineering. To prepare the scaffolds, we modified a grounded target used in conventional EHD direct printing using a poly(ethylene oxide) solution bath, elastically cushioning the plotted struts to prevent crumbling. The fabricated scaffolds were assessed for not only physical properties including surface roughness and water uptake ability but also biological capabilities by culturing osteoblast-like cells (MG63) for the EHD-plotted polycaprolactone (PCL) scaffold. The EHD-scaffolds showed significantly roughened surface and enhanced water-absorption ability (400% increase) compared with the pure rapid-prototyped PCL. The results of cell viability, alkaline phosphatase activity, and mineralization analyses showed significantly enhanced biological properties of the scaffold (20 times the cell viability and 6 times the mineralization) compared with the scaffolds fabricated using RP technology. Because of the results, the modified EHD direct-writing process can be a promising method for fabricating 3D biomedical scaffolds in tissue engineering.

Clinical and radiological risk factors for rupture of vertebral artery dissecting aneurysm: significance of the stagnation sign.

OBJECTIVE: The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA. METHODS: Clinical and radiological variables of 117 VADAs treated in a tertiary hospital from September 2008 to December 2020 were retrospectively reviewed. The stagnation sign is defined as the finding of contrast agent remaining in the lesion until the venous phase of angiography. Univariate and multivariate analyses were executed to reveal the associations between rupture status and VADA characteristics. RESULTS: The rate of ruptured VADAs was 29.1% (34 of 117) and the stagnation sign was observed in 39.3% (46 of 117). Fusiform shape (OR 5.105, 95% CI 1.591-16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412-12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288-11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131-9.732, p = 0.029) were significantly related to rupture of VADA in multivariate logistic regression analysis. CONCLUSIONS: This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.

Ultrafast-Selective Nanofiltration of an Hybrid Membrane Comprising Laminated Reduced Graphene Oxide/Graphene Oxide Nanoribbons.

In this study, reduced graphene oxide (rGO) and graphene oxide nanoribbons (GONRs) are used to fabricate a composite membrane that exhibits ultrafast water permeance (312.8 L m-2 h-1 bar-1) and precise molecular separation (molecular weight cutoff: 269 Da), which surpass the upper bound of previously reported polymer and graphene-based nanofiltration membranes. As two-dimensional GONR exhibits a width on the scale of nanometers, its nanochannels can be enlarged without hindering the stacking of rGO. Moreover, abundant oxygen-containing groups on the edge and surface of GONR enhance the electrostatic interactions between the filtered molecules and the membrane nanochannel. By the synergistic effect, rejection and water flux are considerably increased. Owing to the chemically stable nature of rGO, the composite membrane is highly stable in aqueous media (from acidic to alkaline) and is recyclable during repeated filtration tests.

Transforaminal Percutaneous Endoscopic Lumbar Diskectomy with Percutaneous Epidural Neuroplasty in Lumbar Disk Herniation: Technical Note.

OBJECTIVE: Percutaneous endoscopic lumbar diskectomy and percutaneous epidural neuroplasty is a commonly used minimally invasive spinal surgery in lumbar disk herniation. But to our knowledge, there is no report about the results of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty. We did this study to evaluate the effect of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty in lumbar disk herniation. METHODS: We report a series of cases about techniques and results of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty in lumbar disk herniation, as well as introduce technical procedures and advantages. RESULTS: Seven patients improved axial back pain with percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty and had no complications. The percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty has many advantages with removing lumbar disk herniation in procedures. CONCLUSIONS: Percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty is a safe and effective surgical method in lumbar disk herniation.

Ureter Injury as a Complication of Oblique Lumbar Interbody Fusion.

BACKGROUND: Oblique lumbar interbody fusion is a commonly used surgical method of achieving lumbar interbody fusion. There have been some reports about complications of oblique lumbar interbody fusion at the L2-L3 level. However, to our knowledge, there have been no reports about ureter injury during oblique lumbar interbody fusion. We report a case of ureter injury during oblique lumbar interbody fusion to share our experience. CASE DESCRIPTION: A 78-year-old male patient presented with a history of lower back pain and neurogenic intermittent claudication. He was diagnosed with spinal stenosis at L2-L3, L4-L5 level and spondylolisthesis at L4-L5 level. Symptoms were not improved after several months of medical treatments. Then, oblique lumbar interbody fusion was performed at L2-L3, L4-L5 level. During the surgery, anesthesiologist noticed hematuria. A retrourethrogram was performed immediately by urologist, and ureter injury was found. Ureteroureterostomy and double-J catheter insertion were performed. The patient was discharged 2 weeks after surgery without urologic or neurologic complications. At 2 months after surgery, an intravenous pyelogram was performed, which showed an intact ureter. CONCLUSIONS: Our study shows that a low threshold of suspicion of ureter injury and careful manipulation of retroperitoneal fat can be helpful to prevent ureter injury during oblique lumbar interbody fusion at the upper level.

Recent cell printing systems for tissue engineering.

Three-dimensional (3D) printing in tissue engineering has been studied for the bio mimicry of the structures of human tissues and organs. Now, it is being applied to 3D cell printing, which can position cells and biomaterials, such as growth factors, at desired positions in the 3D space. However, there are some challenges of 3D cell printing, such as cell damage during the printing process and the inability to produce a porous 3D shape owing to the embedding of cells in the hydrogel-based printing ink, which should be biocompatible, biodegradable, and non-toxic, etc. Therefore, researchers have been studying ways to balance or enhance the post-print cell viability and the print-ability of 3D cell printing technologies by accommodating several mechanical, electrical, and chemical based systems. In this mini-review, several common 3D cell printing methods and their modified applications are introduced for overcoming deficiencies of the cell printing process.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison Study Based on End Plate Subsidence and Cystic Change in Individuals Older and Younger than 65 Years.

OBJECTIVE: To compare the outcomes between patients older and younger than 65 years who underwent single-level minimally invasive transforaminal interbody fusion (MI-TLIF) surgery. METHODS: This study is a retrospective analysis of 76 patients who underwent MI-TLIF between April 2012 and June 2016. Group A consisted of 35 patients (<65 years) and group B consisted of 41 patients (≥65 years). Intraoperative data were recorded. The evaluation of clinical outcomes was based on the visual analog scale for back and leg pain and the Oswestry Disability Index. Radiologic outcomes including cage subsidence, end plate cyst formation, and fusion rate were assessed. RESULTS: The mean age of the study subjects was 65.3 years, and the mean duration of follow-up was 18.98 months. Group B had a higher rate of comorbidities compared with group A (90.24% vs. 57.14%, respectively; P < 0.05). There was no statistically significant difference in the rate of complications between the groups (group A, 14.29%; group B, 17.07%). Clinical outcomes significantly improved in both groups postoperatively (P < 0.05). Although bony fusion in group A was slightly higher than that in group B, the fusion rate was not statistically different according to age. There were no statistically significant differences in the rates of cage subsidence or positive cyst sign between the groups. CONCLUSIONS: MI-TLIF presented similar safeness and acceptable outcomes and complication rate in both groups. Cyst formation may be aggravated by cage subsidence, because cage subsidence was a useful potential predictor of cyst formation.

Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65.

Background. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a widely accepted surgical procedure. But there are only a few reports of MIS-TLIF using the unilateral approach and single cage in elderly patients. Objective. The study investigated the clinical and radiological outcomes of MIS-TLIF using the unilateral approach and single cage in the patients over 65 years of age. Methods. Thirty-eight patients were followed for a mean of 15.5 ± 11.61 months. Radiological data include fusion rate, change of disc height, and central canal area. The numeric rating scale (NRS) and Oswestry disability index (ODI) were used to assess clinical outcomes. Results. The mean age of these patients at operation was 71.82 ± 4.71 years (range, 65-82 years). Evidence of fusion was observed radiologically in 64.71% at 6 months and 87.5% at 12 months after surgery, giving a final fusion rate of 100%. The mean NRS scores for back and leg pain and ODI scores improved significantly at the final follow-up. Conclusions. Clinical and radiologic outcomes of MIS-TLIF using unilateral approach and single cage in elderly patients indicate an acceptable method for the treatment of various kinds of lumbar spinal diseases.

A novel cell-printing method and its application to hepatogenic differentiation of human adipose stem cell-embedded mesh structures.

We report a cell-dispensing technique, using a core-shell nozzle and an absorbent dispensing stage to form cell-embedded struts. In the shell of the nozzle, a cross-linking agent flowed continuously onto the surface of the dispensed bioink in the core nozzle, so that the bioink struts were rapidly gelled, and any remnant cross-linking solution during the process was rapidly absorbed into the working stage, resulting in high cell-viability in the bioink strut and stable formation of a three-dimensional mesh structure. The cell-printing conditions were optimized by manipulating the process conditions to obtain high mechanical stability and high cell viability. The cell density was 1 × 10(7) mL(-1), which was achieved using a 3-wt% solution of alginate in phosphate-buffered saline, a mass fraction of 1.2 wt% of CaCl2 flowing in the shell nozzle with a fixed flow rate of 0.08 mL min(-1), and a translation velocity of the printing nozzle of 10 mm s(-1). To demonstrate the applicability of the technique, preosteoblasts and human adipose stem cells (hASCs) were used to obtain cell-laden structures with multi-layer porous mesh structures. The fabricated cell-laden mesh structures exhibited reasonable initial cell viabilities for preosteoblasts (93%) and hASCs (92%), and hepatogenic differentiation of hASC was successfully achieved.

A New Approach for Fabricating Collagen/ECM-Based Bioinks Using Preosteoblasts and Human Adipose Stem Cells.

Cell-printing methods have been used widely in tissue regeneration because they enable fabricating biomimetic 3D structures laden with various cells. To achieve a cell-matrix block, various natural hydrogels that are nontoxic, biocompatible, and printable have been combined to obtain "bioinks." Unfortunately, most bioinks, including those with alginates, show low cell-activating properties. Here, a strategy for obtaining highly bioactive ink, which consisted of collagen/extracellular matrix (ECM) and alginate, for printing 3D porous cell blocks is developed. An in vitro assessment of the 3D porous structures laden with preosteoblasts and human adipose stem cells (hASCs) demonstrates that the cells in the bioinks are viable. Osteogenic activities with the designed bioinks show much higher levels than with the "conventional" alginate-based bioink. Furthermore, the hepatogenic differentiation ability of hASCs with the bioink is evaluated using the liver-specific genes, albumin, and TDO2, under hepatogenic differentiation conditions. The genes are activated within the 3D cell block fabricated using the new bioink. These results demonstrate that the 3D cell-laden structure fabricated using collagen/ECM-based bioinks can provide a novel platform for various tissue engineering applications.

Association of systolic blood pressure drop with intravenous administration of itraconazole in children with hemato-oncologic disease.

PURPOSE: Although few adverse effects have been reported for itraconazole, a widely used antifungal therapy for febrile neutropenia, we found intravenous (IV) itraconazole to be associated with serious cases of blood pressure (BP) drop. We therefore evaluated the incidence and risk factors for BP drop during IV administration of the drug. MATERIALS AND METHODS: We reviewed the medical records of children with hemato-oncologic disease who were treated with IV itraconazole from January 2012 to December 2013. By analyzing systolic BP (SBP) measurements made from 4 hours before through to 4 hours after itraconazole administration, we evaluated the changes in SBP and the risk factors for an SBP drop, especially clinically meaningful (≥ 20%) drops. RESULTS: Itraconazole was administered 2,627 times to 180 patients. The SBP during the 4 hours following itraconazole administration was lower than during the 4 hours before administration (104 [53.0-160.33 mmHg] versus 105 [59.8-148.3 mmHg]; P<0.001). The decrease in SBP was associated with the application of continuous renal replacement therapy (CRRT) (P=0.012) and the use of inotropic (P=0.005) and hypotensive drugs (P=0.021). A clinically meaningful SBP drop was seen in 5.37% (141 out of 2,627) of the administrations, and the use of inotropics (odds ratio [OR] 6.70, 95% confidence interval [CI] 3.22-13.92; P<0.001), reducing the dose of inotropics (OR 8.08; 95% CI 1.39-46.94; P=0.02), CRRT (OR 3.10, 95% CI 1.41-6.81; P=0.005), and bacteremia (OR 2.70, 95% CI 1.32-5.51; P=0.007) were risk factors, while age was a protective factor (OR 0.93, 95% CI 0.89-0.97; P<0.001). CONCLUSION: A decrease in SBP was associated with IV administration of itraconazole. It was particularly significant in younger patients with bacteremia using inotropic agents and during application of CRRT. Careful attention to hypotension is warranted during IV administration of itraconazole in this group of patients.

Regeneration of mastoid air cells using polycaprolactone/ß-tricalcium phosphate biocomposites: an experimental study.

OBJECTIVES/HYPOTHESIS: The study aimed to regenerate pneumatic air cells in guinea pig bulla using three-dimenisonal (3D) biocomposite scaffolds consisting of polycaprolactone/ß-tricalcium phosphate (PCL/ß-TCP). STUDY DESIGN: Prospective controlled study in experimental animals. METHODS: PCL/ß-TCP composites were implanted into the bulla with mucosa preservation in group A (n = 10). PCL/ß-TCP composites coated with collagen were implanted in group B (n = 10). After 12 weeks, the bullae were extracted and evaluated by micro-computed tomography (micro-CT) and were processed for histological analyses. RESULTS: In group A, micro-CT showed a well-maintained honeycomb appearance of micropores without obstruction. Regeneration of the mucosa was noted inside the pores of the 3D scaffold. However, partial obstruction of the micropores with new bone formation was evident in group B. CONCLUSIONS: Group A showed more satisfactory mucosal regeneration into the micropores. Our results indicate that the 3D scaffold may be amenable for use during mastoidectomy. Further studies for gas exchange in the regenerated mucosa are necessary.