Analysis of Imaging Results for Semisitting Compared with Supine Positioning in the Retrosigmoid Approach for Resection of Cerebellopontine Angle Vestibular Schwannomas.

OBJECTIVE: To compare the completeness of resection of vestibular schwannomas using three-dimensional segmented volumetric analysis of pre- and postoperative magnetic resonance imaging (MRI) of patients undergoing supine and semisitting positioning for the retrosigmoid approach. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary medical center. PATIENTS: Patients with vestibular schwannomas undergoing surgical resection via the retrosigmoid approach. INTERVENTIONS: Tumor resection via the retrosigmoid approach with different patient positioning: standard supine versus semisitting. MAIN OUTCOME MEASURES: Preoperative versus postoperative three-dimensional segmented volumetric MRI analysis of vestibular schwannomas. RESULTS: A total of 43 patients (15 supine and 28 semisitting) underwent retrosigmoid craniotomy for resection of vestibular schwannomas. For the conventional supine and semisitting positioning, mean preoperative tumor volumes were 12.65 and 8.73 cm 3 ( p = 0.15), respectively. Postoperative mean tumor volumes for the supine and semisitting positions were 2.09 and 0.48 cm 3 ( p = 0.13), respectively. There were 11 cases of postoperative sigmoid sinus thrombosis, 3 in the conventional supine group and 8 in the semisitting groups, and there were 6 cases of postoperative cerebrospinal fluid leaks, all in the semisitting group. The mean House-Brackmann scores for the supine and semisitting groups were 2.9 and 2.3, respectively. There was no statistically significant difference between groups in the rates of these or any other postoperative complications. CONCLUSIONS: The semisitting position for the suboccipital retrosigmoid approach for vestibular schwannoma resection does not compromise the ability to adequately resect the tumor as seen by volumetric MRI results. Further studies are needed to establish the safety of this position compared with the traditional supine approach.

Augmenting Amyloid PET Interpretations With Quantitative Information Improves Consistency of Early Amyloid Detection.

PURPOSE: Establishing reliable methods for interpreting elevated cerebral amyloid-ß plaque on PET scans is increasingly important for radiologists, as availability of PET imaging in clinical practice increases. We examined a 3-step method to detect plaque in cognitively normal older adults, focusing on the additive value of quantitative information during the PET scan interpretation process. METHODS: Fifty-five F-florbetapir PET scans were evaluated by 3 experienced raters. Scans were first visually interpreted as having "elevated" or "nonelevated" plaque burden ("Visual Read"). Images were then processed using a standardized quantitative analysis software (MIMneuro) to generate whole brain and region of interest SUV ratios. This "Quantitative Read" was considered elevated if at least 2 of 6 regions of interest had an SUV ratio of more than 1.1. The final interpretation combined both visual and quantitative data together ("VisQ Read"). Cohen kappa values were assessed as a measure of interpretation agreement. RESULTS: Plaque was elevated in 25.5% to 29.1% of the 165 total Visual Reads. Interrater agreement was strong (kappa = 0.73-0.82) and consistent with reported values. Quantitative Reads were elevated in 45.5% of participants. Final VisQ Reads changed from initial Visual Reads in 16 interpretations (9.7%), with most changing from "nonelevated" Visual Reads to "elevated." These changed interpretations demonstrated lower plaque quantification than those initially read as "elevated" that remained unchanged. Interrater variability improved for VisQ Reads with the addition of quantitative information (kappa = 0.88-0.96). CONCLUSIONS: Inclusion of quantitative information increases consistency of PET scan interpretations for early detection of cerebral amyloid-ß plaque accumulation.

Screw Placement Accuracy and Outcomes Following O-Arm-Navigated Atlantoaxial Fusion: A Feasibility Study.

Study Design Case series of seven patients. Objective C2 stabilization can be challenging due to the complex anatomy of the upper cervical vertebrae. We describe seven cases of C1-C2 fusion using intraoperative navigation to aid in the screw placement at the atlantoaxial (C1-C2) junction. Methods Between 2011 and 2014, seven patients underwent posterior atlantoaxial fusion using intraoperative frameless stereotactic O-arm Surgical Imaging and StealthStation Surgical Navigation System (Medtronic, Inc., Minneapolis, Minnesota, United States). Outcome measures included screw accuracy, neurologic status, radiation dosing, and surgical complications. Results Four patients had fusion at C1-C2 only, and in the remaining three, fixation extended down to C3 due to anatomical considerations for screw placement recognized on intraoperative imaging. Out of 30 screws placed, all demonstrated minimal divergence from desired placement in either C1 lateral mass, C2 pedicle, or C3 lateral mass. No neurovascular compromise was seen following the use of intraoperative guided screw placement. The average radiation dosing due to intraoperative imaging was 39.0 mGy. All patients were followed for a minimum of 12 months. All patients went on to solid fusion. Conclusion C1-C2 fusion using computed tomography-guided navigation is a safe and effective way to treat atlantoaxial instability. Intraoperative neuronavigation allows for high accuracy of screw placement, limits complications by sparing injury to the critical structures in the upper cervical spine, and can help surgeons make intraoperative decisions regarding complex pathology.

Engineering a therapeutic IgG molecule to address cysteinylation, aggregation and enhance thermal stability and expression.

Antibodies can undergo a variety of covalent and non-covalent degradation reactions that have adverse effects on efficacy, safety, manufacture and storage. We had identified an antibody to Angiopoietin 2 (Ang2 mAb) that neutralizes Ang2 binding to its receptor in vitro and inhibits tumor growth in vivo. Despite favorable pharmacological activity, the Ang2 mAb preparations were heterogeneous, aggregated rapidly and were poorly expressed. Here, we report the engineering of the antibody variable and constant domains to generate an antibody with reduced propensity to aggregate, enhanced homogeneity, 11°C elevated T(m), 26-fold improved level of expression and retained activity. The engineered molecule, MEDI-3617, is now compatible with the large scale material supply required for clinical trials and is currently being evaluated in Phase 1 in cancer patients. This is the first report to describe the stability engineering of a therapeutic antibody addressing non canonical cysteine residues and the design strategy reported here is generally applicable to other therapeutic antibodies and proteins.

Stability of helix-rich proteins at high concentrations.

A number of techniques, including circular dichroism, FTIR, front face fluorescence, and UV absorption spectrophotometries, dynamic light scattering, and DSC, were used to directly measure the colloidal and conformational stability of proteins in highly concentrated solutions. Using bovine serum albumin (BSA), chicken egg white lysozyme, human hemoglobin A0, and bovine fibrinogen as model proteins, the thermal transition temperatures of proteins in dilute and concentrated solutions were compared. At 10 degrees C, no significant differences in both secondary and tertiary structures were detected for proteins at different concentrations. When temperature was introduced as a variable, however, hemoglobin and fibrinogen demonstrated higher transition midpoints (T(m)s) in concentrated rather than in dilute solutions (deltaT(m) approximately 2-10 degrees C). In contrast, lysozyme and BSA in concentrated solutions exhibit a lower T(m) than in dilute solutions (deltaT(m) approximately 2-20 degrees C). From these studies, it appears that a variety of factors determine the effect of high concentrations on the colloidal and conformational stability of a particular protein. While the prediction of excluded volume theory is that high concentrations should conformationally stabilize proteins, other factors such as pH, kinetics, protein dynamics, and intermolecular charge-charge effects may affect the overall stability of proteins at high concentrations under certain conditions.

Spectroscopic analysis of highly concentrated suspensions of bovine somatotropin in sesame oil.

Spectroscopy was employed to analyze the structural and thermal stability of highly concentrated oil suspensions of bovine somatotropin (bST). These methods were then compared with more dilute aqueous solutions (1 and 10 mg/mL). All oil suspensions were opaque, viscous, and highly concentrated in bST (>300 mg/mL) and thus provided unique analytical challenges. Using front surface fluorescence and ATR-FTIR spectroscopy, protein structure and stability could be directly monitored in this environment. Differences were detected in structure between concentrated oil and dilute aqueous formulations. Fluorescence spectroscopy found that bST was highly thermally stabile within oil suspensions, since minimal changes in emission peak maxima and emission intensity were observed with increasing temperature when compared to dilute solutions. It was also observed that the amount of aggregate in a sample had some effect on the fluorescence spectra. As the amount of aggregated protein increased, the emission peak maximum and emission intensity changed. Employing ATR-FTIR, the secondary structure was examined with increasing temperature. The secondary structure of bST was also found to be very thermally stabile since no change in relative amount of helix/random structure is observed up to 70 degrees C while significant losses are observed in aqueous solution. This study demonstrates that conformational stability can be directly analyzed within highly concentrated, opaque environments using slight modifications of conventional methods.