Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Bioresour Technol ; 319: 124124, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32977090

RESUMO

Lactic acid (LA), a versatile platform molecule, can be fermented from organic wastes, such as food waste and waste activated sludge. In this study, an efficient approach using salt, a component of food waste as an additive, was proposed to increase LA production. The LA productivity was increased at 10 g NaCl/L and optical pure L-lactate was obtained at 30 g NaCl/L. The enhancement of LA was in accordance with the increased solubilization and the critical hydrolase activities under saline conditions. Moreover, high salinity (30-50 g NaCl/L) changed the common conversion of LA to volatile fatty acids. In addition, the key LA bacteria genera (Bacillus, Enterococcus, Lactobacillus) were selectively enriched under saline conditions. Strong correlations between salinity and functional genes for L-LA production were also observed. This study provides a practical way for the enrichment of L-LA with high optical activity from organic wastes.


Assuntos
Microbiota , Eliminação de Resíduos , Ácidos Graxos Voláteis , Fermentação , Alimentos , Ácido Láctico , Salinidade , Esgotos
2.
Drug Discov Today ; 25(12): 2080-2088, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33017690

RESUMO

The research and development (R&D) of new drugs indicates scientific progress and economic development. However, little is known regarding ongoing or recent clinical trials in China. We analyzed data from clinical trials published before December 31, 2019, and found that the annual registration numbers are increasing annually in the country. Based on clinical indications, most tested drugs target cancers, nervous system, infections, and the cardiovascular system. Furthermore, clinical trials are mostly concentrated in Beijing, Shanghai, and Jiangsu, and conducted by large pharmaceutical companies, with multiple trials for several generic drugs. Going forward, it will be necessary to promote R&D in China of clinically relevant innovative drugs, drug delivery systems, and novel traditional Chinese medicine (TCM) and biological products, as well as to have a balanced distribution of clinical trials to sustainably meet public health needs.

3.
World Neurosurg ; 134: e874-e877, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31733384

RESUMO

OBJECTIVES: To assess the effectiveness of a clinical decision support tool consisting of an electronic medical record best practice alert (BPA) on the frequency of lumbar imaging in patients with acute low back pain in the ambulatory care setting, and to explore why providers order imaging outside of clinical guidelines. METHODS: On March 23, 2016, we implemented a BPA pop-up alert that informed the ordering physician of the Choosing Wisely recommendation to not order imaging within the first 6 weeks of low back pain in the absence of red flags. We calculated imaging rates 1 year before and after implementation of the BPA. To override the BPA, providers could ignore the alert or explain their rationale for ordering imaging using either preset options or a free-text submission. We tracked preset options and manually reviewed 125 free-text submissions. RESULTS: Significant decreases in both total imaging rate (9.6% decrease; P = 0.02) and magnetic resonance imaging rate (14.9% decrease; P < 0.01) were observed after implementation of the BPA. No change was found in the rates of X-ray or computed tomography scan orders. Almost two-thirds (64%) of the providers used preset options in overriding the BPA, and 36% of the providers entered a free-text submission. Among those providers using a free-text submission, 56% entered a non-guideline-supported rationale. CONCLUSIONS: The present study demonstrates the effectiveness of a simple, low-cost clinical decision support tool in reducing imaging rates for patients with acute low back pain. We also identify reasons why providers order imaging outside of clinical guidelines.


Assuntos
Dor Aguda/diagnóstico por imagem , Sistemas de Apoio a Decisões Clínicas , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Assistência Ambulatorial , Registros Eletrônicos de Saúde , Feminino , Fidelidade a Diretrizes , Humanos , Imagem por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Radiografia/economia , Radiografia/estatística & dados numéricos , Tomografia Computadorizada por Raios X/economia , Adulto Jovem
5.
World Neurosurg ; 128: 477-500, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048059

RESUMO

With the increasing interest in big data and health services research, use of administrative databases is becoming commonplace in health care studies, including in neurosurgery. Administrative data offer the unique advantage of accessing large amounts of information previously collected from a population-based sample with geographic diversity. When using administrative data sets, researchers can benefit from application of risk adjustment instruments, which help stratify patients and tailor the original sample for specific research questions. The Charlson Comorbidity Index and Elixhauser Comorbidity Index are 2 of the most common indices. The Pediatric Medical Complexity Algorithm and Clinical Classification Software are other promising tools. Understanding of these tools may assist neurosurgeons who wish to critically assess research findings relevant to their clinical practice. In this review, an overview is presented of risk adjustment tools commonly used in adult as well as pediatric populations and their history, uses, limitations, and applications in neurosurgical research are summarized.


Assuntos
Pesquisa sobre Serviços de Saúde , Neurocirurgia , Risco Ajustado/métodos , Bases de Dados Factuais , Conjuntos de Dados como Assunto , Humanos , Neurocirurgiões
6.
Clin Spine Surg ; 32(4): E188-E192, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30969193

RESUMO

STUDY DESIGN: Retrospective survey review. OBJECTIVE: We seek to evaluate satisfaction scores in patients seen in neurosurgical spine versus neurosurgical nonspine clinics. SUMMARY OF BACKGROUND DATA: The Press Ganey survey is a well-established metric for measuring hospital performance and patient satisfaction. These measures have important implications in setting hospital policy and guiding interventions to improve patient perceptions of care. METHODS: Retrospective Press Ganey survey review was performed to identify patient demographics and patient visit characteristics from January 1st, 2012 to October 10th, 2017 at Stanford Medical Center. A total of 40 questions from the Press Ganey survey were investigated and grouped in categories addressing physician and nursing care, personal concerns, admission, room, meal, operating room, treatment and discharge conditions, visitor accommodations and overall clinic assessment. Raw ordinal scores were converted to continuous scores of 100 for unpaired student t test analysis. We identified 578 neurosurgical spine clinic patients and 1048 neurosurgical nonspine clinic patients. RESULTS: Spine clinic patients reported lower satisfaction scores in aggregate (88.2 vs. 90.1; P=0.0014), physician (89.5 vs. 92.6; P=0.0002) and nurse care (91.3 vs. 93.4; P=0.0038), personal concerns (88.2 vs. 90.9; P=0.0009), room (81.0 vs. 83.1; P=0.0164), admission (90.8 vs. 92.6; P=0.0154) and visitor conditions (87.0 vs. 89.2; P=0.0148), and overall clinic assessment (92.9 vs. 95.5; P=0.005). CONCLUSIONS: This study is the first to evaluate the relationship between neurosurgical spine versus nonspine clinic with regards to patient satisfaction. The spine clinic cohort reported less satisfaction than the nonspine cohort in all significant questions on the Press Ganey survey. Our findings suggest that efforts should be made to further study and improve patient satisfaction in spine clinics. LEVEL OF EVIDENCE: Level III.


Assuntos
Neurocirurgia , Satisfação do Paciente , Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Curr Med Sci ; 39(2): 222-227, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31016514

RESUMO

This study evaluated the significance of serum D-Dimer for predicting survival of patients with diffuse large B-cell lymphoma (DLBCL). We analyzed the clinical data from 113 patients who were newly diagnosed with DLBCL at Tongji Hospital from January 2012 to January 2016. The results indicated that there were higher levels of D-Dimer in DLBCL patients with the following characteristics: stage III/IV, lymphocyte monocyte ratio (LMR) <2.27, lactate dehydrogenase (LDH) > upper limit of normal (ULN), albumin (ALB) < 35 g/L, and anemia. After the first chemotherapeutic regimen, D-Dimer was significantly decreased concomitantly with LDH. Cox univariate regression analysis showed that the overall survival (OS) was negatively affected by the following factors: age > 60 years, stage III/W, LDH > ULN, LMR < 2.27, anemia and D-Dimer > 0.92. Multivariate analysis showed that only LDH > ULN (P=0.038) and age > 60 years (P=0.047) were independent adverse prognostic factors. However, it was suggested that D-Dimer could be regarded as a marker of high tumor burden and a potential prognostic screening tool for patients with DLBCL, not otherwise specified (NOS).


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Linfoma Difuso de Grandes Células B/metabolismo , Linfoma Difuso de Grandes Células B/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Feminino , Humanos , Linfócitos/metabolismo , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Monócitos/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
8.
9.
Nanoscale ; 11(3): 1351-1359, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30604822

RESUMO

Field emission electron beam (EB) pumped AlGaN-based semiconductors are considered to be a potentially promising way to overcome the technical bottlenecks that restrict the development of AlGaN-based UV luminescence devices and realize efficient UV light sources. However, the required field emission electron sources based on nanomaterials are still inefficient due to their low field emission current density. Herein, a type of UV-light-assisted self-positive-feedback enhanced field emission electron source is proposed to develop a high-efficiency electron source which is promising for application in EB pumped AlGaN-based UV light sources that can also be generalized to deep UV (DUV) luminescence devices. The UV-light-assisted field emission source is composed of an n-GaN metal-semiconductor-metal (MSM) structure photodetector assembled with 1D ZnO nanorods by a self-assembled hydrothermal growth method, which simultaneously possesses attributes of the photoelectric effect and electron emission. The optical, photoelectric, and field emission properties are investigated in detail. The results show that the 1D ZnO nanorods/n-GaN heterostructure photodetector presents an obvious photoconductive effect. It has a peak spectral responsivity of 0.793 A W-1 at a bias voltage of 1.3 V, corresponding to an EQE higher than 267.8%, with an internal photoconductive gain reaching up to 2.51 × 103. As to the field emission properties, its turn-on electric field can be greatly reduced from 3.6 V µm-1 in the dark to 1.36 V µm-1 under UV illumination, and the field emission current density increases from lower than 3 mA cm-2 to as high as 8 mA cm-2 at an electric field of 4.5 V µm-1. The mechanism involved can be attributed to an increase of electron concentration in both the conduction bands and an increase of conduction band bending under UV illumination that reduces the effective potential barrier height of the ZnO nanorods. Through this research, an efficient field emission electron source with a self-enhancing effect is developed by combining the photoelectric effect with the electron emission process.

10.
J Clin Neurosci ; 61: 106-111, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30420203

RESUMO

Cortical bone trajectory (CBT) is a novel pedicle insertion technique with comparable or superior mechanical properties and reduced invasiveness compared to traditional methods. We describe the screw accuracy, complications, and learning curve associated with CBT use. A prospective cohort study was performed involving 22 patients who underwent lumbar fusion with CBT screw placement. A total of 100 cortical screws were placed. Post-operative CT scans were reviewed to assess the adequacy of screw placement and calculate the incidence of vertebral body and pedicle breaches from cortical screw placement. Technique-related complications were examined. The entire surgical cohort was divided into two groups: early experience (first 11 patients) and late experience (last 11 patients), to study the effect of learning curve on CBT screw placement. Medial pedicle breach was observed in 6/100 cases and lateral vertebral body breach was observed in 1/100 cases. The incidence of durotomy related to the technique was 4.5% (N = 1/22). Post-surgical wound infection was seen in 9.1% of patients (N = 2/22). 66.7% (N = 4/6) of medial pedicle breaches, 100% (N = 1/1) of lateral breaches, 100% (N = 1/1) of CBT technique-related CSF leaks, and 100% (N = 2/2) of wound infections occurred in the early experience phase of our study (p = 0.0945). A shift in surgical technique and greater efficiency over time decreased the incidence of overall complications in the late cohort. The difference, however, did not reach statistical significance. A lateralized starting point for the cortical screw on the pars interarticularis and use of smaller diameter screws resulted in fewer medial pedicle out-fractures and breaches.


Assuntos
Osso Cortical/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Parafusos Pediculares/efeitos adversos , Fusão Vertebral/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Osso Cortical/diagnóstico por imagem , Feminino , Humanos , Curva de Aprendizado , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Fusão Vertebral/efeitos adversos , Tomografia Computadorizada por Raios X
11.
Cureus ; 10(10): e3462, 2018 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-30564541

RESUMO

Background Pedicle screw fixation is currently the mainstay technique for lumbar spinal fusion; however, more minimally invasive techniques are available such as cortical screw fixation. Numerous studies have proven biomechanical equivalence or superiority for cortical screws but few studies have examined clinical outcomes in patients. Our study aims to examine functional outcomes, as well as fusion rates, in patients who underwent pedicle screw fixation using a cortical trajectory. Methods We retrospectively reviewed prospectively collected functional outcomes data on 10 patients with a degenerative lumbar disease who underwent cortical screw placement by the senior author. Oswestry Disability Index (ODI) and Roland Morris (RM) scoring were calculated preoperatively, at six to 12 weeks and at six to eight months. The Kruskal-Wallis test and Dunn's multiple comparison were used to analyze differences in scores over time. Results We found that over time, cortical screw fixation resulted in a mean decrease of 27 from the baseline ODI at six to eight months (p = 0.014). Additionally, six out of seven (86%) patients who had at least 12 months of radiographic follow-up showed fusion. Conclusions Cortical screw fixation showed a decrease of 27 from the baseline ODI at six to eight months, which is comparable to changes from the baseline ODI reported in three, recent, large clinical trials examining functional outcomes following traditional pedicle screw fixation.

12.
World Neurosurg ; 120: 240-243, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30193964

RESUMO

BACKGROUND: Anterior cervical osteophytes (ACOs) are a common radiologic finding in the elderly; rarely, they can cause dysphagia, dysphonia, and dyspnea. Symptomatic ACOs are most commonly found between C4 and C7 and much less commonly at higher cervical levels. Here, we present a case series, with an example case of a 57-year-old woman with high cervical osteophytes at C1-C2 causing globus sensation, dysphagia, and dysphonia. Additionally, we provide a literature review regarding the causes, diagnosis, and treatment of ACOs, with a focus on management of high ACOs. CASE DESCRIPTION: A 57-year-old smoker with a history of chronic neck pain and previous cervical spinal instrumentation presented with several months of globus sensation, dysphagia, and dysphonia. Imaging revealed 2 large anterior osteophytes at C1-C2. She underwent endoscopic transoral osteophytectomy, with resolution of symptoms. Five other patients are also presented who underwent similar procedures. CONCLUSIONS: ACOs are a potential cause of dysphagia, and their diagnosis is best made with computed tomographic imaging and oropharyngeal swallow study. Although high ACOs at C1-C2 are a rare finding, here we show with an exemplary case and small case series that they can be effectively treated with transoral endoscopic osteophytectomy.


Assuntos
Vértebras Cervicais/cirurgia , Endoscopia/métodos , Osteofitose Vertebral/diagnóstico por imagem , Osteofitose Vertebral/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Feminino , Seguimentos , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Orofaringe/diagnóstico por imagem , Orofaringe/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Fusão Vertebral , Tomografia Computadorizada por Raios X
13.
World Neurosurg ; 113: e179-e189, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29427817

RESUMO

BACKGROUND: Despite multimodal therapies extending patient survival, glioblastoma (GBM) recurrence is all but a certainty. To date, there are few single-center studies of reoperations. Our study aimed to assess GBM reoperation trends nationally in older patients, with emphasis on outcomes. METHODS: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was searched to identify patients 66 years and older with GBM from 1997 to 2010. The primary outcome was survival after diagnosis. Kaplan-Meier curves and multivariate analysis with proportional hazard ratios were used. RESULTS: Three thousand nine hundred sixty-three patients with recurrent GBM who initially received a surgical resection were identified (mean age = 74.7 years). Four hundred ninety-six (12%) of the patients with recurrent GBM underwent at least one reoperation at an average of 7.2 months after the initial diagnosis. Reoperation increased survival in patients compared with those who did not have surgical resection (12 vs. 5 months; P < 0.0001; hazard ratio [HR] = 0.666). Within the reoperated cohort, gross total resection improved median survival over subtotal resection (HR = 0.779). Two or more reoperations upon GBM recurrence improved survival to 17 months (P = 0.002). The overall complication rate was 21.7% in the initial resection-only group, versus 20.4% in the 1-reoperation group and 25.3% in the 2-reoperation group. CONCLUSIONS: Although definitive conclusions cannot be made given the lack of granularity, our national database study supports gross total resection as the initial treatment of choice, followed by reoperation at the time of recurrence, if tolerated, even in older patients.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Procedimentos Neurocirúrgicos/tendências , Reoperação/tendências , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/terapia , Terapia Combinada , Feminino , Glioblastoma/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Programa de SEER , Estados Unidos
14.
Am J Ophthalmol Case Rep ; 7: 115-119, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29260093

RESUMO

Purpose: Superior oblique myokymia (SOM) is a rare eye movement disorder characterized by unilateral oscillopsia and binocular diplopia. Our study aimed to better understand SOM using infrared oculography. Methods: We examined and recorded five patients with SOM. Results: Binocular infrared oculography showed that in primary gaze, all patients exhibited torsional oscillations, which worsened in infraduction and abduction and improved in supraduction and adduction. Saccades showed increased downward saccade amplitudes but normal peak velocities. During fixation in primary gaze, removal of target led to extorsion and supraduction, unmasking underlying superior oblique weakness. Conclusions and importance: Our data suggest both weakness and activity-dependent hyperactivity of the trochlear motor unit, supporting a model of injury followed by aberrant regeneration.

15.
Cureus ; 9(2): e1059, 2017 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-28465867

RESUMO

In recent years, antipsychotic medications have increasingly been used in pediatric and geriatric populations, despite the fact that many of these drugs were approved based on clinical trials in adult patients only. Preliminary studies have shown that the "off-label" use of these drugs in pediatric and geriatric populations may result in adverse events not found in adults. In this study, we utilized the large-scale U.S. Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) database to look at differences in adverse events from antipsychotics among adult, pediatric, and geriatric populations. We performed a systematic analysis of the FDA AERS database using MySQL by standardizing the database using structured terminologies and ontologies. We compared adverse event profiles of atypical versus typical antipsychotic medications among adult (18-65), pediatric (age < 18), and geriatric (> 65) populations. We found statistically significant differences between the number of adverse events in the pediatric versus adult populations with aripiprazole, clozapine, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and thiothixene, and between the geriatric versus adult populations with aripiprazole, chlorpromazine, clozapine, fluphenazine, haloperidol, paliperidone, promazine, risperidone, thiothixene, and ziprasidone (p < 0.05, with adjustment for multiple comparisons). Furthermore, the particular types of adverse events reported also varied significantly between each population for aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (Chi-square, p < 10-6). Diabetes was the most commonly reported side effect in the adult population, compared to behavioral problems in the pediatric population and neurologic symptoms in the geriatric population. We also found discrepancies between the frequencies of reports in AERS and in the literature. Our analysis of the FDA AERS database shows that there are significant differences in both the numbers and types of adverse events among these age groups and between atypical and typical antipsychotics. It is important for clinicians to be mindful of these differences when prescribing antipsychotics, especially when prescribing medications off-label.

16.
Rev Sci Instrum ; 88(1): 015111, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28147640

RESUMO

We present an in situ Radiated Materials (iRadMat) experimental module designed to interface with a servo-hydraulic load frame for X-ray measurements at beamline 1-ID at the Advanced Photon Source. This new capability allows in situ studies of radioactive specimens subject to thermo-mechanical loading using a suite of high-energy X-ray scattering and imaging techniques. The iRadMat is a radiation-shielded vacuum heating system with the sample rotation-under-load capability. We describe the design features and performances of the iRadMat and present a dataset from a 300 °C uniaxial tensile test of a neutron-irradiated pure Fe specimen to demonstrate its capabilities.

17.
Neurosurg Focus ; 42(1): E13, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28041316

RESUMO

OBJECTIVE Symptomatic vertebral hemangiomas (SVHs) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given the relative rarity and difficulty in assessment, the authors sought to present a dedicated series of SVHs treated using stereotactic radiosurgery (SRS) to provide insight into clinical decision making. METHODS A retrospective review of a single institution's experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. The authors report and analyze the treatment course of 5 patients with 7 lesions, 2 of which were treated primarily by SRS. RESULTS Of the 5 patients studied, 4 presented with a chief complaint of pain refractory to conservative measures. Three patients reported dysesthesias, and 2 reported upper-extremity weakness. Following radiosurgery, 4 of 5 patients exhibited improvement in their primary symptoms (3 for pain and 1 for weakness), achieving a clinical response after a mean period of 1 year. In 2 cases there was 20%-40% reduction in lesion size in the most responsive dimension as noted on images. All treatments were well tolerated. CONCLUSIONS SRS for SVH is a safe and feasible treatment strategy, comparable to prior radiotherapy studies, and in select cases may successfully confer delayed decompressive effects. Additional investigation will determine future patient selection and how conformal SRS treatment can best be administered.


Assuntos
Hemangioma/cirurgia , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Hemangioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
18.
J Neurosurg ; 127(4): 807-811, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27935360

RESUMO

OBJECTIVE Glioblastoma is a primary glial neoplasm with a median survival of approximately 1 year. There are anecdotal reports that postoperative infection may confer a survival advantage in patients with glioblastoma. However, only a few case reports in the literature, along with 2 retrospective cohort studies, show some potential link between infection and prolonged survival in patients with glioblastoma. The objective of this study was to evaluate the effect of postoperative infection in patients with glioblastoma using a large national database. METHODS The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was searched to identify patients 66 years of age and older with glioblastoma, with and without infection, from 1997 to 2010. The primary outcome was survival after diagnosis. The statistical analysis was performed with a graphical representation using Kaplan-Meier curves, univariate analysis with the log-rank test, and multivariate analysis with proportional hazards modeling. RESULTS A total of 3784 patients with glioblastoma were identified from the database, and from these, 369 (9.8%) had postoperative infection within 1 month of surgery. In patients with glioblastoma who had an infection within 1 month of surgery, there was no significant difference in survival (median 5 months) compared with patients with no infection (median 6 months; p = 0.17). The study also showed that older age, increased Gagne comorbidity score, and having diabetes may be negatively associated with survival. CONCLUSIONS Infection after craniotomy within 1 month was not associated with a survival benefit in patients with glioblastoma.


Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/cirurgia , Glioblastoma/mortalidade , Glioblastoma/cirurgia , Infecções/mortalidade , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Taxa de Sobrevida
19.
Cureus ; 8(11): e888, 2016 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-28018758

RESUMO

Traumatic injury to an adjacent segment of a previously fused spine is a rare complication of scoliosis surgery. The adjacent spinal segments may be more vulnerable to traumatic fracture or dislocation due to increased strain. We present a patient with prior C2 to sacrum fusion who suffered a C2 fracture/dislocation after falling. A 52-year-old female with a previous C2 to the sacrum fusion for idiopathic scoliosis presented with severe and progressively worsening neck pain after multiple falls. Imaging showed anterior displacement of the C2 vertebral body, fracture of C2, and anterior subluxation of the C1-2 complex on C3. The patient underwent posterior occiput to cervical fusion and reduction of the C1-C2 complex. Our case describes a potential complication of long-segment fusion. Adjacent segments may be more prone to fracture-dislocation because of increased intradiscal pressure and strain. Clinicians should have a high suspicion of fractures in patients with prior spinal fusions in the setting of trauma.

20.
Cureus ; 8(7): e714, 2016 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-27610286

RESUMO

OBJECTIVE: Our study aims to evaluate the clinical outcomes of cortical screws in regards to postoperative pain. BACKGROUND: Pedicle screw fixation is the current mainstay technique for posterior spinal fusion. Over the past decade, a new technique called cortical screw fixation has been developed, which allows for medialized screw placement through stronger cortical bone. There have been several studies that showed either biomechanical equivalence or superiority of cortical screws. However, there is currently only a single study in the literature looking at clinical outcomes of cortical screw fixation in patients who have had no prior spine surgery. METHODS: We prospectively looked at the senior author's patients who underwent cortical versus pedicle lumbar screw fixation surgeries between 2013 and 2015 for lumbar degenerative disease. Eighteen patients underwent cortical screw fixation, and 15 patients underwent traditional pedicle screw fixation. We looked at immediate postoperative pain, changes in short-term pain (six to 12 weeks post-surgery), and changes in long-term pain (six to eight months). All pain outcomes were measured using a visual analog scale ranging from 1 to 10. Mann-Whitney or Kruskal-Wallis tests were used to measure continuous data, and the Fisher Exact test was used to measure categorical data as appropriate. RESULTS: Our results showed that the cortical screw cohort showed a trend towards having less peak postoperative pain (p = 0.09). The average postoperative pain was similar between the two cohorts (p = 0.93). There was also no difference in pain six to 12 weeks after surgery (p = 0.8). However, at six to eight months, the cortical screw cohort had worse pain compared to the pedicle screw cohort (p = 0.02). CONCLUSIONS: The cortical screw patients showed a trend towards less peak pain in the short-term (one to three days post-surgery) and more pain in the long-term (six to eight months post-surgery) compared to pedicle screw patients. Both cohorts had a statistically significant reduction in pain levels compared to preoperative pain. More studies are needed to further evaluate postoperative pain, long-term functional outcomes, and fusion rates in patients who undergo cortical screw fixation.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA