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1.
Neuropathology ; 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34791710

RESUMO

Here, we report two cases showing tumor-like white matter lesions; one case was diagnosed as having inflammatory disease, and the other was diagnosed as having astrocytoma. Their outcomes were completely distinct despite similar pathology. Prior to biopsy, perfusion computed tomography (CT) and magnetic resonance imaging (MRI) were conducted. The two mass-forming lesions were distinct in edema level and vascularity patterns on CT and MRI. However, pathological examination of brain biopsy specimens revealed commonalities, including (1) proliferation of glial cells, (2) perivascular lymphocytic infiltration, and (3) appearance of numerous macrophages. Although atypical astrocytes proliferated in both cases, nuclear atypia was more distinct in case 2 than in case 1. The immunohistochemical results were the same for both cases: isocitrate dehydrogenase 1 (IDH1) R132H mutation was negative, and alpha thalassaemia mental retardation X-linked (ATRX) was retained. Faint immunoreactivity for p53 was observed in a few glial cells, and Ki-67 immunoreactive cells were markedly reduced in numbers (< 1%). Inflammatory reactions were evident in both cases: T cells dominantly infiltrated over B cells in the perivascular area in case 1, whereas both T and B cells infiltrated in case 2. Molecular analysis revealed wild-type IDH1 and IDH2 in both cases. However, a telomerase reverse transcriptase (TERT) sequence mutation was detected in case 2 but not in case 1. Eventually, case 1 was diagnosed as having inflammatory lesions, whereas case 2 was diagnosed as having diffuse astrocytoma associated with inflammatory reactions. The prognosis was favorable for case 1, whereas case 2 died 10 months following biopsy. These data indicated the diagnostic value of molecular analysis, for example, a TERT mutation, in association with the radiological findings. Although in case 2, histopathological evidence did not suggest high-grade glioma, the case met the new diagnostic criteria: "diffuse astrocytic glioma, IDH wild-type, with molecular features of glioblastoma, World Health Organization (WHO) grade IV," according to cIMPACT-NOW, update 3. Thus, interdisciplinary approaches are essential for accurate diagnosis of newly categorized white matter diseases.

2.
J Clin Med ; 10(21)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34768547

RESUMO

Postoperative neck pain has been reported as an unsolved postoperative complication of surgery for cervical ossification of the posterior longitudinal ligament (OPLL). The aim of the present study was to elucidate factors having a significant association with postoperative deterioration of neck pain in cervical OPLL patients. We studied a cohort of patients in a prospective registry of 478 patients who had undergone cervical spine surgery for cervical OPLL. We excluded those without evaluation of preoperative neck pain. Therefore, 438 patients were included in the present study. Neck pain was evaluated with the visual analogue scale (VAS, 0-100 mm). Postoperative neck pain deterioration was defined as a ≥20 mm increase of VAS neck pain. Patient factors, neurological status, imaging factors and surgical factors were assessed. Univariate analyses followed by multivariate analysis using stepwise logistic regression was performed. Six months after surgery, 50 (11.6%) patients showed postoperative neck pain deterioration and 76 (17.4%) patients showed postoperative neck pain deterioration 2 years after surgery. Six months after surgery, the rate of neck pain deterioration was significantly higher in patients who had undergone posterior surgery. Two years after surgery, the number of levels fused was significantly correlated with neck pain deterioration.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34610608

RESUMO

STUDY DESIGN: A prospective, multicenter study. OBJECTIVE: To evaluate the usefulness of transcranial motor-evoked potentials (Tc-MEPs) during supine-to-prone position change for thoracic ossification of the posterior longitudinal ligament (T-OPLL). SUMMARY OF BACKGROUND DATA: Supine-to-prone position change might be a risk of spinal cord injury in posterior decompression and fusion surgeries for T-OPLL. METHODS: The subjects were 145 patients with T-OPLL surgically treated with posterior decompression and fusion using Tc-MEPs in 14 institutes. Tc-MEPs were monitored before surgery from supine-to-prone position and intraoperatively in 7 institutes and only intraoperatively in the other 7 institutes because of disapproval of the anesthesia department. In cases of Tc-MEP alert after position change, we adjusted the cervicothoracic posture. When the MEP did not recover, we reverted the position to supine and monitored the Tc-MEPs in supine position. RESULTS: There were 83 and 62 patients with/without Tc-MEP before position change to prone (group A and B). The true-positive rate was lower in group A than group B, but without statistical significance (8.4% vs 16.1%, p = 0.12). In group A, 5 patients who had Tc-MEP alert during supine-to-prone position change were all female and had larger body mass index values and upper thoracic lesions. Among the patients, 3 underwent surgeries after cervicothoracic alignment adjustment, and 2 had postponed operations to 1 week later with halo-vest fixation because of repeated Tc-MEP alerts during position change to prone. The Tc-MEP alert at exposure was statistically more frequent in group B than in group A (p = 0.033). CONCLUSION: Tc-MEP alert during position change is an important sign of spinal cord injury due to alignment change at the upper thoracic spine. Tc-MEP monitoring before supine-to-prone position change was necessary to prevent spinal cord injury in surgeries for T-OPLL.Level of Evidence: 4.

4.
Spine (Phila Pa 1976) ; 46(22): E1211-E1219, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34714796

RESUMO

STUDY DESIGN: Prospective multicenter study. OBJECTIVE: The purpose of the study is to examine cases with poor baseline waveform derivation for all muscles in multichannel monitoring of transcranial motor-evoked potentials (Tc-MEPs) in spine surgery. SUMMARY OF BACKGROUND DATA: Intraoperative neuromonitoring (IONM) is useful for identifying neurologic deterioration during spinal surgery. Tc-MEPs are widely used for IONM, but some cases have poor waveform derivation, even in multichannel Tc-MEP monitoring. METHODS: The subjects were 3625 patients (mean age 60.1 years, range 4-95; 1886 females, 1739 males) who underwent Tc-MEP monitoring during spinal surgery at 16 spine centers between April 2017 and March 2020. Baseline Tc-MEPs were recorded from the deltoid, abductor pollicis brevis, adductor longus, quadriceps femoris, hamstrings, tibialis anterior, gastrocnemius, and abductor hallucis (AH) muscles after surgical exposure of the spine. RESULTS: The 3625 cases included cervical, thoracic, and lumbar lesions (50%, 33% and 17%, respectively) and had preoperative motor status of no motor deficit, and motor deficit with manual muscle testing (MMT) ≥3 and MMT <3 (70%, 24% and 6%, respectively). High-risk surgery was performed in 1540 cases (43%). There were 73 cases with poor baseline waveform derivation (2%), and this was significantly associated with higher body weight, body mass index, thoracic lesions, motor deficit of MMT <3, high-risk surgery (42/1540 [2.7%] vs. 31/2085 [1.5%], P < 0.05), and surgery for ossification of the posterior longitudinal ligament (OPLL). Intraoperative waveform derivation occurred in 25 poor derivation cases (34%) and the AH had the highest rate. CONCLUSION: The rate of poor baseline waveform derivation in spine surgery was 2% in our series. This was significantly more likely in high-risk surgery for thoracic lesions and OPLL, and in cases with preoperative severe motor deficit. In such cases, it may be preferable to use multiple modalities for IONM to derive multichannel waveforms from distal limb muscles, including the AH.Level of Evidence: 3.


Assuntos
Monitorização Neurofisiológica Intraoperatória , Ossificação do Ligamento Longitudinal Posterior , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Potencial Evocado Motor , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-34474444

RESUMO

STUDY DESIGN: Prospective multicenter study. OBJECTIVE: To examine transcranial motor evoked potential (Tc-MEP) waveforms in intraoperative neurophysiological monitoring (IONM) in surgery for intradural extramedullary (IDEM) tumors, focused on the characteristics for cervical, thoracic and conus lesions. SUMMARY OF BACKGROUND DATA: IDEM tumors are normally curable after resection, but neurological deterioration may occur after surgery. IONM using Tc-MEPs during surgery is important for timely detection of possible neurological injury. METHODS: The subjects were 233 patients with IDEM tumors treated surgically with Tc-MEP monitoring at 9 centers. The alarm threshold was ≥70% waveform deterioration from baseline. A case with a Tc-MEP alert that normalized and had no new motor deficits postoperatively was defined as a rescue case. A deterioration of manual muscle test (MMT) score ≥1 compared to the preoperative value was defined as postoperative worsening of motor status. RESULTS: The 233 patients (92 males, 39%) had a mean age of 58.1 ±â€Š18.1 years, and 185 (79%), 46 (20%) and 2 (1%) had schwannoma, meningioma, and neurofibroma. These lesions had cervical (C1-7), thoracic (Th1-10), and conus (Th11-L2) locations in 82 (35%), 96 (41%) and 55 (24%) cases. There were no significant differences in preoperative motor deficit among the lesion levels. Thoracic lesions had a significantly higher rate of poor baseline waveform derivation (0% cervical, 6% thoracic, 0% conus, p < 0.05) and significantly more frequent intraoperative alarms (20%, 31%, 15%, p < 0.05). Use of Tc-MEPs for predicting neurological deficits after IDEM surgery had sensitivity of 87% and specificity of 89%; however, the positive predictive value was low. CONCLUSION: Poor derivation of waveforms, appearance of alarms, and worse final waveforms were all significantly more frequent for thoracic lesions. Thus, amplification of the waveform amplitude, using multimodal monitoring, and more appropriate interventions after an alarm may be particularly important in surgery for thoracic IDEM tumors.Level of Evidence: 3.

6.
Spine (Phila Pa 1976) ; 46(20): E1069-E1076, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34559750

RESUMO

STUDY DESIGN: Prospective multicenter cohort study. OBJECTIVE: The aim of this study was to validate an alarm point of intraoperative neurophysiological monitoring () formulated by the Monitoring Working Group (WG) of the Japanese Society for Spine Surgery and Related Research (JSSR). SUMMARY OF BACKGROUND DATA: The Monitoring WG of the JSSR formulated an alarm point of IONM using transcranial electrical stimulation-muscle motor evoked potentials (Tc(E)-MEPs) and has conducted a prospective multicenter study. The validity of the JSSR alarm point of ≥ 70% decreased in Tc(E)-MEPs for each high-risk surgery and any other spine surgeries has not been verified. METHODS: Patients who underwent spine and spinal cord surgery with IONM in 16 Japanese spine centers in the Monitoring WG of the JSSR from 2017 to 2018 were enrolled. The patients were divided into the high-risk surgery group (Group HR) and the common surgery group (Group C). Group HR was defined by ossification of the posterior longitudinal ligament (OPLL), spinal deformity, and spinal cord tumor. Group C was classified as other spine surgeries. The alarm point was defined as a ≥70% decrease in the Tc(E)-MEPs. RESULTS: In Group HR, the sensitivity and specificity were 94.4% and 87.0%, respectively. In Group C, the sensitivity and specificity were 63.6% and 91.9%. The sensitivity in Group C was statistically lower than that in Group HR (P < 0.05). In Group HR, the sensitivity and specificity in OPLL were 100% and 86.9%, respectively. The sensitivity and specificity in spinal deformity were 87.5% and 84.8%, respectively, and the sensitivity and specificity in spinal cord tumors were 92.9% and 89.9%, respectively. The sensitivity and specificity in each high-risk surgery showed no significant difference. CONCLUSION: The alarm point of IONM by the Monitoring WG of the JSSR appeared to be valid for each disease in Group HR. Meanwhile, applying the JSSR alarm point for Group C potentially needed attention.Level of Evidence: 3.


Assuntos
Monitorização Neurofisiológica Intraoperatória , Estudos de Coortes , Potencial Evocado Motor , Humanos , Japão , Estudos Prospectivos , Medula Espinal
7.
Mol Pharm ; 18(11): 4058-4066, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34579528

RESUMO

To overcome a lack of selectivity during the chemical modification of native non-engineered antibodies, we have developed a technology platform termed "AJICAP" for the site-specific chemical conjugation of antibodies through the use of a class of IgG Fc-affinity reagents. To date, a limited number of antibody-drug conjugates (ADCs) have been synthesized via this approach, and no toxicological study was reported. Herein, we describe the compatibility and robustness of AJICAP technology, which enabled the synthesis of a wide variety of ADCs. A stability assessment of a thiol-modified antibody synthesized by AJICAP technology indicated no appreciable increase in aggregation or decomposition upon prolonged storage, indicating that the unexpectedly stable thiol intermediate has a great potential intermediate for payload or linker screening or large-scale manufacturing. Payload conjugation with this stable thiol intermediate generated several AJICAP-ADCs. In vivo xenograft studies indicated that the AJICAP-ADCs displayed significant tumor inhibition comparable to benchmark ADC Kadcyla. Furthermore, a rat pharmacokinetic analysis and toxicology study indicated an increase in the maximum tolerated dose, demonstrating an expansion of the AJICAP-ADC therapeutic index, compared with stochastic conjugation technology. This is the first report of the therapeutic index estimation of site-specific ADCs produced by utilizing Fc affinity reagent conjugation. The described site-specific conjugation technology is a powerful platform to enable next-generation ADCs through reduced heterogeneity and enhanced therapeutic index.

8.
J Clin Med ; 10(15)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34362158

RESUMO

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

9.
Ann Nucl Med ; 35(12): 1305-1311, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34426890

RESUMO

OBJECTIVES: Serial changes of focal uptake in whole-body dynamic positron emission tomography (PET) imaging were assessed and compared with those in early-delayed imaging to differentiate pathological uptake from physiological uptake in the colorectal area, based on the change in uptake shape. METHODS: In 60 patients with at least 1 pathologically diagnosed colorectal cancer or adenoma, a serial 3 min dynamic whole-body PET/computed tomography imaging was performed four times around 60 min after the administration of 18F-fluorodeoxyglucose (FDG) to create a conventional (early) image by summation. Delayed imaging was performed separately at 110 min after FDG administration. High focal uptake lesions in the colorectal area were visually assessed as "changed" or "unchanged" on serial dynamic imaging and early-delayed imaging, based on the alteration in uptake shape over time. These criteria on the images were used to differentiate pathological uptake from physiological uptake. RESULTS: In this study, 334 lesions with high focal FDG uptake were observed. Among 73 histologically proven pathological FDG uptakes, no change was observed in 69 on serial dynamic imaging and 72 on early-delayed imaging (sensitivity of 95 vs. 99%, respectively; ns). In contrast, out of 261 physiological FDG uptakes, a change in uptake shape was seen in 159 on dynamic PET imaging and 66 on early-delayed imaging (specificity of 61 vs. 25%, respectively; p < 0.01). High and similar negative predictive values for identifying pathological uptake were obtained by both methods (98 vs 99%, respectively). Thus, the overall accuracy for differentiating pathological from physiological FDG uptake based on change in uptake shape tended to be higher on serial dynamic imaging (68%) than on early-delayed imaging (41%; p < 0.01). CONCLUSIONS: Dynamic whole-body FDG imaging enables differentiation of pathological uptake from physiological uptake based on the serial changes in uptake shape in the colorectal area. It may provide greater diagnostic value than early-delayed PET imaging. Thus, this technique holds a promise for minimizing the need for delayed imaging.

10.
Clin Spine Surg ; 34(10): E594-E600, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34347632

RESUMO

STUDY DESIGN: This was a prospective multicenter study. OBJECTIVE: The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. MATERIALS AND METHODS: We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. RESULTS: Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. CONCLUSIONS: In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy. LEVEL OF EVIDENCE: Level III.

11.
Case Rep Oncol ; 14(2): 854-860, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248551

RESUMO

Prostate squamous cell carcinoma (pSCC) rarely develops as a secondary cancer after treatment with low-dose-rate brachytherapy (LDR-BT). There is no established effective treatment for the disease condition. Herein, we present a 78-year-old man who developed pSCC 8 years after LDR-BT. He was subsequently selected to receive a combined multimodal treatment with high-dose-rate interstitial brachytherapy (HDR-ISBT), external beam radiation therapy, and chemotherapy for his pSCC. Eleven months later, he displayed no biochemical failure nor clinical radiographic recurrence. However, MRI detected a newly developed prostatic-rectal fistula (grade 4), and a colostomy was performed to relieve pain and inflammation. To our knowledge, this is the first report to perform a combined multimodal treatment with HDR-ISBT for pSCC suspected as a secondary cancer due to LDR-BT.

12.
Cancers (Basel) ; 13(14)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34298697

RESUMO

This study aimed to examine the role of very high-risk (VHR) factors (T3b-4 and Gleason score 9-10) for prognosis of clinically localized high-risk prostate cancer. We reviewed multi-institutional retrospective data of 1413 patients treated with radiotherapy (558 patients treated with external beam radiotherapy (EBRT) and 855 patients treated with brachytherapy (BT) ± EBRT. We introduced an index by simple summation of the number of VHR factors-VHR-0, VHR-1, and VHR-2. With median follow-up of 69.6 months, the 5-year biochemical disease free survival rate (bDFS), prostate cancer-specific mortality (PCSM), and distant metastasis-free survival (DMSF) rates were 59.4%, 7.65%, and 83.2% for the VHR-2 group, respectively; 86.7%, 1.50%, and 95.4% for the VHR-1 group, respectively; and 93.1%, 0.12%, and 98.2% for the VHR-0 group, respectively. The VHR-2 group had significantly worse bDFS, PCSM, and DMSF than the VHR-0 (hazard ratios: 4.55, 9.607, and 7.904, respectively) and VHR-1 (hazard ratios: 1.723, 2.391, and 1.491, respectively) groups. The VHR-2 group could be identified as a super high-risk group compared with other groups, and could be a good candidate for clinical trials using multimodal intensified treatments. Simple summation of the number of VHR factors is an easy and useful predictive index for bDFS, PCSM, and DMSF.

13.
Artigo em Inglês | MEDLINE | ID: mdl-34224513

RESUMO

STUDY DESIGN: A prospective multicenter observational study. OBJECTIVE: To elucidate the efficacy of transcranial motor-evoked potentials (Tc(E)-MEPs) in degenerative cervical myelopathy (DCM) surgery by comparing cervical spondylotic myelopathy (CSM) to cervical ossification of the posterior longitudinal ligament (OPLL) and investigate the timing of Tc(E)-MEPs alerts and types of interventions affecting surgical outcomes. SUMMARY OF BACKGROUND DATA: Although CSM and OPLL are the most commonly encountered diseases of DCM, the benefits of Tc(E)-MEPs for DCM remain unclear and comparisons of these two diseases have not yet been conducted. METHODS: We examined the results of Tc(E)-MEPs from 1176 DCM cases (840 CSM /336 OPLL) and compared patients background by disease, preoperative motor deficits, and the type of surgical procedure. We also assessed the efficacy of interventions based on Tc(E)-MEPs alerts. Tc(E)-MEPs alerts were defined as an amplitude reduction of more than 70% below the control waveform. Rescue cases were defined as those in which waveform recovery was achieved after interventions in response to alerts and no postoperative paralysis. RESULTS: Overall sensitivity was 57.1%, and sensitivity was higher with OPLL (71.4%) than with CSM (42.9%). The sensitivity of acute onset segmental palsy including C5 palsy was 40% (OPLL/CSM: 66.7%/0%) whereas that of lower limb palsy was 100%. The most common timing of Tc(E)-MEPs alerts was during decompression (63.16%), followed by screw insertion (15.79%). The overall rescue rate was 57.9% (OPLL/CSM: 58.3%/57.1%). CONCLUSION: Since Tc(E)-MEPs are excellent for detecting long tract injuries, surgeons need to consider appropriate interventions in response to alerts. The detection of acute onset segmental palsy by Tc(E)-MEPs was partially possible with OPLL, but may still be difficult with CSM. The rescue rate was higher than 50% and appropriate interventions may have prevented postoperative neurological complications.Level of Evidence: 3.

14.
Artigo em Inglês | MEDLINE | ID: mdl-34098178

RESUMO

Commercially approved conventional antibody-drug conjugates (ADCs) are produced as heterogeneous mixtures containing a stochastic distribution of payloads decorating the antibody molecules resulting in decreased efficacy and thus lowering their therapeutic index. Control of the DAR and conjugation site in the development of next-generation ADCs is believed to assist in increasing the therapeutic index of these targeted biologics leading to overall enhanced clinical efficacy and reduced toxicity. A chemical site-specific conjugation technology termed AJICAP® allows ADC developers to control both the location and quantity of the payload conjugation to an antibody. Furthermore, this simplified ADC composition enables a streamlined chemical analysis. Here we report the chromatographic separation of site-specific ADCs produced by AJICAP® technology using an analytical affinity chromatography HPLC column containing a recombinant FcγIIIa receptor-ligand immobilized on a non-porous polymer resin (NPR). These HPLC analyses provided visually clear chromatogram results reflecting the heterogeneity of each ADC. The affinity strength was also measured by biolayer interferometry (BLI) and predicted by molecular structure analysis. The results indicate that AJICAP® technology is a promising solution to link hydrophobic payloads to antibodies without compromising antibody receptor function. This study also shows that FcγIIIa-NPR column can be used to characterize site-specific conjugated ADCs compared to ADCs synthesized using conventional methods.


Assuntos
Cromatografia de Afinidade/métodos , Imunoconjugados , Receptores de IgG , Proteínas Recombinantes , Cromatografia Líquida de Alta Pressão/métodos , Humanos , Imunoconjugados/análise , Imunoconjugados/química , Imunoconjugados/metabolismo , Modelos Moleculares , Porosidade , Receptores de IgG/análise , Receptores de IgG/química , Receptores de IgG/metabolismo , Proteínas Recombinantes/análise , Proteínas Recombinantes/química , Proteínas Recombinantes/metabolismo
15.
Brain Nerve ; 73(6): 697-714, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34127566

RESUMO

The cauda equina itself is an unsuitable site for radiological diagnostic imaging because the cauda equina is anatomically a small structure, and magnetic resonance imaging is of limited value to accurately detect lesions in this area. Therefore, in addition to the imaging findings of the cauda equina itself, it is necessary to consider findings in the spinal cord and other areas, as well as clinically correlate these data. In this article, we discuss diseases that cause cauda equina disorders and describe the characteristic imaging findings in such cases.


Assuntos
Cauda Equina , Cauda Equina/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Medula Espinal
16.
Sci Rep ; 11(1): 11910, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099784

RESUMO

Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27-22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.


Assuntos
Vértebras Cervicais/cirurgia , Cervicalgia/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Idoso , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cervicalgia/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Estudos Prospectivos , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
17.
Spine (Phila Pa 1976) ; 46(12): E694-E700, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34027929

RESUMO

STUDY DESIGN: Prospective multicenter observational study. OBJECTIVE: To evaluate transcranial motor-evoked potentials (Tc-MEPs) baseline characteristics of lower limb muscles and to determine the accuracy of Tc-MEPs monitoring based on preoperative motor status in surgery for high-risk spinal disease. SUMMARY OF BACKGROUND DATA: Neurological complications are potentially serious side effects in surgery for high-risk spine disease. Intraoperative spinal neuromonitoring (IONM) using Tc-MEPs waveforms can be used to identify neurologic deterioration, but cases with preoperative motor deficit tend to have poor waveform derivation. METHODS: IONM was performed using Tc-MEPs for 949 patients in high-risk spinal surgery. A total of 4454 muscles in the lower extremities were chosen for monitoring. The baseline Tc-MEPs was recorded immediately after exposure of the spine. The derivation rate was defined as muscles detected/muscles prepared for monitoring. A preoperative neurological grade was assigned using the manual muscle test (MMT) score. RESULTS: The 949 patients (mean age 52.5 ±â€Š23.3 yrs, 409 males [43%]) had cervical, thoracic, thoracolumbar, and lumbar lesions at rates of 32%, 40%, 26%, and 13%, respectively. Preoperative severe motor deficit (MMT ≤3) was present in 105 patients (11%), and thoracic ossification of the posterior longitudinal ligament (OPLL) was the most common disease in these patients. There were 32 patients (3%) with no detectable waveform in any muscles, and these cases had mostly thoracic lesions. Baseline Tc-MEPs responses were obtained from 3653/4454 muscles (82%). Specificity was significantly lower in the severe motor deficit group. Distal muscles had a higher waveform derivation rate, and the abductor hallucis (AH) muscle had the highest derivation rate, including in cases with preoperative severe motor deficit. CONCLUSION: In high-risk spinal surgery, Tc-MEPs collected with multi-channel monitoring had significantly lower specificity in cases with preoperative severe motor deficit. Distal muscles had a higher waveform derivation rate and the AH muscle had the highest rate, regardless of the severity of motor deficit preoperatively.Level of Evidence: 3.


Assuntos
Potencial Evocado Motor/fisiologia , Monitorização Neurofisiológica Intraoperatória , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Extremidade Inferior/inervação , Extremidade Inferior/fisiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Período Pré-Operatório , Estudos Prospectivos
18.
J Vasc Access ; : 11297298211012205, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34000892

RESUMO

BACKGROUND: Anterior chest wall arteriovenous graft (ACWAVG) is one option for haemodialysis patients when vessels of the upper extremities become exhausted. We report here the long-term outcomes of ACWAVG with polyurethane. METHODS: From April 2005 to October 2015, nine ACWAVGs with polyurethane grafts were created. We observed patients until April 2019 and evaluated graft patency, interval from operation to first cannulation, and numbers of interventions and complications. RESULTS: Primary patency rate and secondary patency rate of 6, 12 and 24 months were 55.3%, 33.3%, 33.3% and 77.8%, 55.6%, 55.6% respectively. Mean interval from operation to first cannulation was 3 days. Infection rate and kinking formation rate were slightly higher than previous reports of ACWAVGs with expanded polytetrafluoroethylene (ePTFE). However, one patient was able to keep using a single graft for 166 months with multiple interventions. CONCLUSIONS: Slight disadvantage are seen with patency rate and complication rate in polyurethane ACWAVG compare to ePTFE. However, when early cannulation is required, polyurethane is worth to consider for creating ACWAVG.

19.
Clin Med Insights Case Rep ; 14: 11795476211009251, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33953632

RESUMO

Penoscrotal extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma in older male patients, and no effective nonsurgical treatment strategies are currently available. The aim of this study was to report the usefulness of external radiotherapy (RT) for penoscrotal EMPD in an inoperable elderly patient. This report presents the treatment of an 89-year-old man with widespread penoscrotal EMPD. A multidisciplinary treatment team decided on radical RT. The patient received a radiation dose of 61.8 Gy in 30 fractions through electron and photon beams. His treatment tolerance was good, and no severe toxicity had been observed up the last follow-up. At 6.5 years after the RT, the patient showed no evidence of recurrence. Definitive RT resulted in excellent disease control and minimal toxicity; thus, it could be a promising nonsurgical therapeutic option for penoscrotal EMPD, even in extremely elderly individuals.

20.
Global Spine J ; : 21925682211011443, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34011196

RESUMO

STUDY DESIGN: Multicenter prospective study. OBJECTIVES: Although intramedullary spinal cord tumor (IMSCT) and extramedullary SCT (EMSCT) surgeries carry high risk of intraoperative motor deficits (MDs), the benefits of transcranial motor evoked potential (TcMEP) monitoring are well-accepted; however, comparisons have not yet been conducted. This study aimed to clarify the efficacy of TcMEP monitoring during IMSCT and EMSCT resection surgeries. METHODS: We prospectively reviewed TcMEP monitoring data of 81 consecutive IMSCT and 347 EMSCT patients. We compared the efficacy of interventions based on TcMEP alerts in the IMSCT and EMSCT groups. We defined our alert point as a TcMEP amplitude reduction of ≥70% from baseline. RESULTS: In the IMSCT group, TcMEP monitoring revealed 20 true-positive (25%), 8 rescue (10%; rescue rate 29%), 10 false-positive, a false-negative, and 41 true-negative patients, resulting in a sensitivity of 95% and a specificity of 80%. In the EMSCT group, TcMEP monitoring revealed 20 true-positive (6%), 24 rescue (7%; rescue rate 55%), 29 false-positive, 2 false-negative, and 263 true-negative patients, resulting in a sensitivity of 91% and specificity of 90%. The most common TcMEP alert timing was during tumor resection (96% vs. 91%), and suspension surgeries with or without intravenous steroid administration were performed as intervention techniques. CONCLUSIONS: Postoperative MD rates in IMSCT and EMSCT surgeries using TcMEP monitoring were 25% and 6%, and rescue rates were 29% and 55%. We believe that the usage of TcMEP monitoring and appropriate intervention techniques during SCT surgeries might have predicted and prevented the occurrence of intraoperative MDs.

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