Predictors of spine metastases at initial presentation of pediatric brain tumor patients: a single-institution study.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
PURPOSE: Given the rarity of disseminated disease at the time of initial evaluation for pediatric brain tumor patients, we sought to identify clinical and radiographic predictors of spinal metastasis (SM) at the time of presentation.METHODS: We performed a single-institution retrospective chart review of pediatric brain tumor patients who first presented between 2004 and 2018. We extracted information regarding patient demographics, radiographic attributes, and presenting symptoms. Univariate and multivariate logistic regression was used to estimate the association between measured variables and SMs.RESULTS: We identified 281 patients who met our inclusion criteria, of whom 19 had SM at initial presentation (6.8%). The most common symptoms at presentation were headache (n=12; 63.2%), nausea/vomiting (n=16; 84.2%), and gait abnormalities (n=8; 41.2%). Multivariate models demonstrated that intraventricular and posterior fossa tumors were more frequently associated with SM (OR: 5.28, 95% CI: 1.79-15.59, p=0.003), with 4th ventricular (OR: 7.42, 95% CI: 1.77-31.11, p=0.006) and cerebellar parenchymal tumor location (OR: 4.79, 95% CI: 1.17-19.63, p=0.030) carrying the highest risk for disseminated disease. In addition, evidence of intracranial leptomeningeal enhancement on magnetic resonance imaging (OR: 46.85, 95% CI: 12.31-178.28, p<0.001) and hydrocephalus (OR: 3.19; 95% CI: 1.06-9.58; p=0.038) were associated with SM.CONCLUSIONS: Intraventricular tumors and the presence of intracranial leptomeningeal disease were most frequently associated with disseminated disease at presentation. These findings are consistent with current clinical expectations and offer empirical evidence that heightened suspicion for SM may be prospectively applied to certain subsets of pediatric brain tumor patients at the time of presentation.
View details for DOI 10.1007/s00381-022-05702-5
View details for PubMedID 36266365
A Retrospective Cohort Study of Implantable Pulse Generator Surgical Site Infections After Deep Brain Stimulation Surgery With an Antibacterial Envelope.
Neuromodulation : journal of the International Neuromodulation Society
INTRODUCTION: Deep brain stimulation (DBS) surgery is an established treatment for many patients with neurologic disease, and a common complication of DBS is surgical site infection (SSI). In 2016, neurosurgeons at our institution began enclosing implantable pulse generators (IPGs) within fully absorbable, antibacterial envelopes in patients who underwent initial DBS implantation. We sought to determine whether the use of antibacterial envelopes reduced IPG-related SSIs.MATERIALS AND METHODS: We performed a retrospective chart review of all adult patients who underwent initial DBS implantation at Stanford Hospital between November 14, 2012, and November 9, 2020. Operative details, perioperative antibiotics, comorbidities, and postoperative complications were extracted for all patients. Univariate and multivariate logistic regression were used to identify factors associated with SSIs within three months of surgery, and interrupted time-series analysis was performed to assess whether the departmental adoption of the antibacterial envelope led to a reduction in IPG SSIs.RESULTS: Of 344 patients who underwent initial IPG implantation with the antibacterial envelope, one developed an SSI within three months of surgery (0.3%), compared with six of 204 patients (2.9%) who underwent the same procedure without the antibacterial envelope (odds ratio: 0.10, 95% CI: 0.01-0.80, p= 0.031). Univariate logistic regression revealed that the antibacterial envelope and 2000-mg intravenous cefazolin perioperatively were associated with reduced SSI risk, whereas no other factors reached statistical significance. After adjusting for comorbidities, no association remained statistically significant. Interrupted time-series analysis showed a reduction in SSIs after 2016, but the effect was not significant.CONCLUSIONS: The adoption of antibacterial envelopes was found to reduce IPG SSIs at the univariate level, but this association did not remain significant after controlling for confounding variables including perioperative antibiotic administration. Although encouraging, this study does not conclusively establish that the use of antibacterial pouches in patients who underwent initial DBS implantation reduces the incidence of IPG SSIs. Future prospective studies that control for confounding variables are necessary to determine the efficacy of antibacterial envelopes in reducing post-DBS infections at the IPG site before clear recommendationscan be made.
View details for DOI 10.1016/j.neurom.2022.02.227
View details for PubMedID 35422367
Operating Room Stencil: A Novel Mobile Application for Surgical Planning.
Plastic and reconstructive surgery. Global open
2021; 9 (9): e3807
The techniques used to make preoperative markings before soft tissue reconstruction have remained relatively unchanged since the earliest years of plastic surgery. Using skin-marking pens, many surgeons continue to draw markings freehand as "best estimates" before their first incisions. Although efficient for the experienced surgeon, this strategy may prove challenging for residents and trainees striving to learn and maintain consistency while replicating the intricate geometries of flap markings. To address this need, Operating Room Stencil was developed as a novel tool for digitally planning flap markings that may then be projected onto contoured surfaces such as the human body. As a cost-free mobile application, Operating Room Stencil is widely accessible to the medical community and offers educational captions for a majority of the flaps featured in its database. Users can plot relaxed skin tension lines onto uploaded facial images, thus enabling surgeons to orient surgical markings in a way that optimizes scar formation and reduces wound contraction. Although originally intended to appeal to trainees as a reliable way to learn about flaps and practice their technique, Operating Room Stencil may prove useful even among more experienced surgeons striving to further perfect their visualization and execution of flap markings.
View details for DOI 10.1097/GOX.0000000000003807
View details for PubMedID 34549002
Nerve injury and repair in a ketogenic milieu: A systematic review of traumatic injuries to the spinal cord and peripheral nervous tissue.
2021; 16 (1): e0244244
Dietary interventions such as intermittent fasting and the ketogenic diet have demonstrated neuroprotective effects in various models of neurological insult. However, there has been a lack of evaluation of these interventions from a surgical perspective despite their potential to augment reparative processes that occur following nerve injury. Thus, we sought to analyze the effects of these dietary regimens on nerve regeneration and repair by critical appraisal of the literature. Following PRISMA guidelines, a systematic review was performed to identify studies published between 1950 and 2020 that examined the impact of either the ketogenic diet or intermittent fasting on traumatic injuries to the spinal cord or peripheral nerves. Study characteristics and outcomes were analyzed for each included article. A total of 1,890 articles were reviewed, of which 11 studies met inclusion criteria. Each of these articles was then assessed based on a variety of qualitative parameters, including type of injury, diet composition, timing, duration, and outcome. In total, seven articles examined the ketogenic diet, while four examined intermittent fasting. Only three studies examined peripheral nerves. Neuroprotective effects manifested as either improved histological or functional benefits in most of the included studies. Overall, we conclude that intermittent fasting and the ketogenic diet may promote neuroprotection and facilitate the regeneration and repair of nerve fibers following injury; however, lack of consistency between the studies in terms of animal models, diet compositions, and timing of dietary interventions preclude synthesis of their outcomes as a whole.
View details for DOI 10.1371/journal.pone.0244244
View details for PubMedID 33395427
Plastic Surgery and Music: Examining Plastic Surgery References in Hit Songs.
Plastic and reconstructive surgery. Global open
2021; 9 (6): e3620
The purpose of this study was to assess the frequency by which plastic surgery-related terms have been included in the lyrics of Western music hits from the 1970s to the present day as a proxy for estimating the cultural impact of plastic surgery. A list of the Billboard Year-End Hot 100 songs from 1968 to 2019 and the Billboard Year-End Hot R&B/Hip-Hop songs from 1970 to 2019 was obtained for a combined total of 8550 songs. Lyrics for each song were extracted via a web-scraping system, and a database of plastic surgery-related terms was developed by our team. Each term was then queried amongst the compiled lyrics data sets, and the total frequency of plastic surgery-related terms per year and per decade was determined. Each term was also examined in its context of usage to validate its relevance to plastic surgery and determine its connotation through sentiment analysis. The frequency of plastic surgery-related terms referenced in the Billboard Year-End Hot 100 and Billboard Year-End Hot R&B/Hip-Hop charts has increased 15-fold from the 1970s (n = 1 song) to 2010s (n = 15 songs). The terms most often mentioned included "doctor," "silicone," "plastic," "surgery," "nip-tuck," and "lipo." Artists who most frequently used plastic surgery-related terms were Kanye West, 2 Chainz, and Nicki Minaj. The current study is the first to evaluate trends in plastic surgery references in music formally. In turn, this study helps further our understanding of the interplay between plastic surgery and popular culture.
View details for DOI 10.1097/GOX.0000000000003620
View details for PubMedID 34150421
View details for PubMedCentralID PMC8205195
Management of acute corneal hydrops with intracameral gas injection.
American journal of ophthalmology case reports
2020; 20: 100994
Purpose: To report two cases of severe acute corneal hydrops that were resolved by intracameral gas injection alone.Observations: Case 1 is a 27-year-old woman with bilateral severe keratoconus who developed sequential acute corneal hydrops in the right eye followed by the left eye that were each successfully treated using intracameral 20% sulfur hexafluoride gas injection. Case 2 is a 62-year-old man that developed a large fluid cleft beneath a pre-existing LASIK flap, which resolved with intracameral 20% sulfur hexafluoride gas injection without the need for corneal transplantation.Conclusions and importance: In acute corneal hydrops, intracameral gas injection to tamponade Descemet's membrane tears with decompression of stromal fluid can be an effective intervention to delay or avoid keratoplasty in individuals whose corneal hydrops does not improve with conventional medical management.
View details for DOI 10.1016/j.ajoc.2020.100994
View details for PubMedID 33319122
- Boxing Exercises as Therapy for Parkinson Disease TOPICS IN GERIATRIC REHABILITATION 2020; 36 (3): 160–65
Normative data of a smartphone app-based 6-minute walking test, test-retest reliability, and content validity with patient-reported outcome measures.
Journal of neurosurgery. Spine
The 6-minute walking test (6WT) is used to determine restrictions in a subject's 6-minute walking distance (6WD) due to lumbar degenerative disc disease. To facilitate simple and convenient patient self-measurement, a free and reliable smartphone app using Global Positioning System coordinates was previously designed. The authors aimed to determine normative values for app-based 6WD measurements.The maximum 6WD was determined three times using app-based measurement in a sample of 330 volunteers without previous spine surgery or current spine-related disability, recruited at 8 centers in 5 countries (mean subject age 44.2 years, range 16-91 years; 48.5% male; mean BMI 24.6 kg/m2, range 16.3-40.2 kg/m2; 67.9% working; 14.2% smokers). Subjects provided basic demographic information, including comorbidities and patient-reported outcome measures (PROMs): visual analog scale (VAS) for both low-back and lower-extremity pain, Core Outcome Measures Index (COMI), Zurich Claudication Questionnaire (ZCQ), and subjective walking distance and duration. The authors determined the test-retest reliability across three measurements (intraclass correlation coefficient [ICC], standard error of measurement [SEM], and mean 6WD [95% CI]) stratified for age and sex, and content validity (linear regression coefficients) between 6WD and PROMs.The ICC for repeated app-based 6WD measurements was 0.89 (95% CI 0.87-0.91, p < 0.001) and the SEM was 34 meters. The overall mean 6WD was 585.9 meters (95% CI 574.7-597.0 meters), with significant differences across age categories (p < 0.001). The 6WD was on average about 32 meters less in females (570.5 vs 602.2 meters, p = 0.005). There were linear correlations between average 6WD and VAS back pain, VAS leg pain, COMI Back and COMI subscores of pain intensity and disability, ZCQ symptom severity, ZCQ physical function, and ZCQ pain and neuroischemic symptoms subscores, as well as with subjective walking distance and duration, indicating that subjects with higher pain, higher disability, and lower subjective walking capacity had significantly lower 6WD (all p < 0.001).This study provides normative data for app-based 6WD measurements in a multicenter sample from 8 institutions and 5 countries. These values can now be used as reference to compare 6WT results and quantify objective functional impairment in patients with degenerative diseases of the spine using z-scores. The authors found a good to excellent test-retest reliability of the 6WT app, a low area of uncertainty, and high content validity of the average 6WD with commonly used PROMs.
View details for DOI 10.3171/2020.3.SPINE2084
View details for PubMedID 32470938
- Medically Refractory Epilepsy Stereotactic Radiosurgery (SRS): Procedures, Results and Risks Nova Science Publishers. 2020
- Anatomy and Physiology of the Cornea and Sensory Nerves Techniques in Corneal Neurotization Quality Medical Publishing, Inc.. 2020
Novel Assistive Dress Shoe & Footwear Needs Analysis for Patients with Parkinson's Disease
LIPPINCOTT WILLIAMS & WILKINS. 2019
View details for Web of Science ID 000475965905385
The New Frontier: A Review of Augmented Reality and Virtual Reality in Plastic Surgery.
Aesthetic surgery journal
Mixed reality, a blending of the physical and digital worlds, can enhance the surgical experience, leading to greater precision, efficiency and improved outcomes. Various studies across different disciplines have reported encouraging results using mixed reality technologies, such as augmented and virtual reality. To provide a better understanding of the applications and limitations of this technology in plastic surgery, we performed a systematic review of the literature in accordance with PRISMA guidelines. The initial query of the NCBI database yielded 2,544 results, and only 46 articles met our inclusion criteria. The majority of studies were in the field of craniofacial surgery, and uses of mixed reality included preoperative planning, intraoperative guides and education of surgical trainees. A deeper understanding of mixed reality technologies may promote its integration, and also help inspire new and creative applications in healthcare.
View details for DOI 10.1093/asj/sjz043
View details for PubMedID 30753313
Assessing and addressing footwear needs in Parkinson's disease-design thinking in neurology.
Parkinson's disease (PD) is a neurodegenerative movement disorder that results in a variety of motor deficits such as unsteady gait, bradykinesia, resting tremor, and rigidity.The objective of this study was to quantify and assess the challenges and preferences Parkinson's disease patients have regarding footwear.A 13-question survey was designed to assess footwear challenges and preferences among PD patients. A total of 89 PD patients, both male and female, were surveyed in the outpatient setting at UC Irvine during their appointments with the senior author.A majority of the PD patients in our cohort (64%) reported experiencing difficulties wearing shoes on their own. Patients who experienced difficulties wearing shoes were significantly more likely to report having been forced to make changes to their desired outfits (p = 0.0011), choosing not to wear dress shoes due to their discomfort (p = 0.0175), and preferring shoes without laces (p = 0.0 048).The present study is the first attempt to use a survey to quantify the challenges and preferences reported by PD patients in regard to their usage of footwear. Inspired by our findings, the study team designed a novel dress shoe prototype that may address some of the difficulties and concerns gathered through our survey.
View details for DOI 10.3233/NRE-192897
View details for PubMedID 31884494
The Molecular Pathogenesis of Dupuytren Disease: Review of the Literature and Suggested New Approaches to Treatment.
Annals of plastic surgery
Ever since the classification of Dupuytren disease into the proliferative, involutional, and residual stages, extensive research has been performed to uncover the molecular underpinnings of the disease and develop better treatment modalities for patients. The aim of this article is to systematically review the basic science literature pertaining to Dupuytren disease and suggest a new approach to treatment.Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted using the MEDLINE database to identify basic science literature on Dupuytren pathophysiology falling under 1 or more of the following categories: (1) Molecular alterations, (2) Structural alterations, and (3) Genetic predisposition.A total of 177 articles were reviewed of which 77 studies met inclusion criteria. Articles were categorized into respective sections outlined in the study methods.The pathophysiological changes involved in Dupuytren's disease can be divided into a number of molecular and structural alterations with genetic predisposition playing a contributory role. Understanding these changes can allow for the development of biologics which may disrupt and halt the disease process.
View details for DOI 10.1097/SAP.0000000000001918
View details for PubMedID 31232804
Sequence features associated with the cleavage efficiency of CRISPR/Cas9 system
2016; 6: 19675
The CRISPR-Cas9 system has recently emerged as a versatile tool for biological and medical research. In this system, a single guide RNA (sgRNA) directs the endonuclease Cas9 to a targeted DNA sequence for site-specific manipulation. In addition to this targeting function, the sgRNA has also been shown to play a role in activating the endonuclease activity of Cas9. This dual function of the sgRNA likely underlies observations that different sgRNAs have varying on-target activities. Currently, our understanding of the relationship between sequence features of sgRNAs and their on-target cleavage efficiencies remains limited, largely due to difficulties in assessing the cleavage capacity of a large number of sgRNAs. In this study, we evaluated the cleavage activities of 218 sgRNAs using in vitro Surveyor assays. We found that nucleotides at both PAM-distal and PAM-proximal regions of the sgRNA are significantly correlated with on-target efficiency. Furthermore, we also demonstrated that the genomic context of the targeted DNA, the GC percentage, and the secondary structure of sgRNA are critical factors contributing to cleavage efficiency. In summary, our study reveals important parameters for the design of sgRNAs with high on-target efficiencies, especially in the context of high throughput applications.
View details for DOI 10.1038/srep19675
View details for Web of Science ID 000368737200001
View details for PubMedID 26813419
View details for PubMedCentralID PMC4728555