Category: Nevin Manimala

Vet Comp Orthop Traumatol. 2021 Jul 23. doi: 10.1055/s-0041-1731808. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to validate an imaging technique for evaluation of spinal surgery accuracy and to establish accuracy and safety of freehand technique in the thoracolumbar spine of large breed dogs.

STUDY DESIGN: After thoracolumbar spine computed tomography (CT), 26 drilling corridors were planned then drilled to receive 3.2 mm positive profile pins using a freehand technique. After pin removal, CT was repeated. All entry points, exit points and angles of the preoperative planned trajectories were compared with postoperative ones using an image registration and fusion technique by three observers. Corridor coordinates for entry and exit points were evaluated in three dimensions and angles were measured in one plane. Intraclass correlation coefficient (ICC) was used to establish the imaging technique reliability and descriptive statistics were used to report on the freehand technique accuracy. Safety was evaluated using a vertebral cortical breach grading scheme.

RESULTS: Intraclass correlation coefficient for the entry points, exit points and angle were 0.79, 0.96 and 0.92 respectively. Mean deviations for the entry points, exit points and angle were 3.1 mm, 6.3 mm and 7.6 degrees respectively. Maximum deviations were 6.3 mm, 11.0 mm and 16.4 degrees. Most deviations were lateral and caudal. All corridors were judged as safe.

CONCLUSION: The imaging technique reliability was good to excellent to study spinal surgery accuracy. Implant deviations should be anticipated when planning stabilization surgery in large breed dogs using the freehand-guided technique.

PMID:34298579 | DOI:10.1055/s-0041-1731808

Neurourol Urodyn. 2021 Jul 23. doi: 10.1002/nau.24752. Online ahead of print.

ABSTRACT

AIMS: Although abdominal sacrocolpopexy (ASC) is considered the gold standard for surgical repair of vaginal vault prolapse, the open surgical approach has significant morbidity. We aim to compare anatomic and functional outcomes in women receiving either robotic-assisted sacral colpopexy (RSC) or ASC for post-hysterectomy prolapse.

METHODS: We present a retrospective chart review of all women who underwent ASC and RSC at our institution and had 12-month follow-up (FU). Pelvic organ prolapse quantification (POP-Q) staging was assessed both preoperatively and postoperatively. Perioperative and demographic details were collected from the medical records.

RESULTS: One hundred twenty four women underwent RSC (mean age 63, median FU 16 months). Those in the ASC group (n = 144) were statistically younger (mean age 60) and had longer FU (median 60 months). Both median day of successful voiding trial and discharge day significantly favored RSC. There were no Clavien Grade IV/V complications for either procedure and three RSC procedures were converted to ASC. Both approaches were associated with a significant improvement in POP-Q stage at FU, with few women requiring additional surgery. Overall, 76% of women in each group were dry from stress urinary incontinence. Improvement in storage and emptying indices, dyspareunia, and quality of life measures was observed after both approaches.

CONCLUSION: RSC demonstrates good support of significant vaginal vault prolapse at medium term FU, with shorter hospital stays and low complication rates. Close FU after RSC over a longer period will be needed to fully assess durability of both functional and anatomic outcomes.

PMID:34298584 | DOI:10.1002/nau.24752

J Neurosurg Spine. 2021 Jul 23:1-8. doi: 10.3171/2020.12.SPINE201741. Online ahead of print.

ABSTRACT

OBJECTIVE: Survival scoring systems for spine metastasis (SPM) were designed to help surgical practice. The authors sought to validate the prognostic accuracy of the main preoperative scoring systems for SPM.

METHODS: It was hypothesized that true patient survival in SPM was better than that predicted using prognosis scores. To investigate this hypothesis, the authors designed a French national retrospective study of a prospectively collected multicenter database involving 739 patients treated for SPM between 2014 and 2017.

RESULTS: In this series, the median survival time for all patients from an SPM diagnosis was 17.03 ± 1.5 months. Sensitivity and specificity were estimated using the area under the curve (AUC). The AUC of Tomita’s prognosis score was the lowest and poorest (0.4 ± 0.023, range 0.35-0.44), whereas the AUC of the Tokuhashi score was the highest (0.825). The Lei score presented an AUC of 0.686 ± 0.022 (range 0.64-0.7), and the Rades score showed a weaker AUC (0.583 ± 0.020, range 0.54-0.63). Differences among AUCs were all statistically significant (p < 0.001). The modified Bauer score and the Rades score had the highest rate of agreement in predicting survival, with a weighted Cohen’s kappa of 0.54 and 0.41, respectively, indicating a moderate agreement. The revised Tokuhashi and Lei scores had a fair rate of agreement (weighted Cohen’s kappa = 0.24 and 0.22, respectively). The van der Linden and Tomita scores demonstrated the worst performance, with only a “slight” rate of agreement (weighted Cohen’s kappa = 0.19 and 0.16, respectively) between what was predicted and the actual survival.

CONCLUSIONS: The use of prognostic scoring systems in the estimation of survival in patients with SPM has become obsolete and therefore underestimates survival. Surgical treatment decisions should no longer be based on survival estimations alone but must also take into account patient symptoms, spinal instability, and quality of life.

PMID:34298515 | DOI:10.3171/2020.12.SPINE201741

J Neurosurg Pediatr. 2021 Jul 23:1-12. doi: 10.3171/2021.2.PEDS20810. Online ahead of print.

ABSTRACT

OBJECTIVE: The safety of stereo-electroencephalography (SEEG) has been investigated; however, most studies have not differentiated pediatric and adult populations, which have different anatomy and physiology. The purpose of this study was to assess SEEG safety in the pediatric setting, focusing on surgical complications and the identification of patient and surgical risk factors, if any. The authors also aimed to determine whether robot assistance in SEEG was associated with a change in practice, surgical parameters, and clinical outcomes.

METHODS: The authors retrospectively studied all SEEG cases performed in their department from December 2014 to March 2020. They analyzed both demographic and surgical variables and noted the types of surgery-related complications and their management. They also studied the clinical outcomes of a subset of the patients in relation to robot-assisted and non-robot-assisted SEEG.

RESULTS: Sixty-three children had undergone 64 SEEG procedures. Girls were on average 3 years younger than the boys (mean age 11.1 vs 14.1 years, p < 0.01). The overall complication rate was 6.3%, and the complication rate for patients with left-sided electrodes was higher than that for patients with right-sided electrodes (11.1% vs 3.3%), although the difference between the two groups was not statistically significant. The duration of recording was positively correlated to the number of implanted electrodes (r = 0.296, p < 0.05). Robot assistance was associated with a higher number of implanted electrodes (mean 12.6 vs 7.6 electrodes, p < 0.0001). Robot-assisted implantations were more accurate, with a mean error of 1.51 mm at the target compared to 2.98 mm in nonrobot implantations (p < 0.001). Clinical outcomes were assessed in the first 32 patients treated (16 in the nonrobot group and 16 in the robot group), 23 of whom proceeded to further resective surgery. The children who had undergone robot-assisted SEEG had better eventual seizure control following subsequent epilepsy surgery. Of the children who had undergone resective epilepsy surgery, 42% (5/12) in the nonrobot group and 82% (9/11) in the robot group obtained an Engel class IA outcome at 1 year (χ2 = 3.885, p = 0.049). Based on Kaplan-Meier survival analysis, the robot group had a higher seizure-free rate than the nonrobot group at 30 months postoperation (7/11 vs 2/12, p = 0.063). Two complications, whose causes were attributed to the implantation and head-bandaging steps, required surgical intervention. All complications were either transient or reversible.

CONCLUSIONS: This is the largest single-center, exclusively pediatric SEEG series that includes robot assistance so far. SEEG complications are uncommon and usually transient or treatable. Robot assistance enabled implantation of more electrodes and improved epilepsy surgery outcomes, as compared to those in the non-robot-assisted cases.

PMID:34298516 | DOI:10.3171/2021.2.PEDS20810

J Neurosurg. 2021 Jul 23:1-12. doi: 10.3171/2020.12.JNS203652. Online ahead of print.

ABSTRACT

OBJECTIVE: Gliomas frequently involve the insula both primarily and secondarily by invasion. Despite the high connectivity of the human insula, gliomas do not spread randomly to or from the insula but follow stereotypical anatomical involvement patterns. In the majority of cases, these patterns correspond to the intrinsic connectivity of the limbic system, except for tumors with aggressive biology. On the basis of these observations, the authors hypothesized that these different involvement patterns may be correlated with distinct outcomes and analyzed these correlations in an institutional cohort.

METHODS: Fifty-nine patients who had undergone surgery for insular diffuse gliomas and had complete demographic, pre- and postoperative imaging, pathology, molecular genetics, and clinical follow-up data were included in the analysis (median age 37 years, range 21-71 years, M/F ratio 1.68). Patients with gliomatosis and those with only minor involvement of the insula were excluded. The presence of T2-hyperintense tumor infiltration was evaluated in 12 anatomical structures. Hierarchical biclustering was used to identify co-involved structures, and the findings were correlated with established functional anatomy knowledge. Overall survival was evaluated using Kaplan-Meier and Cox proportional hazards regression analysis (17 parameters).

RESULTS: The tumors involved the anterior insula (98.3%), posterior insula (67.8%), temporal operculum (47.5%), amygdala (42.4%), frontal operculum (40.7%), temporal pole (39%), parolfactory area (35.6%), hypothalamus (23.7%), hippocampus (16.9%), thalamus (6.8%), striatum (5.1%), and cingulate gyrus (3.4%). A mean 4.2 ± 2.6 structures were involved. On the basis of hierarchical biclustering, 7 involvement patterns were identified and correlated with cortical functional anatomy (pure insular [11.9%], olfactocentric [15.3%], olfactoopercular [33.9%], operculoinsular [15.3%], striatoinsular [3.4%], translimbic [11.9%], and multifocal [8.5%] patterns). Cox regression identified hippocampal involvement (p = 0.006) and postoperative tumor volume (p = 0.027) as significant negative independent prognosticators of overall survival and extent of resection (p = 0.015) as a significant positive independent prognosticator.

CONCLUSIONS: The study findings indicate that insular gliomas primarily involve the olfactocentric limbic girdle and that involvement in the hippocampocentric limbic girdle is associated with a worse prognosis.

PMID:34298512 | DOI:10.3171/2020.12.JNS203652

J Neurosurg Pediatr. 2021 Jul 23:1-11. doi: 10.3171/2021.2.PEDS2121. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus.

METHODS: A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests.

RESULTS: Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored-matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5-57.5 vs 62.5, IQR 50-70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures.

CONCLUSIONS: Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.

PMID:34298514 | DOI:10.3171/2021.2.PEDS2121

Comput Methods Programs Biomed. 2021 Jul 13;208:106269. doi: 10.1016/j.cmpb.2021.106269. Online ahead of print.

ABSTRACT

Background and Objective Electrocardiogram (ECG) quality assessment is significant for automatic diagnosis of cardiovascular disease and reducing the massive workload of reviewing continuous ECGs. Hence, how to design an appropriate algorithm for objectively evaluating the multi-lead ECG recordings is particularly important. Despite the deep learning methods performing well in many fields, as a data-driven method, it may not be entirely suitable for ECG analysis due to the difficulty in obtaining sufficient data and the low signal-to-noise ratio of ECG recordings. In this study, with the aim of providing an accurate and automatic ECG quality assessment scheme, we propose an innovative ECG quality assessment algorithm based on hand-crafted statistical features and deep-learned spectral features. Methods In this paper, a novel approach, combining the deep-learned Stockwell transform (S-Transform) spectrogram features and hand-crafted statistical features, is proposed for ECG quality assessment. Firstly, a double-input convolutional neural network (CNN) is established. Then, the S-Transform with a novel online augmentation scheme is performed on the multi-lead raw ECG signal received from one input layer to obtain proper time-frequency representation. After that, the CNN with three convolutional layers is employed to extract robust deep-learned features automatically. Simultaneously, the hand-crafted statistical features, including lead-fall, baseline drift, and R peak features, are calculated and fed into another input layer for feature fusion training. Finally, the deep-learned and hand-crafted features are concatenated and further fused by a fully connected layer for quality classification. Furthermore, a log-odds analysis scheme combining with a gradient-based method can localize the abnormal zone in time, frequency, and spatial domains. Results and Conclusion Our proposed method is evaluated on a publicly available database with 10-fold cross-validation. The experimental results demonstrate that the proposed assessment algorithm reached a mean accuracy of 93.09%, a mean F1-score of 0.8472, and a sensitivity of 0.9767. Moreover, comprehensive experiments indicate that the fusion of CNN features and statistical features has complementary advantages and ideal interpretability, achieving end-to-end multi-lead ECG assessment with satisfying performance.

PMID:34298474 | DOI:10.1016/j.cmpb.2021.106269

Biosens Bioelectron. 2021 Jul 13;192:113502. doi: 10.1016/j.bios.2021.113502. Online ahead of print.

ABSTRACT

Extracellular vesicles (EVs) are essential intercellular communicators that are of increasing interest as diagnostic biomarkers. Exploring their biological functions and clinical values, however, remains challenging due to their small sizes and high heterogeneity. Herein, we report an ultrasensitive method that employs target-initiated construction of DNA nanostructure to detect single EVs with an input as low as 100 vesicles/μL. Taking advantage of both DNA nanostructure labeling and EV membrane staining, the method can also permit calibration-free analysis of the protein profiles among different EV samples, leading to clear EV differentiation by their cell of origin. Moreover, this method allows co-localization of dual protein markers on the same EV, and the increased number of EVs carrying dual tumor proteins present in human serum could differentiate cancer patients at the early developmental stage from healthy controls. Our results demonstrate the great potential of this single-EV visualization method in non-invasive detection of the EV-based protein biomarkers for cancer diagnosis and treatment monitoring.

PMID:34298496 | DOI:10.1016/j.bios.2021.113502

J Neurosurg Spine. 2021 Jul 23:1-12. doi: 10.3171/2020.12.SPINE201527. Online ahead of print.

ABSTRACT

OBJECTIVE: Rod fracture (RF) after adult spinal deformity (ASD) surgery is reported in approximately 6.8%-33% of patients and is associated with loss of deformity correction and higher reoperation rates. The authors’ objective was to determine the effect of accessory supplemental rod (ASR) placement on postoperative occurrence of primary RF after ASD surgery.

METHODS: This retrospective analysis examined patients who underwent ASD surgery between 2014 and 2017 by the senior authors. Inclusion criteria were age > 18 years, ≥ 5 instrumented levels including sacropelvic fixation, and diagnosis of ASD, which was defined as the presence of pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°, coronal Cobb angle ≥ 20°, or pelvic incidence to lumbar lordosis mismatch ≥ 10°. The primary focus was patients with a minimum 2-year follow-up.

RESULTS: Of 148 patients who otherwise met the inclusion criteria, 114 (77.0%) achieved minimum 2-year follow-up and were included (68.4% were women, mean age 67.9 years, average body mass index 30.4 kg/m2). Sixty-two (54.4%) patients were treated with traditional dual-rod construct (DRC), and 52 (45.6%) were treated with ASR. Overall, the mean number of levels fused was 11.7, 79.8% of patients underwent Smith-Petersen osteotomy (SPO), 19.3% underwent pedicle subtraction osteotomy (PSO), and 66.7% underwent transforaminal lumbar interbody fusion (TLIF). Significantly more patients in the DRC cohort underwent SPO (88.7% of the DRC cohort vs 69.2% of the ASR cohort, p = 0.010) and TLIF (77.4% of the DRC cohort vs 53.8% of the ASR cohort, p = 0.0001). Patients treated with ASR had greater baseline sagittal malalignment (12.0 vs 8.6 cm, p = 0.014) than patients treated with DRC, and more patients in the ASR cohort underwent PSO (40.3% vs 1.6%, p < 0.0001). Among the 114 patients who completed follow-up, postoperative occurrence of RF was reported in 16 (14.0%) patients, with mean ± SD time to RF of 27.5 ± 11.8 months. There was significantly greater occurrence of RF among patients who underwent DRC compared with those who underwent ASR (21.0% vs 5.8%, p = 0.012) at comparable mean follow-up (38.4 vs 34.9 months, p = 0.072). Multivariate analysis demonstrated that ASR had a significant protective effect against RF (OR 0.231, 95% CI 0.051-0.770, p = 0.029).

CONCLUSIONS: This study demonstrated a statistically significant decrease in the occurrence of RF among ASD patients treated with ASR, despite greater baseline deformity and higher rate of PSO. These findings suggest that ASR placement may provide benefit to patients who undergo ASD surgery.

PMID:34298503 | DOI:10.3171/2020.12.SPINE201527

Reprod Biol. 2021 Jul 20;21(3):100536. doi: 10.1016/j.repbio.2021.100536. Online ahead of print.

ABSTRACT

Cervical cancer markedly threatens women’s health worldwide and currently ranks fourth leading cause of cancer mortality in women according to recent global cancer statistics. Recent advances have proven that not only tumor suppressor and oncogenes but also non-coding RNAs including micro RNAs (miRNAs) have significant impact in the development and progression of cervical cancers. Previous studies have identified many cancer-specific miRNAs for the early detection of cervical cancers. However, the diagnostic and prognostic use of autophagy-associated miRNAs for the cervical squamous cell cancer (SCC) cases and high-grade squamous intraepithelial lesion (HSIL) have not been uncovered. In the present study, we revealed that miRNAs are differentially expressed in both cervical SCC and HSIL. A total of 35 HSIL, 35 cervical SCC and 30 healthy controls were enrolled for the present study. Total RNA including miRNAs were isolated from the FFPE tissue samples and miRNA expression levels were quantified by quantitative PCR. Predicted miRNA targets of autophagy related genes were determined using miRNA-target prediction algorithms. MiR-143, miR-372, miR-375 and miR-30c were markedly downregulated in HSIL and cervical SCC. MiR-130a was significantly upregulated in the cervical SCC group compared to HSIL and control groups. MiR-30a, miR-520e, miR-548c and miR-372 were significantly associated with the overall survival of cervical SCC patients and these miRNAs were determined to be significant diagnostic markers as revealed by ROC analysis. Together, these results indicate that autophagy-associated miRNAs are potentially valuable for the differential diagnosis and targeted therapy to cervical cancer.

PMID:34298410 | DOI:10.1016/j.repbio.2021.100536