Early Postoperative Assessment Research Articles

Quantitative detection of miR-25 for early diagnosis, postoperative assessment and TNM staging of pancreatic cancer

Objectives: Pancreatic cancer is one of the most common malignant tumors of the digestive tract. Due to its strong concealment and rapid disease progress, it is characterized by high mortality and low cure rate. Current research focuses on screening high-risk populations, preventing the occurrence of pancreatic cancer and developing imaging technology and tumor markers for early diagnosis. This study aimed to investigate the absolute quantitative detection of microRNA-25 (miR-25) and reveal its quantitative changes in the treatment of pancreatic cancer. We compared serum miR-25 level between pancreatic cancer patients and other tumor patients, especially those with gastrointestinal cancer, to provide further evidence for early diagnosis, differential diagnosis and prognosis of pancreatic cancer. Methods: We collected serum samples from 51 pancreatic cancer patients (including 21 patients with preoperative and postoperative samples), 52 pancreatitis patients, 141 other tumor patients, and 50 healthy individuals from Huashan Hospital, Fudan University. The serum levels of miR-25, Carbohydrate Antigen 19–9 (CA19–9), Carbohydrate Antigen 125 (CA125) and Carcinoembryonic Antigen (CEA) in these populations were measured to analyze the value of miR-25 quantitative detection in the diagnosis, postoperative assessment and Tumor Node Metastasis (TNM) staging of pancreatic cancer. Results: Among the 51 pancreatic cancer patients, 50 cases (98.04 %) showed miR-25 levels above the threshold (3333 copies/μl), while all samples in normal group showed negative. The mean level of miR-25 in serum was 5707.45 ± 361.02 copies/μl. In other tumor groups, 21/141 (14.89 %) patients showed positive results and the mean miR-25 level was 847.09 ± 125.97 copies/μl. Comparing before and after operation in 21 paired samples, the level of miR-25 declined significantly after operation, with an average decline rate of 86.36 %. Conclusions: Serum miR-25 levels were significantly higher in pancreatic cancer patients compared to both normal and other tumor groups and decreased significantly after surgery. In addition, miR-25 showed higher sensitivity than common tumor markers (CA19–9, CA125, CEA) in early diagnosis of pancreatic cancer, and proved to be of significant value in evaluating the effect of surgical treatment.

Guiding lights in the early postoperative computed tomography following cranial surgery for traumatic brain injury patients

BackgroundComputed tomography (CT) can be a substantial source of guiding lights during the early postoperative hours in traumatic brain injury (TBI) patients. However, controversy still exists regarding: What is the appropriate time for the first postoperative CT? And what are the guiding lights that can be gained from an early follow-up CT? Therefore, our objective was to reach more clear answers for these questions and to design a simple algorithm for the follow-up of TBI patients during the first 24 h after cranial surgery.MethodsThis is a retrospective study included 164 TBI patients who were surgically treated for various traumatic cranial and/or intracranial lesions in our neurosurgery department from January 2022 to April 2023. Pre- and postoperative clinical and radiological data of these patients were collected and analyzed.ResultsThe mean age was (23.46 ± 15.126) years. The mean glasgow coma scale (GCS) on presentation was (11.62 ± 3.004). 51.2% of patients had their first follow-up CT done within the first postoperative hour (0–1 h). Postoperative remarkable CT findings were detected in 39 patients (23.8%), with 13 cases (33.3%) of them required re-surgery. 69.2% of the postoperative remarkable findings were recognized in the first hour CT (P = 0.025). Acute subdural hematoma was the only significant primary lesion associated with the need for re-surgery (P = 0.015). Postoperative development of remarkable CT findings was significantly (P < 0.001) associated with increased possibility of re-surgery, high mortality rate, prolonged hospital stay and poor outcome.ConclusionsImmediate (0–1 h) follow-up CT brain can be more lucrative in the early postoperative assessment for TBI patients. The first hour CT can provide distinct guiding lights of significant value for the subsequent postoperative management and prediction of patients' clinical course and discharge outcome.

Detection of lung cancer through SERS analysis of serum

Early detection and postoperative assessment are crucial for improving overall survival among lung cancer patients. Here, we report a non-invasive technique that integrates Raman spectroscopy with machine learning for the detection of lung cancer. The study encompassed 88 postoperative lung cancer patients, 73 non-surgical lung cancer patients, and 68 healthy subjects. The primary aim was to explore variations in serum metabolism across these cohorts. Comparative analysis of average Raman spectra was conducted, while principal component analysis was employed for data visualization. Subsequently, the augmented dataset was used to train convolutional neural networks (CNN) and Resnet models, leading to the development of a diagnostic framework. The CNN model exhibited superior performance, as verified by the receiver operating characteristic curve. Notably, postoperative patients demonstrated an increased likelihood of recurrence, emphasizing the crucial need for continuous postoperative monitoring. In summary, the integration of Raman spectroscopy with CNN-based classification shows potential for early detection and postoperative assessment of lung cancer.

Fluorescence/electrochemical dual-mode strategy for Golgi protein 73 detection based on molybdenum disulfide/ferrocene/palladium nanoparticles and nitrogen-doped graphene quantum dots.

Golgi protein 73 (GP73) is a new serum marker associated with early diagnosis and postoperative assessment of hepatocellular carcinoma (HCC). Herein, an electrochemical/fluorescence dual-signal biosensor was designed for determination of GP73 based on molybdenum disulfide/ferrocene/palladium nanoparticles (MoS2-Fc-PdNPs) and nitrogen-doped graphene quantum dots (NGQDs). GP73 aptamer (Apt) was labeled with NGQDs to form the NGQDs-Apt fluorescence probe. MoS2-Fc-PdNPs served not onlyas the fluorescence quencher but also as electrochemical enhancer. The sensing platform (NGQDs-Apt/MoS2-Fc-PdNPs) was formed based on the fluorescence resonance energy transfer (FRET) mechanism. In the presence of GP73, the specific binding of NGQDs-Apt to GP73 interrupted FRET, restoring the fluorescence of NGQDs-Apt at λex/em = 348/438nm and enhancing the oxidation current of Fc in MoS2-Fc-PdNPs at 0.04V through differential pulse voltammetry (DPV). Under the optimal conditions, the DPV current change and fluorescence recovery have a good linear relationship with GP73 concentration from 1.00 to 10.0ng/mL. The calibration equation for the fluorescence mode was Y1 = (0.0213 ± 0.00127)X + (0.0641 ± 0.00448) and LOD was 0.812ng/mL (S/N = 3). The calibration equation of the electrochemical mode was Y2 = (3.41 ± 0.111)X + (1.62 ± 0.731), and LOD of 0.0425ng/mL (S/N = 3). The RSDs of fluorescence mode and electrochemical mode after serum detection were 1.62 to 5.21% and 0.180 to 6.62%, respectively. By combining the electrochemical and fluorescence assay, more comprehensive and valuable information for GP73 was provided. Such dual-mode detection platform shows excellent reproducibility, stability, and selectivity and has great application potential.

Early brain imaging changes and its influence on electrode impedance after implantation of 3.0 T MRI-compatible deep brain stimulation system in Parkinson's disease subthalamic nucleus

Objective: To analyze the imaging changes of in the early period after subthalamic nucleus (STN) deep brain stimulation (DBS) surgery for Parkinson's disease (PD) and its impact on electrode impedance by the application of 3.0T MRI-compatible devices. Methods: A retrospective analysis was performed for the data of 43 PD patients who underwent 3.0T MRI-compatible STN-DBS surgery from October 2022 to April 2023 at the First Affiliated Hospital of USTC(Anhui Provincial Hospital), including 27 males and 16 females, aged 43-68 (56±5) years. All patients underwent postoperative 3.0T MRI, CT scans,and impedance measurements 1 week postoperatively.Fifteen patients underwent 3.0T MRI and impedance measurements 1 month postoperatively. The differences in impedance of electrode contacts before and after the 3.0T MRI scans were compared. The occurrence of peri-lead cerebral edema (PLE) in patients was analyzed, as well as the differences in PLE detection rates between the two imaging methods, and the differences in the incidence and volume of PLE at different microelectrode recordings, the occurrence and detection of postoperative PLE, and different microelectrode recording (MER) times and different time nodes were compared. The correlation between electrode impedance and the volume of edema around the nucleus was analyzed. Results: All 43 patients successfully underwent surgery, with a total of 86 electrodes implanted. There was no significant difference in electrode impedance values before and after the 3.0T MRI examinations at 1 week and 1 month postoperatively. The PLE detection rate with 3.0T MRI was 95.12%(39/43), which is significantly higher than that of CT imaging 17.07% (7/43)(χ2=50.705, P<0.001). One week after surgery, the incidence and volume of PLE were higher in the multiple MER group compared with the single MER group, but the difference was not statistically significant. The volume of PLE [M(Q1, Q3) 0 (0, 1.211) cm3] at 1 month was significantly smaller than that at 1 week [0.243 (0, 2.914) cm3] (Z=-3.408, P=0.001). The impedance of electrode contacts within 1 month postoperatively showed a trend of initial decrease followed by an increase, which was negatively correlated with SE volume(r=-0.317, P=0.014). Conclusions: The application of 3.0T MRI-compatible DBS devices in the surgical treatment of PD patients improves the accuracy of early postoperative imaging assessment. The electrode impedance is more stable as the edema around the nucleus subsided at 1 month after surgery, which is suitable for the first program control.

Early postoperative recovery quality assessment tools for day surgery patients

From the patient's perspective, medical personnel must assess the patients’ recovery reliability in case of day surgery patients. Rather than focusing solely on clinical recovery indicators, it should consider the patient's pain, physiological, psychological, and social function, and quality of life, etc. Due to the return of day surgery patients to their homes following surgery, the doctors and the nurses require discrete observation and guidance. As a result, paying attention to the quality of recuperation following surgery of patients has critical clinical guiding significance. This guidance effectively pays attention to patient recovery, assists medical staff in taking some effective interventions for the quality of postoperative recovery of patients, and promotes high-quality nursing development. This review discusses the commonly used tools for postoperative evaluation in day surgery patients regarding pain assessment, quality of early postoperative recovery, and the quality of life. It examines some evaluation tools for their validity and application status in China and elsewhere. The clinical practice affects direct clinical personnel in evaluating the post-surgery quality of people undergoing daycare procedures.&#x0D; Keywords: Day surgery; Assessment tools; Pain; Postoperative recovery; Quality of life&#x0D; Citation: Nibaruta J, Xingjiao L, Xiaoxia H, Xiaoyu H, Xuefen C, Yufang L. Quality assessment tools for early postoperative recovery in day surgery patients. Anaesth. pain intensive care 2023;27(3):417−425; DOI: 10.35975/apic.v27i3.2201&#x0D; Received: April 11, 2023; Reviewed: April 17, 2023; Accepted: May 12, 2023

Early Dynamic Risk Stratification Decreases Rate of Ablative and Adjuvant Radioiodine Use in ATA Low and Intermediate Risk Papillary Thyroid Cancer Patients.

In differentiated thyroid cancer (DTC), radioiodine (RAI) therapy is most frequently employed for remnant ablation or as adjuvant therapy for the remaining disease. The application of RAI to patients classified as intermediate risk (InR) is still a matter of debate. The aim of this study is to analyze the effect of early postoperative risk assessment on RAI use on papillary thyroid cancer patients who are classified as low risk (LoR) or InR. This is a single-center, prospective registry study. One-hundred-eighty-six patients operated between January 2012 and August 2021 and categorized as LoR or InR were included in this study. All patients had total thyroidectomy and central lymph node dissection by the same endocrine surgeon. An early dynamic risk assessment (EDRA) consisting of neck ultrasonography, serum thyroglobulin (Tg) and anti-Tg levels was performed 6 weeks after surgery. Most of the patients were either followed up without RAI or received ablative low activity (30-50 mCi) RAI based on predetermined criteria. Median follow-up was 63 months. Sixty-six (61%) patients in the LoR group and 43 (56%) patients in the InR group did not receive RAI treatment. Thirty-eight (35%) and 22 (29%) patients in LoR and InR groups received ablative (30-50 mCi) RAI therapy, respectively. In LoR group 5 (4.6%) patients and in InR group 12 (16%) patients received 100 mCi or more RAI activity. Only one patient in the InR group recurred during follow-up. No statistically significant difference regarding local recurrence was found between patients who didn't receive RAI or were treated with RAI within both LoR (p=0.152) and InR (p=0.272) groups. There is consensus for LoR patients about omitting RAI therapy after surgery. Indications for RAI treatment in InR DTC are still under debate. RAI use based on EDRA seems to be a better option than decisions solely made on histopathological risk factors and decreases adjuvant high-activity RAI use without increasing recurrence risk.

Pre and Early Post-Operative Iron Assessment in Obese Patients Underwent Laparoscopic Sleeve Gasterctomy

Obesity is a chronic disease associated with mortality and morbidity. Bariatric surgery (BS) as a long-term weight reduction treatment has been increased. This study investigated the early state of iron storage and deficiency in patients underwent laparoscopic sleeve gastrectomy (LSG). Thirty patients were selected as a prospective study underwent LSG according to specialized inclusion and exclusion criteria at Soran Private Hospital in Erbil, from 1/1/2021 to 1/9/2021 after signing a consent form. All selected patients underwent preoperative and three months’ post-operative hemoglobin (Hb), mean corpuscular volume (MCV), and serum ferritin (SF) assessments. They were instructed to follow specialized diet regimen for three months’ post-operative and not to take any drugs and supplements. Results showed a strong positive correlation between preoperative and postoperative assessment for both Hb and MCV respectively (r= 0.72; P &lt; 0.001), (r= 0.76; P &lt; 0.001), and a moderate correlation for SF (r= 0.41; P &lt; 0.024). Significant difference (P &lt; 0.05) was found between preoperative and postoperative for the three markers (Hb, MCV and SF). Their values were decreased from preoperative to postoperative for the majority of the cases, but they were still within the normal range. The finding demonstrated that after three months from LSG, no patients showed iron deficiency anaemia. However, there was decrease in SF level which indicated that the storage capacity of iron was decreasing. This suggest that the iron supplement has to be started since the food regime followed in by the patients was not sufficient to maintain normal iron level.

Early post-operative neurodevelopment and visual assessment in neonates with congenital heart disease undergoing cardiac surgery.

Assessment of neurobehavior and visual function of newborns with congenital heart disease during the post-operative period to identify infants at risk of neurodevelopmental and visual impairment. Prospective study that included 45 newborns who underwent cardiac surgery. Newborn Behavioral Observations test (NBO) and "ML Battery of Optotypes" were used for assessment. The median NBO global score was 2.4 [2.1-2.6]. Total days of oral morphine [p = 0.005] and total days of sedation [p = 0.009] were strongly related to abnormal evaluations. Time of cerebral regional oxygen saturation (CrSO2) under 40% during surgery and increased lactate were related to abnormal motor evaluation. Only 14.5% of patients presented pathological results in visual evaluation. We have demonstrated alterations in attention, autonomic, motor, and oral motor function. Duration of sedative medication, time of CrSO2 under 40% during surgery, and increased lactate are the most important risk factors. No significant visual impairment was detected.

Surgery and perioperative management of patients with Cushing's disease.

Transsphenoidal surgery (TSS) is the initial treatment modality of first choice in Cushing's disease (CD). With microscopic TSS and endoscopic TSS, two operative techniques with equally favourable remission rates and operative morbidity are available. On average, remission is achieved with primary TSS in 80% of patients with microadenomas and 60% of patients with macroadenomas. The current literature indicates that remission rates in repeat TSS for microadenomas can also exceed 70%. Experience with TSS in CD plays an important role in the success rate and centralization in Pituitary Centres of Excellence has been proposed. Microadenoma stage, imaging-visible adenoma, confirmation of ACTH-positive adenoma on histopathology and noninvasiveness are positive predictors for postoperative remission. In postoperative management, a steroid-sparing protocol with early postoperative assessment of remission status is recommended. Convincing evidence suggests that prolonged postoperative prophylactic antithrombotic measures can significantly reduce the risk of postoperative thromboembolic events in CD. Prevention or successful treatment of cortisol withdrawal syndrome remains an unsolved issue that should be a focus of future research. The further development and broad availability of functional imaging hold promise for improved preoperative detection of microadenomas. Intraoperative identification of microadenomas by specific fluorescent targeting could be a promising future avenue for the treatment of patients with negative imaging.

The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors

Background: Preserving hemodynamic stability, providing a slack brain, and enabling early recovery are the main criteria of neuroanesthesia. The most commonly used volatile anesthetic for neurosurgeries is isoflurane due to its favorable effects on cerebral blood flow and intracranial pressure. On the other hand, desflurane, having lower blood gas partition coefficient, favors rapid recovery from anesthesia. Aims and Objectives: This study was conducted for comparing the effects of desflurane and isoflurane on intraoperative cerebral and cardiovascular hemodynamics and post-operative recovery among patients with supratentorial neoplasms posted for craniotomy. Materials and Methods: A total of 52 patients aged 20–60, ASA I and II, scheduled for craniotomy under general anesthesia, were randomized into Group I (isoflurane) and Group D (desflurane). All patients received standardized anesthetic protocol and anesthesia was maintained either with isoflurane or desflurane (≤1 MAC). Lumbar cerebrospinal fluid pressure (LCSFP) and cerebral perfusion pressure (CPP) were monitored every 5 min till dura was opened and the degree of dural tension and brain swelling were assessed by neurosurgeons, blinded to the study, at the time of dural opening. Perioperative heart rate, mean arterial pressure, and post-operative recovery time were also noted. Results: No statistically significant changes were observed among two groups regarding change in LCSFP, CPP, dural tension, brain swelling, and cardiovascular changes. Post-operative recovery time was significantly shorter in desflurane group (P&lt;0.001) than isoflurane group. Conclusion: Desflurane and isoflurane both can be used safely in maintaining neuroanesthesia. However, due to a significantly faster recovery which facilitates early post-operative neurological assessment, desflurane may be considered a better alternative to isoflurane.

Septoplasty: early (first year) and late (fourth year) post-operative results in 604 patients

As prospective outcomes of septoplasty with or without turbinoplasty beyond the first year are few and have diverging results, this study evaluated later septoplasty results three to four years post-operatively. Patients undergoing septoplasty completed the Nasal Surgical Questionnaire pre-operatively, and at 6-12 months (early post-operative assessment) and 36-48 months (late post-operative assessment) after surgery. Primary outcome was visual analogue scale ratings for nasal obstruction (with a scale ranging from 0 to 100). In 604 patients with high response rates, the largest improvements in nasal obstruction were from pre-operative to early post-operative assessments (daytime score reduction = 33.9, night-time reduction 40.5). Nasal obstruction ratings worsened slightly between early and late post-operative assessments (daytime score increase = 5.3, night-time score increase = 9.7). Improvements were better in patients aged over 35 years and in those with pre-operative nasal obstruction scores of more than 62. There were no differences based on surgery type, septal deviation, allergy or smoking. Septoplasty improves nasal obstruction in both the first and the fourth year after surgery. Post-operative improvements decline slightly over time but remain significant.

Septoplasty: Early (first year) and late (fourth year) postoperative results in 604 patients.

ObjectiveAs prospective outcomes of septoplasty with or without turbinoplasty beyond the first year are few and have diverging results, this study evaluated later septoplasty results three to four years post-operatively.MethodsPatients undergoing septoplasty completed the Nasal Surgical Questionnaire pre-operatively, and at 6–12 months (early post-operative assessment) and 36–48 months (late post-operative assessment) after surgery. Primary outcome was visual analogue scale ratings for nasal obstruction (with a scale ranging from 0 to 100).ResultsIn 604 patients with high response rates, the largest improvements in nasal obstruction were from pre-operative to early post-operative assessments (daytime score reduction = 33.9, night-time reduction 40.5). Nasal obstruction ratings worsened slightly between early and late post-operative assessments (daytime score increase = 5.3, night-time score increase = 9.7). Improvements were better in patients aged over 35 years and in those with pre-operative nasal obstruction scores of more than 62. There were no differences based on surgery type, septal deviation, allergy or smoking.ConclusionSeptoplasty improves nasal obstruction in both the first and the fourth year after surgery. Post-operative improvements decline slightly over time but remain significant.

Insulin-Like Growth Factor 1 in the Early Postoperative Assessment of Acromegaly.

Assessment of surgical outcome in acromegaly is typically recommended at 3 to 6 months following surgery. The purpose of this study was to determine if insulin-like growth factor 1 (IGF-1) concentrations at 6 weeks were equally predictive of surgical outcomes compared with IGF-1 concentrations at 3 to 6 months postoperatively applying newer IGF-1 assays. Retrospective review of patients with newly diagnosed acromegaly who had surgery between 2013 and 2020 and had postoperative IGF-1 measured by 6 weeks and 3 to 6 months. At 6 weeks, 20 (35%) of the total 57 had normal IGF-1 and became abnormal in 1 at 3 to 6 months, whereas 37 (65%) of 57 had abnormal IGF-1 concentrations at 6 weeks, which normalized in 1 patient by 3 to 6 months. In patients who changed clinical status, IGF-1 at 6 weeks was within ±0.1-fold of normal. Although a difference was seen between median IGF-1 concentrations (286 vs 267 ng/mL, P = .009) at 6 weeks and 3 to 6 months, the mean reduction was small (-19.9 ng/mL). Compared with 3 to 6 months, use of IGF-1 at 6 weeks was associated with a change in clinical status in 3.5% of patients. Therefore, in most patients, IGF-1 at 6 weeks can be used to assess clinical outcome via newer assays.

Proposition of quantitative parameters for pre- and early post-operative assessment in pulmonary thromboendarterectomy - An Indian prospective study.

Chronic thromboembolic pulmonary hypertension results from the incomplete resolution of the vascular obstruction associated with pulmonary embolism. Symptoms are exertional dyspnoea and fatigue, and over a period of time, right ventricular dysfunction sets in. Pulmonary thromboendarterectomy is an effective surgical remedy for this condition. Our study is an initial post-operative experience of pulmonary thromboendarterectomy and we have also tried to formulate quantitative parameters for the prediction of the post-operative course in patients who are undergoing surgery. Twenty patients with chronic thromboembolic pulmonary hypertension underwent pulmonary thromboendarterectomy between July 2017 and January 2020. Pre-operatively, each patient was subjected to the (i) 6-min walk test, (ii) pre-operative brain natriuretic peptide values and (iii) pulmonary artery systolic pressure. Following the surgery and subsequent discharge, the patients were followed up at intervals of 15 days, 1, 3, 6, 9 months and at 1 year. At one year post-operatively, the same three quantitative tests were performed on each subject. Post-operatively, the mean 6-min walk distance was 499.75 m as against 341.35 m pre-operatively (p < 0.0001). Mean brain natriuretic peptide was 8.69 pm/l as against 47.58 pm/l pre-operatively (p < 0.0001). Mean pulmonary artery systolic pressure was 22.25 as against 67.1 pre-operatively (p < 0.0001). 6-Min walk test, brain natriuretic peptide and pulmonary artery systolic pressure could be considered as useful predictors of the haemodynamic severity of disease and predict the post-operative outcome.

Routine early postoperative computed tomography angiography after coronary artery bypass surgery: clinical value and management implications.

Computed tomography angiography (CTA) is broadly used for long-term follow-up of graft patency after coronary artery bypass graft surgery (CABG). However, its clinical value in the early postoperative setting has not been established yet. We evaluated the benefit of adding CTA to the routine clinical work-up after CABG on patient management. A total of 305 consecutive patients (269 males, median age 68 years) underwent CABG and postoperative CTA with a median of 6 days after surgery. Graft patency and additional imaging findings were assessed and their influence on diagnosis and clinical management was evaluated. Graft occlusion or high-grade stenosis was found in 15% of the patients. Additional findings were reported in 44% of the patients, including pericardial (2%) and pleural effusion (27%), large pneumothorax (11%), pulmonary infection (4%), cardiac or vascular thrombus (2%), pulmonary embolism (2%), sternal dehiscence (1%) and additional incidental findings requiring follow-up (6%). CT findings initiated new diagnostic and/or therapeutic measures in 15% of the patients, 47% of those with diseased grafts and 19% of patients with non-graft-related findings. No adverse events related to CTA were documented. Early routine postoperative assessment of CABG with CTA reveals both cardiac and non-cardiac findings with a high frequency, affecting clinical management in a substantial proportion of patients.

Outcome Features Analysis in Intramedullary Tumors of the Cervicomedullary Junction: A Surgical Series.

The aim of this study is to investigate the impact of surgery for different cervicomedullary lesions on symptomatic pattern expression and postoperative outcome. We focused on specific outcome features of the early and late postoperative assessments. The former relies on surgery-related transient and permanent morbidity and feasibility of radicality in eloquent areas, whereas the latter on long-term course in lower grade tumors and benign tumorlike lesions (cavernomas, etc.). We retrospectively analyzed 28 cases of intramedullary tumors of the cervicomedullary junction surgically treated at our institution between 1990 and 2018. All cases were stratified for gender, histology, macroscopic appearance, location, surgical approach, and presence of a plane of dissection (POD). Mean follow-up was 5.6 years and it was performed via periodic magnetic resonance imaging (MRI) and functional assessments (Karnofsky Performance Scale [KPS] and modified McCormick [MC] grading system). In all, 78.5% were low-grade tumors (or benign lesions) and 21.5% were high-grade tumors. Sixty-one percent underwent median suboccipital approach, 18% a posterolateral approach, and 21% a posterior cervical approach. Gross total resection was achieved in 54% of cases, near-total resection (>90%) in 14%, and subtotal resection (50-90%) in 32% of cases. Early postoperative morbidity was 25%, but late functional evaluation in 79% of the patients showed KPS > 70 and MC grade I; only 21% of cases showed KPS < 70 and MC grades II and III at late follow-up. Mean overall survival was 7 years in low-grade tumors or cavernomas and 11.7 months in high-grade tumors. Progression-free survival at the end of follow-up was 71% (evaluated mainly on low-grade tumors). The surgical goal should be to achieve maximal cytoreduction and minimal postoperative neurologic damage. Functional outcome is influenced by the presence of a POD, radicality, histology, preoperative status, and employment of advanced neuroimaging planning and intraoperative monitoring.

Long-term upper extremity performance in children with cerebral palsy following selective dorsal rhizotomy.

In children with spastic cerebral palsy, selective dorsal rhizotomy (SDR) is conducted to improve lower limb spasticity. Improvements in upper extremity function have also been noted in early follow-up. The purpose of this study was to determine if upper extremity improvements are sustained in the long term. A retrospective review of prospectively collected data on children who underwent SDR was conducted. Quality of Upper Extremities Skill Test (QUEST) scores for dissociated movement, grasp and total scores were compared using repeated measures ANOVA for individual patients at three time points: preoperatively, early post-operatively (≤ 2 years) and late post-operatively (9+ years). Out of 200+ patients having SDR, 32 had QUEST assessment at all three time points. Significant improvements in QUEST dissociated movement (F = 3.665, p = 0.045), grasp (F = 7.995, p = 0.001) and total scores (F = 9.471, p = 0.001) were found. Pairwise comparisons were significant from pre-operative to early post-operative times for all QUEST scores (p = 0.001, 0.003, 0.001), and this was maintained at late post-operative assessment for grasp and total scores (p = 0.02, p = 0.02). There was no significant change in scores between early and late post-operative assessment time points. Early improvements in upper extremity QUEST total scores are sustained in the long term following SDR.

Lidocaine versus magnesium sulfate infusion during isoflurane anesthesia for brain tumor resection, effect on minimum alveolar concentration reduction guided by bispectral index: a prospective randomized controlled trial

Objective: Goals of neuro-anesthesia include smooth induction, stable perioperative hemodynamics, early and quiet recovery with adequate analgesia. Intraoperative use of co-sedatives allows reduction of anesthetic agents consumption while maintaining a desirable depth of anesthesia. Many drugs like opioids and dexmedetomidine had been studied in different surgeries. Using such drugs enhances rapid recovery for early postoperative assessment and detection of complications. Methods: This study enrolled 50 adult patients undergoing supratentorial brain tumor surgery. Patients of the lidocaine group (group L) received 1.5 mg.kg−1 of lidocaine as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 1.5 mg.kg−1.h−1. Patients of the magnesium group (group M) received 30 mg.kg−1 of magnesium sulfate as a loading dose over 10 min before induction of anesthesia and followed by infusion at a rate of 10 mg.kg−1.h−1. Depth of anesthesia was guided by bispectral index in a range of 50 ± 2, with the primary outcome objective, minimum alveolar concentration reduction of inhaled isoflurane. Results: No significant difference was found regarding patient demographics, basal hemodynamic data, and anesthesia duration. The used isoflurane concentration at the matching time points (every 15 min intraoperatively) and the total dose of muscle relaxant (160 ± 15 mg, 175 ± 18 mg respectively, p 0.003) were statistically lower in group M than in group L. The time required for recovery was statistically shorter in group M than in group L (5.1 ± 0.99 min vs 9.8 ± 1.9 min, respectively, p 0.00). Conclusion: Compared to lidocaine infusion, magnesium sulfate (MgSO4) infusion during anesthesia for brain surgery resulted in lower anesthetic consumption, muscle relaxant requirement, a shorter recovery time, and a better postoperative pain profile. MgSO4 can be used effectively as a co-sedative adjuvant with superior clinical properties than lidocaine infusion.

Cartilage T2 Relaxation Times and Subchondral Trabecular Bone Parameters Predict Morphological Outcome After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting

Background: Quantitative magnetic resonance (MR) imaging techniques are established for evaluation of cartilage composition and trabecular bone microstructure at the knee. It remains unclear whether quantitative MR parameters predict the midterm morphological outcome after matrix-associated chondrocyte implantation (MACI) with autologous bone grafting (ABG). Purpose: To assess longitudinal changes and associations of the biochemical composition of cartilage repair tissue, the subchondral bone architecture, and morphological knee joint abnormalities on 3-T MR imaging after MACI with ABG at the knee. Study Design: Case series; Level of evidence, 4. Methods: Knees of 18 patients (28.7 ± 8.4 years [mean ± SD]; 5 women) were examined preoperatively and 3, 6, 12, and 24 months after MACI and ABG using 3-T MR imaging. Cartilage composition was assessed using T2 relaxation time measurements. Subchondral bone microstructure was quantified using a 3-dimensional phase-cycled balanced steady-state free precision sequence. Trabecular bone parameters were calculated using a dual threshold algorithm (apparent bone fraction, apparent trabecular number, and apparent trabecular separation). Morphological abnormalities were assessed using the MOCART (magnetic resonace observation of cartilage repair tissue) score, the WORMS (Whole-Organ Magnetic Resonance Imaging Score), and the CROAKS (Cartilage Repair Osteoarthritis Knee Score). Clinical symptoms were assessed using the Tegner activity and Lysholm knee scores. Statistical analyses were performed by using multiple linear regression analysis. Results: Total WORMS (P = .02) and MOCART (P = .001) scores significantly improved over 24 months after MACI. Clinical symptoms were significantly associated with the presence of bone marrow edema pattern abnormalities 24 months after surgery (P = .035). Overall there was a good to excellent radiological outcome found after 24 months (MOCART score, 88.8 ± 10.1). Cartilage repair T2 values significantly decreased between 12 and 24 months after MACI (P = .009). Lower global T2 values after 3 months were significantly associated with better MOCART scores after 24 months (P = .04). Moreover, trabecular bone parameters after 3 months were significantly associated with the total WORMS after 24 months (apparent bone fraction, P = .048; apparent trabecular number, P = .013; apparent trabecular separation, P = .013). Conclusion: After MACI with ABG, early postoperative quantitative assessment of biochemical composition of cartilage and microstructure of subchondral bone may predict the outcome after 24 months. The perioperative global joint cartilage matrix quality is essential for proper proliferation of the repair tissue, reflected by MOCART scores. The subchondral bone quality of the ABG site is essential for proper maturation of the cartilage repair tissue, reflected by cartilage T2 values.