Locking Stand-Alone Cage Constructs for the Treatment of Cervical Spine Degenerative Disease

Roberto Alfonso De Leo–Vargas,Ildefonso Muñoz–Romero,Michel Gustavo Mondragón–Soto,Jaime Jesús Martínez–Anda 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.4

Study Design: Prospective case series study. Purpose: Description of the outcome of stand-alone cervical cages for single and multilevel cervical degenerative spine disease. Overview of Literature: The aim of anterior cervical discectomy and fusion (ACDF) for cervical spine disease is to improve patient symptoms and spine stability and restore lordosis. Locking stand-alone cages were developed with the goal of minimizing soft tissue disruption anterior to the vertebrae and reducing the profile of the construct by avoiding an anterior plate, thereby maximizing ACDF benefits. Methods: This study comprises a case series of patients surgically treated between July 2015 and February 2018 who received single or multilevel ACDF with a zero-profile stand-alone cervical cage. Surgical and clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score for myelopathy scales, cervical Cobb angles, postoperative surgical complications, and fusion and subsidence rates. Results: Fifty-three patients underwent ACDF; the mean age of these patients was 58.8 years, and their preoperative VAS, NDI, and JOA scores were 8.1, 31.6, and 15.3, respectively. The preoperative Cobb angle was 30.7°. Forty-five percent of patients had one-level, 54.7% had two-level, and 13.2% had three-level procedures. On preoperative magnetic resonance imaging, foraminal stenosis was present in 94.3% of patients, whereas medullar stenosis was present in 41.5%. The rate of complications was 5.7%: two patients had postoperative dysphagia (3.7%), and one patient had a surgical site hematoma. Mean postoperative follow-up time was 6.7 months; postoperative VAS, NDI, and JOA scores were 2.4, 15.9, and 15.8, respectively. Postoperative Cobb angle was 35.9°, fusion rate was 84.9%, and subsidence rate was 11.3%. Conclusions: ACDF with zero-profile stand-alone cervical devices is an excellent option for cervical degenerative disc disease of one, two, and three levels, with similar results reported when using ACDF with either cage or plate.

모체태아의학

오경준 ( Kyung Joon Oh ),( Roberto Romero ),( Jee Yoon Park ),( Joonho Lee ),( Agustin Conde-agudelo ),( Joon-seok Hong ),( Bo Hyun Yoon ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Background: Cervical insufficiency is a risk factor for spontaneous midtrimester abortion or early preterm birth. Intra-amniotic infection has been reported in 8-52% of such patients and intraamniotic inflammation in 81%. Some professional organizations have recommended perioperative antibiotic treatment when emergency cervical cerclage is performed. The use of prophylactic antibiotics is predicated largely on the basis that they reduce the rate of complications during the course of vaginal surgery. However, it is possible that antibiotic administration can also eradicate intra-amniotic infection/inflammation and improve pregnancy outcome. Objective: To describe the outcome of antibiotic treatment in patients with cervical insufficiency and intra-amniotic infection/inflammation. Study Design: The study population consisted of 22 women who met the following criteria: (1) singleton pregnancy; (2) painless cervical dilatation of >1 cm between 16.0 and 27.9 weeks of gestation; (3) intact membranes and absence of uterine contractions; (4) transabdominal amniocentesis performed for the evaluation of the microbiologic and inflammatory status of the amniotic cavity; (5) presence of intra-amniotic infection/inflammation; and (6) antibiotic treatment (regimen consisted of ceftriaxone, clarithromycin, and metronidazole). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction for Ureaplasma spp. was performed. Intraamniotic infection was defined as a positive amniotic fluid culture for microorganisms or a positive polymerase chain reaction for Ureaplasma spp., and intra-amniotic inflammation was suspected when there was an elevated amniotic fluid white blood cell count (≥19 cells/mm3) or a positive rapid test for metalloproteinase-8 (sensitivity 10 ng/mL). For the purpose of this study, the “gold standard” for diagnosis of intra-amniotic inflammation was an elevated interleukin-6 concentration (>2.6 ng/mL) using an enzyme-linked immunosorbent assay. The results of amniotic fluid interleukin-6 were not available to managing clinicians. Follow-up amniocentesis was routinely offered to monitor the microbiologic and inflammatory status of the amniotic cavity and fetal lung maturity. Treatment success was defined as resolution of intra-amniotic infection/inflammation or delivery ≥34 weeks of gestation. Results: Of 22 patients with cervical insufficiency and intra-amniotic infection/inflammation, 3 (14%) had microorganisms in the amniotic fluid. Of the 22 patients, 6 (27%) delivered within 1 week of amniocentesis and the remaining 16 (73%) delivered more than 1 week after the diagnostic procedure. Among these, 12 had a repeat amniocentesis to assess the microbial and inflammatory status of the amniotic cavity; in 75% (9/12), there was objective evidence of resolution of intra-amniotic inflammation or intra-amniotic infection demonstrated by analysis of amniotic fluid at the time of the repeat amniocentesis. Of the 4 patients who did not have a follow-up amniocentesis, all delivered ≥34 weeks, 2 of them at term; thus, treatment success occurred in 59% (13/22) of cases. Conclusion: In patients with cervical insufficiency and intraamniotic infection/inflammation, administration of antibiotics (ceftriaxone, clarithromycin, and metronidazole) was followed by resolution of the intra-amniotic inflammatory process or intra-amniotic infection in 75% of patients and was associated with treatment success in about 60% of cases.

Amniotic fluid volume in intra-amniotic inflammation with and without culture-proven amniotic fluid infection in preterm premature rupture of membranes

Lee, Si Eun,Romero, Roberto,Lee, Seung Mi,Yoon, Bo Hyun Walter de Gruyter GmbH 2010 Journal of perinatal medicine Vol.38 No.1

<P>Previous studies reported that the clinical significance of intra-amniotic inflammation with a negative amniotic fluid (AF) culture is similar to that of intra-amniotic inflammation with microbiologically-proven AF infection. However, the magnitude of the fetal inflammatory response in these two conditions is different as gauged by umbilical cord C-reactive protein (CRP) concentrations. We undertook this study to determine if the frequency of oligohydramnios is different in these two conditions.</P>

Funisitis in term pregnancy is associated with microbial invasion of the amniotic cavity and intra-amniotic inflammation

Lee, Si Eun,Romero, Roberto,Kim, Chong Jai,Shim, Soon-Sup,Yoon, Bo Hyun Taylor Francis 2006 The journal of maternal-fetal & neonatal medicine Vol.19 No.11

<P><I>Objective</I>. Funisitis is the histologic counterpart of the fetal inflammatory response syndrome, which is a multisystemic disorder associated with impending preterm delivery and adverse neonatal outcome. The purpose of this study was to examine the relationship between funisitis and the microbiologic status of amniotic fluid (AF) and AF white blood cell (WBC) count in patients at term.</P><P><I>Methods</I>. The relationship between the presence of funisitis, AF culture, and AF WBC count was examined in 832 consecutive patients who delivered a term neonate within 72 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria, as well as for mycoplasmas. Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton's jelly. AF WBC count was analyzed in a hemocytometer chamber. Nonparametric statistics were used for data analysis.</P><P><I>Results</I>. Funisitis was present in 4% (30/832) of cases. A positive AF culture was more common in cases with funisitis than in those without funisitis (17% vs. 5%; <I>p</I> < 0.05). Patients with funisitis had a significantly higher median AF WBC count than those without funisitis (median >1000 cells/mm<SUP>3</SUP> vs. median 2 cells/mm<SUP>3</SUP>; <I>p</I> < 0.001). The frequency of funisitis and of a positive AF culture was 1% in women without labor and with intact membranes and the frequencies and the median AF WBC count increased in the presence of labor or rupture of membranes.</P><P><I>Conclusion</I>. Funisitis is present in 4% of women at term and is associated with microbial invasion of the amniotic cavity (MIAC) and inflammation as reflected by increased AF WBC count.</P>

Galectins: Double-edged Swords in the Cross-roads of Pregnancy Complications and Female Reproductive Tract Inflammation and Neoplasia

Nandor Gabor Than,Roberto Romero,Andrea Balogh,Eva Karpati,Salvatore Andrea Mastrolia,Orna Staretz-Chacham,Sinuhe Hahn,Offer Erez,Zoltan Papp,김종재 대한병리학회 2015 Journal of Pathology and Translational Medicine Vol.49 No.3

Galectins are an evolutionarily ancient and widely expressed family of lectins that have unique glycan-binding characteristics. They are pleiotropic regulators of key biological processes, such as cell growth, proliferation, differentiation, apoptosis, signal transduction, and pre-mRNA splicing, as well as homo- and heterotypic cell-cell and cell-extracellular matrix interactions. Galectins are also pivotal in immune responses since they regulate host-pathogen interactions, innate and adaptive immune responses, acute and chronic inflammation, and immune tolerance. Some galectins are also central to the regulation of angiogenesis, cell migration and invasion. Expression and functional data provide convincing evidence that, due to these functions, galectins play key roles in shared and unique pathways of normal embryonic and placental development as well as oncodevelopmental processes in tumorigenesis. Therefore, galectins may sometimes act as double-edged swords since they have beneficial but also harmful effects for the organism. Recent advances facilitate the use of galectins as biomarkers in obstetrical syndromes and in various malignancies, and their therapeutic applications are also under investigation. This review provides a general overview of galectins and a focused review of this lectin subfamily in the context of inflammation, infection and tumors of the female reproductive tract as well as in normal pregnancies and those complicated by the great obstetrical syndromes.

A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes

Lee, Seung Mi,Romero, Roberto,Park, Joong Shin,Chaemsaithong, Piya,Jun, Jong Kwan,Yoon, Bo Hyun Walter de Gruyter GmbH 2015 Journal of perinatal medicine Vol.43 No.4

<B>Abstract</B><P>To describe a new device for the transcervical collection of amniotic fluid (AF) in patients with ruptured membranes, and to compare the concentration of proteins in fluid retrieved by transabdominal amniocentesis and the transcervical AF collector.</P><P>Paired AF samples were collected in patients with preterm prelabor rupture of membranes (PROM) (n=11) by transabdominal amniocentesis and with the transcervical AF collector (Yoon’s AF Collector™). Three proteins known to have high concentrations in AF [α-fetoprotein (AFP), β-human chorionic gonadotrophin (β-hCG), and prolactin] were measured.</P><P>(1) There was a significant correlation between the concentrations of analytes in AF obtained by transabdominal amniocentesis and by the transcervical AF collector (r=0.94, P<0.001 for AFP; r=0.96, P<0.001 for β-hCG; r=0.72, P<0.05 for prolactin); (2) Bland-Altman plots showed no evidence of heteroscedasticity between transabdominal or transcervical AF concentrations of these markers.</P><P>There was a strong correlation between the concentrations of proteins in AF collected by amniocentesis or with the transcervical device.</P>

A high Nugent score but not a positive culture for genital mycoplasmas is a risk factor for spontaneous preterm birth

Lee, Si Eun,Romero, Roberto,Kim, Eui-Chong,Yoon, Bo Hyun Informa UK (TaylorFrancis) 2009 The journal of maternal-fetal & neonatal medicine Vol.22 No.3

<P>This study was performed to evaluate the relationship among the Nugent score for the diagnosis of bacterial vaginosis (BV), the results of vaginal fluid culture for genital mycoplasmas, and the subsequent occurrence of preterm birth.</P>

Biovar diversity of Ureaplasma urealyticum in amniotic fluid: distribution, intrauterine inflammatory response and pregnancy outcomes

김미하 ( Mi Ha Kim ),( Bo Hyun Yoon ),( Roberto Romero ),( Moon Ju Oh ),( Gil Ja Kim ),( Jung Eun Yang ),( Joong Shin Park ),( Jong Kwan Jun ) 대한산부인과학회 2001 대한산부인과학회 학술대회 Vol.86 No.-

Risk Factors for Mortality in Hospitalized Patients with COVID-19: An Overview in a Mexican Population

( Arturo Cortés-tellés ),( Stephanie López-romero ),( Roberto Mancilla-ceballos ),( Diana Lizbeth Ortíz-farías ),( Nelda Núñez-caamal ),( Esperanza Figueroa-hurtado ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.-

Background: Currently, Mexico ranks third worldwide in mortality due to coronavirus disease pandemic 2019 (COVID-19) and reliable information is scarce, with the available data focused on epidemiological characteristics. This study aimed to identify the risk factors associated with mortality and outcomes in hospitalized Mexican patients with COVID-19. Methods: We prospectively assessed patients admitted to a COVID-19 reference center in southeast Mexico between March 28 and June 30, 2020. Mortality was defined as survivors or non-survivors and univariate and multivariate logistic regression analyses were performed to explore the association of the clinical characteristics and laboratory parameters with mortality. Results: We included 200 patients with a mean age of 55 years, 69% were men and 72% had at least one chronic comorbidity. Eighty-six patients required invasive mechanical ventilation (IMV) with an overall mortality rate of 82.5%. Only 51% of the patients with IMV were admitted to the intensive care unit (ICU), with a survival rate of 27.3%, but only 7.2% for patients without ICU admissions (p=0.014). The multivariate analysis found that a neutrophil-to-lymphocyte ratio ≥9 (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.05-10.53) albumin <3.5 g/dL (OR, 3.76; 95% CI, 1.56-9.07), lactate dehydrogenase (LDH) level ≥725 U/L (OR, 5.45; 95% CI, 2.36-12.57), and IMV (OR, 64.7; 95% CI, 15.20-275.39) were independent risk factors associated with mortality. Conclusion: Neutrophil-to-lymphocyte ratio, LDH, albumin, and IMV were independent risk factors for mortality in Mexican patients with COVID-19. Also, the availability of ICU resources is invaluable for better outcomes in critically ill patients. Our results could provide clinical information for timely decision-making in low-and-middle income countries to overcome the pandemic.

Evidence to support that spontaneous preterm labor is adaptive in nature: neonatal RDS is more common in 'indicated' than in 'spontaneous' preterm birth.

Lee, Joonho,Seong, Hyo Suk,Kim, Byoung Jae,Jun, Jong Kwan,Romero, Roberto,Yoon, Bo Hyun De Gruyter 2009 Journal of perinatal medicine Vol.37 No.1

<P>The onset of preterm labor has been proposed to have survival value and to be adaptive in nature. This hypothesis would predict that induced preterm birth may be associated with higher rates of complications than spontaneous preterm birth. The purpose of this study was to determine if there is a difference in the frequency of neonatal respiratory distress syndrome (RDS), the most common neonatal complication, according to the etiology of preterm birth (e.g., preterm labor [PTL], preterm PROM, or pregnancies which ended because of maternal-fetal indications).</P>