http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis
Hinojosa-Gonzalez David Eugenio,Roblesgil-Medrano Andres,Villarreal-Espinosa Juan Bernardo,Tellez-Garcia Eduardo,Bueno-Gutierrez Luis Carlos,Rodriguez-Barreda Jose Ramon,Flores-Villalba Eduardo,Martin 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.4
Bones are the third most common location for solid tumor metastasis affecting up to 10% of patients with solid tumors. When the spine is involved, thoracic and lumbar vertebrae are frequently affected. Access to spinal lesions can be through minimally invasive surgery (MIS) or traditional open surgery (OS). This study aims to determine which method provides an advantage. Following the PRISMA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines, a systematic review was conducted to identify studies that compare MIS with OS in patients with spinal metastatic disease. Data were analyzed using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). Ten studies were included. Operative time was similar among groups at -35.23 minutes (95% confidence interval [CI], -73.36 to 2.91 minutes; <i>p</i>=0.07). Intraoperative bleeding was lower in MIS at -562.59 mL (95% CI, -776.97 to -348.20 mL; <i>p</i><0.00001). OS procedures had higher odds of requiring blood transfusions at 0.26 (95% CI, 0.15 to 0.45; <i>p</i><0.00001). Both approaches instrumented similar numbers of levels at -0.05 levels (95% CI, -0.75 to 0.66 levels; <i>p</i>=0.89). We observed a decreased need for postoperative bed rest at -1.60 days (95% CI, -2.46 to -0.74 days; <i>p</i>=0.0003), a shorter length of stay at -3.08 days (95% CI, -4.50 to -1.66 days; <i>p</i>=0.001), and decreased odds of complications at 0.60 (95% CI, 0.37 to 0.96; <i>p</i>=0.03) in the MIS group. Both approaches revealed similar reintervention rates at 0.65 (95% CI, 0.15 to 2.84; <i>p</i>=0.57), effective rates of reducing metastasis-related pain at -0.74 (95% CI, -2.41 to 0.94; <i>p</i>=0.39), and comparable scores of the Tokuhashi scale at -0.52 (95% CI, -2.08 to 1.05; <i>p</i>=0.41), Frankel scale at 1.00 (95% CI, 0.60 to 1.68; <i>p</i>=1.0), and American Spinal Injury Association Scale at 0.53 (95% CI, 0.21 to 1.37; <i>p</i>=0.19). MIS appears to provide advantages over OS. Larger and prospective studies should fully detail the role of MIS as a treatment for spine metastasis.
Carlos A. Hinojosa,Javier E. Anaya-Ayala,Hugo Laparra-Escareno,Rene Lizola,Adriana Torres-Machorro 대한혈관외과학회 2017 Vascular Specialist International Vol.33 No.3
Marfan syndrome is a connective tissue disorder associated with aortic dissection, aneurysmal degeneration and rupture. These cardiovascular complications represent the main cause of mortality, therefore repair is indicated. We present a 35-year-old woman who experienced acute onset of chest pain. Her imaging revealed a chronic DeBakey type I dissection with aortic root dilation and descending thoracic aneurysmal degeneration. She underwent a Bentall procedure and endovascular exclusion of the descending thoracic aortic aneurysm. She was closely followed and 2 years later a computed tomography angiography (CTA) revealed the aneurysmal degeneration of the thoracoabominal aorta and bilateral iliac arteries. The patient underwent a composite reconstruction using multivisceral branched and bifurcated Dacron grafts. At 5 years from her last surgery, a CTA revealed no new dissection or further aneurysmal degenerations. Aortic disease in Marfan patients is a complex clinical problem that may lead to secondary or tertiary aortic reconstructions; close follow-up is mandatory.
Carlos A. Hinojosa,Javier E. Anaya-Ayala,Hugo Laparra-Escareno,Rene Lizola,Adriana Torres-Machorro 대한혈관외과학회 2016 Vascular Specialist International Vol.32 No.2
The aortic bifurcation and iliac vessels are common sites of atherosclerotic occlusive disease causing the clinical expression known as “Leriche’s syndrome”. An aortobifemoral bypass grafting in the setting of a septic groin remains a significant challenge to vascular surgeons. We present a 65-year-old male with complete occlusion of the distal aorta and iliac arteries; he had undergone a leftaxillo-femoral and femoral-femoral artery bypass 2 years prior to our evaluation. Owing to a complex graft infection in the right groin and worsening lower extremity ischemia, we performed an aortobifemoral reconstruction through the right obturator membrane. This report highlights the safety and efficacy of the obturator bypass for avoiding infected groins while preserving vascular continuity and durability with 78 months of secondary patency rate.
( Steven R. Potter ),( Randall Hinojosa ),( Cliff D. Miles ),( Dan O’brien ),( David J. Ross ) 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.4
Background: Donor-derived, cell-free DNA (dd-cfDNA) level correlates with allograft injury with clinical validity and utility for quiescence and active acute rejection (AR) in kidney transplant recipients. We analyzed trends in dd-cfDNA level immediately preceding and during the coronavirus disease 2019 (COVID-19) pandemic with implemented “shelter in place” and a tele-health strategy with remote home phlebotomy to limit COVID-19 exposure. Methods: During COVID-19 in the United States (US), we surveyed weekly (January 6, 2020-May 25, 2020) metrics for dd-cfDNA corresponding to both a low risk for active rejection (dd-cfDNA < 0.5%) and cohorts with indeterminate levels of 0.5% to 1.0% and > 1.0%. During the study timeframe, over 11,000 patient samples (67%) from 150 kidney transplantation centers were transitioned from standard facility-based to remote phlebotomy. Results: The proportion of dd-cfDNA samples, analyzed in 21 weekly aggregated cohorts by risk-stratification category, was unchanged during the COVID-19 escalation in the US. Linearized slopes for numbers of samples corresponding to indeterminate risk for AR cohorts of > 1.0% and 0.5% to 1.0% were -0.31 and -0.12, respectively; indicating that prevalence of these “at risk for AR cohorts” decreased during remote surveillance. Approximately 73% of samples corresponded to low risk of AR (dd-cfDNA < 0.5%), while an additional 15% of samples had dd-cfDNA level ≤ 1.0%. Conclusion: The combination of remote home phlebotomy including dd-cfDNA analysis and a tele-health program offer a new paradigm that may substantially improve patient compliance and assuage anxiety regarding the state of kidney allograft health during the COVID-19 pandemic. Further prospective multi-center studies with robust outcomes data are warranted.
Left Common Femoral to Right Common Iliac Venous Bypass Through a Retroperitoneal Exposure
Cesar Cuen-Ojeda,Luis O Bobadilla-Rosado,Ramon Garcia-Alva,Luis H. Arzola,Javier E. Anaya-Ayala,Carlos A. Hinojosa 대한혈관외과학회 2018 Vascular Specialist International Vol.34 No.4
The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.
Successful Treatment of a Superficial Femoral Artery Pseudoaneurysm with Balloon Tamponade
Hugo Laparra-Escareno,Cesar Cuen-Ojeda,Ramon García-Alva,Gabriel Lopez-Pena,Javier E. Anaya-Ayala,Carlos A. Hinojosa 대한혈관외과학회 2019 Vascular Specialist International Vol.35 No.3
The development of post-catheterization arterial pseudoaneurysms is one of the most common vascular access complications following angiographies and endovascular interventions. Different therapeutic options to treat these lesions have been used. We herein report the case of a 79-year-old woman who was referred to our service for evaluation with a post-catheterization superficial femoral artery pseudoaneurysm measuring 4 cm. Owing to the anatomical location of the arterial pseudoaneurysm and the patient’s refusal to undergo open surgery, we treated the lesion using an endovascular approach with a balloon tamponade. The procedure was successful, and the patient recovered well and was discharged from the hospital without complications. At 6-month follow-up she remained symptom-free and without recurrence.
Examination of an Audiologist’s Response to Patient’s Expression of Symptoms: A Pilot Study
Ashley L. Dockens,Monica L. Bellon-Harn,Erin S. Burns,Vinaya Manchaiah,Orlando Hinojosa 대한청각학회 2017 Journal of Audiology & Otology Vol.21 No.2
This pilot study explores audiologist-patient interactions during initial evaluations or consultations. In particular, an audiologist’s response to patient symptoms is examined. Conversationsbetween audiologist and patients were recorded using a digital recorder, which weretranscribed, and analyzed using the Codes for Human Analysis of Transcripts and Child LanguageAnalysis computer programs. Mean length of turn and frequency of utterances relatedto explicit discussion or description of symptoms or the patient’s interpretation of symptomswas determined. Study sample: six audiologist-patient interactions were recorded and transcribed. A single audiologist was used for this pilot investigation. Results suggest that duringthe initial audiological consultations related to hearing difficulties the audiologist producedmore utterances related to explicit description of the symptoms, whereas whenduring the sessions about complex disorder and hearing aid consultation the audiologistproduced more utterances related to the patient’s interpretation of the symptoms. Also, amore equitable distribution of words and utterances per turn are observed during the initialconsultation about hearing difficulties when compared to complex disorders and hearingaid consultation sessions where the audiologist was dominant within the interaction. Thispreliminary study reveals unique insights to audiologist’s communication behavior duringaudiology consultation session. Efforts are needed to educate and promote appropriatecommunication between audiologists’ and patients, which could result in increased patientsatisfaction.
Kim, Taeho,Momin, Eric,Choi, Jonghoon,Yuan, Kristy,Zaidi, Hasan,Kim, Jaeyun,Park, Mihyun,Lee, Nohyun,McMahon, Michael T.,Quinones-Hinojosa, Alfredo,Bulte, Jeff W. M.,Hyeon, Taeghwan,Gilad, Assaf A. American Chemical Society 2011 JOURNAL OF THE AMERICAN CHEMICAL SOCIETY - Vol.133 No.9
<P/><P>Mesoporous silica-coated hollow manganese oxide (HMnO@mSiO<SUB>2</SUB>) nanoparticles were developed as a novel <I>T</I><SUB>1</SUB> magnetic resonance imaging (MRI) contrast agent. We hypothesized that the mesoporous structure of the nanoparticle shell enables optimal access of water molecules to the magnetic core, and consequently, an effective longitudinal (<I>R</I><SUB>1</SUB>) relaxation enhancement of water protons, which value was measured to be 0.99 (mM<SUP>−1</SUP>s<SUP>−1</SUP>) at 11.7 T. Adipose-derived mesenchymal stem cells (MSCs) were efficiently labeled using electroporation, with much shorter <I>T</I><SUB>1</SUB> values as compared to direct incubation without electroporation, which was also evidenced by signal enhancement on <I>T</I><SUB>1</SUB>-weighted MR images in vitro. Intracranial grafting of HMnO@mSiO<SUB>2</SUB>-labeled MSCs enabled serial MR monitoring of cell transplants over 14 days. These novel nanoparticles may extend the arsenal of currently available nanoparticle MR contrast agents by providing positive contrast on <I>T</I><SUB>1</SUB>-weighted images at high magnetic field strengths.</P>
Cesar Cuen-Ojeda,Javier E. Anaya-Ayala,Rene Lizola,Julio A. Navarro-Iniguez,Lizeth Luna,Manuel Guerrero-Hernandez,Carlos A. Hinojosa 대한혈관외과학회 2020 Vascular Specialist International Vol.36 No.1
Iodinated contrast is the most common contrast agent used during endovascular abdominal aneurysm repair (EVAR). However, its use may worsen kidney function in patients with renal insufficiency. Previous studies have demonstrated the safety and effectiveness of carbon dioxide (CO2)-EVAR. Here, we report cases of three male patients with mild renal insufficiency (mean age: 79 years) that successfully underwent CO2-EVAR using INCRAFT ultra-low profile endografts. CO2 angiography provided the necessary vascular roadmap for safe and effective percutaneous EVAR, eliminating the need for iodinated contrast media and preventing contrastinduced nephropathy.