ABSTRACT
BACKGROUND AND PURPOSE: Radiation-induced changes can occur after stereotactic radiosurgery for brain AVMs, potentially causing symptomatic complications. We evaluated the incidence of such changes and the efficacy of repeat gamma knife radiosurgery for incompletely obliterated AVMs. MATERIALS AND METHODS: We retrospectively evaluated 150 patients who underwent gamma knife radiosurgery for AVMs between 2002 and 2020; twenty-five underwent further radiosurgical procedures for incompletely obliterated AVMs. We recorded the median margin doses at the first (median, 20 Gy; range, 12-23 Gy; AVM volume, 0.026-31.3 mL) and subsequent procedures (median, 18 Gy; range, 12-23 Gy; AVM volume, 0.048-9.2 mL). RESULTS: After the first treatment, radiologic radiation-induced changes developed in 48 (32%) patients, eight of whom had symptomatic changes. After repeat gamma knife radiosurgery, 16 of 25 patients achieved complete AVM obliteration (64%). The development of radiation-induced changes after the first treatment was significantly associated with successful obliteration by subsequent radiosurgery (OR = 24.0, 95% CI 1.20-483, P = .007). Radiation-induced changes occurred in only 5 (20%) patients who underwent a second gamma knife radiosurgery, one of whom experienced transient neurologic deficits. Between the first and repeat gamma knife radiosurgery procedures, there was no significant difference in radiologic and symptomatic radiation-induced changes (P = .35 and P = 1.0, respectively). CONCLUSIONS: Radiation-induced changes after the first gamma knife radiosurgery were associated with AVM obliteration after a repeat procedure. The risk of symptomatic radiation-induced changes did not increase with retreatment. When the first procedure fails to achieve complete AVM obliteration, a favorable outcome can be achieved by a repeat gamma knife radiosurgery, even if radiation-induced changes occur after the first treatment.
Subject(s)
Intracranial Arteriovenous Malformations , Radiosurgery , Humans , Radiosurgery/adverse effects , Radiosurgery/methods , Treatment Outcome , Follow-Up Studies , Retrospective Studies , Intracranial Arteriovenous Malformations/radiotherapy , Intracranial Arteriovenous Malformations/surgery , Intracranial Arteriovenous Malformations/complications , BrainSubject(s)
Pulmonary Alveolar Proteinosis/diagnosis , Pulmonary Alveolar Proteinosis/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Child , Comorbidity , Dyspnea/epidemiology , Female , Hematologic Diseases/epidemiology , Humans , Japan , Male , Middle Aged , Oxygen/blood , Prognosis , Pulmonary Alveolar Proteinosis/pathology , Respiratory Function Tests , Sex Factors , Smoking/epidemiology , Young AdultABSTRACT
BACKGROUND: Conventional measures of the severity of alveolar proteinosis (AP) include alveolar-arterial oxygen gradient ([A - a]DO(2)), vital capacity (VC), and carbon monoxide transfer factor (TLCO), but alternative serological measures have been sought. Granulocyte-macrophage colony stimulating factor (GM-CSF) neutralising autoantibody is found in patients with idiopathic acquired AP. We have investigated the interrelationships between the levels of this antibody and those of surfactant protein (SP)-A and -B, lactate dehydrogenase (LDH), and conventional measures of disease severity, and the capacity of these parameters to predict the response to rhGM-CSF treatment. METHODS: Blood levels of anti-GM-CSF antibodies, SP-A, SP-B, LDH, and [A - a]DO(2), VC, and TLCO were measured before rhGM-CSF treatment and every 2 weeks thereafter in 14 patients with AP. RESULTS: At baseline, high levels of anti-GM-CSF antibodies and increased SP-A and SP-B levels were seen in all patients, and LDH was raised in 83%. SP-A was highly correlated with [A - a]DO(2), VC, and TLCO (p
Subject(s)
Granulocyte-Macrophage Colony-Stimulating Factor/blood , Protein Precursors/blood , Proteolipids/blood , Pulmonary Alveolar Proteinosis/blood , Pulmonary Surfactant-Associated Protein A/blood , Adolescent , Adult , Autoantibodies/blood , Enzyme-Linked Immunosorbent Assay , Female , Granulocyte-Macrophage Colony-Stimulating Factor/therapeutic use , Humans , Immunoglobulin G/blood , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Prospective Studies , Pulmonary Alveolar Proteinosis/drug therapy , Recombinant ProteinsABSTRACT
1. Phosphofructokinases (PFKs) in immature and adult rat submandibular glands were purified to near homogeneity, and their properties were compared. 2. PFK in immature gland was less sensitive to inhibition by ATP than adult PFK. 3. Saturation curve for fructose 6-phosphate of PFK in immature gland was less sigmoidal than that of adult PFK indicating the lower cooperativity of subunits in immature PFK. 4. Fructose 2,6-bisphosphate relieved PFK from inhibition by ATP in adult gland, but a similar effect was not clearly observed in immature gland PFK. 5. Adult PFK was a heterotetramer consisting of C-, M-, L-subunits, but in immature PFK another type of subunit, which was slightly smaller than L-subunit, existed in addition to C-, M- and L-subunits.
