Real-world evaluation of a QCM-based biosensor for exhaled air.

The biosensor, named "virusmeter" in this study, integrates quartz crystal microbalance technology with an immune-functionalized chip to distinguish between symptomatic patients with respiratory diseases and healthy individuals by analyzing exhaled air samples. Renowned for its compact design, rapidity, and noninvasive nature, this device yields results within a 5-min timeframe. Evaluated under controlled conditions with 54 hospitalized symptomatic COVID-19 patients and 128 control subjects, the biosensor demonstrated good overall sensitivity (98.15%, 95% CI 90.1-100.0) and specificity (96.87%, 95% CI 92.2-99.1). This proof-of-concept presents an innovative approach with significant potential for leveraging piezoelectric sensors to diagnose respiratory diseases.

Navigating the Indeterminate Zone: Surgeons' Decision-Making Factors in Treating Vertebral Metastases with Spinal Instability Scores of 7-12.

BACKGROUND: The Spinal Instability Neoplastic Score (SINS) classification system is a validated and the most widely accepted instrument for defining instability in vertebral metastasis (VM), in which lesions scoring between 7 and 12 are defined as indeterminate and the treatment is controversial. This study aimed to determine which variables more frequently are considered by spine surgeons for choosing between the conservative and the surgical treatment of VMs among patients with an indeterminate SINS. METHODS: A single-round online survey was conducted with 10 spine surgeons with expertise in the management of VMs from our AO Spine Region. In this survey, each surgeon independently reviewed demographic and cancer-related variables of 36 real-life cases of patients with vertebral metastases scored between 7 and 12 in the SINS. Bivariate and multivariate analyses were performed to identify significant SINS and non-SINS variables influencing the decision-making on surgical treatment. RESULTS: The most commonly variables considered important were the SINS element "mechanical pain", rated important for 44.4% of the cases, "lesion type" for 36.1%, and "degree of vertebral collapse" and the non-SINS factor "tumor histology" rated for 13.9% of cases. By far the factor most commonly rated unimportant was "posterior element compromise" (in 72.2% of cases). CONCLUSIONS: Surgeons relied on mechanical pain and type of metastatic lesion for treatment choices. Vertebral collapse, spinal malalignment, and mobility were less influential. Spinal mobility was a predictor of surgical versus non-surgical treatment. The only variables not identified either by surgeons themselves or as a predictor of surgery selection was the presence/degree of posterolateral/posterior element involvement.

Parasagittal resection of multilevel cervical chordoma with autograft duraplasty and unilateral vertebral artery ligation: A case report and literature review.

Chordomas are rare tumors and the recommended course of treatment typically entails surgical resection, which presents significant challenges owing to the anatomical location commonly involved and the inherent resistance of these lesions to radiation and chemotherapy. This case report details the experience of a 61-year-old male who underwent a parasagittal resection spanning from C1 to C4. A durotomy was executed to enable en bloc excision of the tumor. Subsequently, a duraplasty procedure was implemented, utilizing autologous muscle fascia grafting. A comprehensive analysis of the pertinent literature was conducted to underscore the key clinical aspects and outcomes related to this topic.

Water-assisted synthesis of stable and multicolored CsPbX3@SiO2 core-shell nanoparticles as fluorescent probes for biosensing.

Colloidal lead halide perovskite nanocrystals are highly luminescent materials with great promise as fluorescent probes in biosensing as long as their intrinsic instability in aqueous media is effectively addressed. In this study, we successfully prepared stable and multicolored CsPbX3@SiO2 (X = Cl/Br, Br and I) core-shell nanoparticles through a simple method based on the water-induced transformation of Cs4PbX6 into CsPbX3, combined with sol-gel procedures. We observed that the concentration of the Cs4PbX6 precursor plays a crucial role in the formation of isolated nanospheres with uniform silica coating and in controlling the number of core-free particles. Furthermore, our research expands this approach to other halide compositions, resulting in multicolored core-shell nanoparticles with emission wavelengths ranging from 490 to 700 nm, average sizes below 30 nm, and photoluminescence quantum yields close to 60%. Unlike in previous reports, the silica coating boosts the photoluminescence quantum yields compared to uncoated counterparts and provides increased structural stability for more than four days. Moreover, a controlled thermal treatment confers water stability to the as-synthesized nanoparticles. To establish the feasibility of the developed materials as fluorescent probes, we successfully demonstrated their specific recognition of a humanized antibody (omalizumab) used in treating patients with severe allergic asthma. This work paves the way to develop in vitro tests using CsPbX3@SiO2 core-shell nanoparticles as fluorogenic probes.

An all-in-one point-of-care testing device for multiplexed detection of respiratory infections.

The impact of the COVID-19 pandemic has reinforced the need for rapid, cost-effective, and reliable point-of-care testing (POCT) devices for massive population screening. The co-circulation of SARS-CoV-2 with several seasonal respiratory viruses highlights the need for multiplexed biosensing approaches. Herein, we present a fast and robust all-in-one POCT device for parallel viral antigen and serological analysis. The biosensing approach consists of a functionalized polycarbonate disc-shaped surface with microfluidic structures, where specific bioreagents are immobilized in microarray format, and a portable optoelectronic analyzer. The biosensor quantifies the concentration of viral antigens and specific immunoglobulins G and M for SARS-CoV-2, influenza A/B, adenovirus, and respiratory syncytial virus, using 30 µL of a sample. The semi-automated analysis of 6 samples is performed in 30 min. Validation studies performed with 135 serum samples and 147 nasopharyngeal specimens reveal high diagnostic sensitivity (98-100%) and specificity (84-98%), achieving an excellent agreement (κ = 0.937) with commercial immunoassays, which complies with the World Health Organization criteria for POC COVID-19 diagnostic tests. The versatility of the POCT device paves the way for the detection of other pathogens and analytes in the incoming post-pandemic world, integrating specific bioreagents against different variants of concerns and interests.

Sedative effects of an intramuscular or intranasal combination of sufentanil and midazolam in New Zealand White rabbits.

OBJECTIVE: To evaluate the sedative effects of a combination of sufentanil and midazolam administered intramuscularly (IM) or intranasally (IN) prior to induction of anesthesia with propofol in New Zealand White rabbits. STUDY DESIGN: Prospective, randomized, crossover, experimental study. ANIMALS: A total of 11 adult New Zealand White rabbits. METHODS: Sufentanil (0.5 µg kg-1) and midazolam (2 mg kg-1) were administered to rabbits via IM or IN route. The righting reflex was assessed, and sedation was scored. Heart rate, respiratory rate (fR) and temperature were recorded prior to treatment administration and after loss of the righting reflex. RESULTS: Measured variables remained within normal physiologic ranges for all rabbits. The only statistically significant change was for fR, which was significantly lower after sedation for both routes. The time to loss of righting reflex was 14.8 ± 6.5 and 12.5 ± 7.4 minutes and sedation scores were 6 (4-8) and 7 (6-8) for IM and IN routes, respectively, with no difference between treatments. No adverse effects were observed during the experimental period. CONCLUSIONS AND CLINICAL RELEVANCE: Sufentanil combined with midazolam administered either IM or IN resulted in moderate to deep sedation in New Zealand White rabbits at the dose rates studied.

High dose image-guided, intensity modulated radiation therapy (IG-IMRT) for chordomas of the sacrum, mobile spine and skull base: preliminary outcomes.

PURPOSE: To report preliminary outcomes of high dose image-guided intensity modulated radiotherapy (IG-IMRT) in the treatment of chordomas of the sacrum, mobile spine and skull base. METHODS: Retrospective analysis of chordoma patients treated with surgery and/or radiotherapy (RT) in a single tertiary cancer center. Initial treatment was categorized as (A) Adjuvant or definitive high-dose RT (78 Gy/39fx or 24 Gy/1fx) vs (B) surgery-only or low dose RT. The primary endpoint was the cumulative incidence of local failure. RESULTS: A total of 31 patients were treated from 2010 through 2020. Median age was 55 years, tumor location was 64% sacrum, 13% lumbar, 16% cervical and 6% clivus. Median tumor volume was 148 cc (8.3 cm in largest diameter), 42% of patients received curative-intent surgery and 65% received primary RT (adjuvant or definitive). 5-year cumulative incidence of local failure was 48% in group A vs 83% in group B (p = 0.041). Tumor size > 330 cc was associated with local failure (SHR 2.2, 95% CI 1.12 to 7.45; p = 0.028). Eight patients developed distant metastases, with a median metastases-free survival of 56.1 months. 5-year survival for patients that received high dose RT was 72% vs 76% in patients that received no or low dose RT (p = 0.63). CONCLUSION: Our study suggests high-dose photon IG-IMRT improves local control in the initial management of chordomas. Health systems should promote reference centers with clinical expertise and technical capabilities to improve outcomes for this complex disease.

Navigated multiplanar osteotomies for spinal primary bone tumors.

BACKGROUND: Establishing the proper diagnosis and rendering appropriate treatment of spinal primary bone tumors (SPBT) can result in definitive cures. Notably, malignant, or benign SPBT (i.e., with aggressive local behavior) generally require en bloc resection. Osteotomies of the vertebral body in more than 1 plane may avoid critical structures, preserve nerve functions, and reduce the volume of healthy bone resected. Here, our objective was to report how we planned and performed navigated multiplanar osteotomies for en bloc resection of 14 SPBT. METHODS: We performed a retrospective analysis of 14 patients with malignant or locally aggressive benign SPBT operated on consecutively between 2014 and 2019 utilizing preoperative 3D planning/navigation. Tumors were resected in an en bloc fashion utilizing multiplanar osteotomies. Patients were followed for a minimum of 12 postoperative months. RESULTS: Diagnoses included three benign but locally aggressive bone tumors (i.e., all osteoblastomas) and 11 primary sarcomas (i.e., six chordomas and five chondrosarcomas). Eleven tumors involved the sacrum and the other three, the thoracic spine. In 12 patients, the en bloc margins were classified as marginal (<1 cm), and in two patients, as wide (>1 cm). Intraoperative navigation facilitated the performance of 40 osteotomies in 14 patients (median = 2.9, range = 2-6). CONCLUSION: Navigated multiplanar osteotomies increased the precision and safety of en bloc resections for 14 primary spinal bone tumors SPBT that included 11 malignant and three benign/locally aggressive lesions.

Complications after partial, total or extended sacrectomy: a case series / Complicações depois de sacrectomia parcial, total ou estendida: série de casos / Complicaciones después de sacrectomía parcial, total o extendida: serie de casos

ABSTRACT Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.

RESUMO Objetivo O objetivo deste estudo é fazer um levantamento das diferentes complicações da sacrectomia parcial, total ou estendida para tratamento de tumores da coluna vertebral. Métodos O estudo é uma análise descritiva de prontuários de uma série de 18 pacientes submetidos à sacrectomia entre 2010 e 2019 em um centro terciário especializado em cirurgias de neoplasia na coluna. As variáveis analisadas foram sexo, idade, tempo de internação, diagnóstico oncológico, padrão de fixação posterior, taxa de complicações e escalas de Frankel, ASA e ECOG. Resultados Dos 18 pacientes, 10 (55,5%) eram homens e 8 (44,5%) mulheres com média de idade de 48 anos. O tempo médio de internação foi de 23 dias. Dos 18 pacientes, 8 (44,5%) contraíram infecções pós-operatórias com necessidade de cirurgia. As complicações perioperatórias incluíram fistula liquórica (22,25%), instabilidade hemodinâmica com necessidade de medicação vasoativa no pós-operatório imediato (22,25%), deiscência da ferida operatória (11,1%), abdome obstrutivo agudo (11,1%), oclusão da artéria ilíaca externa esquerda (11,1%), óbito pós-operatório imediato por infarto agudo do miocárdio (11,1%) e óbito intraoperatório por instabilidade hemodinâmica (11,1%). Conclusões A sacrectomia parcial, total ou estendida é um procedimento complexo com alta taxa de mortalidade e morbidade, mesmo em centros especializados no tratamento de tumores na coluna. Nível de evidência IV; Série de casos.

RESUMEN Objetivo El objetivo de este estudio es evaluar las diferentes complicaciones de la sacrectomía parcial, total o extendida para el tratamiento de tumores vertebrales. Métodos El estudio es un análisis descriptivo de las historias clínicas de 18 pacientes sometidos a sacrectomía entre 2010 y 2019 en un centro terciario especializado en cirugías de neoplasia de columna. Las variables analizadas fueron sexo, edad, estancia hospitalaria, diagnóstico de cáncer, patrón de fijación posterior, tasa de complicaciones, escalas de Frankel, ASA y ECOG. Resultados De los 18 pacientes, 10 (55,5%) eran hombres y 8 (44,5%) mujeres con una edad promedio de 48 años. La estancia hospitalaria promedio fue de 23 días. De los 18 pacientes, 8 (44,5%) contrajeron infecciones posoperatorias que requirieron cirugía. Las complicaciones perioperatorias incluyeron fístula de líquido cefalorraquídeo (22,25%), inestabilidad hemodinámica que requirió medicación vasoactiva en el posoperatorio inmediato (22,25%), dehiscencia de la herida quirúrgica (11,1%), abdomen obstructivo agudo (11,1%), oclusión de la arteria ilíaca externa izquierda (11,1%), muerte posoperatoria inmediata por infarto agudo de miocardio (11,1%) y muerte intraoperatoria por inestabilidad hemodinámica (11,1%). Conclusiones La sacrectomía parcial, total o extendida es un procedimiento complejo con una alta tasa de mortalidad y morbilidad, incluso en centros especializados en el tratamiento de tumores de la columna. Nivel de evidencia IV; Series de casos

Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery.

OBJECTIVES: To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS: All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS: We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS: Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.

Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery

OBJECTIVES: To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS: All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS: We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS: Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.

The sins scale in the evaluation of stability in patients with spinal metastasis / A escala sins na avaliação de doentes com metástase na coluna vertebral, relacionada à estabilidade / La escala sins en la evaluación de pacientes con metastasis en la columna vertebral, relacionada a la estabilidad

ABSTRACT Objective To evaluate the distribution of patients seen in the emergency care unit of the Instituto do Câncer do Estado de São Paulo in the categories "stable", "indeterminate" and "unstable" as classified by the SINS scale. Methods The medical charts of patients treated between May and September 2013 were reviewed. Patients with a diagnosis of spinal metastasis were analyzed and data on age, sex, primary tumor location, neurological status, and the presence and intensity of pain at rest and in movement were obtained. The SINS criteria were used to evaluate the radiological involvement of the spine. Results We included 81 patients with a mean age of 59.57 years; 32 (39.51%) men and 49 (60.49%) women. Breast (19.75%), prostate (18.52%) and lung (17.28%) were the most common primary tumor sites. Only 18 patients (22.22%) had a single lesion and 51 (62.96%) had 3 or more metastatic lesions. Of the total, 56 (69.14%) were of undetermined stability, 19 were stable (23.46%) and 6 were unstable (7.41%). Twenty-two (27.2%) presented neurological deficit in the physical examination. None of the patients with severe deficit, Frankel A or B, were stable according to the SINS classification. All unstable lesions presented with kyphotic and/or scoliotic deviation (p <0.001). Most patients with undetermined lesions (78.6%) and all patients with unstable lesions had mechanical pain (p = 0.001). Conclusion In this case series, there was a high rate of patients classified by the SINS scale as of undetermined instability (69.14%). There was a high number of patients with multiple metastases (62.96%), which was not considered a modifier of the SINS instability criteria and which needs to be the focus of future studies. Level of evidence IV; Case Series.

RESUMO Objetivo Avaliar a distribuição de doentes atendidos no pronto-socorro do Instituto do Câncer do Estado de São Paulo nas categorias "estável", "indeterminada" e "instável" pela escala SINS. Métodos Levantaram-se prontuários dos doentes atendidos entre maio e setembro de 2013. Foram avaliados os doentes com diagnóstico de metástase vertebral e obtidos dados sobre idade, sexo, localização primária, situação neurológica, presença e intensidade da dor no repouso e no movimento. Os critérios da escala SINS foram utilizados para pontuação do comprometimento radiológico da coluna. Resultados Foram incluídos 81 doentes com média de idade de 59,57 anos; 32 (39,51%) homens e 49 (60,49%) mulheres, sendo que a mama (19,75%), próstata (18,52%) e pulmão (17,28%) foram as localizações primárias mais comuns. Apenas 18 doentes (22,22%) apresentaram lesão isolada e 51 (62,96%) apresentaram 3 ou mais lesões metastáticas. Do total, 56 (69,14%) apresentaram coluna com estabilidade indeterminada; 19 (23,46%) estável e 6 (7,41%) instável. Vinte e dois (27,2%) apresentaram déficit neurológico ao exame físico. Dos doentes com déficit grave, Frankel A ou B, nenhum apresentou coluna estável através da classificação SINS. Todas as lesões instáveis apresentaram-se com desvio cifótico e/ou escoliótico (p<0,001). A maioria dos pacientes com lesões indeterminadas (78,6%) apresentou dor de caráter mecânico e todos os pacientes com lesão instável apresentaram dor mecânica (p=0,001). Conclusões Nessa série de casos, o uso da escala SINS teve uma taxa elevada de doentes com coluna classificada como indeterminada (69,14%). Há um número elevado de doentes com metástases múltiplas (62,96%), fato não considerado pela SINS como modificador nos critérios de instabilidade e que precisa ser alvo de novos estudos. Nível de evidência IV; Serie de casos.

RESUMEN Objetivo Evaluar la distribución de los enfermos en la unidad de primeros auxilios del Instituto del Cáncer de Estado de São Paulo en las categorías "estable", "indeterminada" e "inestable" por la escala SINS. Métodos Se levantaron historiales clínicos de los enfermos atendidos entre mayo y septiembre de 2013. Fueron evaluados los enfermos con diagnóstico de metástasis vertebral, y se obtuvieron datos sobre edad, sexo, localización primaria, situación neurológica, presencia e intensidad del dolor en reposo y en movimiento. Los criterios de la escala SINS se utilizaron para puntuación del compromiso radiológico de la columna. Resultados Fueron incluidos 81 pacientes con promedio de edad de 59,57 años; 32 (39,51%) hombres y 49 (60,49%) mujeres, siendo que la mama (19,75%), próstata (18,52%) y pulmón (17,28%) fueron las localizaciones primarias más comunes. Sólo 18 enfermos (22,22%) presentaron lesión aislada y 51 (62,96%) presentaron tres o más lesiones metastásicas. Del total, 56 (69,14%) presentaron columna con estabilidad indeterminada; 19 (23,46%) estable y 6 estable (7,41%) inestable. Veintidós (27,2%) presentaron déficit neurológico al examen físico. De los enfermos con déficit grave, Frankel A o B, ninguno presentó columna estable a través de la clasificación SINS. Todas las lesiones inestables se presentaron con desviación cifótica y/o escoliótica (p <0,001). La mayoría de los pacientes con lesiones indeterminadas (78,6%) presentó dolor de carácter mecánico y todos los pacientes con lesión inestable presentaron dolor mecánico (p = 0,001). Conclusiones En esta serie de casos, el uso de la escala SINS tuvo una tasa elevada de enfermos con columna clasificada como indeterminada (69,14%). Hay un número elevado de enfermos con metástasis múltiples (62,96%), hecho no considerado por la SINS como modificador en los criterios de inestabilidad y que necesita ser objeto de nuevos estudios. Nivel de evidencia IV; Serie de casos.

Acrochordonous plaque in a Doberman Pinscher dog.

An 8-yr old, neutered female Doberman Pinscher was presented for dermatological evaluation due to numerous pruritic, non-pigmented nodules that created a plaque in the lumbo-sacral region. This report is the first published photographic record of an acrochordonous plaque in a dolichocephalic dog and is the first reported case in Brazil.

SPINE METASTASIS OF INTRACRANIAL HEMANGIOPERICYTOMA: CASE REPORT OF TWO TREATMENTS.

OBJECTIVE: To report the use of two techniques (radiosurgery and en bloc vertebrectomy) on the same patient for the treatment of two metastases in different sites of the spine arising from intracranial hemangiopericytoma. Intracranial hemangiopericytomas are rare, comprising approximately 2.4% of meningeal tumors and <1% of all tumors of the central nervous system. Metastases to the spine are even rarer: The largest case series reported in the literature has 5 and 7 cases. METHODS: A 37-year-old man diagnosed with intracranial hemangiopericytoma was referred for a metastatic lesion in T12 and underwent en bloc resection using the Tomita technique. RESULTS: The disease evolved with a metastasis to T2 treated by radiosurgery with 1600 cGy. The patient died 1,706 days after the en bloc resection of T12 and 1324 days after the radiosurgery of T2, and no recurrence occurred in these locations due to progression of the systemic diseases (liver and central nervous system). CONCLUSION: This is the first case reported in the literature in which two different techniques were used to treat metastatic lesions in the spine from an intracranial hemangiopericytoma and is unique for its use of two treatments in the same patient. Level of evidence: V, case report.

OBJETIVO: Reportar o uso de duas técnicas (radiocirurgia e vertebrectomia em bloco) no mesmo paciente, para o tratamento de metástases de um hemangiopericitoma intracraniano em dois locais da coluna. Hemangiopericitomas intracranianos são raros, consistindo em cerca de 2,4% dos tumores da meninge e menos de 1% de todos os tumores do sistema nervoso central, e metástases para a coluna são ainda mais raras: as maiores séries de casos publicada tinham 5 e 7 casos. MÉTODOS: Um homem de 37 anos com diagnóstico de hemangiopericitoma intracraniano foi encaminhado para resecção em bloco de lesão metastática em T12 com a técnica de Tomita. RESULTADOS: A doença evoluiu com metástase em T2, tratada com radiocirurgia (dose de 1600 cGy). O paciente morreu 1.706 dias após a resecção em bloco de T12 e 1.324 dias após a radiocirurgia de T2, livre de recorrência nessas localizações, devido a progressão sistêmica da doença (para fígado e sistema nervoso central). CONCLUSÃO: Este é o primeiro caso na literatura no qual duas técnicas diferentes foram usadas pra tratar lesões metastáticas da coluna de hemangiopericitoma intracraniano, único pelo uso de duas técnicas de tratamento no mesmo paciente. Nível de evidência V, relato de caso.

Spine metastasis of intracranial hemangiopericytoma: case report of two treatments / Metástase na coluna de hemangiopericitoma intracraniano: relato de 2 tratamentos

ABSTRACT Objective: To report the use of two techniques (radiosurgery and en bloc vertebrectomy) on the same patient for the treatment of two metastases in different sites of the spine arising from intracranial hemangiopericytoma. Intracranial hemangiopericytomas are rare, comprising approximately 2.4% of meningeal tumors and <1% of all tumors of the central nervous system. Metastases to the spine are even rarer: The largest case series reported in the literature has 5 and 7 cases. Methods: A 37-year-old man diagnosed with intracranial hemangiopericytoma was referred for a metastatic lesion in T12 and underwent en bloc resection using the Tomita technique. Results: The disease evolved with a metastasis to T2 treated by radiosurgery with 1600 cGy. The patient died 1,706 days after the en bloc resection of T12 and 1324 days after the radiosurgery of T2, and no recurrence occurred in these locations due to progression of the systemic diseases (liver and central nervous system). Conclusion: This is the first case reported in the literature in which two different techniques were used to treat metastatic lesions in the spine from an intracranial hemangiopericytoma and is unique for its use of two treatments in the same patient. Level of evidence: V, case report

RESUMO Objetivo: Reportar o uso de duas técnicas (radiocirurgia e vertebrectomia em bloco) no mesmo paciente, para o tratamento de metástases de um hemangiopericitoma intracraniano em dois locais da coluna. Hemangiopericitomas intracranianos são raros, consistindo em cerca de 2,4% dos tumores da meninge e menos de 1% de todos os tumores do sistema nervoso central, e metástases para a coluna são ainda mais raras: as maiores séries de casos publicada tinham 5 e 7 casos. Métodos: Um homem de 37 anos com diagnóstico de hemangiopericitoma intracraniano foi encaminhado para resecção em bloco de lesão metastática em T12 com a técnica de Tomita. Resultados: A doença evoluiu com metástase em T2, tratada com radiocirurgia (dose de 1600 cGy). O paciente morreu 1.706 dias após a resecção em bloco de T12 e 1.324 dias após a radiocirurgia de T2, livre de recorrência nessas localizações, devido a progressão sistêmica da doença (para fígado e sistema nervoso central). Conclusão: Este é o primeiro caso na literatura no qual duas técnicas diferentes foram usadas pra tratar lesões metastáticas da coluna de hemangiopericitoma intracraniano, único pelo uso de duas técnicas de tratamento no mesmo paciente. Nível de evidência V, relato de caso.

Current treatment strategy for newly diagnosed chordoma of the mobile spine and sacrum: results of an international survey.

OBJECTIVEThe purpose of this study was to investigate the spectrum of current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum.METHODSA survey on the treatment of spinal chordoma was distributed electronically to members of the AOSpine Knowledge Forum Tumor, including neurosurgeons, orthopedic surgeons, and radiation oncologists from North America, South America, Europe, Asia, and Australia. Survey participants were pre-identified clinicians from centers with expertise in the treatment of spinal tumors. The suvey responses were analyzed using descriptive statistics.RESULTSThirty-nine of 43 (91%) participants completed the survey. Most (80%) indicated that they favor en bloc resection without preoperative neoadjuvant radiation therapy (RT) when en bloc resection is feasible with acceptable morbidity. The main area of disagreement was with the role of postoperative RT, where 41% preferred giving RT only if positive margins were achieved and 38% preferred giving RT irrespective of margin status. When en bloc resection would result in significant morbidity, 33% preferred planned intralesional resection followed by RT, and 33% preferred giving neoadjuvant RT prior to surgery. In total, 8 treatment protocols were identified: 3 in which en bloc resection is feasible with acceptable morbidity and 5 in which en bloc resection would result in significant morbidity.CONCLUSIONSThe results confirm that there is treatment variability across centers worldwide for managing newly diagnosed chordoma of the mobile spine and sacrum. This information will be used to design an international prospective cohort study to determine the most appropriate treatment strategy for patients with spinal chordoma.

Four-level en bloc vertebrectomy: a novel technique and literature review / Vertebrectomia em bloco em quatro níveis: nova técnica e revisão da literatura

ABSTRACT Objective: To demonstrate a novel technique for multilevel en bloc post-vertebrectomy reconstruction. Methods: A novel technique for en bloc multiple post-vertebrectomy reconstruction was used in a patient presenting for curative resection of Ewing's Sarcoma at the oncology center of a public university hospital. Results: The procedure described was feasible for en bloc resection of the four vertebrae. The reconstruction was acceptable and satisfactory in terms of mechanical stability and was without any neurological sequelae in the patient. Conclusion: The use of an allograft with a locked intramedullary nail was an adequate solution for reconstructing the anterior and medial spines after multilevel vertebrectomy. In addition, the association of four intramedullary nails provided stability to the reconstruction. Immediate benefits of the technique compared to other commonly used techniques were shorter hospitalization times and reduced surgical morbidity. Level of Evidence V, Clinical study of a new surgical technique and a literature review.

RESUMO Objetivo: Demonstrar uma nova técnica de reconstrução por vertebrectomia em bloco multinível. Métodos: Descrição de uma reconstrução pós-vertebrectomia em bloco multinível, em paciente tratado num hospital oncológico público universitário, com indicação de ressecção curativa de sarcoma de Ewing. Resultados: O procedimento proposto foi viável para a ressecção em bloco de quatro vértebras e a reconstrução foi aceitável e satisfatória em termos de estabilidade mecânica, sem causar dano neurológico ao paciente. Conclusão: O uso de aloenxerto com parafuso intramedular bloqueado é uma solução adequada para a reconstrução da coluna anterior e medial após vertebrectomias multiníveis. Além disso, a associação de quatro parafusos intramedulares dá estabilidade à reconstrução. Benefícios imediatos da técnica são o tempo de hospitalização mais curto e a redução da morbidade cirúrgica, em comparação com outras técnicas, comumente utilizadas. Nível de Evidência V, Estudo clínico de nova técnica cirúrgica e revisão da literatura.

The role of the exogenous supply of adenosine triphosphate in the expression of Bax and Bcl2L1 genes in intestinal ischemia and reperfusion in rats 1.

PURPOSE: To investigate the role of the exogenous supply of adenosine triphosphate (ATP) in the expression of Bax and Bcl2L1 genes in intestinal ischemia and reperfusion (IR) in rats. METHODS: The study was designed as a randomized controlled trial with a blinded assessment of the outcome. Eighteen adult male Wistar-EPM1 rats were housed under controlled temperature and light conditions (22-23°C, 12 h light/dark cycle). The animals were randomly divided into 3 groups: 1. Sham group (SG): no clamping of the superior mesenteric artery; 2. Ischemia and reperfusion group (IRG): 3. Ischemia and reperfusion plus ATP (IRG + ATP). ATP was injected in the femoral vein before and after ischemia. Afterwards, intestinal segments were appropriately removed and processed for Endothelial Cell Biology Rat RT2 Profiler PCR Array. RESULTS: ATP promoted the upregulation of Bcl2L1 gene expression, whereas it did not have significant effects on Bax gene expression. In addition, the relation of Bax/Bcl2L1 gene expression in the IRG group was 1.39, whereas it was 0.43 in the IRG + ATP group. Bcl2L1 plays a crucial role in protecting against intestinal apoptosis after ischemia and reperfusion. Increased Bcl2L1 expression can inhibit apoptosis while decreased Bcl2L1 expression can trigger apoptosis. CONCLUSION: Adenosine triphosphate was associated with antiapoptotic effects on the rat intestine ischemia and reperfusion by upregulating of Bcl2L1 gene expression.

The role of the exogenous supply of adenosine triphosphate in the expression of Bax and Bcl2L1 genes in intestinal ischemia and reperfusion in rats

Abstract Purpose: To investigate the role of the exogenous supply of adenosine triphosphate (ATP) in the expression of Bax and Bcl2L1 genes in intestinal ischemia and reperfusion (IR) in rats. Methods: The study was designed as a randomized controlled trial with a blinded assessment of the outcome. Eighteen adult male Wistar-EPM1 rats were housed under controlled temperature and light conditions (22-23°C, 12 h light/dark cycle). The animals were randomly divided into 3 groups: 1. Sham group (SG): no clamping of the superior mesenteric artery; 2. Ischemia and reperfusion group (IRG): 3. Ischemia and reperfusion plus ATP (IRG + ATP). ATP was injected in the femoral vein before and after ischemia. Afterwards, intestinal segments were appropriately removed and processed for Endothelial Cell Biology Rat RT2 Profiler PCR Array. Results: ATP promoted the upregulation of Bcl2L1 gene expression, whereas it did not have significant effects on Bax gene expression. In addition, the relation of Bax/Bcl2L1 gene expression in the IRG group was 1.39, whereas it was 0.43 in the IRG + ATP group. Bcl2L1 plays a crucial role in protecting against intestinal apoptosis after ischemia and reperfusion. Increased Bcl2L1 expression can inhibit apoptosis while decreased Bcl2L1 expression can trigger apoptosis. Conclusion: Adenosine triphosphate was associated with antiapoptotic effects on the rat intestine ischemia and reperfusion by upregulating of Bcl2L1 gene expression.

SACRECTOMY ASSOCIATED WITH VERTEBRECTOMY: A NEW TECHNIQUE USING DOWEL GRAFTS FROM CADAVERS.

OBJECTIVE: The purpose of this study was to demonstrate, in a case series, a new sacrectomy technique using an iliac crest dowel graft from a cadaver. STUDY DESIGN: Report of a case series with description of a new surgical technique. METHODS: The technique uses four bars to support the posterior spine and a dowel graft in the iliac wings, with compression of the spine and pelvis above it, to support the anterior spine. Three cases were operated on, and in all of them, a vertebrectomy was used. RESULTS: In the first two cases, the technique was performed as a two-stage surgery. The first stage was performed via the anterior and peritoneal access routes, and the second stage via the posterior access route. In the third case, retroperitoneal access via the anterior route meant that the technique could be performed in one stage, resulting in an overall reduction in surgical time (1250 vs. 1750 vs. 990 minutes, respectively). CONCLUSION: The new technique enables fixation with biomechanical stability, which is essential to support the stress in the lumbosacral transition and promote earlier rehabilitation. Level of evidence IV, case series.

OBJETIVO: O propósito do estudo foi demonstrar, por meio de uma série de casos, uma nova técnica de sacrectomia com uso de enxerto encavilhado da crista ilíaca de cadáver. DESENHO DO ESTUDO: Relato de série de casos com descrição de uma nova técnica cirúrgica. MÉTODOS: A técnica usa quatro barras para sustentação da parte posterior da coluna e um enxerto encavilhado nas asas do ilíaco, com compressão da coluna e pelve sobre ele, para suporte da parte anterior da coluna. Foram operados três casos e em todos eles, realizou-se vertebrectomia. RESULTADOS: Nos dois primeiros casos, a técnica foi utilizada em duas etapas. A primeira etapa foi realizada por via anterior e acesso peritoneal, e a segunda etapa, por via posterior. No terceiro caso, o acesso retroperitoneal por via anterior significou que a técnica pôde ser realizada em apenas uma etapa, resultando em redução do tempo cirúrgico total (1250 x 1750 x 990 minutos, respectivamente). CONCLUSÃO: A nova técnica permite a fixação com estabilidade biomecânica, que é essencial para suportar a tensão na transição lombossacral e para a reabilitação precoce. Nível de evidência IV, série de casos.