Tumor regio pineal memiliki insiden 0.4-1% dari tumor intracranial. Lokasinya yang dalam, di antara kedua hemisfer otak, berdekatan dengan batang otak dan hipotalamus menjadi tantangan bagi bedah ...saraf. Operasi dengan supracerebellar approach dalam posisi duduk adalah pilihan terbaik untuk mencapai lokasi. Posisi duduk juga memfasilitasi lapang operasi yang optimal dengan retraksi cerebellum minimal. Posisi duduk membawa tantangan tersendiri untuk dokter anestesi, dengan segala kompleksitas saat memposisikan pasien dan risiko komplikasinya. Venous air embolism adalah pertimbangan utama yang jika tidak terdeteksi dan ditangani dapat menyebabkan kolaps kardiovaskular dalam waktu singkat. Pasien laki-laki berusia 38 tahun datang dengan keluhan nyeri kepala berat dan penglihatan kabur sejak 4 bulan sebelum masuk rumah sakit. Hasil Magnetic Resonance Imaging menunjukkan adanya massa di regio pineal dengan edema perifokal, tanpa deviasi struktur midline. Pasien dilakukan kraniotomi pengangkatan tumor dalam posisi duduk. Operasi berjalan selama 10 jam dengan hemodinamika stabil dan tidak terjadi komplikasi, dalam anestesi umum dengan kombinasi intravena dan inhalasi. Prinsip ABCDE neuroanestesi, posisi duduk dan implikasinya, dan lokasi operasi yang sulit adalah pertimbangan-pertimbangan anestesi yang harus diperhatikan pada pasien ini. Evaluasi preoperasi yang baik, komunikasi dan koordinasi yang baik antara tim bedah dan anestesi sangat diperlukan untuk kelancaran dalam kraniotomi dalam posisi duduk. Anesthetic Management of Patient with Pineal Region Tumor Underwent Craniotomy Tumor Removal in Sitting Position Abstract Incidence of pineal regio tumor is 0.4-1% of intracranial tumors. Its location which is buried between two cerebral hemispheres, close to brainstem and hypothalamus become a difficult challenge for the neurosurgeon. Surgery with supracerebellar approach in sitting position is the best method to access the lesion. Sitting position also facilitates the optimal visual field with minimal retractions. However, for anesthesiologist, sitting position is challenging since it has its own complexities during positioning the patient and the risk of complications. Venous air embolism is one of the main concern and if not detected early and treated appropriately would leads to cardiovascular collapse instantly. This is a case of a 38-year-old male with chief complaint of severe headache and blurred vision started 4 months before admission. The Magnetic Resonance Imaging showed a pineal region tumor with perifocal edema, without midline deviation. The patient underwent craniotomy tumor removal with sitting position. The procedure lasted for 10 hours and uneventful. The principle of ABCDE neuroanesthesia, sitting position and its implications, and difficult tumor location are some anesthesia considerations for this patient. A thorough preoperative evaluation, good communication and coordination between surgery and anesthesia team are needed for a smooth uneventful procedure performed in sitting position.
Visual display terminal (VDT) work has become a major part of operation in majority of workplace. This study aimed to eye fatigue in video display terminal users and its relation to sleep disorders. ...This cross-sectional study was done on 209 computer users who work more than one year in this field. All participants completed a questionnaire about their age, sex, BMI, years of experience, and hours of daily computer use. A standardized visual fatigue questionnaire was used for detection presence and severity of eye strain. Sleep quality was used to assess Pittsburg Sleep Quality Questionnaire (PSQI) , and the Epworth Sleepiness Questionnaire (ESS) to assess daytime sleepiness in participants. Insomnia was assessed by Insomnia Severity Index (ISI). The most common eye symptoms including eye fatigue (65.5%), eyelid heaviness sensation (69.4%), eye irritation (67.2%), dry eye (67.8%), blurred vision (68.5%), and tearing (68.1%) were significantly higher in participants who were working more than 8 hours with DVT in day. There was a significant correlation between scores of eye fatigue and insomnia severity (Rho=0.32, P<0.05).
According to results, the prevalence of eye symptoms particularly eyelid heaviness sensation and blurred vision was high. However, eye fatigue was more affected insomnia severity in VDT users. Therefore, it is needed to protect computer users from the adverse effects of VDT. Implementing proper ergonomic programs to the workplace are important for achievement to good physical and mental health among VDT users.
Rad terminala za vizualni prikaz (VDT) postao je glavni dio pogona na većini radnih mjesta. Ova studija presjeka provedena je na 209 korisnika računala koji rade više od jedne godine u ovom području. Svi sudionici ispunili su upitnik o svojoj dobi, spolu, indeksu tjelesne mase, godinama iskustva i satima svakodnevnog korištenja računala. Standardizirani upitnik korišten je kako bi se detektirala prisutnost i ozbiljnost naprezanja oka. Upitnik sadrži 15 pitanja o problemima s očima. Nesanica je ocijenjena indeksom ozbiljnosti nesanice. Najčešći očni simptomi uključujući umor očiju (65,5 %), osjećaj težine kapaka (69,4 %), iritacija oka (67,2 %), suho oko (67,8 %), zamagljen vid (68,5 %) i suzenje oka (68,1 %) bili su značajno viši u sudionika koji su radili više od osam sati s VDT-om na dan. Postojala je značajna korelacija između rezultata umora očiju i ozbiljnosti nesanice (Rho=0,32, P<0,05).
Prema ovim rezultatima, prevalencija očnih simptoma bila je visoka i povezana s ozbiljnošću nesanice u naših VDT korisnika. Dakle, potrebno je zaštititi korisnike računala od štetnih VDT učinaka. Implementacija ispravnih ergonomskih programa na radnom mjestu važna je kako bi se postiglo dobro fizičko i mentalno zdravlje među VDT korisnicima.
The objective of our study was to assess the growth rate and enhancement of renal masses before and after treatment with stereotactic body radiotherapy (SBRT).
This retrospective study included all ...patients with renal masses who underwent SBRT during a 5-year period. Orthogonal measurements of renal masses were obtained on pre- and posttreatment CT or MRI. Pre- and posttreatment growth rates were compared for renal mass diameter and volume using the t test. Pre- and posttreatment tumor enhancement values were compared for tumors that underwent multiphasic contrast-enhanced MRI.
Forty patients underwent SBRT for the treatment of 41 renal tumors: clear cell renal cell carcinomas (RCCs) (n = 16), papillary RCCs (n = 6), oncocytic neoplasms (n = 8), unclassified RCCs (n = 2), urothelial carcinoma (n = 1), and no pathologic diagnosis (n = 8). The mean maximum tumor diameter before treatment was 3.9 cm (range, 1.6-8.3 cm). Three hundred thirty-eight pre- and posttreatment imaging studies were analyzed: 214 MRI studies and 124 CT studies. The mean pre- and posttreatment lengths of observation were 416 days (range, 2-1800 days) and 561 days (83-1366 days), respectively. The mean pretreatment tumor growth rate of 0.68 cm/y decreased to -0.37 cm/y post treatment (p < 0.0001), and the mean tumor volume growth rate of 21.2 cm(3)/y before treatment decreased to -5.35 cm(3)/y after treatment (p = 0.002). Local control-defined as less than 5 mm of growth-was achieved in 38 of 41 (92.7%) tumors. The Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 showed progression in one tumor (2.4%), stability in 31 tumors (75.6%), partial response in eight tumors (19.5%), and complete response in one tumor (2.4%). No statistically significant change in tumor enhancement was shown (mean follow-up, 142 days; range, 7-581 days).
Renal tumors treated with SBRT show statistically significant reductions in growth rate and tumor size after treatment but do not show statistically significant differences in enhancement in the initial (mean, 142 days) posttreatment period.
The aim of this study is to investigate the relationship between noise exposure, fatigue and subjective mental workload (SMWL) in bank employees. This study was performed on 113 bank employees in ...Iran. Noise pollution in the studied banks was estimated in accordance with the standard ISO 9612 (1997). To determine the SMWL, NASA-TLX method was used. The level of job fatigue of employees was determined using the Swedish Job Fatigue Questionnaire (SOFI-20) and the sensitivity of people to noise was measured using the Weinstein questionnaire. Finally, the predictor variables of mental workload were analyzed using simultaneous multiple linear regression test in SPSS-V16 software. The level equivalent to the noise exposure (Mean ±SD) in the workstations of bank employees was 61.30 dB-A. The Mean ±SD of the final score of SMWL in the studied employees was 71.91±12.79. The results of the simultaneous regression analysis test showed that the fatigue, noise sensitivity, and level of noise exposure predict a total of 0.61 of the variances of SMWL (P < 0.05, df = 112, f = 16.43). Increasing the noise can increase the SMWL of employees by having the effect of increasing fatigue, and this effect is increased by the sensitivity of employees to noise.
Cilj ovog rada je istražiti odnos između izloženosti buci, umora i subjektivnog mentalnog opterećenja (SMWL) kod zaposlenika banaka. Istraživanje je provedeno na 113 zaposlenika banaka u Iranu. Onečišćenje bukom u bankama procijenjeno je u suglasnosti sa standardom ISO 9612 (1997.). Kako bi se utvrdio SMWL, korištena je NASA-TLX metoda. Stupanj zamora poslom zaposlenika određen je korištenjem Švedskog upitnika o umoru na poslu (SOFI-20), a osjetljivost ljudi na buku mjerena je Weinstein upitnikom. Konačno, prediktorske varijable mentalnog opterećenja analizirane su korištenjem simultanog testa višestruke linerane regresije u SPSS-V16 softveru. Ekvivalent izloženosti buci (Mean ±SD) na radnim mjestima zaposlenika banke bio je 61,30 dB-A ±6,41. Mean ±SD konačnog rezultata SMWL kod ispitanih zaposlenika bio je 71,91±12,79. Rezultati simultane regresije testa analize pokazali su da umor, osjetljivost na buku te razina izloženosti buci predviđa ukupno 0,61 varijance SMWL (P < 0,05, df = 112, f = 16,43). Povećanje buke može povisiti SMWL kod zaposlenika imajući učinak povećanog umora, a taj učinak povećan je osjetljivošću zaposlenika na buku.
Tumor-infiltrating lymphocytes (TILs) reflect the host immune response against cancer cells. Immunomodulators have been recently suggested as a novel therapeutic strategy against triple-negative ...breast cancer (TNBC). However, the TIL profile in TNBC has not been thoroughly investigated. In the present study, the percentage, immunophenotype and genetic profiles of TILs in pre-surgical tumor samples of patients with TNBC were evaluated prior to neoadjuvant chemotherapy (NAC). Patients diagnosed with breast cancer at Hospital San Jose TecSalud were consecutively and prospectively enrolled in the present study between August 2011 and August 2015. The pathological response to NAC was evaluated using the de Miller-Payne and MD Anderson Cancer Center system. TIL percentage (low, intermediate, and high) was evaluated using special hematoxylin-eosin staining on the core needle biopsies. The immunophenotype of TILs was assessed by immunohistochemistry (IHC) for CD3.sup.+, CD4.sup.+ and CD8.sup.+. In addition, the gene expression profile of CD3, CD4, CD8, CD20, CD45, forkhead box P3, interleukin 6, programmed cell death 1 and CD274 molecule was assessed in all patients. A total of 26 samples from patients with TNBC prior to NAC were included in the present study. TILs were low in 30.7%, intermediate in 38.4% and elevated in 30.7% of tumors. CD3.sup.+ and CD4.sup.+ counts were associated with the pathological response to NAC (P=0.04). Finally, an overexpression pattern of CD3, CD4, CD8, CD45 and CD20 genes was observed in patients with a partial or complete pathological response. The present results demonstrated that TILs may predict the pathological response to NAC in patients with TNBC. Furthermore, a more accurate association was identified between the high expression levels of CD3, CD4, CD8, CD45 and CD20 genes and partial and complete pathological response, compared with the association between high expression and IHC alone. Key words: tumor-infiltrating lymphocytes, breast cancer, triple-negative breast cancer
Psoriatic arthritis (PsA) is an inflammatory disease characterized by peripheral and axial involvement. Biological disease-modifying antirheumatic drugs (bDMARDs) are the mainstream treatment for PsA ...and bDMARDs retention rate is a proxy for the drug's overall effectiveness. However, it is unclear whether IL-17 inhibitors can have a higher retention rate than tumor necrosis factor (TNF) inhibitors, in particular in axial or peripheral PsA. A real-life observational study was conducted on bDMARD naïve PsA patients initiating TNF inhibitors or secukinumab. Time-to-switch analysis was carried out with Kaplan-Meyer curves (log-rank test) truncated at 3 years (1095 days). Sub-analyses of Kaplan-Meyer curves between patients presenting with prevalent peripheral PsA or prevalent axial PsA were also conducted. Cox regression models were employed to describe predictors of treatment switch/swap. Data on 269 patients with PsA naïve to bDMARD starting either TNF inhibitors (n=220) or secukinumab (n=48) were retrieved. The overall treatment retention at 1 and 2 years was similar for secukinumab and TNF inhibitors (log-rank test p NS). We found a trend towards significance in the Kaplan-Meyer at 3 years in favor of secukinumab (log-rank test p 0.081). Predominant axial disease was significantly associated with a higher chance of drug survival in secukinumab users (adjusted hazard ratio 0.15, 95% confidence interval = 0.04-0.54) but not in TNF inhibitor users. In this real-life, single-center, study on bDMARD naïve PsA patients, axial involvement was associated with longer survival of secukinumab but not of TNF inhibitors. Drug retention of secukinumab and TNF inhibitors were similar in predominantly peripheral PsA.
Meningioma is the most common primary intracranial tumor and recurrence is one of the important challenges in patient management. Prognostic factors for tumor recurrences in these patients especially ...before surgical resection are not fully characterized. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in solid malignancies. We aimed to assess the association between hematologic parameters and tumor recurrence in patients with meningioma.
Preoperative complete blood count (CBC) data were analyzed in patients with newly diagnosed meningioma (n = 222). Clinical data, including history of corticosteroid therapy, tumor characteristics, and follow-up, were obtained. Recurrence-free survival (RFS) was evaluated using Cox proportional hazards models and log-rank tests.
Using preoperative CBC data from patients prior to any steroid therapy, 51 (23%) patients had neutrophilia. In univariate analysis, neutrophilia was significantly associated with meningioma recurrence (hazard ratio HR 2.73; P < 0.01). Neither leukocytosis nor lymphocytosis was associated with RFS. In multivariate analysis, after adjusting for tumor grade, tumor size, and extent of resection, neutrophilia remained an independent prognostic factor for RFS (HR 2.23, P = 0.01). Forty-six (21%) patients had low hemoglobin levels indicative of anemia, and the presence of anemia showed a trend toward high risk for recurrence (HR 1.83; P = 0.06).
The presence of neutrophilia was associated with higher rate of tumor recurrence in patients with meningioma. Validation of these results and the biologic role of neutrophilic inflammatory/immune reaction in meningioma requires further investigation.
Purpose
Glioblastoma Multiforme (GBM) is the most common and lethal primary brain tumor in adults. The goal of this study was to test the predictive value of MR parameters in relation to the survival ...of patients with newly diagnosed GBM who were scanned prior to receiving adjuvant radiation and chemotherapy.
Methods
The study population comprised 68 patients who had surgical resection and were to be treated with fractionated external beam radiation therapy and chemotherapy. Imaging scans included anatomical MRI, diffusion and perfusion weighted imaging and
1
H MRSI. The MR data were acquired 3–5 weeks after surgery and approximately 1 week before treatment with radiation therapy. The diffusion, perfusion and spectroscopic parameter values were quantified and subjected to proportional hazards analysis that was adjusted for age and scanner field strength.
Results
The patients with larger lesion burden based upon volumes of anatomic lesions, volume of CNI2 (number of voxels within the T2 lesion having choline to NAA index >2), volume of CBV3 (number of pixels within the T2 lesion having relative cerebral blood volume >3), and volume of nADC1.5 (number of pixels within the T2 lesion having normalized apparent diffusion coefficient <1.5) had a higher risk for poor outcome. High intensities of combined measures of lactate and lipid in the T2 and CNI2 regions were also associated with poor survival.
Conclusions
Our study indicated that several pre-treatment anatomic, physiological and metabolic MR parameters are predictive of survival. This information may be important for stratifying patients to specific treatment protocols and for planning focal therapy.
IL-33, a member of the IL-1 cytokine family has been shown to play a dual role within the body. First IL-33, similar to other IL-1 family members, is a secreted cytokine that binds to the cell ...surface receptor ST2 to induce a number of cell signaling pathways. Second, IL-33 enters the nucleus where it binds chromatin and directs transcriptional control of an array of growth factors and cytokines. Consistent with its complex cellular regulation, IL-33 mediates an array of biological functions by acting on a wide range of innate and adaptive immune cells. Recently, we found that IL-33 is expressed in a large number of human glioma patient specimens where its expression within the tumor correlates with the increased presence of Iba+ cells that include both resident microglia and recruited monocyte and macrophages. Strikingly, glioma derived expression of IL-33 correlates with a dramatic decrease in overall survival of tumor-bearing animals and thus supports its role as an influential factor in gliomagenesis. Notably however, when the nuclear localization function of IL-33 is crippled, the tumor microenvironment is programmed to be anti-tumorigenic and results in prolonged overall survival suggesting that when educated appropriately this could represent a novel therapeutic strategy for glioma (De Boeck
(2020), Nat Commun, doi: 10.1038/s41467-020-18569-4).
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