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The ability to accurately predict pain generators for chronic neck and back pain remains elusive.We evaluated whether injections targeted at foci with uptake on single-photon emission computerized tomography-computed tomography (SPECT-CT) were associated with improved outcomes in patients with chronic neck and back pain.A retrospective review was completed on patients undergoing SPECT-CT for chronic neck and back pain between 2016 and 2020 at a tertiary academic center. Patients' records were reviewed for demographic, clinical, imaging, and outcomes data. Only those patients who had facet injections after SPECT-CT were included in this evaluation. Patients undergoing injections targeted at foci of abnormal radiotracer uptake were compared with patients without uptake concerning immediate positive response, visual analog scale, and the need for additional injection or surgery at the target level.A total of 2849 patients were evaluated with a SPECT-CT for chronic neck and back pain. Of those, 340 (11.9%) patients received facet joint injections after SPECT-CT. A propensity score regression analysis adjusted for age, gender, body mass index, hypertension, multiple target injections, and injection location showed uptake targeted injections not being associated with an improved immediate positive response (odds ratio: 0.64; 95% confidence interval: 0.34-1.21; P = 0.172). In patients with a failed facet injection preceding SPECT-CT, adding SPECT-CT to guide facet injections was associated with a decrease in visual analog scale pain scores 2 weeks after injection (P = 0.018), particularly when changes were made to the facets being targeted (P = 0.010).This study suggests that there is benefit with SPECT-CT specially to guide facet injections after failed prior facet injections.

Prospective nonrandomized studies have found less postoperative fatigue and improved quality of life in patients undergoing awake spine surgery under spinal anesthesia compared with general anesthesia. Randomized trials are needed to validate these findings.To prospectively investigate patients' willingness to enroll in randomized trials of lumbar spine surgery under spinal versus general anesthesia and identify any potential barriers.We recruited patients undergoing lumbar spine surgery for degenerative disease. We described a randomized trial of spine surgery under spinal versus general anesthesia and assessed patients' willingness to participate in such trial. We elicited preferences for treatment along with demographics. The association between these factors and willingness to participate in the trial was examined.Fifty patients completed interviews; 58% were female, mean age of 60.9 ± 12.5 years. A total of 52% patients stated that they were definitely willing to participate in the hypothetical randomized trial, and 8% probably willing. Only 16% of patients were aware of spinal anesthesia as an option for low back surgery, and 60% indicated no strong preference for the anesthesia techniques. Patients without strong preferences stated a greater willingness to participate than those with strong preferences (80% vs. 10% definitely willing, P0.0001). Age, sex, education, work status, and race were not significantly associated with willingness to participate.Sixty percent of patients stated that they were either definitely or probably willing to participate in the randomized trial. Subjects lacking strong preferences for the anesthesia technique stated a greater willingness to enroll than those with strong preference.

Management of degenerative disease of the spine has evolved to favor minimally invasive techniques, including nonrobotic-assisted and robotic-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Value-based spending is being increasingly implemented to control rising costs in the US healthcare system. With an aging population, it is fundamental to understand which procedure(s) may be most cost-effective.To compare robotic and nonrobotic MIS-TLIF through a cost-utility analysis.We considered direct medical costs related to surgical intervention and to the hospital stay, as well as 1-yr utilities. We estimated costs by assessing all cases involving adults undergoing robotic surgery at a single institution and an equal number of patients undergoing nonrobotic surgery, matched by demographic and clinical characteristics. We adopted a willingness to pay of $50 000/quality-adjusted life year (QALY). Uncertainty was addressed by deterministic and probabilistic sensitivity analyses.Costs were estimated based on a total of 76 patients, including 38 undergoing robot-assisted and 38 matched patients undergoing nonrobot MIS-TLIF. Using point estimates, robotic surgery was projected to cost $21 546.80 and to be associated with 0.68 QALY, and nonrobotic surgery was projected to cost $22 398.98 and to be associated with 0.67 QALY. Robotic surgery was found to be more cost-effective strategy, with cost-effectiveness being sensitive operating room/materials and room costs. Probabilistic sensitivity analysis identified robotic surgery as cost-effective in 63% of simulations.Our results suggest that at a willingness to pay of $50 000/QALY, robotic-assisted MIS-TLIF was cost-effective in 63% of simulations. Cost-effectiveness depends on operating room and room (admission) costs, with potentially different results under distinct neurosurgical practices.

Tissue microarrays (TMAs) are commonly used for the rapid analysis of large numbers of tissue samples, often in morphological assessments but increasingly in spectroscopic analysis, where specific molecular markers are targeted via immunostaining. Here we report the use of an automated high-throughput system based on desorption electrospray ionization (DESI) mass spectrometry (MS) for the rapid generation and online analysis of high-density (6144 samples/array) TMAs, at rates better than 1 sample/second. Direct open-air analysis of tissue samples (hundreds of nanograms) not subjected to prior preparation, plus the ability to provide molecular characterization by tandem mass spectrometry (MS/MS), make this experiment versatile and applicable to both targeted and untargeted analysis in a label-free manner. These capabilities are demonstrated in a proof-of-concept study of frozen brain tissue biopsies where we showcase (i) a targeted MS/MS application aimed at identification of isocitrate dehydrogenase mutation in glioma samples and (ii) an untargeted MS tissue type classification using lipid profiles and correlation with tumor cell percentage estimates from histopathology. The small sample sizes and large sample numbers accessible with this methodology make for a powerful analytical system that facilitates the identification of molecular markers for later use in intraoperative applications to guide precision surgeries and ultimately improve patient outcomes.

Overcoming immunosurveillance is a major step in the progression of many types of tumors. Several immune escape strategies have been identified, including immunoediting and the establishment of an immune suppressive microenvironment. The aim of the present study was to determine whether the hereditary or sporadic context has any influence in the relationship between immune surveillance and tumor development, using sporadic and familial adenomatous polyposis related colorectal adenomas as a model.The immune tumor-infiltrating cells of a total of 58 low-grade and 18 high-grade colorectal adenomas were examined and compared, using immunostaining for CD3, CD4, CD8, CD57, CD68 and FoxP3.FoxP3 and CD68 counts were significantly higher in sporadic low-grade dysplasia (p = 0.0003 and p = 0.0103, respectively),and FoxP3 and CD4 counts were found to be significantly higher in high-grade sporadic dysplasia (p = 0.0008 and p = 0.0018, respectively)when compared with corresponding lesions in patients with familial adenomatous polyposis.This study suggests that the immune microenvironment of sporadic and hereditary lesions is different. Sporadic lesions contain a higher number of immune suppressive Treg cells, which suggests a stronger immune selective pressure. In contrast, hereditarylesions seem to benefit from a more tolerant immune microenvironment, allowing for the development of lesions with lower immune cell infiltration.This study shows that sporadic lesions harbor higher tumor-infiltrating immune cell counts, which might reflect a higher immune tolerance towards hereditary lesions.Introdução: A capacidade de contornar a imunovigilância é fundamental na progressão de muitos tumores. Já foram identificadas várias estratégias de escape imunológico, incluindo immunoediting e o estabelecimento de um microambiente imunológico supressivo. O objetivo do presente estudo passa por determinar se o contexto hereditário ou esporádico influencia a relação entre a imunovigilância e o desenvolvimento do tumor, usando adenomas coloretais esporádicos e hereditários, no contexto de polipose adenomatosa familiar, como modelos. Material e Métodos: Os infiltrados imunológicos tumorais de um total de 58 adenomas coloretais de baixo grau e de 18 de alto grau foram avaliados e comparados, usando imunohistoquímica com marcação para CD3, CD4, CD8, CD57, CD68 e FoxP3. Resultados: As contagens celulares com imunorreatividade para FoxP3 e CD68 foram significativamente mais elevadas na displasia esporádica de baixo grau (p = 0,0003 e p = 0,0103, respetivamente), enquanto que as contagens para FoxP3 e CD4 foram significativamente mais elevadas na displasia esporádica de alto grau (p = 0,0008 e p = 0,0018, respetivamente) quando comparadas com lesões correspondentes em doentes com polipose adenomatosa familiar. Discussão: O presente estudo sugere que o microambiente imunológico de lesões esporádicas e hereditárias é diferente. As lesões esporádicas contam com um número superior de células T reguladoras, supressoras da função imunológica, sugerindo-se uma pressão imune seletiva mais forte. Por seu turno, as lesões hereditárias parecem beneficiar de um microambiente imunológico mais tolerante, permitindo o desenvolvimento de lesões com menor infiltrado celular imune. Conclusão: Este estudo demonstra que as lesões esporádicas contam com contagens de infiltrados imunológicos tumorais superiores, o que poderá refletir uma maior tolerância imunológica face a lesões hereditárias.

Objective Robotic surgical systems have been developed to improve spine surgery accuracy. Studies have found significant reductions in screw revision rates and radiation exposure with robotic assistance compared with open surgery. The aim of the present study was to compare the perioperative outcomes between robot-assisted (RA) and fluoroscopically guided (FG) minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) performed by a single surgeon. Methods The present retrospective cohort study analyzed all patients with lumbar degenerative disease who had undergone MI-TLIF by a single surgeon from July 2017 to March 2020. One group had undergone FG MI-TLIF and one group had undergone RA MI-TLIF. Results Of the 101 patients included in the present study, 52 had undergone RA MI-TLIF and 49, FG MI-TLIF. We found no statistically significant differences in the operative time (RA, 241 ± 69.3 minutes; FG, 246.2 ± 56.3 minutes; P = 0.681). The mean radiation time for the RA group was 32.8 ± 28.8 seconds, and the mean fluoroscopy dose was 31.5 ± 30 mGy. The RA radiation exposure data were compared with similar data for the FG MI-TLIF group in a previous study (59.5 ± 60.4 mGy), with our patients' radiation exposure significantly lower (P = 0.035). The postoperative complications and rates of surgical revision were comparable. Conclusions Our results have demonstrated that RA MI-TLIF provides perioperative outcomes comparable to those with FG MI-TLIF. A reduced radiation dose to the patient was observed with RA compared with FG MI-TLIF. No differences were noted between the RA and FG cohorts in operative times, complication rates, revision rates, or length of stay.

Background. The tumor immune microenvironment exerts a pivotal influence in tumor initiation and progression. The aim of this study was to analyze the immune context of sporadic and familial adenomatous polyposis (FAP) lesions along the colorectal adenoma–carcinoma sequence (ACS). Methods. We analyzed immune cell counts (CD3+, CD4+, CD8+, Foxp3+, and CD57+), tumor mutation burden (TMB), MHC-I expression and PD-L1 expression of 59 FAP and 74 sporadic colorectal lesions, encompassing adenomas with low-grade dysplasia (LGD) (30 FAP, 30 sporadic), adenomas with high-grade dysplasia (22 FAP, 30 sporadic), and invasive adenocarcinomas (7 FAP, 14 sporadic). Results. The sporadic colorectal ACS was characterized by (1) a stepwise decrease in immune cell counts, (2) an increase in TMB and MHC-I expression, and (3) a lower PD-L1 expression. In FAP lesions, we observed the same patterns, except for an increase in TMB along the ACS. FAP LGD lesions harbored lower Foxp3+ T cell counts than sporadic LGD lesions. A decrease in PD-L1 expression occurred earlier in FAP lesions compared to sporadic ones. Conclusions. The colorectal ACS is characterized by a progressive loss of adaptive immune infiltrate and by the establishment of a progressively immune cold microenvironment. These changes do not appear to be related with the loss of immunogenicity of tumor cells, or to the onset of an immunosuppressive tumor microenvironment.

OBJECTIVE: The aim of this study was to determine the prevalence of open angle glaucoma in first-degree relatives accompanying POAG patients during routine examination in a reference hospital. METHOD: First-degree relatives of primary open angle glaucoma patients who accompanied their relatives to the glaucoma service of a reference hospital were screened for glaucoma. RESULTS: One-hundred and one first-degree relatives were examined, of which 56.4% had never had their intraocular pressure measured. 10.9% had previously been diagnosed with glaucoma, and 5.9% were newly diagnosed during this study. CONCLUSIONS: The eye examination of first-degree relatives identified a significant percentage of individuals with glaucoma. Despite being first-degree relatives of glaucoma patients, 56.4% of the companions had never had their eye pressure measured, demonstrating a lack of awareness about this disease.