Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment

Abstract Purpose: The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD). Methods: Clinical research and in-vitro experiment are combined. In the in-vitro experiment, 2.0 ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the directly measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disc herniation were treated with PELD, HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤10 ml) and group B (>10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS) and oswestry disability index (ODI) scores were compared between the two groups. Results: In the in-vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P<0.05). There was a significant difference between group A and group B in blood loss (7.40±1.61 vs 19.91±10.94 ml), operation time (80.51±34.70 vs 136.51±41.88 min), and fluoroscopy frequency (6.92±1.52 vs 11.11±2.32 times) (P<0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P<0.05), however the scores were not different between the two groups at pre-operation (P>0.05). Conclusion: HCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short-term

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Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

10.22541/au.161189064.44052928/v1 ◽

2021 ◽

Author(s):

Masayuki Ohta ◽

Kentaro Hayashi ◽

Hiroyuki Sato ◽

Takahiro Noto ◽

Kandoh Kawahatsu ◽

...

Keyword(s):

Contact Angle ◽

Observational Study ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Contact Angles ◽

Retrospective Observational Study ◽

Lesion Formation ◽

Vitro Experiment ◽

In Vitro Experiment

Introduction Little is known on the effect of catheter contact angle on lesion formation and durability of pulmonary vein isolation (PVI). Methods Both in vitro experiment and retrospective observational study were conducted. For in vitro experiment, radiofrequency lesions were created on explanted swine hearts in three different catheter contact angles (0°, 45°, and 90°). In the retrospective observational study, we assessed patients who had undergone repeat catheter ablation due to atrial fibrillation recurrence after initial PVI. When pulmonary vein (PV) reconnection was observed, we analyzed the previous ablation points within and without the gap area. The gap areas were defined where ablation had changed the PV activation sequence or eliminated the PV potential in the repeat session. Results In the in vitro experiment, lesion width was the smallest (5.3 ± 0.4 mm) in perpendicular contact compared to 0° (vs 5.8 ± 0.5 mm, p=0.040) and 45° (vs 6.4 ± 0.4 mm, p<0.001). In the retrospective observational study, we assessed 666 tags of 16 patients with PV reconnections, and 60 tags were in the gap area. Tags in the gap area had longer interlesion distance (odds ratio [OR] 1.49, p < 0.001), greater contact force variability (OR 1.03, p = 0.008), and higher rate of perpendicular contact (OR 3.26, p < 0.001) on multivariate analysis. Conclusion Perpendicular contact was associated with a smaller lesion and higher rate of PV reconnection.

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In Silico and in Vitro Evaluation of Deamidation Effects on the Stability of the Fusion Toxin DAB389IL-2

Current Proteomics ◽

10.2174/1570164616666190131150033 ◽

2019 ◽

Vol 16 (4) ◽

pp. 307-313 ◽

Cited By ~ 2

Author(s):

Nasrin Zarkar ◽

Mohammad Ali Nasiri Khalili ◽

Fathollah Ahmadpour ◽

Sirus Khodadadi ◽

Mehdi Zeinoddini

Keyword(s):

In Silico ◽

Catalytic Domain ◽

Md Simulations ◽

Special Importance ◽

Native Form ◽

Vitro Experiment ◽

In Vitro Experiment ◽

Pharmaceutical Protein ◽

The Stability

Background: DAB389IL-2 (Denileukin diftitox) as an immunotoxin is a targeted pharmaceutical protein and is the first immunotoxin approved by FDA. It is used for the treatment of various kinds of cancer such as CTCL lymphoma, melanoma, and Leukemia but among all of these, treatment of CTCL has special importance. DAB389IL-2 consists of two distinct parts; the catalytic domain of Diphtheria Toxin (DT) that genetically fused to the whole IL-2. Deamidation is the most important reaction for chemical instability of proteins occurs during manufacture and storage. Deamidation of asparagine residues occurs at a higher rate than glutamine residues. The structure of proteins, temperature and pH are the most important factors that influence the rate of deamidation. Methods: Since there is not any information about deamidation of DAB389IL-2, we studied in silico deamidation by Molecular Dynamic (MD) simulations using GROMACS software. The 3D model of fusion protein DAB389IL-2 was used as a template for deamidation. Then, the stability of deamidated and native form of the drug was calculated. Results: The results of MD simulations were showed that the deamidated form of DAB389IL-2 is more unstable than the normal form. Also, deamidation was carried by incubating DAB389IL-2, 0.3 mg/ml in ammonium hydrogen carbonate for 24 h at 37o C in order to in vitro experiment. Conclusion: The results of in vitro experiment were confirmed outcomes of in silico study. In silico and in vitro experiments were demonstrated that DAB389IL-2 is unstable in deamidated form.

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Clinical efficacy of transforaminal percutaneous endoscopic lumbar discectomy combined with ozone therapy for the treatment of lumbar disc herniation: comparison with fenestration discectomy. A prospective study

Investigación Clínica ◽

10.22209/ic.v60n3a02 ◽

2019 ◽

Vol 60 (3) ◽

pp. 204-212

Author(s):

Waiping Zhou ◽

◽

Lei Hua ◽

Mengjie Li ◽

◽

...

Keyword(s):

Prospective Study ◽

Clinical Efficacy ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Ozone Therapy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Endoscopic Lumbar Discectomy ◽

A Prospective Study

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Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04038-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhaojun Song ◽

Maobo Ran ◽

Juan Luo ◽

Kai Zhang ◽

Yongjie Ye ◽

...

Keyword(s):

Back Pain ◽

Blood Loss ◽

Lumbar Disc ◽

Postoperative Recurrence ◽

Day Surgery ◽

Lumbar Discectomy ◽

Height Ratio ◽

Microendoscopic Discectomy ◽

Endoscopic Lumbar Discectomy

Abstract Background Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD. Methods A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared. Results Patients treated by PELD had lower blood loss and shorter hospital stay (P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014). Conclusions Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.

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Does the robot navigation and intraoperative CT guidance help with percutaneous endoscopic lumbar discectomy: a match-paired study

World Neurosurgery ◽

10.1016/j.wneu.2020.12.095 ◽

2020 ◽

Author(s):

Mengran Jin ◽

Longyue Lei ◽

Fengqing Li ◽

Biao Zheng

Keyword(s):

Robot Navigation ◽

Lumbar Discectomy ◽

Ct Guidance ◽

Intraoperative Ct ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Endoscopic Lumbar Discectomy

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Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01968-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hua Li ◽

Yufu Ou ◽

Furong Xie ◽

Weiguo Liang ◽

Gang Tian ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Discectomy ◽

Lumbar Spine Surgery ◽

Decompression Surgery ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Pain Scores ◽

Endoscopic Lumbar Discectomy ◽

Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

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