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Bekelis K.,Section of Neurosurgery | Missios S.,Portsmouth Hospital | Desai A.,Section of Neurosurgery | Labropoulos N.,Section of Vascular Surgery | And 2 more authors.
Journal of Neurosurgery | Year: 2014

Object. Precise delineation of individualized risks of morbidity and mortality is crucial in decision making in cerebrovascular neurosurgery. The authors attempted to create a predictive model of complications in patients undergoing cerebral aneurysm clipping (CAC). Methods. The authors performed a retrospective cohort study of patients who had undergone CAC in the period from 2005 to 2009 and were registered in the Nationwide Inpatient Sample (NIS) database. A model for outcome prediction based on preoperative individual patient characteristics was developed. Results. Of the 7651 patients in the NIS who underwent CAC, 3682 (48.1%) had presented with unruptured aneurysms and 3969 (51.9%) with subarachnoid hemorrhage. The respective inpatient postoperative risks for death, unfavorable discharge, stroke, treated hydrocephalus, cardiac complications, deep vein thrombosis, pulmonary embolism, and acute renal failure were 0.7%, 15.3%, 5.3%, 1.5%, 1.3%, 0.6%, 2.0%, and 0.1% for those with unruptured aneurysms and 11.5%, 52.8%, 5.5%, 39.2%, 1.7%, 2.8%, 2.7%, and 0.8% for those with ruptured aneurysms. Multivariate analysis identified risk factors independently associated with the above outcomes. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated using the area under the receiver operating characteristic curve, and it was found to have good discrimination. Conclusions. The featured model can provide individualized estimates of the risks of postoperative complications based on preoperative conditions and can potentially be used as an adjunct in decision making in cerebrovascular neurosurgery. ©AANS, 2014.


News Article | November 7, 2016
Site: marketersmedia.com

— Acclaimed brain and spine neurosurgeon, Dr. Saeed Bajwa has been named Director of Neurosciences at United Health Services Wilson Medical Center in Johnson City, New York. A dedicated and acclaimed surgeon, Dr. Bajwa has used his vast firsthand knowledge to treat neurological conditions for decades while utilizing his commitment to serve non-profit groups. As the Director of Neurosurgery since 1995 at Southern New York NeuroSurgical Group P.C., his significant contributions in research and experience in neurosurgery and neurology have improved the quality of life for countless patients suffering from brain and spinal injuries in Southern New York. In addition, Dr. Bajwa has used his success for philanthropic purposes for many years, and continues to do so. He brings his extensive knowledge, cutting-edge treatments, and compassionate insight to this distinguished position. In January of 2016, Southern NY NeuroSurgical Group, headed by Dr. Bajwa, joined United Heath Services Medical Group, a multi-specialty group comprised of more than 250 physicians, based in Johnson City, and covering eight counties in the southern tier of New York. As Director of Neurosciences, Dr. Saeed Bajwa will be involved in marketing, enhancing patient care, and developing clinical research as well as coordinating and planning the expansion of services such as neuro-radiology, pain management, stroke care, neuro-intensive care service, and endovascular neurology. United Health Services (UHS), a prominent leader in the treatment of brain and spinal disorders for more than five decades, treats patients with neurological conditions all across the globe. Ranked as one of the top neurosurgical centers in New York, UHS is a not-for-profit health care system comprised of five general hospitals. Dr. Bajwa will be working closely with the qualified staff at UHS Wilson Medical Center to provide comprehensive care to patients with spinal cord and brain injuries, seizure disorders, and other neurological conditions. A contributor to the medical world for 30 years, Dr. Bajwa began his journey to helping others in his homeland of Pakistan, where he attended Nishtar Medical College of the University of Punjab. He pursued his career in neurosurgery after spending several years as a lecturer of Forensic Medicine and Pathology at King Edward Medical College in Lahore. After the devastating earthquake in Pakistan in 2005, Dr. Bajwa took part in treating the injured, broadening his experience and philanthropic efforts. He was recently awarded the ICNA Relief USA Award of Appreciation for his dedicated work with committee and community services. A respected professor in Neurosurgery, Dr. Bajwa received the Distinguished Teaching Award from the SUNY Health Science Center. Currently as Chairman at the Section of Neurosurgery at Lourdes Hospital as well as Wilson Hospital, and a dedicated member of the New York Medical Society, Dr. Saeed Bajwa shares his knowledge with other medical professionals. He was involved in clinical research in CyberKnife for the treatment of trigeminal neuralgia and he assisted in the development of the first CyberKnife Radiosurgery Center in New York state and also later on in Karachi, Pakistan. His expertise and activity in community philanthropy have made Dr. Bajwa one of the most sought-after neurosurgeons in New York. Dr. Saeed Bajwa -- Named One of The Leading Physicians of the World: http://www.streetinsider.com/Press+Releases/Dr.+Saeed+Bajwa+--+Named+One+of+The+Leading+Physicians+of+the+World/11676088.html Dr. Saeed Bajwa Proud Recepient of The ICNA Relief USA Award of Appreciation: http://www.abc6.com/story/33637050/dr-saeed-bajwa-proud-recepient-of-the-icna-relief-usa-award-of-appreciation For more information, please visit http://www.ICMediaDirect.com


Li Y.,Indiana University | Rey-Dios R.,University of Mississippi Medical Center | Roberts D.W.,Section of Neurosurgery | Roberts D.W.,Dartmouth College | And 3 more authors.
World Neurosurgery | Year: 2014

Objective Fluorescence guidance has a demonstrated potential in maximizing the extent of high-grade glioma resection. Different fluorophores (fluorescent biomarkers), including 5-aminolevulinic acid (5-ALA) and fluorescein, have been examined with the use of several imaging techniques. Our goal was to review the state of this technology and discuss strategies for more widespread adoption. Methods We performed a Medline search using the key words "fluorescence," "intraoperative fluorescence-guided resection," "intraoperative image-guided resection," and "brain glioma" for articles from 1960 until the present. This initial search revealed 267 articles. Each abstract and article was reviewed and the reference lists from select articles were further evaluated for relevance. A total of 64 articles included information about the role of fluorescence in resection of high-grade gliomas and therefore were selectively included for our analysis. Results 5-ALA and fluorescein sodium have shown promise as fluorescent markers in detecting residual tumor intraoperatively. These techniques have demonstrated a significant increase in the extent of tumor resection. Regulatory barriers have limited the use of 5-ALA and technological challenges have restricted the use of fluorescein and its derivatives in the United States. Limitations to this technology currently exist, such as the fact that fluorescence at tumor margins is not always reliable for identification of tumor-brain interface. Conclusions These techniques are safe and effective for increasing gross total resection. The development of more tumor-specific fluorophores is needed to resolve problems with subjective interpretation of fluorescent signal at tumor margins. Techniques such as quantum dots and polymer or iron oxide-based nanoparticles have shown promise as potential future tools. © 2014 Elsevier Inc.


Zaiss M.,German Cancer Research Center | Xu J.,Vanderbilt University | Goerke S.,German Cancer Research Center | Khan I.S.,Section of Neurosurgery | And 4 more authors.
NMR in Biomedicine | Year: 2014

Endogenous chemical exchange saturation transfer (CEST) effects are always diluted by competing effects, such as direct water proton saturation (spillover) and semi-solid macromolecular magnetization transfer (MT). This leads to unwanted T2 and MT signal contributions that lessen the CEST signal specificity to the underlying biochemical exchange processes. A spillover correction is of special interest for clinical static field strengths and protons resonating near the water peak. This is the case for all endogenous CEST agents, such as amide proton transfer, -OH-CEST of glycosaminoglycans, glucose or myo-inositol, and amine exchange of creatine or glutamate. All CEST effects also appear to be scaled by the T1 relaxation time of water, as they are mediated by the water pool. This forms the motivation for simple metrics that correct the CEST signal. Based on eigenspace theory, we propose a novel magnetization transfer ratio (MTRRex), employing the inverse Z-spectrum, which eliminates spillover and semi-solid MT effects. This metric can be simply related to Rex, the exchange-dependent relaxation rate in the rotating frame, and ka, the inherent exchange rate. Furthermore, it can be scaled by the duty cycle, allowing for simple translation to clinical protocols. For verification, the amine proton exchange of creatine in solutions with different agar concentrations was studied experimentally at a clinical field strength of 3T, where spillover effects are large. We demonstrate that spillover can be properly corrected and that quantitative evaluation of pH and creatine concentration is possible. This proves that MTRRex is a quantitative and biophysically specific CEST-MRI metric. Applied to acute stroke induced in rat brain, the corrected CEST signal shows significantly higher contrast between the stroke area and normal tissue, as well as less B1 dependence, than conventional approaches. © 2014 John Wiley & Sons, Ltd.


Surbeck W.,Section of Neurosurgery | Bouthillier A.,Notre Dame Hospital | Nguyen D.K.,Notre Dame Hospital
Epilepsy and Behavior Case Reports | Year: 2013

While sexual arousal had been evoked during direct electrical stimulation (DES) of the right mesial temporal lobe and basal forebrain, isolated orgasmic ecstasy (OE) evoked by DES is not reported in the literature. We present the first case of isolated bihemispheric reproduction of OE by stimulation via depth electrode in a patient implanted for epilepsy. © 2013 The Authors.


Khan I.S.,Section of Neurosurgery | Ehtesham M.,Vanderbilt University
Neurosurgical Focus | Year: 2014

Glioblastoma multiforme (GBM) is the most common primary brain tumor and is notorious for its poor prognosis. The highly invasive nature of GBM and its inherent resistance to therapy lead to very high rates of recurrence. Recently, a small cohort of tumor cells, called cancer stem cells (CSCs), has been recognized as a subset of tumor cells with self-renewal ability and multilineage capacity. These properties, along with the remarkable tumorigenicity of CSCs, are thought to account for the high rates of tumor recurrence after treatment. Recent research has been geared toward understanding the unique biological characteristics of CSCs to enable development of targeted therapy. Strategies include inhibition of CSC-specific pathways and receptors; agents that increase sensitivity of CSCs to chemotherapy and radiotherapy; CSC differentiation agents; and CSC-specific immunotherapy, virotherapy, and gene therapy. These approaches could inform the development of newer therapeutics for GBM. © AANS, 2014.


Khan I.S.,Section of Neurosurgery | Ehtesham M.,Vanderbilt University
Advances in Experimental Medicine and Biology | Year: 2015

High-grade central nervous system (CNS) tumors are notorious for high rates of recurrence and poor outcomes. A small cohort of tumor cells, dubbed tumor stem cells (TSC), are now being recognized as an important subset of the tumor that is resistant to chemotherapy and radiotherapy and account for the high recurrence rates. Recent research is developing modalities to target TSCs specifically in a bid to improve the response of the tumor as a whole. The methods being employed to target TSCs include targeting TSC-specific pathways or receptors, TSC sensitizing agents to chemotherapy and radiotherapy, immunotherapy, TSC differentiating agents, and viral therapy. This chapter provides an overview of strategies that are expected to help develop new and more effective treatments for CNS tumors. © Springer International Publishing Switzerland 2015.


Khan I.S.,Section of Neurosurgery | Ehtesham M.,Vanderbilt University
Advances in Experimental Medicine and Biology | Year: 2015

Central Nervous System (CNS) tumors include some of the most invasive and lethal tumors in humans. The poor prognosis in patients with CNS tumors is ascribed to their invasive nature. After the description of a stem cell-like cohort in hematopoietic cancers, tumor stem cells (TSCs) have been isolated from a variety of solid tumors, including brain tumors. Further research has uncovered the crucial role these cells play in the initiation and propagation of brain tumors. More importantly, TSCs have also been shown to be relatively resistant to conventional cytotoxic therapeutics, which may also account for the alarmingly high rate of CNS tumor recurrence. In order to elucidate prospective therapeutic targets it is imperative to study these cells in detail and to accomplish this, we need to be able to reliably isolate and characterize these cells. This chapter will therefore, provide an overview of the methods used to isolate and characterize stem cells from human CNS malignancies. © Springer International Publishing Switzerland 2015.


Khan I.S.,Section of Neurosurgery | Ehtesham M.,Vanderbilt University
Advances in Experimental Medicine and Biology | Year: 2015

Central nervous system (CNS) tumors are complex organ systems comprising of a neoplastic component with associated vasculature, infl ammatory cells, and reactive cellular and extracellular components. Research has identifi ed a subset of cells in CNS tumors that portray defi ning properties of neural stem cells, namely, that of self-renewal and multi-potency. Growing evidence suggests that these tumor stem cells (TSC) play an important role in the maintenance and growth of the tumor. Furthermore, these cells have also been shown to be refractory to conventional therapy and may be crucial for tumor recurrence and metastasis. Current investigations are focusing on isolating these TSC from CNS tumors to investigate their unique biological processes. This understanding will help identify and develop more effective and comprehensive treatment strategies. This chapter provides an overview of some of the most commonly used laboratory models for CNSTSC research. © Springer International Publishing Switzerland 2015.


Crawley C.D.,Section of Neurosurgery | Raleigh D.R.,Section of Neurosurgery | Kang S.,Section of Neurosurgery | Voce D.J.,Section of Neurosurgery | And 3 more authors.
Nucleic Acids Research | Year: 2013

Phosphorylation of the NF-κB subunit, p50, is necessary for cytotoxicity in response to DNA methylation damage. Here, we demonstrate that serine 329 phosphorylation regulates the interaction of p50 with specific NF-κB binding elements based on the identity of a single κB-site nucleotide. Specifically, S329 phosphorylation reduces the affinity of p50 for κB-sites that have a cytosine (C) at the-1 position without affecting binding to sequences with a-1 adenine. The differential interaction between phospho-p50 and the-1 base regulates the downstream transcriptional response and underlies the inhibition of anti-apoptotic gene expression following DNA damage. In genes with multiple κB-sites, the presence of a single-1C κB-site enables inhibition of NF-κB-dependent activity. The data suggest that interaction between phospho-p50 and the-1 κB nucleotide facilitates cytotoxicity in response to DNA damage. Moreover, although conservation of the entire κB-site sequence is not seen across species, the identity of the-1 nt in critical anti-apoptotic genes is conserved such that the overall response to DNA damage is maintained. © 2012 The Author(s).

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