Fluorescence-guided surgery (FGS) allows surgeons to have improved visualization of tumor tissue in the operating room, enabling maximal safe resection of malignant brain tumors. Over the past two decades, multiple fluorescent agents have been studied for FGS, including 5-aminolevulinic acid (5-ALA), fluorescein sodium, and indocyanine green (ICG). Both non-targeted and targeted fluorescent agents are currently being used in clinical practice, as well as under investigation, for glioma visualization and resection. While the efficacy of intraoperative fluorescence in studied fluorophores has been well established in the literature, the effect of timing on fluorophore administration in glioma surgery has not been as well depicted. In the past year, recent studies of 5-ALA use have shown that intraoperative fluorescence may persist beyond the previously studied window used in prior multicenter trials. Additionally, the use of fluorophores for different brain tumor types is discussed in detail, including a discussion of choosing the right fluorophore based on tumor etiology. In the following review, the authors will describe the temporal nature of the various fluorophores used in glioma surgery, what remains uncertain in FGS, and provide a guide for using fluorescence as a surgical adjunct in brain tumor surgery.

No abstract

No abstract

OBJECTIVE: To evaluate how the COVID-19 pandemic may have negatively impacted birth outcomes in patients who tested negative for the SARS-CoV-2 virus. STUDY DESIGN: We conducted a retrospective cohort study using electronic health records of pregnant women admitted to a tertiary medical center in New York City, an epicenter of the pandemic. Women with a singleton gestation admitted for delivery from March 27-May 31, 2019 and March 27-May 31, 2020 were included. Women less than 18 years old, those with a positive SARS-CoV-2 PCR test on admission, fetal anomaly, or multiple gestation were excluded. Adverse pregnancy outcomes were compared between groups. Univariable and multivariable logistic regression was used to assess outcomes. The primary outcome was preterm birth. RESULTS: Women who delivered during the 2020 study interval had a significantly higher rate of hypertensive disorders of pregnancy (gestational hypertension or preeclampsia) (OR 1.40, 95% CI 1.05-1.85; p=0.02), postpartum hemorrhage (PPH) (OR 1.77, 95% CI 1.14-2.73; p=0.01), and preterm birth (OR 1.49, 95% CI 1.10-2.02; p=0.01). Gestational age at delivery was significantly lower in the 2020 cohort compared to the 2019 cohort (39.3 vs. 39.4 weeks, p=0.03). After adjusting for confounding variables, multivariate analysis confirmed a persistent increase in hypertensive disorders of pregnancy (OR=1.56, 95% CI 1.10-2.20, p=0.01), postpartum hemorrhage (OR=1.74, 95% CI: 1.06-2.86, p=0.03), and preterm birth (OR=1.72, 95% CI: 1.20-2.47, p=0.003) in patients who delivered in 2020 compared to the same period in 2019. Specifically, medically indicated preterm births increased during the pandemic (OR=3.17, 95% CI: 1.77-5.67, p<0.0001). CONCLUSION: Those who delivered during the COVID-19 pandemic study interval were more likely to experience hypertensive disorders of pregnancy, medically indicated preterm birth, and postpartum hemorrhage even in the absence of SARS-CoV2 infection.

No abstract