bluuebunny/crossref_metadata_2025 huggingface dataset:
105 Creation and Optimization of a Translational Rodent Model of Cerebrovascular Disease
Authors: Yager Brock , Kondrasov Sasha , Contillo Nicholas , Venkataraman Sidish Srinivas , Xiang Zhidan , Diz Debra , Wolfe Stacey Q.
Published: March 2024

INTRODUCTION:

Spontaneous intracerebral hemorrhage (ICH) continues to have devastating morbidity and mortality, with little progress in managing resultant secondary injury. We have created a cardiometabolic model of ICH using transgenic (mRen2)27 rats to mirror the comorbidities of patients with ICH.

METHODS:

Body weight, blood pressures (BP), sensorimotor testing, cerebrovascular histology, and pro-inflammatory cytokines were quantified in (mRen2)27 and compared with control Hanover Sprague Dawley (SD) in both sexes (n = 32). A stereotaxically-assisted single-injection autologous-blood ICH in the basal ganglia was performed and hemoglobin quantified at 24/72 hours to assess reabsorption (n = 28).

RESULTS:

Mean blood pressures and weights were higher in the cardiometabolic (mRen2)27 strain at baseline (p < 0.005). There were no between-strain differences in sensorimotor testing up to 28 weeks. At 30 weeks, (mRen2)27s had higher serum IL-12 than SDs in both males (p < 0.05) and females (p < 0.05). (mRen2)27 females had higher IL-12 than males (p < 0.05). At 32-weeks, (mRen2)27 males (p < 0.0001) had increased wall to lumen ratios (W:L), signifying hyalinization. At 52-weeks, there was an increase in W:L ratio in both male (p < 0.01) and female (p < 0.05) (mRen2)27s compared to control. There was a difference in amount of residual hemoglobin between male SD and (mRen2)27’ ipsilateral hemispheres 72 hours post-ICH (p < 0.05), demonstrating impaired ICH resolution.

CONCLUSIONS:

There is a need for effective pre-clinical models of ICH. We characterized a cardiometabolic model of ICH that possesses parody at baseline with the traditional rodent model and demonstrates significant strain and sex differences after ICH. (mRen2)27s had delayed hematoma resolution, decrease-in-function morphological changes, and pro-inflammatory cytokine upregulation. These differences provide insight into the mechanism of cerebrovascular injury and may act as targets for translational therapeutics.
106 Characteristics of Cognitive Impairment in Moyamoya Disease
Authors: He Shihao , Wang Rong , Zhao Yuanli
Published: March 2024

INTRODUCTION:

Cognitive impairment in adult moyamoya disease (MMD) is thought to be the result of ischemic stroke; however, the presence and extent of cognitive decline in asymptomatic patients remain largely unknown.

METHODS:

After classification using T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), a total of 19 MMD patients with a history of cerebral infarction, 21 asymptomatic MMD patients, and 20 healthy controls matched for age, sex, and years of education were prospectively included in this study. A detailed neuropsychological evaluation of two moyamoya subgroups and normal controls was conducted. In addition, participants underwent arterial spin labeling and resting state fMRI sequences.

RESULTS:

Asymptomatic patients showed varying degrees of decline in intelligence (Raven’s Standard Progressive Matrices, P = 0.001), spatial imagination (mental rotation, P = 0.014), working memory (verbal working memory-backward digit span, P = 0.011), and computational ability (simple subtraction, P = 0.014; complex subtraction, P < 0.001) compared with normal controls. MMD patients with cerebral infarction had more severe impairment in complex arithmetic (P = 0.027) and word short-term memory (P = 0.01) than those without symptoms. The asymptomatic MMD group also showed decreased CBF in the left anterior central and left inferior frontal gyri of the island fap with multiple node abnormalities in the brain network and reduced network connectivity. There was a significant association of these changes with cognitive decline in the MMD group.

CONCLUSIONS:

In asymptomatic MMD patients, a variety of cognitive impairments precedes the onset of clinical symptoms such as cerebral infarction, which may be a long-term complication of conservative treatment. Besides, disturbance of CBF and impaired brain network connections may be important causes of cognitive decline.
1068 Incidence and Recovery of C5 Nerve Palsy After Various Types of Cervical Spinal Surgery: A Systematic Review and Meta-Analysis of Over 14,834 Patients
Authors: Soliman Mohamed A.R. , Aguirre Alexander Otilio , Kuo Cathleen , Im Justin , Burns Evan , Sood Evan , Masood Umar , Baig Rehman , Khan Asham , Pollina John , Mullin Jeffrey Paul
Published: March 2024

INTRODUCTION:

C5 nerve palsy is a debilitating operative complication of cervical surgery and occurs commonly as many surgical approaches operate near the exiting nerve root. No prior study has attempted to identify the recovery rate of C5 nerve palsy after cervical operations, and identify the rate of which this complication becomes permanent.

METHODS:

A literature search of the PubMed and Embase databases was completed to identify all papers focused on cervical surgery. Studies were excluded if they did not provide the rate of C5 palsy occurrence or if they did not define what type of cervical surgery was completed. A pooled, weighted prevalence rate of C5 palsy was calculated for each type of surgery, including the rate of these becoming permanent.

RESULTS:

A total of 118 studies were identified and met all inclusion criteria. Of these studies, 52 were focused on laminoplasties, 24 on anterior cervical discectomy fusions (ACDF), 22 on laminectomies without fusion, and 20 on posterior cervical fusions (PCF). Laminectomies had the highest incidence of C5 palsy at a pooled rate of 7.08% (95% Confidence Interval [CI], 4.74%-10.46%, I2 = 87%, P < .01), of which 0.05% (CI = 0.00%-0.90%) were permanent. This was followed by PCFs with a rate of 6.70% (CI = 4.50%-9.85%), with the effects being permanent at a rate of 0.04% (CI = 0.00%-1.20%). Laminoplasties had a C5 palsy incidence of 5.49% (CI = 4.65%-6.47%), of these 0.02% (CI = 0.00%-0.11%) were permanent. ACDFs had the lowest incidence at a rate of 4.50% (CI = 2.56%-7.79%), of which only 0.02% (CI = 0.04%-0.08%) were permanent.

CONCLUSIONS:

C5 nerve palsy is a relatively common complication after all types of cervical surgeries with increased rates in posterior approaches, however the rate of these becoming permanent is minimal.
1073 Prone Transpsoas (PTP)-LLIF Approach Versus Standard LLIF in Patients Undergoing Surgical Revision Following Adult Spinal Deformity Correction Surgery
Authors: Diaz Daniel , Brown Nolan James , Nguyen Andrew , Pennington Zach , Stone Lauren , Hernandez Nicholas , Ehresman Jeff , Pollina John , Amaral Rodrigo Augusto , Abd-El-Barr Muhammad M. , Dibble Christopher , Moss Isaac , Lee Bryan S. , Schwartz David Gary , Nguyen Andrew D. , Taylor William R.
Published: March 2024

INTRODUCTION:

Both the prone transpsoas (PTP) and standard LLIF have been developed to facilitate minimally invasive (MIS) indirect decompression, alignment correction, and posterior instrumentation.

METHODS:

A multi-center cohort of all patients was identified and all relevant data were retrospectively collected. Preoperative standing 36” scoliosis radiographs were retrospectively reviewed for pelvic incidence (PI), lumbar lordosis (LL), and PI minus LL (PI-LL mismatch). Postoperative regional sagittal alignment parameters were measured using the first postoperative standing 36” scoliosis radiographs. Finally, multivariable analysis was performed to assess the primary outcome measure: postoperative change in regional sagittal alignment (PI-LL mismatch).

RESULTS:

Two-hundred and two (n = 202) patients were retrospectively identified and included for formal analysis. One-hundred and fifty one (n = 151, 74.8%) of the patients underwent PTP revision while 51 (25.2%) underwent standard LLIF revision. Univariate analysis demonstrated a greater value for baseline mean pre-operative PI-LL mismatch in the PTP versus standard LLIF cohort (21.4 vs. 10.45°; p = 0.0001). Furthermore, multiple linear regression demonstrated that the PTP approach enabled significantly greater PI-LL mismatch change (p = 0.0017) and that this change was associated with the number of levels fused (p = 0.0481) as well as percutaneous (vs. open) screw placement (p = 0.0193). Finally, multiple logistic regression identified standard LLIF (p = 0.0378), female sex (p < 0.0001), non-osteoporotic bone density (p < 0.0001), and younger age (p < 0.0001) as predictive of postoperative PI-LL mismatch < 10° (the threshold under which such mismatch is no longer regarded as clinically significant deformity).

CONCLUSIONS:

Ultimately, PTP-LLIF was associated with greater net improvement in postoperative PI-LL mismatch, the primary outcome measure of this study. The present retrospective analysis therefore corroborated results of previous studies in suggesting that the utility of PTP-LLIF is translatable to ASD revision surgery.
1079 Preoperative Inflection Point According to the Roussouly Classification Is a Predictor of Outcomes Following Adult Spinal Deformity Surgery
Authors: Johnson Graham Walter , Chanbour Hani , Chen Jeffrey , Metcalf Tyler , Younus Iyan , Ahluwalia Ranbir , Jonzzon Soren , Wegner Adam , Abtahi Amir , Stephens Byron , Zuckerman Scott L.
Published: March 2024

INTRODUCTION:

According to the Roussouly classification, the spine’s inflection point is where lordosis transitions to kyphosis.

METHODS:

A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009-21. Inclusion criteria were: =5-level fusion, sagittal/coronal deformity, and 2-year follow-up. The primary independent variable was the inflection point. Postoperative outcomes were overall mechanical complications, reoperations, proximal junction kyphosis, pseudarthrosis, rod fracture, spinopelvic complications, and patient-reported outcomes measures (PROMs) at 2-years. Univariate logistic regression was performed.

RESULTS:

Of 202 patients undergoing ASD surgery, 79 (39.1%) patients had preoperative inflection point at the classically-described thoracolumbar junction at T12 or L1, whereas 60.9% had an inflection point at the following levels: L2 (48.0%), L3 (17.9%), T11 (13.8%), L4 (12.2%), T10 (4.1%), T9 (3.3%), and T8 (0.8%). Postoperatively, 75/79(83.4%) which started at T12 or L1 remained unchanged, while 4 (5.1%) changed to be above T12. Conversely, of the 123 (60.1%) patients with inflection point either above T12 or below L1, 61(49.5%) transitioned to a T12 or L1 postoperatively. Patients with non-T12/L1 inflection points had a greater change in inflection points postoperatively (1.2 ± 1.8 vs. 0.3 ± 0.9 levels, p < 0.001). Patients with a preoperative inflection point above or below T12 or L1 had more spinopelvic complications than those with an inflection point at T12 or L1 (39.0% vs. 24.1%, p = 0.027).

CONCLUSIONS:

In patients undergoing ASD surgery, 61% had a preoperative inflection point above the classically-described T12 or L1 levels. Having a preoperative inflection point above or below T12 or L1 was associated with an increased risk of spinopelvic complications but not reoperation or PROMs.
1084 Spinothalamic Tract Cordotomy and Commissural Myelotomy for Intractable Pain: A Case Series
Authors: McIlwrath Andrew , Blue Rachel , Parker Andrew John
Published: March 2024

INTRODUCTION:

Intractable pain associated with metastatic cancer has a large impact on the quality of life of palliative patients. Spinothalamic Tract Cordotomy and Commissural Myelotomy can aim to improve the quality of life when other therapeutic options have failed.

METHODS:

A case series of 14 patients who underwent Spinothalamic Tract Cordotomy (N = 11) or Commissural Myelotomy (N = 3) between August 2011 and November 2022 for intractable pain from metastatic disease to the abdomen, spine or pelvis in Wellington Regional Hospital. The patients aged 25 - 82 had been referred from the local pain service or palliative care team for consideration of palliative surgical management of their pain. A review of the medical records of each patient from their admission and follow up as well as pain team and palliative care records has been undertaken to determine the effectiveness of these procedures in managing pain and to identify complications, primarily deficits affecting their ability to ambulate or quality of life.

RESULTS:

Of the 14 patients, 10 patients had improvement in their symptoms, ranging from excellent (defined as significant or complete resolution of pain) to good relief (pain still present but improvement in quality of life). Of those without clear improvement in their symptoms, 2 patients passed away within 5 days of their procedure due to the underlying pathology. 4 of the 14 patients had a new deficit that affected their pre-op ambulatory status however each of these had excellent improvements in their symptoms.

CONCLUSIONS:

Spinothalamic Cordotomy and commissural Myelotomy can offer effective pain relief to the appropriately selected patient when counselled about the potential risks to mobility.
1136 Risk Factors for Postoperative Urinary Retention After Deep Brain Stimulation Surgery: The Role of the Subthalamic Nucleus
Authors: Porche Ken Michael , Peart Rodeania Antonia , Silva Victor , Mampre David Michael , Chandra Vyshak , Foote Kelly D. , Robicsek Steven Andrew
Published: March 2024

INTRODUCTION:

Deep brain stimulation (DBS) is a widely used neurosurgical procedure for treating Parkinson's disease (PD) and essential tremor (ET). Lower urinary tract dysfunction is a common complication in PD, and this study examines the risk factors for postoperative urinary retention (POUR) after DBS surgery in PD and ET patients to improve patient outcomes.

METHODS:

This retrospective study analyzed data from patients who underwent DBS surgery for PD and ET at the University of Florida between 2010 and 2021. Data on patient characteristics and surgical details were collected and analyzed using univariate and mixed-linear models.

RESULTS:

350 patients underwent 1086 DBS or IPG surgeries, with 153 of them having PD and 197 having ET. The rate of POUR was 79/477 (16.6%), 19/295 (5.2%), and 1/246 (0.4%) for Part 1, Part 2, and IPG replacement. Optimal mixed linear modeling revealed history of urinary retention (OR = 10.2, p = .002), Part 1 surgery (OR = 3.6 compared to Part 2, p < .0003), male sex (OR = 2.5, p = .011), having an electrode placed or connected for the first time (OR = 1.8, p = .046), surgical time (OR 1.5 for each 30 min increase, p < .0001), CCI (OR = 1.4 per comorbidity, p= .006), and preoperative opioid use (OR 1.4 for each additional 10 MME, p = .022) to be significant risk factors for POUR. Having an electrode in STN was found to be protective of POUR (OR = 0.4, p = .030).

CONCLUSIONS:

While most identified risk factors for POUR in DBS are non-modifiable, they remain important for preoperative planning. Reducing opioid use and minimizing surgical time may help mitigate POUR risk. Targeting the STN during DBS may lead to decreased POUR rates, indicating the potential benefits of STN-targeted DBS for PD and ET patients.
116 The Role of Spinal Surgery Among NF2 Patients With Spinal Tumors: Surgery-associated Characteristics and Response to Bevacizumab
Authors: CreveCoeur Travis Stanley , Sperring Colin , Price Richard L. , Neira Justin Anthony , Spotnitz Matthew , Keister Alex , Munjal Vikas , Kreatsoulas Daniel C. , Elder James Bradley , Lo Sheng-fu Larry , Mandigo Christopher , Angevine Peter D. , Anderson Richard C.E. , Souweidane Mark M. , Feldstein Neil , Chicoine Michael R. , Chakravarthy Vikram , McCormick Paul C. , Ray Wilson Zachary
Published: March 2024

INTRODUCTION:

Neurofibromatosis type 2 (NF2) patients develop spinal neoplasms. Determining indications for spine surgery remains challenging, as localization of spine related symptoms can be confounded by intracranial or peripheral neuropathology. Additionally, patient selection must be balanced with pre-existing comorbidities NF2 incurs with the goal to maintain or improve quality of life.

METHODS:

Seventy-nine patients were enrolled retrospectively based upon NF2 diagnosis and radiographic presence of spine tumors from three tertiary academic centers. Demographic data, clinical findings, treatment course, and spine tumor pathology were collected for all patients.

RESULTS:

Forty-eight percent of patients received spine surgery (38/79, 48.1%). Patients undergoing spine surgery had lower age of symptom onset (15.4 vs. 25.6, p = 0.015), increased cervical (4.2 vs 2.4, p = 0.005) and overall spine tumor burden (10.3 vs 6.2, p < 0.001) and presence of neck (9 vs 1, p = 0.006) and radicular pain (8 vs 1, p = 0.012). Over a quarter of our patients received BEV (25/79, 31.6%), with majority experiencing symptom onset before age 20 (17/19, 89.5%). Schwannoma was the most common BEV-treated pathology. Only one patient experienced worsening of tumor burden at one year while on BEV, and five patients required spine surgery after receiving BEV.

CONCLUSIONS:

NF2 patients who require spine surgery typically present at younger ages with large cervical spine tumor burden and associated symptomology. It is crucial that surgery-associated demographics and symptomology are identified. BEV was utilized in patients with aggressive, early-onset spine disease. Further, BEV halted spine disease progression in all patients except one, with minimal additional spine surgery required. Its ability to slow aggressive, NF2-associated spine tumors should be considered for clinical trial.
121 The Effectiveness of Deep Brain Stimulation in Patients With Disorders of Consciousness During Short- and Long-Term
Authors: Yang Yi , Zhao Jizong , He Jianghong
Published: March 2024

INTRODUCTION:

Disorders of consciousness (DoCs) impose heavy medical and economic burdens on families and society. Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs).

METHODS:

Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year. The CRS-R was used to assess the level of consciousness of each patient. Scores on this scale may vary from 0 to 23, and six subscores are used to quantify auditory, visual, motor and verbal functions as well as communication and arousal. During the surgery, an electrode was implanted into the CM-Pf complex.

RESULTS:

An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65–38.46, p < 0.001). There was a significant treatment × follow-up interaction (H = 14.99, p < 0.001). An priliminary improvement after DBS treatment could also be seen at 6 months. DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index = 0.882).

CONCLUSIONS:

DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.
124 Craniotomy Versus Craniectomy for Traumatic Acute Subdural Hematoma Coarsened Exact Matched Analysis of Outcomes
Authors: Azad Tej D. , Ran Kathleen Renee , Vattipally Vikas , Giwa Ganiat , Myneni Saket , Raj Divyaansh , Dardick Joseph , Rincon Torroella Jordina N. , Ye Xiaobu , Byrne James , Suarez Jose , Lin Shih-Chun , Jackson Christopher Mitchell , Mukherjee Debraj Raj , Gallia Gary L. , Huang Judy , Weingart Jon D. , Bettegowda Chetan
Published: March 2024

INTRODUCTION:

Previous studies comparing craniotomy (CO) versus decompressive hemicraniectomy (DC) for acute subdural hematoma (aSDH) evacuation after traumatic brain injury have not found significant association between surgical approach and patient outcome. We hoped to provide a more granular and real-world assessment of outcomes.

METHODS:

One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P < 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P < 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients.

RESULTS:

One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P < 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P < 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients.

CONCLUSIONS:

aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is an independent predictor of mortality at discharge, as well as at 90-days and 1-year after surgery.
1241 Sustained Localized Delivery of Anti-PD-1 to Tumor Draining Lymph Nodes Increases Survival and Reverses Immunosuppression in Murine Glioblastoma Models
Authors: Choi John , Pant Ayush , Medikonda Ravi , Kim Young-Hoon , Routkevitch Denis , Saleh Laura , Tong Luqing , Chan Hok Yee , Nedrow Jessie , Jackson Christopher Mitchell , Jackson Christina , Lim Michael
Published: March 2024

INTRODUCTION:

Despite the advent of immunotherapy as a promising therapeutic, glioblastoma (GBM) remains resistant to using checkpoint blockade against programmed cell death protein 1 (PD-1) on T cells. The highly immunosuppressive tumor milieu of GBM prevents rescue of inactivated T cells due to decreased numbers of infiltrating T cells at the tumor site as well as increased recruitment of myeloid cells. Moreover, the current strategy of using antibodies against PD-1 (anti-PD-1) requires multiple intravenous infusions every two or three weeks with debilitating systemic effects.

METHODS:

Mice orthotopically implanted with GL261 glioma cells were injected with PCL:PEG:PCL hydrogel polymers loaded with anti-PD-1 in one of the following locations: cervical lymph nodes, inguinal lymph nodes, and the tumor site. Mice treated systemically with anti-PD-1 were used as comparative controls. Kaplan-Meier curves were generated for all arms, with subsequent ex vivo flow cytometric staining for CD4, CD8, IFN-y, TNF-a, Foxp3, and PD-1.

RESULTS:

Mice implanted with PCL:PEG:PCL hydrogels carrying anti-PD-1 at the site of their lymph nodes showed significantly improved survival outcomes compared to mice systemically treated with three doses of anti-PD-1 (p < 0.001). Flow cytometric analysis of lymph nodes and brain tissue in mice injected with this gel demonstrated increased levels of IFN-y, indicating greater reversal of immunosuppression compared to standard treatment.

CONCLUSIONS:

Our data demonstrates proof of principle of the advantages of using localized therapy that targets lymph nodes for GBM. We propose a paradigm shift for developing new sustained local treatments with immunotherapy that are able to eliminate the need for multiple systemic infusions and their off-target effects.
126 Association of PAG Connectivity in SCI Subjects With Neuropathic Pain in a Resting-State FMRI Study
Authors: Shoraka Omid , Mandloi Shreya , Syed Mashaal , Talheimer Sara , Yuan Hsiangkuo , Evans James J. , Heller Joshua E. , Mohamed Feroze , Sharan Ashwini Dayal , Harrop James S. , Krisa Laura , Alizadeh Mahdi
Published: March 2024

INTRODUCTION:

Neuropathic pain (NP) is estimated to be present in 61% of subjects with chronic spinal cord injury (SCI). Periaqueductal Grey (PAG) plays a crucial role in descending pain modulation system. Few studies assessed PAG’s functional connectivity (FC) in pain syndromes, however, it has not been studied in SCI.

METHODS:

10 SCI subjects with NP were divided into two groups (moderate-severe n = 7, mild-no pain n = 3), and 10 healthy controls (HC) were enrolled. Resting-state fMRI was performed for subjects using a 3T Philips Ingenia scanner with a dedicated 32 channels head coil. Seed-to-voxel analysis was performed using CONN toolbox with the PAG as the seed region. Group-based analysis was performed between three groups with age and gender as confounding variables. A voxel threshold p-value of <0.05 was used, with the results corrected for multiple comparisons using fdr with a significance level of 0.05.

RESULTS:

Compared to HCs, SCI with NP demonstrated decreased FC between PAG and one cluster. SCI with pain compared to SCI without pain demonstrated Increased FC in one and decreased FC in two clusters. For each common anatomical region between pairwise analyses, FC alterations were compared to assess whether they are the result of SCI or NP.

CONCLUSIONS:

Altered FC was observed between PAG and regions involved in the pain modulation in SCI with NP compared with SCI without pain and HCs. We hypothesized that alterations between PAG and the Frontal cortex, Thalamus, Brain stem, and Cerebellum could be the result of NP sequela rather than the SCI itself. Further studies with more subjects will be needed to assess this hypothesis.
134 LIN28B as a Novel Therapeutic Target in Diffuse Midline Glioma
Authors: Knowles Truman , Huang Tina , An Shejuan , Qi Jin , Saratsis Amanda Muhs
Published: March 2024

INTRODUCTION:

Diffuse midline glioma (DMG) is the most lethal of all childhood cancers. LIN28B is a RNA binding protein expressed in a variety of cancers, which suppresses the let-7 family of microRNAs, which in turn suppresses a plethora of oncogenes. However, the role of LIN28B in DMG has not yet been explored.

METHODS:

All studies were performed on DMG cell lines (n = 6) and controls (normal human astrocytes n = 1, human neural stem cells n = 1). RNA-Seq was performed using single-read sequencing at 50bp on the Illumina NextSeq 500 Sequencing System. Cells were then treated with DMSO or the LIN28B inhibitor, LI71, and submitted to functional in vitro studies, as well as RNA-Seq and Western Blot analysis. Functional pathways analysis was subsequently performed on resulting gene expression values with Ingenuity Pathways Analysis (Qiagen).

RESULTS:

Differential LIN28B expression was demonstrated across cell lines, with DMG cells expressing greater LIN28B gene and protein levels compared to controls. LIN28B inhibition with small molecule inhibitor LI71 resulted in decreased cell proliferation and migration, in vitro. A total of 946 differentially expressed genes were identified between treatment groups (FC >2 or <-2, p < 0.05). Functional pathways analysis of differentially expressed genes implicated Cancer and Neurological Disease as the top disease processes, with Cellular Movement as the top molecular process in cell lines expressing LIN28B. Further, inactivation of Myc signaling was implicated in cells treated with LI71.

CONCLUSIONS:

Our data demonstrates increased LIN28B expression in DMG cell lines compared with controls, with oncogenic effects on cell proliferation and migration. Further investigation of the LIN28B-let7 signaling axis is warranted in order to further explore LIN28B as a novel therapeutic target in DMG.
137 Light-mediated Vagus Nerve Stimulation Inhibits Pro-inflammatory Cytokine Production in Acute Endotoxemia
Authors: Chen Adrian , Huerta Tomas , Chaudhry Saher , Chang Eric H.
Published: March 2024

INTRODUCTION:

Vagus nerve stimulation (VNS) is a form of neuromodulation being explored to treat chronic inflammatory conditions by activating the inflammatory reflex, an arc reducing proinflammatory cytokine release through efferent cholinergic signaling. Current VNS approaches are primarily invasive and use electricity, but alternatives may improve vagal fiber specificity and eliminate surgical risks. Red-light optogenetics, a biological tool utilizing red light-activatable channelrhodopsins (ReaChR), can selectively activate genetically-modified neurons transdermally with light. Here, we show that ReaChR activation of cholinergic vagal fibers reduces cytokine production in a model of acute inflammation.

METHODS:

Vagus nerve cholinergic fibers were selectively activated using ReaChR expressed on choline acetyltransferase-expressing (ChAT) fibers in transgenic ChAT-ReaChR mice. Sensory afferent vagal fibers were activated in a separate cohort of transient receptor potential vanilloid subfamily member 1 (TRPV1)-ReaChR mice. Lipopolysaccharide (LPS) was injected intraperitoneally under anesthesia to induce acute endotoxemia, as measured by elevated tumor necrosis factor-alpha (TNFa). A 635nm fiber optic was targeted onto an isolated, cervical vagus for optogenetic VNS post-LPS administration.

RESULTS:

Selective ReaChR activation of cholinergic fibers in the cervical vagus nerve stimulates the inflammatory reflex to inhibit splenic TNFa production to bacterial LPS (ChAT-ReaChR: 1.27 ± 1.44 pg/ug; control: 4.26 ± 0.97 pg/ug, p < 0.001), but no significant differences were observed in serum (ChAT-ReaChR: 538 ± 216 pg/ml; littermate: 447 ± 206 pg/ml, p = 0.81). In contrast to efferent activation, ReaChR stimulation of afferent subsets (TRPV1+) failed to show cytokine regulation in splenic nor in serum .Approximate 20% baseline heart rate drop was seen during both ChAT+ and TRPV1+ fiber excitation, but only cholinergic activation sustained bradycardia throughout the stimulation period.

CONCLUSIONS:

Red-light optogenetic activation of cholinergic vagal fibers reduces splenic inflammatory cytokine production in murine endotoxemia and holds potential as a non-invasive, light-mediated VNS approach.
158 Preclinical Direct Endoluminal Assessment of Endothelialization After Flow Diversion With Microangioscopy
Authors: Lazaro Tyler , Srinivasan Visish M. , Covell Michael , O'Leary Sean , Cooper Phillip , Garcia Roberto , Robledo Ariadna , Kan Peter T.
Published: March 2024

INTRODUCTION:

Endoluminal imaging (ELI) is an emerging adjunct in endovascular cerebral aneurysm management. Indirect ELI, as with optical coherence tomography, may be useful in detecting malapposition after flow diversion (FD). Direct ELI technologies, such as with our previous described microangioscope, have been shown to be able to delineate between different thrombi and visualize neoepithelialization after stent placement with high resolution.

METHODS:

In a rabbit model we implanted each left common carotid artery (CCA) with a shielded FD (Medtronic Pipeline Vantage) and non-shielded FD (Medtronic Pipeline Flex) in the right CCA. We studied 9 animals in 3 groups: 1) no periprocedural antiplatelet therapy, 2) aspirin 81 mg daily, 3) aspirin 81 mg and clopidogrel 75 mg daily. FD thrombosis, stenosis, malapposition, and neoepithelialization were all evaluated by diagnostic cerebral angiography (DSA) and microangioscopy after 30 days. DSA and angioscopic video were analyzed by independent evaluators and compared with histopathologic analysis.

RESULTS:

In the aspirin and DAPT groups, there were no significant observed differences in stent thrombosis, stenosis, malapposition, or neoepithelialization between the shielded and non-shielded FDs in each rabbit as measured by histologic analysis. There was significantly more thrombus formation in Group 1. Neointimal thickness as measured by the microangioscope was highly correlated with histology (r = 0.72, p = 0.016). Inter-rater agreement of microangioscope videos was highest for FD thrombosis and stenosis.

CONCLUSIONS:

There were no significant differences between in-stent thrombosis, stenosis, malapposition, or neopithelialization between shielded and non-shielded FDs. Microangioscopy measurements for neointimal thickness were highly correlated with pathology, and thus may be a helpful adjunct to DSA in FD follow-up.
163 Assessing the Economic Benefit of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains
Authors: Tretiakov Peter S. , Mir Jamshaid M. , Dave Pooja , Das Ankita , Jankowski Patrick Patryk , Janjua Burhan , Passias Peter G.
Published: March 2024

INTRODUCTION:

The economic benefit of ERAS protocols, nor the heterogeneous components that make up such protocols, has not been established.

METHODS:

CD patients =18 yrs with pre-(BL) and up to 2-year (2Y) postop data were stratified by enrollment in Standard-of-Care ERAS beginning in 2020. Differences in pre, peri-, and post-operative factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated using NDI mapped to SF6D using validated methodology with 3% discount rate to account for residual decline to life expectancy.

RESULTS:

270 patients were included (58.11 ± 11.97 years, 48% female). 54 (20.0%) received ERAS protocol recovery treatment post-operatively. Peri-operatively, ERAS+ patients also reported lower mean LOS overall (4.33 vs 5.84, p = .393), and were more likely to be discharged directly to home (χ2(1) = 4.974, p = .028). Per cost analysis, ERAS+ patients reported a lower mean total 2Y cost of 33,829 USD compared to ERAS- patients at 36,951 (p < .001). Furthermore, ERAS+ patients trended towards greater life-expectancy 2Y QALYs gained versus ERAS- patients (.423 vs .368, p = .051), and demonstrated lower costs at reoperation by 2Y (7050 USD vs 8110, p < .001). Controlling for age, surgical invasiveness, and deformity per BL TS-CL, ERAS+ patients below 70 years old were more likely to achieve a cost-effective outcome by 2Y compared to their ERAS- counterparts (OR: 1.011 [1.001 – 1.999, p = .048].

CONCLUSIONS:

Patients undergoing Enhanced Recovery After Surgery (ERAS) protocols experience lower operative times, length of stay, and rates of peri-and and post-operative complications. Subsequently, this study demonstrates that ERAS programs in ACD surgery demonstrate improved cost-effectiveness and reduced total cost by 2Y post-operatively. Due to the potential economic benefit of ERAS for patients, physicians and instutions should consider incorporation of ERAS into practice for eligible patients.
165 Can Artificial Intelligence Successfully Identify CPT Codes for Common Procedures in Neurosurgery?
Authors: O'Malley Geoffrey R. , Cassimatis Nicholas , Kumar Rohit Prem , Maggio William Warren , Danish Shabbar F. , Patel Nitesh Vijay
Published: March 2024

INTRODUCTION:

Coding for Neurosurgical procedures is a complex process that is dynamically changing year to year, through the introduction and removal of codes and modifiers every year. It is an increasing challenge for Neurosurgeons to keep up with the changes and implement them in their practice to ensure accurate coding and maximize billing. The AANS reports only 43% of Neurosurgeons are estimated to have certified professional coders.

METHODS:

ChatGPT was asked to provide CPT codes for common neurosurgical procedures of the brain and spine with a given indication for the procedure. The responses of ChatGPT were recorded and compared to the accurate CPT codes used for the procedure. The total amount of RVUs provided by Chat GPT CPT codes were compared to the actual amount of RVUs for the given procedure.

RESULTS:

ChatGPT was asked for four cranial and spinal procedures each. In terms of accuracy, three responses were completely inaccurate, four responses were partially correct, and one response was completely correct. From the total 8 cases, ChatGPT provided CPT codes accounting for 132.88 of 227.33 expected RVUs (58.5%). For spinal procedures ChatGPT provided 81.7 of 107.8 expected RVUs (75.8%). For cranial procedures ChatGPT provided 51.2 of 119.5 expected RVUs (42.8%).

CONCLUSIONS:

The ability of ChatGPT to successfully code for neurosurgical procedures appears to be limited at this time, but it is not without promise. The information to successfully code for billing for medical procedures is not readily available on the internet. Using limited information ChatGPT is still able to successfully identify codes being used for procedures. Teaching artificial intelligence to use CPT codes for billing could offer neurosurgeons increased efficiency and efficacy in their billing in the future.
167 Association Between Safety-net Hospital Status and Postoperative Outcomes Following ACDF or PCDF for Cervical Spondylotic Myelopathy
Authors: Elsamadicy Aladine A. , Sayeed Sumaiya , Craft Samuel , Sherman Josiah , Reeves Benjamin , Koo Andrew B. , Khalid Syed Ibad , Lo Sheng-fu Larry , Shin John H. , Mendel Ehud , Sciubba Daniel M.
Published: March 2024

INTRODUCTION:

Few prior studies have addressed the impact of safety-net hospital (SNH) status on outcomes following anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy (CSM).

METHODS:

A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample Database. All adult patients (>18 years old) undergoing elective ACDF or PCDF for CSM, identified using ICD-10-CM coding, were stratified into SNH and non-SNH (N-SNH) cohorts. Hospitals in the top quartile of Medicaid/uninsured patient admissions were defined as SNHs. Demographics, treating hospital characteristics, comorbidities, operative variables, adverse events (AEs), LOS, discharge disposition, and costs were assessed. Multivariate analyses were performed to identify independent predictors of prolonged LOS, non-routine discharge (NRD) disposition, and increased costs for ACDF and PCDF.

RESULTS:

Of the 49,945 study patients, 34,195 (68.5%) underwent ACDF and 15,750 (31.5%) underwent PCDF. Within the ACDF cohort, 8,025 patients (23.5%) were treated at SNHs. Among patients undergoing PCDF, 4,120 (26.2%) were treated at SNHs. Patients treated at SNHs were more likely to be Black- or Hispanic-identifying and have incomes in the bottom quartile in both cohorts. Mean LOS was significantly greater in the SNH cohorts for both procedures (ACDF:N-SNH: 2.43 ± 3.12 days vs SNH: 2.94 ± 4.13 days, p <0.001; PCDF:N-SNH: 4.36 ± 4.28 days vs SNH: 5.41 ± 8.67 days, p = 0.002), as were mean costs (ACDF:N-SNH: $20,991 ± $12,126 vs SNH: $22,412 ± $15,302, p = 0.010; PCDF:N-SNH: $25,835 ± $16,812 vs SNH: $28,945 ± $29,166, p = 0.010). A significantly greater proportion of patients in the ACDF cohort treated at SNHs experienced NRDs (N-SNH: 10.9% vs SNH: 13.9%, p = 0.006). On multivariate analysis, SNH status was not significantly associated with extended LOS [ACDF: p = 0.097; PCDF: p = 0.158], NRD [ACDF: p = 0.288; PCDF: p = 0.246], or increased costs [ACDF: p = 0.664; PCDF: p = 0.593].

CONCLUSIONS:

Our findings suggest SNH status may not significantly impact postoperative outcomes following ACDF and PCDF.
176 Repetitive Traumatic Brain Injuries Are Associated With Poorer Outcomes at 1-Year and 3-7 Years After Index Injury
Authors: Yue John K. , Etemad Leila , Barber Jason , Satris Gabriela , Belton Patrick , Madhok Debbie , Hamidi Sabah , Tracey Joye , Yuh Esther , Mukherjee Pratik , Huang Michael C. , Tarapore Phiroz E. , Puccio Ava , Okonkwo David O. , Manley Geoffrey T. , Temkin Nancy , DiGiorgio Anthony
Published: March 2024

INTRODUCTION:

Traumatic brain injury (TBI) patients are at risk for subsequent TBIs. Research on the longitudinal impact of repetitive TBI is limited.

METHODS:

The 18-center TRACK-TBI study enrolled subjects who presented to hospital and received head computed tomography (CT) within 24-hours of TBI between 2014-2018. Subjects were interviewed regarding post-index TBI during follow-up. Data from subjects aged = 17-years with 1-year or 3-7-year outcomes were extracted. Outcome measures included functional (GOSE:Glasgow Outcome Scale-Extended), post-concussive symptoms (PCS) (RPQ:Rivermead Post-Concussion Symptoms Questionnaire), psychological distress (BSI-18:Brief Symptom Inventory-18), depression (PHQ-9:Patient Health Questionnaire-9), post-traumatic stress disorder (PCL-5:PTSD-Checklist for DSM-5), and quality of life (QOL) (QOLIBRI-OS:Quality of Life After Brain Injury-Overall Scale). Multivariable regressions were adjusted for demographic, socioeconomic, and injury severity factors, and for multiple comparisons. Mean-differences (B), relative risks (RR), and 95% confidence intervals [CI] were reported.

RESULTS:

In 1,572 subjects, 3.2% and 12.2% sustained post-index TBI at 1-year and 3-7-years, respectively; 2.4% sustained multiple post-index TBIs at 3-7-years. Risk factors included psychiatric history, prior TBI, and extracranial injury severity. At 1-year, post-index TBI was independently associated with incomplete recovery (GOSE<8; RR = 1.75 [1.04-2.94]), decreased QOL (QOLIBRI-OS: B = -15.9 [-22.6, -9.1]), and increased severity of PCS, psychological distress, PTSD, and depression (RPQ: B = 8.1 [4.2-11.9], BSI-18: B = 5.3 [2.1-8.6]; PCL-5: B = 7.8 [3.2-12.4]; PHQ-9: B = 3.0 [1.5-4.4]); effects were conserved at reduced magnitudes at 3-7-years. Multiple (=2 vs. 1) post-index TBIs were associated with greater symptom severities across all outcome measures.

CONCLUSIONS:

Post-index TBI is associated with incomplete functional recovery, increased PCS, psychological distress, PTSD, and depressive symptom severities, and decreased QOL at 1- and 3-7-years post-injury. Sustaining multiple post-index TBIs further increases symptom severity across all outcome domains. Institutional processes and resources for TBI prevention, education, counseling, and follow-up are greatly needed.
191 Online Multi-media Teaching Modules are Effective for Surgical Education in Electrodiagnostic Interpretation
Authors: Zhang Justin , Pripotnev Stahs , Zhou Suzanne , Mackinnon Susan
Published: March 2024

INTRODUCTION:

Though electrodiagnostic studies are the gold standard for diagnosing nerve injuries, most surgeons are not trained to interpret these studies, and therefore typically rely on interpretation from a non-surgical electrodiagnostician. This discrepancy between interpretation and treatment of nerve injuries can lead to suboptimal surgical planning and patient outcomes.

METHODS:

Hand surgeons at various stages of training were recruited from professional surgical societies. All surgeons completed an educational module, which consisted of a pre-intervention knowledge assessment, an educational video, and a post-intervention assessment. The educational video was a 45-minute lecture on electrodiagnostic indications for nerve injury and included either traditional PowerPoint or Prezi formatting. Participants were randomized into receiving one of the two video formats. A retention assessment, including surgeon satisfaction and feedback, was administered at three-months after initial evaluation.

RESULTS:

Sixty-three surgeons completed the pre-intervention knowledge assessment, educational video, and post-intervention assessment, 30 of whom underwent the three-month retention assessment. The average assessment score improved by 2 points between pre- and post-intervention (12-point scale, p < 0.001). The majority of participants responded that the educational video was a “perfect” length (81%), was engaging (86%), improved their knowledge (86%), and that they would incorporate the information into their clinical practice (86%). Seventy-two percent of the surgeons preferred the online teaching module compared to a traditional in-person conference presentation. There was no significant difference in assessment performance and surgeon satisfaction between Prezi and PowerPoint formatting (p > 0.05).

CONCLUSIONS:

Our results demonstrate the feasibility and efficacy of an online educational module to support continuing professional development in nerve injury surgery, irrespective of the presentation style (i.e., Prezi vs. PowerPoint). This study highlights the potential behind online educational content and provides a framework for future multimedia modules for surgical education.
208 Preliminary Results of Novel Method for Identifying Ischemic Stroke Vesicular Protein Signature in Cardiac Surgery Patients
Authors: Carroll Kate T. , Federico Emma , Fillingham Patrick , Nistal Dominic A. , Barros Guilherme , Meyer R. Michael , Gonzalez Alexandra , McAvoy Malia , Keen Jade , Lim Do Hyeong , Hoofnagle Andrew , O'Keefe Grant , Burke Christopher , MacDonald James , Bammler Theo , Wu Christine , MacCoss Michael , Chen Stephanie H. , Levitt Michael Robert
Published: March 2024

INTRODUCTION:

Acute ischemic stroke (AIS) treatment depends on timely diagnosis. Identifying an efficient, blood-based protein signature for AIS has been limited by the lack of a pre-ischemia control group. Here we report the preliminary results of a model for AIS protein signature discovery using cardiac surgery patients and novel mass spectrometry techniques.

METHODS:

Twenty patients undergoing aortic arch repair with deep hypothermic circulatory arrest (n = 17) or coronary artery bypass graft (n = 3) were enrolled. Blood samples were obtained immediately pre- and postoperatively. Magnetic resonance imaging (MRI) of the brain was obtained within 72 hours of surgery. Presence of infarct and total ischemic volume was determined. A novel protein enrichment and mass spectrometry analysis technique (MAG-Net) was used to characterize the pre- and post-surgical proteomes present in extracellular vesicles. Analysis of variance (ANOVA) (false discovery rate < 0.05) was used to analyze protein signatures associated with infarction.

RESULTS:

Post-surgical infarct occurred in 15 patients (75%), with a median volume of 108mm3. A total of 5,376 proteins were identified, 1,125 of which showed a significant difference between paired pre- and post-operative concentrations. Of these 1,125 proteins, 524 proteins were unique to patients without infarction, 340 proteins had a significant change in both populations, and 261 proteins were unique to patients with infarcts. There were no significant proteins for the interaction term comparing pre- and post-operative differences between the infarct/no infarct groups.

CONCLUSIONS:

This clinical model for AIS protein signature development relies on the high rate of ischemia during cardiac surgery to allow for pre-stroke sample collection. The MAG-Net technique enables efficient processing of biologically relevant extracellular vesicle proteins and analysis of an unbiased protein signature. The preliminary results demonstrate the feasibility of combining these innovations for AIS protein signature discovery.