bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of the target trial methodological approach on treatment effect estimates in kidney failure: protocol for a systematic assessment
Authors: Pinter Jule , Tunnicliffe David J. , Karunikaikumar Pooshwikaa , Anastasiadis Anastasios , Hills Robert K.
Published: November 2024

Background

Patients with kidney failure often lack robust evidence because they are excluded from randomized trials. Trial emulation provides an alternative approach to derive treatment effect estimates when randomized trials cannot be conducted. Critical questions about the comparative efficacy and safety of interventions in kidney failure are now being answered using this approach or parts of it. However, variations and inconsistencies in reporting cast doubt on the reliability and validity of effect estimates not derived from randomized trials. The aim of this methodological systematic review is to understand the extent to which the target study approach is used in kidney failure and the appropriateness of this approach. By identifying and evaluating studies that qualify as emulating a target trial, compared with studies that did not apply the principles. We aim to provide more specific methodological guidance to increase the clarity and reliability of reporting treatment effect estimates when running a trial in kidney failure is not feasible.

Methods

This protocol is developed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) statement. MEDLINE, Embase, and reference lists (backwards citation chasing) will be searched up until 1st July 2023 and the search updated prior to publication to identify all studies evaluating patient outcomes in late-stage kidney disease and failure that use target trial emulation as the primary approach for analysis. Two authors (A. A., P. K.) will select articles based on title and abstract and then full text, with a third reviewer settling disagreements (J. P.). The prespecified variables will be extracted, and the risk of bias will be assessed by at least two authors (A. A., P. K., A. N.) using prespecified data forms. This will enable the determination of the robustness of the methodological quality of observational studies in using the whole or elements of the target trial approach. We will thereby assess their ability to reliably report treatment effect estimates.

Discussion

We will provide specific methodological recommendations on how to design target trials and model assumptions for emulation to get reliable treatment effect estimates for therapeutic interventions in kidney failure.

Methodological systematic review registration

Open Science Framework: Identifier https://doi.org/10.17605/OSF.IO/Z4Y29.
Exploring the impacts of agricultural emissions from natural gas on ecological footprint
Authors: Luo Biao , Rauf Aisha , Osei-Kusi Frank , Sundas Rauf , Mehmood Rashid
Published: November 2024

Background

This study investigates the long-term effects of agricultural natural gas emissions on ecological footprints across 19 European countries from 2006 to 2020. Employing Cross-Sectional Distributed Lag and Cross-Sectional Autoregressive Distributed Lag models, the research aims to deepen the understanding of agricultural emissions’ dynamics and their impact on ecological sustainability.

Results

The study reveals that reductions in renewable energy consumption negatively affect ecological footprints, indicating the crucial role of renewable energy adoption in environmental sustainability. The findings emphasize the need for policies that promote renewable energy and address barriers to its adoption. Additionally, the research identifies significant correlations between population growth and ecological footprints, demonstrating the influence of demographic factors on environment. The analysis highlights significant correlations between population growth and ecological footprints, underscoring the importance of demographic trends in shaping environmental policy.

Conclusions

The policy implications of this study include advocating for sustainable urban planning and incentivizing eco-friendly agricultural practices to mitigate emissions and promote environmental sustainability. By enhancing our understanding of the relationship between agricultural emissions and ecological footprints, this research provides valuable insights for evidence-based environmental policymaking in European countries.
Integration of UAV LiDAR and WorldView-2 images for modeling mangrove aboveground biomass with GA-ANN wrapper
Authors: Zhu Yuanhui , Myint Soe W. , Liu Kai , Liu Lin , Cao Jingjing
Published: November 2024

Background

Integrating optical and LiDAR data is crucial for accurately predicting aboveground biomass (AGB) due to their complementarily essential characteristics. It can be anticipated that this integration approach needs to deal with an expanded set of variables and scale-related challenges. To achieve satisfactory accuracy in real-world applications, further exploration is needed to optimize AGB models by selecting appropriate scales and variables.

Methods

This study examined the impact of LiDAR point cloud-derived metrics on estimation accuracies at different scales, ranging from 2 to 16 m cell sizes. We integrated WorldView-2 imagery with LiDAR data to construct biomass models and developed a genetic algorithm-based wrapper for variable selection and parameter tuning in artificial neural networks (GA-ANN wrapper).

Results

Our findings indicated that the highest accuracies in estimating AGB were yielded by 4 m and 6 m cell sizes, followed by 8 m and 10 m, associated with the dimensions of vegetation canopies and sampling plots. Models integrating WorldView-2 and LiDAR data outperformed those using each data source individually, reducing RMSEr by 5.80% and 3.89%, respectively. Combining these data sources can capture the canopy spectral responses and vertical vegetation structure. The GA-ANN wrapper model decreased RMSEr by 1.69% over the ANN model and dwindled the number of variables from 38 to 9. The selected variables included vegetation density, height, species, and vegetation indices.

Conclusions

The appropriate cell size for AGB estimation should consider the sizes of vegetation canopies, tree densities, and sampling plots. The GA-ANN wrapper effectively reduced variables and achieved the highest accuracy. Additionally, canopy spectral and vertical structure information are vital for accurate AGB estimation. Our study offered insights into optimizing mangrove AGB models by integrating optical and LiDAR data. The approach, data, model, and indices employed in this research can effectively predict AGB estimates of any other forest types or vegetation cover types in different climate regions.
Assessment of the dietary amino acid profiles and the relative biomarkers for amino acid balance in the low-protein diets for broiler chickens
Authors: Wang Bin , Zhang Xiaodan , Liu Yongfa , Gao Mingkun , Wang Mi , Wang Yuan , Wang Xinzhi , Guo Yuming
Published: November 2024

Background

Research on low-protein-level diets has indicated that even though the profiles of essential amino acids (EAAs) follow the recommendation for a normal-protein-level diet, broilers fed low-protein diets failed to achieve productive performance compared to those fed normal diets. Therefore, it is imperative to reassess the optimum profile of EAAs in low-protein diets and establish a new ideal pattern for amino acid balance. Furthermore, identifying novel sensitive biomarkers for assessing amino acid balance will greatly facilitate the development of amino acid nutrition and application technology. In this study, 12 dietary treatments [Con(+), Con(-), L&A(-), L&A(+), M&C(-), M&C(+), BCAA (-), BCAA(+), Thr(-), Thr(+), Trp(-) and Trp(+)] were established by combining different EAAs including lysine and arginine, methionine and cysteine, branched-chain amino acid (BCAA), threonine, and tryptophan to observe the growth and development of the broiler chickens fed with low-protein-level diets. Based on the biochemical parameters and untargeted metabolomic analysis of animals subjected to different treatments, biomarkers associated with optimal and suboptimal amino acid balance were identified.

Results

Growth performance, carcass characteristics, hepatic enzyme activity, serum biochemical parameters, and breast muscle mRNA expression differed significantly between male and female broilers under different dietary amino acid patterns. Male broilers exhibited higher sensitivity to the adjustment of amino acid patterns than female broilers. For the low-protein diet, the dietary concentrations of lysine, arginine, and tryptophan, but not of methionine, cystine, or threonine, needed to be increased. Therefore, further research on individual BCAA is required. For untargeted metabolomic analysis, Con(+) was selected as a normal diet (NP) while Con(-) represented a low-protein diet (LP). L&A(+) denotes a low-protein amino acid balanced diet (LPAB) and Thr(+) represents a low-protein amino acid imbalance diet (LPAI). The metabolites oxypurinol, pantothenic acid, and D-octopine in birds were significantly influenced by different dietary amino acid patterns.

Conclusion

Adjusting the amino acid profile of low-protein diets is required to achieve normal growth performance in broiler chickens fed normal-protein diets. Oxypurinol, pantothenic acid, and D-octopine have been identified as potentially sensitive biomarkers for assessing amino acid balance.
F. prausnitzii potentially modulates the association between citrus intake and depression
Authors: Samuthpongtorn Chatpol , Chan Allison A. , Ma Wenjie , Wang Fenglei , Nguyen Long H. , Wang Dong D. , Okereke Olivia I. , Huttenhower Curtis , Chan Andrew T. , Mehta Raaj S.
Published: November 2024

Background

The gut microbiome modulates the effects of diet on host health, but it remains unclear which specific foods and microbial features interact to influence risk of depression. To understand this interplay, we leveraged decades of dietary and depression data from a longitudinal cohort of women (n = 32,427), along with fecal metagenomics and plasma metabolomics from a substudy (n = 207) nested in this cohort, as well as an independent validation cohort of men (n = 307).

Results

We report that citrus intake and its components are prospectively associated with a lower risk of depression and altered abundance of 15 gut microbial species, including enriched Faecalibacterium prausnitzii. In turn, we found a lower abundance of F. prausnitzii and its metabolic pathway, S-adenosyl-L-methionine (SAM) cycle I in participants with depression. To explore causality, we found that lower SAM production by F. prausnitzii may decrease intestinal monoamine oxidase A gene expression implicated in serotonin and dopamine synthesis.

Conclusions

These data underscore the role of diet in the prevention of depression and offer a plausible explanation for how the intestinal microbiome modulates the influence of citrus on mental health.
Approaching onchocerciasis elimination in Equatorial Guinea: Near zero transmission and public health implication
Authors: Ncogo Policarpo , Hernández-González Ana , Ta-Tang Thuy-Huong , Redondo Lidia , Álvarez Ana , Perteguer Maria J. , Rubio José M. , Nguema Rufino , Nguema Justino , García Marta , Reguero Laura , Valverde Teresa , Lanza Marta , Cerrada-Gálvez Laura , Rebollo Maria , Cano Jorge , Benito Agustín , Herrador Zaida
Published: November 2024

Background

Onchocerciasis and lymphatic filariasis (LF) are endemic in Equatorial Guinea with notable variations in disease incidence between island and mainland regions. Historically, efforts to control and map these diseases were concentrated in Bioko Island, where loiasis is absent, allowing for targeted onchocerciasis interruption strategies. With the cessation of onchocerciasis transmission on Bioko and no reported cases on Annobon island, assessing the transmission status in the previously unaddressed mainland region has become imperative. Mapping efforts in mainland Equatorial Guinea have proven low to moderate level of transmission for LF and onchocerciasis, although the results so far have not been very conclusive. The current study aims to update the prevalence estimates for onchocerciasis and LF in mainland Equatorial Guinea using various diagnostic techniques.

Methods

This is the first cross-sectional study carried out to estimate the prevalence of onchocerciasis and LF in the mainland area of Equatorial Guinea, from September to December 2019, based on the combination of skin snip biopsies, thick blood smears, laboratory serological tests (ELISA tests for the detection of IgG4 antibodies against Onchocerca volvulus recombinant antigen Ov16 and Wuchereria bancrofti recombinant antigen Wb123) and molecular laboratory tests. Frequencies and prevalence rates, along with 95% confidence intervals for interval estimation of a binomial proportion, were computed.

Results

The overall onchocerciasis seroprevalence calculated for the study was 0.3% (95% CI: 0.1 to 0.5%). Microscopic examination of skin biopsies from the eight individuals seropositive for Ov16, out of the 3951 individuals initially tested, revealed no O. volvulus microfilariae. However, DNA extracted from one skin snip was successfully amplified, with subsequent sequencing confirming the presence of O. volvulus. Among the 3951 individuals, 182 were found to have anti-Wb123 antibodies, suggesting exposure to W. bancrofti, with an estimated seroprevalence of 4.6% (95% CI: 4.0 to 5.3%). Microscopy and Filaria-real time-PCR (F-RT-PCR) analysis for W. bancrofti were negative across all samples.

Conclusions

The findings indicate that onchocerciasis may no longer constitutes a public health problem in Equatorial Guinea, positioning the country on the verge of achieving elimination. Additionally, the mapped prevalence of LF will facilitate the formulation of national strategies aimed at eradicating filariases countrywide.

Graphical Abstract
A call for objectivity: Radiologists’ proposed wishlist for response evaluation in solid tumors (RECIST 1.1)
Authors: Ruchalski Kathleen , Anaokar Jordan M. , Benz Matthias R. , Dewan Rohit , Douek Michael L. , Goldin Jonathan G.
Published: November 2024

The Response Evaluation in Solid Tumors (RECIST) 1.1 provides key guidance for performing imaging response assessment and defines image-based outcome metrics in oncology clinical trials, including progression free survival. In this framework, tumors identified on imaging are designated as either target lesions, non-target disease or new lesions and a structured categorical response is assigned at each imaging time point. While RECIST provides definitions for these categories, it specifically and objectively defines only the target disease. Predefined thresholds of size change provide unbiased metrics for determining objective response and disease progression of the target lesions. However, worsening of non-target disease or emergence of new lesions is given the same importance in determining disease progression despite these being qualitatively assessed and less rigorously defined. The subjective assessment of non-target and new disease contributes to reader variability, which can impact the quality of image interpretation and even the determination of progression free survival. The RECIST Working Group has made significant efforts in developing RECIST 1.1 beyond its initial publication, particularly in its application to targeted agents and immunotherapy. A review of the literature highlights that the Working Group has occasionally employed or adopted objective measures for assessing non-target and new lesions in their evaluation of RECIST-based outcome measures. Perhaps a prospective evaluation of these more objective definitions for non-target and new lesions within the framework of RECIST 1.1 might improve reader interpretation. Ideally, these changes could also better align with clinically meaningful outcome measures of patient survival or quality of life.
The clinical efficacy of laser in the nonsurgical treatment of peri-implantitis: a systematic review and meta-analysis
Authors: Huang Nengwen , Li Yang , Li Wen , Zhao Rui , Ou Yanjing , Chen Jiang , Li Jinjin
Published: November 2024

Objective

To systematically assess studies regarding the efficacy of lasers in the nonsurgical treatment of peri-implantitis.

Methods

Electronic and manual searches were performed by two reviewers independently. Randomized controlled trials (RCTs) comparing lasers vs. mechanical debridement or air abrasive on primary outcome (probing depth (PD)) and secondary outcomes (bone loss, bleeding on probing (BOP), clinical attachment level (CAL) and plaque index (PI)) were included. Data extraction and quality assessment were conducted independently. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes. Publication bias, leave-one-out analysis and GRADE assessment were conducted.

Result

13 eligible publications were included in the review and 12 in the meta-analysis. Solid-state lasers significantly improved in PD (WMD = -0.39, 95% CI (-0.70, -0.09), p = 0.01, moderate-certainty evidence), BOP (SMD =-0.76, 95% CI (-1.23, -0.28), p = 0.002, moderate-certainty evidence) and CAL (WMD =-0.19, 95% CI (-0.39, -0.00), p = 0.05, moderate-certainty evidence), but not in bone loss (WMD = 0.03, 95% CI (-0.13, 0.18), p = 0.74, low-certainty evidence) and PI (SMD =-0.19, 95% CI (-0.42, 0.04), p = 0.11, moderate-certainty evidence) compared with the control group. However, the diode lasers showed no clinical advantages. No publication bias was detected, and leave-one-out analysis confirmed the robustness of findings.

Conclusion

In the nonsurgical treatment of peri-implantitis, solid-state lasers yielded positive influence in term of PD, BOP and CAL, while diode laser provided no beneficial effect. Future well-designed large RCTs are still needed, considering the limitations of included studies.

Clinical relevance

This review aimed to guide clinicians in choosing the appropriate laser for peri-implantitis, enhancing treatment strategies and attaining better outcomes.
Development of an assessment tool for collaborative problem-solving skills in chemistry
Authors: Ying Yike , Tiemann Rüdiger
Published: November 2024

Collaborative problem-solving (CPS) skills are recognised as an essential aspect of 21st century skills and STEM education. In the STEM framework, students’ CPS skills in the learning process need to be appropriately monitored, yet assessment tools for students’ CPS skills are currently not widely developed in chemistry. This study aimed to develop and validate the assessment tool for measuring high school students’ collaborative problem-solving skills in chemistry (CPS-C). Fifty-two students participated in the assessment, which included tasks on Coke Titration, Fruit Battery, and Soap Making. The data were analyzed using Multidimensional Item Response Theory (MIRT) models and the Generalized Partial Credit Model (GPCM). The results indicated that the CPS-C tool showed good internal consistency and item fit. Additionally, ten students were interviewed, and the interview content was analyzed using MAXQDA, emphasizing the importance of providing clear and concise instructions, reducing the number of tasks, and offering meaningful and relevant options. Moreover, this study also validated the reliability of cognitive ability tests, mental load and effort tests, and interest and motivation tests. The results showed satisfactory reliability for all tests except for the mental load and effort tests, which had a lower reliability coefficient of 0.68. Despite some limitations, the CPS-C tool showed great potential for effectively assessing CPS skills. Further research is needed to validate the tool’s effectiveness and reliability across larger, more diverse samples and different cultural contexts.
Positive and negative syndromes in schizophrenia: analysis of determinants and severity of symptoms in Moroccan patients
Authors: Fritah Khadija , Chakit Miloud , Kassal Yassmine , Belbachir Siham , Laboudi Fouad , Ouanass Aderrazzak , Mesfioui Abdelhalim , El Hessni Aboubaker
Published: November 2024

Background

Schizophrenia is a debilitating psychiatric condition distinguished by a variety of cognitive, emotional, and behavioral manifestations. It affects an individual’s cognition, emotions, and actions, resulting in challenges in discerning reality from illusion. The objective of the current study was to assess the determinants and severity of symptoms in Moroccan patients hospitalized in Ar-Razi Hospital, Rabat, Morocco using Positive and Negative Syndromes scales (PANSS).

Methods

One hundred sixty-one schizophrenic patients were admitted to Ar-Razi Hospital in Sale. The PANSS scale, in conjunction with a sociodemographic questionnaire, is utilized as the assessment tool for symptoms. A chi-square test at a 5% error level and a Pearson correlation test were applied to investigate possible associations.

Results

The findings demonstrate a significant bias towards males (9:1), with 90% being unmarried, and 96.3% originating from urban settings. The breakdown of patients based on symptoms reveals a prevalence of 14.3% for the positive scale, 18% for the negative scale, and 11.2% for the psychopathological scale. The correlation analysis demonstrates a strong relationship between the three scales. The factors that were found to have a notable impact are gender (p < 0.000), functional ability (p < 0.032), socioeconomic status (p < 0.008), living environment (p < 0.05), and use of tobacco and cannabis.

Conclusion

Confronted with this scenario, healthcare professionals are required to evaluate the key factors in the timely detection of schizophrenia and advocate for the consistent utilization of the PANSS scale in the management and monitoring of patients.
Management of multiple valve replacement operations for a young patient with hypereosinophilic syndrome and valvular heart disease: a case report
Authors: Kado Yuichiro , Kan-o Meikun , Ushijima Tomoki , Fujita Satoshi , Shinohara Gen , Kimura Satoshi , Sonoda Hiromichi , Oishi Yasuhisa , Tanoue Yoshihisa , Shiose Akira
Published: November 2024

Background

Hypereosinophilic syndrome (HES) is characterized by the overproduction of eosinophils and manifests as valvular disease and thrombogenesis. Herein, we report our experience with a patient with HES requiring multiple reoperations for prosthetic heart valve replacement via median sternotomy.

Case presentation

The patient was a 54-year-old man who had undergone four valve replacement operations via median sternotomy (three mitral valve replacements and one double valve replacement) because of valvular diseases complicated by HES since he was 26 years old. All the artificial valves were bioprosthetic to prevent thrombotic events. At presentation, he had developed structural deterioration of the artificial aortic valve with severe stenosis. His prosthetic mitral valve did not fulfil the criteria for intervention, as it exhibited only mild regurgitation and no stenosis. The explanted mitral prosthetic valve at the previous (fourth) surgery had exhibited eosinophilic infiltration, resulting in the introduction of cyclosporin for poorly controlled HES. We conducted re-aortic valve replacement via a fifth median sternotomy using a bioprosthetic valve, and no eosinophilic infiltration was observed in the explanted valve. The patient was discharged on postoperative day 15 without complications.

Conclusions

Controlling eosinophil count during the pre- and postoperative course is vital in treating patients with HES after valve replacement surgery. A holistic management and therapeutic strategy, including prosthetic valve selection and medication for HES is required to improve outcomes of patients with HES and heart valve disease.
Bone Microarchitecture Evaluated by HR-PQCT in Chinese Adolescent and Pediatric Patients With X-Linked Hypophosphatemia
Authors: Wu Yushuo , Yang Yisen , Ma Xiaosen , Pang Qianqian , Chi Yue , Jiajue Ruizhi , Liu Wei , Jiang Yan , Wang Ou , Li Mei , Xing Xiaoping , Cui Lijia , Xia Weibo
Published: November 2024

Context

X-linked hypophosphatemia (XLH) is the most common form of heritable hypophosphatemic rickets. Previous studies have found deteriorated bone microarchitecture in adults with XLH. Detailed studies on the skeletal microarchitecture of adolescent and pediatric patients with XLH are still lacking.

Objective

This study aimed to evaluate bone geometry, density, microarchitecture, stiffness in adolescent and pediatric patients with XLH by using high-resolution peripheral quantitative computed tomography (HR-pQCT).

Method

This study utilized HR-pQCT to assess bone geometry, density, microarchitecture, and stiffness in 106 Chinese adolescent and pediatric patients with XLH.

Result

Compared with sex- and age-matched controls, patients with XLH had significantly higher trabecular area (Tb.Ar), lower total volumetric bone mineral density, lower cortical volumetric BMD (Ct.vBMD), and lower stiffness at both the distal radius and the tibia after adjusting for height and weight. Alkaline phosphatase Z score (ALP-Z), a marker to reflect the disease activity of rickets, was negatively correlated with Ct.vBMD and cortical thickness at the distal radius, and Ct.vBMD at the distal tibia, and positively correlated with cortical porosity at the distal tibia. We developed an online calculator to estimate Tb.Ar, Ct.vBMD, and stiffness of the distal tibia of adolescent and pediatric patients with XLH based on clinical general characteristic and biochemical indicators.

Conclusion

The bone microarchitecture of adolescent and pediatric patients with XLH had deteriorated, and ALP-Z was negatively correlated with the skeletal quality of adolescent and pediatric patients with XLH, especially in the cortical bone. HR-pQCT parameters can be estimated using clinical characteristics and biochemical indicators, which may assist physicians to monitor the disease progression in areas without HR-pQCT access.
Treatment of Hypothalamic Obesity With GLP-1 Analogs
Authors: Dimitri Paul , Roth Christian L
Published: November 2024

Introduction

Congenital and acquired damage to hypothalamic nuclei or neuronal circuits controlling satiety and energy expenditure results in hypothalamic obesity (HO). To date, successful weight loss and satiety has only been achieved in a limited number of affected patients across multiple drug trials. Glucagon-like peptide-1 (GLP-1) acts via central pathways that are independent from the hypothalamus to induce satiety. GLP-1 receptor agonists (GLP-1RAs) may provide an alternative approach to treating HO.

Methods

We performed a comprehensive search in Medline, Google Scholar, and clinical trials registries (ClinicalTrials.gov; clinicaltrialsregister.eur). This nonsystematic literature review was conducted to identify scientific papers published from January 2005 to February 2024 using the Pubmed and Embase databases. Key words used were GLP-1, GLP-1RA, hypothalamic obesity, suprasellar tumor, and craniopharyngioma.

Results

Our search identified 7 case studies, 5 case series, and 2 published clinical trials relating to the use of GLP-1RAs in HO. All case studies demonstrated weight loss and improved metabolic function. In contrast, results from case series were variable, with some showing no weight loss and others demonstrating moderate to significant weight loss and improved metabolic parameters. In the ECHO clinical trial, nearly half the subjects randomized to weekly exenatide showed reduced body mass index (BMI). Paradoxically, BMI reduction was greater in patients with more extensive hypothalamic injuries.

Conclusion

GLP-1RAs potentially offer a new approach to treating HO. There is a need to stratify patients who are more likely to respond. Further randomized controlled trials are required to determine their efficacy either in isolation or combined with other therapies.
A New Complication of Spinal Fusion Surgery for Neuromuscular Scoliosis—Posterior Mediastinal Hematoma: Case Report
Authors: Allam Anthony K. , Flores Alex R. , Hanson Darrell S. , Bauer David F.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Neuromuscular scoliosis surgery is affiliated with a high risk of perioperative and postoperative complications. We present the case of a never-before-reported complication: a posterior mediastinal hematoma.

CLINICAL PRESENTATION:

We present the case of a 17-year-old female patient with cerebral palsy and neuromuscular scoliosis with a progressive thoracic kyphosis to 85° and levoscoliosis to 13.5° who presented for spinal fusion surgery. Postoperatively, the patient developed persistent tachycardia despite initial resuscitation, anxiolysis, and analgesia. A computed tomography scan was obtained revealing a posterior mediastinal hematoma. The patient was managed with supportive care and recovered well.

CONCLUSION:

This case highlights a never-before-reported complication of spinal fusion surgery: a posterior mediastinal hematoma. Although unlikely symptomatic, a posterior mediastinal hematoma should be on the differential diagnosis for postoperative tachycardia. This case entreats us to elucidate the true incidence rate of this complication in the population.
Modified Transanterior Perforated Substance Approach Using the Medial Territory to Thalamomesencephalic Cavernous Malformations: A Case Report
Authors: Ni Yunjia , Wang Zhiyu , Zhang Zhongshuai , Li Hongchan , Gu Lianping , Zhou Qiangyi , Yin Jian , Liu Yaohua , Lou Meiqing
Published: November 2024

BACKGROUND AND IMPORTANCE:

Thalamomesencephalic lesions remain a challenge to neurosurgeons for their eloquent anatomy and postoperative neurological deficits. With limited cases in the literature, these lesions are still managed in a case-by-case fashion.

CLINICAL PRESENTATION:

Here, we present a case of an otherwise healthy man who had a 46-day history of impaired vision and right-sided weakness and numbness caused by ventrally located thalamomesencephalic cavernous malformations (CMs). A modified transanterior perforated substance approach using the medial territory was performed for gross total resection of the CMs. No new-onset neurological deficits were observed postoperatively. Apart from visual improvements, the patient's muscle strength constantly improved and recovered full strength on 14-month follow-up.

CONCLUSION:

The authors believe that the transanterior perforated substance approach through the medial territory can be considered as an option for ventrally located thalamomesencephalic CMs.
Assessment of Accuracy of Mixed Reality Device for Neuronavigation: Proposed Methodology and Results
Authors: Jain Swati , Tajsic Tamara , Das Tilak , Gao Yujia , Yuan Ngiam Kee , Yeo Tseng Tsai , Graves Martin J. , Helmy Adel
Published: November 2024

Intraoperative neuronavigation is currently an essential component of neurosurgical operations in several contexts. Recent progress in mixed reality (MR) technology has attempted to overcome the disadvantages of standard neuronavigation systems allowing the surgeon to superimpose a 3D rendered image onto the patient's anatomy. We present the first study in the literature to assess the surface matching accuracy of MR rendered image. For the purposes of this study, we used HoloLens 2 with virtual surgery intelligence providing the software capability for image rendering. To assess the accuracy of using mixed reality device for neuronavigation intraoperatively. This study seeks to assess the accuracy of rendered holographic images from a mixed reality device as a means for neuronavigation intraoperatively. We used the Realistic Operative Workstation for Educating Neurosurgical Apprentices to represent a patient's skull with intracranial components which underwent standardized computed tomography (CT) and MRI imaging. Eleven predefined points were used for purposes of assessing the accuracy of the rendered image, compared with the intraoperative gold standard neuronavigation. The mean HoloLens values against the ground truth were significantly higher when compared with Stealth using CT scan as the imaging modality. Using extracranial anatomic landmarks, the HoloLens error values continued to be significantly higher in magnitude when compared with Stealth across CT and MRI. This study provides a relatively easy and feasible method to assess accuracy of MR-based navigation without requiring any additions to the established imaging protocols. We failed to show the equivalence of MR-based navigation over the current neuronavigation systems.
Diffusely Infiltrating Gliomas With Poor Prognosis, TERT Promotor Mutations, and Histological Anaplastic Pleomorphic Xanthoastrocytoma-Like Appearance Classify as Mesenchymal Type of Glioblastoma, IDH-wildtype by Methylation Analysis
Authors: Tsukamoto Yoshihiro , Natsumeda Manabu , Takahashi Haruhiko , On Jotaro , Seto Hiroki , Saito Taiki , Shibuya Kohei , Ogura Ryosuke , Ito Junko , Okada Masayasu , Oishi Makoto , Shimizu Hiroshi , Okamoto Kouichirou , Kakita Akiyoshi , Fujii Yukihiko
Published: November 2024

BACKGROUND:

Pleomorphic xanthoastrocytoma (PXA) (World Health Organization grade II) is classified as a relatively benign and circumscribed glioma; however, anaplastic PXA (APXA, World Health Organization grade III) has a poorer prognosis, and differentiating from glioblastoma can be difficult both histologically and molecularly.

OBJECTIVE:

To describe the clinical, pathological, and molecular characteristics of diffusely infiltrating gliomas with histological APXA-like features.

METHODS:

Four diffusely infiltrating gliomas in adult patients histologically diagnosed as APXAs at a single institute were retrospectively reviewed. We analyzed their clinical, radiological, pathological, genetic, epigenetic, and prognostic characteristics.

RESULTS:

All tumors histologically showed classical characteristic PXA-like appearance with BRAF wildtype, mitotic figure, necrosis, and an increased mindbomb E3 ubiquitin-protein ligase 1 labeling index and were initially diagnosed as APXAs; moreover, they underwent high-grade glioma treatment. Three patients with TERT promotor mutations died within 18 months. These patients' MRIs showed widespread infiltrating fluid-attenuated inversion recovery hyperintense lesions and Gd-enhancing lesions in the bilateral cerebral hemispheres in 2 of the patients. Contrastingly, a patient with the wildtype TERT promotor has survived for 2.5 years without recurrence. MRI revealed an unilateral fluid-attenuated inversion recovery hyperintense and Gd-enhancing lesion. By methylation classifier analysis, all 4 cases clustered toward GBM, IDH-wildtype, mesenchymal type, although one was deemed unclassifiable due to a low calibrated score.

CONCLUSION:

In diffusely infiltrating gliomas showing histological characteristics of APXA, methylation classification should be performed as these tumors may be difficult to differentiate between glioblastoma, IDH-wildtype by histological or genetic analysis. The aggressive nature of these tumors should be expected, especially in cases that are BRAF-wildtype and TERT promotor mutant.
Peripheral Nerve Stimulation for Chronic Foot Pain Induced by Morton Neuroma: A Novel, Personalized Approach in One Patient
Authors: Saway Brian Fabian , Terry Reese Townsend , Weber Aimee C. , Rowland Nathan C.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Morton neuroma (MN) is a condition characterized by pain that is located within one or more intermetatarsal spaces of the forefoot. Numerous conservative measures are available for the management of mild-to-moderate MN cases. In more severe presentations, surgical interventions may be considered, including neuroma excision, cryogenic or radiofrequency ablation, and decompression. However, no standard treatments exist for occurrences of recurrent MN after surgery. Peripheral nerve stimulation is a neuromodulatory treatment that is highly effective for other neuropathic pain syndromes but remains underutilized for MN.

CLINICAL PRESENTATION:

Here, we present the operative technique and clinical outcome in a patient with chronic pain induced by MN who underwent bilateral implantation of peripheral nerve stimulation devices. In less than 12 months, the patient had near-complete resolution of chronic foot pain with no postoperative complications.

DISCUSSION:

We present the first published case and operative technique of successful peripheral nerve stimulator implantation as an effective treatment of MN.

CONCLUSION:

Peripheral nerve stimulator implantation is a promising and effective intervention that can be considered for refractory MN.
Association Between Neurological Outcomes and Timing of Physical Therapy Initiation Among Patients Treated for Aneurysmal Subarachnoid Hemorrhage: A Propensity-Adjusted Analysis
Authors: Catapano Joshua S. , Koester Stefan W. , Rumalla Kavelin , Dabrowski Stephen J. , Winkler Ethan A. , Rudy Robert F. , Cole Tyler S. , Baranoski Jacob F. , Graffeo Christopher S. , Srinivasan Visish M. , Jha Ruchira M. , Jadhav Ashutosh P. , Ducruet Andrew F. , Albuquerque Felipe C. , Lawton Michael T.
Published: November 2024

BACKGROUND:

Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating neurological disease associated with poor neurological outcomes.

OBJECTIVE:

To evaluate the association between timing of physical therapy (PT) initiation and neurological outcomes among patients treated for aSAH.

METHODS:

Patients receiving definitive aneurysm treatment at a single quaternary center (January 1, 2014-July 31, 2019) with data available on PT initiation and the number of sessions were analyzed. Patients were compared based on whether PT initiation was delayed (>24 hours after definitive aneurysm treatment) or nondelayed (≤24 hours after treatment). The primary outcome was a poor neurological outcome at last follow-up (modified Rankin Scale [mRS] score >2). A propensity-adjusted score was generated and included as a covariate in a logistic regression analysis.

RESULTS:

Among 382 patients, 260 (68%) had delayed and 122 (32%) had nondelayed PT initiation. A significantly greater percentage of patients in the delayed PT group had an mRS score of >2 at last follow-up (42% [n = 110] vs 20% [n = 24];P< .001). Among 298 patients with a Hunt and Hess (HH) grade <4, the percentage with an mRS score of >2 at last follow-up was significantly higher in the delayed (34% [62/184]) than nondelayed (18% [21/114]) PT group (P= .006). The logistic regression analysis showed that, among patients with an HH grade of <4, delayed PT initiation increased the risk of having an mRS score of >2 at follow-up (odds ratio = 1.90, 95% CI = 1.02-3.62,P= .047).

CONCLUSION:

Delayed PT initiation after definitive aneurysm treatment was associated with poor neurological outcomes regardless of patient characteristics, neurological presentation, or aneurysm characteristics.
De Novo Plasmacytoma at the Site of Previous Anterior Cervical Fusion
Authors: Burket Noah J. , Mobasser Dillon C. , Alentado Vincent J. , Mobasser Jean-Pierre
Published: November 2024

BACKGROUND AND IMPORTANCE:

Solitary plasmacytoma of bone (SPB) is a rare tumor that forms from monoclonal plasma cells within bone. These tumors are typically found in patients in their fifth to sixth decade of life and often progress to multiple myeloma. Previous reports have noted the formation of these tumors at the site of previous procedures or trauma, yet none have reported the development of SPB at the same site of a previous spinal surgery.

CLINICAL PRESENTATION:

The authors report on a 47-year-old woman who developed a de novo plasmacytoma 6 years after anterior cervical discectomy and fusion at the surgical site.

CONCLUSION:

Although SPB is a rare tumor primarily seen in bone that has been unaffected by surgery, it should be included in the differential after finding a tumor at the site of a previous spine surgery. Furthermore, biopsy should be considered once a lesion is identified in the area of a previous spine surgery, as SPB may progress to multiple myeloma, resulting in worse outcomes.
Parry-Romberg Syndrome and an Associated Complex Vascular Lesion Managed With Hybrid Strategies: A Case Report
Authors: Hagstrom Rory , Riina Howard A. , Britz Gavin W. , Sharashidze Vera , Chung Charlotte , Weiss Hannah , Spetzler Robert F. , Nelson Peter Kim
Published: November 2024

BACKGROUND AND IMPORTANCE:

Parry-Romberg syndrome (PRS) is a condition of unknown etiology, most commonly characterized by progressive facial hemi-atrophy due to breakdown of the underlying skin and soft tissues. PRS has been associated with neurologic disease such as intracranial aneurysms and vascular malformations. However, its exact role in the incidence of neurovascular disease remains unknown.

CLINICAL PRESENTATION:

We present a case of a complex fusiform aneurysm involving the A1 segment of the left anterior cerebral artery in a 21-year-old man with PRS. The patient initially presented with a left giant fusiform/dissecting internal carotid artery aneurysm initially managed with overlapping flow diverters. His post-flow diverter treatment course was confounded by progressive growth of the aneurysm with worsening mass effect on the optic chiasm leading to complete visual loss in the left eye and a right hemifield cut. To manage the aneurysm recurrence, retreatment with surgical bypass-supported carotid occlusion was performed. Thereafter, visual symptoms improved, but complete normalization of vision was not achieved. The patient remained clinically stable for several years until follow-up imaging demonstrated a novel adjacent recurrence involving the ipsilateral A1 segment, previously noted to be angiographically normal. The patient underwent superselective angiography followed by endovascular occlusion of the new fusiform lesion.

DISCUSSION:

The case presented here illustrates the hybrid roles of endovascular and surgical treatment modalities in treating complex vascular lesions. The recurrence of the lesion following initial treatment strategies introduces questions about how the nature and development of the lesion affected the success of treatment at each stage. Considerations for the efficacy of each stage of treatment in this case include the patients underlying connective tissue disorder, the pediatric etiology of the lesion, and the timing of each treatment option given these factors.

CONCLUSION:

In addition to understanding the biological behavior of flow diversion for complex intracranial aneurysms, the role of PRS in the incidence of neurovascular disease should also be considered when applicable. More research into the mechanisms of PRS in neurovascular disease is needed.
Case Report: Contralateral Progression of a Vestibular Schwannoma After Resection in a Patient with Neurofibromatosis Type 2
Authors: Rampalli Ihika , English Collin William , Lazaro Tyler , Lovin Benjamin Daniel , Lee Sungho , Huang Andrew Tsao , Jalali Ali , Gallagher Kathleen Kelly , Mandel Jacob J. , Sweeney Alex Daniel , Patel Akash J.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Bilateral vestibular schwannomas (VS) are a distinctive feature of neurofibromatosis type 2 (NF2) that result in a serious reduction in the quality of life for patients. The growth rates of these schwannomas are variable, and the early detection of increased growth is fundamental for improving outcomes.

CLINICAL PRESENTATION:

A 17-year-old man with NF2 and bilateral VS presented with complete right facial paralysis and sudden right hearing loss less than 1 month after resection of a left VS. Imaging revealed rapid growth of the right VS with intratumoral hemorrhage, and the patient underwent urgent surgical resection with some improvement in symptoms.

DISCUSSION:

Existing literature indicates a similar phenomenon after a longer post-operative period; however, none have shown such rapid symptomatology. Multiple etiologies were explored for this presentation, including the sudden decompression from the primary resection, paracrine factors, and hypervascularity from prior radiation.

CONCLUSION:

VS resection in a patient with NF2 may be followed by rapid growth in the contralateral VS, leading to severe symptom presentation. Patients should be counseled regarding this risk to enable early detection and intervention.
A Reliable Closure Technique for Retromastoid Craniotomy to Avoid Cerebrospinal Fluid Leaks and Meningitis
Authors: Barkhoudarian Garni , Garling R. Justin , Mallari Regin Jay , Sivakumar Walavan , Kelly Daniel F.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Postoperative cerebrospinal fluid (CSF) leaks and meningitis are well-known risks of retromastoid craniotomy. Use of abdominal fat grafts, collagen allografts, and rigid or semirigid buttresses have demonstrated efficacy in preventing CSF leaks and meningitis in endoscopic endonasal surgery. This study aims to determine the utility of a similar multilayered reconstruction technique for retromastoid craniotomy.

METHODS:

We retrospectively reviewed 212 consecutive patients who underwent retromastoid craniotomy for tumor removal or microvascular decompression from 2007 to 2022. Scalp incisions were linear or slightly curved, muscle and facia opening was performed sharply avoiding monopolar cautery; craniotomies had a maximum dimension of 3 cm. A primary water-tight dural closure was rarely achieved favoring collagen sponge overlay often augmented with autologous fat. Clinical factors including pathology, mastoid air cell entry, and reconstruction material were analyzed. Outcomes including postoperative CSF leakage and meningitis were assessed.

RESULTS:

Of 212 patients (mean age 56 ± 16 years; 60% female; 10% with prior surgery), 148 (70%) had tumor resection and 64 (30%) had microvascular decompression. Mastoid air cells were breached in 67%. Collagen sponge dural overlay was used in 201/212 (95%). A fat graft was placed in 116 (55%) cases: 69% with air cell entry, 27% without air cell entry; 158 (75%) patients had their bone flap replaced, 46 (21%) had titanium mesh cranioplasty, 8 (4%) had no bone flap or titanium mesh. There were no CSF leaks or meningitis. One patient had a lumbar drain placement preoperatively, none postoperatively. Median length of stay was 2 days.

CONCLUSION:

Retromastoid craniotomy multilayered reconstruction with liberal use of collagen sponge and abdominal fat grafts seems to reliably avoid postoperative CSF leaks and meningitis including in the setting of nonwatertight dural closure and mastoid cell entry. Use of shorter incisions, avoidance of monopolar cautery, and a relatively small craniotomy may contribute to the absence of CSF leaks in this series.