bluuebunny/crossref_metadata_2025 huggingface dataset:
691 Correlation of Cerebral Arteriovenous Malformation Flow Measured by Quantitative Magnetic Resonance Angiography and MR-detected Arteriovenous Malformation Microhemorrhage
Authors: Hossa Jessica , McGuire Laura Stone , Patel Saavan , Ferrer Esteban Ramirez , Brunozzi Denise , Charbel Fady T. , Alaraj Ali
Published: March 2024

INTRODUCTION:

Intracranial hemorrhage (ICH) significantly contributes to morbidity and mortality in cerebral arteriovenous malformations (AVM) patients, with a history of prior hemorrhage being the most significant predictor of a future hemorrhage. Recently, silent microhemorrhage as detected on magnetic resonance imaging (MRI) has been proposed as a potential risk factor for future hemorrhage in AVM patients. Recent data suggests that silent microhemorrhage is associated with higher nidal velocity measured through color-coded DSA, raising the question of correlation between flow and microhemorrhage.

METHODS:

All unruptured AVM patients with a baseline QMRA with noninvasive optimal vessel analysis (NOVA) and gradient echo or susceptibility-weighted MRI were retrospectively reviewed (2004-2022). AVM flow was calculated from the aggregate flow within primary arterial feeders relative to their contralateral counterparts. A review of the MRI determined the presence of microhemorrhages. Descriptive statistics, the X2 test, and a binomial logistic regression were performed to test the association of demographics, clinical, and AVM features with microhemorrhage.

RESULTS:

The study consisted of ninety patients, with fifty microhemorrhage-positive and forty microhemorrhage-negative patients. The presence of venous anomaly (varix, ectasia, aneurysm) is independently predictive of microhemorrhage (OR = 2.444, p = 0.050), and a compact AVM nidus trended towards independent negative predictability of microhemorrhage (OR =.462, p = 0.081). Calculated AVM flow trends higher in the microhemorrhage-positive group with the median flow 407 mL/min vs. 238 mL/min, and a trend towards predicting presence of microhemorrhage (OR = 1.375, p = 0.106).

CONCLUSIONS:

Patients with AVM-associated venous anomalies have an increased likelihood of AVM microhemorrhage. Higher AVM flow and a diffuse AVM nidus trend towards a higher likelihood of AVM microhemorrhage. These findings demonstrate the possible relationship between higher AVM flow and risk of future bleeding.
700 Flow-redirection Intraluminal Device (FRED) System for the Management of Intracranial Aneurysms: A Systematic Review and Metanalysis
Authors: Florez-Perdomo William , Moscote-Salazar Luis Rafael , Agrawal Amit , Janjua Tariq , Ossa Gabriel Quiñonez , García-Ballestas Ezequiel
Published: March 2024

INTRODUCTION:

Multiple FDs are available for clinical use. Over the years, the FDs technology has improved considerably. However, overall complications and safety issues using FRED have not been evaluated in detail. Studies comprehensively investigating the clinical and technical events in FRED usage to treat IAs are not available. The purpose of this study is to investigate the outcome, overall complication rates, occlusion rate, retreatment, thromboembolic, and hemorrhagic complications for different patient cohorts treated with FRED flow diverter.

METHODS:

The following descriptors were used for the search: Flow-Redirection Intraluminal Device (FRED) system for the treatment of Intracranial aneurysms, Intracranial aneurysms, and Complication with no constraints applied was searched. Two authors independently revived and identified the studies, and two independent review authors extracted the data. A random-effect model was used to pool data, and the results were reported (odds ratios and 95% CI); heterogeneity was reported as I2.

RESULTS:

Nine studies were included in the final analysis, which involved retrospectively and prospectively collected data on 1167 patients. The use of FRED was associated with a rate of occlusion of 85% (95% confidence interval [CI] 79.5%–90.9%). Low retreatment rate of 2.5% (95% CI 1.0%–4.6%), low thromboembolic complication rate of 4.9% (95% CI 3.0%–7.31%), low hemorrhagic complication rate of 1.35% (95% CI 0.7%–2.0%). The mortality rate was 4% (95% CI 0.8%–2.1%). An overall good outcome was 95.1% (95% CI 92.1%–97.4%), and poor outcome was 4.8% (95% CI 2.5%–7.8%).

CONCLUSIONS:

The available evidence suggests that FRED offers favorable results for the management of intracranial aneurysms, results in high occlusion rate and low complication rates
708 Trends in Carotid Stenosis Literature Between 2012-2022: Applications of Endarterectomy and Translational Research
Authors: Kumarapuram Siddhant , Fu Allen , Sreenivasan Sanjeev , Tang Oliver Young , Kavia Jay , Khan Arsala , Ravoori Sanya , Mumudi Smriti , Roychowdhury Sudipta , Nanda Anil , Gupta Gaurav
Published: March 2024

INTRODUCTION:

Carotid stenosis causes 10-20% of cases with ischemic stroke. Research in this clinical domain continues to progress in improving possible treatment modalities, imaging modalities, mechanistic understandings, and risk factors.

METHODS:

The WebOfScience database was investigated for 6,639 publication items between 2012-2022 pertaining to neurosurgical management of carotid stenosis. Networks were constructed analyzing keywords, key terms, and countries of publication. Subsequently, items within each network were organized into clusters and average publication date was measured for each term. Relevant items were tracked over time to compare their representation and utility in literature. Additionally, relevant key terms and connections were isolated from the network.

RESULTS:

For each network, the top 1,000 terms were selected for analysis. Terms were arranged into six major clusters (treatments, imaging, risk factors, prognostic markers, plaque characteristics, and basic science research). The most recent terms were observed in the treatment cluster (average publication year 2021.24) and basic science cluster (average publication year 2018.4). While terms within basic science have remained consistent over time, analysis of treatments elucidated that “carotid endarterectomy” surpassed “carotid artery stenting” in popularity after 2019. Additionally, the term “mouse” in the basic science cluster was connected to all clusters with a link strength of 18,084 (average 427.6).

CONCLUSIONS:

Modern research in carotid stenosis is characterized by two developments: advancements in basic science and increasing publication focus on carotid endarterectomy. Despite recent advancements in endovascular treatment of carotid stenosis, open treatment continues to remain a significant focus of study. As they continue to expand into modern scientific enterprise, developing nations will continue to impact the future of carotid stenosis research.
754 Prediction of 30-day All-Cause Readmission of Neurosurgery Patients Using Large Language Models
Authors: Jiang Lavender , Liu Chris , Nejatian Nima Pour , Nasir-Moin Mustafa , Wang Duo , Abidin Anas , Eaton Kevin , Riina Howard A. , Laufer Ilya , Punjabi Paawan , Miceli Madeline , Kim Nora Chung , Orillac Cordelia Marcela , Schnurman Zane , Livia Christopher , Weiss Hannah , Kurland David B. , Neifert Sean N. , Dastagirzada Yosef Michael , Kondziolka Douglas S. , Cheung Alexander , Yang Grace , Cao Ming , Flores Mona , Costa Anthony , Aphinyanaphongs Yindalon , Cho Kyunghyun , Oermann Eric Karl
Published: March 2024

INTRODUCTION:

Existing clinical prediction algorithms mostly leverage small cohorts of structured data (e.g., medical imaging or laboratory data). However, large language models have demonstrated the ability to utilize unstructured data to outperform other machine learning approaches given sufficient data. Training large language models on unstructured clinical notes offers a possible alternative to structured data algorithm development in clinical tasks.

METHODS:

An unlabeled dataset of over seven million unstructured clinical notes (e.g., radiology reports and patient histories) was collected from four hospitals within the NYU Langone Health (NYULH) system and utilized to pre-train a bidirectional encoder representation with transformer (BERT) model. This model was further fine-tuned using a labeled dataset of discharge summaries to predict 30-day all-cause readmission. The resulting model, termed NYUTron, was assessed using a held-out retrospective cohort of patients from June to December 2021.

RESULTS:

Over the period of the retrospective study, there were a total 1,072 neurosurgery patients. The BERT model achieved an area under the receiver operating curve of 0.7883, a recall of 95.1% at a precision of 27.3%, and an accuracy of 82.1%.

CONCLUSIONS:

This study demonstrates how large language models and unstructured clinical notes can be used to provide information to physicians on clinical tasks with a flexible framework that is amenable to modification for other clinical tasks.
871 Bedside Neuronavigation for External Ventriculostomy as a Training Tool for Success: A Single-institution Experience and Meta-Analysis of Patients Outcomes and Procedural Accuracy
Authors: Bhanja Debarati , Wilding Hannah Eloise , Stoltzfus Mason , Kim Hali , Barnett Derek , Hazard Sprague , Rizk Elias Boulos
Published: March 2024

INTRODUCTION:

External ventricular drain (EVD) placement is the most universally performed neurosurgical procedure, frequently by trainees. Freehand insertion, which approximates anatomical landmarks to achieve percutaneous ventricular access, bodes a complication risk as high as 40%. Neuronavigation is widely used for neurosurgical procedures; however, its use case for EVD has been inadequately explored.

METHODS:

A single-institution retrospective cohort study was performed, including all EVDs inserted in 2022. A PRISMA-guided systematic review was then conducted, querying databases for relevant articles. Primary outcomes of interest were optimal positioning (using Kakarla grading) and number of passes for ventricular access. Secondary outcomes included postoperative ventricular enlargement, hemorrhage, edema, and drain malfunction. Clinical data was pooled between single-institution and systematic review for meta-analyses. Outcomes were compared using risk ratios (RR [95% CI]) and standardized mean differences (SMD).

RESULTS:

Forty-seven patients (49 EVDs) were included from a single institution (17 neuronavigation; 32 freehand). Through systematic review, 1,289 patients (255 neuronavigation; 1,034 freehand) were identified from 10 eligible studies. Pooled together, patients were predominantly male (52%) and adult-aged (90%). EVD indications most commonly included hemorrhage (61%), obstructive pathology (15%), trauma (10%), and infection (7%). 85% of EVDs were placed by neurosurgical trainees. Frequency of catheter malposition was significantly lower in the neuronavigation cohort compared to the freehand cohort (10% vs. 36%; RR, 0.41 [0.24-0.69]). However, number of catheter passes remained the same between cohorts (mean [SD]; 1.11 [0.42] vs. 1.16 [0.51]; SMD; 0.04 [0.48]). Moreover, frequencies of postoperative ventricular enlargement, hemorrhage, edema, and drain malfunction, although were higher in the freehand cohort, did not differ significantly.

CONCLUSIONS:

These findings suggest neuronavigation helps trainees achieve safe and accurate ventricular access. Neuronavigation-guided external ventriculostomy may offer a promising, accessible, and bedside-ready approach to minimize morbidity, while mastering the procedural technique.
875 Comparison of Anterior Versus Posterior Approaches for Management of Cervical Trauma: A National Database Study
Authors: Sri Bhaskara Mounika Lalitha , Jiang Sam Han , Labib Bichoy , Deysher Daniel , Khilwani Harsh , Chiu Ryan Guan , Sadeh Morteza , Mehta Ankit Indravadan
Published: March 2024

INTRODUCTION:

Cervical spine injuries are a major cause of long-term disability, accounting for almost 65% of all spinal injuries. They often result in major motor and sensory deficits and chronic pain. Prompt surgical intervention is often required to prevent further neurological deterioration and instability, yet there is no definitive evidence for the optimal operative approach.

METHODS:

The National Trauma Data Bank was queried from 2017 to 2019 for all patients with cervical trauma who underwent subsequent spinal fusion surgery with anterior or posterior approaches. Patients receiving combination management were excluded. Paired Student’s t-tests and Pearson’s Chi-squared analyses were used to compare differences in patient demographics, in-hospital complications, and lengths of stay between the two groups. Relative risks for the in-hospital complications were also calculated. Alpha was set to 0.05.

RESULTS:

A total of 10,593 patients meeting the inclusion criteria were identified, with 6,803 patients undergoing fusion with an anterior approach and 3,226 patients with a posterior approach. Patients with a posterior approach were significantly older, had a higher proportion of white and female patients, and a lower total GCS score (p < 0.05 for all). They also had higher rates of comorbidities such as hematologic disorders, COPD, CHF, Hypertension, PAD, MI, and renal disease (p < 0.05 for all). After surgery, the anterior approach group had a shorter hospital stay and a significantly lower risk of developing SSI, requiring unplanned reoperation, and experiencing MI (p < 0.05 for all).

CONCLUSIONS:

To our knowledge, this is the largest study assessing differences in in-hospital morbidities between surgical approaches for cervical trauma. Our findings suggest that the anterior approach has a lower risk of short-term complications, emphasizing its clinical advantage. Further research is needed to elucidate the long-term effects.
876 Neuron Specific Enolase and S-100 Protein in Sepsis Associated Encephalopathy (SAE)
Authors: Newsome-Cuby Takara , Talley Jan
Published: March 2024

INTRODUCTION:

Severe sepsis and septic shock represent one of medicine's oldest and most pressing problems. Sepsis-associated encephalopathy (SAE) is associated with increased mortality and decreased quality of life. By the time a patient is septic, SAE is most often already established. Currently, no standardized laboratory markers of brain injury may aid in the diagnosis. However, S-100 protein and neuron-specific enolase (NSE) may be useful biomarkers. Neuronal injury leads to the cellular release of these biomarkers into the cerebrospinal fluid and then ultimately into the bloodstream. Rapid detection will allow for early diagnosis and intervention in the clinical setting.

METHODS:

A systematic review evaluating patients with severe sepsis and septic shock. In 170 patients, serum S-100 and NSE were measured daily for 4 consecutive days after intensive care unit admission. Admission Glasgow Coma Scale before sedation and daily Sequential Organ Failure Assessment (SOFA) scores were recorded in all patients. Each participant was continuously observed 72 hours after withdrawing sedation.

RESULTS:

S-100 was elevated in 72 patients (42%) and NSE increased in 90 patients (53%). Higher maximum SOFA scores were recorded in patients with elevated biomarkers (p = 0.001). Elevation of S-100 was associated with encephalopathy (p = 0.004).

CONCLUSIONS:

S-100 and NSE are frequently increased in patients with severe sepsis and septic shock. The higher the biomarkers, the worse the brain failure in patients. S-100 levels can be used as predictors of early ICU mortality and better reflect the development of severe encephalopathy and brain injury than NSE levels and the GCS scores.
878 Selective Brain Cooling is Possible via CSF Exchange With Double Lumen EVD- Proof of Concept in Porcine Model
Authors: Jahromi Behnam Rezai , Järveläinen Niko , Kauhanen Jaakko , Niemela Mika Risto , Ylä-Herttuala Seppo
Published: March 2024

INTRODUCTION:

Hypothermia is seen as neuroprotective after brain insult (BI). In acute phase after BI it affects brain metabolism by decreasing oxygen and glucose consumption. Hypothermia affects apoptosis and inflammatory mediators. In the later stage of BI, enzyme activation stimulates protein and lipid breakdown, which can be slowed and decreased with hypothermia. In the latest stage of BI hypothermia has shown positive affect in angiogenesis, neurogenesis, synaptogenesis. Hypothermia also reduces vasogenic oedema and blood brain barrier dysfunction. Despite hypothermia´s neuroprotective effect randomized control trials have demonstrated its benefits only limited scenarios - mainly in global ischemia (post-cardiac infarction and ischemia of new-born). Majority of complications related to hypothermia has been due to systemic hypothermia and selective brain cooling has never been demonstrated in large mammals without changes in core temperature of subject.

METHODS:

We inserted double lumen external ventricular drainage (EVD) into the lateral ventricle of porcine. We added spinal drainage to accelerate CSF exchange to cooled NaCl solution. Brain parenchymal temperature was measured from the contralateral brain hemisphere and the ipsilateral brain hemisphere.

RESULTS:

Contralateral brain hemisphere temperature dropped by 3.1C from baseline while core temperature changed only by 0.5C. Ipsilateral temperature cooled by 7.5C from baseline to 30.8C, while core temperature was 37.7C. Total time needed to achieve selective cooling was 1.5h. Porcine started to have arrhythmias when brain temperature approached 30.8C.

CONCLUSIONS:

We are first to describe that selective brain cooling is possible via CSF exchange with double lumen EVD to achieve significant temperature difference between body core and brain. The timing and rate of selective cooling needs to be established as cause of arrhythmias before starting human trials.
879 Comparison of Perioperative and Long-Term Outcomes Following PEEK and Autologous Cranioplasty: A Single Institution Experience
Authors: Anderson Bradley , Harris Peter Norman , Mozaffari Khashayar , Foster Chase H. , Johnson Michael , Jaco Alejandro , Rosner Michael K.
Published: March 2024

INTRODUCTION:

Cranioplasty is a common neurosurgical procedure to correct congenital or acquired skull defects. Three-dimensionally (3D) printed polyether-ether-ketone (PEEK) implants are a relatively novel option for cranioplasty that has gained popularity in recent years. However, there is ongoing debate with respect to this material’s efficacy and safety compared to autologous bone grafts. The purpose of this study was to offer our institution’s experience and add to the growing body of literature on the topic.

METHODS:

A single-institution retrospective analysis of patients undergoing cranioplasties between 2016 and 2021 was performed. Patients were divided into PEEK and autologous cranioplasty cohorts. Parameters of interest included patient demographics as well as perioperative (<3 months postoperative) and long-term outcomes (>3 months postoperative). A p-value <0.05 was considered statistically significant.

RESULTS:

A total of 31 patients met inclusion criteria (PEEK: 15, Autologous: 16). Mean age of the entire cohort was 51.7 years (range 19-81 years). Baseline demographics using the modified frailty index (mFI) revealed greater rate of comorbidities in the autologous group (p = 0.073), which was accounted for in statistical analyses. Multiple logistic regression model revealed a significantly higher rate of surgical site infection during the immediate postoperative period in the autologous cohort (31.3% vs. 0%, p = 0.011). Otherwise, perioperative and long-term complication profiles were similar between groups. Additionally, a generalized linear model demonstrated that both cohorts had similar mean hospital length of stay (LoS) (autologous: 16.1 vs. PEEK: 10.7 days).

CONCLUSIONS:

PEEK cranioplasty implants may offer a more favorable perioperative complication profile with similar long-term complication rates and hospital LoS compared to autologous bone implants. Future studies are warranted to confirm our findings in larger series, and further examine the utility of PEEK in cranioplasty.
923 Utilization of a Gestational Age Threshold May Improve Pediatric VP Shunt Outcomes
Authors: Black Hannah , Woolard Alice , Quinsey Carolyn , Stuebe Caren , Torres Andrea , Caddell Drew
Published: March 2024

INTRODUCTION:

The highest shunt failure rates occur in patients with hydrocephalus from intraventricular hemorrhage of prematurity (Premie-IVH). Tuli et al (1999) described a 40-week gestational age threshold that significantly differentiated shunt failure rates in a neonatal hydrocephalus population, but this threshold has not been investigated in a dedicated Premie-IVH cohort.

METHODS:

A retrospective cohort study was performed on patients treated for hydrocephalus with VP shunt implant at an academic pediatric institution from 2010-2021. Inclusion criteria were hydrocephalus from Premie-IVH, known gestational age at delivery, 1 year of follow-up, and known surgical history prior to VP shunt implant.

RESULTS:

Among 32 Premie-IVH patients, 50% experienced shunt failure within 1 year after VP shunt implant. Average gestational age (GA) at delivery was 27.5 weeks and average GA at surgery was 45.2 weeks. In total, 44% of patients received a VP shunt before 40 weeks of gestational age. In this population, 64% experienced VP shunt failure within one year and had an average of 0.79 temporizing surgeries prior to VP shunt implant. In the 56% of patients who received VP shunt surgery after 40 weeks of GA, 39% experienced VP shunt failure within one year and had an average of 1.3 temporizing surgeries prior to VP shunt surgery.

CONCLUSIONS:

In patients with hydrocephalus from Premie-IVH, those who had VP shunt surgery after 40 weeks gestational age received a greater number of temporizing measures while experiencing a 49% lower VP shunt failure rate. Temporizing measures may be used to improve VP shunt outcomes by delaying VP shunt surgery until after 40 weeks gestational age.
Prognostic Evaluation of Surgical Re-Resection for Recurrent Glioblastoma Using the Novel RANO Classification for Extent of Resection by The RANO Resect Group
Authors: Karschnia Philipp , Dono Ostorga Antonio Gabriel , Young Jacob , Jünger Stephanie T. , Teske Nico , Häni Levin , Sciortino Tommaso , Mau Christine Y. , Bruno Francesco , Nunez Luis C. , Weller Michael , van den Bent Martin , Beck Juergen , Hervey-Jumper Shawn L. , Molinaro Annette , Tandon Nitin , Rudà Roberta , Vogelbaum Michael A. , Bello Lorenzo , Schnell Oliver , Grau Stefan J. , Chang Susan M. , Berger Mitchel S. , Esquenazi Yoshua , Tonn Joerg-Christian
Published: March 2024

INTRODUCTION:

The value of re-resection in recurrent glioblastoma remains unclear since leaving certain tumor deliberately behind appears ethically not justified.

METHODS:

The international RANO resect group retrospectively compiled an eight-center cohort of patients with first recurrence from a previously resected glioblastoma. The associations of re-resection and clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize potential confounders when comparing the different RANO classes.

RESULTS:

We identified 681 patients with first recurrence of IDH-wildtype glioblastomas, including 310 patients who underwent re-resection. The use of re-resection was associated with prolonged survival also when stratifying for molecular and clinical confounders on multivariate analysis; and ≤ 1 cm3 residual CE tumor translated into improved survival compared to non-surgical management. Accordingly, ‘maximal resection’ (class 2) had superior survival compared to ‘submaximal resection’ (class 3). Adjuvant (radio-)chemotherapy further augmented the beneficial effects of lower residual CE tumor. Conversely, ‘supramaximal resection’ of non-CE tumor (class 1) was not associated with prolonged survival but frequently accompanied by post-operative deficits, hampering further treatment. The prognostic role of residual CE tumor was confirmed in propensity score analyses.

CONCLUSIONS:

Maximal extent of re-resection measured as residual CE tumor is highly prognostic in recurrent glioblastoma. The RANO classification serves to stratify patients accordingly. While the optimal adjuvant therapy awaits evaluation, our study supports that (radio-)chemotherapy consolidates the effects of re-resection.
Targeted DNA Sequencing Reveals Molecular Factors Associated with Clinical Outcomes in Recurrent Glioblastoma
Authors: Al-Adli Nadeem , Chen William , Young Jacob , Mirchia Kanish , Peeran Zain , Braunstein Steve , Perry Arie , de Groot John , Raleigh David R. , Costello Joseph , Berger Mitchel , Vasudevan Harish
Published: March 2024

INTRODUCTION:

The prognostic significance of molecular alterations in recurrent glioblastoma (rGBM) remains unclear.

METHODS:

121 consecutive glioblastoma (GBM) patients who underwent re-resection at a single institution from 2016-2021 were retrospectively reviewed. All patients underwent maximal safe resection followed by radiotherapy with concurrent and adjuvant temozolomide (TMZ) at time of initial diagnosis. DNA mutations from re-resection samples were assessed with a CLIA certified next-generation targeted DNA sequencing assay. Overall (OS) and progression-free survival (PFS) from re-resection were analyzed with the Kaplan-Meier method and Cox regression analyses.

RESULTS:

Median age at first recurrence was 57 years (range, 27-78), and median follow up from re-resection was 11 months. Salvage therapy comprised re-irradiation (n = 52, 43%), temozolomide (TMZ) (n = 39, 32%), lomustine (n = 47, 39%), and/or bevacizumab (n = 22, 18%). Median OS and PFS times were 12.1 and 4.4 months, respectively. Median tumor mutation burden (TMB) was 4 mut/Mb (range, 1-650), microsatellite instability (MSI) was 1.16% (range, 0-20), and MGMT methylation was present in 71 (59%) patients. Longer OS was found after postoperative TMZ (19.1 vs. 9.1), KPS >70 (13.6 vs. 11.1), and/or re-irradiation (12.6 vs. 8.4) (p < .05 for each). On multivariate analysis, TMZ (HR 0.2, 0.079-0.48), re-irradiation (HR 0.27, 0.12-0.58), and mutations in the PDGFRA (HR 0.24, 0.067-0.83) or PTEN (HR 2.3, 1.1-4.8) genes on targeted sequencing were associated with longer OS after re-resection (p < .05). Multivariate predictors of re-irradiation response included MSI > 1.16 (HR 0.25, 0.084-0.75), and mutations in PDGFRA (HR 0.04, 0.005-0.33), TERT (HR 0.16, 0.033-0.78), or PIK3R1 (HR 0.18, 0.041-0.8) genes. In the 46 matched primary/recurrent tumors, 40 (46%) had a longitudinal change in a mutation and 9 (24%) demonstrated hypermutation, of which 4 (57%) had simultaneous mismatch repair deficiencies.

CONCLUSIONS:

Our study identifies molecular factors associated with survival and response to re-irradiation in rGBM.
Tumor Treating Fields for Treatment of Spinal Metastasis
Authors: Tatsui Claudio Esteves , Ledbetter Daniel , North Robert Y. , Alvarez-Breckenridge Christopher , Andrade de Almeida Romulo
Published: March 2024

INTRODUCTION:

Tumor treating fields(TTF) has never been described for treatment of spinal metastasis. We investigate the anti-mitotic effect of TTF to inhibit the growth of human cancer using cells in vitro and in vivo models of spinal metastasis.

METHODS:

In-vitro: human derived osteosarcoma (Krib-Luc-1) and lund adenocarcinoma (A549-Luc) cells were seeded in 5x5mm human demineralized bone grafts kept in culture while treated with 0 KHz (control) or 150 KHz of TTF for 14 days. Bioluminescence images (BLI) were obtained at baseline and 14 days. In-vivo: Krib-Luc-1 cells were surgically implanted via trasperitoneal approach to the L3 vertebra in nude mice. Animals were treated with 0 KHz or 150 KHz of TTF for 30 days or until paralysis. BLI were obtained at day 0 and every 7 days. MRI was obtained at day 22. Histological analysis was performed at the end of the experiment. Control and TTF treated groups were compared with two-tailed t-tests.

RESULTS:

In vitro: BLI of the control grafts demonstrated a median value of 1×10^10 photons/sec at 14 days, significantly higher than 1×10^8 photons/sec observed in the 150 KHz group (p < 0.0001). In Vivo: median time to paralysis in control animals was 25 days, all animals treated with TTF at 150 KHz reached the 30 day mark without deficits. BLI of the control group was 3.5×10^9 photons/sec significantly higher than 1×10^9 photons/sec in the 150 KHz TTF group (p = 0.0212). MRI and histological analysis confirmed significant smaller tumors in the treated group when compared to controls.

CONCLUSIONS:

Application of TTF 150 KHz reduced cellular proliferation in both in vitro and in vivo models of spinal metastasis. We believe TTF could become a groundbreaking treatment for spinal metastasis.
Demographic Variations and Time to Initiation of Adjunct Treatment following Surgical Resection of Anaplastic Astrocytoma in the United States—A National Cancer Database Analysis
Authors: Sharma Mayur , Mckenzie Grant , Gaskins Jeremy , Yusuf Mehran , Woo Shiao Y. , Mistry Akshitkumar , Williams Brian Jeremy
Published: March 2024

INTRODUCTION:

Anaplastic Astrocytoma (AA) is a rare primary brain tumor with a significant variation in the type and timing of adjunct treatment (AT) following the surgical resection.

METHODS:

The National Cancer Database (NCDB) was queried for patients diagnosed with AA from 2004 to 2016. Cox proportional hazards and modeling was used to determine factors influencing survival, including the impact of time to initiation (TTI) of adjuvant therapy.

RESULTS:

Overall, 5890 patients were identified from the database. The use of combined RT+CT temporally increased from 66.3% (2004-2007) to 79% (2014-2016), p < 0001. Patients more likely to receive no treatment following surgical resection included elderly (>60 years old), hispanic patients, those with either no or government insurance, those living >20 miles from the cancer facility, those treated at low volume centers (<2 cases/year). AT was received following surgical resection within 0-4 weeks, 4.1-8 weeks, and >8 weeks in 41%, 48%, and 3%, respectively. Compared to patients who received RT + CT, patients were likely to receive RT only as AT either at 4-8 weeks or >8 weeks after the surgical procedure. Patients who received AT within 0-4 weeks had the 3-year OS of 46% compared to 56.7% for patients who received treatment at 4.1-8 weeks.

CONCLUSIONS:

Across the cohort, nearly 15% of patients received no AT following surgery, with the proportion of patients receiving no AT generally decreasing over time. This decrease corresponds to increased utilization of combined modality AT during the same time span. The highest utilization of combined AT within this cohort was between 4.1-8 weeks following the surgery.
A thermal performance curve perspective explains decades of disagreements over how air temperature affects the flight metabolism of honey bees
Authors: Glass Jordan R. , Harrison Jon F.
Published: March 2024

While multiple studies have shown that honey bees and some other flying insects lower their flight metabolic rates when flying at high air temperatures, critics have suggested such patterns result from poor experimental methods as, theoretically, air temperature should not appreciably affect aerodynamic force requirements. Here, we show that apparently contradictory studies can be reconciled by considering the thermal performance curve of flight muscle. We show that prior studies that found no effects of air temperature on flight metabolism of honey bees achieved flight muscle temperatures that were near or on equal, opposite sides of the thermal performance curve. Honey bees vary their wing kinematics and metabolic heat production to thermoregulate, and how air temperature affects the flight metabolic rate of honey bees is predictable using a non-linear thermal performance perspective of honey bee flight muscle.
Das Aramäische im Altertum und in der Gegenwart
Authors: Nebe G. Wilhelm , Arnold Werner
Published: March 2024

Das Aramäische im Altertum und in der Gegenwart
Barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of oral health policies in the WHO Africa region: A scoping review protocol
Authors: Carrasco-Labra Alonso , Verdugo-Paiva Francisca , Matanhire-Zihanzu Cleopatra N. , Booth Emmett , Kohler Iliana V. , Urquhart Olivia , Makino Yuka , Glick Michael
Published: March 2024

Background Evidence-informed oral health policies (OHP) can be instrumental in ending the neglect of oral health globally. When appropriately developed and implemented, OHP can improve the efficiency of healthcare systems and the quality of health outcomes. However, more than half of the countries in the World Health Organization (WHO) African region do not have an oral health policy or even the existence of a policy in need of additional and more national-specific OHP as part of non-communicable diseases and universal health coverage agendas. The objective of this protocol’s study is to determine the barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in the WHO Africa region. Methods We will conduct a systematic search in Global Health, Embase, PubMed, PAIS, ABI/Inform, Web of Science, Academic Search Complete, Scopus, databases that index gray literature, and the WHO policy repositories. We will include qualitative, quantitative, or mixed-methods research studies and OHP documents published since January 1, 2002, which address stakeholders’ perceptions and experiences regarding barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in countries part of the WHO African region. We will produce descriptive statistics (frequencies and proportions) for quantitative data and conduct descriptive content analysis for qualitative data. Discussion To effectively establish evidence-based OHP in the WHO African region, it is crucial to recognize existing challenges and opportunities for progress. The findings of this review will be relevant for Chief Dental Officers at ministries of health, administrators of dental schools, or academic institutions in the WHO African region and will inform a stakeholder dialogue meeting in Kenya in November of 2023. Registration Open Science Framework: https://doi.org/10.17605/OSF.IO/9KMWR
Machine vision situations: Tracing distributed agency
Authors: Gunderson Marianne , Solberg Ragnhild , Kronman Linda , De Seta Gabriele , Rettberg Jill Walker
Published: March 2024

This article proposes a new method for tracing and examining agency in heterogeneous assemblages, focusing on the role of machine vision technologies in creative works. We introduce the concept of the “machine vision situation” and define it as the moment in which machine vision technologies come into play and make a difference to the course of events. By taking situations as the unit of analysis, we identify moments at which machine vision technologies take part in actions without reducing them to either tools or protagonists, instead allowing for more complex agential entanglements between human and non-human actors. Grounded on an interdisciplinary theoretical framework, this article demonstrates how an analytical unit such as the machine vision situation is a valuable method for tracing how agency is distributed. We illustrate this through three examples by applying the method to creative works – narratives, digital games, and artworks – revealing key aspects of distributed agency and calling attention to the excess, complications, and messy entanglements that might otherwise be overlooked in analyses of agential assemblages. The machine vision situation is shown to be a flexible unit of analysis that can be productively incorporated in both quantitative and qualitative studies and applied to other contexts in which human and non-human agencies interact.
Building a Sphere from Imaginary Points
Authors: Girsh A.
Published: March 2024

Euclidean spaces of various dimensions do not contain imaginary images and objects by definition, but are inextricably linked with them through special cases, and this leads to the need to expand the field in geometry into the region of imaginary values [1, 19, 26]. Such an extension, i.e. adding to the field of real coordinates spaces of different dimensions, the field of imaginary coordinates leads to different variants of spaces of different dimensions, depending on the chosen axiomatics. Earlier in a number of articles, examples of solving some actual problems of geometry using imaginary geometric images and objects were shown [4, 5, 6, 13, 21, 22, 29].

The article provides constructions for constructing a sphere from four predetermined points, of which one pair or both pairs of points can be imaginary complex conjugate. The construction is carried out on combined diagrams by the methods of descriptive geometry by analogy with the well-known problem of constructing a sphere from four real points. The construction of a sphere is based on seven auxiliary constructions for constructing a circle from points that can be imaginary conjugates. Both 3D problems of constructing spheres for given points and methods of 2D construction problems for determining the required imaginary points are considered. A method for calculating the parameters of the obtained sphere is described. The application of the method to other problems of descriptive geometry, for example, to the problems of finding geometric places of points, is considered. equidistant from two given surfaces. Recently, this issue has been intensively studied, for example, in the works [5, 6].
Reverse engineering is an effective tool for teaching engineering graphics
Authors: Verhoturova E. , Pronin S. , Ivaschenko G.
Published: March 2024

This study proposes the introduction of reverse engineering technology into a graphic workshop in the discipline «Engineering Graphics». The purpose of this study was the scientific and methodological substantiation of the need to use reverse engineering in the methodology of teaching engineering graphics. The article considers the concept of «reverse engineering», its application for solving engineering problems and in the educational process. It is shown that reverse engineering of a part and a sketch of a part are used in solving issues of production organization, in pilot production, repair and other cases, to solve similar and sometimes identical engineering problems. It has been suggested that the technology of reverse engineering in production conditions can replace the function of sketching a part. In the educational process for some areas of training, it is proposed to consider reverse engineering of the part in addition to the topic “part sketch”. A comparison is made of the use of reverse engineering technology and part sketching to solve the engineering problem of obtaining a three-dimensional digital model of a part. As part of the educational process, it is proposed to consider it as a situational or complex task. The scientific and methodological substantiation of the need to use reverse engineering in the methodology of teaching engineering graphics is based on the results of the experiment, which included parallel operations of reverse engineering and part sketching.
Engineering graphics in the light of parting with the Bologna agreement
Authors: Tikhonov-Bugrov D. , Abrosimov S.
Published: March 2024

The situation that has developed as a result of the signing by Russia of the Bologna agreement is considered and an attempt is made to evaluate the prospects for leaving it. It is noted that the introduction of undergraduate and master's master has broken a classic domestic system of higher education. A reference is made to the work of specialists who predicted serious problems of building undergraduate in the sphere of professional activity. In relation to graphic training, two aspects are considered: undergraduate and competency -based approach to education. The undergraduate has greatly cut off not only the audit load, but also the total number of hours to study disciplines. The specified deficit gave rise to the exclusion of drawing geometry from a number of educational standards. This trend was paid attention to, in particular, Bulgarian colleagues. The result is the loss of the theoretical basis of the departments teaching graphic disciplines. The investigation is a loss of independence, unification with other departments. Due to the fact that employers in the field of equipment perceived the undergraduate as unacceptable engineers, unsuitable attempts were made to introduce engineering undergraduate. The deficiency of the auditor's load crushed mentoring - the invaluable quality of domestic education. It is especially important when working with 1-2 courses, due to the lack of graphics at school, insufficient training in the field of geometry, a small emphasis on analytics in the educational process. Attention is drawn to the “quiet revolution” that occurred in domestic education in connection with a competency -based approach. The educational process is built from the result to training i.e. In the opposite direction in relation to the classical scheme. Now the main in training is the employer. The relationship, mutual understanding between it and the university, the individual department unambiguously determines the quality of education. A possible dictate can turn a number of aspects of the educational process into formal or ineffective. Examples are given. In terms of forecasts, it is noted that the undergraduate will not disappear at the same time, and the specialists in the field of graphic training are faced with training using innovative approaches in the educational and production educational process within the framework of a specialty.
Inflation, Monetary Policy, and Portfolio Decisions of U.S. Households
Authors: Bonaparte Yosef , Korniotis George M. , Kumar Alok , Vosse Melina
Published: March 2024

We study the impact of monetary policy changes on portfolio decisions of U.S. households. Contrary to the predictions of canonical portfolio choice models, interest rate increases are related to increased equity ownership and larger wealth allocations to risky assets. Inflation hedging is a likely explanation for these findings. Interest rates have a stronger impact on the equity exposure of households that experience higher inflation, especially those with greater inflation awareness and potentially stronger hedging motives. Using household portfolios at a large discount brokerage house, we provide direct evidence that investors with greater inflation sensitivity overweight stocks with high hedging potential.

This paper was accepted by Camelia Kuhnen, finance.

Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2023.02197 .
Costly Information Acquisition in Decentralized Markets: Experimental Evidence
Authors: Asparouhova Elena , Bossaerts Peter , Yang Wenhao
Published: March 2024

This study tests the rationality of the decisions to purchase information, the informational efficiency of prices, and the optimality of the resulting allocations in decentralized markets with a series of laboratory experiments. The theory predicts that markets with dispersed information and natural buyers and sellers converge to a fully revealing equilibrium. It is profitable to pay for information, and as such, the Grossman-Stiglitz paradox does not emerge. Statistically significant improvements in both price efficiency and allocative efficiency are documented across trading periods. In contrast to the theory, which predicts that the higher the number of informed agents, the stronger the individual incentives to invest in information, the and the more data present the opposite result. The price of information is higher when there are fewer informed agents. The result can be explained by boundedly rational decision making.

This paper was accepted by Yan Chen, behavioral economics and decision analysis.

Funding: This work was supported by the National Science Foundation [Price Quality in Dark Markets Grant 1426428].

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.4976 .
Implementing internet-delivered cognitive behavioural therapy in integrated care systems
Authors: Duffy Daniel , Rota Joanna
Published: March 2024

This article discusses the intricacies of integrating digital mental health resources into integrated care systems. It explores the role of internet-delivered cognitive behavioural therapy in supporting people with mental health needs, the impact on waiting times, barriers to implementation and the role of healthcare managers in this process.
The Garden of Perfect Brightness
Authors: Green Jared
Published: March 2024

Abstract: “The Garden of Perfect Brightness” is the story of a displaced mother on the precipice of a major life change, a husband on the road, and a daughter on the verge of a highly unusual transformation—all unfolding beneath a solar eclipse.
Regained Loyalty
Authors: Youssef Saadi , Mattawa Khaled
Published: March 2024

Abstract: poem by Khaled Mattawa
The Cabinet
Authors: Murray Christopher Brean
Published: March 2024

Abstract: “The Cabinet” features the meandering monologue of a speaker who longs for “the bottles of solutions that enhance/memory.” Yet, it seems that the more he remembers, the more reason there is to forget the “wars, floods, betrayal[s]” and other difficulties that he and his family have endured.
All-optical instantaneous RF signal frequency measurement system based on a linear ACF with a steep slope
Authors: Zhi Kun , Huang Chongjia , Chan Erwin H. W. , Hao Peng , Wang Xudong
Published: March 2024

A new microwave photonic structure for measuring the frequency of an RF signal, to the best of our knowledge, is presented. The frequency of an unknown RF signal can be determined by simply measuring the system output optical powers. The proposed frequency measurement system can be designed so that the ratio of the two system output optical powers as a function of the RF signal frequency or the amplitude comparison function (ACF) has a steep linear slope over a wide frequency range. This enables the RF signal frequency to be measured in high resolution and high accuracy. The proposed frequency measurement system has a simple and compact structure, and is free of high-speed photodetectors as well as RF components and instruments. It also has a fast response time compared to many reported photonics-based frequency measurement systems. A proof-of-concept experiment is carried out. Experimental results show a linear ACF with a slope of more than 4.4 dB/GHz over a frequency measurement range of 5–26 GHz and a frequency measurement accuracy of better than ±0.1GHz.
Angularly offset multiline dispersive optical phased array enabling large field of view and plateau envelope
Authors: Wang Chenxi , Lee Woo-Bin , Sunwoo Yoon-Ho , Kwon Yun-Jae , Oh Min-Cheol , Lee Sang-Shin
Published: March 2024

We propose and demonstrate an angularly offset multiline (AOML) dispersive silicon nitride optical phased array (OPA) that enables efficient line beam scanning with an expanded field of view (FOV) and plateau envelope. The suggested AOML OPA incorporates multiline OPA units, which were seamlessly integrated with a 45° angular offset through a thermo-optic switch based on a multimode interference coupler, resulting in a wide FOV that combines three consecutive scanning ranges. Simultaneously, a periodic diffraction envelope rendered by the multiline OPA units contributes to reduced peak intensity fluctuation of the main lobe across the large FOV. An expedient polishing enabling the angled facet was diligently accomplished through the implementation of oblique polishing techniques applied to the 90° angle of the chip. For each dispersive OPA unit, we engineered an array of delay lines with progressively adjustable delay lengths, enabling a passive wavelength-tunable beam scanning. Experimental validation of the proposed OPA revealed efficient beam scanning, achieved by wavelength tuning from 1530 to 1600 nm and seamless switching between multiline OPAs, yielding an FOV of 152° with a main lobe intensity fluctuation of 2.8 dB. The measured efficiency of dispersive scanning was estimated at 0.97°/nm, as intended.