bluuebunny/crossref_metadata_2025 huggingface dataset:
P.068 Discrepancy between post-treatment infarct volume and 90-day
outcome in ischemic stroke: A validation study in the ESCAPE-NA1 randomized
controlled trial
Authors: Ganesh A , Ospel JM , Menon BK , Demchuk AM , Nogueira RG , McTaggart RA , Poppe AY , Almekhlafi MA , Hanel RA , Thomalla G , Holmin S , Puetz V , van Adel BA , Tarpley JW , Tymianski M , Hill MD , Goyal M
Published: January 2022

Background: Some patients do poorly despite small
infarcts after endovascular therapy(EVT) whilst others with large infarcts
do well. We validated exploratory findings from the ESCAPE trial regarding
factors associated with such discrepancies, in the ESCAPE-NA1
trial(NCT02930018). Methods: We identified
“discrepant cases” with modified Rankin Scale(mRS)≥3 despite small follow-up
infarct volume(FIV≤25th-percentile) on 24-hour CT/MRI or mRS≤2 despite large
FIV(volume≥75th-percentile). We compared area-under-the-curve(AUC) of
pre-specified logistic models containing (a)pre-treatment
factors(age/cancer/vascular risk-factors) and
(b)treatment-related/post-treatment factors(serious adverse events/SAEs) in
identifying small-FIV/mRS≥3 and large-FIV/mRS≤2, with stepwise
regression-derived models. Results: Among 1,091
patients, 42/287(14.6%) with FIV≤7mL(25th-percentile) had mRS≥3;
65/275(23.6%) with FIV≥92mL(75th-percentile) had mRS≤2. Pre-specified
pre-treatment factors(age/cancer/vascular risk-factors) were associated with
FIV≤7mL/mRS≥3; stepwise models selected similar variables(similar
AUCs:0.92-0.93,p=0.42). SAEs(infarct-in-new-territory/recurrent
stroke/pneumonia/heart failure) were strongly associated with FIV≤7mL/mRS≥3;
stepwise models also identified onset-to-needle time and
hemoglobin(24-hours) as treatment-related/post-treatment factors(similar
AUCs:0.92-0.94,p=0.14). Younger age was associated with FIV≥92mL/mRS≤2;
stepwise models also selected diabetes absence and baseline
hemoglobin(similar AUCs:0.76-0.77,p=0.82). Absence of SAEs(stroke
progression/pneumonia/intracerebral hemorrhage) was strongly associated with
FIV≥92mL/mRS≤2; stepwise models also identified 24-hour hemoglobin, glucose,
and BP(similar AUCs:0.79-0.80,p=0.030). Conclusions:
FIV-mRS discrepancies are associated with pre-treatment factors like
age/comorbidities; and post-treatment complications related to stroke
evolution, secondary prevention, and post-acute care quality. Optimizing
thrombolysis speed, BP, glucose, and hemoglobin are modifiable factors
meriting further study.
P.084 Pilot Program to Determine Impact of an Orthoptic Clinic on Patient
Perceived Quality of Life of Stroke Patients
Authors: Hyndman J , Whelan K , Hunter G , Racine M , Catton C , Orsak L , Goodkey R , Vols R , Hillis K , Kleiter A , Taylor K , Schreiner L , Graham B
Published: January 2022

Background: Visual impairment exists for an
estimated 70% of individuals who have experienced a stroke. Identification
and remediation of visual impairments can improve overall function and
perceived quality of life. Our project aims to improve visual assessment and
timely intervention for patients with post-stroke visual impairment (PSVI).
Methods: We conducted a quality improvement
initiative to create a standardized screening and referral process for
patients with PSVI to access an orthoptist. Post-stroke visual impairment
was assessed by way of the Visual Screen Assessment (VISA) tool,
administered by an occupational therapist. Patients filled out a VFQ-25
questionnaire before and after orthoptic assessment and intervention. The
VFQ-25 is a validated post-stroke survey assessing a patient’s perceived
quality of life. Differences between pre- and post-orthoptic assessment
scores will be evaluated. Results: Data collection
currently ongoing.The benefits of a standardized screen for PSVI,
standardized referral to, and experience with an orthoptist assessment will
be determined. Learnings gained will also inform how we can expand the
program to benefit a wider demographic of patients.
Conclusions: The data gathered and the subsequent
analysis will be instrumental in guiding ongoing improvement initiatives for
patients with PSVI.
P.222 Subjective pattern of postoperative neurological recovery in
degenerative cervical myelopathy varies by preoperative severity of
disease
Authors: Friesen AC , Detombe SA , Doyle-Pettypiece P , Ng W , Gurr K , Bailey C , Rasoulinejad P , Siddiqi F , Bartha R , Duggal N
Published: January 2022

Background: Degenerative cervical myelopathy is a
spinal disorder resulting in progressive spinal cord compression and
consequent neurological deficits that can be assessed and tracked using the
modified Japanese Orthopedic Association (mJOA) questionnaire. However, it
is difficult to predict which patients will recover neurological function
after surgery, making it difficult for clinicians to set reliable
postoperative patient expectations. Methods:
Sixty-eight operative myelopathy patients (50 male, 14 female) consented to
complete the mJOA questionnaire both preoperatively and 6-months
postoperatively. Fifteen of these patients had mild, twenty-three had
moderate, and thirty had severe preoperative disease.
Results: We found that in mild myelopathy,
sensation and strength recover in similar proportions. In moderate
myelopathy, a greater proportion of patients recover in each domain except
for sensation. Recovery in severe myelopathy was comparable to moderate
disease, but showed more dramatic recovery in sensation and sphincter
function. Conclusions: This study shows that the
severity of myelopathic disease influences the pattern of postoperative
recovery. Though limited in sample size, the recovery patterns identified
above are an important first step in recognizing myelopathy as a disease
that patients experience heterogeneously both pre- and post-operatively. Our
results will aid clinicians in goals-of-surgery discussions and assist with
managing postoperative patient expectations.
P.118 Curriculum mapping can facilitate transition to Competence by
Design
Authors: Curtis C , Mineyko A
Published: January 2022

Background: Curriculum maps outline the content
of an educational program identifying links between targeted outcomes,
educational opportunities, and assessments. The transition to Competence by
Design (CBD) in Canadian specialty residency programs requires thoughtful
reorganization of educational programming. A curriculum map may assist with
understanding the existing curriculum and thereby facilitate planning for
CBD. Methods: A map of the pediatric neurology
residency curriculum at the University of Calgary was constructed by linking
objectives with related learning activities and assessments. Qualitative
line-by-line analysis was then conducted to identify gaps in the existing
curriculum. The map was used as a framework to plot CBD outcomes and
curricular structure as these were established.
Results: Generating the traditional curriculum
map was time-consuming, requiring 48 hours. Careful review identified
several objectives that did not link to formal learning activities or
assessments. Many such gaps were recognized to link to non-clinical
activities. Using the scaffold of the traditional curriculum reduced the
time required for mapping the planned CBD curriculum to 4 hours.
Conclusions: The creation of a curriculum map
prior to transition to CBD improved understanding of the existing curriculum
and will facilitate transition to CBD. Ongoing evaluation of the fit of our
predicted CBD map will support effective implementation.
P.123 Severe DNM1 Encephalopathy with Dysmyelination due to Recurrent
Splice Site Pathogenic Variant
Authors: Sahly AN , Krochmalnek E , St-Onge J , Srour M , Myers KA
Published: January 2022

Background: Patients with DNM1-encephalopathy
almost exclusively have missense variants, mostly in the GTPase domain of
DNM1. Delayed myelination has been reported in at least three patients with
DNM1-encephalopathy, all with missense mutations in the DNM1 central domain.
Only one DNM1 splice-site variant has previously
been reported, and the authors questioned whether the variant accounted for
all aspects of the patient’s phenotype. Methods:
Case-Report. Results: Our patient had hypotonia and
brief multifocal tonic seizures from age-1-month. He still has profound
global developmental delay, daily seizures and microcephaly. MRI-Brain at
age-21-months showed T2 hyperintensity in the bilateral periventricular and
subcortical white matter; spectroscopy showed a questionable lactate peak
and an elevated choline peak relative to N-acetylaspartate. Clinical
gene-panel identified a heterozygous de novo pathogenic variant in intron 9
of DNM1 (c.1197-8G > A; IVS9- 8G>A). In-silico tools categorized this
variant as deleterious secondary to a splicing defect. RT-PCR analysis on
peripheral blood was unsuccessful as DNM1 expression is extremely low
outside of the brain. Conclusions: Our patient
carried the same DNM1 variant previously reported, indicating this is a
recurrent pathogenic splice-site variant. The spectroscopic abnormalities
suggest a possible element of demyelination in
DNM1 variants of the central domain, though
the mechanism remains unclear.
P.134 Movement medicine: A systematic review on the effect of early
aerobic exercise initiation on symptom recovery following concussion
Authors: Kempenaar A , Bayley M
Published: January 2022

Background: Mounting evidence supports aerobic
exercise as a promising treatment option for individuals experiencing
persistent post-concussion symptoms beyond four weeks. The purpose of this
review was to determine whether initiating structured aerobic exercise
within the early period (first two weeks) following concussion affects
symptom recovery compared to standard care. Methods:
A systematic literature search was performed using MEDLINE, Embase, PsycINFO
and CENTRAL databases, combining keywords: (brain concussion,
post-concussion syndrome, mild traumatic brain injury) AND (exercise,
exercise therapy, physical activity, kinesiotherapy). Results were limited
to Randomized Controlled Trials (RCTs). All selected articles underwent
quality assessment. Results: The search generated 112
unique abstracts, of which 5 met inclusion criteria. Sample sizes ranged
from 16 to 103 participants. Of the four studies that were able to analyze
between-group differences, one showed significantly faster recovery in the
early aerobic exercise group compared to control, while three showed no
significant difference. Two studies demonstrated a trend toward faster
initial symptom resolution in the early exercise group.
Conclusions: Preliminary RCT evidence suggests
that aerobic exercise initiated in the early postconcussion period does not
exacerbate symptoms or prolong recovery time, and may potentially hasten
recovery. Larger, more rigorous RCTs are required to define the optimal
exercise parameters to facilitate symptom recovery.
P.135 Willisian collateral and cervical carotid stenosis during large
vessel occlusion stroke: Observations from computed tomography
angiography
Authors: Kiwan R , Lownie S
Published: January 2022

Background: The circle of Willis (CoW) and
cervical carotid arteries are important sources of collateral flow during
acute large vessel occlusion (LVO) in the anterior circulation. We examined
the anatomical components of the circle and the cervical carotid arteries to
determine relationship to acute stroke severity.
Methods: Consecutive patients with acute LVO who
underwent EVT were assessed. Measurements were made of the luminal diameters
of 16 anatomical vascular components. Admission NIHSS, ASPECTS and mCTA
collateral scores were statistically analyzed for any relationship to
vascular measurements. Results: 100 patients were
studied. No relationship was found between the collateral Willisian pathways
and measures of stroke severity. However, the ophthalmic arteries exhibited
a relationship to stroke severity. In adjusted analysis, 1-mm increases in
the ipsilateral and contralateral ophthalmic artery diameter were
independently associated with a 4.80-point decrease and a 6.31-point
increase in the NIHSS scale, respectively. Similarly, a 1.53-point increase
and a 2.62-point decrease in the ASPECTS. In the neck a majority showed
0-55% stenosis, with no stenosis between 55% and 95%, and 14% at 95% to
100%. Conclusions: Stroke severity and collateral
during LVO is unrelated to Willisian collateral. Ophthalmic artery calibers
are related. Acute progression of 55-95% stenoses to complete occlusion
occurs in LVO stroke
P.144 Patient-relevant deficit dictates EVT decision-making in low NIHSS
patients with medium vessel occlusion stroke
Authors: McDonough RV , Cimflova P , Kashani N , Ospel JM , Kappelhof M , Singh N , Segal A , Sakai N , Fiehler J , Chen M , Goyal M
Published: January 2022

Background: There are no recommendations
regarding endovascular treatment (EVT) for patients with acute ischemic
stroke (AIS) due to primary medium vessel occlusion (MeVO). The aim of this
study was to examine the willingness to perform EVT among stroke physicians
in patients with mild, yet personally-disabling deficits due to MeVO.
Methods: In an international survey consisting of
4 cases of primary MeVOs, participants were asked whether the presence of
personally-disabling deficits would influence their decision-making for EVT
despite the patients having low NIHSS scores. Decision rates were calculated
based on physician characteristics. Clustered univariable logistic
regression was performed. Results: 366 participants
from 44 countries provided 2562 answers. 56.9% opted to perform EVT in
scenarios in which the deficit was relevant to the patient’s profession
versus 41.0% in which no information regarding patient profession was
provided (RR1.39, p<0.001). The largest effect sizes were seen for female
participants (RR1.68, 95%CI:1.35-2.09), participants >60 years (RR1.61,
95%CI:1.23-2.10), with more neurointervention experience (RR1.60,
95%CI:1.24-2.06), and who personally performed >100 EVTs per year
(RR1.63, 95%CI:1.22-2.17). Conclusions: The presence
of a patient-relevant deficit in low NIHSS AIS due to MeVO is an important
factor for EVT decision-making. This may have relevance for the conduct and
interpretation of low NIHSS EVT randomized trials.
P.147 Ruptured Intracranial Infectious Aneurysms: Single Canadian Center
Experience
Authors: Son M , Kiwan R , Mayich M , Boulton M , Pandey S , Sharma M
Published: January 2022

Background: Ruptured Intracranial Infected
Aneurysms (IIAs) are a relatively rare phenomenon, but they portend high
mortality. To our knowledge, there are no Canadian studies on IIA with
paucity of data on experiences as well. Our purpose is to share experience
of a single Canadian tertiary centre in managing ruptured IIA and to conduct
a systematic review. Methods: Retrospective case
series review of adult patients with ruptured IIA treated at our
institution. Secondly, we conducted a systematic review of literature on
ruptured IIA between 2011-2021 inclusive. Results: At
our institution, with a total 8 cases with ruptured IIA, 4 patients were
treated endovascularly and 2 by surgical bypass. For the systematic review,
we included 12 non-comparative studies with a total of 547 patients with
IIA. Median percentage of ruptured IIA was at least 65.2%, cases that
required intervention was 23.7% for surgical cases, and 50% for endovascular
cases. The overall median percentage of complications was 5.3%.
Conclusions: This study highlights a single
Canadian tertiary centre experience in the management of IIA and compares it
to the global trends of the last 10 years in a systematic review.
P.154 Subcutaneous intrathecal catheter and port implants for
administration of Nusinersen in patients with Spinal Muscular
Atrophy
Authors: Bokeris A , Mcneely D , restrepo c , Sheriko J
Published: January 2022

Background: Until recently, no effective
treatment was available for spinal muscular atrophy (SMA). In 2017, Health
Canada approved intrathecal Nusinersen a medication that prevents
degeneration of the motor neurons in the spinal cord. The administration is
intrathecally most commonly via lumbar puncture (LP) to have a direct effect
on the motor neurons of the spinal cord. Many older patients with SMA and
concomitant spinal deformities present technical challenges to access the
thecal sac. Different routes have been described for delivery of the
medication whoever these techniques may require sedation, are associated
with radiation exposure, and demand experience personnel.
Methods: A new surgical technique has been
proposed to overcome these obstacles by combining two Health Canada approved
devices: 1) an intrathecal catheter designed for intrathecal baclofen pumps
and 2) an implantable subcutaneous port designed for intravascular
medication administration Results: We describe the
technical nuances and outline the clinical outcomes of six patients with
complex spine deformities who have undergone such an implant for
administration of Nusinersen. Conclusions: We discuss
the benefits of the procedure which includes: 1) administration in the
outpatient setting without sedation, 2) avoidance of costly imaging and
experienced personnel, and 3) placement of the catheter in the
cervicothoracic junction.
P.165 Surgery for recurrent GBM: deciding when to operate
Authors: Voisin MR , Zuccato JA , Zadeh G
Published: January 2022

Background: Previous studies have found
conflicting results regarding the role of repeat surgery on overall survival
(OS) in patients with GBM. We used a novel approach that includes time to
tumour recurrence as an additional prognostic factor in order to determine
which patients benefit most from repeat surgery.
Methods: A retrospective chart review from
1992-2018 was performed on all adult (≥ 18 years old) patients with primary
GBM that received surgery for recurrent disease and compared to publicly
available data from The Cancer Genome Atlas (TCGA) of adult patients with
primary GBM that did not undergo surgery for recurrent disease.
Results: A total of 672 adult patients with GBM
were included in the study, including 87 that received surgery at tumour
recurrence (surgery cohort). The surgery cohort had longer OS and similar
complication rates to those that did not receive surgery at recurrence,
independent of time to tumour recurrence (p < 0.0001 and p = 0.4,
respectively). Within the surgery cohort, patients with tumour recurrence
>6 months demonstrated additional survival benefit (p < 0.0001).
Conclusions: Surgery for recurrent GBM leads to
improved survival without increased complications. Patients with tumour
recurrence >6 months benefit most from repeat surgery.
P.168 Prediction of Pituitary Adenoma Recurrence using the SIPAP
Classification
Authors: Alahmari M , Lasso A , Banaz F , Mohajeri S , Masoudian P , Lamothe A , Agbi C , Caully L , Alshardan M , Kilty S , Alkherayf F
Published: January 2022

Background: Pituitary tumor recurrence following
endoscopic endonasal transsphenoidal surgery (EETS) has been reported
widely. We evaluated a modified score using the SIPAP classification system,
combining the suprasellar and paraseller extension scores of the pituitary
tumor, to determine its impact on adenoma recurrence.
Methods: A retrospective cohort study design with
patient characteristics, tumor type, endocrine, operation, imaging data
collected. Preoperative MRI images were reviewed and SIPAP classification
applied. Postoperative data were extracted for the follow-up period
available for each patient.The suprasellar score and the highest parasellar
scoring from both sides were numerically summed in a bilateral suprasellar
and parasellar (SaP) score and combined to make 4 grades.
Results: 276 patients were identified, 56.5% of
the cohort was male. The mean cohort age was 54 years old.The mean follow up
period was 32 months. Patient perioperative tumor grade according to SaP
classification and recurrence rate was: Grade 1: 11%: Grade 2: 10%; Grade 3:
15%; Grade 4: 22%. The results followed a pattern of logarithmic curve.
Conclusions: The SaP classification was useful in
determining the pituitary tumor expected recurrence following EETS. The
advanced tumors had the highest recurrence rates. Use of the SaP score may
allow for more accurate preoperative counselling of patients with pituitary
adenoma.
P.171 Primary motor cortex metabolite levels correlate with dexterity
following spinal surgery for degenerative cervical myelopathy
Authors: Friesen AC , Detombe SA , Kalsi-Ryan S , Wong D , Ng W , Gurr K , Bailey C , Rasoulinejad P , Siddiqi F , Bartha R , Duggal N
Published: January 2022

Background: Spinal cord compression from
degenerative cervical myelopathy is characterized by progressive loss of
hand dexterity, alongside changes in the metabolite profiles in the brain
and spinal cord. Correlating the changing metabolite profile with measures
of dexterity following decompression surgery may assist in identifying which
patients may benefit most from surgery. Methods:
Thirty operative myelopathy patients consented to receive spectroscopy and
GRASSP-M dexterity assessments both preoperatively and 6-weeks
postoperatively. Magnetic resonance spectroscopy (TE=135) was performed in
the motor cortex using a 3 Tesla Siemens MRI scanner at Robarts Research
Institute. Spearman correlations were used to evaluate associations between
metabolite levels and dexterity (p<0.05 was considered significant).
Paired two-tailed Student t-tests were used to assess for postoperative
changes in metabolite levels. Results:
Postoperatively, we observed a statistically significant (p<0.05)
negative correlation (r=-0.44) between the N-acetylaspartate-to-creatine
ratio (NAA/Cr) and GRASSP-M dexterity scores. There was no significant
difference in NAA, Cr, or NAA/Cr postoperatively.
Conclusions: These findings demonstrate that
patients with lower postoperative NAA/Cr usually have better recovery of
dexterity. This link between the myelopathic metabolite profile and
clinically meaningful dexterity values requires further investigation to
understand the role of both NAA and Cr in mechanisms of postoperative
recovery from myelopathy.
P.172 Diffusion MRI characteristics change in select cerebral white
matter tracts after decompressive surgery for degenerative cervical
myelopathy
Authors: Friesen AC , Detombe SA , Doyle-Pettypiece P , Haddad H , Ng W , Gurr K , Bailey C , Rasoulinejad P , Siddiqi F , Bartha R , Duggal N
Published: January 2022

Background: Degenerative cervical myelopathy is
characterized by progressive compression of the spinal cord resulting in
debilitating loss of dexterity, independent ambulation, and sphincter
control. Diffusion tensor imaging (DTI) has shown that, compared to healthy
controls, myelopathy patients have decreased integrity of the corticospinal
tracts and corpus callosum (Bernabeu-Sanz et al, 2020).
Methods: Twenty-six myelopathy patients consented
to cerebral diffusion tensor imaging (3 Tesla, 32 directions, b=1000)
preoperatively, as well as 6-weeks, 12-weeks, and 6-months postoperatively.
Average mean diffusivity (MD), fractional anisotropy (FA), radial
diffusivity (RD), and axial diffusivity (AD) were measured in the
corticospinal tracts, forceps major, and forceps minor.
Results: Both MD and RD decreased from 6-12 weeks
postoperatively in the right corticospinal tract. The forceps major of the
corpus callosum showed an initial postoperative increase in MD followed by a
subsequent increase in FA and decrease in RD 3-6 months postoperatively. The
AD of the forceps major increased both immediately and 3-6 months
postoperatively. Conclusions: Changes in
microstructural integrity of the corticospinal tract and forceps major over
the postoperative recovery period suggest a pattern of recovery in
myelopathy patients. This study is the first to report postoperative DTI
changes in myelopathy-relevant white matter tracts in the brain.
P.177 The Effect of the COVID 19 Pandemic on theTraining of Surgical
Residents in Canada. A Survey of Residents and Program Directors.
Authors: Girgis H , LeBlanc V , Chaput A , Alkherayf F
Published: January 2022

Background: The coronavirus 2019 pandemic has led
to restructuring of health care systems and has subsequently had secondary
effects on medical education. This study examines the impact on training of
surgical residents in Canada. Methods: The study
consisted of a 25-question survey for residents and a 22-question survey for
program directors, which were distributed electronically through program
administrators on July 3rd- July
11th, 2020. Questions sought to elicit residents’
current experiences and gain insight into methods by which to enhance future
training. Results: 108 residents and 21 program
directors, from various surgical specialties across Canada, completed the
survey. Operative exposures were reported to be reduced by 25-100% and 39%
of residents were redeployed. However, 89% of residents reported accessing
academic half days virtually and 57% had additional online modules. Despite
lost time, 100% of program directors confirmed that residents did not
require training extensions. Concerns regarding training, personal health,
employability and fellowships were raised. 55-70% of residents and program
directors advocated for alternative educational courses, increasing elective
time, utilizing simulation for assessment and flexibility in crediting
different training experiences. Conclusions: Canadian
surgical residents had a significant reduction in operative experiences
during the pandemic. Moving forward, it will be important to find
alternative educational experiences.
P.183 Accuracy of External Ventricular Drain Freehand Placement in
patients with Traumatic Brain injury. A 5-year single-institution
experience
Authors: Alsahlawi A , Marcoux J , Saluja R
Published: January 2022

Background: Placement of an external ventricular
drain is considered a simple yet fundamental procedure. Despite its wide
practice, an inaccuracy rate of around 50% has been reported. In the trauma
setting, targeting the ventricles with a blind freehand technique is
challenging due to distorted anatomy. Failure to cannulate lead to multiple
passes with a higher risk of complications. Methods:
A retrospective study from a single institution was conducted using a trauma
registry between March-2014 and March-2019 were included. Accuracy of EVD
placement was determined using the Kakarla grading system
Results: 224 TBI patients with total of 241 EVDs
were performed, 211 met our criteria. Among them, Grade-1 (optimal
placement) was achieved in 39.3%, Grade-2 (suboptimal in non-eloquent
tissue) in 21.8% and Grade-3 (suboptimal in eloquent tissue) in 38.9%. A
total of 74 EVDs were inserted in the intensive care unit, while 137 EVDs
were inserted in the operating room. Our accuracy for ICU insertions was
50%, 25.7%, 24.3% for Grades1,2 and3 respectively, while our OR insertion
accuracy was 33.6%,19.7%,and46.7% Conclusions: EVD is
commonly performed, yet a substantial rate of inaccuracy is reported. This
highly suggests the need to improve accuracy, possibly with the adjunct of
image-guided techniques, to further optimize catheter placement
P.207 Reducing the risks of proximal and distal shunt failure in adult
hydrocephalus: A Shunt Outcomes Quality Improvement (ShOut-QI) Study
Authors: Hamilton MG , Ball C , Holubkov R , Urbaneja G , Isaacs A
Published: January 2022

Background: Ventriculoperitoneal (VP) shunt
failures in adult patients are common and subject patients to multiple
surgeries and a decreased quality of life. A prospective cohort Shunt
Outcomes Quality Improvement (ShOut-QI) initiative was implemented to reduce
shunt failure incidence through neuronavigation-assisted proximal catheter
insertion and laparoscopy-guided distal catheter anchoring over the liver
dome to drain CSF away from the omentum. Methods:
“Pre-ShOut” and “Post-ShOut” groups of patients included those with and
without neuronavigation/laparoscopy, respectively for insertion of a new VP
shunt. The primary outcome was shunt failure which was defined as any return
to surgery for shunt revision as determined with a standardized clinical and
radiology follow-up protocol. Results: 244 patients
(97 Pre-ShOut, 147 Post-ShOut), mean age 73 years, were enrolled over a
7-year interval and observed for a mean duration of 4 years after shunt
insertion. Neuronavigation improved proximal catheter placement accuracy by
20% (p<.001), and shunt failure occurred in 57% vs 23% in the Pre-ShOut
and Post-ShOut groups, respectively (p=.008), representing a 53% relative
risk reduction in the incidence of shunt failure.
Conclusions: Adult shunt failure incidence may be
significantly reduced by improving the accuracy of proximal catheter
placement with neuronavigation and reducing the risk of distal catheter
failure with laparoscopic-guided placement.
P.208 Pilot Study of a Multi-center, Randomized, Blinded,
Placebo-Controlled Trial of Shunt Surgery in Idiopathic Normal Pressure
Hydrocephalus
Authors: Hamilton MG , Williams M , Holubkov R , Nagel S , Wisoff J , McKhann G , Zwimpfer T , Edwards R , Malm J , Moghekar A , Eklund A , Golomb J , Katzen H , Dasher N , Luciano M
Published: January 2022

Background: To describe preliminary results of a
multi-center, randomized, blinded, placebo-controlled, pilot trial of shunt
surgery in idiopathic normal pressure hydrocephalus (iNPH).
Methods: Five sites of the Adult Hydrocephalus
Clinical Research Network (AHCRN) randomized 18 patients scheduled for
ventriculoperitoneal shunting based on CSF-drainage response. Patients were
randomized to a Codman® Certas® Plus valve with SiphonGuard at either
setting 4 (Active, N=9) or setting 8/”virtual off” (Placebo, N=9). Patients
and assessors were blinded to the shunt setting. Outcomes included 10-meter
gait velocity, cognitive function, and bladder activity scores. The
prespecified primary analysis compared changes in 4-month gait velocity in
the Active versus Placebo groups. Placebo-set shunts were then blindly
adjusted to the active setting and all patients underwent 8 and 12-month
post-surgical assessment. Results: At 4-months, gait
velocity increased by 0.28±0.28m/s in the Active Group and 0.04±0.17m/s in
the Placebo Group (p=0.071). Overactive Bladder (OAB-q) scores significantly
improved in the Active versus Placebo groups (p=0.007). At 8 months, Placebo
gait velocity increased by 0.36±0.27m/s and was comparable to the Active
Group (0.40±0.20m/s; p=0.56). Conclusions: This AHCRN
study shows a trend suggesting gait velocity improves more at an Active
shunt setting than a Placebo shunt setting and demonstrates the feasibility
of a placebo-controlled trial in iNPH.
P.229 Epidemiology and Outcomes of Neck Pain Following Surgery for
Degenerative Cervical Radiculopathy
Authors: MacLean MA , Dakson A , Xavier F , Christie SD , Investigators C
Published: January 2022

Background: Many studies have demonstrated
improved arm pain (AP) following surgery for degenerative cervical
radiculopathy (DCR); however, axial neck pain (NP) is generally not felt to
improve. The purpose of this study was to determine whether surgery for DCR
improves NP. Methods: A ambispective cohort study of
the Canadian Spine Outcomes Research Network (CSORN) registry for
patients

who received 1-level, 2-level, 3-level ADCF (anterior cervical
discectomy and fusion) or cervical disc arthroplasty (CDA) for DCR.
Outcomes: 12-month post-operative Visual Analogue Scale for NP (VAS-NP),
Neck Disability Index (NDI), VAS for AP (VAS-AP), Short-Form Physical Health
Composite Scale (SF36-PCS), and Mental Health Composite Scale (SF36-MCS).
Results: We identified 603 patients with DCR. CDA
patients were the youngest (ANOVA; p<0.001). Patients reported similar
pre-operative AP, NP, disability, and health-related quality of life,
regardless of procedure (ANOVA; all P>0.05). All procedures offered a
statistically significant reduction in VAS-NP, VAS-AP, and NDI (ANOVA; all
P<0.001). Mean change from baseline in NP, AP, and disability, were
similar across procedures. At 12 months, mean reduction in VAS-AP, VAS-NP,
and NDI exceeded minimal clinically important differences for nearly all
procedures. Conclusions: Patients undergoing surgery
for DCR can expect a clinically significant, approximate 50% reduction in
NP, AP, and neck-related disability.
P.230 Modic changes and clinical outcomes in patients undergoing lumbar
surgery for disc herniation
Authors: MacLean MA , Kureshi N , Shankar J , Stewart S , Christie SD
Published: January 2022

Background: Lumbar disc herniation (LDH) is a
risk factor for Modic change (MC) development on spinal MRI. MC has been
associated with worse pre- and post-operative pain, disability, and
health-related quality of life (HRQoL). We examined the relationship between
pre-operative MC and post-operative assessment scores for patients receiving
discectomy (LD) or transforaminal interbody fusion (TLIF) for LDH.
Methods: We reviewed 285 primary single-level
surgeries. Pre-operative and 12-month post-operative assessment scores:
Visual Analog Scale Leg-Pain (VAS-LP), Oswestry Disability Index (ODI), and
Short-Form-36 Physical Component Summary (SF-36-PCS). MC subgroup on
pre-operative MRI was recorded by a single neuroradiologist.
Results: 179 patients were included. The sample
prevalence of MC on pre-operative MRI was 62%; MC2 was most common (35%). No
differences in pre-operative scores were identified, regardless of present
or absent MC. For the overall cohort, improvement in assessment scores were
observed: SF-36 improved an average of 8.2 points (95% CI: [5.8, 10.7]), ODI
by 11.3 points (95% CI: [8.7, 14.0]), and VAS by 2.8 points (95% CI: [2.1,
3.5]). In nearly all cases, MCID values were met.
Conclusions: Clinically significant improvement
in post-operative pain, disability, and HRQoL was observed for both
procedures. Modic change on pre-operative MRI was not associated with worse
clinical assessment scores.
P.231 A Quantitative Degenerative Lumbar Spondylolisthesis Instability
Classification (DSIC) System to Reduce Variation in Surgical
Treatment
Authors: MacLean MA , Bailey C , Fisher C , Rampersaud R , Glennie A
Published: January 2022

Background: The Degenerative lumbar
Spondylolisthesis Instability Classification (DSIC) system categorizes
spondylolisthesis (stable, potentially unstable, unstable) based on surgeon
impression. It does not contain objective criteria.
Objective-1: Develop a quantitative-DSIC system
from predetermined radiographic/clinical variables.
Objective-2: Compare qualitative
(surgeon-assigned) and quantitative (objective) DSIC Types.
Objective-3: Determine proportion of patients
receiving more invasive surgery than warranted based on the objective
system. Methods: Patients from 8 centers were
enrolled prospectively (2015–2020). Radiographic/clinical variables were
collected and included/excluded from the quantitative DSIC system based on
prior systematic review. Scores were converted to DSIC Types: 0-2 points
(“Stable”; Type 1), 3 points (“Potentially Unstable”; Type 2), 4-5 points
(“Unstable”; Type 3). Surgical procedures performed were compared to those
suggested by the objective system. Results:
Quantitative DSIC scores were calculated (309 patients). The score includes
five variables: facet effusion, disc height, translation, disc angle, and
low back pain. Quantitatively, 57% were stable, 34% potentially unstable,
and 9% unstable patients. Qualitatively, 30% were stable, 53% potentially
unstable, and 17% unstable patients. Surgeons assigned more instability than
the objective scoring system in 42% of cases. More invasive surgery was
performed in 57% of cases. Conclusions: Surgeons are
more likely to categorize greater degrees of spinal instability than what is
objectively scored.
P.232 Motor Recovery after Early Surgical Decompression in Cervical ASIA
A Spinal Cord Injury Patients
Authors: Moghaddamjou A , Wilson JR , Fehlings MG
Published: January 2022

Background: Despite growing evidence for early
surgical decompression for traumatic cervical spinal cord injury(tCSCI)
patients, controversy surrounds the efficacy of early surgical decompression
on patients with a complete (ASIA A) cervical injury.
Methods: Patients with ASIA A cervical tCSCI were
isolated from 4 prospective, multi-center datasets. Patients who had a
Glasgow coma scale of less than 13, were over the age of 70 or under 16 were
excluded. Significant gain was defined to include those that recovered more
than two muscle groups (greater than 3/5 power) below their level of injury.
Analysis of variance (ANOVA) was then done to compare significant gain over
the 1 year follow-up period for patients with and without early
decompressive surgery (<24hrs). Results: We
identified 420 cervical ASIA A tCSCI patients. The mean number of muscle
groups gained was 2.69 (SD 2.3.12) for those who had early surgery compared
to 2.37 (SD 3.38) for those with late surgery. Of those patients who had
early surgery 39.67% had a significant improvement vs. 28.76% of those who
did not have early surgery (P = 0.030). Conclusions:
For the first time, we have shown a clear therapeutic benefit of early
surgical decompression within 24 hrs in ASIA A tCSCI patients.
P.233 Implementation of an Enhanced Recovery After Surgery (ERAS)
Protocol for Scheduled Spine Surgery
Authors: Smith-Forrester J , Greene R , Christie S
Published: January 2022

Background: Enhanced Recovery After Surgery
(ERAS) Protocols improve post-surgical outcomes through decreased length of
hospital stay, reduced readmission rates, decreased post-operative pain, and
greater patient satisfaction. ERAS also has significant benefits to the
healthcare system through reduced cost of post-operative care. While ERAS
protocols are well established in many surgical fields, a complete guideline
for spine surgery is lacking. Early ERAS studies in spine surgery suggest up
to a 50% reduction in length of stay (LOS) and decreased cost of care.
Methods: Primary literature review followed by
multidisciplinary critical appraisal for optimization and redesign of our
current system of care for scheduled spine surgery (SSS), including patient
experience and team logistics from initial consultation through
post-operative care and follow up. Results: An
evidence-based guideline, optimizing pre-, intra-, and post-operative phases
of care was developed. Specific focus catered to pre-operative education and
patient barriers to discharge. Further improvements in pre-admission patient
goal setting, introduction of a patient care “passport”, post-operative
reduction in narcotic administration, and increased same day post-operative
mobilization were means to reduce LOS. Conclusions: A
spine ERAS pathway was developed, allowing our care program to better
facilitate patient recovery after SSS. Future work will aim to determine
economic impact of the pathway.
Household consumption and home production at retirement in Thailand: evidence from a regression discontinuity approach
Authors: Wongmonta Sasiwooth
Published: January 2022

This paper uses Socio-Economic Surveys covering the period from 2013 to 2019 and the 2015 Time Use Survey to investigate the extent to which household consumption changes at retirement in Thailand. A fuzzy regression discontinuity design is applied to evaluate the retirement effect on total household expenditure and expenditures on four major categories: food-at-home, work-related items, non-durable entertainment, and others. The results reveal that retirement decreases household expenditure by 11%. Further investigations show that the dramatic declines in expenditures on work-related and non-durable entertainment contribute significantly to the spending drop at retirement. The magnitudes of the declines are more pronounced for low-income and low-wealth households. The results also indicate that the retirees spend more leisure time on home production activities after retirement. Once accounting for this effect, it finds that the drop in total household expenditure decreases to 6%. These results suggest that the sizable consumption expenditure drop at retirement is due to substituting away from market purchased goods toward home-produced goods.
Documenting design research by structured multilevel analysis: supporting the diversity of the design research community of practice
Authors: Reich Yoram , Subrahmanian Eswaran
Published: January 2022

The diversity of design research studies and their associated methods and reporting style make it difficult for the design research community of practice to leverage its work into further advancing the field. We illustrate how a structured multilevel analysis of diverse studies creates a canonical model that allows for the transfer of insight between studies, enhances their comprehension, and supports improved study designs. The benefits of such an approach will increase if different stakeholders adopt such structured approaches to enrich the design research community of practice.
Decellularised extracellular matrix-based biomaterials for repair and regeneration of central nervous system
Authors: Yaldiz Burcu , Saglam-Metiner Pelin , Yesil-Celiktas Ozlem
Published: January 2022

The central nervous system (CNS), consisting of the brain and spinal cord, regulates the mind and functions of the organs. CNS diseases, leading to changes in neurological functions in corresponding sites and causing long-term disability, represent one of the major public health issues with significant clinical and economic burdens worldwide. In particular, the abnormal changes in the extracellular matrix under various disease conditions have been demonstrated as one of the main factors that can alter normal cell function and reduce the neuroregeneration potential in damaged tissue. Decellularised extracellular matrix (dECM)-based biomaterials have been recently utilised for CNS applications, closely mimicking the native tissue. dECM retains tissue-specific components, including proteoglycan as well as structural and functional proteins. Due to their unique composition, these biomaterials can stimulate sensitive repair mechanisms associated with CNS damages. Herein, we discuss the decellularisation of the brain and spinal cord as well as recellularisation of acellular matrix and the recent progress in the utilisation of brain and spinal cord dECM.
Tres Palos Revisited: Understanding the Middle Horizon in the Rio Grande de Nasca Drainage
Authors: Matsumoto Yuichi , Olano Jorge , Sakai Masato
Published: January 2022

A recent survey in the Ingenio Valley provides new insight into the nature of the Middle Horizon on the south coast of Peru. A reconsideration of the Tres Palos I and II sites could provide a new perspective on Wari expansion into the region.
The Laws of Finance For a Sociology of Finance and Law Entanglement
Authors: Angeletti Thomas , Lemoine Benjamin
Published: January 2022

In this special issue, we unpack law and finance entities and consider their co-construction, entanglement and interchanging relationship. Adopting a processual sociology lens, we aim to connect micro-technical devices and controversies to the macroscopic big picture of financialized capitalism. We combine analytical tools from pragmatic sociology, emphasizing how social reality and institutions are (re-)enacted through trials, with a dynamic and historicized sociology of the state and the juridical field. Four avenues illustrate our research program on the sociology of financial law. First, we focus on how this juridical space is co-produced by public and private forces, organizations and initiatives. Second, we look at how financial law displaces and endogenizes core regalian purposes traditionally associated with the state. Third, we show the forms of asymmetries that pervade law enforcement in financial cases. Fourth, we address how power intervenes in normal and exceptional times, such as financial crises. The legal and financial co-production of political regimes shapes economies and legitimate forms of social distribution.
Pharyngocutaneous fistula in irradiated patients: systematic review and our experience
Authors: Casasayas M , Sansa A , García-Lorenzo J , Venegas M del Prado , Quer M , León X
Published: January 2022

Objective

Radiotherapy is considered a risk factor for pharyngocutaneous fistula after a total laryngectomy. This study aimed to analyse the impact of exclusive radiotherapy versus chemoradiotherapy and the time interval between radiotherapy and surgery on the risk of pharyngocutaneous fistula.

Method

This study was a retrospective revision of 171 patients treated with a total laryngectomy after radiotherapy or chemoradiotherapy.

Results

Pharyngocutaneous fistula occurred in 33 patients (19.3 per cent). Patients previously treated with chemoradiotherapy showed a non-significant higher pharyngocutaneous fistula rate compared with patients treated with radiotherapy (25.0 per cent vs 18.0 per cent; p = 0.455). Patients with a pharyngocutaneous fistula after chemoradiotherapy treatment required a surgical repair more frequently than patients treated with radiotherapy (p = 0.005). There were no significant differences in the pharyngocutaneous fistula rate depending on the time interval between radiotherapy and surgery (p = 0.580).

Conclusion

There were no differences in the pharyngocutaneous fistula rate after total laryngectomy depending on the previous treatment with radiotherapy or chemoradiotherapy, or depending on the interval between radiotherapy treatment and surgery.
Effects of polygenic risk of schizophrenia on interhemispheric callosal white matter integrity and frontotemporal functional connectivity in first-episode schizophrenia
Authors: Su Wenjun , Yuan Aihua , Tang Yingying , Xu Lihua , Wei Yanyan , Wang Yingchan , Li Zhixing , Cui Huiru , Qian Zhenying , Tang Xiaochen , Hu Yegang , Zhang Tianhong , Feng Jianfeng , Li Zhiqiang , Zhang Jie , Wang Jijun
Published: January 2022

Background

Schizophrenia is a severely debilitating psychiatric disorder with high heritability and polygenic architecture. A higher polygenic risk score for schizophrenia (SzPRS) has been associated with smaller gray matter volume, lower activation, and decreased functional connectivity (FC). However, the effect of polygenic inheritance on the brain white matter microstructure has only been sparsely reported.

Methods

Eighty-four patients with first-episode schizophrenia (FES) patients and ninety-three healthy controls (HC) with genetics, diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (rs-fMRI) data were included in our study. We investigated impaired white matter integrity as measured by fractional anisotropy (FA) in the FES group, further examined the effect of SzPRS on white matter FA and FC in the regions connected by SzPRS-related white matter tracts.

Results

Decreased FA was observed in FES in many commonly identified regions. Among these regions, we observed that in the FES group, but not the HC group, SzPRS was negatively associated with the mean FA in the genu and body of corpus callosum, right anterior corona radiata, and right superior corona radiata. Higher SzPRS was also associated with lower FCs between the left inferior frontal gyrus (IFG)–left inferior temporal gyrus (ITG), right IFG–left ITG, right IFG–left middle frontal gyrus (MFG), and right IFG–right MFG in the FES group.

Conclusion

Higher polygenic risks are linked with disrupted white matter integrity and FC in patients with schizophrenia. These correlations are strongly driven by the interhemispheric callosal fibers and the connections between frontotemporal regions.