bluuebunny/crossref_metadata_2025 huggingface dataset:
120 Moral Distress Among Attending Neurosurgeons: A National Survey
Authors: Mackel Charles E. , Alterman Ron L. , Stippler Martina
Published: March 2022

INTRODUCTION:

“Moral distress” arises from the inability to carry out one's chosen decision or action because of constraints. Within medicine, moral distress may predispose to burnout and physician attrition and arises most dramatically from being forced to inflict aggressive, unwarranted, or non-beneficial treatment upon a patient.

METHODS:

An online survey evaluating moral distress and burnout among neurosurgical attendings was emailed to all members of the Congress of Neurological Surgeons in 2020; 269 neurosurgeons answered the survey. The moral distress survey consisted of 8 questions developed in-house and fitted to neurosurgical practice; burnout was gauged using Oldenburg Burnout Inventory (OLBI). Demographic characteristics were also collected.

RESULTS:

Nearly half (46.88%) of neurosurgeons experienced significant moral distress within the past year. The scenario encountered most frequently was caring for patients lacking clear treatment plans; the scenario eliciting the greatest intensity was providing aggressive treatment at the family’s insistence contrary to the surgeon’s judgment. Moral distress led 10.43% of neurosurgeons to leave a position. Neurosurgeons with burnout had higher moral distress scores. Our 8-question moral distress survey demonstrated excellent internal consistency (Cronbach alpha = 0.89).

CONCLUSION:

We developed an internally consistent and reliable 8-question survey assessing moral distress among neurosurgeons. Nearly half of neurosurgeons suffered moral distress within the past year, particularly from a lack of clarity around patient treatment goals and pressure to operate. Moral distress caused 10% of neurosurgeons to leave a position and was correlated with burnout risk.
123 Long-Term High-Frequency (10 kHz) Spinal Cord Stimulation in Painful Diabetic Neuropathy - A Randomized Controlled Trial
Authors: Petersen Erika A. , Stauss Thomas , Scowcroft James , Brooks Elizabeth , White Judith , Sills Shawn , Amirdelfan Kasra , Guirguis Maged , Xu Jijun , Yu Cong , Nairizi Ali , Patterson Denis , Galan Vincent , Bundschu Richard , Mehta Neel , Sayed Dawood , Lad Nandan P. , DiBenedetto David , Sethi Khalid A. , Wu Paul , Argoff Charles , Nasr Christian , Taylor Rod S. , Caraway David , Mekhail Nagy
Published: March 2022

INTRODUCTION:

World Health Organization estimates 422 million people with diabetes globally and approximately 20% with painful diabetic neuropathy (PDN). Current treatment options are ineffective for many patients; however, previous results suggest high-frequency (10 kHz) spinal cord stimulation (SCS) relieves pain and may improve sensation in patients with refractory symptoms.

METHODS:

Randomization of 216 patients assigned 1:1 to 10 kHz SCS (Nevro Corp.) combined with conventional medical management (CMM) or CMM alone. Patients had PDN symptoms ≥12 months, lower limb pain ≥5 cm (10 cm visual analog scale), and hemoglobin A1c ≤10%. Outcomes include pain, interference with daily activities and sleep, and neurological examination. Patients could opt to crossover to the other treatment arm at 6 months.

RESULTS:

At 6 months, 86% of patients in the 10 kHz SCS group were responders with at least 50% pain relief. They reported reduced pain interference with daily activities and improvements in sleep. None of the patients in the 10 kHz SCS group chose to crossover to CMM at 6 months. Treatment benefits were sustained through 12 months. A majority of patients treated with 10 kHz SCS were noted to have improvement on neurological examination. Participants in the CMM group experienced no change in pain levels, pain interference with daily activities, or sleep quality over 6 months. Eighty-two percent opted to crossover to 10 kHz SCS at 6 months. Results post-crossover were similar to those in patients originally randomized to 10 kHz SCS: 84% responders as well as reduced pain interference with daily activities, improvements in sleep, and a majority with observed improvements on neurological examination.

CONCLUSION:

This is the largest RCT to-date of SCS management in PDN. Substantial improvements with high-frequency (10kHz) SCS were sustained over 12 months and support this treatment for PDN patients with refractory symptoms.
129 Development and External Validation of the KIIDS-TBI Tool for Managing Children with Mild Traumatic Brain Injury and Intracranial Injuries
Authors: Greenberg Jacob K. , Ahluwalia Ranbir , Hill Madelyn , Johnson Gabbie , Hale Andrew T. , Belal Ahmed M. A. , Baygani Shawyon , Olsen Margaret , Foraker Randi , Carpenter Christopher , Yan Yan , Ackerman Laurie , Noje Corina , Jackson Eric , Burns Erin , Sayama Christina M. , Selden Nathan R. , Vachhrajani Shobhan H. , Shannon Chevis , Kuppermann Nathan , Limbrick David D.
Published: March 2022

INTRODUCTION:

Clinical decision support may improve the post-neuroimaging management of children with mild traumatic brain injuries (mTBI) and intracranial injuries. While the CHIIDA score has been proposed for this purpose, a more sensitive risk model may have broader use.

METHODS:

We analyzed children <18 years-old with mTBI and intracranial injuries included in the PECARN head injury dataset (2004-2006). We used binary recursive partitioning to predict the composite outcome of neurosurgical intervention, intubation for >24 hours due to TBI, or death due to TBI. The new model, the KIIDS-TBI model, was externally validated in a separate dataset that included children treated between 2006-2019 at one of six centers participating in the pediatric TBI Research Consortium (PTRC).

RESULTS:

There were 839 children included in the derivation (PECARN) and 1,630 in the validation (PTRC) datasets. Derived using the PECARN dataset, the KIIDS-TBI model incorporated imaging (e.g. midline shift) and clinical (e.g. GCS score) findings. Based on the model-predicted probability of the composite outcome, three cutoffs were evaluated in the external validation (PTRC) dataset to classify patients as ‘high risk.' The most conservative cutoff (i.e. any predictor present) identified 119/119 children with the composite outcome (sensitivity 100%), but had the lowest specificity (26.3%). The other two cutoffs had worse sensitivity (94.1%-96.6%) but improved specificity (67.4%-81.3%). The CHIIDA model lacked the most conservative cutoff and otherwise showed the same or slightly worse performance compared to the other two cutoffs.

CONCLUSION:

The KIIDS-TBI model has high sensitivity and moderate specificity for risk-stratifying children with mTBI and intracranial injuries. Use of this clinical decision support tool may help improve the safe, resource-efficient management of this important patient population.
132 Same Day Discharges Following Intracranial Shunt Revision: A Retrospective Safety Analysis
Authors: Bailey David , Daggubati Lekhaj C. , Fritsche Madelaine , Lehman Morgan , Strausser Sarah , Rizk Elias B.
Published: March 2022

INTRODUCTION:

Cerebrospinal fluid shunting is the mainstay for intracranial hydrocephalus but has a high rate of surgical revision secondary to infections and blockage. Traditionally, the hospital stay is one day post-operative for a non-complicated shunt revision. However, in the appropriate population we believe the same day discharge after a shunt revision is safe.

METHODS:

We perform a retrospective chart review of all shunt revisions performed at Penn State Milton S. Hershey Medical Center between 2014 and 2021. Patient characteristics were evaluated for the ideal demographics for same day discharge. We compared rates of emergency department visits, hospitalization, and revision at 30 and 90 days between same day discharge and control patients following shunt revision. Non-parametric, Logistic regression and Chi-squared testing was done for statistically significant with and without Propensity Score Matching.

RESULTS:

A total of 996 patient were examined with 56 (5.6%) patients being discharged on the same day as the surgery. On univariate analysis, patient with same day discharge were older (OR 1.019; 1.007-1.032), more like for distal shunt failure (OR 4.914; 2.792-8.649), more likely for elective surgery (OR 5.472; 2.346-12.763), and less likely to have visited the emergency department in the prior 30 d (OR 0.216; 0.112-0.413). On multivariate analysis, recent ED visit, elective surgery, and distal shunt failure remained significant. In unmatched data, same-day discharge patients had significantly less 30-day revisions (p=.035) but a comparable rate of 90-day revisions as well as 30-day and 90-day emergency room visits and hospitalization. Propensity-score matching compared 29 revisions in each group; all covariates were non-significant (p > 0.05) and all 30-day and 90-day outcomes were not significantly different.

CONCLUSION:

These findings validate the safety profile for same day discharge in post-operative shunt patients as well as describe the preferred characteristics of our patient cohort. Elective, distal shunt failure patients are preferred for early discharge post-operatively.
159 Outcomes of Ventriculoperitoneal Shunt Placement with or without Laparoscopic Assistance: An Analysis of the National Inpatient Sample
Authors: Zhao Kevin , Maloney Monica , Hilden Patrick , Turner Amber , Merchant Aziz , Agarwalla Pankaj K.
Published: March 2022

INTRODUCTION:

Ventriculoperitoneal shunt (VPS) can be placed solely by a neurosurgeon often via an open-laparotomy approach, or laparoscopically as a collaborative effort between a neurosurgeon and a general surgeon. Prior studies have shown conflicting results when examining outcomes regarding infection, revision rate, hospital charges, length of stay, and mortality between the open mini-laparotomy and the laparoscopic approaches.

METHODS:

We performed a retrospective database study of the NIS from October 2015-December 2017 utilizing International Classification of Diseases, 10th Revision coding to identify all cases of VPS placement. All analyses accounted for the sampling design of the NIS.

RESULTS:

A total of 6,580 cases (4,969 with open mini-laparotomy approach and 1,611 with laparoscopic collaborative approach) met inclusion criteria. Hospital charges (median $91, 900 v. $84,400; p = 0.231) and revision rate (3.2% v. 3.1%; p = 0.796) were similar between approaches. There were no significant differences in length of stay, mortality, or complication rates between the two approaches.

CONCLUSION:

The collaborative, laparoscopic approach to VPS placement has similar outcomes and is non-inferior to the traditional open mini-laparotomy approach.
188 Outcomes in Patients Undergoing Kyphoplasty for Spinal Metastasis and Associated Compression Fractures: The Moffitt Experience
Authors: Farooq Jeffrey , Rabil Maximilian , Goldman-Daleo Hannah , Tran Nam D.
Published: March 2022

INTRODUCTION:

Nearly two thirds of patients with metastatic cancer will experience painful spinal metastasis and pathologic compression fractures that negatively impact their quality of life and function status. Furthermore, invasive surgical interventions to treat these spinal lesions could delay chemoradiation for the treatment of their underlying disease.

METHODS:

The authors performed a retrospective chart review of all patients who underwent kyphoplasty procedures for the treatment of cancer-associated vertebral compression fractures at the Moffitt Cancer Center from 2009-2019. Patient demographics, tumor characteristics, pain severity, concurrent palliative therapies and complications were assessed.

RESULTS:

625 patients underwent kyphoplasty procedures. 119 patients required additional kyphoplasty at additional levels. Greater than 1500 spinal levels were performed ranging from C2-S1. SINS score ranged from 4-13. Tumor types include multiple myloma (23%), breast (13%), lung (13%), lymphoma (6%). Significant pain reduction with reduction in VAS was observed in at 2 weeks and persisted beyond 3 months (p < 0.01). Nearly all patient experienced reduction in 24hr opioid usage. Greater than 25% had 2 column tumor involvement. Less than 1% required additional stabilization procedures.

CONCLUSION:

Kyphoplasty is safe and effective in controlling pain and stability. Kyphoplasty should be offered to any patient with spinal metastasis and compression fracture with significant pain (VAS >4).
191 Clinical and Economic Outcomes of Patients Undergoing Surgical Intervention for Trigeminal Neuralgia: Analysis From a National Database
Authors: Alexander Yohan , Doherty Ronan , Alvi Mohammed A. , Yolcu Yagiz , Kerezoudis Panagiotis , Brown Desmond A. , Agarwal Vijay , Van Gompel Jamie J. , Ghogawala Zoher , Link Michael J. , Meyer Fredric B.
Published: March 2022

INTRODUCTION:

The management of trigeminal neuralgia (TN) has evolved significantly in the past century. In the current manuscript, we compare clinical and economic outcomes of patients undergoing surgical intervention for TN between microvascular decompression (MVD), percutaneous procedures and stereotactic radiosurgery (SRS) using a national database.

METHODS:

The national inpatient sample (NIS) was queried for cases undergoing a surgical intervention for TN between 2002-2015 3rd quarter using the International Classification of Disease 9th Revision Clinical Modification (ICD-9-CM) and procedure codes (ICD-9-PCS). Outcomes assessed included length of stay (LOS), discharge disposition and cost.

RESULTS:

A total of 8,317 patients undergoing a surgical intervention for TN were identified between 2002 and 2015 3rd quarter, of which 7,202 (86.6%) underwent MVD, 548 (6.6%) underwent percutaneous procedures and 567 (6.8%) underwent SRS. Patients undergoing percutaneous and SRS procedures were more likely to be older compared to those undergoing MVD (>65: 58.1% and 72.1% vs 32.2%, respectively; p < 0.001). MVD was significantly more likely to be performed in an urban academic institution compared to percutaneous procedures and SRS (84.8% vs 75.1% and 75.8%; p < 0.001). Patients undergoing SRS had the lowest LOS (1.34 days vs 3.2 days and 3.5 days; p < 0.001) and lowest odds for a prolonged LOS (OR = 0.29; CI: 0.18-0.46; p < 0.001) and non-routine discharge (OR = 0.44; CI: 0.28-0.71; p < 0.001). Percutaneous procedures had the highest odds for a prolonged LOS (OR = 2.07; CI: 1.65-2.61; p < 0.001). The total charges billed by the hospital were highest for patients undergoing MVD ($50,432.30) followed by those undergoing SRS ($38,450.90) and percutaneous procedures ($18,655.10) (p < 0.001). The total reimbursed cost was highest for SRS ($18,265.70) followed by MVD ($17,590.20) and percutaneous procedures ($8,183.30).

CONCLUSION:

In the current era of value-based care, these analyses are important in helping physicians, hospitals and other stakeholders devise appropriate policies to ensure optimal patient outcomes, as well as optimal reimbursements.
192 Meckel's Cave Meningoencephaloceles Causing Typical Trigeminal Neuralgia
Authors: Santos Jaime L. M. , Domingo Ricardo , Rowland Nathan C. , Vandergrift William A.
Published: March 2022

INTRODUCTION:

The culprit of trigeminal neuralgia (TGN) may occur on any point from the nerve’s root entry zone(REZ) to Meckel’s cave. Meckel’s cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN.

METHODS:

A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management and outcomes are illustrated with clinical case.

RESULTS:

Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. The preferred treatment modality was surgical with subtemporal extradural repairs using various combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.

CONCLUSION:

MEC containing prolapsed trigeminal fascicles can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
333 First FDA Cleared Thin Film Electrode for Intracranial Recording and Monitoring of Brain Activity – Device Testing and Initial Clinical Use
Authors: Kullmann Aura , Mertens Steve , Christianson Mark , Rosa Dave , Botia Camilo D.
Published: March 2022

INTRODUCTION:

Subdural strip and grid (SDG) electrodes are routinely used for pre-surgical evaluation of patients with drug resistant epilepsy (DRE). Although these electrodes have been in the US market since their first FDA clearance in 1985, their fabrication, materials and properties have hardly changed. They are made of silicone, are thick (>0.5 mm), manufactured by hand, and do not optimally conform to brain convolutions. Technological solutions that overcome these limitations are needed.

METHODS:

Thin film electrode (0.08 mm) arrays were manufactured from polyimide with platinum contacts (multiple configurations, 3 mm contact diameter, spaced 10 mm apart). Electrochemical and electrical testing include electrolyte interface impedance, cyclic voltammetry and other impedance and isolation tests, according to the International Electrotechnical Commission 60601 for proving device safety and performance. Biocompatibility was tested using standard methods according to International Organization for Standardization 10993. Post-market data were collected employing a user feedback questionnaire using a rating scale (1 to 5, with 5 being the highest).

RESULTS:

Thin film electrodes passed all electrochemical, electrical and biocompatibility testing required for FDA clearance (obtained Nov 2019). Electrodes (n = 19) were used in clinical practice between Nov 23, 2020 and May 3, 2021 in the epilepsy monitoring units and for intraoperative monitoring (IOM) for recording brain activity in (a) DRE patients undergoing evaluation for potential surgical resection, and (b) patients undergoing tumor resection. Users (neurosurgeons; n = 6) provided ratings between 4 and 5 regarding the properties (thickness, flexibility, weight), features (ease of placement, conformability to the brain areas) and performance (qualitative signal recording quality) of the electrodes during surgical implantation.

CONCLUSION:

This is the first thin film electrode technology FDA cleared for use in clinical practice. The properties of these thin, flexible polyimide electrode arrays may overcome many limitations of the existing technology. Initial clinical use indicated that the technology is feasible for surgical implantation with greater flexibility compared to silicone based cortical electrodes.
410 Total Hospital Cost of Middle Meningeal Artery Embolization Compared to Surgery for Chronic Subdural Hematomas: A Propensity Matched Analysis
Authors: Catapano Joshua , Srinivasan Visish M. , Koester Stefan , Rumalla Kavelin , Baranoski Jacob F. , Rutledge Caleb , Cole Tyler S. , Winkler Ethan A. , Lawton Michael T. , Jadhav Ashutosh , Ducruet Andrew F. , Albuquerque Felipe
Published: March 2022

INTRODUCTION:

Fewer treatment failures have been found with middle meningeal artery (MMA) embolization compared to surgical evacuation for chronic subdural hematomas (cSDH).

METHODS:

All patients who presented with a cSDH to a single center from January 1st, 2018 to December 31, 2020 were retrospectively reviewed. Patients with one-year of post-treatment hospital cost data were included. Patients were placed into two cohorts based on initial treatment: surgery versus MMA embolization. Total hospital cost was obtained by the hospital financial department. A propensity match analysis(matching for age, sex, Charlson Comorbidity Index(CCI), presenting symptoms, previous trauma, use of pre-operative anticoagulants/antiplatelets(AC/AP), and maximal diameter of cSDH on pre-treatment CT image) was performed. The primary outcome was the mean hospital cost difference between surgery and MMA embolization after propensity match analysis.

RESULTS:

One-hundred-and-seventy patients met inclusion criteria, 48(28%) in the MMA and 122(72%) in the surgical cohort. There was no significant difference between the groups in mean age, CCI, preoperative AC/AP use, and initial presenting symptoms. The surgical cohort was found to have larger pre-treatment cSDHs (20.5mm,sD 6.7) and longer index hospital admissions (9.8 days,sD 7) compared to the MMA cohort(cSDH size:16.9 mm,sD 4.6; hospital days: 5.7,sD 2.4) (p<0.001). A higher percentage of patients in the surgical cohort required an unplanned additional hematoma treatment (N=20, 16.4%) and hospital readmission(N=34, 28%) compared to the MMA group (additional treatment and hospital readmission:N=2, 4%)(p=0.04 and p=0.004, respectively). There was no significant difference in complications between the two cohorts. After propensity matching, the total hospital cost for the surgical cohort(N=28, $59,809,sD $27,730) was significantly higher compared to MMA embolization (N=28, $44,273, sD $17,622) (p=0.015). Linear regression analysis found an unexpected additional treatment as the only variable significant for total hospital cost in the match cohort (difference of $20,772,sD $10,037) (p=0.04).

CONCLUSION:

MMA embolization is associated with a decreased hospital cost compared to surgery. This lower cost is directly related to the decreased need for additional treatment interventions in the MMA group. This analysis further supports the overall clinical and financial efficacy of MMA embolization in select cSDH patients.
447 Full-Endoscopic Resection of Osteoid Osteoma in the Thoracic Spine
Authors: Sandon Luiz H. , Bergamaschi João P.
Published: March 2022

INTRODUCTION:

Common symptoms such as axial pain or nocturnal pain, associated with warning signs that are often worrisome, in addition to non-specific radiological findings can characterize benign lesions in the spine, and Osteoid Osteoma is among them.

METHODS:

This case report is the first in the literature whereby this modality, which until now has been reserved for degenerative diseases, was used successfully for diagnosis and treatment of osteoid osteoma.

RESULTS:

The patient reported immediate pain improvement without neurological changes in the postoperative period. She was discharged less than 24 hours after surgery and routine activities were resumed within 7 days. The anatomopathological examination identified osteoid osteoma. At the 1-year outpatient follow-up, the patient showed complete remission of clinical symptoms and no radiological signs of recurrence The technique allows good preservation of adjacent structures (muscle tissue and nerve roots), does not compromise spinal stability, allows good resection of the nidus, and, with the use of radiofrequency probes, allows cauterization of neovascularization, limiting tumor's recurrence.

CONCLUSION:

Endoscopy is becoming the preferred method in terms of therapeutic effectiveness and medical costs, it is important to remember, that in general (whatever the technique), the results of surgical treatment for osteoid osteoma reported in the literature are satisfactory: complete pain relief was achieved in more than 90% of the cases, and the majority (70%–90%) of patients with preoperative scoliosis evolved satisfactorily. Moreover, for good results with endoscopic techniques, experience and skill are required, which are achieved only with a considerable learning curve.
450 Minimally Invasive Multiple-Rod Constructs With Robotics Planning in Adult Spinal Deformity Surgery: A Case Series
Authors: Shah Vrajesh , Pham Martin H. , Diaz-Aguilar Luis D. , Lehman Ronald A.
Published: March 2022

INTRODUCTION:

Multiple rod constructs (MRCs) are often used in adult spinal deformity correction for increased stability and rigidity. There are currently no reports showing minimally invasive robotic multi-rod long-segment posterior fixation and its technical feasibility through preoperative software planning.

METHODS:

Data was collected retrospectively from medical records of 6 consecutive patients who underwent minimally invasive multiple-rod constructs with robotics planning by a single surgeon at an academic center between March-August 2020.

RESULTS:

A total of 6 patients (4 females, mean age 69.7 years) underwent minimally invasive long-segment (6+) posterior fixation with multiple rods (3+) using the Mazor X Stealth Edition robotics platform. Average follow-up was 9.3 months. All patients underwent oblique lumbar interbody fusion as a first stage, followed by second stage posterior fixation in the same day. The mean number of levels posteriorly instrumented was 8.8. One patient underwent 3 rod fixation (1 iliac, 2 S2AI) and 5 patients underwent quad rod fixation (2 iliac, 2 S2AI). The mean time to secure all rods was 8 minutes 36 seconds. Mean improvement in spinopelvic parameters was -4.9 cm sagittal vertical axis, 18.0° lumbar lordosis, and -10.7° pelvic tilt with an average pelvic incidence of 62.5°. Mean EBL was 200 cc with no blood transfusions, and all but one patient ambulated on postoperative day 1 or 2.

CONCLUSION:

The preoperative software planning required of spinal robotics allows for not just the accurate placement of each pedicle screw in isolation, but the fine-detailing of an entire spine construct design. This concept is demonstrated in this case series where rod placement in a minimally invasive approach depends upon the preoperative design of the whole construct. Spinal robotics brings us into this new era of minimally invasive construct design. To our knowledge, this is the first description of the technical feasibility of multiple-rod constructs in minimally invasive adult spinal deformity surgery.
455 Predicting Outcomes Following Single-Level Lumbar Fusion
Authors: Borja Austin , Glauser Gregory , Strouz Krista , Ali Zarina S. , McClintock Scott D. , Schuster James M. , Yoon Jang W. , Malhotra Neil R.
Published: March 2022

INTRODUCTION:

Spinal fusions represent one of the most common neurosurgical procedures. The LACE (Length of Stay, Acuity of Admission, Charlson Comorbidity Index (CCI) Score, Emergency Department (ED) visits within the previous 6 months) index was developed to predict readmissions, but has not been tested in a large, homogenous spinal fusion population.

METHODS:

LACE+ scores were calculated for all patients with complete information who underwent single-level, posterior-only lumbar fusion at a single, university medical system (n = 1598). Logistic regression was performed to assess the ability of the LACE+ score as a continuous variable to predict hospital readmissions within 90 days (90D) of the index operation. Secondary outcome measures included ED visits and reoperations. Subsequently, the risk of adverse postsurgical events was compared between the lowest and the highest quartile of LACE+ scores, then between the bottom decile and top 4 deciles of LACE+ scores. Finally, patients with the bottom decile of LACE+ scores were exact matched to the top 4 deciles to control for sociodemographic and procedural variables.

RESULTS:

Among all patients, increased LACE+ score significantly predicted higher rates of readmissions in the 30-day (30D), 30-90-day (30-90D), and 90D postoperative windows (p < 0.001, p = 0.001, p < 0.001, respectively). LACE+ score also predicted risk of ED visits at all 3 timepoints, and reoperations at 30-90D and 90D. When comparing the lowest quartile of LACE+ scores to the highest quartile, higher LACE+ score predicted higher risk of readmissions at 30D, 30-90D, and 90D following the index surgery (p = 0.003, p = 0.016, p < 0.001, respectively). When comparing the bottom decile of LACE+ scores to the top 4 deciles, higher LACE+ score predicted higher risk of readmissions at 30D (p = 0.009) and 90D (p = 0.005). Between exact-matched cohorts, no significant difference was observed in hospital readmissions.

CONCLUSION:

The LACE+ index may be a powerful tool in predicting other important postsurgical outcomes.
467 Cost Effectiveness of Using a New Autograft Harvesting Technology in Adult Posterior Lumbar Spine Fusion Surgery
Authors: Gandhoke Gurpreet S. , Orsheln Sarah , Smith Kenneth
Published: March 2022

INTRODUCTION:

Autograft in the form of the patient’s own bone dust can be harvested during surgery and used to facilitate fusion, or allograft can be purchased at a cost and used as an alternative.

METHODS:

We compared allograft use to the upfront investment of a new autograft harvesting technology (Bone Collector), enrolling 107 patients. In 81 patients, Bone Collector was used to collect autologous graft. We compared the allograft requirement and allograft cost to similar variables in a control group of 26 patients where the Collector was not utilized. Quality Adjusted Life Years (QALYs) were calculated as the effectiveness parameter for both groups. EQ-5D scores were used to calculate quality of life utilities pre-operatively and at 3 months, 1 year and 2 years post-operatively. The cost-effectiveness study was performed from a societal perspective with a 2-year horizon for US populations.

RESULTS:

Of the 81 patients for whom the Bone Collector was used, 58% patients required autograft only. Forty-Two percent required allograft supplementation with the harvested autograft. In the 26 patients where the bone collector was not utilized, 35% required autograft only, while 66% required both autograft and allograft. The mean allograft requirement for the Bone Collector group was 4cc, while that of the group not utilizing the Bone Collector was 7.5cc. The cost of Allograft ranged from $100 to $4000. The cost of the 2 different Bone Collectors that were used in this study ranged from $400 to $1000. Preoperative ODI and EQ-5D scores for the entire cohort improved at 3 months, one year and 2 years postoperatively. Our decision analysis revealed that using the Bone collector was dominant (cost saving and more effective) compared to non-use, saving $326 and gaining 0.04 QALYs. Results were robust in multiple sensitivity analyses, with Bone Collector remaining dominant unless its cost is >$2900.

CONCLUSION:

Our cost-effectiveness analysis revealed that Bone Collector would be cost saving and more effective in most plausible scenarios.
481 Subacute Cell Specific Gene Expression Changes After Experimental TBI Suggest Target Genes for Cognitive Dysfunction
Authors: Alfawares Yara , Correll Erika , McGuire Jennifer , Ngwenya Laura B.
Published: March 2022

INTRODUCTION:

Approximately 1.8 million Americans suffer from traumatic brain injury (TBI) each year, many of whom develop persistent cognitive difficulties. Understanding gene expression changes in cell types important for cognitive function may provide insight for therapeutic targets.

METHODS:

The dentate gyrus was dissected from the hippocampi of adult Sprague Dawley rats three weeks after either control or moderate lateral fluid percussion injury. Nuclei were isolated, the RNA was extracted, and sequenced using 10X Genomics technology. The RNA sequences were mapped to the rat genome (Rnor 6.0), quantified, and their expression normalized. Clustering of nuclei based on their gene expression profiles was done using Seurat (v4.0.1; R version 4.0.5). The granule cell cluster from each sample was identified based on expression of Prox1 and Rfx3, along with other neuronal markers. Genes with significant negatively correlated expressions between conditions were identified as differentially expressed and their functions were explored through Gene Ontology (GO).

RESULTS:

We identified a total of 14819 genes expressed in the granule cell clusters. Of these, 85 were differentially expressed. We identified twelve statistically significant biological processes using GO terms. GO terms with implications for cognitive function included: memory (p=0.000191, GO:0007613), negative regulation of amyloid-beta formation (p=0.000192, GO:1902430), and protein-lipid complex assembly (p=0.000192, GO:0065005). Statistically significant genes of interest associated with GO terms were under-expressed in the TBI condition: Apoe (p=0.00039), Atad1 (p=0.000013), Cpe (p=0.000438), and Dbn1 (0.002505).

CONCLUSION:

Three weeks after experimental TBI, hippocampal dentate granule cells under-express genes important for neurotransmitter receptor trafficking and neuronal survival. Future studies with cell-specific methodologies may yield targets for therapeutic strategies to improve cognitive dysfunction after TBI.
482 Traumatic Brain Injury and Hemorrhage in a Juvenile Rat Model of Polytrauma Leads to Immunosuppression and Splenic Alterations
Authors: Sribnick Eric A. , Warner Timothy , Hall Mark
Published: March 2022

INTRODUCTION:

Traumatic brain injury (TBI) is a common cause of morbidity and mortality for which there are no pharmacotherapeutic agents. We have previously shown, with clinical data and in an animal model, that TBI with a concurrent extra-cranial injury can reliably lead to post-injury immunosuppression.

METHODS:

To assess the clinical relevance of our combined model, we examined lungs for evidence of spontaneous bacterial colonization. Prepubescent (28 day old) rats were injured with a moderately severe controlled cortical impact model and then had 25% blood volume removed by arteriotomy. Blood and spleen samples at post-injury day 1 were incubated with T or B cell immunostimulant and were examined for IFN-G production using an Eli-Spot assay. Spleen samples were examined at this timepoint for apoptosis using Annexin V staining. Lungs were also harvested and plated on blood agar to examine spontaneous bacterial colonization.

RESULTS:

Stimulation of whole blood samples and spleen with PMA at post-injury day 1 were associated with significant decreases in IFN-G-positive cells/million, as compared with samples from sham animals. As compared to sham, spleen samples from injured animals showed a marked increase in splenocyte apoptosis in the white pulp of the spleen. Lung samples, plated on blood agar, showed a 300% increase in colonies per plate in injured animals.

CONCLUSION:

These data add to a growing body of literature suggesting that severe trauma can lead to immunosuppression. Our findings further suggest a potential role for the spleen in altering leukocyte function following injury.
500 Fluorescein-guided Resection of High Grade Gliomas: A Meta-analysis
Authors: Smith Emily J. , Gohil Kavita , Mostafa Wael H. , Thompson Charee
Published: March 2022

INTRODUCTION:

High grade gliomas (HGGs) have a poor prognosis despite current standard of care of surgery, chemotherapy, and radiation therapy. Achieving gross total resection (GTR) has been found to prolong survival in these patients. Intraoperative fluorescent agents are often used to aid resection of HGGs. Currently, 5-ALA is the only FDA-approved fluorescent agent but can be inconvenient to use, requiring ingestion hours before surgery, dark room isolation for 1-2 days post-operatively, and high cost. Another fluorescent agent commonly used is fluorescein sodium which is FDA approved for ocular surgeries and has a better side effect profile and is less costly than 5-ALA. Many studies have been published documenting the use of fluorescein in HGG resection, reporting rates of GTR and with some studies comparing it to a non-fluorescent or 5-ALA arm. In this meta-analysis, we provide statistical evidence of the efficacy in using fluorescein for HGG resection.

METHODS:

Following the PRISMA framework, we assessed 119 articles from Pubmed, Medline (Ovid), and BIOSIS Citation Index and found 23 eligible studies for meta-analysis, assessing the rates of GTR with fluorescein-guided resection of HGGs.

RESULTS:

Of the 23 eligible studies, 22 reported GTR rates. A pooled cohort of 336 patients underwent fluorescein-guided HGG resection with a GTR rate of 81% (95% CI, 73-89%; p<.001). 11 case-controlled studies were analyzed, showing a 23.6% increase in GTR rate in the fluorescein group compared to non-fluorescein-guided surgeries.

CONCLUSION:

This meta-analysis shows significantly increased GTR rates in fluorescein-guided resection of HGGs when compared to resection without fluorescein. This is comparable to GTR rates found with 5-ALA (76.8%) in previous meta-analyses. Though our results are statistically significant, there was significant heterogeneity in the fluorescein studies analyzed, so we cannot definitively conclude an association between fluorescein-guidance and GTR.
Λειτουργικότητα της οικογένειας, εκφραζόμενο συναίσθημα και ποιότητα ζωής στα παιδιά και εφήβους με ψυχωτικές διαταραχές
Authors: Ρόπη Σταυρούλα
Published: March 2022

Ιστορικό: Η ποιότητα της οικογενειακής λειτουργικότητας και τα επίπεδα του Εκφραζόμενου Συναισθήματος (Κριτικά Σχόλια, Εχθρότητα ή Συναισθηματική Υπερεμπλοκή) συσχετίζονται προοπτικά με την πορεία και την έκβαση μιας πληθώρας ψυχιατρικών διαταραχών. Η συμπεριφορά της οικογένειας στα πρώτα στάδια της νόσου, κυρίως της σχιζοφρένειας καθορίζει σε μεγάλο βαθμό την μετέπειτα πορεία.Σκοπός: Αυτή η μελέτη διερευνά την οικογενειακή λειτουργικότητα, το Εκφραζόμενο Συναίσθημα και την Ποιότητα Ζωής σε πάσχοντες εφήβους και τους γονείς τους.Μέθοδοι: Το Εκφραζόμενο Συναίσθημα μετρήθηκε με την κλίμακα Family Questionnaire, η λειτουργικότητα της οικογένειας με το Family Assessment Device, και η Ποιότητα Ζωής με το KIDSCREEN 27 σε ένα κλινικό δείγμα 40 εφήβων που παρουσίασαν διαταραχές του σχιζοφρενικού φάσματος ή συναισθηματικές ψυχωτικές διαταραχές και των γονέων τους.Αποτελέσματα: Οι γονείς είχαν υψηλές βαθμολογίες και στις δύο διαστάσεις της κλίμακας, τα Κριτικά Σχόλια και τη Συναισθηματική Υπερεμπλοκή. Το υψηλότερο Εκφραζόμενο Συναίσθημα συσχετίστηκε με περισσότερες συναισθηματικές δυσκολίες και στους δύο γονείς και ιδιαίτερα προεξήρχαν τα καταθλιπτικά χαρακτηριστικά. Οι οικονομικές δυσκολίες της οικογένειας συσχετίστηκαν αρνητικά με τα τη διάσταση της ψυχολογικής ευεξίας των εφήβων. Λαμβάνοντας υπόψιν ότι οι έφηβοι είναι πιο ευάλωτοι στις επιδράσεις ενός δυσλειτουργικού περιβάλλοντος, είναι πιθανό να υφίστανται σε μεγαλύτερο βαθμό τις επιδράσεις του αυξημένου εκφραζόμενου συναισθήματος εκ μέρους των γονέων τους.Συμπεράσματα: Η μελέτη υπογραμμίζει την ανάγκη για κατάλληλες παρεμβάσεις στην οικογένεια, οι οποίες θα βοηθήσουν τους γονείς στην ανάπτυξη στρατηγικών επικοινωνίας και επίλυσης προβλημάτων και θα συνεισφέρουν στη μείωση των υψηλών επιπέδων Εχθρότητας ή Εκφραζόμενου Συναισθήματος και Συναισθηματικής Υπερεμπλοκής στην οικογένεια.
Automobility and urban visions
Authors: Σακελλαρίδου Αρετή
Published: March 2022

Το αυτοκίνητο, ως μέσο μεταφοράς, τεχνολογικό επίτευγμα, προϊόν βιομηχανικής παραγωγής και μαζικής κατανάλωσης, αλλά και ως πολιτιστικό στοιχείο της σύγχρονης ζωής, έπαιξε καθοριστικό ρόλο στη μεταμόρφωση των αστικών τοπίων του 19ου αιώνα σε σύγχρονες πόλεις και ανέδειξε το ρόλο της κινητικότητας ως δομικού στοιχείου στη διαδικασία παραγωγής του αστικού χώρου και σημαντικής παραμέτρου για τον προσδιορισμό της κλίμακας και της μορφής των πόλεων. Έτσι, θεωρείται σήμερα ως ένα από τα σημαντικότερα τεχνολογικά επιτεύγματα του 20ου αιώνα, αντανακλώντας μια παγκόσμια επανάσταση που προώθησε νέα μοντέλα παραγωγής, διαμόρφωσε φυσικά περιβάλλοντα και άλλαξε τον τρόπο αντίληψης και κατανάλωσης του χώρου. Η συγκεκριμένη διατριβή πραγματεύεται τη σχέση μεταξύ της αυτοκίνησης και του αστικού σχεδιασμού στον Δυτικό Κόσμο των αρχών του 20ου αιώνα. Ωστόσο, δεν επικεντρώνεται στην περιγραφή και ανάλυση του παραγόμενου αστικού χώρου, αλλά αναλύει τα οραματικά αστικά περιβάλλοντα που παρουσιάστηκαν εκείνη την εποχή. Μέσα από τη μελέτη συγκεκριμένων ιδεατών πόλεων / αστικών μοντέλων, επιχειρεί να απεικονίσει τη σχέση μεταξύ της αυτοκίνησης και της οραματικής αρχιτεκτονικής και να διατυπώσει ερωτήματα σχετικά με τον συμβολικό χαρακτήρα αυτών των έργων. Η ανάλυση, που βασίζεται στην αντιπαραβαλλόμενη μελέτη συγκεκριμένων προγραμμάτων που διατυπώθηκαν στα τέλη του 19ου αιώνα και στις αρχές του 20ου αιώνα για να περιγράψουν αστικά μορφώματα που τοποθετούνται στον Δυτικό Κόσμο, οργανώνεται σε τρεις ερευνητικούς άξονες. Ο πρώτος αναφέρεται στο τεχνολογικό δημιούργημα, το αυτοκίνητο, ο δεύτερος σχετίζεται με την κινητικότητα και τον γενικό επαναπροσδιορισμό του όρου στα υπό μελέτη προγράμματα, ενώ ο τρίτος εστιάζει στην αποτύπωση της αυτοκίνησης στο χώρο, μέσω του σχεδιασμού, της οργάνωσης και της κατασκευής μεταφορικών υποδομών. Σε αυτό το πλαίσιο, επιχειρείται μια νέα χωρική ανάγνωση υπό το πρίσμα των μεταφορικών υποδομών και τα επιλεγμένα έργα μελετώνται ως χωρικά μοντέλα που προώθησαν νέους τύπους αστικοποίησης με βάση την κινητικότητα.
Αναγνώριση αναδιπλώσεων με κάμερες βάθους και ρομποτικός χειρισμός υπερ-εύκαμπτων αντικειμένων
Authors: Τριανταφύλλου Δήμητρα
Published: March 2022

Στόχος αυτής της διατριβής είναι η ανάπτυξη μιας μεθόδου ρομποτικού ξεδιπλώματος, ανεξάρτητης από τον τύπο (π.χ. μπλούζα, παντελόνι, πετσέτα κλπ.), το ύφασμα, τα χρώματα και τα μοτίβα ενός ρούχου καθώς και από τα διακοσμητικά του στοιχεία, όπως τσέπες και γιακάδες. Για την επίτευξη αυτού του στόχου αναπτύσσονται μέθοδοι που ενσωματώνουν την ανθρώπινη γνώση και τον τρόπο αντίληψης, οι οποίες συνδυάζονται με τεχνικές μηχανικής μάθησης. Επιπροσθέτως, χρησιμοποιούνται αισθητήρες βάθους, οι οποίοι παρέχουν περισσότερη πληροφορία για τη διαμόρφωση ενός ρούχου σε σχέση με μια απλή κάμερα και δεν επηρεάζονται από τα χρώματα των ρούχων, ούτε από τις σκιές που μπορούν να δημιουργήσουν διαφορετικές συνθήκες φωτισμού.Η διαδικασία ρομποτικού ξεδιπλώματος που ακολουθείται στην προτεινόμενη προσέγγιση αποτελείται από τρία βασικά βήματα: 1) το ρούχο από τυχαία αρχική κατάσταση μεταβαίνει, μέσω ρομποτικών χειρισμών και με τη βοήθεια της βαρύτητας, σε ημι-διπλωμένη κατάσταση πάνω σε ένα τραπέζι εργασίας, 2) αναγνωρίζεται η διαμόρφωση του ρούχου με βασικό στόχο την ανίχνευση του άνω επιπέδου του (το ημι-διπλωμένο ρούχο χωρίζεται στο άνω και κάτω επίπεδο τα οποία συνδέονται μεταξύ τους μέσω του άξονα δίπλωσης), 3) το ρούχο ξεδιπλώνεται πλήρως είτε σηκώνοντάς το στον αέρα από κατάλληλα σημεία, είτε με μετακίνηση του άνω επιπέδου γύρω από τον άξονα δίπλωσής του.
COVID-19 testing systems and their effectiveness in small, semi-isolated groups for sports events
Authors: Kamo Masashi , Murakami Michio , Naito Wataru , Takeshita Jun-ichi , Yasutaka Tetsuo , Imoto Seiya
Published: March 2022

In this study, we quantitatively assessed the effectiveness of systems for COVID-19 testing in small groups of sport teams that are semi-isolated from the general population by countermeasures against infection. Two types of group were assumed, and the dynamics of infection within each group was modeled by using a compartment model of infectious disease. One group (Group A) comprised domestic professional sports teams that play many games over a season while remaining within a relatively small region. Polymerase chain reaction (PCR) tests were routinely conducted once every 2 weeks, and the number of infected individuals that could not be quarantined after identification by testing or checking for symptoms was defined as the risk. The other group (Group B) comprised teams that travel across borders for mass-gathering events like the Olympic and Paralympic Games. The teams were isolated for 2 weeks at their destination; frequent testing and checking for symptoms was conducted, and any infected individuals were quarantined. The number of infected individuals participating in games after the isolation period was defined as the risk. In Group A, the number of infected individuals detected by routinely conducted PCR testing was lower than the number of infected individuals detected by checking for symptoms, indicating that routine testing every 2 weeks was not very effective. In Group B, daily PCR testing was the most effective, followed by daily antigen testing. Dual testing, in which individuals with a positive antigen test were given an additional PCR test, was the least effective with an effect equal to PCR testing every other day. These results indicate that repeated testing does not necessarily increase the detection of infected individuals.
An Introduction to the Phenomenology of Performance Art: SELF/s
Authors: Bacon T. J.
Published: March 2022

An introduction to the study and application of performance art through phenomenology for radical artists, educators and practitioner-researchers. Features exercises to activate your practice, clear introductory definitions to key phenomenological terms and a multimodal design that lets the reader choose how to read the book.
Confronting Nostalgia for Racism in American Popular Music via BioShock Inﬁnite
Authors: Pozderac-Chenevey Sarah
Published: March 2022

American history frequently whitewashes the past, minimizing the parts that are uncomfortable for the present. Nostalgia for the antebellum South conceals the personhood and suffering of enslaved Black people; nostalgia for the early twentieth century erases the racism engrained in American society at the time. But the 2013 videogame BioShock Infinite (BI) repeatedly forces the player to confront both the racism endemic to its early twentieth-century setting as well as the nostalgia that conceals it. This essay theorizes a specific form of restorative nostalgia, termed “idealizing nostalgia,” that is satirized in BI. It examines the historical context of racism and nostalgia in BI’s music, including blackface minstrelsy, and analyzes five musical case studies, including the music of Polk Miller’s Old South Quartette, the appropriation of Huddie “Lead Belly” Ledbetter’s “Goodnight, Irene,” and the transformation of R.E.M.’s “Shiny Happy People” into an Al Jolson-esque song.