bluuebunny/crossref_metadata_2025 huggingface dataset:
Harnessing the stream: algorithmic imaginary and coping strategies for live-streaming e-commerce entrepreneurs on Douyin
Authors: Wang Xinlu , Cao Shule
Published: March 2024

When an algorithm is embedded into the platform economy as a digital infrastructure, it affects the visibility of information, the distribution of interests, and the labor process. In the context of live-streaming e-commerce, entrepreneurs interact with algorithms and consumers in real time to obtain more traffic. Compared with platform users, entrepreneurs are more sensitive to changes in the algorithm when facing great uncertainty in live-streaming and have become “algorithm experts”. This paper focuses on the short video platform Douyin and adopts the methods of field research and in-depth interviews. We interviewed 45 live commerce entrepreneurs and explored how entrepreneurs understand and interact with algorithms, particularly how their understanding of algorithms differs from that of users. By examining algorithmic imaginaries and coping practices, the authors hope to further the understanding of the relationships among labor, technology, and economic activity in new social contexts. In our study, we found that unlike platform users, who are often resilient, entrepreneurs have more active attitudes to learn about and interact with algorithms. They use words such as “admission tickets” and “like the wind” to describe algorithms. Unlike content creators, entrepreneurs’ understanding of arithmetic is influenced by the logic of traditional trade business when faced with traffic uncertainty. To seek certainty from a blurry stream, they adapt the methods of farther learning, frequent algorithm tests, more sophisticated work division, and resignation to fate. This study enriches the research perspective in the field of STS from a social-economic perspective and discusses the impact of technology on individual movement in the context of e-commerce. At the same time, this study also explores the technological ideology behind precarious work, which reflects individuals’ expectations of social order.
Gastric inflammatory myofibroblastic tumor: a case report
Authors: Hattori Taku , Tanizawa Yutaka , Shimoda Tadakazu , Koseki Yusuke , Furukawa Kenichiro , Fujiya Keiichi , Aizawa Daisuke , Sugino Takashi , Terashima Masanori , Bando Etsuro
Published: March 2024

Background

Inflammatory myofibroblastic tumor (IMT) of the stomach is an uncommon mesenchymal neoplasm. We present a case of gastric submucosal tumor (SMT) where the final diagnosis was IMT.

Case presentation

A 69-year-old man presented with a 24-mm SMT on the posterior wall of the middle third of the stomach that was detected by screening upper gastrointestinal endoscopy. Abdominal contrast-enhanced computed tomography showed that the tumor was well-enhanced. Although endoscopic ultrasonography-guided biopsy was performed, the histological diagnosis was not confirmed preoperatively. Since the tumor was clinically suspected to be a gastrointestinal stromal tumor, we performed gastric wedge resection by laparoscopic–endoscopic cooperative surgery. Pathologically, proliferative spindle cells with a positive reaction for smooth muscle actin, negativity for c-kit, desmin, s-100, CD34, STAT-6, β-catenin and anaplastic lymphoma kinase 1 were identified. Hence, the tumor was finally diagnosed as an IMT originating from the stomach.

Conclusions

When an SMT of the stomach is identified, the possibility of gastric IMT should be considered.
Efficacy and safety of FDG-PET for determining target volume during intensity-modulated radiotherapy for head and neck cancer involving the oral level
Authors: Kosugi Yasuo , Sasai Keisuke , Murakami Naoya , Karino Tatsuki , Muramoto Yoichi , Kawamoto Terufumi , Oshima Masaki , Okonogi Noriyuki , Takatsu Jun , Iijima Kotaro , Karube Shuhei , Isobe Akira , Hara Naoya , Fujimaki Mitsuhisa , Ohba Shinichi , Matsumoto Fumihiko , Murakami Koji , Shikama Naoto
Published: March 2024

Purpose

To determine the efficacy and safety of target volume determination by 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) for intensity-modulated radiation therapy (IMRT) for locally advanced head and neck squamous cell carcinoma (HNSCC) extending into the oral cavity or oropharynx.

Methods

We prospectively treated 10 consecutive consenting patients with HNSCC using IMRT, with target volumes determined by PET-CT. Gross tumor volume (GTV) and clinical target volume (CTV) at the oral level were determined by two radiation oncologists for CT, magnetic resonance imaging (MRI), and PET-CT. Differences in target volume (GTVPET, GTVCT, GTVMRI, CTVPET, CTVCT, and CTVMRI) for each modality and the interobserver variability of the target volume were evaluated using the Dice similarity coefficient and Hausdorff distance. Clinical outcomes, including acute adverse events (AEs) and local control were evaluated.

Results

The mean GTV was smallest for GTVPET, followed by GTVCT and GTVMRI. There was a significant difference between GTVPET and GTVMRI, but not between the other two groups. The interobserver variability of target volume with PET-CT was significantly less than that with CT or MRI for GTV and tended to be less for CTV, but there was no significant difference in CTV between the modalities. Grade ≤ 3 acute dermatitis, mucositis, and dysphagia occurred in 55%, 88%, and 22% of patients, respectively, but no grade 4 AEs were observed. There was no local recurrence at the oral level after a median follow-up period of 37 months (range, 15–55 months).

Conclusions

The results suggest that the target volume determined by PET-CT could safely reduce GTV size and interobserver variability in patients with locally advanced HNSCC extending into the oral cavity or oropharynx undergoing IMRT.

Trial registration

UMIN, UMIN000033007. Registered 16 jun 2018, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037631
Rendezvous-PIERCE technique: establishing a channel through severe calcification in infrainguinal arterial lesions using needle rendezvous
Authors: Haraguchi Takuya , Tsujimoto Masanaga , Kashima Yoshifumi , Sato Katsuhiko , Fujita Tsutomu
Published: March 2024

Background

Severe calcification often prevents device passage and balloon expansion in cases of lower extremity artery disease. To address this limitation, we introduced a novel calcium modification technique called Rendezvous-PIERCE (R-PIERCE).

Methods

A needle was inserted in a retrograde manner and advanced to touch the tip of an antegrade guidewire within the lesion. Then, the guidewire was advanced into the lumen of the needle to achieve partial guidewire externalization, also known as needle rendezvous. The needle was then introduced over the externalized guidewire under wire tension and repeatedly rotated and advanced across the lesion to modify calcified intimal plaques. Notably, this technique can be applied in the opposite direction.

Results

Case 1 involved a 68-year-old male with a calcified occlusion of the anterior tibial artery. An antegrade guidewire reached the midpoint of the occlusion; however, microcatheters and balloons could not pass through the proximal calcification. Therefore, R-PIERCE was used to modify uncrossable lesions. An antegrade 2.5-mm balloon crossed and dilated the lesion, achieving hemostasis at the needle insertion site. The antegrade guidewire successfully crossed the entire lesion and was dilated by the 2.5-mm balloon. Final angiography demonstrated successful flow. In Case 2, an 80-year-old male had a calcified femoropopliteal occlusion. An antegrade guidewire was advanced into the distal superficial femoral artery (SFA); however, no device could follow it. R-PIERCE was performed to modify the calcification from the distal to the medial SFA. The antegrade balloon successfully crossed and dilated obstructed lesions. Furthermore, the antegrade guidewire crossed the entire lesion, and the antegrade balloon was dilated. Final angiography revealed a successful flow without complications.

Conclusions

R-PIERCE is useful for modifying complex calcified lesions during the wiring of occlusive lesions.
Spatial and temporal patterns and driving factors of forest fires based on an optimal parameter-based geographic detector in the Panxi region, Southwest China
Authors: Liu Jia , Wang Yukuan , Guo Haiyan , Lu Yafeng , Xu Yuanxin , Sun Yu , Gan Weiwei , Sun Rui , Li Zhengyang
Published: March 2024

Background

The Panxi region in China is among the areas that are most severely impacted by forest fires. Despite this, there is currently a lack of comprehensive and systematic research on the spatial and temporal distribution patterns, as well as the drivers, of forest fires in the region. To reveal bio-geo-climatic and anthropogenic influences, this study investigated the temporal and spatial characteristics of forest fires and migration patterns of the center of gravity of forest fires in Panxi. A parametric optimal geographical detection model was utilized to quantify the influence of various individual factors and their combinations on the spatial patterns of forest fire occurrence in the whole Panxi region and sub-region, by analyzing the forest fire dataset from 2004 to 2020.

Results

From 2004 to 2020, the Panxi region experienced an upward trend in the number of forest fires and the area burned. However, the trends were not consistent over the entire period. Between 2004 and 2014, both the number of fires and the area burned showed fluctuations and an overall increase. In contrast, between 2015 and 2020, there was a significant decrease in the number of fires, while the area burned showed a continued upward trend. The study identified abrupt changes in the frequency of forest fires and burned areas, primarily in 2007 and 2016. Spatially, forest fires in Panxi exhibited a positive correlation and local clustering. The river valley basin and hilly regions displayed a higher incidence of forest fires, which were concentrated mainly along the hill edges. In the whole area of Panxi, climatic factors have a predominant influence on forest fire occurrences. Specifically, evaporation, maximum temperature, average temperature, number of days without rain, and minimum temperature demonstrated the strongest explanatory power. Furthermore, this relationship was found to be reinforced when combined with topographical, human activities, and vegetation factors. The spatial variation of drought within each sub-district has a stronger explanatory power for the distribution characteristics of forest fires in the region than at the Panxi-wide scale. The factor with the maximum interaction in most regions was the dual factor of rainfall and drought.

Conclusions

The study’s findings validate the applicability of geographic probes for identifying the drivers of fire occurrence and enhance our understanding of the drivers and their combined effects on the spatial context of the fire-incident study area.
Assessment of serum interleukin 6 in a sample of Egyptian patients with schizophrenia
Authors: Ella Eman Ibrahim Abo El , Rabie Eman S. , Sheikh Mona Mahmoud El , Ghamry Reem Hassan El , Hotar Mostafa Salah , Gabrielle Fiby Fayez
Published: March 2024

Background

Inflammation has been demonstrated to play a pathophysiological function in schizophrenia. Raised interleukin-6 (IL-6) levels have been the most consistently linked to schizophrenia. It was hypothesized that IL-6 contributed to the development of both adverse and beneficial symptoms.

The aim of the study was to estimate the level of serum IL-6 in patients with schizophrenia and its relation to positive in addition to negative symptoms.

Patient and methods

This case–control descriptive cross-sectional study was conducted on 40 patients, divided into two groups: 20 individuals in Group A (patients group) were treatment-naive for their first episode of schizophrenia, and 20 volunteers in Group B (control group) were matched for gender and age to the patient group. Both groups were evaluated for their serum interleukin-6 levels using the ELISA method. Patients and controls were recruited from the Okasha Institute of Psychiatry, Faculty of Medicine, and Ain Shams University Hospitals.

Results

Cases with schizophrenia who were experiencing their first episode and had not yet begun any form of therapy had a considerably higher mean serum IL-6 level compared to the healthy control group.

Conclusion

The level of serum interleukin 6 in first-episode treatment-naïve individuals with schizophrenia is higher than that of healthy controls, revealing a probable underlying immunological pathology. However, serum interleukin-6 levels were not significantly correlated with positive, negative, or general psychopathology symptoms.
Economic evaluations performed alongside randomized implementation trials in clinical settings: a systematic review
Authors: Carrandi Alayna , Grove Amy , Skouteris Helen , Melder Angela , Hu Yanan , Dever Michelle , Higgins Alisa
Published: March 2024

Background

Economic evaluations alongside implementation trials compare the outcomes and costs of competing implementation strategies to identify the most efficient strategies. The aims of this systematic review were to investigate how economic evaluations are performed in randomized implementation trials in clinical settings and to assess the quality of these evaluations.

Methods

A systematic literature review was conducted on 23 March 2023 to identify studies that reported on economic evaluations embedded in randomized implementation trials in clinical settings. A systematic search was applied across seven databases, and references of relevant reviews were screened for additional studies. The Drummond Checklist was used to assess the quality and risk of bias of included economic evaluations. Study characteristics and quality assessments were tabulated and described.

Results

Of the 6,550 studies screened for eligibility, 10 met the inclusion criteria. Included studies were published between 1990 and 2022 and from North America, the United Kingdom, Europe, and Africa. Most studies were conducted in the primary and out-patient care setting. Implementation costs included materials, staffing, and training, and the most common approach to collecting implementation costs was obtaining expense and budget reports. Included studies scored medium to high in terms of economic methodological quality.

Conclusions

Economic evidence is particularly useful for healthcare funders and service providers to inform the prioritization of implementation efforts in the context of limited resources and competing demands. The relatively small number of studies identified may be due to lack of guidance on how to conduct economic evaluations alongside implementation trials and the lack of standardized terminology used to describe implementation strategies in clinical research. We discuss these methodological gaps and present recommendations for embedding economic evaluations in implementation trials. First, reporting implementation strategies used in clinical trials and aligning these strategies with implementation outcomes and costs are an important advancement in clinical research. Second, economic evaluations of implementation trials should follow guidelines for standard clinical trial economic evaluations and adopt an appropriate costing and data collection approach. Third, hybrid trial designs are recommended to generate evidence for effective and cost-effective implementation strategies alongside clinical effectiveness and cost-effectiveness.

Trial registration

The review was prospectively registered with PROSPERO (CRD42023410186).
Anti-cancer activity of Moringa oleifera Lam. seed oil on oral cancer
Authors: Das Moumita , Mohanty Jatindra Nath , Bhuyan Sanat Kumar , Bhuyan Ruchi
Published: March 2024

Background

Despite recent advances in the diagnosis and treatment of oral cancer, relative survival rates have not changed significantly. Moringa oleifera (M. oleifera) Lam. is one such plant with its anticancer properties being proved in its leaves, stem, flowers but no studies are yet reported proving the anticancer property of its seed oil on oral cancer. This study aimed to evaluate the anti-proliferative and cytotoxic effect of M. oleifera seed oil against two Oral squamous cell carcinoma cell lines CAL27 and SCC15 using MTT assay.

Results

2D GC-TOF Mass spectrometry revealed a total of 199 compounds, among which the majority were alkanes (68.2016%) and fatty acid esters (11.1399%). The MTT assay report showed good dose-dependent activity. A significant reduction in cell viability within 24 h with IC50 value of 17.78 µg/mL and 24.28 µg/mL for all treatment groups was observed for both the cell lines CAL27 and SCC15.

Conclusion

MTT assay showed a significant decrease in cell viability with an increase in the oil dose, thereby revealing the cytotoxic and anti-proliferative activity of M. oleifera seed oil on oral cancer cell lines namely CAL27and SCC15. The results of this study indicate that M. oleifera seed oil can be used as a potent anti-cancer agent in the treatment of Oral cancer.

Graphical abstract
Deep Vein Thrombosis as the Presenting Sign in an Adolescent With New-Onset Type 2 Diabetes
Authors: Cooper Felicia , Carakushansky Mauri , Johnson Craig M , Gurnurkar Shilpa
Published: March 2024

Prothrombin G20210A mutation occurs in only 2% to 3% of the population, but usually does not become apparent unless the individual exhibits another risk factor for clotting. A risk factor such as hyperglycemia in the setting of diabetes mellitus may accelerate this clotting process, even at a very young age. In this case report, we discuss a 15-year-old boy presenting with left calf swelling and pain, found to have extensive deep vein thrombosis in the setting of hyperglycemia and a newly discovered prothrombin G20210A mutation. Venous thromboembolism in the setting of type 2 diabetes mellitus has not been described in children.
104 Use of the eShunt Implant in Treatment of Aneurysmal Subarachnoid Hemorrhage Communicating Hydrocephalus
Authors: Lylyk Pedro , Lylyk Ivan , Bleise Carlos , Scrivano Esteban , Lylyk Nicholas Pedro , Beneduce Brandon , Heilman Carl B. , Malek Adel M.
Published: March 2024

INTRODUCTION:

Aneurysmal subarachnoid hemorrhage (aSAH) may cause communicating hydrocephalus and elevated intracranial pressure (ICP) not amenable to weaning of cerebrospinal fluid (CSF) external ventricular drainage (EVD), often requiring surgical ventriculoperitoneal shunting (VPS) with risk of hemorrhage and infection.

METHODS:

Patients having intractable elevated ICP with EVD clamping and favorable inferior petrosal sinus and bony anatomy were included. ICP was monitored before and after eShunt deployment for 36-48 hours. Primary endpoint was reached if ICP remained <20 cmH2O enabling EVD removal. CT imaging of the brain was obtained immediately post-eShunt placement to evaluate eShunt placement and assess for any presence of new procedural hemorrhage.

RESULTS:

Seven out of eight patients (5 female; age 64 ± 12 years) underwent successful transfemoral transvenous eShunt procedure at 25.3 days (Range 14-38) post aSAH. Primary endpoint was achieved in all with EVD removal by 36-48 hours without procedural or delayed hemorrhage. Mean ICP rapidly decreased from 33.4 to 13 cmH2O at 1 hour (p < 0.0001) and to 9 cmH2O (p < 0.0001) at 36 hours post eShunt placement.

CONCLUSIONS:

These early encouraging results of the eShunt implant suggest clinical role and utility in the management of subarachnoid hemorrhage associated hydrocephalus possibly eschewing the need for VP shunt surgery and enabling minimally invasive CSF diversion in patients requiring dual anti-platelet or anticoagulant therapy.
1075 The Effect of Regional Procedural Preference on Outcomes After Posterior Decompression for Degenerative Cervical Myelopathy: Individual Participant Data Meta-Analysis of a Prospective, Multinational Dataset of 1047 Cases
Authors: Bak Alex Beomju , Moghaddamjou Ali , Arnold Paul M. , Harrop James S. , Fehlings Michael G. , Hachem Laureen D.
Published: March 2024

INTRODUCTION:

There is considerable debate regarding the relative effectiveness of laminoplasty vs. laminectomy and fusion for posterior surgical decompression of degenerative cervical myelopathy (DCM).

METHODS:

Subjects with DCM that underwent posterior decompression was derived from three independent, prospective, multicentre clinical trials (CSM-NA, CSM-I, CSM-Protect). Primary endpoint was change in SF36-PCS (minimum clinically important difference [MCID] 4) at 1yr compared to pre-operative assessment. Secondary endpoints were change in mJOA (MCID 2) score, Neck Disability Index (NDI; MCID 15) score, NDI Pain Intensity score, and SF36-MCS (MCID 4) score. Two comparison cohorts were created: i) laminoplasty (LP) and ii) laminectomy and fusion (LF). One-stage hierarchical mixed-effects meta-analyses with study and treatment exposure as random effects were performed. As subgroup analysis, the influence of procedural volume between LP-predominant sites, LF-predominant sites, and volume-equivalent sites was investigated.

RESULTS:

From a total of 1047 patients with DCM, 369 patients met eligibility criteria. There was geographic variability in surgical choice with higher rates of laminectomy and fusion in Brazil and Canada and higher laminoplasty rates in Japan and India. USA had similar rates of LF and LP. When compared to LF-predominant sites, LP-predominant sites achieved greater rates of MCID for mJOA at 1yr (85.4% v. 68.7%, p=0.036) with their predominant technique. There were no significant differences in MCID rates of NDI, SF36-PCS, or SF36-MCS. When comparing LF-predominant and LP-predominant sites with USA, a volume equivalent site, there were no significant differences in MCID rates of all outcomes.

CONCLUSIONS:

Sites that primarily used LP achieved greater rate of MCID in mJOA with laminoplasty than laminectomy with fusion from primarily LF sites. This suggests that experience with either LP or LF can drive outcomes which has interesting healthcare delivery implications.
1083 Investigating Quantitative Long-term Outcomes of Surgical Intervention in Patients With Adolescent Idiopathic Scoliosis and Cobb Angles Between 40 and 50 Degrees: A Retrospective Analysis of the Harms Study Group Scoliosis Outcomes Database Registry
Authors: Friedman Adam , Koneru Manisha , Gentile Pietro , Clements David
Published: March 2024

INTRODUCTION:

Many patients with Adolescent Idiopathic Scoliosis (AIS) are successfully managed with conservative methods, and when indicated, with additional surgical intervention. However, current evidence is limited in supporting therapeutic recommendations for AIS patients with Cobb angles between 40-50 degrees.

METHODS:

De-identified patient data was acquired with permission from the Harms Study Group. Patients 10-21 years old with AIS and 40-50-degree Cobb angles at the time of baseline data collection were grouped based on whether they received operative (op) or nonoperative (non-op) management. Baseline and 2-year follow-up Scoliosis Research Society 22-item questionnaire (SRS-22) scores were analyzed using two-tailed Student’s t-tests and Chi-square tests. Significance level was set to alpha = 0.05.

RESULTS:

A total of 919 patients were analyzed; 863 patients in the op group, and 56 patients in the non-op group. There was no significant difference between op and non-op groups in the distribution of spinal curvature locations at baseline (p = 0.52). The op and non-op groups were found to be significantly different in both average baseline (3.9 vs. 4.1, p = 0.002), and average 2-year follow-up (4.4 vs. 4.0, p < 0.001) SRS-22 scores. The average change in pairwise SRS-22 scores over the 2-year period also significantly differed between op (+0.5) and non-op (-0.1) groups (p < 0.001).

CONCLUSIONS:

Our results showed significantly higher 2-year follow-up average SRS-22 scores, as well as a markedly positive pairwise score change for the operative group, when compared to the non-operative group. This demonstrates better long-term outcomes amongst patients who underwent surgery rather than conservative management alone. Our study provides novel evidence that supports recommending surgical intervention for AIS patients with Cobb angles between 40-50 degrees.
1085 Adjunctive Use of Bone Growth Stimulation in Cervical Spine Fusion in Patients at Risk for Nonunion
Authors: Wind Joshua James , Patel Vikas , Lansford Todd , Weinstein Marc , Campbell Peter , Vokshoor Amir A. , Beaumont Andrew , Hassanzadeh Hamid , Radcliff Kristen , Aleem Ilyas , Coric Domagoj , Cowgill Ian
Published: March 2024

INTRODUCTION:

Prior failed fusion, multi-level disease, diabetes, nicotine usage, and osteoporosis are factors associated with nonunion, leading to prolonged pain, reduced function, and overall decreased quality of life. Previous studies have shown that pulsed electromagnetic field (PEMF) stimulation can improve fusion rates, particularly in subjects at risk for nonunion.

METHODS:

Data from a multi-center prospective study of subjects that underwent cervical spine fusion and were treated with PEMF was compared to a “matched” retrospective cohort that had fusion but were not treated with PEMF. The prospective cohort was enrolled based on having 1 or more of the following risk factors for nonunion: prior failed cervical spine fusion, multilevel fusion, diabetes, osteoporosis, or nicotine use. Fusion was assessed at 12 months postop using x-rays and/or CT. A cohort of cervical spine fusion patients that were prescribed PEMF, but did not receive PEMF treatment (e.g., insurance denial) were compared to PEMF treated subjects.

RESULTS:

At baseline, subjects in the PEMF treated group had a significantly higher average number of risk factors for nonunion (1.8 for treated group vs. 1.1 for control, p < 0.001), and significantly higher average number of surgical levels (2.8 for treated group vs. 2.0 for control, p < 0.005). At 12 months post-op, subjects in the PEMF group (n = 161) had a 90.1% fusion rate, compared to a 65.4% for the control group (n = 26) (p < 0.001).

CONCLUSIONS:

PEMF stimulation provides significant improvements in cervical spine fusion rates in subjects having risk factors for nonunion. Compared to control subjects, PEMF treated subjects had improved fusion outcomes despite being older, having more risk factors for pseudarthrosis, and undergoing more complex surgeries.
1087 Large Incidence and Risk Factors Meta-analysis of Dysphagia in Over 132,000 Anterior, Posterior, and Hybrid Surgeries for Cervical Spondylosis Myelopathy
Authors: Mohammadi Esmaeil , Khan Ali Fahim , Villeneuve Lance , Hameed Sanaa , Haynes Grace , Muhammad Fauziyya , Smith Zachary Adam
Published: March 2024

INTRODUCTION:

Surgical management of Cervical Spondylotic Myelopathy (CSM) is associated with complications with devastating impacts. Dysphagia is one of these major complications with the incidence rate being not completely known in different surgical approaches.

METHODS:

PubMed/MEDLINE, SCOPUS, and Cochrane were systematically searched until January 2023. Rates and risk of complications were assessed. Meta-analysis of rates and risks was performed with generalized linear mixed model (GLMM) and inverse variance method, respectively, and compared between techniques.

RESULTS:

1196 citations were screened and 39 studies with 60 instances of dysphagia incidence/risk factors reports from over 132,442 patients were identified. Dysphagia’s overall incidence rate was 4.98%[95% confidence interval 3.23-7.61] and was significantly different between surgery groups (Chi2 p < 0.01). It was found in 7.97% [4.95–12.57] of anterior surgeries, 1.52% [0.94–2.45] of posterior ones, and 11.25% [3.38–31.44] of hybrid techniques (statistical comparison: P < A < H). Advanced age (>65) risked dysphagia significantly (OR 1.38 [95%CI 1.11-1.71]).

CONCLUSIONS:

Chances of posterior surgery being complicated with dysphagia is not negligible and should be discussed with patient before surgery, especially with older adults.
1139 Retrospective Review of Stereotactic Electroencephalogram Recordings in Temporal Lobectomy Patients Demonstrates the Predictive Value of Interictal Cross-frequency Correlations
Authors: Sathe Anish , Alizadeh Mahdi , Johannan Emily , Raimondo Christian , Sperling Michael , Sharan Ashwini Dayal , Kogan Michael
Published: March 2024

INTRODUCTION:

Positive correlations between low and high frequency spectra in invasive electroencephalogram (EEG) have been implicated in pathological brain activity interictally and have been used for ictal detection in both focal and network models.

METHODS:

We retrospectively analyzed interictal signals from 22 patients who underwent SEEG at our institution between 12/2/14 to 12/8/20. We then analyzed significant HG/Beta cross-frequency correlations using similar processing to our previous publication. These signals were then separated based on temporal and extra-temporal locations. We further evaluated any statistical differences between the seizure free (SF) and non-seizure free (NSF) groups, and mesial (M) versus mesial temporal-plus (M+) onset location.

RESULTS:

1) Clinical recordings from SEEG electrodes can detect cross-frequency correlations between HG/Beta using our previous methodology. 2) Positive correlations are significantly increased in temporal versus other sampled areas. 3) Positive correlations are more predictive of seizure onset during asleep recordings. 4) NSF patients show a significantly higher proportion of positive electrodes in the resected temporal lobe than SF patients. 5) SF patients have a greater proportion of significant contacts in the mesial versus the lateral temporal lobe than NSF patients. 6) Significant HG/Beta correlations in the mesial versus lateral temporal lobe predict seizure freedom better than ictal SEEG localization of seizure onset to M or M+ locations.

CONCLUSIONS:

We present preliminary data that local HG/Beta correlations may be predictive for epilepsy focus and surgical outcome and may have utility as adjunct methods to conventional SEEG analysis. Further studies are needed to determine strategies for prospective studies and clinical use.
115 Time-driven Activity-based Costing for ACDF: An Automated and Scalable Solution
Authors: Ali Daniyal Mansoor , Tecce Eric , August Ari , Thalheimer Sara , O'Leary Matthew , Mandloi Shreya , Sarikonda Advith , Harrop James S. , Vaccaro Alexander R. , Jallo Jack , Prasad Srinivas K. , Heller Joshua E. , Sivaganesan Ahilan
Published: March 2024

INTRODUCTION:

Understanding the true (intraoperative) cost to the hospital when neurosurgeons perform anterior cervical discectomy and fusion (ACDF) is critical as we move towards value-based purchasing.

METHODS:

Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. Total intraoperative costs were estimated for all ACDFs from 2017 and 2022.

RESULTS:

A total of 959 patients underwent anterior cervical fusions between 2017 and 2022 (one-level: n = 400, 41.7%; two-level: n = 407, 42.4%; three-level: n = 139, 14.5%; greater than three-level: n = 13, 1.4%). The most common pre-operative diagnosis was myelopathy (n=586, 61.1%), followed by radiculopathy (n = 256, 26.7%). The average total intraoperative cost per case was $5,970 ± $2,137; $7,542 ± $3,119; $8,958 ± $3,096; and $9,297 ± $2,633 for one-, two-, three-, and greater than three-level fusions, respectively. The major cost contributors were supply costs ($4,745, 66%) and personnel costs ($2,417; 34%). Total intraoperative costs displayed more variation with two-level ACDFs as compared to other fusions. Total supply cost, particularly implant cost ($3,399 ± $2,161), followed by total personnel cost (2,417 ± $917) was responsible for most of the observed total cost variability across all anterior cervical fusions.

CONCLUSIONS:

TDABC is a feasible and scalable methodology for understanding the true intraoperative costs of ACDF, without having to rely on proprietary third-party software. The most common reason for surgery was myelopathy, followed by radiculopathy. The major cost contributors were supply and personnel costs. Two-level ACDFs appeared to display more total cost variability as compared to other fusions. Implant costs, followed by personnel costs, appeared to be responsible for cost variation across all anterior cervical fusions.
1227 Superior Hypophyseal Artery Intraoperative Indocyanine Green Angiogram as a Predictor of Postoperative Visual Function After Endoscopic Endonasal Surgery
Authors: Osorio Robert , Aabedi Alexander Arash , El-Sayed Ivan , Gurrola Jose , Goldschmidt Ezequiel
Published: March 2024

INTRODUCTION:

To date, there are no tools to intraoperatively predict postoperative visual function following endoscopic endonasal surgery (EES) for suprasellar lesions. The development of such a tool would impact postoperative care for patients at risk of new visual deficits.

METHODS:

Patients undergoing EES for resection of suprasellar lesions were administered 5 mg of ICG diluted in 10 mL of saline after tumor removal. Time between luminescence of the anterior cerebral artery and the superior hypophyseal artery branches enveloping the optic chiasm was noted, and the percentage of optic chiasm vessels that luminesced was recorded. Postoperative exams and imaging studies were then used to assess visual function. Patients with and without new deficits were compared to examine trends in ICG findings.

RESULTS:

A total of seven trials were performed on six patients. Mean time to chiasm peak luminescence was 3.8 seconds, and 81.8% of chiasm vessels luminesced. Patients with stable or improved vision after resection demonstrated over 90% chiasm luminescence in every case, and mean time to chiasm luminescence in these post-resection ICG administrations was 4.0 seconds. One patient experienced new postoperative visual deficits; on review of their ICG administration, 11.5% of chiasm vessels luminesced, and the chiasm itself failed to display robust luminescence after 30 seconds of direct observation.

CONCLUSIONS:

This pilot study showed the capability of intraoperative indocyanine green angiography to demonstrate perfusion of the optic chiasm during endoscopic endonasal surgery for resection of suprasellar lesions. Chiasm times under 5 seconds and over 90% chiasm vessel illumination may reflect adequate chiasm perfusion, while those with delayed or absent chiasm luminescence may have compromised chiasm perfusion.
1231 Inhibition of YAP With Vertoporfin Makes Chordomas Sensitive to Radiation in Vitro and in Vivo: New Therapies to Combat Radioresistance
Authors: Akinduro Oluwaseun , Suarez-Meade Paola , Schiapparelli Paula , Roberts Mckinley , Tzeng Stephany , Rosenfeld Steven , Krishnan Sunil , Gokaslan Ziya L. , Green Jordan , Quinones-Hinojosa Alfredo
Published: March 2024

INTRODUCTION:

Chordomas are locally invasive tumors of notochordal origin with a propensity to resist radiotherapy and with no FDA approved therapies. Verteporfin is a photosensitizer with the ability to inhibit the yes-associated-protein (YAP) pathway which is upregulated in chordomas and enables their resistance to radiotherapy.

METHODS:

We used five primary chordoma cell lines (JHC7, UCH1, UCH2, MUG-CHOR1, UM-CHOR1) to perform in vitro and in vivo experiments with 64 mice using a xenograft subcutaneous model of chordoma. We then knocked down the YAP gene in chordoma cells and performed experiments to confirm our results were secondary to verteporfin effects on YAP.

RESULTS:

Verteporfin has additive and synergistic effects on chordoma cells when combined with radiation. Chordoma cells treated with verteporfin have significantly more double-stranded DNA damage after radiation therapy (p < 0.0001) and verteporfin prevents repair of that DNA damage. Verteporfin significantly reduces DNA damage repair proteins and genes in chordoma cells (ATM: p = 0.0007, ATR: p < 0.0001, RADS1: p = 0.0033, BRCA1: p < 0.0001, BRCA2: p = 0.0012, PPP2R4: p < 0.0001). Verteporfin leads to significantly increased frequency of cells in G2/M phase (MUG-CHOR1: p < 0.0001, UCH2: p = 0.0021). We then performed all the above experiments using chordoma cells with the YAP gene knocked down and found that YAP knockdown led to enhanced radiation induced DNA damage (p<0.0001), diminished yH2AX response (p = 0.0264), and increased frequency of cells in G2/M phase (p < 0.0001). In vivo verteporfin treatment significantly inhibited chordoma tumor growth (p < 0.0001) and microparticles were most effective at radiosensitization.

CONCLUSIONS:

Inhibition of YAP using verteporfin radiosensitizes chordoma via 1) inhibition of the DNA damage repair cascade and 2) increasing frequency of the G2/M cell cycle phase when cells are most sensitive to radiation.
1234 The Transposition Technique of Internal Carotid Artery in Endonasal Endoscopic Surgery: Beyond the Lateral Boundary of Middle Line Approach
Authors: Xiao Limin , Ding Han , Xie Shenhao , Tang Bin , Hong Tao
Published: March 2024

INTRODUCTION:

There was no report regarding the transposition technique of ICA in endonasal endoscopic surgery (EES)

METHODS:

Six cadaveric heads (3 arterial and venous injected, 1 embalmed artery injected, 1 fresh artery injected) were prepared for dissection. The trabecular fiber (parasellar ligaments) in cavernous sinus(CS), small branches of ICA, dura, bony structures along ICA were meticulously dissected and photographed. The endoscopic dissections were performed using 0° (4-mm-diameter, 18-cm-long) rod lens endoscopes (Karl Storz). 36 cases (Jan 2014 to June 2022) underwent EES ICA transposition were reviewed.

RESULTS:

The trabecular fiber and small branches of ICA formed four sets of limiting structures around ICA: the medial, lateral, anterior, and posterior group. The medial group consisted of carotid clinoid ligaments (12/12), inferior hypophyseal artery (11/12), inferior parasellar ligament (6/12). The lateral groupcomprised inferolateral trunk (12/12), the sympathetic nerve plexus (12/12), the trabecular fibers between ICA and CN3 (6/12),CN4 (5/12), CN6 (12/12). The anterior group consisted of trabecular fibers between the proximal dural ring and the ICA (7/12). The posterior group was made of trabecual fibers (8/12) around the post genu and posterior wall of CS. Proximal and distal dura ring was the main dura structures impeding mobilizing ICA. The anterior clinoid and lingual process obstructed ICA lateral transposition. Grade 1 (inner CS limiting structures), Grade 2 (inner CS + dura ring open), Grade 3 (inner CS + dura ring + bony remove) transposition were used in 24 (66.7%), 9 (25%), 3 (8.3%) cases respectively. CSF leakage (2.7%), ICA injury (2.7%), new transient CN palsy (8.3%), permanent CN palsy (5.4%) were developed postoperatively.

CONCLUSIONS:

The EES ICA transposition technique is technically feasible and could be graded according to extent of freeing the limiting structures. It is a novel technique worth exploring in suitable cases to enlarge the working zone and surgical freedom in middle line approaches.
1243 FOXM1*3 Overexpression Correlates to Staging of Astrocytic Glioma
Authors: Salazar Ramirez Zita Elizabeth , Feria Romero Iris Angelica , Chavez Valderrama Isaura Z. , Otero Israel Grijalva , Rueda Barbara Nettel
Published: March 2024

INTRODUCTION:

Diffuse gliomas are a group of primary brain tumors characterized by the presence of neoplastic glial-lineage cells. WHO 2021 classification of gliomas recognizes the mutational status of the isocitrate dehydrogenase-1(IDH-1,G395A) gene and the 1p/19q codeletion as identification of cell lineage and a prognosis marker. Transcription factors are binding proteins of genomic DNA and can activate or suppress gene expression. Forkhead box M1(FOXM1) is a transcription factor for Forkhead box(Fox) proteins, a superfamily which is defined by a conserved winged helix DNA binding domain. FOXM1 is a key regulator of both G1/S and G2/M phases of cell cycle and mitotic spindle integrity, it also plays an important role in angiogenesis, DNA damage repair and tissue regeneration. The human FOXM1 gene consists of 10 exons, two of them alternatively spliced. This splicing gives rise to three isoforms: FOXM1*1,*2 and *3. FOXM1*3 is the smallest isoform and is overexpressed in proliferative tissue such as malignant tumors.

METHODS:

A control group of 10 brain cortex, 22 A2, 13 O2, 11 A3, 3 O3, 6 A4 and 46 GBM with histological and molecular diagnosis of astrocytoma, oligodendroglioma and glioblastoma from 2011 to 2022 were included. The diagnosis correlated with patient outcome. mRNA FOXM1*3 and its housekeeping gen IPO8 was quantified by qPCR with Taqman probes. Data analysis was conducted by MannWhitney U test.

RESULTS:

There was a statistically significant difference between expression of mRNA FOXM1*3 in normal brain tissue compared to tumor tissue (p < 0.001). The transcript allowed differentiation between grade 2, 3 and 4 astrocytomas (p < 0.005), nevertheless there was no difference between astrocytic versus oligodendrocytic lineage, and grade 4 astrocytoma versus glioblastoma.

CONCLUSIONS:

The normalized expression of transcript FOXM1*3 allows differentiation of astrocytic gliomas grades.
1244 Immunotherapy With Autological Dendritic Cells in the Structure of Complex Treatment of Gliomas
Authors: Rynda Artemii Y. , Olyushin Victor , Rostovtsev Dmitry
Published: March 2024

INTRODUCTION:

Malignant gliomas are the most common primary brain tumor. Despite the variety of modern treatments, it is still a fatal disease with an extremely poor prognosis. The use of immunotherapy as a technique for the treatment of malignant tumors has great promise, retraining and exploiting the patient's immune response against tumors.

METHODS:

Long-term results of treatment of 220 patients with malignant supratentorial gliomas (anaplastic astrocytomas, glioblastomas) were analyzed. Of these patients, 110 patients, in addition to standard methods of treatment (surgery, radiation therapy and chemotherapy), underwent specific antitumor immunotherapy with autologous dendritic cells. In 110 patients, only standard methods were used in the structure of complex treatment. The relapse-free period and median life expectancy were assessed.

RESULTS:

Conducting specific antitumor immunotherapy in patients with malignant gliomas was safe and did not lead to an increase in the number of complications compared with the control group. It was revealed that the use of immunotherapy based on autologous dendritic cells, in addition to standard methods of treating patients, increases the average life expectancy (in patients with anaplastic astrocytomas up to 40.5 months (p = 0.001), in patients with glioblastomas up to 21.8 months (p = 0.002)) and increases the relapse-free period (in patients with anaplastic astrocytomas up to 17.4 months (p = 0.002), in patients with glioblastomas up to 14.3 months (p = 0.003)) provided that three or more courses are taken. Conducting 1 or 2 courses of immunotherapy does not significantly affect the average life expectancy and median survival of patients.

CONCLUSIONS:

The development and use in clinical practice of specific antitumor immunotherapy based on autologous dendritic cells seems to be a very promising direction for further research, the development of which will improve the long-term results of patient treatment.
1246 The Impact of Latency Variations on the Predictive Value of Facial Nerve Proximal-to-distal Amplitude Ratio During Vestibular Schwannoma Surgery
Authors: Zohdy Youssef M. , Garzon-Muvdi Tomas , Ashram Yasmine A.
Published: March 2024

INTRODUCTION:

Intraoperative facial nerve (FN) electromyographic (EMG) monitoring is now considered an essential part of vestibular schwannoma (VS) surgery and is used for both intraoperative monitoring and postoperative outcome prediction.

METHODS:

Forty-eight patients underwent FN stimulation at the brainstem (proximal) and the internal acoustic meatus (distal) using a current intensity of 2 mA. The proximal latency and the P/D amplitude ratio were assessed. House-Brackmann grades I-II indicated good FN function; and grades III-VI were considered fair/poor function. A P/D amplitude ratio >0.6 was used as a cutoff to indicate good FN function, while a ratio of =0.6 indicated fair/poor FN function.

RESULTS:

The P/D amplitude ratio was measured for all patients, and the calculated sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were 85.2%, 85.7%, 88.5%, and 81.8% respectively. Then the CMAPs from the mentalis muscle were classified based on their proximal latency into: Group I (<6 msec); group II (6-8 msec); and group III (>8 msec). The SE, SP, PPV, and NPV became 90.5%, 90.9%, 95%, and 83.3% respectively in group II. In group I, SE and NPV increased whereas, SP and PPV decreased. While in group III, SP and PPV increased, whereas SE and NPV decreased.

CONCLUSIONS:

At a latency between 6-8msec, the P/D amplitude ratio was predictive of outcome with high SE and SP. When the latency was <6 msec or >8 msec, the same predictive ability was not observed. Knowing the impact of latency variations of P/D amplitude ratio measurement is important for a better understanding of the ability and limitations of this method in predicting postoperative FN function.
127 Durable Treatment of Painful Diabetic Neuropathy With 10 kHz Spinal Cord Stimulation
Authors: Petersen Erika A. , Stauss Thomas , Scowcroft James , Jaasma Michael , 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 , Creamer Michael , Wu Paul , Argoff Charles , Nasr Christian , Taylor Rod S. , Caraway David , Mekhail Nagy
Published: March 2024

INTRODUCTION:

Approximately 25% of people with diabetes experience painful diabetic neuropathy (PDN), but conventional medical management (CMM) is ineffective for many patients. We previously presented partial study results showing that high-frequency (10 kHz) spinal cord stimulation (SCS) provides substantial symptom relief. Here we report full study results through 24-month (24M) follow-up.

METHODS:

We conducted a multicenter RCT to evaluate 10 kHz SCS in PDN patients. Key study inclusion criteria were: PDN symptoms = 12M refractory to medications, lower limb pain intensity = 5cm (0-10 cm visual analog scale [VAS]), and hemoglobin A1c = 10%. Patients (n = 216) were randomized 1:1 to 10 kHz SCS plus CMM or CMM alone, with optional treatment crossover at 6M.

RESULTS:

Patients randomized to 10 kHz SCS experienced significantly greater pain relief at 6M than those treated with CMM alone (p < 0.001). For all patients who received 10 kHz SCS, at 24M post-implantation the average pain relief was 80% from pre-implantation (p < 0.001), and the treatment responder rate was 90%. Clinician-assessed sensory function showed significant improvements with 10 kHz SCS. At 6M, 59% of patients treated with 10 kHz SCS had sensory improvement versus 9% of those treated with CMM alone (p < 0.001). At 24M, 10 kHz SCS improved sensory function for 65% of patients. Patients receiving 10 kHz SCS also experienced significant improvements in health-related quality of life (HRQoL, p < 0.001). At 24M, the mean HRQoL improvement was 2.9-4.8 times the minimum clinically important difference for patients with type 2 diabetes.

CONCLUSIONS:

The results demonstrate that 10 kHz SCS provides significant, durable reductions in pain and improvements in sensory function and HRQoL. Sensory function improvements support the unique disease-modifying potential of 10 kHz SCS.