bluuebunny/crossref_metadata_2025 huggingface dataset:
A frontotemporal dementia-like case after high-altitude climbing
Authors: Tunalı Cemile Hazan , Ünal Süheyla , Kamışlı Suat
Published: January 2023

Background

We report a case who developed long-term neuropsychiatric sequelae similar to frontotemporal dementia after suffering a "high altitude sickness" while climbing a high mountain without taking precautions against acute hypoxia.

Case presentation

The 57-year-old patient showed symptoms of acute mountain sickness after climbing 3500 m. A few months after descending the mountain, he developed symptoms such as loss of empathy, decreased speech, perseveration, echolalia, and increased interest in sugary foods. The patient's MRI and PET/CT results were consistent with frontotemporal neurodegeneration. After the start of donepezil, persecution delusions developed, and the clinical picture worsened. In the process, he developed visual agnosia and anomic aphasia. Although there was no significant change in personality traits at the beginning, the patient developed apathy, loss of inhibition, lack of empathy, progressive aphasia, and problems perceiving and expressing emotions. A significant loss of function occurred within 4 years. The patient met the criteria for "probable behavioral variant frontotemporal dementia", but was defined as a frontotemporal dementia-like case due to possible relevance to a medical condition affecting the brain.

Conclusions

This case suggests that clinicians should be more careful about the chronic consequences of high-altitude diseases and avoid cholinesterase inhibitors such as donepezil, as it can worsen behavioral symptoms of frontotemporal dementia-like symptomatology.
What training should psychiatrists have to interpret six- and 12-lead electrocardiograms?
Authors: Crowther George , Krishnan Mani S. , Richardson Jonathan , Bowes Robert , Fitzpatrick Andrew , Tayebjee Muzahir H.
Published: January 2023

To monitor for drug-related cardiac arrhythmias, psychiatrists regularly perform and interpret 12-lead (12L) and, increasingly often, six-lead (6L) electrocardiograms (ECGs). It is not known how training on this complex skill is updated or how well psychiatrists can interpret relevant arrhythmias on either device.

We conducted an online survey and ECG interpretation test of cardiac rhythms relevant to psychiatrists.

A total of 183 prescribers took part; 75% did not regularly update their ECG interpretation skills, and only 22% felt confident in interpreting ECGs. Most participants were able to recognise normal ECGs. For both 6L and 12L ECGs, the majority of participants were able to recognise abnormal ECGs, but fewer than 50% were able to correctly identify relevant arrhythmias (complete heart block and long QTc). A small number prescribed in the presence of potentially fatal arrhythmias. These findings suggest a need for mandatory ECG interpretation training to improve safe prescribing practice.
Psychological profiles, including emotion regulation characteristics, defence strategies and mentalisation capacity, of male adolescents involved in fights among peers
Authors: Cimino Silvia , Cerniglia Luca
Published: January 2023

Background

Youth violence has become a worrying public health issue worldwide. In Europe and the USA, research has shown a prevalence of this phenomenon ranging from 30 to 70% in boys.

Aims

This descriptive study aimed to evaluate psychological profiles of male adolescents involved in fights with their peers.

Method

Identity consolidation was evaluated with the Self-Concept and Identity Measure; defence strategies were assessed by the Response Evaluation Measure for Youth; emotion regulation was assessed with the Difficulties in Emotion Regulation Scale and mentalisation capacity was evaluated by the Reflective Functioning Questionnaire.

Results

Through a series of multivariate analyses of variance, our results showed that adolescents reporting four or more fights in the past year, when compared with peers reporting none or fewer than four fights, displayed lower identity consolidation, greater use of immature defence strategies, poorer emotion regulation processes and poorer mentalisation capacity.

Conclusions

The results of this study could be useful for the promotion of prevention and intervention programmes to stem fights among adolescents.
Crip Colony
Authors: Coráñez Bolton Sony
Published: January 2023

In Crip Colony, Sony Coráñez Bolton examines the racial politics of disability, mestizaje, and sexuality in the Philippines. Drawing on literature, poetry, colonial records, political essays, travel narratives, and visual culture, Coráñez Bolton traces how disability politics colluded with notions of Philippine mestizaje. He demonstrates that Filipino mestizo writers in the late nineteenth and early twentieth centuries used mestizaje as a racial ideology of ability that marked Indigenous inhabitants of the Philippines as lacking in civilization and in need of uplift and rehabilitation. Heteronormative, able-bodied, and able-minded mixed-race Filipinos offered a model and path for assimilation into the US empire. In this way, mestizaje allowed for supposedly superior mixed-race subjects to govern the archipelago in collusion with American imperialism. By bringing disability studies together with studies of colonialism and queer-of-color critique, Coráñez Bolton extends theorizations of mestizaje beyond the United States and Latin America while considering how Filipinx and Filipinx American thought fundamentally enhances understandings of the colonial body and the racial histories of disability.
Time of Discharge and 30-Day Re-Presentation to an Acute Care Setting After Elective Lumbar Decompression Surgery
Authors: Sastry Rahul A. , Hagan Matthew , Feler Joshua , Abdulrazeq Hael , Walek Konrad , Sullivan Patricia Z. , Abinader Jose Fernandez , Camara Joaquin Q. , Niu Tianyi , Fridley Jared S. , Oyelese Adetokunbo A. , Sampath Prakash , Telfeian Albert E. , Gokaslan Ziya L. , Toms Steven A. , Weil Robert J.
Published: January 2023

BACKGROUND:

Evidence regarding the consequence of efforts to increase patient throughput and decrease length of stay in the context of elective spine surgery is limited.

OBJECTIVE:

To evaluate whether early time of discharge results in increased rates of hospital readmission or return to emergency department for patients admitted after elective, posterior, lumbar decompression surgery.

METHODS:

We conducted a retrospective cohort study of 779 patients admitted to hospital after undergoing elective, posterior, lumbar decompression surgery. Multiple logistic regression evaluated the relationship between time of discharge and the primary outcome of return to acute care within 30 days, while controlling for sociodemographic, procedural, and discharge characteristics.

RESULTS:

In multiple logistic regression, time of discharge earlier in the day was not associated with increased odds of return to acute care within 30 days (odds ratio [OR] 1.18, 95% CI 0.92-1.52, P = .19). Weekend discharge (OR 1.99, 95% CI 1.04-3.79, P = .04) increased the likelihood of return to acute care. Surgeon experience (<1 year of attending practice, OR 0.43, 95% CI 0.19-1.00, P = .05 and 2-5 years of attending practice, OR 0.50, 95% CI 0.25-1.01, P = .054), weekend discharge (OR 0.49, 95% CI 0.27-0.89, P = .02), and physical therapy evaluation (OR 0.20, 95% CI 0.12-0.33, P < .001) decreased the likelihood of discharge before noon.

CONCLUSION:

Time of discharge is not associated with risk of readmission or presentation to the emergency department after elective lumbar decompression. Weekend discharge is independently associated with increased risk of readmission and decreased likelihood of prenoon discharge.
Evaluation of Selective Tibial Neurotomy for the Spastic Foot Treatment Using a Personal Goal-Centered Approach: A 1-Year Cohort Study
Authors: Dauleac Corentin , Luaute Jacques , Rode Gilles , Afif Afif , Sindou Marc , Mertens Patrick
Published: January 2023

BACKGROUND:

Selective tibial neurotomy (STN) has already demonstrated its effectiveness to reduce foot deformities and spasticity, but assessment according to a goal-centered approach is missing.

OBJECTIVE:

To evaluate the effectiveness of STN associated with a postoperative rehabilitation program for the treatment of the spastic foot, according to a goal-centered approach.

METHODS:

Interventional study (before-after STN and rehabilitation program) with observational design including consecutive adult patients with spastic foot, who received STN followed by a rehabilitation program, was performed. The primary outcome measure was the achievement of individual goals at the 1-year follow-up using the Goal Attainment Scaling methodology (with T-score). The secondary outcomes measures were the Modified Ashworth Scale and the modified Rankin Score.

RESULTS:

A total of 104 patients were included. At the 1-year follow-up, 228/252 (90.5%) goals were achieved: 62/252 (24.6%) were achieved as initially expected, 86/252 (34.1%) were achieved better than initially expected, and 80 (31.7%) were achieved much better than initially expected. The mean T-score was significantly increased at the 1-year follow-up (61.5 ± 10.5) compared with the preoperative period (38.1 ± 2.9, P < .00001), and 95/104 (91.3%) patients had a T-score ≥50, meaning that these patients have achieved their goals. At follow-up, spastic deformities were all significantly decreased (P < .0001), the Modified Ashworth Scale was significantly lower for each muscle targeted (P < .0001), and the modified Rankin Score was significantly decreased (P < .0001) allowing the patient population to improve from a moderate to a slight disability status.

CONCLUSION:

This study showed that STN, associated with a postoperative rehabilitation program, successfully achieve personal goals in patients with spastic foot.
Feasibility and Accuracy of Robot-Assisted, Stereotactic Biopsy Using 3-Dimensional Intraoperative Imaging and Frameless Registration Tool
Authors: Deboeuf Louise , Moiraghi Alessandro , Debacker Clément , Peeters Sophie M. , Simboli Giorgia Antonia , Roux Alexandre , Dezamis Edouard , Oppenheim Catherine , Chretien Fabrice , Pallud Johan , Zanello Marc
Published: January 2023

BACKGROUND:

Robot-assisted stereotactic biopsy is evolving: 3-dimensional intraoperative imaging tools and new frameless registration systems are spreading.

OBJECTIVE:

To investigate the accuracy and effectiveness of a new stereotactic biopsy procedure.

METHODS:

Observational, retrospective analysis of consecutive robot-assisted stereotactic biopsies using the Neurolocate (Renishaw) frameless registration system and intraoperative O-Arm (Medtronic) performed at a single institution in adults (2019-2021) and comparison with a historical series from the same institution (2006-2016) not using the Neurolocate nor the O-Arm.

RESULTS:

In 100 patients (55% men), 6.2 ± 2.5 (1-14) biopsy samples were obtained at 1.7 ± 0.7 (1-3) biopsy sites. An histomolecular diagnosis was obtained in 96% of cases. The mean duration of the procedure was 59.0 ± 22.3 min. The mean distance between the planned and the actual target was 0.7 ± 0.7 mm. On systematic postoperative computed tomography scans, a hemorrhage ≥10 mm was observed in 8 cases (8%) while pneumocephalus was distant from the biopsy site in 76%. A Karnofsky Performance Status score decrease ≥20 points postoperatively was observed in 4%. The average dose length product was 159.7 ± 63.4 mGy cm. Compared with the historical neurosurgical procedure, this new procedure had similar diagnostic yield (96 vs 98.7%; P = .111) and rate of postoperative disability (4.0 vs 4.2%, P = .914) but was shorter (57.8 ± 22.9 vs 77.8 ± 20.9 min; P < .001) despite older patients.

CONCLUSION:

Robot-assisted stereotactic biopsy using the Neurolocate frameless registration system and intraoperative O-Arm is a safe and effective neurosurgical procedure. The accuracy of this robot-assisted surgery supports its effectiveness for daily use in stereotactic neurosurgery.
Internal Ventricular Cerebrospinal Fluid Shunt for Adult Hydrocephalus: A Systematic Review and Meta-Analysis of the Infection Rate
Authors: Ramasy Razafindratovo Rado Malalatiana , Migliavaca Celina Borges , Chevret Sylvie , Champeaux-Depond Charles
Published: January 2023

BACKGROUND:

Hydrocephalus is a common neurological condition that usually requires internal ventricular cerebrospinal fluid shunt (IVCSFS). The reported infection rate (IR) varies greatly from below 1% up to over 50%, but no meta-analysis to assess the overall IR has ever been performed.

OBJECTIVE:

To determine the IVCSFS overall IR in the adult population and search for associated factors.

METHODS:

Six databases were searched from January 1990 to July 2022. Only original articles reporting on adult IVCSFS IR were included. Random-effects meta-analysis with generalized linear mixed model method and logit transformation was used to assess the overall IR.

RESULTS:

Of 1703 identified articles, 44 were selected, reporting on 57 259 patients who had IVCSFS implantation and 2546 infections. The pooled IR value and its 95% CI were 4.75%, 95% CI (3.8 to 5.92). Ninety-five percent prediction interval ranged from 1.19% to 17.1%. The patients who had IVCSFS after intracranial hemorrhage showed a higher IR (7.65%, 95% CI [5.82 to 10], P-value = .002). A meta-regression by year of publication found a decreasing IR (−0.031, 95% CI [−0.06 to 0.003], P-value = .032) over the past 32 years.

CONCLUSION:

IVCSF is a procedure that every neurosurgeon should be well trained to perform. However, the complication rate remains high, with an estimated overall IR of 4.75%. The IR is especially elevated for hydrocephalic patients who require IVCSFS after intracranial hemorrhage. However, decades of surgical advances may have succeeded in reducing IR over the past 32 years.
Comparison of Single-Session, Neoadjuvant, and Adjuvant Embolization Gamma Knife Radiosurgery for Arteriovenous Malformation
Authors: Kim Myung Ji , Jung Hyun Ho , Kim Yong Bae , Chang Jong Hee , Chang Jin Woo , Park Keun Young , Chang Won Seok
Published: January 2023

BACKGROUND:

The purpose of intracranial arteriovenous malformations (AVMs) treatment is to prevent bleeding or subsequent hemorrhage with complete obliteration. For large, difficult-to-treat AVMs, multimodal approaches including surgery, endovascular embolization, and gamma knife radiosurgery (GKRS) are frequently used.

OBJECTIVE:

To analyze the outcomes of AVMs treated with single-session, neoadjuvant, and adjuvant embolization GKRS.

METHODS:

We retrospectively reviewed a database of 453 patients with AVMs who underwent GKRS between January 2007 and December 2017 at our facility. The obliteration rate, incidence of latent period bleeding, cyst formation, and radiation-induced changes were compared among the 3 groups, neoadjuvant-embolized, adjuvant-embolized, nonembolized group. In addition, the variables predicting AVM obliteration and complications were investigated.

RESULTS:

A total of 228 patients were enrolled in this study. The neoadjuvant-embolized, adjuvant-embolized, and nonembolized groups comprised 29 (12.7%), 19 (8.3%), and 180 (78.9%) patients, respectively. Significant differences were detected among the 3 groups in the history of previous hemorrhage and the presence of aneurysms (P < .0001). Multivariate Cox regression analyses revealed a significant inverse correlation between neoadjuvant embolization and obliteration occurring 36 months after GKRS (hazard ratio, 0.326; P = .006).

CONCLUSION:

GKRS with either neoadjuvant or adjuvant embolization is a beneficial approach for the treatment of AVMs with highly complex angioarchitectures that are at risk for hemorrhage during the latency period. Embolization before GKRS may be a negative predictive factor for late-stage obliteration (>36 months). To confirm our conclusions, further studies involving a larger number of patients and continuous follow-up are necessary.
Futile Recanalization After Endovascular Treatment in Patients With Acute Basilar Artery Occlusion
Authors: Yang Jie , Jin Zhenglong , Song Jiaxing , Guo Changwei , Xie Dongjing , Yue Chengsong , Kong Weilin , Hu Jinrong , Luo Weidong , Liu Shuai , Huang Jiacheng , Zeng Guoyong
Published: January 2023

BACKGROUND:

It is estimated that >50% of acute basilar artery occlusion (ABAO) patients with successful reperfusion after endovascular treatment (EVT) have futile recanalization. However, few studies investigated the reasons behind this.

OBJECTIVE:

To identify the factors associated with futile recanalization in ABAO after successful reperfusion.

METHODS:

We recruited patients with successful reperfusion (expanded Thrombolysis In Cerebral Infarction score of ≥2b) after EVT from the Basilar Artery Occlusion Study registry. Patients were divided into meaningful recanalization (90-day modified Rankin Scale 0-3) and futile recanalization (90-day modified Rankin Scale 4-6) groups. Multivariable logistic regression analyses were used to identify the predictors of futile recanalization.

RESULTS:

A total of 522 patients with successful reperfusion were selected. Of these, 328 patients had futile recanalization and 194 had meaningful recanalization. Multivariable logistic regression shows that higher neutrophil-to-lymphocyte ratio (P = .01), higher baseline National Institutes of Health Stroke Scale score (P < .001), longer puncture to recanalization time (P = .02), lower baseline posterior circulation Alberta Stroke Program Early CT score (P < .001), lower posterior circulation collateral score (P = .02), incomplete reperfusion (P < .001), and diabetes mellitus (P < .001) were predictors of futile recanalization.

CONCLUSION:

Higher neutrophil-to-lymphocyte ratio, longer puncture to recanalization time, incomplete reperfusion, stroke severity, lower baseline posterior circulation Alberta Stroke Program Early CT score, poor collaterals, and diabetes mellitus were independent predictors of futile recanalization in patients with ABAO with successful reperfusion after EVT. Moreover, multiple stent retriever passes were associated with a high proportion of futile recanalization in patients with late time windows.
Identifying the Sources of Racial Disparity in the Treatment of Parkinson's Disease With Deep Brain Stimulation
Authors: Skelton Henry M. , Grogan Dayton P. , Laxpati Nealen G. , Miocinovic Svjetlana , Gross Robert E. , Yong Nicholas Au
Published: January 2023

BACKGROUND:

Deep brain stimulation (DBS) is a highly efficacious treatment for appropriately selected patients with advanced, medically refractory Parkinson’s disease (PD). It is severely underutilized in Black patients—constituting a major treatment gap. The source of this disparity is unknown, but its identification and correction are necessary to provide equitable care.

OBJECTIVE:

To identify sources of racial disparity in DBS for PD.

METHODS:

We predicted the demographics of potential DBS candidates by synthesizing published data on PD and race. We retrospectively examined the clinical course of a cohort including all patients with PD evaluated for DBS at our center from 2016 to 2020, testing whether the rate of DBS use and time from evaluation to surgery differed by race. We also tested whether the geographic distribution of patient catchment was biased relative to racial demographics.

RESULTS:

Far fewer Black patients were evaluated for DBS than would be expected, given regional demographics. There was no significant difference in the rate at which Black patients evaluated in our clinic were treated with DBS, compared with White patients. Fewer patients were recruited from portions of the surrounding area with larger Black populations.

CONCLUSION:

The known underuse of DBS in Black patients with PD was replicated in this sample from a center in a racially diverse metropolitan area, but was not attributable to the presurgical workup. Future work should examine the transition from medical management to surgical evaluation where drivers of disparity are potentially situated. Surgical practices should increase outreach to physicians managing PD in underserved areas.
Idiopathic Ventral Spinal Cord Hernia—A Single-Center Case Series of 11 Patients
Authors: Jesse Christopher Marvin , Gallus Marco , Beck Jürgen , Ulrich Christian T. , Seidel Kathleen , Piechowiak Eike , Dobrocky Tomas , Häni Levin , Schär Ralph T. , Raabe Andreas
Published: January 2023

BACKGROUND:

Idiopathic spinal cord herniations (ISCH) are rare defects of the ventromedial or mediolateral dura mater with herniation of the spinal cord through the defect with approximately 350 described cases worldwide. Patients usually become symptomatic with motor or sensory neurological deficits and gait disturbances.

OBJECTIVE:

To describe characteristic symptoms and clinical findings and to evaluate the postoperative course and outcomes of ISCH.

METHODS:

We present a single-center data analysis of a case series of 11 consecutive patients who were diagnosed with ISCH and underwent surgery in our department between 2009 and 2021.

RESULTS:

All herniations were located in the thoracic spine between T2 and T9. In most cases, gait ataxia and dysesthesia led to further workup and subsequently to the diagnosis of ISCH. A “far-enough” posterior-lateral surgical approach, hemilaminectomy or laminectomy with a transdural approach, was performed under intraoperative neurophysiological monitoring which was followed by adhesiolysis, repositioning of the spinal cord and sealing using a dura patch. After surgery, clinical symptoms improved in 9 of 11 patients (81.8%), while only 1 patient experienced deterioration of symptoms (9.1%) and 1 patient remained equal (9.1%). The median preoperative McCormick grade was 3 (±0.70), while the median postoperative grade was 2 (±0.98) (P = .0047).

CONCLUSION:

In our case series of ISCH, we found that in most patients, neurological deficits improved postoperatively. This indicates that surgery in ISCH should not be delayed in symptomatic patients.
Complications Related to Deep Brain Stimulation Lead Implantation: A Single-Surgeon Case Series
Authors: Powers Andrew Y. , Nguyen Michael , Phillips Katharine , Mackel Charles E. , Alterman Ron L.
Published: January 2023

BACKGROUND:

Deep brain stimulation (DBS) is the mainstay of surgical treatment for movement disorders, yet previous studies have shown widely varying complication rates. Given the elective nature of DBS surgery, minimizing surgical complications is imperative.

OBJECTIVE:

To evaluate short-term and long-term complications related to DBS lead implantation surgeries performed by an experienced surgeon and provide an updated benchmark comparison for other DBS centers and alternative therapies.

METHODS:

A retrospective chart review of patients who underwent DBS lead implantation surgery by a single surgeon at our institution between 2012 and 2020 was conducted. Demographic and clinical data including surgical complications were collected. A Kaplan-Meier survival analysis was used to evaluate the cumulative risk of lead revision or removal over time. Associations between patient characteristics and various complications were evaluated.

RESULTS:

Four hundred fifty-one DBS leads were placed in 255 patients. Thirteen leads and 11 patients required revision. In total, 3.6% (95% CI [1.3%-5.9%]) of patients required revision at 1 year and 4.8% (95% CI [1.9%-7.6%]) at 5 years, with per-lead revision rates of 2.3% (95% CI [0.9%-3.6%]) and 3.3% (95% CI [1.5%-5.1%]), respectively. Less common diagnoses such as Tourette syndrome, post-traumatic tremor, and cluster headache trended toward association with lead revision or removal.

CONCLUSION:

DBS performed by an experienced surgeon is associated with extremely low complication rates.
Seventh Cervical Nerve (C7) Transection for Spastic Arm Paralysis After Cerebral Injury
Authors: Agarwal Pawan , Jana Sinjan , Sharma Dhananjaya , Parihar Vijay , Bajaj Jitin , Yadav Yad Ram , Dhakar Jagmohan Singh
Published: January 2023

BACKGROUND:

Spastic limb paralysis because of cerebral injury can cause long-term disability. Its treatment varies from conservative to operative; however, the optimum treatment is yet to be found.

OBJECTIVE:

To test the hypothesis that patients with spastic arm paralysis who receive C7 nerve transection to their paralyzed side might have reduction in spasticity, pain, and improvement in arm function.

METHODS:

Four patients with spastic hemiparesis that had ceased to improve after 1 year of rehabilitation, having pain and poor function, were included. All 4 patients underwent C7 nerve transection plus rehabilitation. The outcome was assessed at 1, 3, and 6 months by the Fugl-Meyer upper extremity scale for motor recovery, by the Modified Ashworth Scale score for spasticity, and by the visual analogue score for pain. Functional use of the limb was also assessed by performance of activities such as dressing, tying shoe laces, wringing a towel, and operating a mobile phone.

RESULTS:

At the end of 6 months, there was a significant improvement in mean Fugl Meyer score, reduction in Modified Ashworth score, and Visual Analogue scale for pain. At the beginning of the study, none of the patients could perform any day-to-day activities; however, at the end of 6 months, 3/4 of the patients could perform at least 1 activity.

CONCLUSION:

C7 neurectomy leads to improved motor function, reduction of spasticity and pain, and improvement in function in patients with spastic arm paralysis because of cerebral injury.
Single-Position Transpsoas Corpectomy and Posterior Instrumentation in the Thoracolumbar Spine for Different Clinical Scenarios
Authors: Guiroy Alfredo , Thomas J. Alex , Bodon Gergely , Patel Ashish , Rogers Michael , Smith William , Seale Justin , Camino-Willhuber Gastón , Menezes Cristiano M. , Galgano Michael , Asghar Jahangir
Published: January 2023

BACKGROUND:

The concept of single-position spine surgery has been gaining momentum because it has proven to reduce operative time, blood loss, and hospital length of stay with similar or better outcomes than traditional dual-position surgery. The latest development in single-position spine surgery techniques combines either open or posterior pedicle screw fixation with transpsoas corpectomy while in the lateral or prone positioning.

OBJECTIVE:

To provide, through a multicenter study, the results of our first patients treated by single-position corpectomy.

METHODS:

This is a multicenter retrospective study of patients who underwent corpectomy and instrumentation in the lateral or prone position without repositioning between the anterior and posterior techniques. Data regarding demographics, diagnosis, neurological status, surgical details, complications, and radiographic parameters were collected. The minimum follow-up for inclusion was 6 months.

RESULTS:

Thirty-four patients were finally included in our study (24 male patients and 10 female patients), with a mean age of 51.2 (SD ± 17.5) years. Three-quarter of cases (n = 27) presented with thoracolumbar fracture as main diagnosis, followed by spinal metastases and primary spinal infection. Lateral positioning was used in 27 cases, and prone positioning was used in 7 cases. The overall rate of complications was 14.7%.

CONCLUSION:

This is the first multicenter series of patients who underwent single-position corpectomy and fusion. This technique has shown to be safe and effective to treat a variety of spinal conditions with a relatively low rate of complications. More series are required to validate this technique as a possible standard approach when thoracolumbar corpectomies are indicated.
Use of 3-Dimensional Modeling and Augmented/Virtual Reality Applications in Microsurgical Neuroanatomy Training
Authors: Aydin Serdar Onur , Barut Ozan , Yilmaz Mehmet Ozgur , Sahin Balkan , Akyoldas Goktug , Akgun Mehmet Yigit , Baran Oguz , Tanriover Necmettin
Published: January 2023

BACKGROUND:

Understanding the microsurgical neuroanatomy of the brain is challenging yet crucial for safe and effective surgery. Training on human cadavers provides an opportunity to practice approaches and learn about the brain's complex organization from a surgical view. Innovations in visual technology, such as virtual reality (VR) and augmented reality (AR), have immensely added a new dimension to neuroanatomy education. In this regard, a 3-dimensional (3D) model and AR/VR application may facilitate the understanding of the microsurgical neuroanatomy of the brain and improve spatial recognition during neurosurgical procedures by generating a better comprehension of interrelated neuroanatomic structures.

OBJECTIVE:

To investigate the results of 3D volumetric modeling and AR/VR applications in showing the brain's complex organization during fiber dissection.

METHODS:

Fiber dissection was applied to the specimen, and the 3D model was created with a new photogrammetry method. After photogrammetry, the 3D model was edited using 3D editing programs and viewed in AR. The 3D model was also viewed in VR using a head-mounted display device.

RESULTS:

The 3D model was viewed in internet-based sites and AR/VR platforms with high resolution. The fibers could be panned, rotated, and moved freely on different planes and viewed from different angles on AR and VR platforms.

CONCLUSION:

This study demonstrated that fiber dissections can be transformed and viewed digitally on AR/VR platforms. These models can be considered a powerful teaching tool for improving the surgical spatial recognition of interrelated neuroanatomic structures. Neurosurgeons worldwide can easily avail of these models on digital platforms.
Development of a Novel Device for Decompressive Craniectomy: An Experimental and Cadaveric Study and Preliminary Clinical Application
Authors: Berra Luigi Valentino , Cedrone Guido , Di Norcia Valerio , D'Angelo Luca , Brunetto Floriana , Familiari Pietro , Palmieri Mauro , Capobianco Mattia , Pappone Federica , Santoro Antonio
Published: January 2023

BACKGROUND:

Decompressive craniectomy is an intervention of established efficacy in patients with intractable cerebral edema.

OBJECTIVE:

To evaluate a new device used in alternative to decompressive craniectomy. This device is designed to perform an augmentative craniotomy by keeping the bone flap elevated using specific cranial suspension titanium plates and giving the brain enough room to swell.

METHODS:

We tested the mechanical characteristics of the cranial brackets on dried skulls, on 3D-printed skull models, and on a preserved cadaver head. The resistance of the device was examined through dynamometric testing, and the feasibility of the surgical technique, including the suspension of the bone flap and the skin closure, was investigated on the cadaveric model. A preliminary clinical series of 2 patients is also reported.

RESULTS:

The laboratory tests have shown that this system allows an adequate expansion of the intracranial volume and it could withstand a force up to 637 ± 13 N in the synthetic model and up to 658 ± 9 N in the human skull without dislocation or failure of the brackets nor fractures of the bone ridges. Preliminary application in the clinical setting has shown that augmentative craniotomy is effective in the control of intracranial hypertension and could reduce the costs and complications associated with the classical decompressive craniectomy technique.

CONCLUSION:

Preliminary laboratory and clinical results show augmentative craniotomy to be a promising, alternative technique to decompressive craniectomy. Further clinical studies will be needed to validate its efficacy.
Comparison of Accessibility to Cavernous Sinus Areas Throughout Endonasal, Transorbital, and Transcranial Approaches: Anatomic Study With Quantitative Analysis
Authors: Santos Carlos , Guizzardi Giulia , Di Somma Alberto , Lopez Patricia , Mato David , Enseñat Joaquim , Prats-Galino Alberto
Published: January 2023

BACKGROUND:

The cavernous sinus (CS) is accessed through several approaches, both transcranially and endoscopically. The transorbital endoscopic approach is the newest proposed route in the literature.

OBJECTIVE:

The aim is to quantify and observe the areas of the CS reach from 2 endoscopic and 1 transcranial approaches to the CS in the cadaver laboratory.

METHOD:

Six CSs were dissected through endoscopic endonasal, transorbital endoscopic, and transcranial pterional approaches, with previous implanted references for neuronavigation during the dissection. Point registration was used to mark the CS exposure and limits through each approach for later area and volume quantification through a computerized technique.

RESULTS:

The endoscopic endonasal approach reaches most of the CS except part of the sinus's superior, lateral, and posterior regions. The area exposed through this approach was 210 mm2, and the volume was 1165 mm3. The transcranial pterional approach reached the superior and part of the lateral sides of the sinus, not allowing good access to the medial side. The area exposed through this approach was 306 m2, whereas the volume was 815 m3. Finally, the transorbital endoscopic approach accessed the whole lateral side of the sinus but not the medial one. The area exposed was the greatest, 374 m2, but its volume was the smallest, 754 m3.

CONCLUSION:

According to our results, the endonasal endoscopic approach is the direct route to access the medial, inferior, and part of the superior CS compartments. The transorbital approach is for the lateral side of the CS. Finally, the transcranial pterional approach is the one for the superior side of the CS.
Bilateral Persistent Primitive Olfactory Arteries Observed During Resection of Olfactory Groove Meningioma: Technical Case Report
Authors: Ferreira Júnior Tancredo Alcântara , Dourado Jules Carlos , Medeiros Giulia De Leo Rodrigues , da Paz Matheus Gomes da Silva , Lima Thiago Vinícius de Oliveira , Alcântara Mariana Torres , de Avellar Leonardo Miranda
Published: January 2023

BACKGROUND AND IMPORTANCE:

Resection of olfactory groove meningiomas is challenging because of their close proximity with the anterior cerebral circulation. It is important to recognize the vascular variants in procedures at the anterior skull base because inadvertent maneuvers may result in the rupture of these arteries and unexpected bleeding.

CLINICAL PRESENTATION:

We reported a type 2 persistent primitive olfactory artery with a dural branch of the elongated anterior cerebral artery directly to the ethmoid region, visualized during the surgical removal of an olfactory groove meningioma.

CONCLUSION:

This is the first report of bilateral persistent primitive olfactory artery demonstrated by operative visualization and confirmed with vascular study. Understanding and recognizing the possible variations of this vascular anatomy is of great importance for anterior skull base surgeries.
Ultra-High-Molecular-Weight Polyethylene Merlon Shape: Novel Fixation of Artificial Bone for Cranioplasty
Authors: Nagai Arata , Kimura Naoto , Uchida Hiroki , Yokosawa Michiko , Degawa Kazuki , Sugawara Takayuki , Tominaga Teiji
Published: January 2023

BACKGROUND:

Cranioplasty is a surgical procedure widely performed for repairing cranial defects caused by external decompression surgery for cerebrovascular disease or traumatic brain injury. We devised a new cranioplasty method using artificial bone made up of ultra-high molecular-weight polyethylene, with serrated wings on the edge. We named this newly designed artificial bone as Merlon shape.

OBJECTIVE:

To describe our initial experience with the Merlon shape and evaluate its usefulness and safety in cranioplasty.

METHODS:

The serrated wings of the Merlon shape were preoperatively designed for solid fixation and improving cosmetic results by reducing the thickness of the artificial bone. We evaluated 25 patients who underwent cranioplasty with the Merlon shape between December 2018 and December 2021. The causes of bone defects in these patients (male: 9, female: 16; median age: 62 years) were subarachnoid hemorrhage (n = 14), cerebral infarction (n = 8), and traumatic brain injury (n = 3).

RESULTS:

There were no postoperative adverse events such as infection, bone resorption, implant exposure, or graft sinking in 24 patients during an average follow-up period of 19 months. One patient experienced acute epidural hemorrhage and required reoperation.

CONCLUSION:

This is the first report on the use of the ultra-high molecular-weight polyethylene Merlon shape. Our initial 4-year case series showed good outcomes with this method.
Novel Approach of Femur Shortening With Insertion of Expandable Rod to Achieve End-to-End Repair of Sciatic Nerve Laceration
Authors: Lubelski Daniel , Halsey Jordan , Suk Ian , Tuffaha Sami , Osgood Greg , Belzberg Allan J.
Published: January 2023

BACKGROUND:

Sciatic nerve injuries are challenging for diagnosis and treatment. Particularly in proximally located high-grade injuries, neurorrhaphy often has poor outcomes. Most advocate autologous grafting and some more recently have suggested the value of knee flexion braces to facilitate end-to-end repair.

OBJECTIVE:

To describe a case of femur shortening to facilitate tension-free, end-to-end sciatic nerve neurorrhaphy.

METHODS:

The patient was a 17-year-old man who was injured by the propeller of a motor boat and suffered a series of lacerations to both lower extremities including transection of his right sciatic nerve in the proximal thigh. After extensive mobilization of the nerve, a greater than 7-cm gap was still present. The patient was treated with femur shortening to facilitate end-to-end coaptation. He subsequently had an expandable rod placed which was lengthened 1 mm per day until his leg length was symmetric.

RESULTS:

Within 7 months postoperatively, the patient had an advancing Tinel sign and paresthesias to the dorsum of his foot. Nine months postoperatively, he had early mobility in his plantarflexion.

CONCLUSION:

We present a novel method of femur shortening with insertion of an expandable rod to facilitate direct end-to-end and tension-free sciatic nerve neurorrhaphy in a proximally located injury. Furthermore, larger scale and comparative studies are warranted to further explore this and other techniques.
Accurate Deep Brain Stimulation Lead Placement Concurrent With Research Electrocorticography
Authors: Kons Zachary , Hadanny Amir , Bush Alan , Nanda Pranav , Herrington Todd M. , Richardson R. Mark
Published: January 2023

BACKGROUND:

Using electrocorticography for research (R-ECoG) during deep brain stimulation (DBS) surgery has advanced our understanding of human cortical-basal ganglia neurophysiology and mechanisms of therapeutic circuit modulation. The safety of R-ECoG has been established, but potential effects of temporary ECoG strip placement on targeting accuracy have not been reported.

OBJECTIVE:

To determine whether temporary subdural electrode strip placement during DBS implantation surgery affects lead implantation accuracy.

METHODS:

Twenty-four consecutive patients enrolled in a prospective database who underwent awake DBS surgery were identified. Ten of 24 subjects participated in R-ECoG. Lead locations were determined after fusing postoperative computed tomography scans into the surgical planning software. The effect of brain shift was quantified using Lead-DBS and analyzed in a mixed-effects model controlling for time interval to postoperative computed tomography. Targeting accuracy was reported as radial and Euclidean distance errors and compared with Mann–Whitney tests.

RESULTS:

Neither radial error nor Euclidean distance error differed significantly between R-ECoG participants and nonparticipants. Pneumocephalus volume did not differ between the 2 groups, but brain shift was slightly greater with R-ECoG. Pneumocephalus volume correlated with brain shift, but neither of these measures significantly correlated with Euclidean distance error. There were no complications in either group.

CONCLUSION:

In addition to an excellent general safety profile as has been reported previously, these results suggest that performing R-ECoG during DBS implantation surgery does not affect the accuracy of lead placement.
Joint mobility as a bridge between form and function
Authors: Manafzadeh Armita R.
Published: January 2023

Joints enable nearly all vertebrate animal motion, from feeding to locomotion. However, despite well over a century of arthrological research, we still understand very little about how the structure of joints relates to the kinematics they exhibit in life. This Commentary discusses the value of joint mobility as a lens through which to study articular form and function. By independently exploring form–mobility and mobility–function relationships and integrating the insights gained, we can develop a deep understanding of the strength and causality of articular form–function relationships. In turn, we will better illuminate the basics of ‘how joints work’ and be well positioned to tackle comparative investigations of the diverse repertoire of vertebrate animal motion.
Nutrition Interactions With Exercise Training on Endothelial Function
Authors: Lobene Andrea J. , Ragland Tristan J. , Lennon Shannon L. , Malin Steven K.
Published: January 2023

Exercise is advised to improve overall cardiovascular health and endothelial function. However, the role of nutrition on this exercise-induced endothelial adaptation is not clear. Here, we hypothesize that nutrients interact with exercise to influence endothelial function and chronic disease risk.
Clinical efficacy of chemotherapy regimen combined with Levofloxacin in patients with Pulmonary Tuberculosis complicated with Type-2 Diabetes
Authors: Luo Pei-pei , Wu Li , Liu Fang , Tian Yan-hong , Chen Lai-yin , Liu Ya-lin
Published: January 2023

Objective: To evaluate the clinical efficacy of a chemotherapy regimen combined with levofloxacin in patients with pulmonary tuberculosis complicated with Type-2 diabetes.

Methods: Total 80 patients with pulmonary tuberculosis complicated with Type-2 diabetes admitted to Baoding People’s Hospital from January, 2019 to January, 2022 were randomly divided into two groups: the experimental group and the control group, with 40 cases in each group. Patients in the control group were given the conventional 2HRZE/10HRE regimen, while those in the experimental group were given the chemotherapy regimen 2HRZEL/6HRE combined with levofloxacin. Sixty four slice spiral CT was used for chest plain scan before and after treatment, respectively, to evaluate the absorption of lesions based on the range of lung lesions; Venous blood was drawn to detect the changes of oxidative stress indicators, the incidence of adverse drug reactions and the negative conversion rate of sputum tuberculosis bacteria in the two groups.

Results: After treatment, the efficacy of the experimental group was 90%, which was significantly higher than that of the control group (67.5%), with a statistically significant difference (p=0.01). After treatment, CD3+, CD4+, CD4+/CD8+ and other indicators in the experimental group were significantly higher than those in the control group, with a statistically significant difference (CD3+, p=0.01; CD4+, p=0.01; CD4+/CD8+, p=0.00), while CD8+ did not change significantly (p=0.92); The incidence of adverse reactions was 52.5% in the experimental group and 47.5% in the control group, with no statistically significant difference (p=0.66); The negative conversion rate of patients in the experimental group was significantly higher than that in the control group at one month, three months and six months after treatment, with a statistically significant difference (p<0.05).

Conclusion: Chemotherapy combined with levofloxacin is a safe and effective regimen for patients’ pulmonary tuberculosis complicated with Type-2 diabetes, boasting a variety of benefits such as improved clinical efficacy, ameliorated cellular immune status, a high negative conversion rate of sputum tuberculosis bacteria, and no significant increase in adverse reactions.

doi: https://doi.org/10.12669/pjms.39.2.6364

How to cite this: Luo P, Wu L, Liu F, Tian Y, Chen L, Liu Y. Clinical efficacy of chemotherapy regimen combined with Levofloxacin in patients with Pulmonary Tuberculosis complicated with Type-2 Diabetes. Pak J Med Sci. 2023;39(2):---------.  doi: https://doi.org/10.12669/pjms.39.2.6364

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effect of nimodipine combined with atorvastatin calcium on microinflammation and oxidative stress levels in patients with cerebral vasospasm after subarachnoid hemorrhage
Authors: Gan Ning , Jia Tong-le , Tian Nan , Liu Si-si , Cao Shan
Published: January 2023

Objective: To evaluate the effect of nimodipine combined with atorvastatin calcium on the micro inflammation and oxidative stress levels in patients with cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) and its clinical implications.

Methods: A total of 80 patients with CVS caused by SAH who had been admitted to Baoding First Central Hospital from August 2021 to August 2022 were selected and randomly divided into two groups. The control group underwent conventional symptomatic treatment, while the experimental group was administered nimodipine combined with atorvastatin calcium on the basis of conventional treatment. The changes in the micro inflammatory cytokines and oxidative stress factors in the two groups were compared, as well as the differences in clinical efficacy and incidence of adverse drug reactions.

Results: After treatment, the levels of inflammatory cytokines in the experimental group decreased more significantly than those in the control group (p=0.00). After treatment, the serum levels of oxidative stress factors were obviously higher in the experimental group than in the control group (p=0.00). After treatment, the total efficacy was 77.5% in the experimental group and 55% in the control group, and the difference was statistically significant (p=0.04).

Conclusions: Nimodipine combined with atorvastatin calcium could significantly improve the clinical symptoms in patients with CVS after SAH, which would be beneficial, safe, and effective for the patient’s recovery.

doi: https://doi.org/10.12669/pjms.39.2.6721

How to cite this: Gan N, Jia T, Tian N, Liu S, Cao S. Effect of nimodipine combined with atorvastatin calcium on microinflammation and oxidative stress levels in patients with cerebral vasospasm after subarachnoid hemorrhage. Pak J Med Sci. 2023;39(2):---------.  doi: https://doi.org/10.12669/pjms.39.2.6721

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.