bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Stress Hyperglycemia Is Associated With Malignant Cerebral Edema, Hemorrhage, and Poor Functional Outcome After Mechanical Thrombectomy
Authors: Cannarsa Gregory J. , Wessell Aaron P. , Chryssikos Timothy , Stokum Jesse A. , Kim Kevin , De Paula Carvalho Helio , Miller Timothy R. , Morris Nicholas , Badjatia Neeraj , Chaturvedi Seemant , Gandhi Dheeraj , Simard J. Marc , Jindal Gaurav 
Published: December 2021

BACKGROUND:
Malignant cerebral edema (MCE) and intracranial hemorrhage (ICH) are associated with poor neurological outcomes despite revascularization after mechanical thrombectomy (MT). The factors associated with the development of MCE and ICH after MT are not well understood.

OBJECTIVE:
To determine periprocedural factors associated with MCE, ICH, and poor functional outcome.

METHODS:
We retrospectively analyzed anterior cerebral circulation large vessel occlusion cases that underwent MT from 2012 to 2019 at a single Comprehensive Stroke Center. Multivariate logistic regression analyses were performed to determine significant predictors of MCE, ICH, and poor functional outcome (modified Rankin Scale, 3-6) at 90 d.

RESULTS:
Four hundred patients were included. Significant independent predictors of MCE after MT included initial stress glucose ratio (iSGR) (odds ratio [OR], 14.26; 95% CI, 3.82-53.26; P < .001), National Institutes of Health Stroke Scale (NIHSS) (OR, 1.10; 95% CI, 1.03-1.18; P = .008), internal carotid artery compared with M1 or M2 occlusion, and absence of successful revascularization (OR, 0.16; 95% CI, 0.06-0.44; P < .001). Significant independent predictors of poor functional outcome included MCE (OR, 7.47; 95% CI, 2.20-25.37; P = .001), iSGR (OR, 5.15; 95% CI, 1.82-14.53; P = .002), ICH (OR, 4.77; 95% CI, 1.20-18.69; P = .024), NIHSS (OR, 1.10; 95% CI, 1.05-1.16; P < .001), age (OR, 1.04; 95% CI, 1.03-1.07; P < .001), and thrombolysis in cerebral infarction 2C/3 recanalization (OR, 0.12; 95% CI, 0.05-0.29; P < .001).

CONCLUSION:
Elevated iSGR significantly increases the risk of MCE and ICH and is an independent predictor of poor functional outcome. Thrombolysis in cerebral infarction 2C/3 revascularization is associated with reduced risk of MCE, ICH, and poor functional outcome. Whether stress hyperglycemia represents a modifiable risk factor is uncertain, and further investigation is warranted.
Effects of Preoperative Embolization on Spetzler–Martin Grade I and II Arteriovenous Malformations: A Propensity-Adjusted Analysis
Authors: Catapano Joshua S. , Srinivasan Visish M. , Rumalla Kavelin , Koester Stefan W. , Kimata Anna R. , Ma Kevin L. , Labib Mohamed A. , Baranoski Jacob F. , Cole Tyler S. , Rutledge Caleb , Ducruet Andrew F. , Albuquerque Felipe C. , Spetzler Robert F. , Lawton Michael T. 
Published: December 2021

BACKGROUND:
Cerebral arteriovenous malformations (AVMs) with low Spetzler–Martin grades (I and II) are associated with good neurological outcomes after microsurgical resection; however, the use of preoperative embolization for these lesions is controversial.

OBJECTIVE:
To compare the neurological outcomes of preoperative embolization with no embolization in patients with low-grade AVMs.

METHODS:
Patients with a Spetzler–Martin grade I or II AVM who underwent microsurgical resection during January 1, 1997, through December 31, 2019, were analyzed. Patients undergoing preoperative embolization were compared with patients not undergoing embolization. A propensity score was constructed from baseline characteristics and used to match intervention (embolization) and control (nonembolization) groups in a 1:1 ratio. The primary outcome was poor neurological status on last follow-up examination, defined as a modified Rankin Scale score >2 and a modified Rankin Scale score worse at follow-up than at the preoperative examination.

RESULTS:
Of the 603 patients analyzed, 310 (51.4%) underwent preoperative embolization and 293 (48.6%) did not. Patients in the embolization cohort compared with those in the nonembolization cohort had a higher percentage of Spetzler–Martin grade II AVMs (71.6% vs 52.6%, P < .001) and a lower percentage of hemorrhage (41% vs 55%, P = .001). After propensity score matching, no differences were found between paired cohorts (each N = 203) for baseline characteristics with a significant reduction in absolute standardized mean differences. No significant differences were found in primary outcomes between treatment groups in the matched or unmatched cohorts.

CONCLUSION:
Preoperative embolization of low-grade Spetzler–Martin AVMs is not associated with improved neurological outcomes after microsurgical resection.
Treatment Outcomes in American Football Players After Intervertebral Disk Herniation: Systematic Review and Meta-Analysis
Authors: Abola Matthew V. , Lin Charles C. , Colasanti Christopher A. , Schreiber-Stainthorp William , Passias Peter G. 
Published: December 2021

BACKGROUND:
American football players are at increased risk for many forms of spinal injury. Intervertebral disk herniations are particularly concerning as they are the leading cause of days lost to injury and can have long-term effects on player careers. Disk herniation management plays a major role in the likelihood and success of return-to-play (RTP).

OBJECTIVE:
To assess the incidence, demographic variables, treatment approaches, outcomes, and RTP rates of disk herniations in American football players.

METHODS:
A systematic review of the literature investigating disk herniations in American football players using PubMed, Cochrane Library, and Embase was performed. RTP estimates were calculated by pooling study-specific data using a random-effects model.

RESULTS:
Four hundred twenty-two studies were identified, with 18 meeting inclusion criteria. Offensive and defensive linemen were the 2 most commonly injured positions. Players undergoing operations were on average younger, with higher body mass indexes, fewer seasons played, and longer post-treatment careers than nonsurgical counterparts. Postsurgical recovery periods lasted an average 106 d, with a mean RTP duration of 33 games over 2.7 yr and an 8.45% reoperation rate. Operative treatment offered a nonsignificant increase in the likelihood of return-to-play compared with nonoperative treatment (odds ratio = 2.81, 95% CI 0.83-9.51).

CONCLUSION:
Disk herniations are a common injury, with surgery potentially improving post-treatment outcomes. The literature suffers from heterogeneous definitions of RTP and varying performance metrics, making it difficult to draw clear conclusions. To better understand the impact of disk herniation and treatment on player health and performance, more studies should be performed prospectively and with standardized metrics.
Racial and Socioeconomic Disparities in Patients With Meningioma: A Retrospective Cohort Study
Authors: Jackson Hudin N. , Hadley Caroline C. , Khan A. Basit , Gadot Ron , Bayley James C. , Shetty Arya , Mandel Jacob , Jalali Ali , Gallagher K. Kelly , Sweeney Alex D. , Harmanci Arif O. , Harmanci Akdes S. , Klisch Tiemo , Gopinath Shankar P. , Rao Ganesh , Yoshor Daniel , Patel Akash J. 
Published: December 2021

BACKGROUND:
Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.

OBJECTIVE:
To determine factors that contribute to different clinical outcomes in racial populations.

METHODS:
We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences.

RESULTS:
Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival.

CONCLUSION:
Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.
Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?
Authors: Figueroa Christopher , Hadanny Amir , Kroll Kyle , DiMarzio Marisa , Ahktar Kainat , Gillogly Michael , Mitchell Dorothy , Cangero Theodore , Pilitsis Julie G. 
Published: December 2021

BACKGROUND:
Chronic pain (CP) affects roughly 100 million adults in the United States. These subjects present disproportionately to the emergency department (ED). Neuromodulation (NM) has been shown to reduce ED visits longitudinally in subjects.

OBJECTIVE:
To compare ED utilization rates between subjects with CP with and without NM.

METHODS:
Subjects with failed back surgery syndrome, complex regional pain syndrome, or neuropathic pain diagnosis who visited the hospital between January 1, 2019, and December 31, 2019, were included. Subjects were divided into a NM-treated cohort and a non-NM cohort. Demographic information, medications, and pain provider visits were obtained. Pain-related ED visits between 2017 and 2019 were compared.

RESULTS:
A total of 2516 subjects were identified; 291 (11.6%) previously underwent NM. The non-NM cohort had significantly higher rate of pain-related ED visits compared with the NM cohort (15.1% vs 10.0%, P = .018). Younger age (odds ratio [OR] = 0.888 [0.843-0.935]), shorter distance to the hospital (OR = 0.807 [0.767-0.849]), lower household income (OR = 0.865 [0.831-0.901]), opioid use (OR = 1.375 [1.291-1.465]), nonopioid use (OR = 1.079 [1.033-1.128]), and non-NM therapy (OR = 1.751 [1.283-2.390]) were significant predictors of ED visits. Opioid use was the only significant predictor (OR = 6.124 [1.417-26.473]) associated with ED visits in the NM cohort.

CONCLUSION:
Subjects who underwent NM had fewer visits to the ED when compared with similar subjects who received conventional treatment. Opioid use prompted increased ED utilization in both cohorts. We posit that NM leads to improvement in pain outcomes, integration with multidisciplinary pain specialists, and reduction in severity and frequency of acute pain exacerbations, thereby limiting health care resource utilization.
Multicentric Chordoma With Initial Resection by Bilateral Transcondylar Approach: 2-Dimensional Operative Video
Authors: Ibn Essayed Walid , Rassi Marcio , Chi John H. , Al-Mefty Ossama 
Published: December 2021

Chordoma is a rare skull base tumor with malignant behavior.
1–3
It invades locally with high recurrences, metastasizes distally, and seeds after interventions.
1–4
Chordoma exemplifies the malignant progression doctrine as it accumulated genetic mutations. The natural history of untreated disease is 2.4 yr on average survival.
5
Best tumor control is achieved by radical resection, followed by high doses radiation. Multicentric chordoma is an ill-defined challenging entity extremely rare in the literature. However, chordoma is known for distal metastasis, particularly to the lungs, iatrogenic cerebrospinal fluid (CSF) dissemination with drop metastasis, or surgical implantation. A subset of patients present with synchronous or metachronous regional or distal neuraxial lesions associated with the initial chordoma. Patients presenting with multicentric bony axial lesions and no extra-axial metastases point toward the multicentric chordoma concept rather than local, hematogenous, or CSF spread.
6–12
Biopsy of these multicentric lesions can show a spectrum of abnormalities ranging from benign notochordal tumor to chordomas confirming the multicentric hypothesis.
9
We present a patient who underwent a bilateral transcondylar approach for giant craniovertebral junction chordoma and then treated with radiation and a second lesion at the C6 transverse foramen. Six years later, she presented with a chordoma at the petrous apex. The patient consented to surgery and to the publications of her image. The participants and any identifiable individuals consented to publication of his/her image.
Image at 1:39 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, © LWW, 1998.
Trans-Sulcal Parafascicular Port-Based Resection of a Subcortical Occipital High-Grade Glioma: 2-Dimensional Operative Video
Authors: Revuelta Barbero Juan M. , Rindler Rima S. , Lamanna Jason , Soriano Roberto M. , Pradilla Gustavo 
Published: December 2021

Minimally invasive trans-sulcal parafascicular port-based approaches can provide safe access to a wide variety of deep brain lesions.
1,2
This surgical video illustrates the use of a minimally invasive port-based approach for resection of a subcortical right medial occipital lobe lesion in a 63-year-old woman who presented with seizures and bilateral left homonymous hemianopia.
MRI showed a 2.5-cm contrast enhancing lesion with a necrotic center and significant T2 and fluid-attenuated inversion recovery signal consistent with vasogenic edema. Diffusion tensor imaging revealed compromise of the right optic radiations and edema extending through the right corticospinal tract. A minimally invasive trans-sulcal parafascicular port-based approach to the deep occipital lobe and periatrial region was performed under full exoscopic visualization. A gross total tumor resection was achieved, and histopathology revealed an IDH1-mutant, MGMT-methylated–positive glioblastoma. The patient's presentation, rationale, key surgical steps, and outcomes are discussed, and informed consent for surgery was obtained. The participants and any identifiable individuals consented to the publication of their image. Images at 3:50 used with permission from Nico Corporation. All rights reserved.
Sugita–Kobayashi Maneuver for Preservation of Large Bridging Veins in the Interhemispheric Approach: 2-Dimensional Operative Video
Authors: Mooney Michael A. , Al-Mefty Ossama 
Published: December 2021

Giants of neurosurgery have made contributions that might at times seem to be minor maneuvers but have a major impact on safe surgery, such as Sugita and Kobayashi's description of the preservation of the bridging sagittal veins.
1

The interhemispheric approach is haunted by risk to the bridging veins and resultant venous infarction. At the midsegment, this could produce devastating neurological deficits.
2
This is an especially critical factor in falcine meningiomas in which the location of the tumor narrows the options for the surgical corridor, particularly if an additional falcine margin, “Grade Zero” resection, is to be performed.
3

Detailed preoperative neuroimaging workup is required to plan the appropriate surgical strategy and minimize risk for venous complications. This may include magnetic resonance or computed tomography venogram, dynamic computed tomography angiography,
4
or in some cases formal angiography to assess the relationship with the superior sagittal sinus, the anatomy of parasagittal bridging veins in relation to the lesion, and the patterns of collateral venous drainage.
While bridging veins may be displaced, compressed, or obscured by tumor involvement,
5
microsurgical technique can facilitate the safe identification and preservation of this crucial anatomy. Bridging veins are separated from the underlying cortex to a distance from the sinus, allowing for improved relaxation of the ipsilateral cortex, without venous compromise.
1,6

Herein, we demonstrate a case of a large falcine meningioma with a “Grade Zero” resection, with mobilization of the parasagittal bridging veins to develop the interhemispheric surgical corridor.
The patient consented for surgery.
More than two populations of microtubules comprise the dynamic mitotic spindle
Authors: Tipton Aaron R. , Gorbsky Gary J. 
Published: December 2021

ABSTRACT
The microtubules of the mitotic spindle mediate chromosome alignment to the metaphase plate, then sister chromatid segregation to the spindle poles in anaphase. Previous analyses of spindle microtubule kinetics utilizing fluorescence dissipation after photoactivation described two main populations, a slow and a fast turnover population, and these were ascribed as reflecting kinetochore versus non-kinetochore microtubules, respectively. Here, we test this categorization by disrupting kinetochores through depletion of the Ndc80 complex in U2OS cells. In the absence of functional kinetochores, microtubule dynamics still exhibit slow and fast turnover populations, although the proportion of each population and the timings of turnover are altered. Importantly, the data obtained following Hec1 (also known as Ndc80) depletion suggests that other subpopulations, in addition to kinetochore microtubules, contribute to the slow turnover population. Further manipulation of spindle microtubules revealed a complex landscape. For example, although Aurora B kinase functions to destabilize kinetochore bound microtubules it might also stabilize certain slow turnover non-kinetochore microtubules. Dissection of the dynamics of microtubule populations provides a greater understanding of mitotic spindle kinetics and insight into their roles in facilitating chromosome attachment, movement and segregation during mitosis.
Chiffon triggers global histone H3 acetylation and expression of developmental genes in Drosophila embryos
Authors: Torres-Zelada Eliana F. , George Smitha , Blum Hannah R. , Weake Vikki M. 
Published: December 2021

ABSTRACT
The histone acetyltransferase Gcn5 is critical for gene expression and development. In Drosophila, Gcn5 is part of four complexes (SAGA, ATAC, CHAT and ADA) that are essential for fly viability and have key roles in regulating gene expression. Here, we show that although the SAGA, ADA and CHAT complexes play redundant roles in embryonic gene expression, the insect-specific CHAT complex uniquely regulates expression of a subset of developmental genes. We also identify a substantial decrease in histone acetylation in chiffon mutant embryos that exceeds that observed in Ada2b, suggesting broader roles for Chiffon in regulating histone acetylation outside of the Gcn5 complexes. The chiffon gene encodes two independent polypeptides that nucleate formation of either the CHAT or Dbf4-dependent kinase (DDK) complexes. DDK includes the cell cycle kinase Cdc7, which is necessary for maternally driven DNA replication in the embryo. We identify a temporal switch between the expression of these chiffon gene products during a short window during the early nuclear cycles in embryos that correlates with the onset of zygotic genome activation, suggesting a potential role for CHAT in this process.
This article has an associated First Person interview with the first author of the paper.
Case Report: Transorbital approach for the management of an orbito-temporal penetrating brain injury (skull base region) secondary to wooden spikes
Authors: Apriawan Tedy , Hafid Bajamal Abdul , Darlan Ditto , Ramadhan Yusriandi 
Published: December 2021

Background and importance: Transorbital penetrating brain injury (PBI) due to a non-projectile foreign body is rare. It can lead to life-threatening severe neurovascular damage. Surgery is the primary treatment choice; however, there are a number of approaches that can be considered based on the patient's condition in terms of foreign body location and state of the patient. Clinical presentation: An 18-year-old male carpenter was hit by a log and sustained transorbital PBI while cutting wood with a machine. Computed tomography (CT) scan showed a wooden spike that was approximately 11 cm from the left medial orbital to the superior part of the posterolateral of the petrous bone, crossing the right side at the base of the skull. CT angiography (CTA), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) revealed no internal carotid artery (ICA) and cavernous sinus lesions, respectively. We had a 3D-printed model for preoperative planning, and surgery was performed using a transorbital approach to extract the wood 14 days after the accident. The impacted wood was removed without any complications. Conclusion: There are many surgical approaches for transorbital PBI. We decided to perform the transorbital approach because it is perpendicular to the entry zone. Surgeons should consistently perform minimally invasive procedures based on the clinical and radiological findings.
Closed incision negative pressure wound therapy versus conventional dressings following soft-tissue sarcoma excision: a prospective, randomized controlled trial
Authors: Shields David W. , Razii Nima , Doonan James , Mahendra Ashish , Gupta Sanjay 
Published: December 2021

AimsThe primary objective of this study was to compare the postoperative infection rate between negative pressure wound therapy (NPWT) and conventional dressings for closed incisions following soft-tissue sarcoma (STS) surgery. Secondary objectives were to compare rates of adverse wound events and functional scores.MethodsIn this prospective, single-centre, randomized controlled trial (RCT), patients were randomized to either NPWT or conventional sterile occlusive dressings. A total of 17 patients, with a mean age of 54 years (21 to 81), were successfully recruited and none were lost to follow-up. Wound reviews were undertaken to identify any surgical site infection (SSI) or adverse wound events within 30 days. The Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) score were recorded as patient-reported outcome measures (PROMs).ResultsThere were two out of seven patients in the control group (28.6%), and two out of ten patients in the intervention group (20%) who were diagnosed with a SSI (p > 0.999), while one additional adverse wound event was identified in the control group (p = 0.593). No significant differences in PROMs were identified between the groups at either 30 days (TESS, p = 0.987; MSTS, p = 0.951) or six-month (TESS, p = 0.400) follow-up. However, neoadjuvant radiotherapy was significantly associated with a SSI within 30 days of surgery, across all patients (p = 0.029). The mean preoperative modified Glasgow Prognostic Score (mGPS) was also significantly higher among patients who developed a postoperative adverse wound event (p = 0.028), including a SSI (p = 0.008), across both groups.ConclusionThis is the first RCT comparing NPWT with conventional dressings following musculoskeletal tumour surgery. Postoperative wound complications are common in this group of patients and we observed an overall SSI rate of 23.5%. We propose proceeding to a multicentre trial, which will help more clearly define the role of closed incision NPWT in STS surgery. Cite this article: Bone Jt Open 2021;2(12):1049–1056.