bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP3-11 Sir geoffrey jefferson, a father of the SBNS, a remarkable life
Authors: Hope T 
Published: February 2019

ObjectivesThe foundation of a Society of Neurological Surgeons was Jefferson`s idea. How did this come about? The objective is to research this period of our history and its development.DesignA review of papers and articles held in the University of Manchester, The University of Oxford and abstracts from a biography of Jefferson by Peter Schurr, enables an historic presentation to the SBNS and the ABN.SubjectsIn 1926 Sir Geoffrey Jefferson was closely connected to the leading minds in British neurology and neurological surgery. His friendship and correspondence with Cushing was a major force in his drive for a specialist society. These players on the neurosurgical stage are the subjects of this presentation.MethodsAs in the design, the author will survey all available material including photography and handwritten manuscripts.ResultsOn the very next day after being appointed a consultant neurological surgeon at the Manchester Royal Infirmary, Jefferson arranged a meeting at the Athenaeum Club to consider the formation of our society. This was held on December the 2nd 1926 and the first formal scientific meeting was held on the 3rd at Queen Square!ConclusionsThe formation of this small society was crucial in presenting British neurosurgery as a specialty in its own right to medicine in the United Kingdom. No other neurosurgical society existed in Europe at this stage. Jefferson is indeed the father figure of our society today.
WP1-4 Bilateral laminotomy through a unilateral approach (minimally invasive) vs open laminectomy for lumbar spinal stenosis
Authors: Horan J , Husein MB , Bolger C 
Published: February 2019

ObjectivesThe purpose of our prospective randomised study is to compare safety and functional outcomes in traditional laminectomy versus minimally invasive (MI) bilateral laminectomy via unilateral approach for lumbar spinal stenosis (LSS).DesignThis is a prospective randomised trial comparing two procedures for LSS.Subjects62 patients were treated for LSS and randomised to one of two groups over a 6 month period.MethodsGroup A comprised 37 patients that underwent MI intersegmental unilateral decompression. Group B comprised 25 patients that underwent traditional laminectomy. Follow-up duration was 3 years. The primary outcomes were walking distance, the visual analogue scale (VAS) pain outcome score and the Oswestry Disability Index (ODI).ResultsVAS pain outcome was reduced from 9 to 2 and 8 to 5 in MI and open, ODI improved from 56.5 to 13 and 58 to 24 in MI and open respectively. Complication rates were lower in MI compared to open (8% vs 56%) and consisted of CSF leak, temporary leg pain, TIA, urinary retention and wound infections. Length of stay was 1–3 days compared to 7–30 days in MI against open respectively.ConclusionsBilateral laminectomy through a unilateral approach (MI) and traditional laminectomy are both effective in improving pain, ODI and walking distance in LSS. MI procedures have an advantage in shorter hospital stays, sparing of more bony structures and lower complication rates. We conclude that MI unilateral decompression is at least as good as laminectomy in the treatment of pain and disability in LSS.
FP2-6 Modelling neonatal intraventricular haemorrhage using organotypic samples from the wall of the lateral ventricle
Authors: Dawes WJ , Obernier K , Tisdall M 
Published: February 2019

ObjectivesIntraventricular Haemorrhage (IVH) impacts on ependyma and neural stem cells (NSC) within the subventricular zone.1Developing therapeutic interventions to curtail this impact is a key research goal. Organotypic models from the wall of the lateral ventricle (LV) of mice2and humans have the potential to offer unique insight into the dynamic impact of IVH.DesignBasic science research using whole mount preparations (WMP) from the wall of the LV from mice and humans (SOLVe trial: IRAS ID 247936).SubjectsTransgenic mouse line: Fucci:hGFAPCreER:TomatoTD. Human samples from children undergoing surgery for medically intractable epilepsy.MethodsUsing a published protocol2WMP of the LV were prepared. Two samples of human CSF were acquired: a ‘haemorrhagic’ sample from a neonate with IVH and a ‘clean’ sample from a newborn undergoing repair of myelomeningocele. 72 hours time-lapse confocal microscopy was undertaken from multiple wells.ResultsColocalisation of GFP (Fucci+ve) in hGFAP +ve (RFP +ve) cells revealed dividing NSC within the wall of the LV. Quantification of fucci +ve cells revealed ‘haemorrhagic’ CSF caused a significant reduction in proliferation whilst ‘clean’ CSF caused a significant increase in early proliferation.ConclusionsOrganotypic slice preparation from mice and human lateral ventricle represents a novel approach to investigating the impact of IVH on the wall of the lateral ventricle.ReferencesBack SA, Miller SP. Brain injury in premature neonates: A primary cerebral dysmaturation disorder? Ann Neurol 2014 April;75(4):469–86.Obernier K, Cebrian-Silla A, Thomson M, Parraguez JI, Anderson R, Guinto C, Rodas Rodriguez J, Garcia-Verdugo JM, Alvarez-Buylla A. Adult neurogenesis is sustained by symmetric self-renewal and differentiation. Cell Stem Cell2018February 1;22(2):221–234.
P2 A clinical pathway for the investigation and follow-up of incidental pineal cysts
Authors: Raza-Knight SR , Mathur S , Lekka E 
Published: February 2019

ObjectivesPineal cysts (PCs) may be incidentally found on intracranial imaging. They are typically quiescent, benign and asymptomatic. However, imaging alone cannot exclude an underlying pineal malignancy. This study reviewed our hospital’s experience of managing PCs in order to develop a clinical pathway to guide their investigation and follow-up.DesignSingle-centre retrospective review of cases.SubjectsPatients referred to our hospital with a PC.MethodsCase notes and imaging from patients referred to our hospital with a clinically-coded ‘pineal cyst’ between 2007 and 2017 were reviewed.Results43 cases were included. The most common indication for intracranial imaging was headache (12/43), followed by seizures (4/43). No symptoms were attributable to the PC. Follow-up imaging to monitor the PC was performed in 13/43 cases; in a further 10/43 cases, it was carried out for an indication unrelated to the PC. Follow-up was arranged by the neurosurgical team in 12 cases. Uncertainty about the diagnosis led to an endoscopic biopsy in one case, which confirmed a PC. There was no consistent clinical rationale underlying the decision to undertake follow-up imaging, nor its interval or duration.ConclusionsClinical practice varied widely for the management of incidental PCs. We propose that all PCs should be investigated with standardised MRI, reported by a neuroradiologist and repeated at 6–12 months. Further follow-up and its duration should be guided by the patient’s clinical condition and the radiological features of the PC.
WP1-6 The syndrome of the trephined
Authors: Shah AM , Hayes L , Weston P , Lowe A , Liu C , Watkins L , Greenwood R 
Published: February 2019

ObjectivesSyndrome of the Trephined (SoT) or sinking skin flap syndrome is characterised by neurological deterioration occurring after a delay post-craniectomy, with or without a significant postural component, that may improve with cranioplasty. The symptoms and signs seen are heterogeneous and can be readily missed. With increasing numbers of patients surviving after decompressive craniectomies, and often a long delay before cranioplasty, we think it important that awareness of this potentially lethal but reversible condition is raised.DesignCase Series.SubjectsCases with suspected SoT were identified retrospectively from all admissions to a Level 1 Neurorehabilitation Unit over 2 years.MethodsCases were identified by their treating clinicians. Their clinical features are described, and outcomes after cranioplasty are discussed.ResultsFrom 36 patients admitted after craniectomy over 2 years, 4 patients with suspected SoT were identified, with a latency of 4–12 months post-injury. Late neurological deterioriation included reduced alertness and mobility, cognitive decline and headache. Two patients had a clear postural component to their symptoms. Coexisting hydrocephalus was sometimes seen, and complicated neurosurgical management. All cases improved after cranioplasty.ConclusionsSoT is an under-reported and under-recognised complication of craniectomy. It is a potentially reversible cause of significant late deterioration following craniectomy. Further research into the optimal timing for cranioplasty is needed.
P11 Which factors influence the decision to transfer patients with traumatic brain injury to a neurosurgery unit in a major trauma network?
Authors: Rajwani KM , Lavrador JP , Ansaripour A , Maratos E , Tolias C 
Published: February 2019

ObjectivesTo identify factors that influence the decision to transfer patients with traumatic brain injury (TBI) to a neurosurgical centre.DesignRetrospective data collected as part of TrIBAL study.SubjectsAll patients with TBI referred to our neurosurgery unit from regional acute hospitals over a 4 month period.MethodsOur primary outcome was transfer to a neurosurgical centre. We identified the following factors that may predict decision to transfer: patient demographics, transfer distance, anticoagulation therapy and severity of TBI (initial GCS and Marshall score). A multivariable logistic regression analysis was performed.ResultsA total of 347 patients were referred from regional hospitals with TBI and of these, 53 (15%) were transferred. The mean age of patients referred was 69.6 years, 62.5% were men and 43% on antiplatelets or anticoagulated. Similar number of patients were referred from hospitals within 30 miles (54%) and those more than 30miles away (46%). Eighty-four percent of patients had mild TBI (GCS 13–15) on initial assessment and 67% had a Marshall CT score of 2. After regression analysis, younger age, male gender and higher Marshall score predicted transfer to our neurosurgical centre (p<0.05).ConclusionsMany patients with TBI have relatively ‘minor’ injuries and remain at their local hospital. In our cohort higher Marshall score, younger age and male gender predicted transfer to a neurosurgicial centre. Transfer distance, anticoagulation therapy and initial GCS did not influence decision to transfer.
Flap Related Complications Requiring Secondary Surgery in a Series of 851 Local Flaps Used for Fingertip Reconstruction
Authors: Karjalainen T. , Sebastin S.J. , Chee K.G. , Peng Y.P. , Chong A.K.S. 
Published: February 2019

Background: Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues. Methods: 851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis. Results: 31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis. Conclusions: Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.
Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures
Authors: Katayama Takeshi , Ono Hiroshi , Omokawa Shohei 
Published: February 2019

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures.Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis.Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle.Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.
Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans
Authors: Goto Kenji , Naito Kiyohito , Sugiyama Yoichi , Nagura Nana , Kaneko Ayaka , Iwase Yoshiyuki , Kaneko Kazuo 
Published: February 2019

Background: The aim of this study was to assess the height of nonunion formation injuring the ulnar-side finger flexor tendon, the positional relationship between the hook of the hamate and little finger flexor tendon was evaluated on CT scans.Methods: The subjects were 20 healthy patients (40 hands) (14 males and 6 females, mean age: 28 years old). Their hands were imaged in extension and flexion of the fingers on CT. The position of the little finger flexor tendon was determined regarding the height of the hook of the hamate as 100%.Results: The heights of the flexor digitorum profundus tendons were 46 ± 6% in extension and 44 ± 9% in flexion, and those of the flexor digitorum superficialis tendons were 87 ± 8% in extension and 91 ± 9% in flexion.Conclusions: Our study suggested that 40% of the base of the hook of the hamate does not contact with the flexor tendon, suggesting that flexor tendon injury is unlikely to occur in that region.
Design and Multi-Abstraction-Level Evaluation of a NoC Router for Mixed-Criticality Real-Time Systems
Authors: Dridi Mourad , Rubini Stéphane , Lallali Mounir , Flórez Martha Johanna Sepúlveda , Singhoff Frank , Diguet Jean-Philippe 
Published: February 2019

A Mixed Criticality System (MCS) combines real-time software tasks with different criticality levels. In a MCS, the criticality level specifies the level of assurance against system failure. For high-critical flows of messages, it is imperative to meet deadlines; otherwise, the whole system might fail, leading to catastrophic results, like loss of life or serious damage to the environment. In contrast, low-critical flows may tolerate some delays.
Furthermore, in MCS, flow performances such as the Worst Case Communication Time (WCCT) may vary depending on the criticality level of the applications. Then execution platforms must provide different operating modes for applications with different levels of criticality. To conclude, in Network-On-Chip (NoC), sharing resources between communication flows can lead to unpredictable latencies and subsequently turns the implementation of MCS in many-core architectures challenging.

In this article, we propose and evaluate a new NoC router to support MCS based on an accurate WCCT analysis for high-critical flows. The proposed router, called Double Arbiter and Switching router (DAS), jointly uses
Wormhole
and
Store And Forward
communication techniques for low- and high-critical flows, respectively. It ensures that high-critical flows meet their deadlines while maximizing the bandwidth remaining for the low-critical flows. We also propose a new method for high-critical communication time analysis, applied to
Store And Forward
switching mode with virtual channels. For low-critical flows communication time analysis, we adapt an existing wormhole communication time analysis with share policy to our context.

The second contribution of this article is a multi-abstraction-level evaluation of DAS. We evaluate the communication time of flows, the system mode change, the cost, and four properties of DAS. Simulations with a cycle-accurate SystemC NoC simulator show that, with a 15% network use rate, the communication delay of high-critical flows is reduced by 80% while communication delay of low-critical flow is increased by 18% compared to solutions based on routers with multiple virtual channels. For 10% of network interferences, using system mode change, DAS reduces the high-critical communication delays about 66%. We synthesize our router with a 28nm SOI technology and show that the size overhead is limited of 2.5% compared to the solution based on virtual channel router. Finally, we applied model checking verification techniques to automatically prove several DAS properties required by critical systems designers.
Reinforcement Learning for UAV Attitude Control
Authors: Koch William , Mancuso Renato , West Richard , Bestavros Azer 
Published: February 2019

Autopilot systems are typically composed of an “inner loop” providing stability and control, whereas an “outer loop” is responsible for mission-level objectives, such as way-point navigation. Autopilot systems for unmanned aerial vehicles are predominately implemented using Proportional-Integral-Derivative (PID) control systems, which have demonstrated exceptional performance in stable environments. However, more sophisticated control is required to operate in unpredictable and harsh environments. Intelligent flight control systems is an active area of research addressing limitations of PID control most recently through the use of reinforcement learning (RL), which has had success in other applications, such as robotics. Yet previous work has focused primarily on using RL at the mission-level controller. In this work, we investigate the performance and accuracy of the inner control loop providing attitude control when using intelligent flight control systems trained with state-of-the-art RL algorithms—Deep Deterministic Policy Gradient, Trust Region Policy Optimization, and Proximal Policy Optimization. To investigate these unknowns, we first developed an open source high-fidelity simulation environment to train a flight controller attitude control of a quadrotor through RL. We then used our environment to compare their performance to that of a PID controller to identify if using RL is appropriate in high-precision, time-critical flight control.
Increased central cholinergic drive contributes to the apneas of serotonin-deficient rat pups during active sleep
Authors: Davis Marina R. , Magnusson Jennifer L. , Cummings Kevin J. 
Published: February 2019

Infant rat pups lacking central nervous system (CNS) serotonin (5-hydroxytryptamine; 5-HT) have unstable breathing during prolonged periods of active sleep. Given that cholinergic neurons are drivers of active sleep and project to respiratory patterning regions in the brainstem, we hypothesized that 5-HT preserves respiratory stability in active sleep by dampening central cholinergic drive. We used whole-body plethysmography coupled with nuchal electromyography to monitor the breathing pattern of 2-wk-old tryptophan hydroxylase 2 ( TPH2)+/+ and TPH2-deficient ( TPH2−/−) pups in active sleep, before and after muscarinic blockade. For the group 1 experiment we injected methylatropine (Ap-M), a CNS-impermeant form of atropine, followed ~30 min later by an injection of atropine sulfate (Ap-S), the CNS-permeant form (both 1 mg/kg, 10 μl bolus iv); both injections occurred within an active sleep episode. We analyzed the effect of each drug on the coefficient of variation of the respiratory period (CV-P) during active sleep. For the group 2 experiment rats were cycled through several episodes of active and quiet sleep before administration of Ap-S (1 mg/kg, 200 μl ip) or vehicle. We assessed the effect of Ap-S on the apnea indices of both genotypes during quiet and active sleep. In group 1 Ap-S significantly reduced the CV-P of TPH2−/− pups ( P = 0.03), an effect not observed in TPH2+/+ pups or following Ap-M. In group 2 the apnea index of TPH2−/− pups was significantly reduced following Ap-S injection ( P = 0.04), whereas the apnea index of TPH2+/+ littermates was unaffected ( P = 0.58). These findings suggest that central 5-HT reduces apnea and stabilizes breathing by reducing cholinergic signaling through muscarinic receptors. NEW & NOTEWORTHY Serotonin in the central nervous system (CNS) is necessary for maintaining the stability of breathing in the early postnatal period, particularly during active sleep. Here we show that the administration of atropine to the CNS selectively stabilizes the respiratory pattern of tryptophan hydroxylase 2-deficient rat pups and reduces their apneas. This suggests that CNS serotonin stabilizes breathing at least in part by reducing central cholinergic drive.