bluuebunny/crossref_metadata_2025_split huggingface dataset:
127 Durable Treatment of Painful Diabetic Neuropathy With 10 kHz Spinal Cord Stimulation
Authors: Petersen Erika A. , Stauss Thomas , Scowcroft James , Jaasma Michael , White Judith , Sills Shawn , Amirdelfan Kasra , Guirguis Maged , Xu Jijun , Yu Cong , Nairizi Ali , Patterson Denis , Galan Vincent , Bundschu Richard , Mehta Neel , Sayed Dawood , Lad Nandan P. , DiBenedetto David , Creamer Michael , Wu Paul , Argoff Charles , Nasr Christian , Taylor Rod S. , Caraway David , Mekhail Nagy 
Published: March 2024

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

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

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

CONCLUSIONS:
The results demonstrate that 10 kHz SCS provides significant, durable reductions in pain and improvements in sensory function and HRQoL. Sensory function improvements support the unique disease-modifying potential of 10 kHz SCS.
130 Heterotopia and Neurodevelopmental Outcomes Patients With Prenatal Diagnosis of Myelomeningocele or Myeloschisis
Authors: Flanders Tracy Ma , Punchak Maria , Land Sierra , Flohr Sabrina , Bostwick Anna , Reynolds Tom , Schmidt Katie , Ertz Danielle , Schreiber Jane , Moldenhauer Julie , Soni Shelly , Adzick N. Scott , Heuer Gregory G. 
Published: March 2024

INTRODUCTION:
Gray matter heterotopia is a cortical malformation and a known risk factor for seizures and epilepsy. Historically, presence of heterotopia in one or both cerebral ventricles was a concern for postnatal neurological status in patients undergoing fetal closure of myelomeningocele/myeloschisis. There is little information known regarding the overall impact of heterotopia in this patient population.

METHODS:
A retrospective chart review was conducted for all patients evaluated at the Center of Fetal Diagnosis and Treatment with a diagnosis of myelomeningocele or myeloschisis between June 2016 to March 2023. Gray matter heterotopia was determined from prenatal US and confirmed with prenatal and postnatal MRI. The Bayley Scales of Infant and Toddler Development (edition III and IV) were used for neurodevelopmental assessments.

RESULTS:
Of 497 patients evaluated with a prenatal diagnosis of myelomeningocele or myeloschisis, 99 were found to have gray matter heterotopia on prenatal MRI. In the postnatal period, 347 patients ultimately delivered at our institution, of which 26 had confirmed gray matter heterotopia on postnatal MRI as well as underwent neurodevelopmental testing. The median age at neurodevelopmental assessment was 13.3 months. The median cognitive and language scores (95 and 99, respectively) were average in those patients with gray matter heterotopia.

CONCLUSIONS:
This study suggests that the presence of gray matter heterotopia in patients with prenatal diagnosis of myelomeningocele or myeloschisis is not associated with increased cognitive or language delay on neurodevelopmental testing at approximately 1 year of age. These findings can aid clinicians during prenatal consultation regarding fetal repair of spina bifida.
133 BMAL1 is Upregulated in Pediatric High-Grade Gliomas
Authors: Nettnin Ella Adeline , Garcia Cesar Andres , Schonfeld Ethan , Arana Sophia , Barros Guinle Maria Isabel , Gibson Erin , Prolo Laura Marie 
Published: March 2024

INTRODUCTION:
Pediatric high-grade gliomas (pHGG) are highly invasive brain tumors with poor survival outcomes, and novel therapeutic approaches are urgently needed. Recently, a retrospective study found timing of Temozolomide administration affects survival in adult patients with glioblastoma (Damato et al. 2021). There has, however, been limited exploration into circadian gene expression in pediatric gliomas.

METHODS:
We analyzed expression of BMAL1, a key circadian gene, in pediatric gliomas using bioinformatic approaches, Western blotting, and immunocytochemistry (ICC). We first compared BMAL1 expression in pLGGs and pHGGs using published publicly available data from cBioPortal for Cancer Genomics. Immunoblotting was utilized to determine BMAL1 protein expression levels in patient specimens of pHGG, pLGG and cortex from epilepsy surgery. Immunocytochemistry on synchronized primary tumor lines was used to show localization of BMAL1 protein.

RESULTS:
Using data from cBioPortal, we found significantly higher expression of BMAL1 in pHGGs compared to pLGGs (0.349 + 1.05 vs 0.0545 + 0.666, p < 0.001). Western blotting showed increased expression of BMAL1 in HGG tumor specimens compared to LGG and cortical specimens. Immunostaining demonstrated cellular localization of BMAL1.

CONCLUSIONS:
In this study, we found that the circadian gene BMAL1 is expressed in pHGGs, and that expression is higher in pHGGs compared to pLGGs and cortex. Next steps will be to understand how timing of Temozolomide in relationship to the circadian cycle affects tumor cell survival.
139 Alternative Anatomical Landmarks for the Lateral Femoral Cutaneous Nerve: Cadaveric Study With Implications for Difficult Decompressive Cases
Authors: Tucci Marissa , Anadkat Samir , Dumont Aaron S. , Spinner Robert J. , Tubbs R. Shane 
Published: March 2024

INTRODUCTION:
During decompressive procedures, localizing the lateral femoral cutaneous nerve (LFCN) using only the anterior superior iliac spine (ASIS) can be difficult due to variations in nerve course and specific patient anatomy, e.g., body habitus. Therefore, the present anatomical study was performed to provide additional landmarks for localizing this nerve.

METHODS:
The LFCN was dissected in 30 adult cadavers (60 sides). The nerve was exposed distal to the ASIS in the proximal thigh and along an imaginary line connecting the ASIS to the midpoint of the patella with the lower limb in a neutral position.

RESULTS:
The main trunk of the LFCN was identified deep to the fascia lata on all sides, 5-8 cm distal to the ASIS along the ASIS-patella line. The nerve was bordered by the sartorius muscle superficially and medially, the tensor fasciae latae muscle laterally, and the proximal rectus femoris tendon on its deep surface. Proximal to this triangular region, the LFCN was found to cross superficially to the proximal sartorius muscle on 58 sides and through the muscle on two sides.

CONCLUSIONS:
The study findings suggest an alternative method for identifying the LFCN, which could help locate the nerve during challenging cases and reduce the incidence of iatrogenic LFCN injuries resulting from inadequate anatomical landmarks.
142 Common Peroneal Nerve Decompression for Slimmers Palsy: A Case Series With Intraoperative Stimulation
Authors: Miranda Stephen , Chauhan Daksh , Nguyen Jessica , Zager Eric L. , Ali Zarina S. 
Published: March 2024

INTRODUCTION:
Slimmer’s palsy refers to common peroneal nerve (CPN) entrapment neuropathy associated with rapid or significant weight loss. Indications and outcomes for CPN decompression in this population remain unclear. While there are reports documenting functional improvement after surgical decompression, there are also case series demonstrating recovery with non-operative management, including diet modification, nutritional supplementation, and rehabilitation.

METHODS:
Retrospective chart review was performed to identify patients (age >18) who underwent CPN decompression between 2012-2021 with documented history of weight loss >5 kg. Demographics, weight loss, operative details, electromyography findings, onset/degree of weakness by manual muscle testing (MMT), and extent of improvement were collected. Pre- and post-decompression conduction thresholds were measured intraoperatively. Descriptive statistics were performed, including paired t-tests for pre- and post-operative MMT scores and pre- and post-decompression conduction thresholds.

RESULTS:
Five total patients were identified. Median age was 39 years. Most were male (3/5), White (5/5), privately insured (3/5), current/former smokers (3/5), and normal weight (3/5). Mean weight loss was 27 kg (range: 5-45). Reasons for weight loss included intentional, chemotherapy-related, bariatric surgery, and one case of unexplained weight loss. Mean MMT score at time of evaluation was 2.0 + 0.45 for tibialis anterior (TA), 2.0 + 0.55 for extensor hallucis longus (EHL) and 2.2 + 0.58 for peroneus longus (PL). Time to surgery ranged from 4-6 months. Mean postoperative MMT scores were significantly improved in TA (4.6 + 0.24, p = 0.007), EHL (4.6 + 0.24, p = 0.007) and PL (4.6 + 0.24, p = 0.02) compared to baseline. Mean conduction thresholds (5.75 + 1.89) were lower after decompression (1.2 + 0.31), although not statistically significant in this sample (p = 0.12).

CONCLUSIONS:
In this small series, CPN decompression restored function for patients with Slimmer’s palsy. Nerve conduction block was observed intraoperatively in most cases, perhaps supporting a compressive etiology for this condition.
147 Medial Septal Nucleus Theta Stimulation Improves Spatial Working Memory and Increases Hippocampal Neurovascular Activity in a Mouse Model of Alzheimers Disease (5xFAD)
Authors: Wu Kevin , Agyerman Kofi , Zepeda Nancy , Crown Lindsey , Bergosh Matthew , Choi Wooseong , Liu Charles Y. , Christopoulos Vasileios , Lee Darrin J. 
Published: March 2024

INTRODUCTION:
Alzheimer’s disease (AD) remains among the most prolific neurodegenerative disorders. The pathogenesis is the result, in part, of aberrant cerebral circuitry; in particular, the mesolimbic-septohippocampal circuit and its associated medial septal nucleus (MSN). Interestingly, the administration of theta stimulation via deep brain stimulation (DBS) to the MSN has been demonstrated to increase hippocampal theta oscillations, which are critical to the role of the hippocampus in learning and memory. Recently, functional ultrasound imaging (fUSI) has emerged as a method of evaluating large-scale neural activity with both high spatiotemporal resolution (∼100 μm3) and sensitivity to slow blood flow (∼1 mm/s). fUSI allows for the in-vivo analyses of neurovascular changes secondary to our theta-burst neuromodulatory intervention.

METHODS:
12 male 5xFAD mice were partitioned into two groups, one received theta-burst stimulation targeting the MSN (n = 4) and the other acted as controls (n = 8). Following stimulation, spatial working memory was assessed via the Barnes maze task. An additional 44 C57BL/6 mice were partitioned into three groups: one receiving theta (7.7 Hz) stimulation to the MSN (n = 16), one receiving gamma stimulation to the MSN (100 Hz, n = 14), and the remaining group acting as the control (n = 14).

RESULTS:
The MSN theta stimulation group of 5xFAD mice demonstrated decreased latency compared to controls (p = 0.003). CBF volumes in the hippocampus were relatively increased in the theta-burst group when compared to both control and gamma stimulation groups.

CONCLUSIONS:
Our results demonstrate significant improvement in cognitive performance secondary to MSN theta-burst stimulation. Additionally, these changes were mirrored by CBF volume increases in the hippocampus in a frequency-dependent manner. These findings provide evidence for the therapeutic role of theta MSN stimulation in the treatment of AD and furthers fUSI’s role in evaluating in-vivo CBF.
150 Backbone Spiking Sequence as a Basis for Preplay, Replay, and Default States in Human Cortex
Authors: Vaz Alex , Wittig John , Inati Sara , Zaghloul Kareem A. 
Published: March 2024

INTRODUCTION:
Sequences of spiking activity are a fundamental feature of many neural systems, and recent evidence suggests that they play an important role in information coding in the human brain. A parallel set of studies also asserts that sequential activity may in part derive from a pre-existing network structure. Sequential spiking activity therefore may arise as a natural property of the neurophysiologic properties of the human cortex.

METHODS:
We measured single unit spiking activity in the human cortex by implanting Utah micro-electrode arrays into participants who performed an episodic memory task while undergoing invasive monitoring for potential resective epilepsy surgery.

RESULTS:
We confirm the presence of an average backbone spiking sequence identified during pre-task rest that is stable over time and different cognitive states. These resting backbone sequences served as a scaffold for cognitively relevant sequential spiking activity occurring later in the recording session. We further demonstrate that backbone sequences are composed of both rigid and flexible sequence elements, and that flexible elements serve to promote memory specificity when forming and retrieving new memories.

CONCLUSIONS:
Here we demonstrate that backbone sequences can be measured in the human cortex and that they persist over time and through different cognitive states. Our data show that backbone sequences are composed of both rigid and flexible elements, and flexibility around the backbone allows for the formation of memory specific spiking sequences. Taken together, our results provide the first evidence for backbone spiking sequences in the human cortex, and more generally suggest a cognitive role of predetermined spiking network dynamics in the human brain.
156 Stenting of Intracranial Stenosis With a Fibrin-heparin Coated Stent Multicentre Experience
Authors: Nordmeyer Hannes , Dorn Franziska 
Published: March 2024

INTRODUCTION:
Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke due to large vessel occlusions (LVO). However, in up to 30% MT may not result in successful recanalization due to an underlying stenosis or clot recalcitrant to retrieval. Bail-out stenting has been reported to be a treatment option to achieve permanent recanalization.

METHODS:
We retrospectively analysed data from 16 stroke centres. Patients treated with the CREDO heal Stent were divided into two groups: symptomatic high-grade intracranial stenosis (sICAD group) and persisting LVO due to underlying stenosis after at least one mechanical thrombectomy attempt (Rescue Stenting group). Primary endpoints were the improvement of stenosis grade and the rate of successful recanalization after stenting defined as mTICI = 2b for the sICAD and the Rescue Stenting group respectively. Favourable neurological outcome was defined by modified Rankin Score (mRS) at 90 days.

RESULTS:
121 patients were treated from 2021-2023 with the CREDO heal Stent. Rescue stenting and sICAD treatment was performed in 82 and 39 cases respectively. Overall, a final TICI = 2b score was achieved in 94.5%. In 14% periprocedural complications occurred were in-stent thrombosis accounted for 6.3% (rescue stenting group). The mean stenosis grade in the sICAD group was 90% before and 15% after PTA and stenting. On follow-up (n = 27) restenosis was observed in 2.8%.

CONCLUSIONS:
The CREDO® heal stent offers a new treatment option for patients with sICAD or with persistent occlusion during thrombectomy procedures. The final mTICI sore is in accordance with uncoated devices. The rate of restenosis is low compared to previous trials. Its effectiveness with regard to long-term ischemic complications has to be evaluated in the prospective ReCHRUT trial.
164 Characterization of Market Movements and Private Equity in Neurosurgery Practices and Hospitals
Authors: Koester Stefan Wolfgang , Dambrino Robert J. , Bishay Anthony , Bhamidipati Akshay , Liles Campbell , Cole Tyler S. , Gooldy Tim , Youngerman Brett E. , Chambless Lola Blackwell 
Published: March 2024

INTRODUCTION:
Surgical services could be faced with shifts in corporate management, restructuring, and incentives as trends such as private equity (PE) investment in healthcare continue to evolve. The number of surgical services acquired by PE firms has increased significantly over the last 20 years. Due to financial vulnerability and movement towards digital health, PE activity within healthcare has further grownsince the COVID pandemic.

METHODS:
PitchBook and Mergermarket were used to query deals involving neurosurgical practice within the United States at any time. Exclusion criteria consisted of non-neurosurgery practices and debt restructuring deals without a change in ownership. The company name, deal type, financing year, and state were extracted for each deal. Deal type was stratified by the following categories: angel investment, mergers and acquisitions, private equity and venture capital (PE/VC), and corporate buyout. Internal debt refinancing such as leveraged recapitalization was excluded from the analysis.

RESULTS:
A total of 125 companies were discovered in the initial search. After further review, 63 companies were included in final analysis. The deals occurred between 1994 to 2022 and involved companies in 27 different states. Of the 63 companies, 36 (57.1%) involved mergers or acquisitions, 16 (25.4%) involved private equity or venture capital firms, 7 (11.1%) involved corporate buyouts, and 4 (6.3%) involved angel investments.

CONCLUSIONS:
PE is increasingly involved with neurosurgery practices, with an associated decline in mergers and acquisitions. Future qualitative investigation is required to help characterize physician attitudes of PE-run practices in comparison to non-PE practices.
168 Sustenance of Substantial Clinical Benefit in Adult Spinal Deformity Corrective Surgery Patients: A Minimum 5-Year Outcomes Analysis
Authors: Mir Jamshaid M. , Galetta Matthew , Tretiakov Peter S. , Dave Pooja , Das Ankita , Janjua Burhan , Jankowski Patrick , Schoenfeld Andrew , Passias Peter G. 
Published: March 2024

INTRODUCTION:
Clinical outcomes for adult spinal deformity patients has been extensively reported on, however factors associated with sustaining two year (2Y) substantial clinical benefit (SCB) till five year (5Y) remains unclear.

METHODS:
ASD patients fused from at least L1 to sacrum with 5Y postoperative data were included. Good Outcome(GO) was defined as: no reoperation, mechanical failure, proximal junctional failure(PJF) based on Lafage criteria, and [meeting either: (1) SCB for Oswestry Disability Index(ODI)(decrease of >18.8), or (2) ODI <15 and Scoliosis Research Society(SRS-22r) Total>4.5]. Multivariable analysis controlled for age, BMI, CCI, frailty, deformity, HRQLs, and surgical variations.

RESULTS:
330 ASD patients were included. 42% achieved GO at 2Y(2+) while 47% at 5Y(5+) did. 71% of 2+ cohort attained 5+. In 2- cohort, 29% achieved 5+.
Isolating 2+ cohort, assessing 5+ vs 5-: 5- had greater SVA deformity at 5Y (p < .05).
Regaining the level of activity postoperatively was associated with 4x higher odds of maintaining GO from 2Y to 5Y (p < .05).
The odds of achieving GO at 5Y in 2+ decreased by 47% for each additional comorbidity and decreased by 74% in those that had lower extremity paresthesias at BL (both p < .05). Decreased number of levels fused, decreased correction in SVA and increased correction in PI-LL to be predictive of sustaining 2Y GO till 5Y (all p < 0.05).

CONCLUSIONS:
Overall, 47% had substantial clinical benefit till 5Y. While 71% of patients at 2Y sustained good clinical outcome till 5Y, major contributors to its loss were adjacent segment changes and rod fracture. The odds of achieving SCB till 5Y decreased by nearly 50% for each additional comorbidity. Decreased levels fused along with decreased correction of SVA and increased correction in PI-LL were predictive of optimal sustaining of clinical outcomes.
172 Does the Number of Social Risk Factors Affect Long-term Patient-Reported Outcomes and Satisfaction in Those With Cervical Myelopathy? A QOD Study
Authors: Park Christine , Shaffrey Christopher I. , Than Khoi Duc , Bisson Erica Fay , Sherrod Brandon , Asher Anthony L. , Coric Domagoj , Potts Eric A. , Foley Kevin T. , Wang Michael Y. , Fu Kai-Ming G. , Virk Michael S. , Knightly John J. , Meyer Scott A. , Park Paul , Upadhyaya Cheerag D. , Shaffrey Mark Edwin , Lee Buchholz Avery , Tumialan Luis Manuel , Turner Jay D. , Agarwal Nitin , Chan Andrew , Chou Dean , Chaudhry Nauman Shaukat , Haid Regis W. , Mummaneni Praveen V. , Michalopulos Giorgos , Bydon Mohamad , Gottfried Oren N. 
Published: March 2024

INTRODUCTION:
It is not clear whether there is an additive effect of social risk factors in affecting patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery.

METHODS:
This was a retrospective study of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort. Social risk factors included race, education, employment, and insurance. Patients were considered to have improved from surgery if 1) they reported a score of 1 or 2 on the NASS index and 2) met the MCID in patient-reported outcomes (VAS neck and arm pain, NDI, EQ5D, or mJOA score) at 24-month follow-up.

RESULTS:
Of the 1,141 patients included in the study, 205 (18.0%) had zero, 347 (30.4%) had one, 334 (29.3%) had two, and 255 (22.3%) had three social risk factors. The 24-month follow-up rate was 87.4% for patient-reported outcomes. After adjusting for all significant covariates, patients with one or more social risk factors were less likely to improve from surgery in all measured outcomes including VAS neck and arm pain, NDI, EQ-5D, and mJOA (all p < 0.05) compared to those without any social risk factors. Patients with two or three social risk factors were more likely to fare worse in all outcomes compared to those with only one social risk factor (all p < 0.05).

CONCLUSIONS:
Compared to those without any social risk factors, patients who had at least one social risk factor were less likely to achieve MCID and feel satisfied after surgery. The effect of social risk factors is additive in that those with a higher number of risk factors are less likely to improve compared to those with only one social risk factor.