bluuebunny/crossref_metadata_2025_split huggingface dataset:
124 Craniotomy Versus Craniectomy for Traumatic Acute Subdural Hematoma Coarsened Exact Matched Analysis of Outcomes
Authors: Azad Tej D. , Ran Kathleen Renee , Vattipally Vikas , Giwa Ganiat , Myneni Saket , Raj Divyaansh , Dardick Joseph , Rincon Torroella Jordina N. , Ye Xiaobu , Byrne James , Suarez Jose , Lin Shih-Chun , Jackson Christopher Mitchell , Mukherjee Debraj Raj , Gallia Gary L. , Huang Judy , Weingart Jon D. , Bettegowda Chetan 
Published: March 2024

INTRODUCTION:
Previous studies comparing craniotomy (CO) versus decompressive hemicraniectomy (DC) for acute subdural hematoma (aSDH) evacuation after traumatic brain injury have not found significant association between surgical approach and patient outcome. We hoped to provide a more granular and real-world assessment of outcomes.

METHODS:
One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P < 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P < 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients.

RESULTS:
One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P < 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P < 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients.

CONCLUSIONS:
aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is an independent predictor of mortality at discharge, as well as at 90-days and 1-year after surgery.
1241 Sustained Localized Delivery of Anti-PD-1 to Tumor Draining Lymph Nodes Increases Survival and Reverses Immunosuppression in Murine Glioblastoma Models
Authors: Choi John , Pant Ayush , Medikonda Ravi , Kim Young-Hoon , Routkevitch Denis , Saleh Laura , Tong Luqing , Chan Hok Yee , Nedrow Jessie , Jackson Christopher Mitchell , Jackson Christina , Lim Michael 
Published: March 2024

INTRODUCTION:
Despite the advent of immunotherapy as a promising therapeutic, glioblastoma (GBM) remains resistant to using checkpoint blockade against programmed cell death protein 1 (PD-1) on T cells. The highly immunosuppressive tumor milieu of GBM prevents rescue of inactivated T cells due to decreased numbers of infiltrating T cells at the tumor site as well as increased recruitment of myeloid cells. Moreover, the current strategy of using antibodies against PD-1 (anti-PD-1) requires multiple intravenous infusions every two or three weeks with debilitating systemic effects.

METHODS:
Mice orthotopically implanted with GL261 glioma cells were injected with PCL:PEG:PCL hydrogel polymers loaded with anti-PD-1 in one of the following locations: cervical lymph nodes, inguinal lymph nodes, and the tumor site. Mice treated systemically with anti-PD-1 were used as comparative controls. Kaplan-Meier curves were generated for all arms, with subsequent ex vivo flow cytometric staining for CD4, CD8, IFN-y, TNF-a, Foxp3, and PD-1.

RESULTS:
Mice implanted with PCL:PEG:PCL hydrogels carrying anti-PD-1 at the site of their lymph nodes showed significantly improved survival outcomes compared to mice systemically treated with three doses of anti-PD-1 (p < 0.001). Flow cytometric analysis of lymph nodes and brain tissue in mice injected with this gel demonstrated increased levels of IFN-y, indicating greater reversal of immunosuppression compared to standard treatment.

CONCLUSIONS:
Our data demonstrates proof of principle of the advantages of using localized therapy that targets lymph nodes for GBM. We propose a paradigm shift for developing new sustained local treatments with immunotherapy that are able to eliminate the need for multiple systemic infusions and their off-target effects.
126 Association of PAG Connectivity in SCI Subjects With Neuropathic Pain in a Resting-State FMRI Study
Authors: Shoraka Omid , Mandloi Shreya , Syed Mashaal , Talheimer Sara , Yuan Hsiangkuo , Evans James J. , Heller Joshua E. , Mohamed Feroze , Sharan Ashwini Dayal , Harrop James S. , Krisa Laura , Alizadeh Mahdi 
Published: March 2024

INTRODUCTION:
Neuropathic pain (NP) is estimated to be present in 61% of subjects with chronic spinal cord injury (SCI). Periaqueductal Grey (PAG) plays a crucial role in descending pain modulation system. Few studies assessed PAG’s functional connectivity (FC) in pain syndromes, however, it has not been studied in SCI.

METHODS:
10 SCI subjects with NP were divided into two groups (moderate-severe n = 7, mild-no pain n = 3), and 10 healthy controls (HC) were enrolled. Resting-state fMRI was performed for subjects using a 3T Philips Ingenia scanner with a dedicated 32 channels head coil. Seed-to-voxel analysis was performed using CONN toolbox with the PAG as the seed region. Group-based analysis was performed between three groups with age and gender as confounding variables. A voxel threshold p-value of <0.05 was used, with the results corrected for multiple comparisons using fdr with a significance level of 0.05.

RESULTS:
Compared to HCs, SCI with NP demonstrated decreased FC between PAG and one cluster. SCI with pain compared to SCI without pain demonstrated Increased FC in one and decreased FC in two clusters. For each common anatomical region between pairwise analyses, FC alterations were compared to assess whether they are the result of SCI or NP.

CONCLUSIONS:
Altered FC was observed between PAG and regions involved in the pain modulation in SCI with NP compared with SCI without pain and HCs. We hypothesized that alterations between PAG and the Frontal cortex, Thalamus, Brain stem, and Cerebellum could be the result of NP sequela rather than the SCI itself. Further studies with more subjects will be needed to assess this hypothesis.
134 LIN28B as a Novel Therapeutic Target in Diffuse Midline Glioma
Authors: Knowles Truman , Huang Tina , An Shejuan , Qi Jin , Saratsis Amanda Muhs 
Published: March 2024

INTRODUCTION:
Diffuse midline glioma (DMG) is the most lethal of all childhood cancers. LIN28B is a RNA binding protein expressed in a variety of cancers, which suppresses the let-7 family of microRNAs, which in turn suppresses a plethora of oncogenes. However, the role of LIN28B in DMG has not yet been explored.

METHODS:
All studies were performed on DMG cell lines (n = 6) and controls (normal human astrocytes n = 1, human neural stem cells n = 1). RNA-Seq was performed using single-read sequencing at 50bp on the Illumina NextSeq 500 Sequencing System. Cells were then treated with DMSO or the LIN28B inhibitor, LI71, and submitted to functional in vitro studies, as well as RNA-Seq and Western Blot analysis. Functional pathways analysis was subsequently performed on resulting gene expression values with Ingenuity Pathways Analysis (Qiagen).

RESULTS:
Differential LIN28B expression was demonstrated across cell lines, with DMG cells expressing greater LIN28B gene and protein levels compared to controls. LIN28B inhibition with small molecule inhibitor LI71 resulted in decreased cell proliferation and migration, in vitro. A total of 946 differentially expressed genes were identified between treatment groups (FC >2 or <-2, p < 0.05). Functional pathways analysis of differentially expressed genes implicated Cancer and Neurological Disease as the top disease processes, with Cellular Movement as the top molecular process in cell lines expressing LIN28B. Further, inactivation of Myc signaling was implicated in cells treated with LI71.

CONCLUSIONS:
Our data demonstrates increased LIN28B expression in DMG cell lines compared with controls, with oncogenic effects on cell proliferation and migration. Further investigation of the LIN28B-let7 signaling axis is warranted in order to further explore LIN28B as a novel therapeutic target in DMG.
137 Light-mediated Vagus Nerve Stimulation Inhibits Pro-inflammatory Cytokine Production in Acute Endotoxemia
Authors: Chen Adrian , Huerta Tomas , Chaudhry Saher , Chang Eric H. 
Published: March 2024

INTRODUCTION:
Vagus nerve stimulation (VNS) is a form of neuromodulation being explored to treat chronic inflammatory conditions by activating the inflammatory reflex, an arc reducing proinflammatory cytokine release through efferent cholinergic signaling. Current VNS approaches are primarily invasive and use electricity, but alternatives may improve vagal fiber specificity and eliminate surgical risks. Red-light optogenetics, a biological tool utilizing red light-activatable channelrhodopsins (ReaChR), can selectively activate genetically-modified neurons transdermally with light. Here, we show that ReaChR activation of cholinergic vagal fibers reduces cytokine production in a model of acute inflammation.

METHODS:
Vagus nerve cholinergic fibers were selectively activated using ReaChR expressed on choline acetyltransferase-expressing (ChAT) fibers in transgenic ChAT-ReaChR mice. Sensory afferent vagal fibers were activated in a separate cohort of transient receptor potential vanilloid subfamily member 1 (TRPV1)-ReaChR mice. Lipopolysaccharide (LPS) was injected intraperitoneally under anesthesia to induce acute endotoxemia, as measured by elevated tumor necrosis factor-alpha (TNFa). A 635nm fiber optic was targeted onto an isolated, cervical vagus for optogenetic VNS post-LPS administration.

RESULTS:
Selective ReaChR activation of cholinergic fibers in the cervical vagus nerve stimulates the inflammatory reflex to inhibit splenic TNFa production to bacterial LPS (ChAT-ReaChR: 1.27 ± 1.44 pg/ug; control: 4.26 ± 0.97 pg/ug, p < 0.001), but no significant differences were observed in serum (ChAT-ReaChR: 538 ± 216 pg/ml; littermate: 447 ± 206 pg/ml, p = 0.81). In contrast to efferent activation, ReaChR stimulation of afferent subsets (TRPV1+) failed to show cytokine regulation in splenic nor in serum .Approximate 20% baseline heart rate drop was seen during both ChAT+ and TRPV1+ fiber excitation, but only cholinergic activation sustained bradycardia throughout the stimulation period.

CONCLUSIONS:
Red-light optogenetic activation of cholinergic vagal fibers reduces splenic inflammatory cytokine production in murine endotoxemia and holds potential as a non-invasive, light-mediated VNS approach.
158 Preclinical Direct Endoluminal Assessment of Endothelialization After Flow Diversion With Microangioscopy
Authors: Lazaro Tyler , Srinivasan Visish M. , Covell Michael , O'Leary Sean , Cooper Phillip , Garcia Roberto , Robledo Ariadna , Kan Peter T. 
Published: March 2024

INTRODUCTION:
Endoluminal imaging (ELI) is an emerging adjunct in endovascular cerebral aneurysm management. Indirect ELI, as with optical coherence tomography, may be useful in detecting malapposition after flow diversion (FD). Direct ELI technologies, such as with our previous described microangioscope, have been shown to be able to delineate between different thrombi and visualize neoepithelialization after stent placement with high resolution.

METHODS:
In a rabbit model we implanted each left common carotid artery (CCA) with a shielded FD (Medtronic Pipeline Vantage) and non-shielded FD (Medtronic Pipeline Flex) in the right CCA. We studied 9 animals in 3 groups: 1) no periprocedural antiplatelet therapy, 2) aspirin 81 mg daily, 3) aspirin 81 mg and clopidogrel 75 mg daily. FD thrombosis, stenosis, malapposition, and neoepithelialization were all evaluated by diagnostic cerebral angiography (DSA) and microangioscopy after 30 days. DSA and angioscopic video were analyzed by independent evaluators and compared with histopathologic analysis.

RESULTS:
In the aspirin and DAPT groups, there were no significant observed differences in stent thrombosis, stenosis, malapposition, or neoepithelialization between the shielded and non-shielded FDs in each rabbit as measured by histologic analysis. There was significantly more thrombus formation in Group 1. Neointimal thickness as measured by the microangioscope was highly correlated with histology (r = 0.72, p = 0.016). Inter-rater agreement of microangioscope videos was highest for FD thrombosis and stenosis.

CONCLUSIONS:
There were no significant differences between in-stent thrombosis, stenosis, malapposition, or neopithelialization between shielded and non-shielded FDs. Microangioscopy measurements for neointimal thickness were highly correlated with pathology, and thus may be a helpful adjunct to DSA in FD follow-up.
163 Assessing the Economic Benefit of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains
Authors: Tretiakov Peter S. , Mir Jamshaid M. , Dave Pooja , Das Ankita , Jankowski Patrick Patryk , Janjua Burhan , Passias Peter G. 
Published: March 2024

INTRODUCTION:
The economic benefit of ERAS protocols, nor the heterogeneous components that make up such protocols, has not been established.

METHODS:
CD patients =18 yrs with pre-(BL) and up to 2-year (2Y) postop data were stratified by enrollment in Standard-of-Care ERAS beginning in 2020. Differences in pre, peri-, and post-operative factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. QALY was calculated using NDI mapped to SF6D using validated methodology with 3% discount rate to account for residual decline to life expectancy.

RESULTS:
270 patients were included (58.11 ± 11.97 years, 48% female). 54 (20.0%) received ERAS protocol recovery treatment post-operatively. Peri-operatively, ERAS+ patients also reported lower mean LOS overall (4.33 vs 5.84, p = .393), and were more likely to be discharged directly to home (χ2(1) = 4.974, p = .028). Per cost analysis, ERAS+ patients reported a lower mean total 2Y cost of 33,829 USD compared to ERAS- patients at 36,951 (p < .001). Furthermore, ERAS+ patients trended towards greater life-expectancy 2Y QALYs gained versus ERAS- patients (.423 vs .368, p = .051), and demonstrated lower costs at reoperation by 2Y (7050 USD vs 8110, p < .001). Controlling for age, surgical invasiveness, and deformity per BL TS-CL, ERAS+ patients below 70 years old were more likely to achieve a cost-effective outcome by 2Y compared to their ERAS- counterparts (OR: 1.011 [1.001 – 1.999, p = .048].

CONCLUSIONS:
Patients undergoing Enhanced Recovery After Surgery (ERAS) protocols experience lower operative times, length of stay, and rates of peri-and and post-operative complications. Subsequently, this study demonstrates that ERAS programs in ACD surgery demonstrate improved cost-effectiveness and reduced total cost by 2Y post-operatively. Due to the potential economic benefit of ERAS for patients, physicians and instutions should consider incorporation of ERAS into practice for eligible patients.
165 Can Artificial Intelligence Successfully Identify CPT Codes for Common Procedures in Neurosurgery?
Authors: O'Malley Geoffrey R. , Cassimatis Nicholas , Kumar Rohit Prem , Maggio William Warren , Danish Shabbar F. , Patel Nitesh Vijay 
Published: March 2024

INTRODUCTION:
Coding for Neurosurgical procedures is a complex process that is dynamically changing year to year, through the introduction and removal of codes and modifiers every year. It is an increasing challenge for Neurosurgeons to keep up with the changes and implement them in their practice to ensure accurate coding and maximize billing. The AANS reports only 43% of Neurosurgeons are estimated to have certified professional coders.

METHODS:
ChatGPT was asked to provide CPT codes for common neurosurgical procedures of the brain and spine with a given indication for the procedure. The responses of ChatGPT were recorded and compared to the accurate CPT codes used for the procedure. The total amount of RVUs provided by Chat GPT CPT codes were compared to the actual amount of RVUs for the given procedure.

RESULTS:
ChatGPT was asked for four cranial and spinal procedures each. In terms of accuracy, three responses were completely inaccurate, four responses were partially correct, and one response was completely correct. From the total 8 cases, ChatGPT provided CPT codes accounting for 132.88 of 227.33 expected RVUs (58.5%). For spinal procedures ChatGPT provided 81.7 of 107.8 expected RVUs (75.8%). For cranial procedures ChatGPT provided 51.2 of 119.5 expected RVUs (42.8%).

CONCLUSIONS:
The ability of ChatGPT to successfully code for neurosurgical procedures appears to be limited at this time, but it is not without promise. The information to successfully code for billing for medical procedures is not readily available on the internet. Using limited information ChatGPT is still able to successfully identify codes being used for procedures. Teaching artificial intelligence to use CPT codes for billing could offer neurosurgeons increased efficiency and efficacy in their billing in the future.
167 Association Between Safety-net Hospital Status and Postoperative Outcomes Following ACDF or PCDF for Cervical Spondylotic Myelopathy
Authors: Elsamadicy Aladine A. , Sayeed Sumaiya , Craft Samuel , Sherman Josiah , Reeves Benjamin , Koo Andrew B. , Khalid Syed Ibad , Lo Sheng-fu Larry , Shin John H. , Mendel Ehud , Sciubba Daniel M. 
Published: March 2024

INTRODUCTION:
Few prior studies have addressed the impact of safety-net hospital (SNH) status on outcomes following anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy (CSM).

METHODS:
A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample Database. All adult patients (>18 years old) undergoing elective ACDF or PCDF for CSM, identified using ICD-10-CM coding, were stratified into SNH and non-SNH (N-SNH) cohorts. Hospitals in the top quartile of Medicaid/uninsured patient admissions were defined as SNHs. Demographics, treating hospital characteristics, comorbidities, operative variables, adverse events (AEs), LOS, discharge disposition, and costs were assessed. Multivariate analyses were performed to identify independent predictors of prolonged LOS, non-routine discharge (NRD) disposition, and increased costs for ACDF and PCDF.

RESULTS:
Of the 49,945 study patients, 34,195 (68.5%) underwent ACDF and 15,750 (31.5%) underwent PCDF. Within the ACDF cohort, 8,025 patients (23.5%) were treated at SNHs. Among patients undergoing PCDF, 4,120 (26.2%) were treated at SNHs. Patients treated at SNHs were more likely to be Black- or Hispanic-identifying and have incomes in the bottom quartile in both cohorts. Mean LOS was significantly greater in the SNH cohorts for both procedures (ACDF:N-SNH: 2.43 ± 3.12 days vs SNH: 2.94 ± 4.13 days, p <0.001; PCDF:N-SNH: 4.36 ± 4.28 days vs SNH: 5.41 ± 8.67 days, p = 0.002), as were mean costs (ACDF:N-SNH: $20,991 ± $12,126 vs SNH: $22,412 ± $15,302, p = 0.010; PCDF:N-SNH: $25,835 ± $16,812 vs SNH: $28,945 ± $29,166, p = 0.010). A significantly greater proportion of patients in the ACDF cohort treated at SNHs experienced NRDs (N-SNH: 10.9% vs SNH: 13.9%, p = 0.006). On multivariate analysis, SNH status was not significantly associated with extended LOS [ACDF: p = 0.097; PCDF: p = 0.158], NRD [ACDF: p = 0.288; PCDF: p = 0.246], or increased costs [ACDF: p = 0.664; PCDF: p = 0.593].

CONCLUSIONS:
Our findings suggest SNH status may not significantly impact postoperative outcomes following ACDF and PCDF.
176 Repetitive Traumatic Brain Injuries Are Associated With Poorer Outcomes at 1-Year and 3-7 Years After Index Injury
Authors: Yue John K. , Etemad Leila , Barber Jason , Satris Gabriela , Belton Patrick , Madhok Debbie , Hamidi Sabah , Tracey Joye , Yuh Esther , Mukherjee Pratik , Huang Michael C. , Tarapore Phiroz E. , Puccio Ava , Okonkwo David O. , Manley Geoffrey T. , Temkin Nancy , DiGiorgio Anthony 
Published: March 2024

INTRODUCTION:
Traumatic brain injury (TBI) patients are at risk for subsequent TBIs. Research on the longitudinal impact of repetitive TBI is limited.

METHODS:
The 18-center TRACK-TBI study enrolled subjects who presented to hospital and received head computed tomography (CT) within 24-hours of TBI between 2014-2018. Subjects were interviewed regarding post-index TBI during follow-up. Data from subjects aged = 17-years with 1-year or 3-7-year outcomes were extracted. Outcome measures included functional (GOSE:Glasgow Outcome Scale-Extended), post-concussive symptoms (PCS) (RPQ:Rivermead Post-Concussion Symptoms Questionnaire), psychological distress (BSI-18:Brief Symptom Inventory-18), depression (PHQ-9:Patient Health Questionnaire-9), post-traumatic stress disorder (PCL-5:PTSD-Checklist for DSM-5), and quality of life (QOL) (QOLIBRI-OS:Quality of Life After Brain Injury-Overall Scale). Multivariable regressions were adjusted for demographic, socioeconomic, and injury severity factors, and for multiple comparisons. Mean-differences (B), relative risks (RR), and 95% confidence intervals [CI] were reported.

RESULTS:
In 1,572 subjects, 3.2% and 12.2% sustained post-index TBI at 1-year and 3-7-years, respectively; 2.4% sustained multiple post-index TBIs at 3-7-years. Risk factors included psychiatric history, prior TBI, and extracranial injury severity. At 1-year, post-index TBI was independently associated with incomplete recovery (GOSE<8; RR = 1.75 [1.04-2.94]), decreased QOL (QOLIBRI-OS: B = -15.9 [-22.6, -9.1]), and increased severity of PCS, psychological distress, PTSD, and depression (RPQ: B = 8.1 [4.2-11.9], BSI-18: B = 5.3 [2.1-8.6]; PCL-5: B = 7.8 [3.2-12.4]; PHQ-9: B = 3.0 [1.5-4.4]); effects were conserved at reduced magnitudes at 3-7-years. Multiple (=2 vs. 1) post-index TBIs were associated with greater symptom severities across all outcome measures.

CONCLUSIONS:
Post-index TBI is associated with incomplete functional recovery, increased PCS, psychological distress, PTSD, and depressive symptom severities, and decreased QOL at 1- and 3-7-years post-injury. Sustaining multiple post-index TBIs further increases symptom severity across all outcome domains. Institutional processes and resources for TBI prevention, education, counseling, and follow-up are greatly needed.