bluuebunny/crossref_metadata_2025_split huggingface dataset:
413 Evaluation of Osteoporosis in the Lumbar Spine in Multiple Myeloma Patients Using 18F-NaF PET/CT
Authors: Gandhi Om , Park Peter , Gujral Jaskeerat , Park Mia , Werner Thomas , Høilund-Carlsen Poul , Alavi Abass 
Published: March 2024

INTRODUCTION:
Multiple myeloma (MM) is a plasma cell malignancy that structurally damages and weakens the bone, most commonly in the spine, by inducing osteoporosis, osteolytic lesions and pathological fractures. Detecting molecular changes in bone metabolism, such as reduced osteoblastic activity and bone remodeling associated with MM, would allow for early diagnosis of osteoporosis in the lumbar spine and reduce risk for surgical spinal interventions. One such imaging candidate is 18F-NaF PET/CT, a molecular imaging technique sensitive to bone formation.

METHODS:
The FULIMA clinical trial (NCT02187731) was conducted with 70 newly diagnosed MM patients, with exclusion criteria leaving 33 patients for analysis (9 females, 24 males; mean age 66.6y). Patients’ trabecular body of the L1-L4 vertebrae was analyzed using 18F-NaF PET/CT scans to calculate and evaluate the linear associations among mean standardized NaF uptake value (SUVmean), mean Hounsfield unit (HU) values, and age. Receiver-operating characteristic (ROC) curve analysis with area under the curve (AUC) using the Wilson/Brown method assessed the predictive value of NaF uptake via SUVmean for osteoporosis determined by HU threshold.

RESULTS:
There was significant positive correlation between HU value and SUVmean (r = 0.64, p < 0.0001) and negative correlations between age and both HU value (r = -0.59, p < 0.0003) and SUVmean (r = -0.53, p = 0.002). Additionally, on average, there was a 29.1% difference in the NaF uptake of MM patients with osteoporosis (SUVmean = 7.0 ± 1.48) compared to normal MM patients (SUVmean = 4.96 ± 1.46). Predictive value of NaF per AUC analysis was 0.857 with p = 0.002.

CONCLUSIONS:
18F-NaF PET/CT detects the decreased osteoblastic activity of osteoporosis in the lumbar spine with high precision and accuracy in MM patients, facilitating timely interventions and reducing risk for invasive procedures.
416 Redefining Treatment Expectations: Exploring Long-Term Outcomes of Venous Sinus Stenting in Idiopathic Intracranial Hypertension
Authors: Midtlien Jackson , Klever Lucas , Kiritsis Nicholas , Fargen Kyle Michael 
Published: March 2024

INTRODUCTION:
Idiopathic intracranial hypertension (IIH) is a condition characterized by various symptoms such as pulsatile tinnitus, chronic headaches, and papilledema. Venous sinus stenosis has been associated with IIH, and venous sinus stenting (VSS) has emerged as a potential treatment option. However, there is a lack of standardized outcome definitions and limited long-term data on the effectiveness of VSS in current literature.

METHODS:
In this study, we analyzed the long-term outcomes of 178 patients with medically-refractory IIH who underwent VSS by the senior author. Demographic information, pressure gradients, symptom improvement, recurrence, and persistence were recorded. Quality of life and symptom severity scores were assessed using standardized HIT-6, WHO-BREF, and pulsatile tinnitus surveys. Follow-up duration and patient-reported outcomes were also considered.

RESULTS:
Among the VSS cohort, 52.8% reported initial symptom relief followed by recurrence, and 13.5% experienced persistent symptoms without improvement. Overall failure rate of VSS was found to be 66.3%. Repeat procedures, such as lumbar puncture or additional stenting occurred in many patients. Survey data showed varying degrees of improvement in symptom severity and quality of life, and these changes were found to be statistically insignificant long-term.

CONCLUSIONS:
Our study challenges the prevailing notion of favorable outcomes in VSS suggests a need for reevaluation of the procedure as a long-term treatment option for severe IIH. High rates of symptom recurrence, persistence, and the need for repeat interventions indicate limitations in the efficacy of VSS. Improved understanding of the underlying factors contributing to poor outcomes and the development of alternative interventions are essential for better management of this debilitating condition.
419 Synergistic White Matter Injury Secondary to Chronic Cerebral Hypoperfusion and Air Pollution is Reduced by Microglia-Specific TLR4-Knockdown
Authors: Sizdahkhani Saman , Shkirkova Kristina , Lamorie-Foote Krista , Zhang Hongquiao , Zhao Lifu , Diaz Arnold , Sioutas Constantinos , Finch Caleb , Pike Christian , Mack William 
Published: March 2024

INTRODUCTION:
Air pollution is recognized as a neurotoxin which damages white matter and increases the risk of cognitive decline. Our previous work in a murine model found that air pollution in the setting of chronic cerebral hypoperfusion (CCH) leads to a synergistic deleterious effect on white matter. Air pollution studies have shown that increased microglial activation was associated with neurotoxicity. We hypothesize that inhibition of a microglial-specific TLR4 pathway will decrease the neurodegenerative effects that normally result from combined CCH and air pollution.

METHODS:
Our air pollution model used eight weeks of standardized Diesel Exhaust Particles (DEP) from National Institute of Science and Technology (DEP NIST2975). We performed bilateral carotid stenosis (BCAS) surgery to induce CCH using Wild Type (WT) and TLR4 flx/flx (CX3CR1CreER +/-) (TLR4-KD) in 2-month-old male mice. WT and TLR4-KD mice were randomized into eight groups as follows: WT-filtered air (FA), WT-DEP, WT-FA-BCAS, WT-DEP-BCAS, TLR4-KD-FA, TLR4-KD-DEP, TLR4-KD-FA-BCAS, and TLR4-KD-DEP-BCAS. Neurotoxicity was quantified with immunohistochemistry of degraded myelin basic protein (dMBP), ionized calcium-binding adaptor molecule-1 (Iba-1), and complement (C5a).

RESULTS:
DEP exposure resulted in increased white matter injury in corpus callosum (dMBP), worsened by the presence of CCH (p = 0.004) and significantly attenuated by TLR4-KD (p = 0.005). DEP exposure resulted in increased white matter microglial activation (Iba-1), worsened by the presence of CCH (p < 0.0001) and significantly attenuated by TLR4-KD (p = 0.04).DEP exposure resulted in increased white matter complement activation (C5a), worsened by the presence of CCH (p < 0.0001) and significantly attenuated by TLR4-KD (p < 0.0001).

CONCLUSIONS:
Microglial-specific TLR4-KD reduces air pollution-induced neurotoxicity measured by white matter injury, microglial activation, and neuroinflammation.
443 Myeloid Immunometabolic Reprogramming Mitigates Chronic Neurodegeneration After Experimental Traumatic Brain Injury
Authors: Moore Nicholas , Jarrahi Abbas , Lu Yujiao , Khodadadi Hesam , Jones Earl Dane , Kaoutzani Lydia , Vale Fernando L. , Vender John R. , Baban Babak , Dhandapani Krishnan 
Published: March 2024

INTRODUCTION:
Traumatic brain injury (TBI) induces immediate mechanical injury, including diffuse axonal shearing and myelin degradation. Epidemiological studies suggest a single, severe TBI initiates progressive neurodegeneration, including extensive white matter injury and culminating in long-term cognitive decline. While underlying mechanisms remain undefined, the degree of chronic inflammation correlates with delayed white matter tract damage after TBI.

METHODS:
Immune cell infiltration and activation was measured using preparative and analytical flow cytometry after controlled cortical impact, a pre-clinical model of focal penetrating injury, in adult mice. To assess T cell priming, APCs pulsed with myelin or isolated after experimental TBI were co-cultured with naÏve splenic T cells. Progressive neurodegeneration was assessed by histology and magnetic resonance imaging at eight weeks post-injury.

RESULTS:
Peripheral macrophages predominated as APCs within the CNS parenchyma after severe TBI. Myelin-pulsed APCs or APCs isolated after experimental TBI efficiently primed naÏve T cells ex vivo, generating myelin-reactive Th1/Th17 cells. Activity of the master metabolic regulator AMPK, previously shown to promote counter-inflammatory immune polarization, was decreased in myeloid cells after injury. Treatment with metformin, an AMPK activator, restored myeloid AMPK activity and attenuated neurodegenerative changes at eight weeks post-TBI.

CONCLUSIONS:
TBI-induced immunometabolic dysregulation allows generation of auto-reactive T cells that may contribute to chronic inflammation and progressive neurodegeneration. Metabolic reprogramming of myeloid cells via metformin restores AMPK activity and reduces progressive white matter loss after TBI, representing a potential therapeutic intervention to mitigate long-term consequences of TBI.
444 Quantitative Mapping of Cerebral Blood Flow and Blood-Brain Barrier Water Exchange Rate (Kw) Reveals the Mechanobiological Impact of Cranioplasty: A Magnetic Resonance Imaging Study of Patients With Cranial Defects
Authors: Abedi Aidin , Ojogho Brandon , Lee Darrin J. , Shao Xingfeng , Russin Jonathan , Wang Danny J. J. , Liu Charles Y. 
Published: March 2024

INTRODUCTION:
Large cranial defects may cause neurological decline due to brain shift, while cranioplasty may improve cognitive function, although the underlying mechanisms remain poorly understood. Blood-brain barrier (BBB) water exchange rate (Kw) is a novel magnetic resonance imaging (MRI) method which provides insights into the processes underlying the effects of cranioplasty.

METHODS:
Adult patients with cranial defects who were candidates for elective cranioplasty were consented and enrolled. Using a 3T MRI, we conducted baseline imaging on all patients, and repeated the imaging during the early post-cranioplasty period. The Kw and CBF were quantified, and asymmetry was calculated as the difference between the values on the ipsilateral and contralateral hemispheres relative to the cranial defect, divided by the sum of those values. Pairwise comparisons of the changes from baseline to post-cranioplasty period were performed using Wilcoxon signed-rank test.

RESULTS:
A total of 10 patients were enrolled (mean age: 35.4 ± 9.49, 9/10 men). The global CBF showed significant improvements after cranioplasty. There was a remarkable Kw asymmetry in the caudate area at baseline (low on defect side), which significantly improved post-operatively (median: -0.077 vs. 0.021, p = 0.049), while the changes in CBF in this area were not significant (median: -0.002 vs. 0.014, p = 0.160). Other brain regions yielded no significant changes in Kw asymmetry.

CONCLUSIONS:
Reduced Kw has been reported in cognitive decline and cerebral small vessel diseases, and may be related to impaired water circulation in the brain. We observed increased global CBF and Kw asymmetry in caudate which may reflect improved brain physiology and water circulation following cranioplasty. Kw is a non-invasive and non-contrast method that offers an opportunity to understand the intricate changes in brain homeostasis following reconstruction surgery.
450 Inflammatory Brachial Plexitis Mimics Postoperative Iatrogenic Neurological Deficits
Authors: Ambati Vardhaan Sai , Madugala Neha , Anderson Noriko , Shah Vinil , Mummaneni Praveen V. , Poncelet Ann 
Published: March 2024

INTRODUCTION:
A common cause of neurosurgical malpractice cases is the misrepresentation of idiopathic brachial neuritis (incidence: 1/1000) as an iatrogenic neurological insult caused by a surgeon.

METHODS:
Confirmed postprocedural brachial neuritis patients from a single quaternary care institution were identified and analyzed.

RESULTS:
We identified 6 (3 female) postprocedural brachial neuritis patients with mean age 63.7 (range 50-75) years. Procedures included 5 cervical spine surgeries (3 multilevel ACDFs, 2 multilevel posterior fusions with laminectomies, 1 multilevel disc arthroplasty) and 1 intrajugular central venous catheter placement. Average time to symptom onset was 1 week post-procedure (range 1 day-2.5 weeks). Initial symptom was moderate-to-severe shoulder (5), arm (4), and/or neck (1) pain. Subsequently, all developed axillary/shoulder weakness; 3 distal arm/hand weakness, 2 winged scapula, and 2 dyspnea/orthopnea. For diagnosis, two patients had confirmatory EMG, 1 had MR neurography confirming plexus inflammation, and 3 had both (positive EMG findings and inflammation on MR Neurography). Average time to accurate diagnosis was 3.1 (range 1.5-5) months. Average number of clinicians seen prior to accurate diagnosis: 5. Treatments included opioids (5), steroids (1), and/or physical therapy (6). All experienced partial pain relief by 1-8 weeks; 2 had persistent pain requiring gabapentin past 6 months. All patients continued to experience motor deficits past 6 months: (4 patients had atrophy and 2-4/5 motor strength in proximal the proximal arm, 1 had distal arm 3/5 motor strength, and 1 had scapular winging).

CONCLUSIONS:
Postoperative idiopathic brachial plexitis mimics iatrogenic nerve damage following neurosurgical procedures. Recognition of this entity is difficult, and 6 patients at our institution saw on average 5 providers over 3 months prior to accurate diagnosis. Brachial plexitis has a prolonged course with typically only partial recovery at 6 months.
458 Endoscopic Versus Open Carpal Tunnel Release: An Umbrella Review and a Meta-Analysis
Authors: Chanbour Hani , El Masri Jad , Masri Diala , Liles Campbell , Ghazi Maya , Jonzzon Soren , Younus Iyan , Salemeh Pascale , Hill Brad , Zuckerman Scott L. 
Published: March 2024

INTRODUCTION:
Whether open carpal tunnel release (OCTR) versus endoscopic carpal tunnel release (ECTR) has super outcomes remains a controversial topic.

METHODS:
A PubMed, Scopus and Cochrane databases was conducted for all meta-analyses comparing OCTR and ECTR performed between 2000-2022 in accordance to PRISMA and Joanna Briggs Institute guidance of umbrella reviews. The primary outcomes were: 1) functional ability: symptoms severity, grip strength, pinch strength, two-point discrimination, and pain, 2) operative outcomes: operation time, total complications, nerve injury, scar formation, and 3) time to return to work. Pooled analysis was performed to compare outcomes using Review Manager Version 5.2.11.

RESULTS:
9 meta-analyses were included, 5 were of high quality and 4 were moderate quality on the Assessment of Multiple Systematic Reviews (AMSTAR) scale. Functional ability: OCTR was associated with better pinch strength after 3-months (0.70, 95% CI = 0.00, 1.40, p = 0.05) and after 6-months (0.77, 95% CI = 0.14, 1.40, p = 0.02, I2 = 84%). Operative outcomes: OCTR was associated with less nerve injury (3.26, 95% CI = 1.20, 8.86, p = 0.02, I2 = 0%) and more risk of scars formation (0.40, 95% CI = 0.24, 0.66, p = 0.0003, I2 = 41). Return to work: OCTR was associated with longer return to work (-10.89, 95% CI = -15.14, -6.64, p < 0.00001, I2 = 83%). There were no significant differences between OCTR and ECTR in the hand function, symptom severity, grip strength, pain, operation time and total complications.

CONCLUSIONS:
In an umbrella review and meta-analysis of OCTR vs. ECTR, we found that while OCTR demonstrated higher pinch strength and lower nerve injury risk, ECTR was associated with less scar formation and a shorter time to return to work.
468 Does the Choice of C2 Versus Subaxial Upper Instrumented Vertebrae Impact 24-month Outcome and Satisfaction in Patients With Cervical Myelopathy? A QOD Study
Authors: Park Christine , Shaffrey Christopher I. , Johnson Sarah , 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 , Haid Regis W. , Mummaneni Praveen V. , Michalopoulos Giorgos , Bydon Mohamad , Gottfried Oren N. 
Published: March 2024

INTRODUCTION:
There is limited data on the outcomes regarding the effect of upper instrumented vertebrae (UIV) selection in patients with cervical spondylotic myelopathy (CSM).

METHODS:
This was an analysis of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort which included adult patients who were diagnosed with primary CSM undergoing elective surgery. Patient-reported outcomes including VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction were collected at baseline and 24 months.

RESULTS:
Of the 239 patients with CSM who underwent PCF, 48 (20.1%) had UIV of C2 and 191 (79.9%) had UIV of C3/below. The 24-month follow-up rate was 87.4% for patient-reported outcomes. At baseline, C2 group had a higher frequency of motor deficit (83.3% vs 68.1%, p = 0.04) compared to the C3/below group; otherwise, there was no difference in pain, function, and quality of life. C2 group had greater number of treated levels (6.1 ± 2.0 vs 4.5 ± 1.3, p < 0.01) compared to the C3/below group. At 24-month follow-up, the two groups achieved similar rates of satisfaction and MCID for pain, disability, myelopathy, and quality of life (all p > 0.05) postoperatively.

CONCLUSIONS:
Although the C2 group had greater number of treated levels compared to the C3/below group, the two cohorts had overall similar baseline characteristics and achieved similar MCID rates of the measured outcomes. The results of this study suggest that UIV of C2 may not have appreciable benefit over subaxial UIV in patient-reported outcomes.
473 Does Bioactive Glass Ceramic Cage Achieve Early Fusion in Anterior Cervical Discectomy and Fusion?: A Prospective Multicenter Study
Authors: Moon Bongju 
Published: March 2024

INTRODUCTION:
Bioactive glass ceramic (BGC) is known to chemically bond with bones by forming a hydroxyapatite layer and inducing osteoblastic differentiation.

METHODS:
A total of 40 patients who underwent 1-level ACDF using BGC cage to treat degenerative cervical radiculopathy/myelopathy were enrolled in multicenter (3 hospitals) prospectively. Fusion defined by CT and X-ray, subsidence, and breakage of BGC cage were evaluated at postoperative six months period. Demographic data, fusion rates, visual analog scale (VAS) scores for neck or arm pain, Neck Disability Index (NDI) scores, SF-36 and complications were also checked.

RESULTS:
Fusion rates were 88.5% when assessed by interspinous motion and 92.3% when CT assessed by intragraft and extragraft bone bridging in the BGC group at 6-month follow-up. The neck pain or arm pain VAS scores, NDI scores and SF-36 significantly improved. No material-related complications were observed related BGC cage, such as graft resorption and breakage. Subsidence occurred 3 patients who improved neck pain or arm pain VAS scores, and NDI scores compared to preoperative status.

CONCLUSIONS:
BGC cage was effective and safe when used in ACDF, conferring a early and high fusion rate and favorable clinical outcomes at postoperative 6 months period.
476 Middle Cranial Fossa Encephaloceles With Temporal Lobe Epilepsy: An Underdiagnosed Entity
Authors: McCormack Ryan , Tandon Nitin 
Published: March 2024

INTRODUCTION:
Temporal lobe epilepsy with encephalocele (TLEE) is a lesional epilepsy increasingly recognized as underdiagnosed. Here we report our experience with TLEE-associated epilepsy managed with both traditional ATL with AH compared to a targeted lesionectomy of the encephalocele.

METHODS:
We used a prospectively maintained database of surgical epilepsy patients to identify all patients with TLEE-associated epilepsy managed over a 13-year interval using ATL with AH, ATL only, or a targeted encephalocele-only lesionectomy. Details regarding epilepsy, neuropsychology, management, complications, and outcomes at the last follow-up were compiled.

RESULTS:
793 surgical epilepsy patients were evaluated, with 56 (7.1%) demonstrating TLEE. The average age of epilepsy onset was 31.7 years (range 2-57); the age at the time of surgery was 38.3 years (range 15-69). Twenty-one patients (37.5%) were managed with ATL with AH, 20 (35.7%) with temporal pole resection without AH, and 15 (26.7%) with targeted lesionectomy/LITT of the temporal encephalocele. Forty-seven patients (84%) had good surgical epilepsy outcomes with no significant difference in modality. Targeted lesionectomy demonstrated significantly greater language preservation (p = 0.046) and verbal memory (p = 0.038) when compared to more extensive surgical resections.

CONCLUSIONS:
TLEE is an overlooked and underreported etiology of epilepsy. In select cases, good surgical epilepsy outcomes can be achieved with targeted lesionectomy of the encephalocele when the epilepsy network is not widespread.
477 Identifying the Neural Correlates of the Triple Code Model in Numerical Cognition Using Stereotactic Electroencephalography in Epilepsy Patients
Authors: Ramos Christian Lopez , Tan Hao , Rockhill Alexander P. , Yamamoto Erin A. , Shahin Maryam Nour , Nerison Caleb , Raslan Ahmed M. T. 
Published: March 2024

INTRODUCTION:
The capacity to process numerical quantities is an essential human trait. The “Triple Code Model” (TCM) in numerical cognition, theorizes that different neural substrates encode the processing of visual, auditory, and nonsymbolic numerical representations formats. Limited data exists examining the direct electrophysiological activity involved in numerical cognition.

METHODS:
Thirteen patients with medically refractory epilepsy that underwent sEEG for the localization of seizures performed a passive numerical recognition task. Subjects were presented with a number quantity from 1 to 9 in one of five different representation formats: two were auditory (spoken numbers, sequential beeps) and three were visual (Arabic numeral, written word, assortment of dots). A total of 2,482 electrode contacts were analyzed. Time-frequency spectrograms were reduced with principal component analysis (PCA) and passed into a linear support vector machine (SVM) classification algorithm to identify neural correlates of number processing.

RESULTS:
The highest classification accuracy in number processing, irrespective of representation format occurred in the bilateral parietal lobes, right lingual cortex, and bilateral putamen. A total of 407, 776, 854, 475, and 513 contacts had significant classification values during Arabic, beep, spoken, written, and dots, respectively. Bilateral superior temporal cortices demonstrated the best classification value for the processing of auditory formats, whereas visual formats (Arabic and written number) showed greatest involvement in the frontal lobe and inferior precentral gyrus. Classification of dots indicated preferential engagement of the left parietal cortex. Spectral analyses revealed that non-gamma frequency bands held greater than chance classification values to characterize format-specific number representations.

CONCLUSIONS:
Using a linear SVM classifier with PCA, we examined the Triple Code Model in numerical cognition and identified several neural structures with high classification values involved in numerical processing.