bluuebunny/crossref_metadata_2025_split huggingface dataset:
815 Gender Parity in Neurosurgery Residencies: An Analysis
Authors: Kabangu Jean-Luc , Lei Catherine , Yekzaman Bailey R. , Minchew Heather , Birney Jalee , Heskett Cody , Lundy Paige , Miller Christopher 
Published: March 2024

INTRODUCTION:
The number of women graduating from U.S. medical schools has reached parity with that of men. However, persistent inequalities and barriers have made the pace towards equity in application and representation in neurosurgery residency slow despite initiatives to increase female representation.

METHODS:
Data on the number of active female neurosurgery residents and female applicants to neurosurgery was collected from the American Council of Graduation Medical Education Data Resource Book from 2007 to 2021 and Electronic Residency Application Service from 2014 to 2022, respectively. Bivariate linear regression analysis was used to predict percent of active female residents based on academic year (AY). Pearson Chi-squared was conducted to determine the odds ratio of a female applicant to neurosurgery.

RESULTS:
The percent of active female residents in neurosurgery increased from 11.0% in 2007 to 21.8% in 2021. Bivariate linear regression analysis using AY as predictor of percent of active females was statistically significant. On average, the percent of active female residents increases by 0.65% per year. If trends persist, parity in neurosurgery will not be reached until 2069. Linear regression analysis of the overall rate of attrition in neurosurgery as a predictor of percent of active female residents revealed that for every 1% increase in rate of attrition the percent of active female residents decreases between 1.4% to 4.4%. The percent of female applicants to neurosurgery increased from 19.6% in 2014 to 29.8% in 2022, yet the odds of a female applying to neurosurgery remains low.

CONCLUSIONS:
Neurosurgery continues to struggle with recruitment of female medical students, despite achievement of parity for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.
816 Comparing Match Data for Neurological and Orthopaedic Surgery Applicants From 2016-2022: Is There a Point of Diminishing Return for Research Experiences and Publications?
Authors: Allen Austin James , O'Connell Daniel , de Araujo Olivia , Ullman Lawrence , Carolyn Quinsey MD 
Published: March 2024

INTRODUCTION:
The application process for neurological surgery (NSGY) and orthopaedic surgery (Ortho) residency positions is highly competitive. Prior work has characterized variables associated with improved match rates; however, limited analyses have been published in recent years.

METHODS:
Data on the characteristics of NSGY and Ortho applicants was obtained from the National Residency Matching Program Interactive Charting Outcomes in the Match tool from 2016 to 2022. The POM was computed for each subgroup classification available for applicant characteristics.

RESULTS:
Applicant characteristics that correlated with an improved POM into both NSGY and Ortho included increasing USMLE Step 1 and Step 2 scores, being a US MD Senior, number (#) of contiguous ranks (a proxy for # of interviews), # of volunteer experiences, and being a member of AOA. An increasing # of publications correlated with an increased POM until 25+ were reported for NSGY applicants but only until more than 11-15 were reported for Ortho applicants. A PhD correlated positively with the POM for NSGY applicants but negatively for Ortho applicants. Non-PhD graduate degrees correlated negatively with the POM for both NSGY and Ortho applicants. An increasing # of work experiences correlated negatively with the POM for NSGY applicants at all levels, and correlated negatively with the POM for Ortho applicants after 3-5 were reported.

CONCLUSIONS:
There appeared to be a point of diminishing return where an increasing number of publications no longer increased the probability of matching for both NSGY and Ortho applicants. Non-PhD graduate degrees did not improve the POM. Ranking more programs was associated with a higher POM for both NSGY and Ortho applicants, suggesting an incentive to take as many interviews as possible if not otherwise restricted.
869 Early Signs of Elevated Intracranial Pressure (ICP) on Computed Tomography Correlate With Measured ICP in the Intensive Care Unit and Six-month Outcome Following Moderate to Severe TBI
Authors: Lucke-Wold Brandon 
Published: March 2024

INTRODUCTION:
Identifying patients at risk for increased intracranial pressure (ICP) followingTBI via baseline computed tomography (CT) has not previously been validated in a prospective dataset.

METHODS:
Data were obtained from the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECTIII) multicenter clinical trial. Baseline CT scans for 881 participants were individually reviewed by a blinded central neuroradiologist. Five signs of elevated ICP were measured (sulcal obliteration, lateral ventricle compression, 3rd ventricle compression, midline shift, and herniation). Associations between signs of increased ICP and outcomes (6-month functional outcome and mortality) were assessed.

RESULTS:
Sulcal obliteration (p = 0.029) and third ventricular compression (p = 0.039) were associated with elevated ICP. Univariate regression analyses indicated that increasing combinations of the five defined signs of elevated ICP were associated with mortality, poor functional outcome, and time to death. There was also an increased likelihood of mortality if patients required craniotomy (OR = 4.318, 95% Confidence Interval [1.330-16.030]) or hemicraniectomy (OR = 2.993 [1.109-8.482]). On multivariate regression analyses, hemorrhage location was associated with mortality (posterior fossa, OR = 3.208 [1.120-9.188] and basal ganglia, OR = 3.079 [1.178-8.077]). Volume of hemorrhage >30cc was also associated with increased mortality, OR = 3.702 [1.575-8.956]). The proportion of patient hours with sustained ICP = 20 mmHg, and maximum ICP = 20 mmHg, were also directly correlated with increased mortality (OR = 64.99 [7.731-635.51]; and OR = 1.025 [1.004-1.047]). Poor functional outcome was predicted by concurrent presence of all five radiographic signs of elevated ICP (OR = 4.44 [1.514-14.183]) and presence of frontal lobe (OR = 2.951 [1.265-7.067]), subarachnoid (OR = 2.231 [1.067-4.717]), or intraventricular (OR = 2.249 [1.159-4.508]) hemorrhage. Time to death was modulated by total patient days of elevated ICP = 20 mmHg (Effect Size = 3.424 [1.500, 5.439]) in the first two weeks of hospitalization.

CONCLUSIONS:
ICP-related imaging variables can be prognosticate for moderate-severe TBI.
872 Natural History of Conservatively Managed Patients With Chiari Malformation Type I and Syringomyelia
Authors: Patel Jay , Huang Jesse , Agwu Chibueze , Das Paramita 
Published: March 2024

INTRODUCTION:
Chiari malformation type 1 (CM1) describes caudal ectopia of the cerebellar tonsils. Though often asymptomatic earlier in life and found incidentally on imaging, CM1 can disturb cerebrospinal fluid (CSF) flow and generate an array of symptoms. Surgical treatment for CM1 centers around procedures to increase the posterior fossa volume and improve CSF circulation. Many surgeons elect to operate on CM1 patients in the setting of a syrinx, making it difficult to understand the natural history of these patients.

METHODS:
Retrospective study of 37 CM1 patients with syrinx who were managed conservatively at our institution. All patients had initial and follow-up clinic visits with a neurologist or neurosurgeon. Of the 37 patients, 27 had initial and follow-up MRI images at least six months apart. Student t-tests were used to compare radiological parameters.

RESULTS:
A total of three patients saw complete resolution of their syrinxes. Regarding clinical symptomatology, 19 out of 32 patients who were initially symptomatic saw clinical improvement by follow up, while 13 remained stable, and five declined. Of the five patients that declined, three had worsening neurological conditions not attributed to the syrinx or CM1 while the remaining two patients were the only patients that declined surgery despite recommendation. A total of 16 patients saw decreases in both syrinx size and tonsillar descent. There were no statistically significant differences between tonsillar descent, syrinx size, and number of vertebral bodies spanned by syrinx between the initial and latest follow up. The presence of tonsillar pegging was predictive of decrease in syrinx size. Tonsillar descent and syrinx size were not predictive of clinical outcomes.

CONCLUSIONS:
Although the surgical treatment of the CM1 patient successfully resolves the syrinx, the natural history of the syrinx can be benign.
893 Psychophysical Pain Encoding in the Cingulate Cortex Predicts Responsiveness of Electrical Stimulation
Authors: Caston Rose , Smith Elliot , Davis Tyler , Singh Hargunbir , Rahimpour Shervin , Rolston John David 
Published: March 2024

INTRODUCTION:
The anterior cingulate cortex (ACC) plays an important role in pain's cognitive and emotional processing. Prior studies have used deep brain stimulation (DBS) to treat chronic pain, but results have been inconsistent. This may be due to network adaptation over time and variable causes of chronic pain. Identifying patient-specific pain network features may be necessary to determine patients' candidacy for DBS.

METHODS:
Four patients who underwent intracranial monitoring for epilepsy (stereo-electroencephalography) participated in a pain task. Subjects placed their hand on a device capable of eliciting thermal pain for five seconds and rated their pain. Current-controlled biphasic trains of electrical stimulation were applied to a random subset of trials for each subject. Thermal pain thresholds with and without electrical stimulation were determined. To evaluate whether patients had neural activity susceptible to modulation, generalized linear mixed-effects models assessed the relationship between broadband high-frequency local field potential amplitude within the cingulate cortex (HFA; 70-150 Hz) and the resulting psychophysical pain evaluations.

RESULTS:
The pain threshold for each patient was determined from the psychometric probability density function. Two patients had a higher pain threshold with stimulation than without, while the others had no difference. We also evaluated the relationship between neural activity and pain responses. We found that patients who responded to stimulation had specific time windows where high-frequency activity was associated with increased pain ratings.

CONCLUSIONS:
Stimulation of cingulate regions with increased pain-related neural activity was more effective at modulating pain perception than stimulating non-encoding regions. Personalized evaluation of neural activity biomarkers could help identify the best target for stimulation and predict its effectiveness in future studies evaluating DBS.
907 Do Grades Suffer After Sport-Related Concussion? A Study of 94 Adolescent Athletes
Authors: Jo Jacob , Rigney Grant Harding , Williams Kristen , Burns Carter , Terry Douglas , Zuckerman Scott L. , Chanbour Hani 
Published: March 2024

INTRODUCTION:
Academic performance upon return-to-learn (RTL) following sport-related concussion (SRC) in adolescent athletes is an understudied yet important topic in the concussion literature.

METHODS:
A retrospective, cohort study was conducted of athletes 12-24-years-old who were treated for a SRC at a regional sports concussion center between 11/2017-04/2022. Athletes/parents were interviewed via phone regarding grades following concussion. Outcome variables included worsening of grades (yes/no) upon RTL to school and delayed time-to-normalization-of-grades (dichotomized: 0-90 days vs. >90 days). Independent variables include demographics, personal/family medical history, injury characteristics, school factors (type [private/public], accommodations received [yes/no], presence of concussion specialist/athletic trainer at school [yes/no], participant rating of teacher/school’s concussion knowledge [1-10]), and recovery (return-to-learn [RTL], symptom resolution, return-to-play). Univariate logistic regressions were performed.

RESULTS:
A total of 94 participants (60.4% male, 16.6 ± 2.6 years-old) were interviewed at a median time of 286 days (IQR: 247-420) post-concussion. The mean RTL of the cohort was 9.0 ± 13.2 days. Of all participants, 30/94 (31.9%) endorsed having worsening of grades upon RTL, and of those, 17/30 (43.6%) reported delayed time-to-normalization-of-grades (>90 days). Univariate analysis revealed no statistically significant predictors for worsening of grades; however, marginal significance was obtained as such that those with worse initial concussion symptoms were more likely to endorse feeling their grades worsened (OR = 1.02, p = .08, 95% CI 0.99, 1.04). No statistically significant predictors of delayed time-to-normalization-of-grades were found.

CONCLUSIONS:
In a cohort of adolescents with SRC, approximately 1 in 3 athletes reported worsening of grades, and 18% reported their grades did not normalize for >3 months. Marginal significance was obtained supporting the notion that those with worse initial symptoms were more likely to report worsened grades.
926 End of Life Decision-Making Inequities for Pediatric Patients With Severe Traumatic Brain Injury
Authors: Malhotra Armaan K. , Shakil Husain , Smith Christopher , Sader Nicholas , Ladha Karim , Wijeysundera Duminda , Singhal Ashutosh , Kulkarni Abhaya Vivek , Wilson Jefferson , Witiw Christopher , Nathens Avery 
Published: March 2024

INTRODUCTION:
The decision to withdraw life sustaining treatment (WLST) for pediatric patients with severe traumatic brain injury (TBI) is challenging for clinicians and families with limited evidence quantifying existing practices.

METHODS:
This retrospective study utilized data collected from trauma centers through the American College of Surgeons Trauma Quality Improvement Program between 2017-2020. We included pediatric patients (<19 years) with severe TBI and a documented decision for WLST. We utilized a random intercept multilevel logistic regression model to quantify patient, injury and hospital characteristics influencing WLST. In order to quantify the impact of disparate WLST practices on mortality, we ranked centers by their conditional random intercept computed quartile-specific adjusted mortality.

RESULTS:
We identified a total of 9803 children with severe TBI treated across 515 trauma centers, of which 1003 (10.2%) had WLST. Patient-level factors associated with increased likelihood of WLST were young age (<3 years), higher severity intracranial and extracranial injuries and mechanism of injury related to firearms. Following adjustment for patient and hospital attributes, the median odds ratio was 1.54 (95% CI: 1.50-1.57), reflecting residual variation in WLST between centers. When centers were grouped into quartiles by their propensity for WLST, adjusted mortality was higher for fourth compared to first quartile centers (OR 1.67, 95% CI: 1.47-1.90).

CONCLUSIONS:
Several patient and injury factors were associated with WLST decision-making for pediatric patients with severe TBI. We also showed variation in WLST practices between trauma centers after adjustment for case mix; these differences were associated with differing quartile-specific adjusted mortality rates. Taken together, these findings highlight the presence of care provision inequities among North American trauma centers regarding WLST practice patterns for pediatric patients with severe TBI.
Comparative Analysis of Single Versus Dual Anti-Epileptic Drugs for Controlling Intra-Operative and Early Postoperative Seizure in Glioma Patients Undergoing an Awake Craniotomy; A Retrospective Study
Authors: Zandpazandi Sara , Pour-Rashidi Ahmad 
Published: March 2024

INTRODUCTION:
Awake craniotomy (AC) is the standard approach for tumors of eloquent areas. However, concerns remain regarding the perioperative seizure risks and complications requiring general anesthesia (GA) or termination.

METHODS:
This retrospective cohort study included patients who underwent awake craniotomy for Glioma resection. Patients were divided into two groups based on their seizure control medication: Group S (N = 29) received one AED, while Group D (N = 26) received dual AEDs. We compared intraoperative seizures (IOS) and post-operative seizures (POS) rates between Groups S and D. Additionally, we evaluated the risk factors associated with POS and the 1-month post-operative Karnofsky Performance Scale (1M-KPS).

RESULTS:
This study considered a power of 0.9 so the effect size obtained was 0.866. 55 patients (41.8% female) with a median age of 39.0 (IQR 33.0-51.0) entered. The rate of IOS was 8 (27.6%) in Group S and 3 (11.5%) in Group D, with no statistically significant difference. (p = 0.137) POS occurred in 7 (24.1%) patients in group S and 2 (7.7%) patients in group D, (p = 0.100) pointing out no significant difference. The length of hospital stay (p = 0.606) and the length of ICU stay (p = 0.141), Post-op KPS, and 1M-KPS were not significantly different between the two cohorts (p = 0.131 and p = 0.217, respectively). The occurrence of POS was influenced neither by adjuvant therapy nor IDH1 mutation. The univariate and multivariate regression models showed pre-op KPS and the extent of resection had a significant effect on 1M-KPS.

CONCLUSIONS:
The addition of a second AED did not significantly affect POS prevention, IOS rate, or 1M-KPS improvement. Further research is needed for optimized strategies and improved patient outcomes.
Determining the Underlying Mechanisms of Glioma Progression and Recurrence
Authors: Voisin Mathew , Patil Vikas , Liu Jeffrey , Sosa Julio , Khan Shahbaz , Nassiri Farshad , Kislinger Thomas , Zadeh Gelareh 
Published: March 2024

INTRODUCTION:
Gliomas are the most common malignant brain tumour. Despite standard-of-care therapy, these tumours inevitably recur. Recurrent tumours are often treatment-resistant and associated with a poor prognosis, and there is an urgent need for novel treatments.

METHODS:
The epigenome-wide methylome, transcriptome, and proteome was analyzed in a total of 271 samples from 176 patients with gliomas, including 166 primary (pre-treatment) and 105 recurrent (post-treatment) tumours. Included is a unique cohort of 81 patients with paired tumour samples collected at both pre- and post- treatment.

RESULTS:
Epigenomics accounted for the majority of observed variance between samples and was driven by IDH status. Paired analyses identified epigenetic stability in IDH wildtype tumours at recurrence, compared to a loss of methylation at recurrence in IDH mutant tumours. Loss of methylation in IDH mutant gliomas at recurrence was driven by astrocytomas undergoing malignant transformation. Integrated, multi-platform analyses of paired samples undergoing malignant transformation identified novel genetic markers and pathways of transformation. Finally, a novel subgroup of IDH wildtype GBM with improved survival and a distinct proteomics signature was discovered. Multi-platform analyses characterized this novel subgroup as exhibiting hypermethylation, increased DNA mismatch repair and cell cycle regulation, and an altered tumour microenvironment.

CONCLUSIONS:
In conclusion, this study identifies targetable molecular factors that promote malignant transformation in IDH mutant gliomas and classifies a novel subgroup of IDH wildtype GBM with improved prognosis.
Human Plasma-Like Medium Activates Immune Elements in Glioma
Authors: El Shami Mohamad , Savani Milan , Hicks William Harrison , Gattie Lauren , McBrayer Samuel , Abdullah Kalil G. 
Published: March 2024

INTRODUCTION:
Glioma Surgically eXplanted Organoids (SXOs) are ex vivo three-dimensional models demonstrated to recapitulate the parental tumor microenvironment (TME). Human plasma-like medium (HPLM), a culture medium that mirrors physiologic nutrient conditions, has been found in other cancer subtypes to induce transcriptional differences in T-lymphocyte activation. We hypothesized that SXO culture in HPLM would maintain immune cell populations and induce physiologically relevant immune-modulatory pathways.

METHODS:
SXOs were established and cultured in conventional Glioma Organoid Complete medium (GOC) and transitioned to HPLM for 24 or 120 hours. Formalin-fixed paraffin-embedded samples were stained for tumor cells (GFAP), immune cells (CD45), and nucleic acid (SYTO-13) and analyzed using the Nanostring GeoMx™ Digital Spatial Profiler for spatial transcriptomics. Gene expression clustering profiles were conducted using GSEA and CIBERSORT. The gene expression differences of SXOs cultured in HPLM for 24 and 120 hours compared to those in GOC were analyzed by unpaired t-tests.

RESULTS:
Glioma SXOs retain diverse cell populations, with 20-30% of cells belonging to the TME. CD4+ T-cells were the most common (9.7 ± 1.0), followed by CD8+ T-cells (4.4 ± 0.6) and macrophages (3.1 ± 1.2). Following the transition to HPLM for 24 or 120 hours, there were no significant differences in tumor, immune, and stromal cell fractions. HPLM culture upregulated the immune response in SXOs, encompassing enhanced cytokine secretion, as well as improved adaptive and innate immune pathways. We particularly highlighted CD4+ T-cell activation (CD69+), Treg, and TGF-β signaling pathways as significantly increased.

CONCLUSIONS:
Here, we present that the culture of SXOs in physiologically similar media retains the heterogeneous TME and activates innate and adaptive immune signaling pathways. Culture in HPLM enables investigation of the glioma immune microenvironment, expanding the biological relevance of experimental results from in vitro SXO models.