bluuebunny/crossref_metadata_2025_split huggingface dataset:
338 Getting Ahead of the Disparities Curve: Increasing Capture Rate of Comorbidities Which Would Exacerbate Socioeconomic Disparities in a Value-Based System
Authors: Patel Pious D. , Khanna Omaditya , Salwi Sanjana , Metzinger Matthew , Rosenwasser Robert H. 
Published: March 2024

INTRODUCTION:
Value-based systems will place financial risk on providers. If these payments are not adequately adjusted for comorbidity burden, systems will be disincentivized to treat marginalized socioeconomic groups who have disproportionately high comorbidity burden.

METHODS:
Comorbidity-focused note-writing templates were incorporated into the physicians’ workflow within Jefferson University Hospital’s Neurosurgery Department. A list of high-risk comorbidities was identified and incorporated into the top of each note. Emphasis was given to comorbidities which have high historical impact on mortality and which are commonly overlooked in the acute neurosurgical decisionmaking process (e.g. obesity). The selected comorbidities were populated into the top of every note which included treatment plans for each condition. The process measure included the percentage of notes in compliance with the template. The outcome measures were expected mortality (composite variable representing comorbidity burden) and the capture rate of major comorbidities within the coding process. Measures were compared between one full year pre and post-intervention. Coders were blinded to the presence of our intervention.

RESULTS:
There was 100% compliance after the second week post-intervention (as measured by full audit of all notes written). There was a 44% (3.4% to 4.9%) improvement in expected mortality for the department’s encounters. There was an increased capture rate for several major comorbidities which are disproportionately associated with marginalized socioeconomic groups. These included malnutrition (233% increase, from 3% to 10%), coagulopathies (71% increase from 7% to 12%), obesity (50% increase from 22% to 33%), congestive heart failure (43% increase from 7% to 10%), hypertension (31% increase from 13% to 17%), and deficiency anemias (31% increase from 16% to 21%).

CONCLUSIONS:
We present a low-cost framework to increase capture rate of high-risk comorbidities which traditionally contribute to socioeconomic disparities.
365 Outcomes of Circumferential Minimally-Invasive Technique Versus Open Technique in Adult Spinal Deformity Surgery Patients Over 80 Years of Age: A Propensity-Matched Analysis
Authors: Tretiakov Peter S. , Passias Peter G. , Uribe Juan S. , Alan Nima , Le Vivian , Dave Pooja , Mir Jamshaid M. , Lafage Renaud , Line Breton G. , Wang Michael Y. , Okonkwo David O. , Anand Neel , Fessler Richard G. , Fu Kai-Ming G. , Nunley Pierce D. , Park Paul , Turner Jay D. , Kanter Adam S. , Mundis Gregory M. , Chou Dean , Ames Christopher P. , Hart Robert A. , Smith Justin S. , Shaffrey Christopher I. , Schwab Frank , Bess Shay , Lafage Virginie , Eastlack Robert , Mummaneni Praveen V. , Burton Douglas C. , Das Ankita ,   International Spine Study Group
Published: March 2024

INTRODUCTION:
Circumferential minimally-invasive surgery (cMIS) techniques in ASD surgery may provide benefit in reducing physiologic burden, but the utility of such surgeries in patients greater than 80 years of age has not been assessed.

METHODS:
Operative ASD patients 18yrs with complete pre-(BL) and 2-year(2Y) data were assessed. Patients aged =80years were isolated and compared by surgical technique: Open vs cMIS. BL and peri/post-operative factors were assessed using ANOVA and Bonferroni-adjusted ANCOVA while controlling for BL CCI and posterior levels fused. Propensity score matching (PSM) was used to align cMIS vs Open groups by BL CCI, C7-S1 SVA, PI-LL, and C7PL.

RESULTS:
174 ASD patients were included (62.85 ± 13.93 years, 75.7% female), split evenly between cMIS and Open. 19.5% (n = 34) were octogenarians; 29.4% operated via cMIS vs 70.6% Open. At baseline, patients were comparable in gender, BMI, and history of spine surgery (all p > .05). At BL, frailty scores were comparable (both p > .05). Post-operatively, Open patients reported higher SRS-22 Appearance and Mental domain scores (both p < .005), and were more likely to reach MCID in both domains by 2Y (p = .025, .024, respectively). In terms of post-operative complications, cMIS patients were more likely to require reoperation for radiographic sagittal imbalance by 2Y when controlling for CCI and levels fused (20.0% vs 8.3%, p < .001). By 2Y, there were no recorded deaths in the cMIS nor Open octogenarians.

CONCLUSIONS:
Our comparison of octogenarian adult spinal deformity patients undergoing circumferential minimally-invasive versus open surgery demonstrates that while cMIS patients benefit from decreased blood loss, operative time, and SICU and hospital length of stay, both Open and cMIS patients benefit from similar improvement in patient-reported outcomes. Likewise, Open technique, though more invasive, may also reduce the risk for reoperation due to radiographic instability by 2Y post-operatively.
378 Meningiomas Causing Bony Hyperostosis Upregulate Cell Adhesion, Bone Mineralization, and Bone Development Gene Signatures
Authors: McDonald Malcolm F. , Khan Basit , English Collin , Chang Andrew , Harmanci Arif , Harmanci Akdes , Klisch Tiemo , Patel Akash J. 
Published: March 2024

INTRODUCTION:
Meningiomas are the most common primary intracranial tumor. Some meningiomas cause hyperostosis of the adjacent bone, affecting surgical approach.

METHODS:
Two hundred twelve meningioma MRIs were reviewed by a neuroradiologist to classify location and hyperostosis or bone involvement. These tumors were bulk RNA sequenced and analyzed with gene sets enrichment analysis (GSEA), gene ontologies (GO), and differentially expressed genes (DEGs).

RESULTS:
Sixty-seven meningiomas had hyperostosis detected in imaging compared to 145 without it. Meningiomas with hyperostosis occurred most commonly in the sphenoid wing and lateral skull base and relatively less commonly in the clinoidal and clival region (p-val = 0.033, Fisher’s Exact). Looking at the distribution throughout MenG groups, a multi-omic classifier used to predict recurrence, meningiomas with hyperostosis occurred more frequently in the MenG A and MenG C groups compared to MenG B group (p-val = 0.0299, Fisher’s Exact). This may reflect previously described similarity in transcriptional signatures of group A and C. GO analysis revealed upregulation of skeletal system development, peptide breakdown, cell adhesion, and collagen biological processes in hyperostotic tumors (a.,p-val < 0.05), and downregulation of synaptic signaling and receptor activity (b.,p-val < 0.05). When analyzing only genes that were significantly upregulated (padj < 0.05), GOs related to skeletal system development, cellular movement, and hydrogen peroxide processing were upregulated. Alternatively, synaptic transport and negative regulation of peptide breakdown were downregulated. Specific upregulated genes include MEPE, a bone mineralization gene, and cell migration genes like NYAP2, TNS4, and GPM6A (Log2FC > 1, padj < 0.05).

CONCLUSIONS:
Meningiomas with hyperostosis occurred more frequently in the sphenoid wing and lateral skull base. MenG B tumors were least likely to cause hypoerostosis, Meningiomas causing hypoerostosis have unique transcriptional signatures related to bone involvement and cell motility, matching their invasive phenotype.
384 BOLD Asynchrony Reveals Tumor Burden in IDH-Wildtype Gliomas
Authors: Yoh Nina , Petridis Petros , Chokran Cole , Kotidis Corina , Bruce Jeffrey N. , Canoll Peter D. , Grinband Jack 
Published: March 2024

INTRODUCTION:
IDH-wildtype gliomas are aggressive, highly invasive, and invariably fatal. Maximal safe resection of tumors is the primary goal in glioma surgery, as it has been associated with improved survival and better outcomes. However, there is no clinically accepted method for identifying the extent of tumor burden in these neoplasms. This uncertainty poses a challenge for clinicians who must balance tumor removal with the sparing of healthy brain.

METHODS:
Forty stereotactically-localized biopsies were obtained during open surgical resection from twenty treatment-naÏve patients with IDH-wildtype gliomas who received standard-of-care preoperative imaging as well as echo-planar resting-state BOLD fMRI. Signal intensity for BOLD asynchrony and standard-of-care imaging was compared to cell counts of total cellularity (H&E), tumor density (Sox2), cellular proliferation (Ki67), and neuronal density (NeuN), for each corresponding sample.

RESULTS:
BOLD asynchrony was directly related to tumor density as well as cellular proliferation and inversely related to neuronal density. Peritumoral regions that appeared normal on standard-of-care imaging but with elevated BOLD asynchrony showed elevated tumor burden on histology.

CONCLUSIONS:
BOLD asynchrony is a novel imaging technique that can elucidate tumor burden that is not observable on standard-of-care imaging. Including BOLD asynchrony in preoperative planning can provide more accurate margins for tumor resection, which may improve patient outcomes and overall survival.
405 The Impact of Cerebral Revascularization on Pial Collateral Flow in Patients With Moyamoya Disease Using Quantitative Magnetic Resonance Angiography
Authors: Santhumayor Brandon , White Timothy G. , Rivera Moses , Ryu Brendan Hanil , Golombeck David , Turpin Justin , Dehdashti Amir R. , Langer David J. 
Published: March 2024

INTRODUCTION:
Moyamoya disease (MMD) is a chronic steno-occlusive disease primarily of the anterior circulation leading to significant pial collateralization. Changes in the distribution of intracranial blood flow after revascularization surgery are not well understood.

METHODS:
We conducted a retrospective chart review of 46 patients with unilateral MMD who underwent cerebral revascularization from 2011-2019. Patients who underwent pre- and post- QMRA NOVA were included in the study. Flow was measured at the M1 segment of the middle cerebral artery (MCA), P2 segment of the posterior cerebral artery (PCA), and A2 segment of the anterior cerebral artery (ACA). Pial collaterals were defined as the sum of (A2+P2) flow. Total hemispheric flow was calculated as (M1+PCA+A2) pre-operatively and (M1+PCA+A2+Bypass) post-operatively, with the incorporation of the bypass graft.

RESULTS:
A total of 46 patients with unilateral MMD underwent revascularization with pre and post QMRA. Total intracranial flow at baseline prior to revascularization was lower in the side of disease (214.9 ml/min vs. 269.1 ml/min). Total intracranial flow at baseline after revascularization remained lower on the ipsilateral side of disease with an increased flow in the contralateral healthy side (211.7 ml/min vs 286.1 ml/min). Pre-bypass there was a higher flow through pial collaterals on the ipsilateral diseased side (183 ml/min) than the contralateral healthy side (135 ml/min). Post-bypass this difference in pial flow between ipsilateral and contralateral sides decreased from 48 ml/min to 22 ml/min (p = 0.02). Collateral ratio decreased significantly (0.46 preoperatively vs. 0.18 postoperatively) (P < 0.01).

CONCLUSIONS:
The results of this study quantitatively confirm that direct cerebral revascularization decreases collateral stress in patients with moyamoya disease.
408 Nerve to Subclavius for Neurotization Procedures: An Anatomical Feasibility Study
Authors: Cardona Juan J. , McCarty Patrick John , Chaiyamoon Arada , Carrera Ana , Reina Francisco , Georgiev Georgi P. , Iwanaga Joe , Dumont Aaron S. , Tubbs R. Shane 
Published: March 2024

INTRODUCTION:
Injuries to the inferior trunk (IT) of the brachial plexus and its components can be debilitating. As such injuries are prioritized by surgeons during repair, an additional nerve transfer is considered.

METHODS:
13 adult cadavers (26 sides) underwent dissection of the nerve to subclavius and proximal brachial plexus. Once the nerve was isolated from origin to termination, the C8 and T1 roots and IT were identified. The distal end of the nerve to subclavius was transected and swung to these roots and the IT. Once the nerves to subclavius were transposed and in a tension-free manner, the length of excess nerve following being brought to each of these nerves was measured.

RESULTS:
A nerve to subclavius originated from the superior trunk and traveled anterior to the middle and inferior trunks on all sides. The mean diameter of the nerve to subclavius was 0.8 mm and the mean length was 57 mm. After cutting the nerve to subclavius at its entrance into the subclavius muscle, the distal nerve could be transferred tension free to the IT of the brachial plexus and T1 ventral ramus on all sides. The distal nerve to subclavius reached the T1 ventral ramus with an average of 18 mm of additional length and to the C8 ventral ramus with an average of 19 mm. The nerve also could be transferred to the IT of the brachial plexus with an average of 20 mm of additional length. The nerve to subclavius was found to have approximately 3,000 axons.

CONCLUSIONS:
To our knowledge, use of the nerve to subclavius has previously not been used for nerve transfer procedures. Based on our cadaveric study, this often-overlooked nerve can be easily transposed to other regional nerves such as the IT of the brachial plexus.
441 Glasgow Coma Scale Motor Score Predicts Need for Tracheostomy After Decompressive Craniectomy for Traumatic Brain Injury
Authors: Guillotte Andrew , Fry Lane , Gattozzi Domenico A. , Shah Kushal 
Published: March 2024

INTRODUCTION:
Traumatic brain injury (TBI) is a common problem worldwide. Severe TBI is sometimes treated with decompressive craniectomy. Many patients who survive require tracheostomy. The decision to proceed with tracheostomy and at what time is often ambiguous. Existing methods for predicting which patients with neurologic insult will require tracheostomy are aimed at stroke and spontaneous intracranial hemorrhage (ICH).

METHODS:
We performed a retrospective review of adult patients who underwent decompressive craniectomy for severe TBI at the University of Kansas Medical Center between 2007 and 2020.

RESULTS:
100% of patients who have GCS motor score of 4 or less on POD 5 required tracheostomy. 80% of patients with GCS motor score of 5 on POD 5 required tracheostomy. Setting the threshold at GCS motor score of 5 on POD 5 for recommending proceeding with tracheostomy results in 86.7% sensitivity, 91.7% specificity, and 90.5% PPV with area under the receiver operator curve of 0.9101.

CONCLUSIONS:
GCS motor score of 5 or less on POD 5 from decompressive craniectomy for TBI is predictive of need for tracheostomy.
447 Is Surgical Management of Brachial Plexus Schwannomas Safe and Effective: A Review of Clinical Experience
Authors: Al-Mistarehi Abdel-Hameed , Menta Arjun , Hersh Andrew , Ochuba Arinze , Blakeley Jaishri , MacLean Luke , Theodore Nicholas , Belzberg Allan J. , Lubelski Daniel 
Published: March 2024

INTRODUCTION:
Tumors of the brachial plexus represent a challenge because of the plexus neuroanatomical complexity and the scarce literature on the management of such rare tumors. One of these tumors is schwannomas which arise from the nerve sheath.

METHODS:
The medical records of 213 patients diagnosed with schwannomas between July 2003 and February 2020 at Johns Hopkins Medical Institutes were reviewed. The patients who had surgery for brachial plexus schwannomas were identified. Their demographic characteristics, clinical presentations, and surgical outcomes were described.

RESULTS:
Of 29 patients with brachial plexus schwannoma, 26 had surgical resection and were included in this study [Mean ± SD age, 45.00 ± 16.87 (range, 18-77); Women, 16 (61.5%)]. The most common presenting symptoms were pain (19, 73.1%) and palpable mass (18, 69.2%). Sensory and motor deficits were reported in 19 (73.1%) and 11 (42.3%) patients, respectively. The mean ± SD duration of symptoms was 20.34 ± 21.04 months, and the tumor was discovered as an incidental finding in 7 (26.9%) patients. The gross total resection was achieved in 20 (76.9%) patients. During their hospitalization for a mean of 1.58 ± 1.14 (range, 1-6) days, one patient developed postoperative wound infection, with no recorded deaths. Postoperatively, the mean follow-up duration was 17.04 ± 23.78 months. After follow-up, 12 patients reported improvements in their preoperative pains, with a recovery rate of 63.2%. Among those with preoperative neurological deficits, complete recovery from sensory and motor deficits was documented in 10 (52.6%) and 8 (72.7%) patients, respectively. However, a total of 6 patients developed new sensory and/or motor deficits. Tumor recurrence was reported in two (6.9%) patients.

CONCLUSIONS:
Brachial plexus schwannomas are surgically curable lesions by gross total resection with favorable outcomes, acceptable risks, and low incidence of tumor recurrence.
452 Leg Flexion to Overcome Gaps for Direct Sciatic Nerve Repair: An Anatomic Study
Authors: Thum Jasmine A. , Luk Justin , Brown Justin M. 
Published: March 2024

INTRODUCTION:
Direct nerve repairs fare better than grafted nerves, especially for large caliber nerves. Numerous surgical techniques are used to achieve tension-free end-to-end repairs for large gaps in the sciatic nerve (SN) and common peroneal nerve (CPN), including distal nerve mobilization, transposition, side-branch neurectomy, or even shortening of the femur with distraction osteogenesis. However, leg flexion with serial distraction is the simplest, least morbid, and most easily implemented technique.

METHODS:
Eight fresh cadavers with pelvis intact were dissected to determine the relationship between degrees of knee flexion (ranged from 0 to 90-degree flexion) and the gap length overcome with nerve excursion. Additional excursion from SN side-branch neurectomy was also assessed.

RESULTS:
We found an approximately linear relationship between knee flexion and nerve excursion. In the mid-thigh there was 7-9 mm of SN excursion per 10 degrees of flexion, and 10-11 mm of SN excursion per 10 degrees of flexion with neurectomy. There was 11-13 mm of CPN excursion per 10 degrees of flexion in the distal half of the thigh.

CONCLUSIONS:
Knee flexion can significantly augment the ability to achieve an end-to-end repair of the SN and CPN. Simplified, each 10 degrees of knee flexion provides about 1 cm of additional length for both nerves, which is essentially constant throughout the arc of flexion. Neurectomy allows approximately 1-2 cm in total additional length at full flexion in fresh cadavers. Approximately 10 cm total excursion can be gained at 90-degree knee flexion with side-branch neurectomies. We recommend 45-90 days of progressive extension to respect the safe regeneration timing of 1-2 mm/day from a repair performed with 90-degree knee flexion.
469 Recovery Rate of Motor Function During Rehabilitation After Traumatic Cervical Spinal Cord Injury Predicts Functional Status at Years 1 and 5 After Surgery: A Multicenter, Longitudinal Cohort Study
Authors: Abraham Benjamin , Naik Anant , Falavigna Asdrubal , Harrop James S. , Zuckerman Scott L. , Arnold Paul M. 
Published: March 2024

INTRODUCTION:
Traumatic spinal cord injury (SCI) is a devastating condition. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes.

METHODS:
A longitudinal, retrospective cohort study was conducted from the multicenter Spinal Cord Injury Model Systems (SCIMS) database on patients with motor Functional Independence Measure (FIM) scores at admission to and discharge from rehabilitation, year 1, and year 5. Patients who underwent surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The FIM score was utilized to calculate changes in motor FIM scores over each respective time period. Multivariate logistical regression was performed to identify longitudinal predictors associated with functional independence.

RESULTS:
A total of 351 patients met the inclusion criteria. The change in motor FIM score during the inpatient rehab period was a significant predictor of achieving FI at 1 and 5 years (year 1: aOR = 15.6, 95% CI 3.94-77.6, p < 0.0001; year 5: aOR = 28.0, 95% CI 6.13-173.6, p < 0.0001). For patients not achieving FI at year 1, the change in motor FIM score during inpatient rehab was a greater predictor of FI at year 5 (aOR = 64.7, 95% CI 5.15-1717.3, p = 0.0004).

CONCLUSIONS:
Inpatient rehabilitation efforts may lead to greater long-term functional status and carry emphasized importance for patients who do not attain functional independence by year 1.
471 Using the QOD to Identify Minimum Clinically Important Differences for Patients With Cervical Spondylotic Myelopathy
Authors: Lakomkin Nikita , Michalopoulos Giorgos , Kai-Hong Chan Andrew , Potts Eric A. , Park Paul , Foley Kevin T. , Wang Michael Y. , Knightly John J. , Sherrod Brandon , Gottfried Oren N. , Shaffrey Christopher I. , Agarwal Nitin , Goldberg Jacob , Virk Michael S. , Hussain Ibrahim , Fu Kai-Ming G. , Glassman Steven D. , Tumialan Luis Manuel , Turner Jay D. , Meyer Scott A. , Lu Daniel C. , Upadhyaya Cheerag D. , Shaffrey Mark Edwin , Coric Domagoj , Slotkin Jonathan , Chou Dean , Haid Regis W. , Asher Anthony L. , Bisson Erica Fay , Mummaneni Praveen V. , Bydon Mohamad 
Published: March 2024

INTRODUCTION:
Minimum clinically important differences (MCID) for quality-adjusted life years (QALYs) and arm pain patient-reported outcome metrics (PROMs) in cervical spondylotic myelopathy (CSM) have yet to be determined, while data for myelopathy severity, impairment, and neck pain remain limited by small series and low rates of follow-up.

METHODS:
The CSM database of the QOD Study Group was utilized for this analysis. Patients were prospectively enrolled and followed for 24 months, with a follow-up rate of 85.2%. The MCIDs were computed for five standardized instruments: Neck Disability Index (NDI), five-dimension Euro-QoL (EQ-5D) in QALYs, neck and arm pain numeric rating scale (NRS), and modified Japanese Orthopedic Association score (mJOA) at both 3 and 24-month follow-up. Seven previously validated measures of MCID were compared using the area-under-the-curve (AUC). The North American Spine Society (NASS) satisfaction scale was the anchor, with scores of 1-2 meeting criteria for satisfaction.

RESULTS:
A total of 1,141 patients underwent surgery for CSM. Improvement of =30% from baseline was the optimal MCID across time points for NDI and neck/arm NRS. At 24 months, 30% improvement for these three instruments resulted in AUCs of 0.73, 0.71, and 0.67, respectively. Numeric cut-offs (0.065 at 3 months and 0.149 at 24 months) were the superior MCIDs for EQ-5D-derived QALYs. For mJOA, a severity-adjusted MCID outperformed the other methods, yielding an AUC of 0.67 at 24 months.

CONCLUSIONS:
We used the QOD dataset to define previously unknown MCIDs for several outcome measures. A =30% improvement from baseline was a consistent, high-performing MCID in NDI and arm/neck NRS. However, an absolute numeric cut-off (0.149) was the superior MCID for EQ-5D QALYs. mJOA exhibited the lowest predictive capacity for patient satisfaction.