bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Breastfeeding Duration on Coagulation in Women With and Without History of Gestational Diabetes Mellitus
Authors: Fritsche Louise , Löffler Dorina , Kantartzis Konstantinos , Flehmig Gesine , Roden Michael , Fritsche Andreas , Birkenfeld Andreas L , Peter Andreas , Heni Martin , Hörber Sebastian 
Published: March 2024

Abstract

Context
Breastfeeding is associated with a reduced maternal risk for cardiovascular diseases (CVDs).

Objective
Since the underlying mechanisms are still poorly understood, we here examined the effect of breastfeeding on the plasmatic coagulation system in women with and without history of gestational diabetes mellitus (GDM).

Methods
A total of 76 participants of the German Gestational Diabetes Study (PREG; NCT04270578) were examined 14 months (interquartile range [IQR], 12-26 months) after delivery with a 5-point oral glucose tolerance test. Global coagulation tests, prothrombotic coagulation proteins (FII/FVII/FVIII/FIX), antithrombotic proteins (antithrombin, protein C/S), and endothelial markers (von Willebrand factor and plasminogen activator inhibitor 1) were determined. The Framingham risk score was used to estimate the 10-year CV risk. The effect of breastfeeding duration on coagulation was analyzed using multivariable linear models.

Results
The mean duration of breastfeeding was 11 months (IQR, 7-14 months). Overall, longer duration of breastfeeding was associated with lower CV risk (Framingham risk score; P = .05) and was negatively associated with FIX (P = .018). We detected an interaction between previous GDM and breastfeeding duration for FIX (PInteraction = .017): Only in women with GDM history was the duration of breastfeeding negatively associated with FIX activity (P = .016). This association persisted in statistical models adjusted for age, body mass index, insulin sensitivity, and C-reactive protein. The duration of breastfeeding was not associated with anticoagulant proteins and endothelial markers.

Conclusion
Longer duration of breastfeeding is associated with lower CV risk and an improved coagulation profile. Women with GDM history appear to benefit particularly from prolonged breastfeeding.
103 A Bifurcation Model Predicts Intravascular Catheter Herniation When Using Transradial Access in Neuroendovascular Procedures
Authors: Lee Jin Vivian , Hartquist Chase , Qiu Michael , Suskin Charles , Chandrasekaran Vinay , Lowe Halle , Zayed Mohamed , Osbun Joshua W. , Genin Guy 
Published: March 2024

INTRODUCTION:
The speed and safety of acute ischemic stroke interventions can be improved with catheter-based revascularization performed via the transradial access versus the traditional transfemoral access. A critical source of delay and procedural failure is a phenomenon known as herniation where the catheter system suddenly buckles and deviates from the intended endovascular pathway as the surgeon attempts to track one device over or through another around a tight bend.

METHODS:
Recent modeling work suggests that herniation is associated with a bifurcation in strain energy. We hypothesized that herniation could be predicted by modeling the strain energy stored in a catheter based on its flexural rigidity and the vascular anatomy. To test our hypothesis, we developed a computational model using finite element analysis and an experimental benchtop model using 3D-printed patient-specific aortic arches. Our mathematical model was validated in vivo using observational data derived from patient and porcine endovascular surgeries.

RESULTS:
Vascular geometry and flexural rigidity were used to derive the bifurcation condition and predict catheter stability versus instability (herniation). Catheter instability criterion was predictive of herniation in our computational model (sensitivity 100.0%, PPV 93.5%, NPV 100.0%); experimental ex vivo model (sensitivity 92.3%, PPV 89.6%, NPV 90.0%); patient in vivo model (sensitivity 100.0%, PPV 80.0%, NPV 100.0%); and porcine in vivo model (sensitivity 100%, PPV 100%, NPV 100%).

CONCLUSIONS:
We validated a predictive model of catheter herniation based upon the hypothesis that bifurcation in strain energy drive the phenomenon. Key factors in the model are the curvature of the vascular pathway and the flexural rigidity of the coaxial devices. Results suggest that strategic selection of catheters and wires based on their known flexural rigidity can be used to prevent the bifurcation in strain energy that causes herniation.
105 Creation and Optimization of a Translational Rodent Model of Cerebrovascular Disease
Authors: Yager Brock , Kondrasov Sasha , Contillo Nicholas , Venkataraman Sidish Srinivas , Xiang Zhidan , Diz Debra , Wolfe Stacey Q. 
Published: March 2024

INTRODUCTION:
Spontaneous intracerebral hemorrhage (ICH) continues to have devastating morbidity and mortality, with little progress in managing resultant secondary injury. We have created a cardiometabolic model of ICH using transgenic (mRen2)27 rats to mirror the comorbidities of patients with ICH.

METHODS:
Body weight, blood pressures (BP), sensorimotor testing, cerebrovascular histology, and pro-inflammatory cytokines were quantified in (mRen2)27 and compared with control Hanover Sprague Dawley (SD) in both sexes (n = 32). A stereotaxically-assisted single-injection autologous-blood ICH in the basal ganglia was performed and hemoglobin quantified at 24/72 hours to assess reabsorption (n = 28).

RESULTS:
Mean blood pressures and weights were higher in the cardiometabolic (mRen2)27 strain at baseline (p < 0.005). There were no between-strain differences in sensorimotor testing up to 28 weeks. At 30 weeks, (mRen2)27s had higher serum IL-12 than SDs in both males (p < 0.05) and females (p < 0.05). (mRen2)27 females had higher IL-12 than males (p < 0.05). At 32-weeks, (mRen2)27 males (p < 0.0001) had increased wall to lumen ratios (W:L), signifying hyalinization. At 52-weeks, there was an increase in W:L ratio in both male (p < 0.01) and female (p < 0.05) (mRen2)27s compared to control. There was a difference in amount of residual hemoglobin between male SD and (mRen2)27’ ipsilateral hemispheres 72 hours post-ICH (p < 0.05), demonstrating impaired ICH resolution.

CONCLUSIONS:
There is a need for effective pre-clinical models of ICH. We characterized a cardiometabolic model of ICH that possesses parody at baseline with the traditional rodent model and demonstrates significant strain and sex differences after ICH. (mRen2)27s had delayed hematoma resolution, decrease-in-function morphological changes, and pro-inflammatory cytokine upregulation. These differences provide insight into the mechanism of cerebrovascular injury and may act as targets for translational therapeutics.
106 Characteristics of Cognitive Impairment in Moyamoya Disease
Authors: He Shihao , Wang Rong , Zhao Yuanli 
Published: March 2024

INTRODUCTION:
Cognitive impairment in adult moyamoya disease (MMD) is thought to be the result of ischemic stroke; however, the presence and extent of cognitive decline in asymptomatic patients remain largely unknown.

METHODS:
After classification using T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), a total of 19 MMD patients with a history of cerebral infarction, 21 asymptomatic MMD patients, and 20 healthy controls matched for age, sex, and years of education were prospectively included in this study. A detailed neuropsychological evaluation of two moyamoya subgroups and normal controls was conducted. In addition, participants underwent arterial spin labeling and resting state fMRI sequences.

RESULTS:
Asymptomatic patients showed varying degrees of decline in intelligence (Raven’s Standard Progressive Matrices, P = 0.001), spatial imagination (mental rotation, P = 0.014), working memory (verbal working memory-backward digit span, P = 0.011), and computational ability (simple subtraction, P = 0.014; complex subtraction, P < 0.001) compared with normal controls. MMD patients with cerebral infarction had more severe impairment in complex arithmetic (P = 0.027) and word short-term memory (P = 0.01) than those without symptoms. The asymptomatic MMD group also showed decreased CBF in the left anterior central and left inferior frontal gyri of the island fap with multiple node abnormalities in the brain network and reduced network connectivity. There was a significant association of these changes with cognitive decline in the MMD group.

CONCLUSIONS:
In asymptomatic MMD patients, a variety of cognitive impairments precedes the onset of clinical symptoms such as cerebral infarction, which may be a long-term complication of conservative treatment. Besides, disturbance of CBF and impaired brain network connections may be important causes of cognitive decline.
1068 Incidence and Recovery of C5 Nerve Palsy After Various Types of Cervical Spinal Surgery: A Systematic Review and Meta-Analysis of Over 14,834 Patients
Authors: Soliman Mohamed A.R. , Aguirre Alexander Otilio , Kuo Cathleen , Im Justin , Burns Evan , Sood Evan , Masood Umar , Baig Rehman , Khan Asham , Pollina John , Mullin Jeffrey Paul 
Published: March 2024

INTRODUCTION:
C5 nerve palsy is a debilitating operative complication of cervical surgery and occurs commonly as many surgical approaches operate near the exiting nerve root. No prior study has attempted to identify the recovery rate of C5 nerve palsy after cervical operations, and identify the rate of which this complication becomes permanent.

METHODS:
A literature search of the PubMed and Embase databases was completed to identify all papers focused on cervical surgery. Studies were excluded if they did not provide the rate of C5 palsy occurrence or if they did not define what type of cervical surgery was completed. A pooled, weighted prevalence rate of C5 palsy was calculated for each type of surgery, including the rate of these becoming permanent.

RESULTS:
A total of 118 studies were identified and met all inclusion criteria. Of these studies, 52 were focused on laminoplasties, 24 on anterior cervical discectomy fusions (ACDF), 22 on laminectomies without fusion, and 20 on posterior cervical fusions (PCF). Laminectomies had the highest incidence of C5 palsy at a pooled rate of 7.08% (95% Confidence Interval [CI], 4.74%-10.46%, I2 = 87%, P < .01), of which 0.05% (CI = 0.00%-0.90%) were permanent. This was followed by PCFs with a rate of 6.70% (CI = 4.50%-9.85%), with the effects being permanent at a rate of 0.04% (CI = 0.00%-1.20%). Laminoplasties had a C5 palsy incidence of 5.49% (CI = 4.65%-6.47%), of these 0.02% (CI = 0.00%-0.11%) were permanent. ACDFs had the lowest incidence at a rate of 4.50% (CI = 2.56%-7.79%), of which only 0.02% (CI = 0.04%-0.08%) were permanent.

CONCLUSIONS:
C5 nerve palsy is a relatively common complication after all types of cervical surgeries with increased rates in posterior approaches, however the rate of these becoming permanent is minimal.
1073 Prone Transpsoas (PTP)-LLIF Approach Versus Standard LLIF in Patients Undergoing Surgical Revision Following Adult Spinal Deformity Correction Surgery
Authors: Diaz Daniel , Brown Nolan James , Nguyen Andrew , Pennington Zach , Stone Lauren , Hernandez Nicholas , Ehresman Jeff , Pollina John , Amaral Rodrigo Augusto , Abd-El-Barr Muhammad M. , Dibble Christopher , Moss Isaac , Lee Bryan S. , Schwartz David Gary , Nguyen Andrew D. , Taylor William R. 
Published: March 2024

INTRODUCTION:
Both the prone transpsoas (PTP) and standard LLIF have been developed to facilitate minimally invasive (MIS) indirect decompression, alignment correction, and posterior instrumentation.

METHODS:
A multi-center cohort of all patients was identified and all relevant data were retrospectively collected. Preoperative standing 36” scoliosis radiographs were retrospectively reviewed for pelvic incidence (PI), lumbar lordosis (LL), and PI minus LL (PI-LL mismatch). Postoperative regional sagittal alignment parameters were measured using the first postoperative standing 36” scoliosis radiographs. Finally, multivariable analysis was performed to assess the primary outcome measure: postoperative change in regional sagittal alignment (PI-LL mismatch).

RESULTS:
Two-hundred and two (n = 202) patients were retrospectively identified and included for formal analysis. One-hundred and fifty one (n = 151, 74.8%) of the patients underwent PTP revision while 51 (25.2%) underwent standard LLIF revision. Univariate analysis demonstrated a greater value for baseline mean pre-operative PI-LL mismatch in the PTP versus standard LLIF cohort (21.4 vs. 10.45°; p = 0.0001). Furthermore, multiple linear regression demonstrated that the PTP approach enabled significantly greater PI-LL mismatch change (p = 0.0017) and that this change was associated with the number of levels fused (p = 0.0481) as well as percutaneous (vs. open) screw placement (p = 0.0193). Finally, multiple logistic regression identified standard LLIF (p = 0.0378), female sex (p < 0.0001), non-osteoporotic bone density (p < 0.0001), and younger age (p < 0.0001) as predictive of postoperative PI-LL mismatch < 10° (the threshold under which such mismatch is no longer regarded as clinically significant deformity).

CONCLUSIONS:
Ultimately, PTP-LLIF was associated with greater net improvement in postoperative PI-LL mismatch, the primary outcome measure of this study. The present retrospective analysis therefore corroborated results of previous studies in suggesting that the utility of PTP-LLIF is translatable to ASD revision surgery.
1079 Preoperative Inflection Point According to the Roussouly Classification Is a Predictor of Outcomes Following Adult Spinal Deformity Surgery
Authors: Johnson Graham Walter , Chanbour Hani , Chen Jeffrey , Metcalf Tyler , Younus Iyan , Ahluwalia Ranbir , Jonzzon Soren , Wegner Adam , Abtahi Amir , Stephens Byron , Zuckerman Scott L. 
Published: March 2024

INTRODUCTION:
According to the Roussouly classification, the spine’s inflection point is where lordosis transitions to kyphosis.

METHODS:
A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009-21. Inclusion criteria were: =5-level fusion, sagittal/coronal deformity, and 2-year follow-up. The primary independent variable was the inflection point. Postoperative outcomes were overall mechanical complications, reoperations, proximal junction kyphosis, pseudarthrosis, rod fracture, spinopelvic complications, and patient-reported outcomes measures (PROMs) at 2-years. Univariate logistic regression was performed.

RESULTS:
Of 202 patients undergoing ASD surgery, 79 (39.1%) patients had preoperative inflection point at the classically-described thoracolumbar junction at T12 or L1, whereas 60.9% had an inflection point at the following levels: L2 (48.0%), L3 (17.9%), T11 (13.8%), L4 (12.2%), T10 (4.1%), T9 (3.3%), and T8 (0.8%). Postoperatively, 75/79(83.4%) which started at T12 or L1 remained unchanged, while 4 (5.1%) changed to be above T12. Conversely, of the 123 (60.1%) patients with inflection point either above T12 or below L1, 61(49.5%) transitioned to a T12 or L1 postoperatively. Patients with non-T12/L1 inflection points had a greater change in inflection points postoperatively (1.2 ± 1.8 vs. 0.3 ± 0.9 levels, p < 0.001). Patients with a preoperative inflection point above or below T12 or L1 had more spinopelvic complications than those with an inflection point at T12 or L1 (39.0% vs. 24.1%, p = 0.027).

CONCLUSIONS:
In patients undergoing ASD surgery, 61% had a preoperative inflection point above the classically-described T12 or L1 levels. Having a preoperative inflection point above or below T12 or L1 was associated with an increased risk of spinopelvic complications but not reoperation or PROMs.
1084 Spinothalamic Tract Cordotomy and Commissural Myelotomy for Intractable Pain: A Case Series
Authors: McIlwrath Andrew , Blue Rachel , Parker Andrew John 
Published: March 2024

INTRODUCTION:
Intractable pain associated with metastatic cancer has a large impact on the quality of life of palliative patients. Spinothalamic Tract Cordotomy and Commissural Myelotomy can aim to improve the quality of life when other therapeutic options have failed.

METHODS:
A case series of 14 patients who underwent Spinothalamic Tract Cordotomy (N = 11) or Commissural Myelotomy (N = 3) between August 2011 and November 2022 for intractable pain from metastatic disease to the abdomen, spine or pelvis in Wellington Regional Hospital. The patients aged 25 - 82 had been referred from the local pain service or palliative care team for consideration of palliative surgical management of their pain. A review of the medical records of each patient from their admission and follow up as well as pain team and palliative care records has been undertaken to determine the effectiveness of these procedures in managing pain and to identify complications, primarily deficits affecting their ability to ambulate or quality of life.

RESULTS:
Of the 14 patients, 10 patients had improvement in their symptoms, ranging from excellent (defined as significant or complete resolution of pain) to good relief (pain still present but improvement in quality of life). Of those without clear improvement in their symptoms, 2 patients passed away within 5 days of their procedure due to the underlying pathology. 4 of the 14 patients had a new deficit that affected their pre-op ambulatory status however each of these had excellent improvements in their symptoms.

CONCLUSIONS:
Spinothalamic Cordotomy and commissural Myelotomy can offer effective pain relief to the appropriately selected patient when counselled about the potential risks to mobility.
1136 Risk Factors for Postoperative Urinary Retention After Deep Brain Stimulation Surgery: The Role of the Subthalamic Nucleus
Authors: Porche Ken Michael , Peart Rodeania Antonia , Silva Victor , Mampre David Michael , Chandra Vyshak , Foote Kelly D. , Robicsek Steven Andrew 
Published: March 2024

INTRODUCTION:
Deep brain stimulation (DBS) is a widely used neurosurgical procedure for treating Parkinson's disease (PD) and essential tremor (ET). Lower urinary tract dysfunction is a common complication in PD, and this study examines the risk factors for postoperative urinary retention (POUR) after DBS surgery in PD and ET patients to improve patient outcomes.

METHODS:
This retrospective study analyzed data from patients who underwent DBS surgery for PD and ET at the University of Florida between 2010 and 2021. Data on patient characteristics and surgical details were collected and analyzed using univariate and mixed-linear models.

RESULTS:
350 patients underwent 1086 DBS or IPG surgeries, with 153 of them having PD and 197 having ET. The rate of POUR was 79/477 (16.6%), 19/295 (5.2%), and 1/246 (0.4%) for Part 1, Part 2, and IPG replacement. Optimal mixed linear modeling revealed history of urinary retention (OR = 10.2, p = .002), Part 1 surgery (OR = 3.6 compared to Part 2, p < .0003), male sex (OR = 2.5, p = .011), having an electrode placed or connected for the first time (OR = 1.8, p = .046), surgical time (OR 1.5 for each 30 min increase, p < .0001), CCI (OR = 1.4 per comorbidity, p= .006), and preoperative opioid use (OR 1.4 for each additional 10 MME, p = .022) to be significant risk factors for POUR. Having an electrode in STN was found to be protective of POUR (OR = 0.4, p = .030).

CONCLUSIONS:
While most identified risk factors for POUR in DBS are non-modifiable, they remain important for preoperative planning. Reducing opioid use and minimizing surgical time may help mitigate POUR risk. Targeting the STN during DBS may lead to decreased POUR rates, indicating the potential benefits of STN-targeted DBS for PD and ET patients.
116 The Role of Spinal Surgery Among NF2 Patients With Spinal Tumors: Surgery-associated Characteristics and Response to Bevacizumab
Authors: CreveCoeur Travis Stanley , Sperring Colin , Price Richard L. , Neira Justin Anthony , Spotnitz Matthew , Keister Alex , Munjal Vikas , Kreatsoulas Daniel C. , Elder James Bradley , Lo Sheng-fu Larry , Mandigo Christopher , Angevine Peter D. , Anderson Richard C.E. , Souweidane Mark M. , Feldstein Neil , Chicoine Michael R. , Chakravarthy Vikram , McCormick Paul C. , Ray Wilson Zachary 
Published: March 2024

INTRODUCTION:
Neurofibromatosis type 2 (NF2) patients develop spinal neoplasms. Determining indications for spine surgery remains challenging, as localization of spine related symptoms can be confounded by intracranial or peripheral neuropathology. Additionally, patient selection must be balanced with pre-existing comorbidities NF2 incurs with the goal to maintain or improve quality of life.

METHODS:
Seventy-nine patients were enrolled retrospectively based upon NF2 diagnosis and radiographic presence of spine tumors from three tertiary academic centers. Demographic data, clinical findings, treatment course, and spine tumor pathology were collected for all patients.

RESULTS:
Forty-eight percent of patients received spine surgery (38/79, 48.1%). Patients undergoing spine surgery had lower age of symptom onset (15.4 vs. 25.6, p = 0.015), increased cervical (4.2 vs 2.4, p = 0.005) and overall spine tumor burden (10.3 vs 6.2, p < 0.001) and presence of neck (9 vs 1, p = 0.006) and radicular pain (8 vs 1, p = 0.012). Over a quarter of our patients received BEV (25/79, 31.6%), with majority experiencing symptom onset before age 20 (17/19, 89.5%). Schwannoma was the most common BEV-treated pathology. Only one patient experienced worsening of tumor burden at one year while on BEV, and five patients required spine surgery after receiving BEV.

CONCLUSIONS:
NF2 patients who require spine surgery typically present at younger ages with large cervical spine tumor burden and associated symptomology. It is crucial that surgery-associated demographics and symptomology are identified. BEV was utilized in patients with aggressive, early-onset spine disease. Further, BEV halted spine disease progression in all patients except one, with minimal additional spine surgery required. Its ability to slow aggressive, NF2-associated spine tumors should be considered for clinical trial.
121 The Effectiveness of Deep Brain Stimulation in Patients With Disorders of Consciousness During Short- and Long-Term
Authors: Yang Yi , Zhao Jizong , He Jianghong 
Published: March 2024

INTRODUCTION:
Disorders of consciousness (DoCs) impose heavy medical and economic burdens on families and society. Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs).

METHODS:
Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year. The CRS-R was used to assess the level of consciousness of each patient. Scores on this scale may vary from 0 to 23, and six subscores are used to quantify auditory, visual, motor and verbal functions as well as communication and arousal. During the surgery, an electrode was implanted into the CM-Pf complex.

RESULTS:
An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65–38.46, p < 0.001). There was a significant treatment × follow-up interaction (H = 14.99, p < 0.001). An priliminary improvement after DBS treatment could also be seen at 6 months. DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index = 0.882).

CONCLUSIONS:
DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.