bluuebunny/crossref_metadata_2025_split huggingface dataset:
191 Online Multi-media Teaching Modules are Effective for Surgical Education in Electrodiagnostic Interpretation
Authors: Zhang Justin , Pripotnev Stahs , Zhou Suzanne , Mackinnon Susan 
Published: March 2024

INTRODUCTION:
Though electrodiagnostic studies are the gold standard for diagnosing nerve injuries, most surgeons are not trained to interpret these studies, and therefore typically rely on interpretation from a non-surgical electrodiagnostician. This discrepancy between interpretation and treatment of nerve injuries can lead to suboptimal surgical planning and patient outcomes.

METHODS:
Hand surgeons at various stages of training were recruited from professional surgical societies. All surgeons completed an educational module, which consisted of a pre-intervention knowledge assessment, an educational video, and a post-intervention assessment. The educational video was a 45-minute lecture on electrodiagnostic indications for nerve injury and included either traditional PowerPoint or Prezi formatting. Participants were randomized into receiving one of the two video formats. A retention assessment, including surgeon satisfaction and feedback, was administered at three-months after initial evaluation.

RESULTS:
Sixty-three surgeons completed the pre-intervention knowledge assessment, educational video, and post-intervention assessment, 30 of whom underwent the three-month retention assessment. The average assessment score improved by 2 points between pre- and post-intervention (12-point scale, p < 0.001). The majority of participants responded that the educational video was a “perfect” length (81%), was engaging (86%), improved their knowledge (86%), and that they would incorporate the information into their clinical practice (86%). Seventy-two percent of the surgeons preferred the online teaching module compared to a traditional in-person conference presentation. There was no significant difference in assessment performance and surgeon satisfaction between Prezi and PowerPoint formatting (p > 0.05).

CONCLUSIONS:
Our results demonstrate the feasibility and efficacy of an online educational module to support continuing professional development in nerve injury surgery, irrespective of the presentation style (i.e., Prezi vs. PowerPoint). This study highlights the potential behind online educational content and provides a framework for future multimedia modules for surgical education.
208 Preliminary Results of Novel Method for Identifying Ischemic Stroke Vesicular Protein Signature in Cardiac Surgery Patients
Authors: Carroll Kate T. , Federico Emma , Fillingham Patrick , Nistal Dominic A. , Barros Guilherme , Meyer R. Michael , Gonzalez Alexandra , McAvoy Malia , Keen Jade , Lim Do Hyeong , Hoofnagle Andrew , O'Keefe Grant , Burke Christopher , MacDonald James , Bammler Theo , Wu Christine , MacCoss Michael , Chen Stephanie H. , Levitt Michael Robert 
Published: March 2024

INTRODUCTION:
Acute ischemic stroke (AIS) treatment depends on timely diagnosis. Identifying an efficient, blood-based protein signature for AIS has been limited by the lack of a pre-ischemia control group. Here we report the preliminary results of a model for AIS protein signature discovery using cardiac surgery patients and novel mass spectrometry techniques.

METHODS:
Twenty patients undergoing aortic arch repair with deep hypothermic circulatory arrest (n = 17) or coronary artery bypass graft (n = 3) were enrolled. Blood samples were obtained immediately pre- and postoperatively. Magnetic resonance imaging (MRI) of the brain was obtained within 72 hours of surgery. Presence of infarct and total ischemic volume was determined. A novel protein enrichment and mass spectrometry analysis technique (MAG-Net) was used to characterize the pre- and post-surgical proteomes present in extracellular vesicles. Analysis of variance (ANOVA) (false discovery rate < 0.05) was used to analyze protein signatures associated with infarction.

RESULTS:
Post-surgical infarct occurred in 15 patients (75%), with a median volume of 108mm3. A total of 5,376 proteins were identified, 1,125 of which showed a significant difference between paired pre- and post-operative concentrations. Of these 1,125 proteins, 524 proteins were unique to patients without infarction, 340 proteins had a significant change in both populations, and 261 proteins were unique to patients with infarcts. There were no significant proteins for the interaction term comparing pre- and post-operative differences between the infarct/no infarct groups.

CONCLUSIONS:
This clinical model for AIS protein signature development relies on the high rate of ischemia during cardiac surgery to allow for pre-stroke sample collection. The MAG-Net technique enables efficient processing of biologically relevant extracellular vesicle proteins and analysis of an unbiased protein signature. The preliminary results demonstrate the feasibility of combining these innovations for AIS protein signature discovery.
213 Acute Flow Diversion for Ruptured Cerebral Aneurysms Arising From Vessels of Small Caliber Using FRED Jr: A Clinical Case Series
Authors: Doron Omer , McLellan Rachel , Vranic Justin , Regenhardt Robert , Stapleton Christopher James , Patel Aman B. 
Published: March 2024

INTRODUCTION:
Ruptured aneurysms arising from small caliber (<2.5 mm) or distal vessels beyond the circle of Willis are considered challenging for all treatment modalities. Recently, the FRED Jr stent, designed for flow diversion in small arteries, was approved in the US for the treatment of non-ruptured aneurysms.

METHODS:
Clinical and radiological records of patients sustaining SAH treated with FRED Jr between June 2020 and October 2022 were reviewed. Treatment course including anti-platelet therapy, external ventricular drain (EVD) management, and vasospasm, as well as clinical outcomes were analyzed. Angiographic results were assessed according to the O’Kelly-Marotta (OKM) scale.

RESULTS:
Nine patients with at a median age of 62 (27-75) were included. The median Hunt Hess score was 2 (IQR 1) and modified Fischer score was 4 (IQR 1). Six aAneurysms’ morphologies included were saccular (6 case), 1 blister (1 case) and 2 were and dissecting (2 cases) type, located at the ACOM complex (3), A2/A3 (3), M2/M3 (1), V4 (1), and P2 (1) segments. All stents were deployed successfully with no intraprocedural complications. Post-operatively, no re-bleeding events were encountered. Vasospasm therapy was initiated in 6 cases, and no symptomatic EVD-related hematomas were observed. Post- operative ischemic events were encountered in 2 cases. Median 3-month mRS was 2 (IQR 1) for the7 surviving patients, and 3-months radiographic follow-up revealed OKM scale D in 4/7 cases.

CONCLUSIONS:
Flow diversion as a potential treatment strategy for acutely ruptured aneurysms arising from small caliber vessels is feasible using FRED Jr. Since As the complication profile reported in this series is comparable to historical microsurgical cohorts and effective protection was conferred by this treatment modality, our small cohort provides a glimpse into acute flow diversion for this subset of difficult-to-treat aneurysms.
218 Cost-Effectiveness and Quality-Adjusted Life Years Analysis for Endovascular Management of Acute Stroke With a Large Ischemic Region
Authors: Adeeb Nimer 
Published: March 2024

INTRODUCTION:
Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the infarction is large (defined as ASPECT score of < 5). However, a recent trial (RESCUE-Japan) published in NEJM, showed that patients with large cerebral infarctions had better functional outcomes, measured as mRS of 0-3 at 90 days, with MT compared to best medical management (BMM) alone.

METHODS:
Treeage, a decision-analytic software, was used to construct a cost effectiveness analysis model that compares the cost-effectiveness of MT vs. BMM alone based on the RESCUE-Japan study. The model includes a short-term decision model that examines costs and clinical outcomes of patients with acute ischemic stroke during the initial three months of treatment. Additionally, a long-term Markov state transition model is created to estimate expected outcomes and costs annually over a 20-year timeframe, with patients potentially experiencing recurrent strokes, transitioning to lower health states, and death from stroke. The success of each treatment was evaluated using QALYs. Then, to assess the robustness of this model, a sensitivity analysis was performed.

RESULTS:
In the base–case analysis of the total study population using a time horizon of 20 years, MT and BMM alone were found to have a 2.86 QALY and 1.44 QALY, respectively. This increase in the number of QALY by MT came at a lower cost of $275,805 compared to BMM alone, which had a cost $282,476. The incremental cost-effectiveness ratio (ICER) was determined at $-4697/QALY. The results were further supported by the 1-way deterministic and probabilistic sensitivity analyses.

CONCLUSIONS:
This study shows that, besides having a better clinical outcome, MT was more cost effective and associated with higher QALYs compared to BMM alone, when accounting for health care cost associated with treatment outcome.
231 Postoperative Seizure Outcome of a Cohort of Patients With Drug Resistant Epilepsy and Malformations of Cortical Development Selected Predominantly by Non-invasive Evaluation
Authors: Malla Bhaskara Rao , Rewatkar Ajinkya , Arimappamagan Arivazhagan , Sinha Sanjib 
Published: March 2024

INTRODUCTION:
Optimizing the surgical outcome of people with drug-resistant epilepsy (DRE) and malformations of cortical development (MCD) can be quite challenging. The studies are limited in this regard, especially from the low and middle income countries (LAMIC).

METHODS:
Between April, 2011 and March, 2023, 584 people with drug resistant epilepsy underwent surgery at NIMHANS, Bangalore, India. MCD as an underlying substrate have been identified among 170 patients. Different types of MCD, their pre-surgical evaluation, surgical strategy and outcome predictors have been studied.

RESULTS:
Cohort consists of 170 people with a mean age at surgery of 17.01 ± 10.94 (range 1.2 – 60) years. Mean age at seizure onset of 7.45 ± 7.39 (range 1 month to 40) years. The mean duration of epilepsy before surgery of 9.17 ± 7.58 (range 1-32) years. Males constituted 62.35% of patients (n= 106). Mean seizure score of the cohort was at 8.61 ± 1.34 (range 4-12 on a scale of 0 -12). Lifetime drugs tried by the cohort ranged from 1- 6 with mean of 2.85 ± 0.95. FCD was noted in 120 patients (70.587%). At a mean follow up of 4.66 ± 2.80 years, cohort had an Engel outcome class Ia, I, II, III and IV of 71.1%, 83.6%, 3.1%, 7.80% and 5.5 % respectively. Range of current AEDs used by the cohort is nil to 5, with mean of 2.28 ± 1.41.

CONCLUSIONS:
In this study, three variables were found to influence the outcome towards favourable arm of Engel class Ia. These factors are histopathology of FCD with balloon cells, glioneuronal aetiology and an age of less than 18 years at the time of surgery.
232 Onco-functional Outcome After Resection for Eloquent Glioblastoma (GLIOFO): A Propensity-score Matched Analysis of an International, Multicenter, Cohort Study
Authors: Gerritsen Jasper , Mekary Rania , Pisica Dana , Zwarthoed Rosa , Kilgallon John , Lee Ahmad Nawabi Noah , Jessurun Charissa , Versyck Georges , Pruijn Koen , Fisher Fleur , Larivière Emma , Solie Lien , Kloet Alfred , Tewarie Rishi Nandoe , Schouten Joost , Bos Eelke , Smith Timothy R. , Dirven Clemens M. F. , Broekman Marike , Vincent Arnaud , De Vleeschouwer Steven 
Published: March 2024

INTRODUCTION:
Minimizing residual tumor volume and preventing functional loss are the primary goal in glioblastoma resections in eloquent areas. However, their combined impact on patient outcomes remains poorly understood.

METHODS:
Propensity-score matching was used to match OFO 1 (gross-total resection with no functional loss), OFO 2 (no gross-total resection with no functional loss), OFO 3 (gross-total resection with functional loss) and OFO 4 patients (no gross-total resection with functional loss) for the overall cohort and subgroups. Cox proportional-hazard regressions were performed to analyze the association between OFO class and surgical outcomes. Logistic regressions were performed to identify preoperative predictors for OFO class.

RESULTS:
Between 2010 and 2020, 858 patients were included as the overall unmatched cohort. After matching, the cohort comprised of 512 patients: 256 received OFO 1 and 256 received non-OFO 1. OFO 1 resulted in fewer postoperative neurological deficits at 6 weeks (10.2% vs. 25.8%, p < 0.001), 3 months (12.7% vs. 9.9%, p < 0.001), and 6 months (21.0% vs. 35.1%, p = 0.0010); lower rates of KPS deterioration at 3 months (14.2% vs. 52.4%, p < 0.001), and 6 months (26.5% vs. 52.9%, p < 0.001); higher rate of receipt of adjuvant therapy (HR 3.91, p < 0.001), longer overall survival (median 21.0 vs. 13.0 months, p < 0.001), and longer progression-free survival (median 10.0 vs. 7.5 months, p < 0.001). Patients who underwent awake craniotomy more often received OFO 1 (43.0% vs. 26.9%, p < 0.001; OR 1.92, p = 0.0070).

CONCLUSIONS:
OFO 1 is beneficial in patients with eloquent glioblastoma to improve outcomes - irrespective of age, preoperative NIHSS, or KPS - in terms of survival, functional outcomes, and receipt of adjuvant therapy. Awake craniotomy was significantly associated with achieving this.
240 Impact of a Large Geographical Area on Outcomes in Acute Traumatic Intracranial Extra-axial Haemorrhage Requiring Urgent Surgical Evacuatio
Authors: Mantha Sidharth , Olson Sarah 
Published: March 2024

INTRODUCTION:
The Princess Alexandra Hospital (PAH) Department of Neurosurgery services a population of 1.85 million people over a 420,000 km2 area in Queensland, Australia. Increased distance from a neurosurgical centre has previously been correlated with poorer outcomes in traumatic brain injury.

METHODS:
This single-centre retrospective study identified patients aged 16-85 who underwent evacuation of an acute traumatic subdural (ASDH) or extradural haemorrhage (EDH) between 2016 and 2022. Initial Glasgow Coma Score (GCS), pupillary abnormalities, time to intervention, distance from PAH and the Extended Glasgow Outcome Scale (GOS-E) at 6 months were recorded.

RESULTS:
106 and 50 patients underwent evacuation of ASDH and EDH respectively. In the ASDH group, age was inversely correlated (p = 0.03, r2 = 0.04) and the motor component of the initial GCS was directly correlated (p = 0.002, r2 = 0.09) with GOS-E at 6 months. Distance from PAH directly correlated with an increased time to intervention (p<0.0001, r2 = 0.23) but did not correlate with GOS-E at 6 months (p = 0.09). There was no difference between survivors and non-survivors regarding distance from PAH (43.43 ± 75.05 km vs. 25.56 ± 41.32 km, p = 0.15) or time to operation (276.14 ± 192.77 mins vs. 217.40 ± 147.27 mins, p = 0.08). This was also found for survivors with poor (GOS-E <6) and fair (GOS-E = 6) recovery at 6 months. In the EDH group there was no correlation between distance, time to operative intervention, age or initial motor score with outcomes at 6 months.

CONCLUSIONS:
Whilst increased distance from treatment centre correlated with increased time to surgical intervention for ASDH, it did not impact on survival or functional outcomes at 6 months. For ASDH requiring urgent evacuation, increasing age and severity of primary brain injury are predictors of poorer long-term outcomes.
260 Pediatric Penetrating Head Trauma: Do Children Need to be Taken to Pediatric Trauma Centers?
Authors: Wathen Connor , Howard Susanna , Kaufman Elinore , Cannon Jeremy , Petrov Dmitriy , Schuster James M. 
Published: March 2024

INTRODUCTION:
Gun violence has become the leading cause of death in children. Debate exists regarding the optimal treatment setting for pediatric trauma patients at either Adult Trauma Centers (ATC) or Pediatric Trauma Centers (PTC).

METHODS:
A retrospective analysis of the National Trauma Data Bank (NTDB) was performed from 2017-2020. Inclusion criteria included age 18 years or younger, firearm related mechanism, and associated ICD-10 code corresponding to intracranial injury. Patient characteristics and outcomes were compared across groups.

RESULTS:
2,662 cases met inclusion criteria. Overall mortality was 52.1%. 57.4% of patients presented to ATC, 12.8% to PTC, and 29.7% to dual-certified centers. The median age of patients treated at ATC was 17, 13 at PTC, and 16 at dual-certified centers. While mortality was lower for patients presenting to PTC relative to ATC and dual-certified centers (38.2% vs. 55.6% vs. 52.9%, respectively, p < 0.001), PTC patients had higher GCS scores (7.8 vs. 6.5 vs. 6.7, p < 0.001) and lower rates of bilaterally fixed and dilated pupils at presentation (38.9% vs 53% vs 6.7%, p < 0.001). In a logistic regression analysis controlling for baseline pupillary response, GCS, age, ISS, and treatment center type, no significant association was seen between center type and mortality (p = 0.550).

CONCLUSIONS:
Although mortality was significantly higher for patients presenting to ATC, when baseline injury severity was controlled for, no statistically significant effect was seen with respect to mortality. These results show that the bulk of pediatric GSW are already being treated at ATC and suggest that there is no significant difference in mortality relative to PTC.
269 Risk Factors for Fusion Failure in Children Undergoing Occipital to C2 Rigid Instrumentation and Fusion
Authors: Eremiev Alexander , Kurland David B. , Cheung Alexander , Dastagirzada Yosef Michael , Harter David H. , Rodriguez-Olaverri Juan , Brockmeyer Douglas L. , Pahys Joshua , Hedequist Daniel J. , Oetgen Matthew , Anderson Richard C.E. 
Published: March 2024

INTRODUCTION:
Studies of pediatric occipital-cervical fusions have been limited, and there is substantial variation among surgical constructs with reported failure rates as high as 20%.

METHODS:
The Pediatric Spine Study Group (PSSG) registry was queried to identify patients </= 21-years-old who had: (1) O-C2 posterior rigid instrumentation and fusion, (2) 2-year clinical and radiographic follow-up, and (3) available post-operative lateral cervical radiograph or CT. Failure was defined as hardware revision surgery >30 days following the index procedure or the presence of screw haloing or breakage on the most recent imaging study. Univariate comparisons were made using Mann-Whitney U-tests, Chi-square tests, and Fisher’s Exact tests followed by multivariable logistic regression.

RESULTS:
76 patients were included. The median age at surgery was 9 years (range, 0.2 to 17.2 years), and 51% of the cohort was male. 55% percent of patients had syndromic etiology (41/75), and the most frequent diagnosis was Down Syndrome (28%). Of the 74 patients with complete information, 28/74 (38%) had fusion failure (95% CI, 27%-50%). Rib autographs were used more frequently in patients with successful fusions compared to failures (52% vs 25%; p = 0.04). Multivariable logistic regression determined that patients with rib autograft have a 75% decrease in the odds of failure compared to those without rib autograft (OR = 0.25; 95% CI = 0.08-0.75; p = 0.01). Other variables did not influence the risk for failure.

CONCLUSIONS:
In this multicenter, international registry study of children undergoing O-C2 rigid instrumentation, fusion failure was seen in 38% of patients, a higher rate than previously reported. Based on this study, the use of structural rib autograft should be considered to reduce fusion failure.
276 Outpatient Versus Inpatient Laminoplasty for Cervical Spondylosis: A Non-inferiority Analysis of Surgical Outcomes
Authors: Nathani Karim , Ghanem Marc , Ibrahim Sufyan , Ghaith Abdul Karim , Jarrah Ryan , Bydon Mohamad , Dominari Asimina 
Published: March 2024

INTRODUCTION:
A rising trend of outpatient spinal procedures has been observed recently due to increasing evidence of lower risk of hospital-associated risks and better value-based healthcare delivery.

METHODS:
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients undergoing cervical laminoplasty for spinal spondylosis. Patients with a hospital stay of more than 48 hours were excluded from the comparative analysis to increase baseline comparability between the two groups. Patients undergoing other spinal procedures during the same hospital stay were also excluded. The outcomes of interest were postoperative complications, nonroutine discharge, readmissions, and reoperations within 30 days after surgery. The non-inferiority of outpatient compared with inpatient surgery was defined as a risk difference of <10.0% at a one-sided 97.5% confidence interval.

RESULTS:
A total of 808 cervical laminoplasty surgeries were identified. The study cohorts consisted of 107 and 701 patients in outpatient and inpatient groups, respectively. All recorded baseline characteristics, except age (58.3 ± 10.6 vs. 61.4 ± 11.5, p=0.01), were similar between the two groups. The incidences of postoperative complications were 2.8% and 3.4% for the outpatient and inpatient groups, respectively, while the non-routine discharge rates were 6.5% and 3.5%. Both groups had a 30-day readmission rate of 3.7%. In addition, the 30-day reoperation rates were 2.8 % and 1.4% for the outpatient and inpatient groups, respectively. Noninferiority of outpatient surgery was documented at a risk difference of 10% for postoperative complications, non-routine discharge, and readmission and reoperation rates.

CONCLUSIONS:
Outpatient cervical laminoplasty demonstrated similar early postoperative outcomes compared to inpatient surgery. Noninferiority in surgical outcomes after surgery was documented for outpatient compared with inpatient cervical laminoplasty surgery.
286 Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis Than Vertebral Bone Quality Following Long-segment Thoracolumbar Fusion
Authors: Pennington Zach , Mikula Anthony L. , Lakomkin Nikita , Martini Michael Louis , Pinter Zachariah , Nassr Ahmad , Freedman Brett , Sebastian Arjun , Clarke Michelle J. , Krauss William E. , Bydon Mohamad , Fogelson Jeremy L. , Elder Benjamin D. 
Published: March 2024

INTRODUCTION:
Both Hounsfield units (HU) on computed tomography and Vertebral Bone Quality (VBQ) score on MRI have been advanced as means of assessing underlying bone quality and predicting mechanical complications amongst spine patients.

METHODS:
Patients = 50 with =12-month follow-up following long-segment thoracolumbar fusion were included. Bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also measured. PJK was defined as a change of =10° in the Cobb angle between the cephalad endplate of UIV+2 and caudal endplate of UIV. Univariable analysis to identify predictors of the occurrence of PJK and survival analyses with Kaplan-Meier method and Cox regression were performed to identify predictors of time to PJK. Sensitivity analyses showed thresholds of HU < 164 and VBQ > 2.7 to be most predictive for PJK.

RESULTS:
Seventy-six patients (66.0 ± 7.0 yr; 27.6% male) were identified, with 15 suffering PJK. On univariable analyses PJK was predicted by high postoperative pelvic tilt (p = 0.038), postoperative T1-pelvic angle (p=0.041), and postoperative PI-LL mismatch (p = 0.028). On multivariable survival analysis, bone quality, as assessed by average HU of the UIV and UIV+1 was the only significant predictor of time to PJK (OR=3.053; 95%CI [1.032, 9.032]; p = 0.044). VBQ measured using the UIV, UIV+1, UIV+2, and UIV-1 vertebrae approached, but did not reach significance (2.913; [0.797, 10.646]; 0.106).

CONCLUSIONS:
In larger cohorts, VBQ may prove to be a significant predictor of PJK following long-segment thoracolumbar fusion. However, it has less predictive power than Hounsfield units on CT, suggesting preoperative workup for patients undergoing long-segment thoracolumbar fusion may benefit from CT versus MRI alone to identify those at increased risk of PJK.