bluuebunny/crossref_metadata_2025_split huggingface dataset:
439 Optimal Targets, Connectivity, and Tissue Integrity for Deep Brain Stimulation in Patients With Disorders of Consciousness
Authors: Warren Aaron , Raguz Marina , Chudy Darko , Rolston John 
Published: March 2024

INTRODUCTION:
Disorders of consciousness (DOC) are characterized by alterations in arousal and/or awareness resulting from brain injuries. Deep brain stimulation (DBS) is an emerging treatment to restore arousal/awareness in DOC. However, little is known about optimal targets and whether outcomes depend on brain connectivity, tissue integrity, or reorganization potential.

METHODS:
Retrospective analysis of 38 patients with DOC who underwent unilateral DBS targeting thalamic centromedian nucleus (ages = 12-65 years). DOC resulted from anoxic (n = 26) or traumatic (n = 12) injuries. Patients were classified as ‘responders’ or ‘non-responders’ using Coma/Near Coma and Coma Recovery Scales. Volumes of tissue activated (VTAs) assessed DBS locations associated with favorable response. Correlations were also performed with age, regional brain volumes from pre-operative MRI, and structural connectivity calculated from patients’ VTAs using normative diffusion MRI.

RESULTS:
8/38 patients were responders and 24/38 non-responders; outcomes are pending in 6/38 patients due to <3 months follow-up. Favorable response was associated with younger age (median age = 19 years in responders, 42 years in non-responders) and greater volumes of whole-brain grey matter and subcortical regions including putamen, pallidum, caudate, and cerebellum. Responders also tended to have deeper and more medial implantations, with VTAs engaging parafascicular nucleus, reticular nucleus, and peri-midbrain red nucleus. In responders, VTA connectivity was higher with superior frontal gyrus, caudate, pallidum, and cerebellum, and lower with sensorimotor and occipital cortex.

CONCLUSIONS:
Efficacious DBS for DOC is linked to younger age, greater preservation of whole-brain grey-matter, greater volumes of and connectivity with select subcortical areas (pallidum, caudate, cerebellum), stronger connectivity with superior frontal gyrus, and stimulation of locations inferomedial to the centromedian nucleus. Findings may assist with optimizing patient selection, DBS targeting, and post-implantation programming.
445 Performance of the IMPACT and CRASH Prognostic Models for Traumatic Brain Injury in a Contemporary Multicenter Cohort: A TRACK-TBI Study
Authors: Yue John K. , Lee Young Min , Jain Sonia , Sun Xiaoying , van Essen Thomas , Elguindy Mahmoud , Pisica Dana , Belton Patrick , Deng Hansen , Satris Gabriela , Wong Justin , Kanter John , Ambati Vardhaan Sai , Puccio Ava , Mukherjee Pratik , Yuh Esther , Markowitz Amy , Valadka Alex B. , Tarapore Phiroz E. , Huang Michael C. , DiGiorgio Anthony Michael , Okonkwo David O. , Steyerberg Ewout W. , Lingsma Hester F. , Menon David K. , Ramsay Maas Andrew Ian , Manley Geoffrey T. 
Published: March 2024

INTRODUCTION:
The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomisation After Significant Head Injury (CRASH) prognostic models for mortality and functional outcome in traumatic brain injury (TBI) were developed using historical data from 1984-2004.

METHODS:
The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury study enrolled participants aged = 17-years who presented to Level 1 trauma center and received head computed tomography (CT) scan <24-hours of TBI. Data was extracted from participants meeting IMPACT (Glasgow Coma Scale (GCS) 3-12; completed 6-month Glasgow Outcome Scale-Extended (GOSE); N = 441) and CRASH criteria (GCS 3-14; completed 2-week and 6-month GOSE; N = 831). Original model coefficients were applied, and performances were assessed using discrimination (area under the receiver-operating characteristic curve (AUC)) and calibration (intercept; slope; [95% confidence interval]).

RESULTS:
IMPACT and CRASH models discriminated mortality (AUC = 0.77-0.81, 0.90-0.91, respectively) and unfavorable outcome (0.77-0.81; 0.83, respectively). The IMPACT Lab model overestimated mortality (intercept = -0.79 [-1.05, -0.53]; slope = 1.37 [1.05-1.69]) and acceptably estimated unfavorable outcome (intercept = 0.07 [-0.14, 0.29]; slope = 1.19 [0.96-1.42]). The CRASH CT model overestimated mortality (intercept = -1.06 [-1.36, -0.75]; slope = 0.96 [0.79-1.14]) and unfavorable outcome (intercept = -0.60 [-0.78, -0.41]; slope = 1.20 [1.03-1.37]). Calibration performance differences were observed across the 5 leading enrollment centers (IMPACT Lab model: intercept -1.66 to -0.35, slope 1.07-1.86; CRASH CT model: intercept -1.81 to -0.67, slope 0.67-1.56) and unfavorable outcome (IMPACT Lab model: intercept -0.57 to 0.34, slope 1.28-2.89; CRASH CT model: intercept -1.15 to -0.10, slope 1.02-1.44).

CONCLUSIONS:
IMPACT and CRASH models discriminated mortality and unfavorable outcome. Observed overestimations of mortality and unfavorable outcome underscore the need to develop prognostic models that incorporate contemporary changes in TBI casemix. Investigations to elucidate the relationships between increased survival, functional outcome, treatment intensity, and center-specific practices will be highly relevant.
449 The Efficiency of Non-surgical Therapies for the Treatment of Mortons Neuroma: A Systematic Review
Authors: Budihal Bhargavi R. , K Nischal , Singh Harminder 
Published: March 2024

INTRODUCTION:
Morton’s neuroma or Intermetatarsal neuroma is a benign inflammation of the peripheral nerves in the feet causing sharp, burning metatarsalgia and significant morbidity while walking, running, etc. It occurs more in females because tight shoe styles put pressure on the nerve.

METHODS:
Keyword search of “Morton’s Neuroma”, “treatment”, “conservative” and “non-surgical” was conducted across MEDLINE, EMBASE, and Cochrane databases. Two cohort studies and seven Randomised Controlled Trials were included for review following PRISMA guidelines. These studies were reviewed for pain relief, functionality, and limitations of each procedure.

RESULTS:
Methylprednisolone injections were proved to reduce the Visual Analog Scale score with >50% cases showing no difficulty in functional daily activity at 9 months post-procedure. Short-term relief was achieved by alcohol and capsaicin injections independently. Modifications in the shoe insole indicated better functionality and analgesia compared to a flat insole but combined with steroids it showed better outcomes. Extracorporeal shockwave therapy provided relief for up to 3 months compared to radiofrequency ablation which provided relief for a longer period.

CONCLUSIONS:
Although these procedures show statistically significant changes, they are not without limitations. Well-designed randomized controlled trials looking into the avenues for radiofrequency ablation and shockwave therapies as opposed to surgical excision of neuromas are vital.
453 Changed Innervation Upon Loss of Mandibular Division of Trigeminal Nerve to Muscles of Mastication
Authors: Wilson Nehemiah , Ziermann Janine 
Published: March 2024

INTRODUCTION:
The gastrulation brain homeobox (Gbx) genes are essential for patterning and maintenance of neurons along the anteroposterior axis of the developing neural tube. Knockout (ko) of Gbx2 results in neonatal lethality associated with neurological and other defects. To understand pathologies, ko studies are not realistic as gene loss usually results in death before birth. Gbx2 neo/neo mutant mice express 6-10% of the wildtype Gbx2 expression levels. They have milder malformations than ko mice but lack the cerebellar vermis and mandibular division of the trigeminal nerve (3rd division of 5th cranial nerve = V3), among other defects. These Gbx2 neo/neo mutant mice die perinatally as they are unable to suckle due to lack of motor innervation via V3 to the muscles of mastication. Muscle cells develop largely without interaction with their motor nerve. However, the final differentiation of myocytes requires interactions with nerve fibers. Unexpectedly, the muscles of mastication appear normal in Gbx2 neo/neo mutant mice, despite the lack of V3.

METHODS:
We performed microdissections of neonate wildtype and Gbx2neo/neo mutant mice. Additionally, we embedded mutant and wildtype mouse embryos in paraffin, serial sectioned them (7 μm), stained the sections with Azan staining, and analyzed specimen microscopically.

RESULTS:
Current analysis of the data to identify where nerve fibers in the muscles of mastication originate is in process. We favor the origin of these fibers from the facial nerve (7th cranial nerve), which has several overlapping territories with the trigeminal nerve.

CONCLUSIONS:
Muscles require innervation for their final differentiation steps. The loss of a nerve can result in the invasion of another nerve into the territory of the lost one, which rescues muscle differentiation but not muscle function. IACUC Ziermann Med-20-02, Funding NSF #2000005 to Ziermann.
455 Distal Nerve Transfers in Treatment of Peripheral Nerve Lesions
Authors: Rasulic Lukas G. , Savić Andrija , Lepic Milan , Grujić Jovan , Radojević Stefan , Mićić Aleksa 
Published: March 2024

INTRODUCTION:
Distal nerve transfers can be used in treating patients with irreparable high nerve lesions, aiming to regain hand function. The indications for these transfers include upper (C5-C6) and lower (C8-T1) brachial plexus palsy, isolated proximal extensive radial, median, or ulnar nerve lesion, or isolated axillary or musculocutaneous nerve lesion.

METHODS:
The selected cases (n = 5) included lower brachial plexus injury (n = 2), and isolated radial (n = 1), ulnar (n = 1), and median (n = 1) nerve injuries. The MRC grading was used to examine postoperative muscle strength. The DASH and PNSQoL questionnaires were used to assess the postoperative quality of life.

RESULTS:
The useful functional recovery (MRC = 4-5) was achieved in all presented cases. The DASH and PNSQoL scores indicated a satisfying quality of life in terms of the absence of postoperative disability.

CONCLUSIONS:
Distal nerve transfers are a valuable technique for treatment of the patients with irreparable proximal nerve lesions. This technique reduces the path necessary for the regenerative nerve fibers to pass, provides direct nerve coaptation without additional suture line, and facilitates faster and better recovery, with the final outcome as an increase in the patients’ quality of life.
467 Analysis of Surgical Smoke Generated by Electrocautery and Standard Surgical Mask Protection in a Simulated Neurosurgical Operating Room Using a Post-mortem Porcine Model for Laminectomy Exposures
Authors: Levy Bennett Reuben , Monteiro Andre , Jaikumar Vinay , Donnelly Brianna M. , Smolar David , Lim Jaims , Mullin Jeffrey Paul , Levy Elad I. 
Published: March 2024

INTRODUCTION:
Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (OR) where neurosurgical procedures are being performed.

METHODS:
Four freshly post-mortem porcine models were used to perform 4 laminectomy exposures measuring 20cm using electrocautery in a simulated neurosurgical OR. Air sampling media and pumps were connected to a 3D-printed human face model. In 2 models the face was covered with a standard surgical mask, and in 2 models no masks were placed. The models were positioned at 40 cm distance from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amount of respirable dust and 31 VOCs were conducted. The mean total amount between each 2 samples of the masked vs non-masked models were compared.

RESULTS:
On all 2 masked and 2 non-masked models, all 31 VOCs were below the levels of quantitation. On the 2 non-masked models, the total amount of respirable dust were 8.2 times higher than in the 2 masked models.

CONCLUSIONS:
Total amount of VOCs appears to be low at the distance measured regardless of mask use, however further studies are needed to determine if even small amounts can still be harmful over time. Standard surgical masks seem to be efficient in protecting against the high amounts of respirable dust generated by surgical smoke.
486 Responsive Neurostimulation of the Centromedian Nucleus of the Thalamus in Adult Epilepsy: Multi-center Case Series
Authors: Gadot Ron , Shofty Ben , Giridharan Nisha , Banks Garrett P. , Sharma Himanshu , Gavvala Jay R. , Goldman Alica , Krishnan Vaishnav , Lin Lu , Rahimpour Shervin , Sheth Sameer A. 
Published: March 2024

INTRODUCTION:
Responsive neurostimulation (RNS) is an FDA-approved therapy for focal drug-resistant epilepsy (DRE). Emerging evidence supports a role for RNS in DRE with regional, multifocal, or non-resectable seizure onset zones. The centromedian nucleus of the thalamus (CMT) is a promising target, although descriptions of predictors of longer-term response are lacking.

METHODS:
We retrospectively reviewed patients who underwent RNS implantation with at least one CMT electrode at Baylor College of Medicine (BCM) and the University of Utah (UoU) from 2019-2023. Patients with = 6 months of follow-up were assessed for changes in clinical seizure frequency following surgery, as well as changes in seizure severity and subjective quality-of-life (QoL).

RESULTS:
Sixteen patients underwent CMT RNS (n = 12 BCM, n = 4 UoU) at a median age of 30 years [range 20-51] with a median 19-year history of epilepsy. All patients were evaluated by a multidisciplinary team that recommended thalamic RNS. Thirteen underwent bilateral CMT implantation and 7 had a documented lesional effect (>50% reduction in seizures in the months following implantation). Thirteen patients had = 6-month follow-up with which to do subsequent seizure outcome analysis. In these patients, with a median follow-up of 18 months [6-40], median clinical seizure reduction was 80% [0-100%], 2 patients were seizure free for 6 months, and 1 was seizure free for 40 months. Patients with a lesional effect had a median 87% seizure reduction at last follow-up while those without a lesional effect had a 51% seizure reduction (two-tailed, two-sample t-test, p = 0.04). Subjective reduced seizure severity and increased QoL was documented in 92% of patients.

CONCLUSIONS:
RNS of the CMT can result in robust seizure frequency, severity, and QoL improvements in patients with DRE. Post-implantation lesional effect may be associated with longer-term improved response.
489 Increase in Broadband Power Is an Electrophysiologic Marker of Focal Thalamic Activity During Movement
Authors: Klassen Bryan T. , Valencia Gabriela Ojeda , Kaufmann Timothy , Miller Kai Joshua 
Published: March 2024

INTRODUCTION:
The architecture of the human thalamus is currently indirectly inferred from human histopathologic and non-human animal studies. Given that movement-related increases in broadband power from electrocorticography recording have been previously shown to identify specific motor cortical subregions involved with a particular movement, we explored whether this phenomenon can also be used to localize motor subregions of thalamus.

METHODS:
We performed serial human thalamic local field potentials recordings using an electrode moved through the lateral thalamusduring deep brain stimulation surgery in 10 subjects. During the recording at each location, subjects alternated between 5 second epochs of rest and 5 second periods of contralateral hand movement. Power spectra were generated for each epoch using Welch’s overlapping periodogram method (1 second window, 50% overlap). Spectra from all movement and rest epochs were separately averaged. The difference between the power in the 65 to 95 Hz band during movement versus rest was used as a proxy for task-related change in broadband activity. Task-related differences in prominent low-frequency oscillations (patient-specific sub-ranges within 5 to 30 Hz) were analyzed per individual oscillation and in aggregate. Significance was determined using unpaired T tests at a threshold of p = 0.05.

RESULTS:
We find that recording sites showing statistically significant increases in broadband power during movement tend to tightly cluster in areas predicted to represent motor thalamus, whereas sites showing statistically significant reduction in the power (desynchronization) of low frequency oscillations are more diffusely distributed. This finding is replicated across all subjects.

CONCLUSIONS:
These results suggest that a task-dependent increase in broadband power is an electrophysiologic marker of focal thalamic activity and may be useful to delineate specific thalamic subregions on an individual subject basis.
501 Systemic Immunological Suppression in Glioblastoma Is Targeted by Concurrent VEGF and PD-1 Inhibition in a Dose-Dependent Manner: Cellular Indexing of Transcriptomes and Epitopes by Sequencing (CITE-Seq) From a Randomized Controlled Trial
Authors: Ozair Ahmad , Alban Tyler J. , Grabowski Matthew M. , Otvos Balint , Bayik Defne , Bamashmos Anas , Rayman Pat , Diaz Marcella , Khosla Atulya , Bellur Shreyas , McDermott Michael William , Reardon David A. , Wen Patrick , Mohammadi Alireza M. , Peereboom David M. , Lathia Justin D. , Ahluwalia Manmeet 
Published: March 2024

INTRODUCTION:
Anti-PD1 blockade has had poor efficacy in recurrent glioblastoma (rGBM) across three RCTs. VEGF, a proangiogenic factor that is upregulated in rGBM, contributes to tumor-associated immunosuppression and is widely targeted through bevacizumab. Preclinical data indicate a potential dose-dependent effect of anti-VEGF therapy on immunomodulation. Hence, a combination of anti-PD-1 and anti-VEGF agents is a promising approach for rGBM, for which an RCT was conducted.

METHODS:
Patients with rGBM were administered nivolumab (240mg IV q2weeks) plus either standard dose bevacizumab (10mg/kg) or low dose bevacizumab (3mg/kg) IV q2weeks, with 1:1 randomization. Stratification factors were age, performance status, extent of resection, and MGMT methylation status. Primary endpoint was overall survival (OS) at 12 months. CITE-Seq was performed on 16 patients across trial arms, both pre- and on-therapy, yielding total 32 immunological profiles. For control, CITE-seq was done on three patients receiving anti-VEGF therapy alone.

RESULTS:
90 patients were enrolled with median age of 60.6 years and 45 patients per arm. Both arms had similar OS at 12 months (P = 0.14). Significantly higher OS was found in posthoc analysis for patients aged = 60 years with standard dose. Distinct immune cell populations were identified and differential changes in myeloid-derived suppressor cells (MDSCs) found across trial arms on-therapy. Network medicine approach identified VEGF as target to reduce MDSCs, with VEGF primarily expressed by responders’ MDSCs. Differential gene expression analysis identified increased pro-inflammatory signatures in standard dose arm.

CONCLUSIONS:
Standard dose bevacizumab was associated with increased inflammatory response and reduction of immunosuppressive MDSC. These mechanistic insights potentially explain survival benefit seen with concurrent VEGF and PD-1 inhibition in elderly rGBM patients.
706 Radial Versus Femoral Access for Diagnostic Cerebral Angiography: A Systematic Review and Meta-analysis of Randomized Trials
Authors: Lima Fonseca Rodrigues Amanda Cyntia , Tonetti Daniel 
Published: March 2024

INTRODUCTION:
Radial artery access is the gold standard for percutaneous coronary procedures, desmonstrating benefits for patient safety and comfort, its adoption for diagnostic cerebral angiography has been limited by doctors’ concerns about achieving procedural success.

METHODS:
PubMed, Embase and Cochrane databases were searched through April 2023. Statistical analysis were performed using R version 4.2.3. Random-effects meta-analysis with risk ratio (RR) and 95% CI were estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and DerSimonian-Laird estimator for continuous outcomes. The primary outcome was technical success, and the secondary outcomes were procedure time, radiation exposure and fluoroscopy.

RESULTS:
After reviewing 142 studies, were included 3 randomized trials involving 492 patients with 250 patients in radial group (50.81%) and 242 in femoral (49.19%). The total mean age of the patients was 57 years old, 249 males (50.61%) and 243 females (49.39%). There is no significant difference in technical success (RR 0.99, 95% CI 0.94 to 1.03, p = 0.555, I2 = 0%), procedure time (WMD 2.08 minutes, 95% CI -5.11 to 9.28, p = 0.570, I2 = 87%) and radiation exposure also showed no significant difference (WMD 27.87 mGy, 95% CI -21.43 to 77.17, p=0.268, I2 = 0%). Fluoroscopy time had high heterogeneity and a non-significant result (WMD 2.70 minutes, 95% CI -0.73 to 6.13, p = 0.123, I2 = 82%). The funnel plots showed roughly inverted symmetrical distributions among study points which indicated the lack of any preliminary publication bias. Leave-one-out sensitivity analysis determined that the final pooled results were unstable.

CONCLUSIONS:
The findings suggest that the procedures studied have similar technical success rates and radiation exposure. Studies are needed to explore the factors contributing to heterogeneity in procedure and fluoroscopy times to optimize safety and efficiency in radial or femoral access.
726 Changes of Reported Industry Payments to Neurosurgeons Pre- and Post-Covid-19 Epidemic
Authors: Elsamadicy Aladine A. , Cross James 
Published: March 2024

INTRODUCTION:
Under the Affordable Care Act, the Physcian Patient Sunshine Act was implemented in 2010, providing public transparency of industry relationships with physcians. Open Payments Data (OPD) was released in 2014, and annually since. Payments to Neurosurgeons have been found to be amongst the highest. However, the implications Covid-19 in 2020 had on payments has not been reported.

METHODS:
A retrospective study was performed from January 1, 2017 to December 31, 2021 of the Open Payments Database. Collected data included the total number of industry payments, the aggregate value of industry payments, and the mean value of each industry payment made to neurosurgeons per year over the 5-year period.

RESULTS:
A total of 7,985 unique neurosurgeons recieved payments, totaling $451,610,410, There was a decreasing trend in the number of Neurosurgeons recieving payments during Covid-19 (2020): 5,478 (2017), 5,286 (2018), 5,146 (2019), 4,330 (2020), and 4,880 (2021). Additionally, there was decline in the total amount of payments made in 2020, compared to the other years: 80,358 (2017), 82,143 (2018), 85,026 (2019), 46,762 (2020), and 67,507 (2021). Among the types of payments, year 2020 was lower than the other years in Food and Beverage, Travel and Lodging, Services other than Consulting, and Eduction. Interestingly, year 2020 had higher number of payments for Consulting Fee and Royalty/License payments compared to pre-Covid-19 years.

CONCLUSIONS:
Our study shows that over the 5-year period (2017-2021) of the Centers for Medicare and Medicaid Services OPD, there was decrease in number of Neurosurgeons recieving payments and the number of payments made to Neurosurgeons compared to Pre-Covid. However, 2021 demonstrated an increasing trend similar to Pre-Covid.