bluuebunny/crossref_metadata_2025_split huggingface dataset:
497 Does Physical Activity Improve Patient Outcomes Following Lumbar Microdiscectomy?
Authors: Yang Amy , Goldschlager Tony , Daly Chris D. , Castle-Kirszbaum Mendel , Rogers Myron A. 
Published: March 2023

INTRODUCTION:
Lumbar microdiscectomy is widely performed for disc herniation, however outcomes may be unsatisfactory in 10-40% patients and up to 12.5% require re-operation. Evidence regarding the effect of physical activity on post-operative outcomes is scant. The majority of existing studies rely on biased activity self-reporting or short-term monitoring. Duration of physical activity presents a tangible goal for patient counselling, can be measured using wearable technology, and can be targeted to improve outcomes.

METHODS:
53 patients underwent lumbar microdiscectomy and wore an accelerometer for 30 days post-operatively, which measured activity duration (lying, sitting, standing, walking, cycling) and intensity. Patient-reported outcome scores (VASB, VASL, ODI, EQ-5D, SF-12) at 1, 3, 6, and 12 months, and activity data were analysed. The primary outcome (treatment success) was a predetermined reduction in VASB, VASL, and ODI. The relationship between treatment success and activity was assessed using the Mann-Whitney U test. Associations between outcomes and activity were investigated using MANOVA and Pearson Correlations.

RESULTS:
Longer standing time was associated with worse ODI scores at 6 months (p = .034). There was no other statistically significant association between treatment success and activity duration or intensity. MANOVA demonstrated that shorter sitting time was associated with less back pain at 3 (p = .01) and 12 months (p = .011). Univariate analysis revealed that longer walking time was associated with improved EQ-5D scores at 3 (p = .001) and 12 months (p = .034), and improved SF-12 physical scores at 3 months (p = .026).

CONCLUSIONS:
Shorter standing time was associated with less disability, shorter sitting time with less back pain, and longer walking time with improved physical wellbeing after lumbar microdiscectomy. Higher-powered studies are needed to further explore the relationship between physical activity and outcomes.
499 Prospective, Randomized and Controlled Multicenter Study of Posterior Lumbar Facet Arthroplasty for the Treatment of Spondylolisthesis
Authors: Welch William Charles , Coric Domagoj , Nassr Ahmad , Steinmetz Michael P. , Whiting Donald M. , Groff Michael , Chi John , Whitmore Robert Gray , Meyer Scott , Arnold Paul M. 
Published: March 2023

INTRODUCTION:
Prospective, Randomized and Controlled Multicenter Study of Posterior Lumbar Facet Arthroplasty for the Treatment of Spondylolisthesis.

METHODS:
The study was a prospective, randomized, controlled Food and Drug Administration (FDA) Investigational Device Exemption (IDE) trial evaluating the investigational TOPS device to the control, transforaminal interbody fusion (TLIF) and pedicle screw fixation. Follow-up duration was a minimum twenty-four months.

RESULTS:
A total of 249 patients were evaluated comparing the investigational TOPS group (n = 170) to the control TLIF group (n = 79. There were no statistically significant differences between implanted levels (L4-5 TOPS 95%; L4-5 TLIF 95%) or blood loss. The overall composite measure for clinical success was statistically significantly higher in the TOPS group, 85%, compared to the fusion group, 64% (p = 0.0138). The percentage of subjects reporting minimum 15-point improvement in ODI showed a statistically significant difference (p-value = 0.037) favoring TOPS (94.0%) over TLIF (79.4%).

CONCLUSIONS:
This study demonstrates that posterior lumbar decompression and dynamic stabilization with the TOPS device is safe and efficacious in the treatment of lumbar stenosis with degenerative spondylolisthesis. Additionally, decompression and dynamic stabilization with the TOPS device maintains segmental motion.
508 Deep Learning Segmentation of the Nucleus Basalis of Meynert for Deep Brain Stimulation Surgical Planning
Authors: Doss Derek , Johnson Graham Walter , Narasimhan Saramati , Jiang Jasmine , Gonzalez Hernan F.J. , Paulo Danika Lea , Chang Catie , Morgan Victoria , Constantinidis Christos , Dawant Benoit M. , Englot Dario J. 
Published: March 2023

INTRODUCTION:
The nucleus basalis of Meynert (NBM) is a subcortical structure involved in arousal and cognition being explored as a deep brain stimulation (DBS) target for Alzheimer’s disease and other disorders. Given the small size of the NBM and variability between patients, accurate patient-specific targeting for DBS is needed. Accurate patient-specific manual segmentation is possible but requires high resolution 7T MRI. Therefore, the current standard is a non-patient-specific probabilistic atlas (Zaborszky 2008).

METHODS:
Paired 3T and 7T MRI datasets of 21 healthy subjects were obtained and the NBM was expertly segmented on 7T MRI. The 7T NBM segmentation was then used on the 3T MRI. To increase generalizability, we augmented the dataset to a total of 210 images. An external dataset of 14 patients with temporal lobe epilepsy (TLE) was used to validate the network’s performance on brains with pathological changes (Alvim 2016). A 3D-Unet convolutional neural network was constructed, and a 5-fold cross-validation was performed for model selection. The model was evaluated on healthy subjects using the held-out test dataset and on the external dataset of 14 TLE patients.

RESULTS:
When tested on the held-out dataset, the deep learning network demonstrated significantly improved dice coefficient compared against the probabilistic atlas for both healthy subjects (0.68 ± 0.08, 0.47 ± 0.06) and patients with TLE (0.63 ± 0.08, 0.38 ± 0.19). Additionally, the centroid distance was significantly decreased when using the network in patients with TLE (1.22 ± 0.33 mm, 3.25 ± 2.57 mm).

CONCLUSIONS:
We developed the first network, to our knowledge, for automatic and accurate patient-specific segmentation of the NBM using deep learning. The proposed network has less error than accepted targeting margins. This segmentation strategy allows accurate patient-specific targeting of the NBM for DBS.
509 Modern Hearing Preservation Outcomes After Vestibular Schwannoma Stereotactic Radiosurgery
Authors: Berger Assaf , AlzateRamirez Juan , Bernstein Kenneth , Mullen Reed , McMenomey Sean , Jethanemest Daniel , Friedmann David R. , Smouha Eric , Sulman Erik P. , Silverman Joshua S. , Roland J. Thomas , Golfinos John G. , Kondziolka Douglas 
Published: March 2023

INTRODUCTION:
For patients with vestibular schwannoma (VS), stereotactic radiosurgery (SRS) has proven effective in controlling tumor growth, while hearing preservation remains a key goal.

METHODS:
During the years 2013-2018, 353 patients underwent Gamma-knife surgery for VS at our institution. We followed 175 patients with pre-SRS serviceable hearing (Gardner-Robertson Score, GR 1 and 2). Volumetric and dosimetry data were collected, including Biological Effective Dose (BED), integral doses (ID) of total and intra-canalicular (IC) tumor components and hearing outcomes.

RESULTS:
Mean age was 56 years, 74 (42%) had baseline GR of 2, and mean cochlear dose was 3.5 Gy. Time to serviceable hearing loss (GR 3-4) was 38 months (95% CI, 26-46), with 77% and 62% hearing preservation in the 1st and 2nd years. Patients optimal for best hearing outcomes were younger than 58 with baseline GR of 1, free canal space 0.041cc (diameter of 4.5 mm) and mean cochlear dose <3.1 Gy. For such patients, hearing preservation rates were 92% by 12 months and 81% by 2 years, staying stable for >5 years post-SRS, significantly higher than the rest of the population.

CONCLUSIONS:
Hearing preservation after SRS for VS patients with serviceable hearing is correlated to the specific baseline GR score (1 or 2), age, cochlear dose and BED. Increased tumor-free canal space correlates with better outcomes. The most durable hearing preservation correlates with factors commonly associated with smaller tumors away from the cochlea.
516 Functional Impact of Intratumoral Heterogeneity in Therapeutic Vulnerabilities Across Enhancing and Non-Enhancing Tumor Components of Glioblastoma: A Paradigm-Shifting Personalized Medicine Approach
Authors: Garcia Diogo P. , Lin Wan-hsin , Brooks Mieu , Feathers Ryan , Middlebrooks Erik , Chaichana Kaisorn L. , Anastasiadis Panagiotis , Quinones-Hinojosa Alfredo 
Published: March 2023

INTRODUCTION:
Glioblastoma (GBM) remains a fatal disease without effective targeted therapeutics. This is largely attributed to molecular and spatial heterogeneity and absence of clinically applicable models to guide patient care. Moreover, as standard surgical resection is aimed at contrast-enhancing (CE) tumor, the molecular landscape and treatment response of the remaining non-contrast enhancing (nCE) component remains unknown despite its active role in tumor progression and local recurrence.

METHODS:
Freshly resected tumor tissue was subjected to the generation of 3D tumor models (brain tumor initiating-enriched cell lines [BTICs] and microcancers). To identify the best treatment strategy, a panel of 25 brain penetrant drugs (alone/ in combination) targeting GBM drivers (i.e. RTK/Ras/PI3K, RB, p53/apoptosis, DNA damage repair, transcription addiction) was developed and used to test therapeutic vulnerabilities. Comprehensive sequencing including genome and transcriptome profiling and pathway analysis from these different tumor regions is ongoing.

RESULTS:
Thirty-two patients have been prospectively enrolled, with generation of 38 microcancers and 17 BTICs, and drug screening completed in 26 patients. For a subset, four tumor regions (two CE and two nCE) were collected under neuronavigation. Among 25 drugs tested, 5 ± 3 (mean ± SD) treatment strategies showed strong (≥70%) growth inhibition at Cmax, with inter-tumor drug response heterogeneity ranging from 18.9% to 5.4% (p = 0.02). Intra-tumor drug response heterogeneity varied from high (5/25 drugs tested) to low (0/25, p < 0.05) and was independent of enhancement status or spatial proximity.

CONCLUSIONS:
This is the first study to systematically assess treatment response from both CE and nCE patient-derived GBM models. By interrogating molecular landscapes and vulnerability profiles, we will be able to personalize and prioritize effective targeted interventions for GBM treatment.
521 An Integrated Workflow for Identification, Enrichment, and Molecular Profiling of Tumor-Derived and Non-Tumor Derived Plasma Extracellular Vesicles in Glioblastoma Patients
Authors: Aibaidula Abudumijiti , Fain Cori , Garcia Luz Cumba , Jung Mi-Yeon , Johnson Aaron J. , Parney Ian F. 
Published: March 2023

INTRODUCTION:
Molecular analysis of bulk glioblastoma plasma EVs has demonstrated tumor-associated miRNA expression profiles. It remains unclear whether this molecular signature originates from tumor EVs or non-tumor EVs. Elucidating differences in molecular cargo in EVs originating from different cells could potentially identify highly specific EV biomarkers for glioblastoma diagnosis and disease progression monitoring.

METHODS:
EVs were isolated in vitro from human glioblastoma cells (dBT116)and CD14+ monocytes alone and as co-cultures +/- 5-amino levulinic acid (5-ALA) treatment. CD11b (myeloid marker) and protoporphyrin IX (tumor marker) expression were determined by flow cytometry. In addition, an EV characterization panel including 9 EV markers was further developed for GBM plasma samples. All assays and controls were performed per published guidelines. We utilized spectral flow cytometry to establish our gating strategy then used standard flow cytometry sorting to enrich plasma EVs into different subpopulations. LC-MS/MS proteomics was performed on sorted EVs.

RESULTS:
Protoporphyrin IX positivity was specific to tumor derived EVs. Rigorous assay controls confirmed that our EV characterization panel followed the current ISEV guideline for EV flow cytometry study. Our integrated workflow characterizes and can enrich plasma EVs with high efficiency, confirmed by the presence of multiple EV-associated proteins in proteomic analysis. Initial proteomic analysis suggests protoporphyrin IX-positive tumor EVs have unique protein expression profiles compared to CD11b-positive myeloid EVs.

CONCLUSIONS:
In this study, we were able developed an integrated workflow characterizing plasma EVs and enriching them into different subpopulations based on cell of origin. Application of this workflow in future larger cohorts will be conducted to identify additional specific plasma EV biomarkers for GBM.
523 Deep Phenotyping Reveals Germline Determinants of Disease Severity in Neurofibromatosis Type 2
Authors: Celano Emma , Asuzu David , Chittiboina Prashant 
Published: March 2023

INTRODUCTION:
Although germline nonsense and frameshift mutations are hypothesized to confer more severe disease in neurofibromatosis type 2 (NF2), the mechanisms of genotype-phenotype association are unknown.

METHODS:
Patients (n = 169) with NF2 were enrolled in a natural history study (NCT NCT00598351). Deep phenotypic profiles were created (serially for 5 years) including clinical evaluations, self-reported functional measures, lifetime interventions (surgical, radiation and drug treatments), and imaging (tumor number, type, and volume). CLIA certified germline mutation analyses (n= 69) were supplemented with a custom PCR panel (NF2, LZTR1, SMARCB1, SMARCE1, and SUFU). Data were analyzed (QIAGEN CLC Genomics Workbench) for mutation type, location, and predicted protein effect (truncating/non-truncating). Low frequency variant detection was used to detect mosaicism.

RESULTS:
Germline mutations (nonsense-36%, splice-site-16%, and large deletions-16%) were grouped by predicted protein effect (truncating-41%, non-truncating-27%, and mosaic-33%) and mapped to the chromosomal locus. As predicted, disease severity increased in patients during the study (mean increase of 1.9 tumors/5-yrs and 3,793mm3/5-yrs). However, the disease severity was not associated with age at study enrollment (tumor number/volume) (p = 0.15/0.58). We found that truncating mutations in exons 8, 11-12 were associated with a higher tumor burden (p = 0.03). Truncating mutations at exon 8 were also associated with schwannomas (p = 0.04). Change in tumor volume during the study was predicted by younger age (p < 0.01) and truncating mutation (p = 0.05). Unlike prior studies, mortality was not predicted by truncating mutation type.

CONCLUSIONS:
We deeply phenotyped a diverse cohort of patients with NF2 and found that the location of truncating mutation determined the phenotype. We suspect that truncating mutations at exons 8 & 11-12 disrupt the transition from highly conserved FERM domain to the alpha-helix region leading to a severe NF2 phenotype.
556 A Matched-Pair Analysis of Patients with Ischemic Strokes Undergoing Thrombectomy Using the BOBBY Balloon Guide Catheter
Authors: Kim Lily H. , Choi John H. , Wolman Dylan , Pendharkar Arjun Vivek , Dodd Robert L. , Do Huy M. , Heit Jeremy , Telischak Nicholas 
Published: March 2023

INTRODUCTION:
Endovascular thrombectomy has become the standard-of-care in treatment of large-vessel occlusion. Despite evidence of enhanced clot retrieval with balloon guide catheters (BGC), their routine use is yet to be widely adopted possibly due to incompatibility of past generation BGCs with large bore intermediate catheters. The next-generation BOBBY BGC is compatible with the 0.070-inch SOFIATM Flow Plus catheter.

METHODS:
We conducted a retrospective study of 112 thrombectomy cases utilizing BGC (N = 56) and non-BGC (N=56) methods. Sixty consecutive thrombectomy cases that used BOBBYTM BGC (MicroVention, Aliso Viejo, CA) at a single institution between 2/2021-3/2022 were identified. Of them, 56 BGC cases were 1:1 matched with non-BGC cases performed between 4/2016-12/2021 by proceduralists, age (±10 years), gender, stent retriever + aspiration device versus aspiration-only, and site of occlusion. First-pass effect was defined as Thrombolysis In Cerebral Infarction scale ≥IIB with a single pass, and good functional outcome as Modified Rankin Scale ≤2.

RESULTS:
BGC and non-BGC cohorts had similar mean age (67 versus 69 years), gender distribution (44.6%, 48.2% females), mean initial National Institutes of Health Stroke Scale (14.5, 14), and median pre-treatment ischemic core volumes (12.5 ml, 11 ml). BGC and non-BGC cases had similar rates of single pass (58.9%, 55.4%), first-pass effect (57.1%, 50.0%), and complications (5.4%, 8.9%). In aspiration-only cases, adding BGC led to a significantly higher rate of first-pass effect (71.4% vs 50.0%, P = 0.01). BGC was associated with higher likelihood of achieving good functional outcome at discharge (OR 2.30, P = 0.01). No additional procedural time was required for BGC cases (46.7 versus 48.4 minutes).

CONCLUSIONS:
An initial one-year experience from a tertiary academic center shows BGC can be safely adopted with comparable procedural efficacy, benefits to aspiration-only techniques, and earlier functional improvement when compared to conventional guide catheter cases.
558 Use Of Balloon-Guide Catheters For Concomitant Mechanical Thrombectomy And Carotid Revascularization With Flow-Arrest Results In Significantly Lower sICH And Better 90-Day Outcomes In Tandem Stroke Patients: A Propensity Score-Matched Study
Authors: Baig Ammad , Waqas Muhammad , Cappuzzo Justin Mark , Kuo Cathleen , Donnelly Brianna , Monteiro Andre , Davies Jason , Siddiqui Adnan Hussain , Levy Elad I. 
Published: March 2023

INTRODUCTION:
A larger than normal clot burden accounts for worse presentation and poorer thrombectomy outcomes in tandem stroke cases.

METHODS:
A prospectively maintained database was retrospectively searched for patients who presented with a tandem stroke. Patients were dichotomized into two groups; those treated with BGCs and those treated without BGCs. A one-to-one matched propensity score analysis was performed to adjust for treatment selection bias using the nearest-neighbor matching technique for covariates (baseline comorbidities and stroke severity). Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes were assessed as periprocedural sICH, in-hospital mortality, and 90-day mRS. Mann-whitney U test, and multivariate logistic regression was performed to compare the procedural parameters and the clinical outcomes between groups.

RESULTS:
We included 125 patients (BGC: 85 [40 after PSM]; No BGC: 40 [40 after PSM]). Concomitant carotid revascularization (stenting or angioplasty) was performed in all cases. After PSM, no difference was seen between the two groups in terms of comorbidities, and initial stroke severity. BGC group had significantly lower procedure duration (61.5% vs. 77.9% (OR = 0.996; P = 0.006)), lower NIHSS at discharge (8.0% vs. 11.0% (OR = 0.987; P = 0.042)), and higher odds of good outcomes (mRS 0-2 at 90-day) (52.3% vs. 27.5% (OR = 0.34; P = 0.040)). On multivariate regression analysis, BGC group had significantly higher rate of first-pass effect (mTICI 2B-3) (OR = 0.660, 95% CI = 0.480-0.908;P = 0.013), and a lower periprocedural sICH rate (OR = 0.615, 95% CI = 0.406-0.932; P = 0.025). No difference in in-hospital mortality was observed (OR = 1.591; 95% CI = 0.976-2.593; P = 0.067).

CONCLUSIONS:
Use of BGCs for concomitant mechanical thrombectomy and carotid revascularization with flow-arrest is safe and results in superior clinical and angiographic outcomes in tandem stroke patients.
559 Novel Technique of Head-Mounted Augmented Reality Assisted Cerebral Angiogram: Proof of Concept on a Flow Model
Authors: Costa Matias , Basamh Mohammed , Monteith Stephen J. 
Published: March 2023

INTRODUCTION:
Augmented reality (AR) is an emerging technology in medicine while still under-explored in the endovascular field.

METHODS:
A 5 French guide was delivered to the proximal ICA-equivalent vessel. DynaCT was performed for the flow model using a uniplanar Artis Q angiogram suite (Siemens Medical Solutions, Erlangen, Germany) to create a CTA to act as a surrogate for non-invasive CTA in patients. A 3D reconstruction of the circulation was performed using the Syngo station (Siemens Medical Solutions, Erlangen, Germany). After importing the 3D image to the HMAR system, a hologram of the circulation was created. A roadmap image was created and the AR hologram was superimposed to it on the angiography screen. A 0.012” microcatheter with a microwire was then advanced to the tip of the guide catheter.

RESULTS:
The operator navigated the proximal and distal intracranial vessels using the hologram to replace the roadmap; and fluoroscopy guidance for visualization of the catheters and microwire. No contrast was needed as the hologram acted as the roadmap. The microcatheter was navigated successfully to distal targets in the ipsilateral and contralateral intracranial vasculature without the need to repeat road maps or inject contrast.

CONCLUSIONS:
The concept of HMAR-assisted cerebral angiography is feasible. We were able to perform the whole intracranial navigation using one pre-operative CTA only. This technology needs further development and has huge potential to decrease contrast use and possibly radiation exposure.
645 Getting What You Pay For: Impact of Copayments on Physical Therapy Initiation, Timing, and Continuation for Acute-Onset Low Back Pain
Authors: Jin Michael Chuwei , Jensen Michael , Barros Guinle Maria Isabel , Ren Alexander , Zhou Zeyi , Zygourakis Corinna Clio , Desai Atman , Veeravagu Anand , Ratliff John K. 
Published: March 2023

INTRODUCTION:
Physical therapy (PT) is an important component of acute low back pain (LBP) management. Despite established guidelines, heterogeneity in medical management remains common.

METHODS:
The IBM Watson Health MarketScan claims database was queried for adult patients with new-onset idiopathic LBP. The primary outcomes-of-interest were timing and overall utilization of PT services. Additional outcomes-of-interest included timing of opioid prescribing. Actual and inferred copayments based on specialist visit claims were used to evaluate the relationship between PT copayment and incidence of PT initiation. Multivariable regression models were used to evaluate factors influencing PT usage.

RESULTS:
Overall, 2,467,389 patients were included. PT initiation, among those with at ≥1 PT service during the year after LBP diagnosis (30.6%), occurred at a median of 8 days post-diagnosis (IQR 1-55). Among those with at least one PT encounter, incidence of subsequent PT visits was significantly lower for those with high initial PT copayments. High initial PT copayments, while inversely correlated with PT utilization, were directly correlated with subsequent opioid use. High PT copayments affected relative timing of PT and opioid initiation, with every $10 increase associated with a delay in PT initiation of 3.06 days (95%CI 2.76-3.36) and an advancement of opioid prescription by 2.58 days (95%CI 2.24-2.92). For multivariable whole-cohort analyses, incidence of PT initiation among patients with inferred copayments in the 50-75th and 75th-100th percentiles was significantly lower than those below the 50th percentile (HR = 0.893 [95% CI 0.887-0.899] and HR=0.905 [95% CI 0.899-0.912], respectively).

CONCLUSIONS:
Higher PT copayments correlated with reduced PT utilization; higher PT copayments and lower opioid copayments were independent contributors to delayed PT initiation and higher opioid use. In patients covered by plans charging high PT copayments, opioid use was significantly higher. Co-pays impact long-term adherence to PT.