bluuebunny/crossref_metadata_2025_split huggingface dataset:
209 What Happens to Brain Outside the Thermal Ablation Zones? An Assessment of Needle-Based Therapeutic Ultrasound in Survival Swine
Authors: Szewczyk Benjamin , Johansen Phillip , Tarasek Matthew , Campwala Zahabiya , Trowbridge Rachel , Zhao Zhanyue , Olmsted Zachary T. , Bhushan Chitresh , Fiveland Eric , Ghoushal Goutam , Heffter Tamas , Tavakkolmoghaddam Farid , Bales Charles , Wang Yang , Rajamani Dhruv Kool , Gandomi Katie , Nycz Christopher , Jeannotte Erin , Mane Shweta , Nalwalk Julia , Burdette Clif , Fischer Gregory S. , Yeo Desmond , Qian Jiang , Pilitsis Julie G. 
Published: March 2023

INTRODUCTION:
For stereotactic radiosurgery, isodense lines must be considered to determine how surrounding tissue is affected. In thermal ablative therapy, such as laser interstitial thermal therapy (LITT) transcranial MR-guided focused ultrasound (tcMRgFUS) and needle-based therapeutic ultrasound (NBTU) how the surrounding area is effected has not been well studies in large animal models.

METHODS:
Four swine underwent MRgRA NBTU using varying treatment doses. Neurological evaluation of swine was performed up to 30 days post-procedure. Serial MRI images were obtained, and the most representative were overlaid with isodose lines and compared to brain tissue acquired post-mortem which underwent histopathologic analysis. These results were also compared to predicted volumes using a finite element analysis (FEA).

RESULTS:
NBTU applicator orientation at 360° induced smaller lesion volumes (33.19 mm3; 120 s, 3 W; 30.05 mm3, 180 s, 4 W) versus 180o (77.20 mm3, 120 s, 3 W; 109.29 mm3; 180 s; 4 W). The ablation-zone was characterized by dense macrophage infiltration and glial/neuronal loss as demonstrated by glial fibrillary acidic protein (GFAP) and neurofilament (NF) absence and avid CD163 staining. The transition-zone between lesion and normal brain demonstrated decreased macrophage infiltration and measured ∼345 microns. None of the experimental swine suffered any long-term neurologic or behavioral complications. MRTI/histology overlay demonstrated the boundary of ablation at ∼200 (cumulative equivalent minutes) CEM43 isodose boundary.

CONCLUSIONS:
We successfully performed MRgRA NBTU ablation in swine and demonstrated minimal histologic changes extended past the ablation-zone. The lesion was characterized by macrophage infiltration and glial/neuronal loss which decreased through the transition-zone. Whether NBTU offers advantage over tcMRgFUS and LITT in this regard warrants further study.
210 Intra-Operative Electrocorticography (ECoG) for Lesional Epilepsy: A Randomized Controlled Trial (IO-ECoG Trial)
Authors: Rajeev Sreenath , Chandy Vilanilam George , Abraham Mathew , Easwer Hariharan Venkat , Menon Ramshekhar , Radhakrishnan Ashalatha , Cherian Ajith , Thomas Sanjeev , Vimala Smita , A N Deepti 
Published: March 2023

INTRODUCTION:
Usage of Electrocorticography (ECoG) is not clearly established. Robust evidence doesnot exist to support its regular usage in Long term Epilepsy associated tumors (LEATs) which constitutes approximately 25-35% cases of drug resistant epilepsy.

METHODS:
Prospective randomized controlled trial, including all patients operated for drug resistant epilepsy with non-eloquent area LEATs. Patients were randomized into 2 groups namely Group I (without usage of ECoG) and Group II (with ECoG usage). Group II patients further underwent tailored resections if necessary, as per ECoG practice protocols. Surgical outcomes were evaluated for seizure outcome (Engel scale) and adverse event profile.

RESULTS:
Total of 38 patients operated for LEATs having drug resistant epilepsy were included in the study with mean age of 21.1 years (range 2-46 years). 18 patients belonged to Group I and 20 patients belonged to Group II with mean follow-up period of 11.02 months (range 3-22 months). 30% patients (n = 6) in Group II underwent extended resection based on rhythmic persistent post resection spikes. 90% of Group II patients had Engel score Ia during follow up compared to 77.7% of Group I with Engel score Ia (p = 0.302). In Group II, 85.7% patients with extended tailored resection had Engel score Ia compared to 83.8% cases without extended resection (p = 0.904).

CONCLUSIONS:
Though ECoGs role may have been established in focal cortical dysplasia, its utility in LEATs is limited. Our randomized study confirmed that there is no added benefit conferred by the use of ECoG in LEATS. Additional tailored resections aided by ECoG also did not yield seizure outcome benefits in LEATS.
215 Extent of Resection in Glioblastoma: Prognostic Validation of a New Classification from the RANO Resect Group
Authors: Karschnia Philipp , Young Jacob , Ostorga Antonio Gabriel Dono , Häni Levin , Sciortino Tommaso , Bruno Francesco , Jünger Stephanie T. , Teske Nico , Morshed Ramin A. , Haddad Alexander F. , Zhang Yalan , Stöcklein Sophia , Weller Michael , Vogelbaum Michael A. , Beck Juergen , Tandon Nitin , Hervey-Jumper Shawn L. , Molinaro Annette , Rudà Roberta , Bello Lorenzo , Schnell Oliver , Esquenazi Yoshua , Ruge Maximilian I. , Grau Stefan J. , Berger Mitchel , Chang Susan M. , van den Bent Martin , Tonn Joerg-Christian 
Published: March 2023

INTRODUCTION:
Terminology to describe extent of resection in glioblastoma is inconsistently applied. Based upon residual contrast-enhancing (CE) tumor, a surgical classification system was previously proposed.

METHODS:
The members of the RANO resect group retrospectively searched the databases from international seven neuro-oncological centers for newly diagnosed glioblastoma per WHO 2021 classification. Volumetric information (from pre- and post-operative MRI) and clinical data were collected.

RESULTS:
We identified 1021 patients with newly diagnosed glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC 26981/22981 (TMZ/RT→TMZ) following surgery. Among such homogenously treated IDHwt patients, lower absolute residual tumor volumes (in cm3) were superiorly associated with outcome. Accordingly, individuals with ‘maximal CE resection’ (class 2) had more favourable outcome compared to individuals with ‘submaximal CE resection’ (class 3) or ‘biopsy’ (class 4) (median OS: 19 versus 15 versus 10 months; p = 0.001). Additional resection of non-CE tumor (with ≤ 5 cm3 residual non-CE tumor) translated into an additional survival benefit in patients with complete CE resection, thus defining class 1 (‘supramaximal CE resection’) (median OS: 24 versus 19 months; p = 0.008). The prognostic role of the resection classes was retained on multivariate analysis when adjusting for clinical and molecular markers. Notably, relative tumor reduction (in percentage) was not prognostic on multivariate analysis, and inter-rater agreement for CE and non-CE tumor on post-operative MRI was sufficient.

CONCLUSIONS:
The suggested “RANO categories for extent of resection in glioblastoma” are prognostic for outcome and may therefore be used for stratification of clinical trials. Removal of non-CE tumor beyond the CE tumor borders is associated with improved survival, providing a rationale to explicitly denominate such ‘supramaximal CE resection’.
304 Correlation of Preoperative Suzuki Stage, Postoperative Matsushima Grade, and Clinical Outcomes in Surgically Treated Pediatric Moyamoya
Authors: Wilson Christopher , Newman Sharlé , Martinez Mesha , Huh Andrew , Avila Stephen , Ducis Katrina 
Published: March 2023

INTRODUCTION:
Moyamoya disease and syndrome among pediatric patients is often treated with surgical revascularization. There is limited literature regarding associations between preoperative angiography, postoperative angiography, and clinical outcomes.

METHODS:
We report a case series of consecutive moyamoya disease (MMD) and moyamoya syndrome (MMS) pediatric patients who underwent pial synangiosis. Correlations between preoperative Suzuki stage, Matsushima grade at one year postoperatively, and pediatric modified Rankin score (mRS) were assessed using Speakman’s Rank correlation testing. Factors associated with angiographic and clinical outcomes were analyzed using Fisher’s Exact tests.

RESULTS:
40 patients (60 hemispheres) were treated with median follow up 2.29 years. No significant correlation between preoperative Suzuki stage and postoperative Matsushima grade was identified overall. Suzuki stage two hemispheres developed less robust revascularization. Preoperative Suzuki stage was not associated with postoperative disability severity whereas a nonsignificant trend towards improved clinical outcomes was observed with better Matsushima grade. Poor angiographic revascularization was more frequent in MMS patients, Sickle Cell Disease (SCD) patients, patients with preoperative ivy sign, preoperative NIHSS ≥3, and preoperative symptom duration more than 6 months. Postoperative intracranial hemorrhage, reoperation, Suzuki stage ≥5, and postoperative ischemic stroke conferred more unfavorable clinical outcomes whereas Matsushima A and B revascularization and symptom duration <6 months were protective from unfavorable outcomes.

CONCLUSIONS:
Although Suzuki stage does not significantly correlate with Matsushima grade, the degree of revascularization according to Matsushima grade may be associated with clinical outcomes. Multiple factors associated with degree of revascularization and clinical outcomes are identified.
305 Enhancing Endothelialization of Flow Diverting Stents: An In Vitro Study
Authors: Abdelsalam Ahmed , Corsaletti Gina , Haniff Rianna , Sheinberg Dallas L. , Ramsay Ian , Ehiemua Uchechi , Starke Robert M. , Thompson John 
Published: March 2023

INTRODUCTION:
Flow diverting (FD) stents revolutionized the management of broad neck aneurysms. Several FD stents surface modifications have been developed over the last decade to reduce thromboembolic complications or enhance aneurysmal occlusion rates. Promoting FD endothelization through surface coating has emerged as a novel modality to enhance stent coverage, thus improving aneurysmal occlusion, reducing aneurysmal progression and post-treatment failure. Herein, we report our in vitro experience with FD surface modification using gelatin.

METHODS:
PED Flex stents were incubated overnight with either PBS (unmodified) or gelatin, followed by a three-hour incubation with human microvascular endothelial cells. Endothelial cell attachment and proliferation were assessed at various time points.

RESULTS:
There was a significant increase(p < 0.05) in endothelial cell attachment on gelatin(6.3 ± 2.1)surface modified stents compared to unmodified control stents. This increase in endothelial cells was maintained 14 days gelatin 6.3 ± 2.7, fold of control)following cell incubation but gradually decreased until it became insignificant by day 21. Next, we analyzed the temporal rate of endothelial stent coverage. Following cell incubation, 20% of surface-modified stents were coated by endothelial cells on day 5 compared to just 2% in unmodified stents. This difference in cell coverage remained significant (p < 0.05), with surface-modified stents being entirely covered by 2 weeks while unmodified stents were only 50% covered. We also observed a significant increase (p < 0.05, fold of unmodified) in endothelial cell migration onto (1.8 ± 0.2) and from (1.5 ± 0.033) gelatin-coated stents compared to unmodified controls.

CONCLUSIONS:
Our in vitro experience demonstrates that gelatin has the potential to enhance the endothelialization of FD, leading to increased aneurysm occlusion rates, thereby minimizing post-treatment failure. Further investigations are essential to fully evaluate this novel modality and compare it to the commercially available devices.
307 Clinical Efficacy of Thrombolytic Therapies in Mothership Versus Drip and Ship Model: A Systematic Review and Meta-Analysis
Authors: Mohamed Ahmed , Fatima Nida , Altahou Abraham , Ahmed Ayman , Shuaib Ashfaq , Saqqur Maher 
Published: March 2023

INTRODUCTION:
There exist substantial uncertainty in understanding the benefit of organizational paradigms in stroke centers.

METHODS:
Studies between 1990 and 2021 were analyzed from electronic databases. Critical time measurements, functional independence, and mortality were all compared. IBM SPSS 23 and Rev Manager were used for statistical analysis.

RESULTS:
7,232 patients’ data were collected from 24 studies. MT+IVtPA vs. IVtPA only did not show significant difference between both cohorts when analyzing NIHSS (p = 0.461). When conducting a subgroup analysis to interpret differences between MS and DS patients in each treatment method, no significant difference (p > 0.05) was noted for the mean time of symptoms to onset and the mean stroke onset to successful recanalization time for the Mt+IVtPA (p = 0.267) and IVtPA cohorts (p = 0.461). The MT+/-IVtPA reported significant differences between MS and DS patients in both these times (p < 0.001 and p = 0.011, respectively). Moreover, no significant difference was noted for mortality at 90-days and symptomatic intracranial hemorrhage (sICH) among these different thrombolytic groups for the DS and MS model patients in all three treatment method cohorts (p = 0.941 for the MT+IVtPA group, p = 0.993 for the MT+/-ItPA and N/A for IVtPA only). The MT+/-IVtPA cohort was the only one to show a significantly larger percentage of patients in the DS group, compared to the MS, to have a mRS score of 3-6 (bad functional outcome) (p = 0.034).

CONCLUSIONS:
Our results showed that there is no sufficient significant difference in clinical efficacy based on MS or DS models in each treatment type.
312 Neutrophil Extracellular Trap (NET) Proteins Enriched in Emboli Retrieved from Stroke Patients with Atrial Fibrillation
Authors: Akkipeddi Sajal Medha , Rahmani Redi , Schartz Derrek , Chittaranjan Siddharth , Gunturi Aditya , Bhalla Tarun , Mattingly Thomas , Morrell Craig , Bender Matthew T. 
Published: March 2023

INTRODUCTION:
Recent literature has demonstrated remarkable heterogeneity in the composition of acute ischemic stroke (AIS) emboli from different etiologies, which may directly impact their susceptibility to current standard-of-care therapies.

METHODS:
The full proteomic composition of retrieved thromboembolic material from 24 patients with AIS was evaluated by mass spectrometry. Of the 1797 total proteins identified, 88 known marker proteins were sorted into groups representing broad classes of embolus components: RBCs, PLTs, PMNs, histones, complement proteins, and other clotting-associated proteins (e.g., fibrinogen). The abundance of individual proteins in patients with AF was compared to that of patients without AF using Mann-Whitney U-tests, with significant differences described by the fold change (FC) in abundance. Functional implications of identified differences were explored using the Gene Ontology (GO) enRIchment anaLysis and visuaLizAtion tool (GOrilla).

RESULTS:
There were no significant differences in protein abundance in the RBC, complement, or clotting-associated protein groups. One out of the 11 PLT group proteins (p = 0.042, FC = 2.46), eight out of the 15 PMN group proteins (p < 0.05, FC > 2), and four out of the 14 histone proteins were significantly enriched in emboli from patients with AF (p < 0.05, FC > 2). The most significantly represented functional GO pathways in patients with AF involved PMN activation and degranulation (p < 10-7).

CONCLUSIONS:
The enrichment of PMN proteins and histones, as well as pathways culminating in PMN activation and degranulation, suggests the presence of neutrophil extracellular traps (NETs) in emboli of stroke patients with AF. NETs are a significant though understudied structural component of clots, and so this work hints at not only significant pathological immunothrombosis in patients with AF, but also at potential therapeutic targets for AIS in this population.
318 Designing and Developing a Novel Deep Computer Vision Platform for Intraoperative Prediction and Analytics
Authors: Blue Rachel , Doiphode Nehal , Jena Rohit , Madsen Peter J. , Lee John Y.K. , Shi Jianbo , Buch Vivek 
Published: March 2023

INTRODUCTION:
Robust artificial intelligence (AI)-based surgical video analysis platforms could lead to novel insights for intraoperative guidance.

METHODS:
Microvascular decompression surgeries were recorded using a Storz endoscope. A dataset of 2611 frames from 4 operative videos were segmented to create ground truth images. A sparse labeling paradigm was used, and training data comprised only 3% of the total video frames. Surgical anatomy including the brain stem, cerebellum, cranial nerves, vascular structures and surgical instruments were annotated. We developed a custom deep learning framework built on top of a state-of-the-art instance segmentation algorithm SOLOv2, the baseline. Model was trained for each video and pre-training was transferred across videos. Mean average precision(mAP) was computed within and across videos as an evaluation metric. Lastly, a novel metric to quantify arterial pulsation-induced nerve deformation is introduced, and compared before and after Teflon sponge placement.

RESULTS:
Our model consistently outperforms the baseline, with an average mAP of 63.75 for within video, and shows feasibility on novel patient video test set with mAP of 40.13 using few-shot learning. For the novel test video, our pulsatility index during compression is 9.5 whereas after decompression is 6.0, indicating successful dampening of artery-nerve pulsation after sponge insertion.

CONCLUSIONS:
In a sparse labeling paradigm, we design and develop a custom deep computer vision-based instance segmentation architecture to predict and track anatomical structures and surgical objects with high accuracy. We create a novel metric, the “pulsatility index”, which is able to quantify the nerve-artery interface for the first time. Once correlated with outcome measures, real-time AI-based video feed analysis may have the transformative potential to re-define intraoperative standard of care.
323 Pre-Operative MRI Radiomics Model Non-Invasively Predicts Key Genomic Markers and Survival in Glioblastoma Patients
Authors: Pease Matthew , Gersey Zachary Charles , Colen Rivka R. , Zinn Pascal O. 
Published: March 2023

INTRODUCTION:
Although Glioblastoma (GBM) is the most common type of primary brain malignancy, few tools exist to pre-operatively risk stratify patients by overall survival (OS) or common genetic alterations.

METHODS:
We retrospectively identified 236 patients with pathologically confirmed GBMs from the Cancer Genome Atlas (89; TCGA) and MD Anderson Cancer Center (147; MDACC). After two neuro-radiologists segmented MRI tumor volumes, we extracted first order and second order radiomic features (gray-level co-occurrence matrixes). We used the Maximum Relevance Minimum Redundancy technique to identify the 100 most relevant features and validated models using leave one out cross validation (LOOCV) and validation on external datasets (i.e., TCGA). Our results were reported as area under the curve (AUC).

RESULTS:
MDACC has significantly higher OS (22 months) compared to the TCGA dataset (14 months). On both LOOCV and external validation, our radiomics models were able to identify EGFR amplification (all AUCs >0.83), MGMT methylation (all AUCs >0.85), GBM subtype (classical; proneural; mesenchymal; all AUCs >0.92), and OS (AUC >0.91 on LOOCV and 0.71 for TCGA validation). We developed a personalized radiomics “report card” that pre-operatively risk stratifies patients by likely genetic alteration.

CONCLUSIONS:
Our robust radiomics pipeline has the potential to pre-operatively discriminate common genetic alterations and patients with favorable survival.
326 Sleep Stages Variation in Intracranial Pressure and Pulse Amplitude
Authors: Darie Lucia , Bancroft Matthew , Glorioso Dolora , Pandit Anand , Moncur Eleanor , Thorne Lewis , Radcliffe Jeremy , Eriksson Sofia , Watkins Laurence Dale , Toma Ahmed 
Published: March 2023

INTRODUCTION:
It is thought that CSF pulsatility has an important role in brain physiology during sleep. Yet few studies have looked into changes of ICP and pulsatility during sleep.

METHODS:
A single centre prospective cohort study. Patients undergoing 24 h ICP monitoring for suspected CSF dynamic disorders underwent concomitant polysomnography. Clinical and radiological presentation were derived from the patient’s records. Aggregate mean ICP and pulse amplitude (mPA) values were recorded for each sleep stage. Sleep staging was performed in conformity with the AASM guidelines. Within subject values were compared using repeated-measures, one-way ANOVA. Post-hoc paired t-tests were used to compare sleep stages between groups corrected for multiple comparisons (Benjamini-Hochberg method).

RESULTS:
A total of 12 patients (10 females, 2 males; mean age 40.8 years, SD+/- 12.9) with complete data were analysed. There were significant differences in mean ICP between sleep stages (F(3,33) = 10.7, p < 0.00001). Post-hoc paired t-tests revealed significant differences between rapid eye movement (REM; mean ICP 14.4 mmHg) and all other sleep stages (mean ICP/N1 = 12.0 mmHg, t = -3.6, p = 0.004; ICP/N2 = 11.8 mmHg, t = -4.3, p = 0.001; ICP/N3 = 12.3 mmHg, t = -3.5, p = 0.004). Significant differences were also found in mPA between sleep stages (F(3,33) = 5.7, p = 0.003) confirmed on post-hoc paired t-tests: REM (mean mPA 5.5 mmHg and all other sleep stages: mPA/N1 = 4.7 mmHg, t = -2.3, p = 0.04; mPA/N2 = 4.3 mmHg, t = -2.7, p = 0.02; mPA/N3 = 4.5 mmHg, t = -2.3, p = 0.04).

CONCLUSIONS:
REM is characterized by higher ICP and mPA values, result confirmed in near-normal patients included in this cohort.
327 Identification of Clinically Relevant Patient Endotypes in Traumatic Brain Injury (TBI) Using Latent Class Analysis
Authors: Qiu Steven , Zador Zsolt E. , Sharma Sunjay Vishnu 
Published: March 2023

INTRODUCTION:
Despite advances in medical knowledge, TBI still has a significant burden of disease. Better prognostic factors would allow for earlier identification of patients at risk for poor outcomes and enable targeted interventions to improve outcomes and reduce costs.

METHODS:
We obtained clinical information from a subset of TBI patients from the MIMIC-III dataset and codified each patient's comorbidities based on the Elixhauser comorbidity groups. Latent class analysis was performed on the patients based on their codified comorbidities to identify distinct patient endotypes. The characteristics (comorbidity distribution, mortality rate) of these patient endotypes were then visualized using Matplotlib. A Chi-squared test of homogeneity was performed to determine if mortality rates differed across patient endotypes. Relationships between the codified comorbidities were visualized using a network graph across all TBI patients and within each patient endotype.

RESULTS:
2981 patients qualified under our TBI query. Average age was 58 ± 21. The network graph shows that there is only one major connected component composed of the most common comorbidities. An elbow plot was constructed to help identify 8 as the optimal number of classes to model patient endotypes. The distribution of comorbidities differs between patient endotypes. Furthermore, there was a significant difference in survival rates between the patient endotypes (p < 0.0001) with Endotype 1 having the lowest survival and Endotype 6 having the highest. Intra-endotype network analysis and comorbidity distributions suggest that Endotype 1 is a cancer-related endotype whereas Endotype 6 is a relatively "healthy" endotype with some degree of alcohol and drug abuse.

CONCLUSIONS:
In this study, we use LCA to demonstrate the existence of patient endotypes in a TBI population that differ in their comorbidity profiles and clinical outcomes.