bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needle Electromyography in the Acute Phase of Stroke
Authors: Silva Bitencourt Ana Carolina , Fernandes Thiago Dias , Bazan Rodrigo , Luvizutto Gustavo José 
Published: August 2023

Background:
After the stroke, the development of the second motor neuron degeneration can reduce muscle strength and functional capacity.

Objective:
The aim of this study was to describe the electro-myographic findings in the acute phase of stroke and to correlate them with the severity and muscle strength.

Material and Methods:
Twenty patients were studied in the first 72 hours after stroke. The severity of the lesion was assessed using the National Institutes of Health Stroke Scale (NIHSS), and muscle strength was assessed using the Medical Research Council Scale (MRC). Sensory conduction and motor conduction were studied to exclude peripheral polyneuropathy, radiculopathies, or other neuro-muscular diseases, and electro-myography (EMG) was performed with co-axial needle electrodes in the deltoid, carpal radial extensor, vastus lateralis, and anterior tibialis at rest, slight effort and maximum effort. The associations between qualitative and quantitative variables were studied using the Chi-square test and Fisher's exact test.

Results:
Among the patients, 40% had abnormal EMG [positive sharp waves (PSWs), fibrillation, fasciculations, and abnormal patterns in maximum effort]. Positive correlations were found between NIHSS and PSW (p = 0.005; r = 0.65) and abnormal EMG (p = 0.017; r = 0.72), and negative correlations were found between MRC and PSW (p = 0.041; r = -0.83) and abnormal EMG (p = 0.027; r = -0.81).

Conclusion:
It was concluded that the main EMG findings in the acute phase of stroke were the presence of the denervation process and polyphasic motor unit potentials. These changes in EMG were correlated with stroke severity and lower muscle strength.
Retinal Changes in Parkinson's Disease
Authors: Mailankody Pooja , Battu Rajani , Lenka Abhishek , Mohammed Shereef PM , Thennarasu K , Yadav Ravi , Pal Pramod Kumar 
Published: August 2023

Background:
There is definite evidence for the involvement of retina in Parkinson's disease (PD). However, a specific pattern has not been clear due to the cross-sectional nature of the majority of the previous studies.

Objective:
The aim of this work was to study the pattern of changes in the retinal layers in patients with PD on longitudinal follow-up.

Materials and Methods:
Twelve patients with PD (23 eyes) were evaluated at baseline with complete history, clinical examination, Unified Parkinson's Disease Rating Scale (UPDRS) motor part, visual acuity, and retinal imaging with spectral-domain Optical Coherence Tomography. After a mean duration of 3.7 ± 0.46 years, patients were re-evaluated.

Results:
The Central Macular Thickness (CMT) of the right eye was found to be significantly thicker during the follow-up (P = 0.002). The outer retinal layer in the temporal quadrant at 0.5 centimeters from the fovea of the left eye was found to be significantly thinner (P = 0.001).

Conclusion:
The serial evaluation of the retinal layers in patients with PD suggests a progressive loss of thickness of the outer retinal layer. The involvement of non-dopaminergic mechanisms, especially glutamatergic pathways, may be responsible for these changes.
Clinical and Molecular Spectrum of Degenerative Cerebellar Ataxia
Authors: Balakrishnan Surya , Aggarwal Shagun , Muthulakshmi Mayandi , Meena Angamuthu Kanikannan , Borgohain Rupam , Mridula Kandadai Rukmini , Yareeda Sireesha , Ranganath Prajnya , Dalal Ashwin 
Published: August 2023

Background:
Cerebellar ataxia is a disabling neurological symptom with extreme clinical and etiological heterogeneity.

Objective:
To study the clinical and molecular characteristics in patients with degenerative cerebellar ataxia.

Materials and Methods:
In this study, 150 South-Indian patients with degenerative cerebellar ataxia underwent a phenotype guided, sequential tiered testing. Phenotypic features studied included cerebellar symptoms, pyramidal and extrapyramidal features, and ophthalmic and systemic findings. Tier one included conventional tests such as short PCR/fragment analysis for spinocerebellar ataxia (SCA) subtypes 1, 2, 3, 6, 7, 8, 12, 17, and 36 and TP-PCR for Friedreich ataxia (FA). Tier two testing comprised next-generation sequencing (NGS)-based strategies reserved for select undiagnosed cases.

Results:
The clinical features were highly overlapping and had limited specificity, except in autosomal recessive ataxias and SCA 34. The overall diagnostic yield of our study was 49.3%. SCA 1, 2, and 3 were noted in 13 (12.6%), 12 (11.6%) and 14 (13.5%), respectively, out of the 103 tested, and FA was noted in 17/55 (30.9%) patients. SCA subtypes 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. Targeted Sanger sequencing and NGS revealed some rare diagnoses in 17 among the 18 patients tested. Whole exome sequencing uncovered a novel genotype-phenotype association in a sibling-pair with ataxia, dysmorphism, and retinopathy.

Conclusion:
SCA 1, 2, 3 and FRDA were the most common causes of ataxia. SCA 6, 7, 8, 12, 17, and 36 were absent in the cohort studied. NGS testing revealed several rare forms of ataxia. Clinical features based testing is cost-effective, achieves good genotype-phenotype correlation, and prioritizes variants for further studies.
Development and Validation of a Multivariable Model to Predict Surgical Outcome in Patients with Chiari malformations
Authors: Kumar Shishir , Chandrachari Komal P. , Mariswamappa Kiran , Pillai Shibu V. , Vijayendra Vishwas H. , Lale Sathyanarayana , Hegde Thimappa 
Published: August 2023

Background:
Surgical outcome predictive models for Chiari malformations (CM) which are applicable to all age groups and simple enough to use on outpatient basis are lacking.

Objective:
The aim of this study was to develop and validate a preoperative index for predicting long-term outcomes in Chiari 1 (CM1) and Chiari 0 (CM0) malformations.

Materials and Methods:
It was a single-institution, ambidirectional, cohort study from 2014 to 2019, having patients between 5 to 70 years. Outcome was assessed using Chicago Chiari outcome score (CCOS) over 2 years follow-up. Preoperative clinical and radiological factors were analyzed using Chi-square test and Mann Whitney U test, in relation to CCOS and those attaining P value ≤0.05, were used to develop model - Chiari Outcome Predictive Index (COPI). COPI was internally validated using 10-fold cross-validation and c-statistic for discrimination.

Results:
A total of 88 patients (66 in development and 22 in validation cohort) were included in the study. Outcome was negatively associated with presence of motor, sensory or cranial nerve symptoms, poor functional status, basilar invagination, and tonsillar descent. It was positively associated with shorter duration of presenting symptom (<9 months) and syrinx diameter <6 mm. COPI predicted CCOS with 91.1% accuracy (10-fold cross-validation). It had excellent discrimination for improved outcome (c = 0.968 in development and 0.976 in validation cohort), at threshold index of -1.

Conclusions:
COPI is simple tool that can be administered in outpatient setting. It can facilitate evidence-based preoperative counseling of patients, to help them develop reasonable expectations regarding surgical outcomes.
A Review of the Diagnostic Features of Posteriorly Migrated Lumbar Discs with Reports of Two Cases
Authors: Ayyappan Unnithan Ajaya Kumar 
Published: August 2023

Background:
The radiological features of posteriorly migrated intervertebral discs mimic tumors, hematoma, and abscess.

Objective:
The aim is to analyze two cases of posteriorly migrated lumbar discs.

Cases:
Two males had features of cauda equina syndrome. Both had posterior lesions at L4/5 level in magnetic resonance imaging. The mass of the 41-year-old man had peripheral rim enhancement with gadolinium. The epidural mass was excised. The histopathology showed fibrocartilaginous disc. The 67-year-old man had mass with moderate enhancement. The mass had thinned the dura to appear as intradural tumor. The histopathology showed a fibrocartilaginous disc. Immunohistochemistry was negative for neoplasm.

Conclusion:
A migrated disc should be considered in the case of a posterior extramedullary mass. The granulation tissue around the disc produces peripheral enhancement with gadolinium. Thin enhancement is common. Thick enhancement is also reported. Neoplasms have intense enhancement and inflammatory changes are seen in abscess.
Prospective Study of Sinonasal Outcome Following Endoscopic Skull Base Surgery
Authors: Gohil Jaypalsinh A , Stanley Antony , Jamaluddin Mohamed A , Singh Arvind K , Shah Shreykumar , George Tobin , Rangnekar Ranjit D , Nair Prakash , Abraham Mathew 
Published: August 2023

Background:
Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia.

Aim:
To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES.

Materials and Method:
Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery.

Results:
Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (P = 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96.

Conclusion:
Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.
Microsurgery versus stereotactic radiosurgery for small petroclival meningiomas presenting with intractable trigeminal neuropathy
Authors: Hegazy Ahmed , Al-Shami Hieder A , Arundhati Biswas , Negida Ahmed , A Hafez Raef F , Fahmy Osama M , Ragab Omar A , Elkatatny Amr M , Amin Sameh M , Ali Mohammed F A 
Published: August 2023

Background:
Data on the outcomes of microsurgical resection (SR) and stereotactic gamma knife radiosurgery (GKRS) in patients with trigeminal neuralgia associated with small petrous apex meningiomas are scarce.

Objective:
We conducted this study to evaluate the pain relief, tumor control, and procedure costs following SR and GKRS for small petroclival meningiomas (less than 3 cm in maximal diameter) using real-world data from our center in Egypt.

Material and Methods:
We conducted a retrospective cohort study of 47 patients with small petrous apex meningiomas presenting with intractable trigeminal nerve pain (SR: n = 22 and GKRS: n = 25). Data regarding pain relief on Barrow Neurological Institute (BNI), procedure cost, and tumor control were retrieved and analyzed using appropriate statistical tests.

Results:
Patients who underwent SR had lower median BNI pain intensity scores compared to those patients who underwent GKRS, and a significantly higher proportion of patients in the SR group had good BNI scores compared to those in GKRS group (P < 0.05); however, the total costs of SR were significantly less than GKRS (30,519$ vs. 92,372$, respectively).

Conclusion:
Both SR and GKRS provide pain relief and tumor control in patients with trigeminal neuralgia associated with petrous apex meningioma. However, in the present study, SR achieved better pain control and was more affordable than GKRS.
iCT Navigation for Transpedicular Screw Fixation in the Thoracolumbar Spine
Authors: Payer Michael , Wiesli Markus , Woernle Christoph 
Published: August 2023

Background:Various guidance techniques have been developed for optimal pedicle screw placement. We present our initial experience with intraoperative CT (iCT) navigation for transpedicular screw fixation in the thoracolumbar spine.Objective:This study aimed to describe the accuracy and reliability of iCT navigation for transpedicular screw fixation.Material and Methods:One hundred consecutive patients underwent thoracolumbar pedicle screw fixation under iCT navigation. After iCT registration of the local bony anatomy with a firmly attached spinous process tracker, pedicle screw placement was performed under navigation with an infrared camera and infrared reflectors on insertion instruments. Screw trajectories of the intraoperative verification CT were matched against the navigation paths. Radiological and clinical follow-up was prospectively documented and retrospectively analyzed. The study included 47 women and 53 men with a mean age of 66 years. Indications for thoracolumbar pedicle fixation were degenerative instability with stenosis, cyst or disc herniation (82), spondylolytic instability (9), scoliosis with stenosis (6), and traumatic fractures (3). A total of 443 pedicle screws were inserted: 22 in the thoracic spine, 371 in the lumbar spine, and 50 in S1.Results and Conclusions:Four hundred thirty-five out of 443 screws (98%) were correctly placed. Misplacement was explained by loosened infrared reflectors on pedicle awl or probe, or by the displacement of the spinous process tracker; misplaced screws were re-inserted intraoperatively and showed correct placement on the second verification CT. Based on our first 100 cases, iCT navigation for transpedicular screw fixation in the thoracolumbar spine seems to be very accurate and reliable.
A New Surface Technique for Phrenic Nerve Conduction Study
Authors: Pradhan Sunil , Anand Sucharita 
Published: August 2023

Objective:
To report a new patient friendly and convenient technique for phrenic nerve conduction with alternative sites of stimulation and recording.

Methods:
Phrenic nerve conduction was performed in forty volunteers and ten patients of peripheral neuropathy. Active recording electrode was placed in tenth intercostal space 2.5 cm away from para-spinal muscles (mid-scapular line), reference electrode in eighth intercostal space just medial to subcostal margin with ground between stimulating and recording electrode. Stimulation was done at the level of crico-thyroid space near or under the posterior margin of sternocleidomastoid muscle. This new method was compared with existing ones.

Analysis:
Data was analysed using SPSS 23 version. Correlation between height, weight, body mass index, age, and chest expansion was done using bi-variate correlation. Mean latency and amplitude of the study method were compared with other methods using MANNOVA test.

Results:
Total of forty subjects were studied. Thirty-seven were male subjects. Mean age was 28.03 ± 9.63 years, height 168.0 ± 9.60 cm and chest expansion 3.53 ± 0.64 cm. Right sided phrenic nerve mean latency was 5.99 ± 0.629 ms and amplitude 1.088 ± 0.178 mV. Left sided phrenic nerve conductions showed mean latency of 6.02 ± 1.82 ms, amplitude of 1.092 ± 0.2912 mV. These standard deviations were smaller than what were observed with other methods suggesting increased consistency of our results. There was no correlation between phrenic nerve conduction with age, height, gender or chest expansion.

Conclusion:
This study method gave a better as well as consistent morphology, higher amplitude and required lower amount of current strength. It was superior to previously reported methods in consistency of normative data.
Analysis of Nanohydroxyapatite/Polyamide-66 Cage, Titanium Mesh, and Iliac Crest in Spinal Reconstruction of the Patients with Thoracic and Lumbar Tuberculosis
Authors: Zhong Dian , Lin Lu , Liu Yang , Ke Zhen-Yong , Wang Yang 
Published: August 2023

Background:The standard recommended and common reconstruction method for spinal tuberculosis is titanium mesh bone graft and autogenous iliac crest. However, these methods have their own disadvantages.Objective:To evaluate the clinical efficacy of one-stage posterior debridement with iliac bone graft, titanium mesh bone graft, or nanohydroxyapatite/polyamide-66 cage in thoracic and lumbar tuberculosis.Materials and Methods:Between January 2013 and December 2018, 57 patients with thoracic or lumbar tuberculosis were treated by interbody bone graft combined with posterior internal fixation after debridement. Thirteen patients were treated with iliac bone graft to construct the stability of the vertebral body, 26 patients were treated with titanium mesh bone graft, and 18 patients were treated with nanohydroxyapatite/polyamide-66 cage bone graft. The main clinical results were evaluated by intervertebral height, cage subsidence, operation time, operative blood loss, postoperative hospitalization, postoperative complications, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, and bone graft fusion time. All the outcomes were recorded and analyzed by statistical methods.Results:The mean follow-up time was 24.5 months. Neurologic function was improved in most patients at the last follow-up. There were significant differences in ESR, CRP, and VAS score between preoperative and postoperative values; however, there were no significant differences in ESR, CRP, and VAS score among the three groups. There were no significant differences in operation time, blood loss, postoperative hospitalization, and postoperative complications among the three groups at discharge. There was no significant difference in ASIA grade among the three groups at the last follow-up. Nanohydroxyapatite/polyamide-66 cage group had a lower cage subsidence (P= 0.013). The bone graft fusion time of the nanohydroxyapatite/polyamide-66 cage group was significantly shorter than the iliac bone graft group and the titanium mesh bone graft (P< 0.05).Conclusions:The follow-up outcomes showed that the method involving one-stage posterior debridement and internal fixation, interbody graft, and fusion is an effective and safe surgical method for patients with thoracic and lumbar tuberculosis. The incidence rate of cage subsidence was less and the bone graft fusion time was shorter with nanohydroxyap atite/polyamide 66 cage when compared with iliac bone graft and titanium mesh bone graft in the surgical treatment of thoracic and lumbar tuberculosis. Nanohydroxyapatite/polyamide-66 cage has a promising application prospect to be a new bone graft material.
Double Anchoring Technique of Occipito-Cervical Fixation Using Innovative Occipital Plate
Authors: Singh Deepak K. , Pathak Vipul V. , Singh Neha , Kaif Mohammad , Yadav Kuldeep , Kumar Rakesh 
Published: August 2023

Background:
Occipito-cervical fixation (OCF) provides immediate rigid fixation to cranio-vertebral junction (CVJ); however, in current practice, the optimal occipito-cervical fixation method is arguable.

Aim:
The aim of this study was to test the safety and efficacy of a newly designed inside-outside occipital (OC) plate system for the treatment of cranio-vertebral junction instability.

Material and Methods:
Thirty-two patients of CVJ instability were treated using this new OC plate system. Safety and efficacy of this new OC plate was evaluated radiologically and clinically.

Results:
Follow-up period ranged from 9 to 23 months. During the follow-up, no implant failure, recurrent subluxation, or newly developed instability at adjacent levels occurred, except in one patient in whom C2 screw pullout occurred due to trauma. All patients showed a satisfactory fusion at three months follow-up examination.

Conclusions:
These preliminary results suggest that this OC plate system is a simple, safe, and effective method for providing immediate internal rigid fixation of the CV junction. Long-term results are needed to determine the superiority of this OC plate over other methods of occipital fixation.
Efficacy of Non-Fusion Surgeries in the Management of AO Type C Injuries of the Thoracic and Thoracolumbar Spine
Authors: Murugan Chandhan , Shetty Ajoy P. , Kavishwar Rohit , Krishnan Vibhu , Kanna Rishi M. , Rajasekaran Shanmuganathan 
Published: August 2023

Background:The initial descriptions of successful management of non-fusion surgeries in the management of unstable burst injuries of the thoracic and thoracolumbar spine (TTLS) were published by Osti in 1987 and Sanderson in 1999. These were further supported by prospective studies and meta-analyses establishing comparable results between fusion and non-fusion surgeries. However, there is a paucity of literature regarding the efficacy of non-fusion surgeries in the management of AO type C injuries.Objective, Materials and Methods:The study aims to determine the efficacy of open posterior instrumented stabilization without fusion in AO type C injuries of the TTLS. Patients with AO type C injuries of the TTLS (T4-L2 levels) with normal neurology who underwent open, posterior, long segment instrumented stabilization without fusion between January 2015 and June 2018 were included. The regional kyphotic angle, local kyphotic angle, AP (anterior and posterior wall) ratio, and cumulative loss of disc space angle were assessed on radiographs. Functional outcome was assessed using Oswestry Disability Index (ODI) and the AO Spine patient-reported outcome spine trauma (PROST) instrument.Results and Conclusion:The study included 35 patients with AO type C injury of the TTLS and a normal neurology who underwent open posterior instrumented stabilization and had a mean follow-up of 43.2 months (range 24–60 months). The mean preoperative regional kyphotic angle decreased from 19.8 ± 13.7° to 6.6 ± 11.3° after surgery but showed an increase to 9.21 ± 10.5° at final follow-up (P= 0.003). The cumulative loss of disc space angle was significant at final follow-up (2.4 ± 5° [P= 0.002]). Twenty-eight out of 35 patients had minimal while seven had moderate disability on the ODI score. The AO Spine PROST revealed that patients regained 95.7 ± 4.2% of their pre-injury functional status at final follow-up. Posterior instrumented stabilization without fusion in the management of AO type C injuries of the TTLS gives satisfactory results with acceptable functional and radiological outcomes.