bluuebunny/crossref_metadata_2025_split huggingface dataset:
175 Patient Safety Indicator 04 Does not Consistently Identify Failure to Rescue in the Neurosurgical Population
Authors: Azad Tej D. , Rodriguez Emily , Raj Divyaansh , Xia Yuanxuan , Materi Joshua , Rincon Torroella Jordina N. , Gonzalez L. Fernando , Suarez Jose , Tamargo Rafael Jesus , Brem Henry , Haut Elliot , Bettegowda Chetan 
Published: March 2023

INTRODUCTION:
Patient safety indicator (PSI) 04 is a quality index designed by the Agency for Health Research and Quality to measure Failure to Rescue (FTR). PSI 04 has been scrutinized for inaccurately measuring FTR, a framework developed to capture a hospital’s ability to identify and manage preventable complications and post-operative mortality.

METHODS:
We conducted a single-center retrospective cohort study. We identified patients from 1/12/2017-6/1/2021 who sustained a PSI 04-attributed complication (pneumonia, deep venous thrombosis/pulmonary embolism (DVT/PE), sepsis, shock/cardiac arrest, or gastrointestinal (GI) hemorrhage/acute ulcer), underwent a neurosurgical procedure, and had inpatient mortality. The primary outcome was whether the attributed PSI 04 designation was the primary driver of mortality.

RESULTS:
We identified 67 patients who met PSI 04 criteria (median age, 61; female sex, 43.4%). Nearly 20% of patients met the PSI complication criteria prior to admission. Patients who underwent emergent bedside procedures were more likely to present with poor GCS (P = 0.016), more likely to be intubated prior to admission (P = 0.016), and less likely to have mortality due to a PSI 04-related complication (P = 0.002). PSI 04-related complications were identified as the cause of death in only 43.2% of cases. Procedures occurring in the interventional radiology suite (OR, 23.2; 95% CI, 3.5-229.3; P = 0.003) or the operating room (OR, 6.2; 95% CI, 1.25-39.5; P = 0.03) were more likely to have mortality due to a PSI 04-related complication compared to bedside procedures.

CONCLUSIONS:
Most neurosurgical procedures meeting PSI 04 criteria took place outside of a traditional operating room and may capture a fundamentally different patient population. 65.7% of patients were inappropriately flagged as meeting PSI 04 criteria. PSI 04 currently identifies patients with complications unrelated to operating room procedures. Improvement in patient safety within neurosurgery necessitates the development of a subspecialty specific measure to capture FTR.
184 Clinical Outcomes of the Prone Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spine Disease: A Multicentre Study
Authors: Soliman Mohamed A. R. , Diaz-Aguilar Luis Daniel , Khan Asham , San Miguel Jose , Amaral Rodrigo Augusto , Lee Bryan S. , Abd-El-Barr Muhammad M. , Massey Gene , McMains Craig , Schwartz David Gary , Deol Gurvinder , Nguyen Andrew D. , Smith Tyler , Pimenta Luiz , Taylor William R. , Pollina John 
Published: March 2023

INTRODUCTION:
The prone transpsoas lateral lumbar interbody fusion (PTP) is a novel technique for degenerative lumbar spine disease. However, there is a paucity of the literature on the clinical outcomes of this procedure, with all the published being of a small sample size.

METHODS:
A retrospective electronic medical records review was conducted in ten centers for patients who underwent PTP. We collected the intraoperative data (operative time, estimated blood loss [EBL], intraoperative complications [anterior longitudinal ligament (ALL) rupture, cage subsidence, vascular and visceral injuries), postoperative complications, the patient-reported outcome measures (PROMS) such as back pain visual analogue scale (VAS), and hospital stay.

RESULTS:
A total of 350 patients were included in the study. There was a significant improvement in the mean VAS by 4.4 ± 6.7 (p < 0.001). 2.8% had ALL rupture, 1.2% had cage subsidence, 0.4% had a vascular injury, and none had visceral injuries. The mean operative time was 229.9 ± 144 minutes, the mean EBL was 134.3±210.2 mL, and the mean hospital stay was 2.6 ± 2.2. In regard to postoperative complications, there was 8.9% new sensory symptoms, 6% transient hip flexor weakness, 1.4% wound infection, 1.4% cage subsidence, 0.6% psoas hematoma, 0.3% ureteric injury, 0.3% small bowel obstruction/ischemia, and 1.6% 90-days readmission.

CONCLUSIONS:
Multicenter consecutive case series show that PTP is well tolerated and has satisfactory clinical outcomes.
195 Aberrant Brain Biomechanics Initiates Ventricular Dilation in a Genetic Subtype of Congenital Hydrocephalus
Authors: Phan Duy , Dahl Peter , Koundal Sunil , Pedram Maysam , Deniz Engin , Benveniste Helene , Malvankar Nikhil , Kahle Kristopher 
Published: March 2023

INTRODUCTION:
We have previously shown using human genetics and mouse models that TRIM71 is a bona fide disease gene causing human congenital hydrocephalus. Disease-associated mutations in TRIM71 disrupt neural stem cell proliferation, however how these developmental effects physiologically lead to ventricular dilation is not clear.

METHODS:
We developed a number of novel methods to characterize cerebrospinal fluid (CSF) circulation, including cilia-generated currents and bulk flow. We then used these methods to comprehensively characterize CSF dynamics and intracranial physiology in hydrocephalic Trim71R595H/+ mice that harbor the same point mutation found in human hydrocephalus patients.

RESULTS:
We found that in hydrocephalic Trim71R595H/+ mice, impaired neurogenesis results in a hypoplastic cerebrocortical wall that exhibits loss of stiffness and elasticity. This leads to a floppy hypercompliant state wherein the brain parenchyma is unable to hold the pressure exerted by CSF, thereby facilitating passive pooling of CSF and secondary distention of the ventricles. Ventriculomegaly occurs in the absence of altered cilia-generated CSF flow or congenital aqueductal obstruction. Neuroimaging studies in patients with TRIM71 mutations also suggest cortical hypoplasia as the primary physiological factor leading to secondary ventricular dilation and passive pooling of CSF.

CONCLUSIONS:
We highlight the importance of precisely regulated neural stem cell fate and neurogenesis for maintaining normal brain-CSF biomechanical interactions that limit ventricular expansion. We thus demonstrate that some or potentially many forms of CH are in fact a congenital brain malformation akin to microcephaly with secondarily enlarged ventricles rather than a primary disturbance in CSF circulation.
201 Descriptive Case Series of Oncologic Brachial Plexopathy at a Comprehensive Cancer Center
Authors: Lim Jaims , Moser Matthew , Popoola Daniel , Prasad Dheerendra , Fenstermaker Robert A. , Fabiano Andrew J. , Lipinski Lindsay 
Published: March 2023

INTRODUCTION:
Primary compression or metastatic spread into the peripheral nervous system is an unfortunate sequela of solid-organ cancers and leads to serious pain and neurologic symptoms. Neoplastic brachial plexopathy is poorly understood and treatments vary based on systemic disease burden and symptoms.

METHODS:
After IRB approval, a systematic search of the medical record was conducted for patients with brachial plexopathy based on CPT from 2016 to 2020. Patients with direct neural infiltration and/or external compression by primary or metastatic tumor were included. Radiation-induced brachial plexopathy cases were excluded. Data were collected regarding demographics, primary cancer, symptoms, exam, pain management treatments, primary cancer management, and outcomes.

RESULTS:
A total of 15 patients were identified with either infiltrative or compressive brachial plexopathies. The most common primary cancer was breast. Other types included squamous cell carcinoma of the head and neck, renal cell carcinoma, cholangiocarcinoma, and prostate carcinoma. Patients presented with a diverse array of motor and sensory symptoms including proximal and distal upper extremity weakness, hand spasms, numbness and decreased sensation, paresthesia, and upper extremity swelling. The majority of included patients complained of pain of varying nature. Gabapentin, opioids, and pregabalin were the most common prescribed medications. Overall prognosis in patients with brachial plexus infiltration was poor and less than 1 year. There was little consensus on standardized treatment regimens and management for included patients with plexopathies.

CONCLUSIONS:
Neoplastic brachial plexopathy is a relatively uncommon, and perhaps underrecognized, pattern of metastatic disease or direct spread in solid organ malignancy and is often associated with severe symptoms and disability. This study highlights need for a multidisciplinary approach including medical oncology, neurosurgery, radiation medicine, pain management, and physical/occupational therapy.
202 Molecular Signature of Malignant Peripheral Nerve Sheath on Tumor Site
Authors: Smith Caitlyn , Rao Deepthi , Mesfin Fassil B. 
Published: March 2023

INTRODUCTION:
Malignant peripheral nerve sheath tumors (MPNSTs) are rare, highly aggressive soft tissue sarcomas that may occur sporadically, in association with neurofibromatosis type I (NF1) or after radiotherapy (RT). High recurrence rates and distant metastases are common, with lung and bone being the most common sites, yet the anatomic distribution of molecular changes is largely unknown.

METHODS:
Using the cBioPortal platform and systematic bioinformatical-analysis of the Cancer Genome Atlas (MSKCC) Nature Genetics 2014 dataset, we screened the dataset for the ADAM3A gene in the completed gene panel and twelve MPNST patients [pulmonary (6), neck (1), chest-wall (2), calf (1), arm (2)] with were included in the study. Broadly, these twelve patients were categorized as primary-pulmonary MPNST (6) and non-pulmonary MPNST (6) subgroups.

RESULTS:
The putative copy-number alteration pattern involving the ADAM3A gene based on the primary site was distinct (p <0.0001). All six patients with primary-pulmonary MPNST showed ADAM3A amplification while all six patients with non-pulmonary MPNST demonstrated ADAM3A homodeletion. Remarkably, regardless of the underlying etiology and pathogenesis, ADAM3A amplification in primary-pulmonary MPNST was invariably noted across the board in sporadic (3), NF1-associated (2), and RT-associated (1) tumor samples (p <0.0001).

CONCLUSIONS:
The findings in this study highlight the site-specificity of the MPNST molecular landscape. Further studies are essential for understanding the underlying molecular implications, pathways, and the specific role of ADAM3A in pulmonary and non-pulmonary MPNSTs.
211 Subthalamic Nucleus Deep Brain Stimulation Engages Memory Networks in Patients With Parkinson’s Disease
Authors: Talati Pratik , Neudorfer Clemens , Kratter Ian , Jorge Ahmed , Henry Luke , Horn Andreas , Richardson Robert Mark 
Published: March 2023

INTRODUCTION:
Parkinson’s disease (PD) patients with deep brain stimulation (DBS) implantation to the subthalamic nucleus (STN) often have neurocognitive side effects, but the modulated networks associated with their occurrence are largely unknown.

METHODS:
We localized electrodes and investigated brain connectivity seeding from stimulation volumes in patients that underwent subthalamic deep brain stimulation using a normative resting state functional connectome atlas composed of 1000 healthy subjects. Pre- and post-operative neuropsychological testing data was acquired before and after surgery using two similar memory paradigms (list recall and figure recall). The connectivity profiles associated with changes in these tests were calculated. Results were compared with automated meta-analysis maps calculated using neurosynth and neuroquery.

RESULTS:
41 patients were included in the analysis. Positive functional connections between stimulation sites and medial temporal lobe, medial prefrontal cortex, and parieto-occipital region were associated with improvement in list recall. This connectivity profile showed robustness in a leave-one-out cross-validation (R = 0.32, p = 0.027). A similar connectivity profile was associated with figure recall improvement, also robust to cross-validation (R = 0.30, p = 0.019). The profiles associated with the two tasks were able to cross-estimate performance on the respective other task (R = 0.45, p = 0.008; R = 0.26, p = 0.045). When comparing these connectivity profiles with meta-analytic maps in the neurosynth database, the cognitive terms involved with memory showed highest improvement. The neuroquery database areas of predicted activation overlapped with the connectivity maps in the midbody and posterior hippocampal region.

CONCLUSIONS:
This retrospective study relates modulation of brain networks associated with memory processing with improvements in two separate memory tasks.
212 Intra-Operative Near Real-Time Detection of Tumor Infiltration in IDH-Mutant Gliomas Using Desorption Electrospray Ionization-Mass Spectrometry (DESI-MS)
Authors: Garcia Diogo P. , Brown Hannah , Chen Rong , Jentoft Mark E. , Middlebrooks Erik , Chaichana Kaisorn L. , Cooks Graham , Quinones-Hinojosa Alfredo 
Published: March 2023

INTRODUCTION:
Surgery remains the mainstay of treatment in gliomas. However, distinction between tumor infiltrated and non-infiltrated tissues remains a challenge with current surgical adjuncts, particularly at the margin. Isocitrate dehydrogenase (IDH) mutation is unique to IDH mutant glioma cells and can be used as a potential surrogate for tumor infiltration.

METHODS:
We conducted a prospective study, using intraoperative DESI-MS analysis on freshly obtained tissue samples to evaluate the presence of 2-hydroxyglutarate (2HG) by relative quantitation in comparison with an internal control (glutamate), with subsequent review of each smear by board-certified neuropathologist.

RESULTS:
Earlier iterations of our DESI-MS allowed for genotyping of the tumor with a total of 247 biopsies from a 49-patient study yielding sensitivity, specificity, and accuracy values of 89, 100, and 94% for core biopsies (n = 71). Subsequent improvement of DESI-MS, from absolute quantitation to relative measurement in comparison to glutamate (GLU) allowed for detection of IDH-mut infiltration at the margin. We have collected 183 biopsies (116 core and 67 margin) from 23 patients. Preliminary results of IDH mutation assessments of core biopsies indicate 93% sensitivity, 100% specificity, and 98% accuracy and margin biopsies indicate 88% sensitivity, 100% specificity, 94% accuracy, with turnover times averaging 3 minutes per patient. Tumor infiltration at the margin after surgical resection was detected in 88% of margin biopsies from IDH mutant tumors (30 of 34 biopsies).

CONCLUSIONS:
We present a novel system to allow intraoperative evaluation of tumor infiltration at the margin in IDH-mutant gliomas. Our method and its validation identified tumor infiltration beyond the surgical margins and serves as a foundation for future uses employing DESI-MS to allow for molecularly guided surgery in IDH-mut gliomas.
301 Natural History and Treatments of The Pediatrics’ Deep-Seated Brain Arteriovenous Malformations
Authors: Sattari Shahab Aldin , Yang Wuyang , Feghali James , Xu Risheng , Huang Judy 
Published: March 2023

INTRODUCTION:
Literature is sparse about the hemorrhage risk associated with the pediatrics’ deep-seated brain AVMs (bAVMs) during the natural history and after treatment.

METHODS:
We retrospectively reviewed our institutional bAVM database from 1990 to 2019 and included pediatrics who had deep-seated bAVMs. We presented the annual hemorrhage risk; during the natural history and after treatments, and functional outcomes.

RESULTS:
After the screening of 914 patients, 31 pediatric cases; including 13 males and 18 females, with the mean (SD) age of 11.8 (4.4) were included. The most frequent presenting symptoms were headache (54.83%), weakness (38.7%), and seizure (22.5%). The mean (SD) of followed-up duration was 13.14 (12.5) years, during which 7(22.5%) AVMs were found obliterated, 10 (32.2%) individuals sustained hemorrhage, and the modified Rankin Score (mRS) worsened in 8 (25.8%) patients. The annual hemorrhage risk of natural history was 3.26% per patient, and the overall annual hemorrhage risk after treatment was 1.97% per patient. The annual hemorrhage risk in each treatment group was 0.64% per patient in radiosurgery, 6.3% per patient in surgery, and 6.29% per patient in embolization. Those with non-white race showed a trend of higher ruptured presentation (OR = 5 [0.84-41.68], p = 0.09). Female sex was associated with higher (OR = 13.076 [1.424-333.591], p = 0.048) and treatment radiosurgery was associated with lower (OR = 0.21 [0.03-1.02], p = 0.06) odds of follow-up hemorrhage. Headache presentation was associated with the lower odds of poor functional outcome (OR = 0.102 [0.011-0.670], p = 0.024).

CONCLUSIONS:
Given the substantial cumulative risk of lifelong hemorrhagic stroke in pediatric patients, timely definitive treatment is warranted. Radiosurgery treatment is beneficial when the risk-benefit profile is deemed favorable.
302 Super Mitochondria, the Next Super Therapy to Reverse Ischemic Damage in Stroke?
Authors: Monsour Molly , Gorsky Anna , Nguyen Hung , Castelli Vanessa , Lee Jea , Borlongan Cesario 
Published: March 2023

INTRODUCTION:
Stroke represents a massive healthcare emergency, ranking in the top 5 causes of death and disability and impacting nearly 800,000 Americans annually. Current therapies are limited. A deeper analysis of the mechanisms of cell death after ischemic brain insult may usher novel safe and effective treatments. Mitochondrial damage serves as a key modulator of ischemic cell death, which may be reversible with transfer of healthy mitochondria from mesenchymal stem cells (MSCs) to ischemic neurons.

METHODS:
MSCs were grown under ambient condition (normal MSCs) (nMSCs) or metabolic switching paradigm involving exchanging galactose for glucose in the cell culture medium (switched MSCs) (sMSCs) then assayed for oxygen consumption rates using the Seahorse technology. Subsequently, primary neurons were subjected to OGD then co-cultured with either nMSCs or sMSCs, and assessed for cell viability, cell metabolism, mitochondrial reactive oxidative species mRNA, and mitochondrial ATP mRNA.

RESULTS:
Compared to nMSCs, sMSCs displayed robust mitochondrial respiration as evidenced by higher basal energy production, larger spare respiratory capacity, greater ATP production, and decreased proton (H+) leak. Co-culture of OGD-exposed neurons with sMSCs conferred increased cell viability and enhanced cell metabolism, coupled with reduced mitochondrial reactive oxidative species mRNA and elevated mitochondrial ATP mRNA, which were significantly better than those afforded by nMSCs.

CONCLUSIONS:
These findings suggest sMSCs generated “super” mitochondria. Metabolic switching produces healthy mitochondria that may enhance the mitochondrial transfer between MSCs and ischemic cells warranting consideration as a stroke therapeutic.
309 Mechanical Thrombectomy for Acute Basilar Artery Occlusion, Where Do We Stand? A Safety and Efficacy Analysis
Authors: Abbas Rawad , Chen Ching-Jen , Atallah Elias , El Naamani Kareem , Herial Nabeel , Gooch Michael , Jabbour Pascal , Rosenwasser Robert H. , Tjoumakaris Stavropoula I. 
Published: March 2023

INTRODUCTION:
Acute basilar artery occlusion accounts for 1% of all ischemic strokes, but more often than not, leads to devastating neurological injury and mortality. Many institutions still opt for best medical therapy for this type of ischemic stroke, however there is increasing evidence that mechanical thrombectomy for these patients leads to better outcomes.

METHODS:
This study was a retrospective chart review of a prospectively maintained database for patients with acute basilar artery occlusion treated with mechanical thrombectomy from January 2014 through March 2022.

RESULTS:
Our study included a total of 74 patients. The mean age was 62.7 years and 55.4% were male. The most common comorbidity was hypertension (73%). The mean door to puncture time was 75 minutes and the mean procedure time was 54 minutes. 86.5% of patients had a good mTICI score (≥ 2b). There were 4 patients who had procedural complications, and symptomatic intracerebral hemorrhage occurred in 3 patients. At 90 days, 62.5% of patients had a favorable functional outcome (mRS, 0 – 3). The mortality rate was 32.4% and 2% during the hospital admission and at 90 days respectively. Finally, on univariate analysis, the need for adjunct treatment and higher presenting NIHSS score was associated with poor functional outcome at 90 days (p-value, 0.03 and <0.001 respectively). Shorter procedure time was associated with better revascularization (mTICI score ≥ 2b) (p-value, 0.0015).

CONCLUSIONS:
Our findings showed that MT is safe and effective for patients presenting with acute basilar artery conclusion and is in conjunction with previous literature. Final results from upcoming trials should hopefully establish MT as gold standard for these patients.
325 Evaluating the Utility of Repeat CT Scans in Patients With Isolated Traumatic Subarachnoid Hemorrhage
Authors: McNulty Jack , Nawabi Noah , Kilgallon John , Stopa Brittany M. , Smith Timothy R. 
Published: March 2023

INTRODUCTION:
Subarachnoid hemorrhage (SAH) is a relatively common consequence of head trauma. Treatment of traumatic SAH (tSAH) patients often involves serial CT imaging to assess for expansile hemorrhage. However, evidence suggests that tSAH rarely leads to neurologic deterioration or necessitates neurosurgical intervention, particularly in patients who present neurologically intact. Thus, the current standard of care may be overly extensive.

METHODS:
Patients presenting to Mass General Brigham Hospitals with tSAH between 2000 and 2021 were eligible for inclusion. Patients were excluded if: (a) their SAH was non-traumatic, (b) they experienced another form of intracerebral hemorrhage, or (c) they had a documented GCS of 12 or lower. Univariate and multivariate regression models were used to analyze the retrospectively collected data.

RESULTS:
Overall, 293 patients were included, 130 of which were male. The most common mechanism of trauma was fall from standing (n = 171). 131 patients presented with other significant traumatic injuries in addition to their tSAH. The mean number of total CTs for all patients was 2.3, with 230 patients (78.50%) receiving at least two CT scans and 92 patients (31.40%) receiving three or more scans. Of the 230 patients receiving multiple scans, only 12 (5.22%) had any degree of documented hemorrhagic expansion. No patients developed acute neurologic deterioration or required neurosurgical intervention related to their bleed.

CONCLUSIONS:
The standard of care for tSAH patients centers on close observation and repeat CT imaging. However, these repeat CTs rarely demonstrate any degree of hemorrhagic expansion for patients who present neurologically intact. Excessive CT imaging is thus unlikely to affect patient management and potentially presents an unnecessary burden to both the patient and the hospital staff.