bluuebunny/crossref_metadata_2025_split huggingface dataset:
140 Social Determinants of Health: A Critical Factor in Adult Traumatic Brachial Plexus Injury Outcomes
Authors: Maasarani Samantha , Khalid Syed I. , Noland Shelley 
Published: March 2022

INTRODUCTION:
Over the past three decades, there has been an accumulation of evidence pointing to social determinants of health (SDOH) as inherent causes for an array of health outcomes.

METHODS:
Between January 2010—June 2019, a retrospective analysis was performed using PearlDiver’s Mariner. One-to-one exact-matching based on baseline patient demographics was completed, creating three identical groups:
AT-BPI disparity cohort: patients with AT-BPI and presence of at least one SDOH disparity prior to injury:
• economic instability
• food insecurity
• inadequate education
• community and social context problems
• inaccessible healthcare facilities
• neighborhood and physical environment issues
AT-BPI without disparity cohort: patients with AT-BPI and the absence of any SDOH disparity. Control cohort: patients without AT-BPIs. The following primary psychosocial outcomes were included in our study: depression, anxiety, drug abuse, alcohol abuse, suicide attempt, post-traumatic stress disorder, and divorce.

RESULTS:
The matched population analyzed in this study consisted of 1,176 patients that were equally represented in the AT-BPI disparity cohort (n = 392, 33.33%), AT-BPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with four-years of their injury. Patients in the AT-BPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, p < 0.0005), depression (22.70%, p = 0.0032), anxiety (18.62%, p = 0.0203), drug abuse (7.91%, p = 0.0060), and alcohol abuse (4.85%, p = 0.03499) when compared to the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (HR 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups.

CONCLUSION:
AT-BPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Clinicians should routinely screen for psychiatric conditions and assess social factors to improve identification of at-risk patients. A multidisciplinary approach incorporating medical, surgical, social, and psychological experts should be considered when managing these injuries.
142 Simultaneous Versus Staged Bilateral Carpal Tunnel Release Surgeries: A Retrospective Propensity-Matched Patient Comorbidity Analysis
Authors: Freedman Zachary , Daggubati Lekhaj C. , Rizk Elias B. 
Published: March 2022

INTRODUCTION:
Carpal Tunnel Entrapment is the most common peripheral neuropathy, accounting for ∼ 90% of all neuropathies and frequently, occurs bilaterally. While thousands of carpal tunnel releases are performed each year bilaterally, the current understanding of pre-operative factors and postoperative outcomes in simultaneous and staged bilateral carpal tunnel release remain poor.

METHODS:
We performed a retrospective database analysis of the TriNetX database, consisting of 92 health care networks throughout the United States. Patients were divided into two cohorts: individuals with simultaneous bilateral carpal tunnel release and individuals with staged carpal tunnel releases within 3 months of each other. Numerous pre-operative comorbidities were evaluated for surgical determination and then, matched via propensity score matching. Post-operative outcomes were measured within 180 of surgery with and without propensity score matching. Statistical analysis was done through TriNetX software, which utilizes JAVA, R, and Python programming languages.

RESULTS:
The two cohorts result in 17,513 patients for staged carpal tunnel releases and 9,649 for simultaneous bilateral carpal tunnel release surgery. After propensity score matching, 9,289 patients were used in the analysis. Overall, those that underwent staged surgeries had more pre-operative co-morbidities (Hypertension, obesity, chronic kidney disease, arthritis, etc.). Upon matching, patients with staged releases had significantly higher postprocedural aftercare (OR 2.023; 1.813, 2.258), hand/ joint pain (OR 1.876; 1.212-2.905), pain in the extremity (OR 1.161; 1.055, 1.277), trigger finger (OR 1.608; 1.387-1.865), and an upper respiratory tract infection (OR 1.366; 1.206-1.546). Patients with simultaneous bilateral carpal tunnel release had more emergency room visits (OR .835; .766-.91). Non-significant outcomes pulmonary or venous embolism, intraoperative complications, hematomas, surgical site infection, and rehospitalizations.

CONCLUSION:
These findings demonstrate selection variance between simultaneous and staged carpal tunnel releases. Even after matching, simultaneous bilateral carpal tunnel releases provide fewer post-operative complications while only showing a mild increase in emergency room visits. Further prospective studies could be used to validate these results as well as provide new findings to the management and treatment of these groups.
143 Caudate and Dorsolateral Prefrontal Cortex Beta Power Plays an Important Role in Working Memory Updating
Authors: Qian Helen , Williams Ziv , Bick Sarah K. B. 
Published: March 2022

INTRODUCTION:
Working memory, the short-term maintenance and manipulation of information in memory, plays a crucial role in both daily functioning and complex cognitive tasks. Working memory impairment is a prominent feature of multiple neurocognitive disorders. Previous imaging work has demonstrated that caudate and dorsolateral prefrontal cortex (DLPFC) exhibit significant activity during working memory updating and maintenance, and previous animal work has suggested that caudate beta power plays an important role in updating information held in DLPFC. A better understanding of the neurophysiology underlying working memory is needed to develop novel treatment strategies such as neuromodulation.

METHODS:
Eight subjects who underwent depth electrode placement for medically refractory epilepsy participated in our study. Subjects participated in an auditory working memory task in which they heard a set of three syllables and then were prompted to repeat the syllables in either the original or reverse order. We computed beta power and coherence in caudate and DLPFC electrodes during working memory updating.

RESULTS:
Both caudate and DLPFC showed a peak in beta power during updating of working memory, and beta power was significantly higher for correct trials during this peak period compared to both incorrect and control trials. Just prior to beta power increase during working memory updating, there was also an increase in beta coherence between caudate and DLPFC. Coherence during this interval was significantly greater for correct trials as well.

CONCLUSION:
Caudate and DLPFC beta power and connectivity are important for updating information held in working memory.
176 Changes in Brain and Spine Trauma Volume, Management, and Outcomes During the COVID-19 Pandemic in Kigali, Rwanda
Authors: Tang Oliver Y. , Uwamahoro Chantal , Marqués Catalina G. , Beeman Aly , Nshuti Steven , Jarmale Spandana , Aluisio Adam 
Published: March 2022

INTRODUCTION:
During the COVID-19 pandemic, lockdown policies, movement restriction, and healthcare resource reallocation impacted traumatic brain injury (TBI) and spinal cord injury (SCI) incidence and treatment patterns. However, these trends have not been characterized in the Sub-Saharan Africa setting.

METHODS:
The study setting was Centre Hospitalier Universitaire de Kigali (CHUK), Rwanda’s national referral hospital. Adult injury patients presenting to the CHUK Emergency Department were prospectively enrolled from 1/27/20-6/28/20, excluding a cessation in research activities from March-May due to pandemic restrictions. Study personnel collected data on demographics, injury characteristics, treatments, and clinical outcomes. Differences in patients admitted before (1/27/20-3/22/20) and during (6/1/20-6/28/20) the COVID-19 pandemic were queried using chi-squared and Mann-Whitney tests.

RESULTS:
216 neurosurgical trauma patients at CHUK were included for analysis. 83.8% had TBI, 8.3% had SCI, and 7.9% had both TBI and SCI. The mean age was 34.1 (standard deviation = 12.5) and most patients were male (77.8%). Patients predominantly experienced injury following road traffic accident (65.7%). Weekly volumes for TBI (mean = 16.5 vs. 17.1, P = 0.819) and SCI (mean = 2.0 vs. 3.4, P = 0.086) did not change during the COVID-19 period. Patients during this period had lower Glasgow Coma Scale scores (mean = 13.8 vs. 14.3, P = 0.068) and Kampala Trauma Scores (mean = 14.0 vs. 14.3, P = 0.083) at admission, both denoting higher injury severity, but these differences did not reach significance. Patients admitted during the pandemic were significantly more likely to undergo brain CT imaging (65.7% vs. 50.0%, P = 0.030), with higher rates of documented hemorrhage, contusion, or fracture (35.7% vs. 19.2%, P = 0.008). Craniotomy rates also significantly increased during the pandemic (22.7% vs. 11.4%, P = 0.036). ED discharge (44.8% vs. 53.7%, P = 0.231) and mortality rates (2.9% vs. 4.9%, P = 0.505) did not change during this period.

CONCLUSION:
Neurosurgical trauma volume did not change significantly at CHUK during the COVID-19 pandemic, but presenting patients had higher injury severity and craniotomy rates. To the best of the authors’ knowledge, this is the first such TBI and SCI analysis conducted in Africa.
198 Use of GOLD Laser for the Endoscopic Treatment of Intracranial Cysts: Report of 25 Cases
Authors: Jimenez David F. 
Published: March 2022

INTRODUCTION:
The GOLD Laser utilizes an active medium comprised of InGaAsP (Indium-Gallium III-Arsenide Phosphide) and the chemical element Au(gold). It is a solid-state laser that operates in the 980nm-1000nm infrared light spectrum using Wavelength Conversion Technology (TM).

METHODS:
A total of 25 patients presenting with intracranial cysts and elevated intracranial pressure were treated with a GOLD laser using endoscopic techniques. There were 19 intraventricular cysts and 6 middle fossa arachnoid cysts. There were 13 males and 12 females. Ages ranged between 19 days and 12 years with a mean of 14.15 years. In all cases the laser was used to fenestrate the cyst wall.

RESULTS:
The study period extended between February 2018 and May 2021. Surgical time ranged between 1.2 and 2.6 hours with a mean of 1.6 hours. There were no mortalities. There were no infections or complications. In all cases the cyst walls were able to be successful fenestrated. There were no recurrences or cyst reclosure requiring reoperation except for one patient who had multiloculated hydrocephalus secondary to gram negative infection. Total Joules used ranged between 912 and 2237 with a mean of 1779 J. The laser was set between 2 and 10 watts.

CONCLUSION:
The GOLD laser is an excellent tool for fenestrating loculated intracranial cysts successfully. Energy delivery from the laser allows for wall fulguration and permanently keeping the fenestration open and minimizing recurrences. There are no complications associated with its use. Excellent hemostasis and control of bleeding was achieved in all cases.
209 Detection and Characterization of Glioma and Therapy-associated Biomarkers in CSF
Authors: Carlstrom Lucas P. , Riviere-Cazaux Cecile , Casabella Amanda , Rahman Masum , Burns Terry C. 
Published: March 2022

INTRODUCTION:
Molecular characterization of human gliomas currently requires access to tissue samples. While tumor-associated cell-free DNA has been detected in CSF and cell-free DNA, utility is limited to those harboring specific detectable mutations. Gliomas with IDH-mutations produce high levels of D-2-Hydroxyglutarate (D2-HG), a stable and quantifiable oncometabolite that is correlated with tumor burden as assessed within the tumor mass. However, the reliability of D2-HG in CSF as an in vivo pharmacodynamic biomarker is unknown.

METHODS:
A brain tumor CSF biorepository has been launched, including prospective samples obtained intra-operatively and via ventriculoperitoneal shunts, Ommaya reservoirs, or lumbar punctures at clinically-relevant time points. Analyses included targeted and untargeted metabolomic analyses, and PCR for patient-specific chromosomal junctions utilizing primers specific to junctions predicted to be stable over time.

RESULTS:
Twenty-one CSF samples were utilized for one or more analyses. Patients with IDH-mutant gliomas had over twenty-fold higher levels of D2HG in CSF (median 4.1 uM, range 1.6-13.2 uM, n = 7) compared to IDH-wild type gliomas (median 0.19 uM; range 0.89-0.35, n = 14) (p < 0.001). A total of 13 CSF samples from 8 patients were evaluated via targeted and untargeted untargeted metabolomics. 282 metabolites were identified consistently in all 13-samples. In addition to IDH-mutant status, signatures were identified conveying patient identity Correlation and Principle component analyses identified distinct clustering of CSF samples by patient identify, prior radiation status, and clinical/collection variables including plasma contamination, and NPO status. Samples obtained after prior radiation were enriched for curated metabolite sets including TCA cycle and Warburg effect. Relative CNS levels of several pharmacologic agents (acetaminophen/levetiracetam/mannitol/caffeine) could also be quantified from the untargeted metabolomic profiles. Multiple unique patient tumor-specific chromosomal junctions were robustly quantifiable in all evaluated CSF samples, but no plasma samples, correlating with tumor burden across serial samples.

CONCLUSION:
Mutation-specific oncometabolites, cell-free DNA mutations and signatures of prior therapy were sensitively and dynamically detected in intra-operative and ventricular CSF samples. CSF may provide an underutilized resource to monitor glioma burden and phenotype.
211 Deep Phenotyping Reveals Germline Determinants of Disease Severity in Neurofibromatosis Type 2
Authors: Celano Emma , Nwokoye Diana , Chittiboina Prashant 
Published: March 2022

INTRODUCTION:
Neurofibromatosis type 2 (NF2) is an autosomal dominant tumor predisposition syndrome with central and peripheral nervous system tumors and non-neoplastic manifestations including peripheral neuropathy. NF2 presents with a large variation in penetrance and severity. Although germline nonsense and frameshift NF2mutations are hypothesized to confer severe disease, the relationship between mutation type and manifestations of this disease is not completely understood.

METHODS:
Patients (n = 169) with NF2 (Manchester criteria) were enrolled in a Natural History protocol (NCTNCT00598351). 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 using volumetric MRI of the neuroaxis). Validated germline mutation data (n = 68) was used to examine relationships between genotype and phenotype with attention to NF2 mutation type (indel/large deletion), genomic effect (missense/nonsense/frameshift), predicted protein effect (truncating/non-truncating) and location (exonic/intronic/splice-site).

RESULTS:
Tumor burden varied greatly between patients (tumor number range 1-165, median 25). We found that cranial meningiomas were a major determinant of total tumor burden. Total tumor burden (number and volume) was associated with worse KPS and decline in KPS over the study protocol (p < 0.001). We found that truncating mutations in exons 11-12 were associated with more severe disease in terms of tumor number on MRI (p = 0.0439).

CONCLUSION:
This is the first large scale study to deeply phenotype patients with NF2 including longitudinal analysis and demonstrates several previously unrecognized trends related to germline mutations type, imaging findings, and measures of disease severity.
304 Cannabis Use and Increased Non-aneurysmal Subarachnoid Hemorrhage in the Last Decade
Authors: Lai Pui M. R. , Ng Isaac , Gormley William , Patel Nirav J. , Frerichs Kai U. , Du Rose 
Published: March 2022

INTRODUCTION:
Spontaneous subarachnoid hemorrhage is often due to rupture of an intracranial aneurysm, but some patients present with no identifiable source. Increased incidence of non-aneurysmal subarachnoid hemorrhage (naSAH) has been reported over time.

METHODS:
We performed a retrospective analysis of naSAH from 2008-2017 to determine the rate of naSAH change over time, and its association with cannabis use. Univariable and multivariable regression analyses were performed to study the trend over time, radiographic patterns of hemorrhage, and clinical outcome at the time of discharge. Additionally, we compared the rate of naSAH with the rate of aneurysmal SAH (aSAH) to adjust for changes in hospital volume and prevalence/reporting of cannabis use in the population over time.

RESULTS:
A total of 86 naSAH and 328 aSAH patients were identified, with an increase in naSAH over time compared to aSAH (p = 0.0034). Increased cannabis use was associated with naSAH (OR 2.1, 95% CI 1.1, 4.1, p = 0.035), but not aSAH over time. Cannabis use was also associated with different subarachnoid hemorrhage patterns (p = 0.0065) in naSAH. Multivariable analysis demonstrated good neurological outcome after naSAH to be inversely associated with cocaine use (OR 0.008 [0.002-0.4]), ventriculostomy placement (OR 0.004 [0.03-0.50]), and anticoagulant use (OR 0.016 [0.003-0.54]), but was not associated with cannabis use.

CONCLUSION:
As cannabis use becomes more prevalent with legalization, it is important to further investigate this association with spontaneous SAH.
306 Nationwide Readmission Rates and Costs for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1—Craniotomy
Authors: Shaftel Kelly T. , Cole Tyler S. , Jubran Jubran H. , Schriber Tyler , Little Andrew S. 
Published: March 2022

INTRODUCTION:
Despite patients experiencing high recurrence and readmission rates after surgical management of nontraumatic subdural hematomas (SDHs), few studies have examined the causes and predictors of unplanned readmissions in this population on a national scale.

METHODS:
Using the Nationwide Readmissions Database, we identified patients who underwent craniotomy for nontraumatic SDH evacuation (2010-2015) using a retrospective cohort observational study design. National estimates and variances within the cohort were calculated after stratifying, hospital clustering, and weighting variables.

RESULTS:
Among 49,013 patients, 10,643 (21.7%) had at least 1 readmission within 30 days of their index treatment and 38,370 (78.3%) were not readmitted. Annual readmission rates did not change during the study period (P = 0.74). The most common primary causes of 30-day readmissions were recurrent SDH (37.1%), venous thromboembolism (12.9%), and delayed hyponatremia and SIADH (syndrome of inappropriate antidiuretic hormone secretion) (12.8%). Comorbidities that independently predicted readmission included congestive heart failure, chronic obstructive pulmonary disease, coagulopathy, diabetes mellitus, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disease, psychosis, and renal failure (P = 0.03). Household income in the 51st-75th percentile was associated with a decreased risk of readmission.

CONCLUSION:
National trends in 30-day readmission rates after nontraumatic SDH treatment via craniotomy provide quality benchmarks that can be used to drive quality improvement efforts on a national level.
308 Comparison of Demographics and Outcomes Between Surgical and Conservative Management in Patients Undergoing Treatment for Posterior Cranial Fossa Hemorrhages—Experience from a Low-Resource Country
Authors: Aziz Hafiza F. , Hani Ummey , Suleman Fatima , Qadeer Namra , Nazir Danyal , Shamim Shahzad M. , Zahid Nida 
Published: March 2022

INTRODUCTION:
Posterior Cranial Fossa Hemorrhages (PCFH) often require surgical intervention. However, comparison between outcomes in surgical vs conservative management has ben rarely sought in the literature.

METHODS:
Retrospective review of patient data was conducted under IRB approval. All patients managed for PCFH at Aga Khan University, Karachi, Pakistan, from January 2009 to December 2020 were included. SPSS (IBM) was utilized to analyze data.

RESULTS:
Surgery vs Conservative: Out of 79 patients, 30.7% vs 69.6% patients underwent each, respectively. Mean age 51 +/- 16.4 vs 56+/-10.7. Males (62.5% vs 70.9%), and females (37.5% v 29.1%). Median GCS at presentation was 9 vs 13. Surgery was indicated at initial presentation (54.2%) or if clinical deterioration was observed (29.2%). Radiographically, significant differences were noted in the mean Intracranial Hemorrhage Score (ICH) (3 vs 2; p = 0.036), maximum hematoma diameter (3.37 vs 2.31 cm; p < 0.001), brainstem involvement (2 vs 32; p < 0.001), 4th ventricle abnormality (100% vs 23%; p < 0.001); intraventricular hemorrhage (78.3% vs 29.4%; p < 0.001), tight posterior fossa (87% vs 37.3%; p < 0.001); clot location (hemispheric vs brainstem; 41.7% vs 52.9%; p = 0.001); median temporal horn width (2.1 vs 0.38 cm; p < 0.001) and clot volume (14.7 cm3 vs 5.5 cm3; p < 0.001). Differences in median length of hospital, ventilator, and ICU stays (14.5 vs 4; p < 0.001, 1.5 vs 0; p < 0.001 and 3 vs 0 days; p < 0.001 respectively), tracheostomy (5% vs 1%; p = 0.003), Infection rate (66.6 vs 29.1%; p < 0.001) and median overall survival (53 vs 10 months; p = 0.046) were all significant.

CONCLUSION:
While surgery increased survival, significant morbidity and late hospital discharge was observed in patients undergoing surgery for PCFH.
310 Impact of Obesity on Morbidity Associated With Endoscopic Spine Surgery
Authors: Bergquist Julia , Greil Madeline , Hofstetter Christoph P. 
Published: March 2022

INTRODUCTION:
Obesity has profound impact on traditional spine surgery and is associated with increased surgical complexity and postoperative complications.

METHODS:
A retrospective review of a single-surgeon database was conducted for all adult patients undergoing unilateral laminotomies for bilateral decompression between November 2015 and March 2021. Data collected included operating room induction time, procedure time, length of hospital stay, use of analgesics, post-operative complications, post-operative pain reduction measured by visual analogue scale (VAS), and quality of life measured by EQ-5D-5L and Oswestry Disability Index (ODI). For statistical analysis, patients were categorized into non-obese and obese groups as defined by the World Health Organization based on body mass index (BMI, kg/m2): 18-29.9 and 30+. Data between groups were compared using Kolmogorov-Smirnov test. Recovery complications, analgesics use, and need for same-level revision were assessed using logistic regression.

RESULTS:
Our patient cohort included 181 patients with an average age of 63.5 years. Patients with higher BMI suffered more pronounced back pain disability (P < 0.01) preoperatively. Operative details including number of segments operated on were similar within our cohort. Surgical induction times increased significantly with BMI (Pearson correlation 0.228, P < 0.01), while procedure times were not affected. Mean follow-up was 22.8 +/-1.4 months. There were no differences between obese and non-obese patient populations’ low-level analgesic use at two weeks post-operation, need for revision, and degree of VAS, ODI, and EQ-5D-5L improvement. However, there were significant positive correlations between BMI and length of hospital stay (P < 0.009), two-week post-operative narcotic use (P = 0.001), and postoperative complications (P = 0.027).

CONCLUSION:
Working channel endoscope can mitigate some procedural challenges related to obesity, however, the obese patient population requires increased health care resources and suffers from more frequent postoperative complications.