bluuebunny/crossref_metadata_2025_split huggingface dataset:
466 Influence of Race on Early Outcomes of Elective Lumbar Interbody Fusions: An Updated Propensity-Matched and Subgroup Analysis
Authors: Alomari Safwan , Porras Jose L. , Jud Brendan F. , Witham Timothy F. , Bydon Ali 
Published: March 2022

INTRODUCTION:
Several studies have consistently found that black patients, when compared to white patients, were more likely to have postoperative morbidity and mortality. However, these studies have several limitations.

METHODS:
Patients who underwent (PLIF/TLIF) or (ALIF/LLIF) between 2015-2018 were reviewed from ACS-NSQIP database. Propensity score matching and subgroup (single/multi-level) analysis were used

RESULTS:
17,471 PLIF/TLIF cases and 8,760 ALIF/LLIF cases met inclusion criteria and were reviewed. In both single/multi-level PLIF/TLIF and ALIF/LLIF, black patients were more likely to be younger, have higher BMI, be of female gender, have inpatient admission status, have an ASA class 3 or more, be a smoker, have baseline dyspnea, have hypertension and be functionally dependent. In both single/multi-level ALIF/LLIF, black patients were more likely to have diabetes mellitus. In both groups (single/multi-level PLIF/TLIF and ALIF/LLIF), except for the higher incidence of DVT in the black cohort, there were no significant differences in morbidity and mortality measures between the black and white cohorts.

CONCLUSION:
In contrast to prior literature, our analysis did not identify black race as an independent risk factor for higher perioperative morbidity or mortality in patients undergoing elective lumbar fusion, except for the higher incidence of venous thromboembolism. The findings of the present study are important for clinicians and spine surgeons while counseling patients undergoing these types of procedures. It is important to address patient’s concerns and to explain that the previously reported inferior perioperative morbidity and mortality outcomes in black patients might be due differences in baseline health status, and not due to the race difference itself.
477 Development and Validation of a Second-generation of PupilScreen, a Smartphone-based Pupillometer, in Healthy Population
Authors: Lim Do , Maxin Anthony , Gulek Bernice G. , Buzytsky Chungeun (Chloe) Lee; Ilya , Coppess Steve , Alfieri Robin , Bly Randall , Law Anthony , Levitt Michael R. , Kelly Cory , McGrath Lynn 
Published: March 2022

INTRODUCTION:
Although there are continuous efforts towards promoting pupillary light reflex (PLR) as a biomarker, its use has been limited due to the expense and limited mobility of pupillometry devices. With demands for non-invasive methods, the expanded use and improved accuracy of PLR are vital to advancing neurological care in myriad settings.

METHODS:
PLR was captured with both a commercial pupillometer and the PupilScreen app for n=21 subjects, utilizing a standard iPhone camera in a standard clinical environment. The captured data was processed via our machine learning model utilizing a fully convolutional neural network to generate the PLR parameters. Then the parameters were compared to standard pupillometry for both eyes: initial pupil size(px), latency(s), the percentage change in size, average and peak constriction velocity (px/s), average and peak dilatation velocity (px/s), and construction amplitude (px) were analyzed and compared in consideration of age, gender, ethnicity, and the eye color.

RESULTS:
The second generation of PupilScreen continues to meet the gold standard accuracy of manual pupillometry, despite no longer requiring control of external conditions. Mean parameters were as followed for pupillometry and PupilScreen respectively: mean latency 0.22s(L)/0.23(R) vs via 0.17s(L/R) (p<0.05), mean percent diameter change 36%(L/R) vs 39% (L/R) (p=0.07), and mean constriction velocity 3.1mm/s(L)/3.0mm/s(R) vs 3.0mm/s(L)/2.9mm/s(R) (p<0.05). Demographics subjects: Mean age: 35 years; 62% female; Race/Ethnicity: White 76%, Black/African-American 10%, Asian 14%. Eye color was 38% brown, 29% blue, 33% mixed.

CONCLUSION:
These results validate the accuracy that the second generation of PupilScreen, can provide estimates of PLR that meet or exceed the accuracy of manual pupillometry and current clinical gold standard digital infrared pupillometry, with the advantage of its being able to be used anywhere there’s a smartphone.
494 Enhanced Senescence Phenotype In Human Medulloblastoma via Protein Phosphatase 2A Inhibition and Radiation Therapy
Authors: Mondal Isha , Lu Rongze , Ho Winson , Chiou Brandon , Das Oishika , McFadden Elizabeth , Ahn Julia , Wang Junying 
Published: March 2022

INTRODUCTION:
Medulloblastoma is the most common malignant pediatric brain tumor. Radiation(RT) is a part of standard care but causes significant neurocognitive impairment. Strategies to sensitize RT is critical to improving the quality of life and long-term survival of patients. Previous studies show that inhibition of protein-phosphatase 2A(PP2A)–a ubiquitous serine/threonine phosphatase–enhanced sensitivity to RT in multiple brain tumor xenografts. However, the mechanism behind enhanced radio-cytotoxicity is poorly understood. We hypothesize that PP2A inhibition combined with RT will increase cytoplasmic double-stranded DNA (dsDNA) and induce cGAS-cGAMP-STING signaling, promoting cellular senescence and thereby decreasing tumor growth.

METHODS:
D425-WT, a human group-3 medulloblastoma cell line, was used to generate a CRISPR sgPP2A knock out, D425-KO. We radiated WT and KO cells in vitro, quantified dsDNA in cytoplasmic extract using dsDNA Assay kit, and measured cGAMP levels in whole cell lysate using ELISA. Through FACS, we quantified the proportion of b-gal-expressing senescent cells. We measured protein expression of senescence markers (p21, p16, g-h2aX) by Western blot(WB). Finally, we injected D425 WT or KO cells orthotopically into cerebellum of nude NU/J mice followed by RT (10Gy) 3 days post-injection and monitored survival.

RESULTS:
In response to RT, D425-KO compared to WT showed significant increase in cytoplasmic dsDNA and intracellular cGAMP--a cyclic di-nucleotide STING agonist. There was also an increase in b-gal+ senescent cells and senescence markers expression in WB. In vivo, PP2AKO alone extended longevity, but PP2AKO with RT further prolonged survival compared to KO or RT alone.

CONCLUSION:
PP2A inhibition enhances RT induced cytosolic dsDNA damage and STING activation, promoting cellular senescence in vitro and sensitivity to RT in vivo.
504 Improving Precision of Resection Limits in Surgery for High-grade Gliomas: Preliminary Experience with an In Vivo Raman Spectroscopy Probe
Authors: Herta Johannes , Cho Anna , Roetzer Thomas , Kronreif Gernot , Wolfsberger Stefan 
Published: March 2022

INTRODUCTION:
Supramaximal resection of gliomas to anatomic-functional boundaries is currently widely employed. This leads to removal of potentially tumor-negative thus healthy brain tissue. Therefore, a device that detects glioma tissue infiltrating the white matter in vivo would be valuable.

METHODS:
Patients and methods. An in vivo Raman spectroscopic system (Sentry 1000, ODS Medical, Montreal, Canada) with an early stage binary classifier trained on 501 samples from 17 patients (tumor n=211 and pure normal n=290 from Montreal Neurological Hospital, Montreal, Canada) has been employed in 15 patients with high-grade gliomas . Of those, 172 samples were collected from 2 areas: n=18 from the central tumor core and n=154 from the adjacent glioma-infiltrated white matter until Raman negative or until an anatomic or functional boundary was reached. All samples were reviewed for the presence of glioma cells by histopathology.

RESULTS:
Sensitivity of Raman spectroscopy for correct high-grade glioma cells was 79%, specificity for non-infiltrated white matter was 52%. Median resection volume outside MR contrast enhancement was 78 ± 143 cm3. Removal of the infiltration zone guided by Raman spectroscopy revealed a non-concentric growth mainly along white matter fiber bundles.

CONCLUSION:
According to our data, Raman spectroscopy has the potential to improve the precision of high-grade glioma resection. This may allow a more selective removal of the tumor-infiltrated white matter.
506 Evaluating Traditional and Non-Traditional Eloquent Areas in Patients with Brain Tumors: Large-scale Network Analysis Using a Machine Learning-Based Platform
Authors: Morell Alexis A. , Eichberg Daniel G. , Luther Evan , Shah Ashish H. , Lu Victor M. , Komotar Ricardo J. , Ivan Michael E. 
Published: March 2022

INTRODUCTION:
Developing mapping tools that allow identification of traditional or non-traditional eloquent areas is necessary to minimize the risk of postoperative neurologic deficits. The objective of our study is to evaluate the use of a novel cloud-based platform that uses machine learning to identify cerebral networks in patients with brain tumors.

METHODS:
We retrospectively included all adult patients who underwent surgery for brain tumor resection or thermal ablation at our Institution between the 16th of February and the 15th of May of 2021. Pre and postoperative contrast-enhanced MRI with T1-weighted and high-resolution Diffusion Tensor Imaging (DTI) sequences were uploaded into the Quicktome platform. After processing the data, we categorized the integrity of seven large-scale brain networks: sensorimotor, visual, ventral attention, central executive, default mode, dorsal attention and limbic. Affected networks were correlated with pre and postoperative clinical data, including neurologic deficits.

RESULTS:
Thirty-five (35) patients were included in the study. The average age of the sample was 63.2 years, and 51.4% (n=18) were females. The most affected network was the central executive network (40%), followed by the dorsal attention and default mode networks (31.4%), while the least affected were the visual (11%) and ventral attention networks (17%). Patients with preoperative deficits showed a significantly higher number of altered networks before the surgery (p=0.021), compared to patients without deficits. In addition, we found that patients without neurologic deficits had an average of 2.06 large-scale networks affected, with 75% of them not being related to traditional eloquent areas as the sensorimotor, language or visual circuits.

CONCLUSION:
The Quicktome platform is a practical tool that allows automatic visualization of large-scale brain networks in patients with brain tumors. Although further studies are needed, it may assist in the surgical management of traditional and non-traditional eloquent areas.
507 Rational Radiomic Design for Stepwise Diagnosis of Posterior Fossa Pediatric Tumors
Authors: Zhang Michael , Wong Samuel , Wright Jason , Toescu Sebastian , Mohammadzadeh Maryam , Han Michelle , Lummus Seth , Wagner Matt , Yecies Derek W. , Lai Hollie , Eghbal Azam , Radmanesh Alireza , Nemelka Jordan , Harward Stephen C. , Malinzak Michael , Laughlin Suzanne , Perreault Sebastien , Braun Kristina , Vosough Arastoo , Poussaint Tina Y. , Goetti Robert , Ertl-Wagner Birgit , Ho Chang , Oztekin Ozgur , Ramaswamy Vijay , Mankad Kshitij , Vitanza Nick , Cheshier Samuel H. , Said Mourad , Aquilina Kristian , Thompson Eric M. , Jaju Alok , Grant Gerald A. , Lober Robert , Yeom Kristen 
Published: March 2022

INTRODUCTION:
Medulloblastoma (MB), pilocytic astrocytoma (PA), and ependymoma (EP) compose the majority of posterior fossa (PF) pediatric tumors and share similar features on MRI. Pre-operative anticipation of pathology can inform the surgical approach, extent of resection, and potential complications.

METHODS:
We extracted 1800 Image features from T2- and gadolinium-enhanced T1-weighted images in a multinational cohort of 274 MB, 156 PA, and 97 EP. We designed a two-step classifier—first ruling out PA with a three-way classifier, and next distinguishing MB from EP with a binary classifier. For each step, we selected the best performing classifier model from six candidates following LASSO-feature reduction. Final multi-class classifier performance was measured on a holdout test set with the micro-averaged F1-score.

RESULTS:
Optimal diagnostic performance was achieved using two decision steps, each with their respective feature set and classifier method. An initial three-way (MB, PA, and EP) logistic regression classifier exhibited a micro-averaged F1-score of 0.739. From a reduced feature set of 61 features, T2-Uniformity and T1-Contrast were the most relevant for distinguishing PA. A subsequent two-way neural net classifier distinguished MB from EP with F1-score 0.9189. In the second reduced feature set of 39 features, T2-Sphericity and T1-Flatness were most relevant. Performing the two classifiers sequentially for MB, PA, and EP classification produced a micro-averaged F1-score of 0.9179.

CONCLUSION:
A sequential radiomic improved upon a single-step radiographic classifier for pediatric PF tumors. Strong overlap between MB and EP prevented a single-step classifier from distinguishing all three pathologies at once. PA-relevant features aligned with avid gadolinium-enhancement and non-enhancing cystic components. MB and EP-related features correlated to how each conform within and extrude from the fourth ventricle, respectively.
512 TMS Seeded DTI Tractography Provides Superior Identification of Eloquent Cortex Compared to Anatomic Seeded Tractography
Authors: Muir Matthew , Prinsloo Sarah , Traylor Jeffrey I. , Bastos Dhiego , Prabhu Sujit S. 
Published: March 2022

INTRODUCTION:
Previous studies have shown the feasability of seeding DTI tractography using transcranial magnetic stimulation (TMS) points for the cortical region of interest (ROI). Previous work from our group has shown that resection of TMS points with connecting white matter tracts identified by TMS tractography leads to permanent neurological deficits.

METHODS:
We selected a cohort of 42 patients with perirolandic gliomas who underwent preoperative TMS mapping with subsequent resection. The primary outcome collected from the chart was new or worsened motor deficit present at 3 month follow up. We overlayed the postoperative resection cavity onto the preoperative MRI containing the tractography data, seeded either by TMS points or the precentral gyrus. We used a confusion matrix to model the predictive value of permanent deficits for each tractography scheme. Positive predictive value denotes the likelihood that a patient with the corresponding tract resected develops a permanent deficit, while negative predictive value denotes the likelihood that a patient with the corresponding tract preserved does not develop a permanent deficit.

RESULTS:
22/42 patients showed TMS positive points significantly displaced from the precentral gyrus. With respect to prediction of permanent deficit upon resection of relevant tracts versus preservation of relevant tracts, TMS seeded tractography showed a positive predictive value (PPV) of 87% and negative predictive value (NPV) of 97%. Anatomic tractography showed a positive predictive value (PPV) of 50% and negative predictive value (NPV) of 91%.

CONCLUSION:
Over half of the patients in our cohort exhibited tumor induced plasticity measured by TMS. TMS seeded tractography provided significantly higher positive and negative predictive value for identifying true non-resectable, eloquent cortex compared to anatomic seeded tractography.
801 Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas
Authors: Enriquez-Marulanda Alejandro , Gomez-Paz Santiago , Salem Mohamed M. , Mallick Akashleena , Arle Jeffrey E. , Stippler Martina , Papavassiliou Efstathios , Alterman Ron L. , Ogilvy Christopher S. , Moore Justin M. , Thomas Ajith J. 
Published: March 2022

INTRODUCTION:
Middle meningeal artery (MMA) embolization is an emerging minimally invasive endovascular technique for chronic subdural hematoma (cSDH). Currently, limited amount of literature exists on its safety and efficacy compared with conventional treatment (open-surgical-evacuation-only).

METHODS:
Retrospective analysis of patients with cSDHs treated with MMA embolization in a single center from 2018-2019 was performed. Comparisons were made with a historical conventional treatment cohort from 2006-2016. Propensity score matching (PSM) analysis was used to assemble a balanced group of subjects.

RESULTS:
A total of 357 conventionally treated cSDH and 45 with MMA embolization were included. After balancing with PSM, a total of 25 pairs of cSDH were analyzed. Comparing the embolization with the conventional treatment group yielded no significant differences in complications (4% vs. 4%; p>0.99), clinical improvement (82.6% vs. 83.3%; p=0.95), cSDH recurrence (4.3% vs. 21.7%; p=0.08), overall re-intervention rates (12% vs. 24%; p=0.26), mRS >2 on last follow-up (17.4% vs. 32%; p=0.24) as well as mortality (0% vs. 12%; p=0.09). Radiographic improvement at last follow-up was significantly higher in the open surgery cohort (73.9% vs. 95.6%; p=0.04). However, there was a trend for lengthier last follow-up for the historical cohort (72 vs. 104 days; p=0.07).

CONCLUSIONS:
There was a trend for lower recurrence and mortality rates in the embolization era cohort. There were significantly higher radiological improvement rates on last follow-up in the surgical only cohort era. There were no significant differences in complications and clinical improvement.
807 Peak Force of the Posterior Ligamentous Complex is Lower in Patients with Adult Spinal Deformity Requiring Revision Surgery
Authors: Shahidi Bahar , Anderson Brad , Malone Hani , Iannacone Tina , Moltzen Courtney , Eastlack Robert , Mundis Gregory M. 
Published: March 2022

INTRODUCTION:
Proximal Junctional Kyphosis (PJK) is observed in up to 40% of those undergoing fusion surgery for adult spinal deformity (ASD). Despite common use of surgical techniques reinforcing ligamentous integrity (e.g. tethering, augmentation), it is unknown whether ligamentous biomechanics are impaired in this population.

METHODS:
Sample: 23 consented individuals with a diagnosis of ASD undergoing primary (N=14) or revision (N=9) multilevel spinal fusions (>4 levels). Intraoperative biopsies of the PLC were harvested 2 levels below the upper instrumented level (primary) or at the failed junctional segment (revision). Peak force (strength) and elastic modulus (stiffness) were compared between primary and revision groups using independent student t-tests, and relationships between biomechanical parameters and patient characteristics evaluated.

RESULTS:
Participants in the revision group were older (73.3(3.6) years) than the primary group (54.7(19.2)years), p=0.02, but did not differ in number of fused vertebrae (12.0(4.3); primary and (11.3(3.4); revision), p=0.71). Mean pre-operative Vitamin D levels were 40.6(11.5), spino-vertebral angle (SVA) was 54.4(56.8) degrees, Pelvic Tilt (PT) was 24.1(11.0) degrees, Pelvic Incidence-Lumbar Lordosis mismatch (PI-LL) was 15.3(22.4) degrees, and Proximal Junctional Kyphosis (PJK) was 9.4(8.1) degrees. Mean post-operative SVA was 8.3(28.2) degrees, PT was 20.6(6.9) degrees, PI-LL was 4.4(10.0) degrees, and PJK was 12.0 (10.5) degrees. Peak force was significantly lower in the revision group (143.1(72.5) N) compared to the primary group (238.5(109.8) N), p=0.03. There were no differences in ligament stiffness between the primary (5.9(2.0) MPa) and revision groups (5.3(3.1) MPa), p=0.92). There was a significant association between greater peak force and lower age (r=-0.56, p=0.003), larger ligament area (r=0.50, p=0.015), lower vitamin D levels (r=-0.63, p=0.015), and lower pre-operative PI-LL (r=-0.53, p=0.014). There was also a significant association between greater ligament stiffness and greater post-operative PJK (r=0.60, p=0.013).

CONCLUSIONS:
Peak force of the posterior ligamentous complex in individuals undergoing revision surgery was <60% of those undergoing primary surgery, suggesting an important role of ligament in stabilization of the proximal junctional interface in patients with ASD, particularly in older individuals.
811 Lesional Hemorrhage and Hemorrhage-Negative Patients May Confound the Study of Severe TBI Using Institutional Trauma Databases: Results from a Single Level I Trauma Center
Authors: Bonney Phillip A. , Lin Michelle , Cote David J. , Attenello Frank 
Published: March 2022

INTRODUCTION:
Single institution trauma databases are frequently used for outcomes studies in severe traumatic brain injury (sTBI). The etiology of hemorrhage is commonly uncertain at the time of presentation in the neurologically impaired patient, who may be considered potentially traumatic during initial resuscitation. The complexity of intracranial hemorrhage and coding practices serve as barriers to the effective characterization of sTBI patients.

METHODS:
The LAC+USC trauma database was queried from 2010 to 2018. Patients greater than 18 years of age with initial Glasgow Coma Scale 3 to 8 and abbreviated injury scale head score (AIS-H) of 3 to 5 were selected as those with putative sTBI. Initial and subsequent CT scans of the head and radiology reports were reviewed. Hemorrhages suggestive of spontaneous etiologies including lesional hemorrhages and hypertensive hemorrhages were noted. Review of angiographic studies was performed when relevant.

RESULTS:
Of 24,763 database patients, 1,310 (5.3%) were adults with putative blunt sTBI. Among this cohort, 119 (9.1%) did not survive to CT scan. Among patients receiving CTH, 87 patients (6.6%) had no acute intracranial findings, and 12 (0.9%) had ischemic stroke or diffuse anoxic injury. Non-traumatic etiologies were present in 31 patients (2.4%), consisting of 8 lesional hemorrhages and 23 hypertensive hemorrhages.

CONCLUSIONS:
19% of patients did not meet sTBI criteria. The study of sTBI in institutional databases may be confounded by non-hemorrhagic injuries and non-traumatic intracranial hemorrhages.
814 Differences in Human, Pig, and Rat Spinal Cord Stem Cells in Response to Inflammatory and Regenerative Factors In Vitro
Authors: Kassab Abdul Mounnem 
Published: March 2022

INTRODUCTION:
The translation of preclinical science to human applications, including regenerative strategies for spinal cord injury, has been poor. Historically, animal models, such as rats and pigs, have been used to model human spinal cord given the difficulty in obtaining live human spinal cord.

METHODS:
To mimic post-injury inflammation, primary-derived NSPCs from adult humans (n=8), rats (n=6), and pigs (n=5) were treated with interleukin-6 (IL-6), tumor necrosis factor- α (TNFα), or transforming growth factor- β (TGFβ). To direct regeneration, NSPCs were treated with retinoic acid (RA), platelet-derived growth factor (PDGFα), or bone morphogenic protein-4 (BMP4) to induce neurons, oligodendrocytes or astrocytes, respectively. NSPCs were treated for 7 or 14 days and characterized by immunocytochemistry (GFAP, β-iii tubulin, O4).

RESULTS:
IL-6, TNFα and TGFβ induced astrogenesis of rat NSPCs (3.9±0.7, 5.0±0.9, and 4.0±0.6 fold, respectively) and reduced neurogenesis (0.14±0.90, 0.07±0.04, 0.07±0.05 fold, respectively) after 7 days. Pig NSPCs increased astrogenesis (1.38±0.04, 1.26±0.05, and 1.45±0.04 fold, respectively) after 14 days. Human NSPCs had reduced astrogenesis (0.14±0.07, 0.6±0.2, and 0.12±0.07 fold, respectively) over 14 days, but generated more neurons with IL-6 and TGFβ treatments (1.23±0.05 and 1.34±0.04 fold, respectively). RA increased neurogenesis of human and rat NSPCs, PDGFα increased oligodendrocyte differentiation of rat NSPCs, and BMP4 increased astrogenesis of human and rat NSPCs at low (40ng/mL) and high (100ng/mL) concentrations, respectively.

CONCLUSIONS:
For the first time, we have compared primary-derived adult spinal cord NSPCs from humans, pigs, and rats and identified differences in their response to pathophysiological and regenerative factors which would impact successful translation of stem cell-based therapies.