bluuebunny/crossref_metadata_2025_split huggingface dataset:
109 Morphological Changes in Chronic Subdural Hematomas Following Upfront Middle Meningeal Artery Embolization: Sequence, Timing, and Association with Outcomes
Authors: Khorasanizadeh MirHojjat , Chang Yu-Ming , Enriquez-Marulanda Alejandro , Mizuhashi Satomi , Moore Justin M. , Ogilvy Christopher S. , Thoma Ajith J. 
Published: March 2022

INTRODUCTION:
Middle meningeal artery embolization (MMAE) is a novel approach for treatment of chronic subdural hematomas (cSDH). The course of morphological progression of cSDHs following MMAE is poorly understood.

METHODS:
Through a retrospective survey of the institutional database, cSDH cases treated by upfront MMAE, without prior/adjunctive surgical evacuation, were selected. Hematomas were categorized into 6 morphological subtypes. CT-scans were assessed for hematoma structural appearance, density, and loculations. Changes in hematoma size were quantified via 3-dimensional reconstruction for volumetric measurement.

RESULTS:
52 hematomas in 45 patients treated by upfront MMAE were identified. Hematomas were followed for a mean of 92.9 days. Volume of hematomas decreased by =50% in 79.6% of cases. The overall rescue surgery rate was 9.6%. A clear sequence of morphological changes after MMAE was identified. Hematomas not conforming to this sequence (5.4%) all required rescue surgery. Hematomas were categorized into early, intermediate and late stage on this basis. Progression from early to intermediate and then to late stage took 12.7 and 30.0 days respectively on average. Volume of early/intermediate and late-stage hematomas decreased by =50% a mean of 78.2 and 47.6 days after MMAE respectively. Early/intermediate-stage hematomas showed more favorable outcomes compared to late-stage hematomas. Density of homogenous hypodense hematomas (H-SDHs) transiently increased immediately after MMAE (p<0.001). A marked decrease in density and volume 1-3 weeks after MMAE in H-SDHs was detected, lack of which indicated eventual need for rescue surgery. In H-SDHs, a baseline mean density of <20 HU, and a lower density than baseline by 1 month post-MMAE were predictors of favorable outcomes. Baseline hematoma volume, axial thickness, and midline shift were not correlated with outcomes. Loculated, trabecular, and laminar hematomas – known to have unfavorable surgical outcomes – had outcomes similar to other “surgical” hematomas.

CONCLUSION:
This is the first study to describe nature, sequence, and timing of morphological changes after MMAE of cSDHs, and identify structural features that can predict treatment outcomes.
114 Percutaneous Transforaminal Lumbar Interbody Fusion Is Associated with Reduced Postoperative Opioid Consumption When Compared with Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Shalita Chidyaonga , Crutcher Clifford , Mitra Hari , Zhang Hans , Grossi Peter M. , Abd-El-Barr Muhammad M. 
Published: March 2022

INTRODUCTION:
Opioid use and postoperative pain following lumbar interbody fusion is a common problem for patients during rehabilitation. Less invasive surgical techniques techniques such as minimally invasive transforaminal lumbar interbody fusion (miTLIF) and Percutaneous transforaminal lumbar interbody fusion (pTLIF) have been associated with decreased post-operative pain, estimated blood loss, and shorter hospital length of stay. While pTLIF is a newer technique, its utilization has been increasing and preliminary studies have shown a reduction in post-operative pain, blood loss, faster recovery, and shorter LOS in comparison to miTLIF.

METHODS:
We performed a multi-surgeon, single institution retrospective analysis on consecutive patients undergoing 1 or 2 level percutaneous or minimally invasive TLIF from January 1, 2018- December 31, 2020. We collected data for each patient regarding time spent in the post-anesthesia care unit (PACU), PACU Visual Analogue Scale (VAS), 24-hour postoperative opioid use, hospital LOS, and documented distance ambulated on post-operative day (POD) 1.

RESULTS:
There were 37 patients who underwent pTLIF and 70 who underwent miTLIF. The average postoperative 24-hour oral morphine equivalent utilizations for pTLIF and miTLIF patients were 90 mg and 149 mg, respectively (p < 0.004). Time spent in the PACU, PACU VAS, distance ambulated on POD1, and LOS were similar between the two groups.

CONCLUSION:
Percutaneous TLIF was associated with a 40% reduction in 24-hour postoperative oral morphine equivalent utilization. Larger prospective studies maybe helpful in determining the impact of pTLIF on perioperative outcomes.
122 ECAP-Controlled Closed-Loop Spinal Cord Stimulation (CL SCS): Double-Blind, Randomized Trial for the Treatment of Chronic Pain – 24-Month Outcomes
Authors: Falowski Steven M. 
Published: March 2022

INTRODUCTION:
Evoked compound action potential (ECAP) recording provides an objective measure of spinal cord (SC) activation during SCS and can assist in programing of the SCS system. ECAP-controlled CL SCS, in which the stimulation output is automatically adjusted to maintain a desired ECAP amplitude, has been shown to provide effective pain relief in an open-label study (ACTRN12615000713594).

METHODS:
134 subjects were enrolled and randomized after trial leads were implanted. The primary endpoint evaluated =50% reduction in overall back and leg pain measured by the Visual Analog Scale (VAS). Opioid usage and other patient-reported outcomes (PROs) including emotional/physical functioning, sleep quality, and quality of life were also collected. Additionally, objective neurophysiological data, including SC activation and time spent in the therapeutic range, were collected.

RESULTS:
Herein the Evoke Study Group reports the 24-month outcomes from this ongoing RCT. The proportion of implanted subjects with =50% overall back and leg pain reduction at 24 months was statistically superior in the CL vs. OL group (84.0% vs. 65.9% subjects, respectively; p = 0.040). Long-term improvements in all other PROs, including POMS, ODI, PSQI, EQ-5D-5L, and SF-12, were also demonstrated. Opioids were reduced or eliminated in 66.7% (CL) and 60.9% (OL), respectively. The most frequent level of SC activation was three times greater for CL (median ECAP Amplitude: 22.5 µV CL vs. 7.5 µV OL). SC activation was better maintained within the therapeutic range with CL (median: 93.9% CL vs. 46.1% OL). There were no differences in the safety profiles between treatment groups, and the type, nature, and severity of adverse events were similar to other SCS studies.

CONCLUSION:
In this ongoing study, ECAP-controlled CL SCS provided statistically superior pain relief and greater improvement in other PROs compared with OL SCS at 24 months. CL delivered greater levels of SC activation and better maintained SC activation in the subject’s therapeutic range.
364 AlloDerm with Duragen Underlay for Duraplasty in Chiari Malformation Result in Excellent Outcomes
Authors: Eli Ilyas , Hamrick Forrest , Kim Robert , Schmidt Richard 
Published: March 2022

INTRODUCTION:
Numerous tissue grafts are available for posterior fossa dural augmentation after Chiari decompression surgery. The outcomes for preventing postoperative pseudomeningocele and csf leak formation vary, but no consensus exists for the graft material with lowest complication rates. Use of Alloderm has been shown to have superior outcomes with a 2.2% rate of causing pseudomeniogcele requiring reoperation.

METHODS:
A retrospective single institution cohort included 106 patients who underwent Chiari decompression surgery by a single surgeon from 2014 through 2021. Age, sex, BMI, tonsillar descent, syrinx formation, type of dural graft used, and follow up data were analyzed with univariate statistical tests and Chi-squared test.

RESULTS:
A retrospective single institution cohort included 106 patients who underwent Chiari decompression surgery by a single surgeon from 2014 through 2021. Age, sex, BMI, tonsillar descent, syrinx formation, type of dural graft used, and follow up data were analyzed with univariate statistical tests and Chi-squared test.

CONCLUSION:
The use of the AlloDerm dural graft with Durgen underlay for duraplasty in Chiari decompressions resulted in similar pseudomeningocele formation rate when compared with the use of Alloderm alone. However, the use of Alloderrm with Duragen underlay results in a significantly lower rate for need for reoperation. There was no association between patient age, sex, BMI, on the need for reoperation.
406 The BLED2 Neurologic Event Prediction Score for Patients with Symptomatic Cerebral Cavernous Malformation
Authors: Orlev Alon , Feghali James , Kimchi Gil , Salomon Moran , Berkowitz Shani , Oxman Liat , Levitan Idan , Knoller Nachshon , Uriel Eitan , Huang Judy , Tamargo Rafael J. , Harnof Sagi 
Published: March 2022

INTRODUCTION:
Studies using retrospective patient cohorts have identified risk factors associated with recurrent focal neurologic events in patients with symptomatic cerebral cavernous malformations (CCMs).

METHODS:
Adult patients presenting with symptomatic CCMs causing focal neurologic deficits or seizures were included. Baseline variables included age, gender, history of intracerebral hemorrhage, lesion multiplicity, location, eloquence, size, number of past neurologic events, and duration since last event. Stepwise multivariable Cox regression was used to derive independent predictors of recurrent neurologic events, and predictive accuracy was assessed. A scoring system based on the relative magnitude of the risk factors was devised, and Kaplan-Meier curve analysis compared event-free survival between different score values. Subsequently, 1-, 2-, and 5-year neurologic event rates were calculated for every score value based on the final model.

RESULTS:
126 (47%) of 270 patients met inclusion criteria. During a mean follow-up of 4.5 years (54.4 months, range 12-66 months), 55 patients (44%) experienced recurrent neurologic events. Multivariable analysis yielded four risk factors: Bleeding at presentation (HR=1.92, p=0.048), Large size =12mm (HR=2.06, p=0.016), Eloquent location (HR=3.01, p=0.013), and Duration of =1 year since last event (HR=9.28, p=0.002). The model achieved an optimism-corrected c-statistic of 0.7209. All factors were assigned 1 point except duration from last event, which was assigned 2 points. The acronym, BLED2 summarizes the scoring system. The 1-, 2-, and 5-year risk of a recurrent neurologic event ranged from 0.6%, 1.2%, and 2.3%, respectively for patients with a BLED2 score of 0, to 48%, 74%, and 93%, respectively for patients with a BLED2 score of 5.

CONCLUSION:
The BLED2 risk score predicts prospective neurologic events in symptomatic CCM patients.
436 Colored Pain Drawing in Patients With Trigeminal Neuralgia and Its Impact on Gamma Knife Radiosurgery Outcomes
Authors: Samanci Yavuz , Akdemir Eyub Y. , Peker Selcuk 
Published: March 2022

INTRODUCTION:
Trigeminal neuralgia (TN) is one of the most common causes of facial pain and Gamma Knife radiosurgery (GKRS) has been used for a long time with high pain relief rates. However, psychological processes can influence the pain perception and adversely affect treatment outcome. Colored pain drawing (CPD) is a simple,powerful tool for capturing essential aspects of the subjective pain.

METHODS:
Fifty consecutive patients with medically intractable, ICHD-3 beta-confirmed TN were included. A numerical pain rate scale (NPRS) was used to assess usual level of pain experienced by the patient. Patients were asked to draw the distribution of usual pain pattern with a colored pen of their choice on two standardized face charts. The patients then underwent GKRS. Follow-up data were obtained by clinical examination and/or telephone questionnaire postoperatively at 1, 3 and 6 months. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale (BNI I–III:good outcomes and BNI IV–V:treatment failure). BNI facial numbness score was used to assess complications. All CPDs were classified as “expected” or “unexpected” based on the patient’s description of pain.

RESULTS:
The median age was 64 years (range, 27-88) years and the male/female ratio was 3:2. 86% of the patients experienced immediate pain relief within the first 3 months. Of those patients, 39 (90.7%) did not have any pain recurrence (BNI I). At last follow-up, 39 (78%) patients had good treatment outcome and 11 patients (22%) had treatment failure. 96% of the patients did not experience any facial numbness. There were 35 patients with “expected” and 15 patients with “unexpected” CPDs. NPRS scores were not significantly different between groups (p = 0.985). The preference of association of pain with black or red color was distinct and did not differ between two groups (p = 0.08). Patients with “expected” CPDs reported significantly better freedom from pain compared with those with “unexpected” CPDs (p < 0.0001).

CONCLUSION:
CPDs could serve as clinical acumen for outcomes of GKRS treatment for TN.
475 Complications Associated With Early Cranioplasty for Traumatic Brain Injury Patients: A 25-year Single-center Analysis
Authors: Eaton Jessica C. , Greil Madeline , Nistal Dominic A. , Caldwell David , Robinson Emily , Aljuboori Zaid , Temkin Nancy , Bonow Robert H. , Chesnut Randall M. 
Published: March 2022

INTRODUCTION:
Cranioplasty is a technically simple procedure, but one with potentially high rates of complications. Ideal timing of cranioplasty should minimize the risk of complications, but research investigating cranioplasty timing and risk of complications has generated diverse findings.

METHODS:
We conducted a single institution retrospective review of patients undergoing cranioplasty after trauma. Patients were identified and clinical and demographic variables obtained from 2 neurotrauma databases. Patients were categorized into 3 groups based on timing of cranioplasty: early (= 90 days after craniectomy), intermediate (91-180 days after craniectomy) and late (>180 days after craniectomy). We also conducted a subgroup analysis in TBI patients who underwent ultra-early cranioplasty (<6 weeks, after craniectomy).

RESULTS:
Of 435 patients identified, 141 patients underwent early cranioplasty, 187 patients received intermediate cranioplasty, and 107 patients underwent late cranioplasty. A total of 54 patients underwent ultra-early cranioplasty. Among the total cohort, the mean rate of post-op hydrocephalus was 2.8%, the rate of seizure was 4.6%, the rate of post-operative hematoma was 3.4%, and the rate of infection was 6.0%. The total complication rate for the entire population was 16.8%. There was no significant difference in complications between any of the 3 groups. No significant differences in post-operative complications were found comparing the ultra-early cranioplasty group with all other patients combined.

CONCLUSION:
In this cohort of TB patients, early cranioplasty, including ultra-early procedures, were not associated with higher rates of complications.
Fast Rates for Contextual Linear Optimization
Authors: Hu Yichun , Kallus Nathan , Mao Xiaojie 
Published: March 2022

Incorporating side observations in decision making can reduce uncertainty and boost performance, but it also requires that we tackle a potentially complex predictive relationship. Although one may use off-the-shelf machine learning methods to separately learn a predictive model and plug it in, a variety of recent methods instead integrate estimation and optimization by fitting the model to directly optimize downstream decision performance. Surprisingly, in the case of contextual linear optimization, we show that the naïve plug-in approach actually achieves regret convergence rates that are significantly faster than methods that directly optimize downstream decision performance. We show this by leveraging the fact that specific problem instances do not have arbitrarily bad near-dual-degeneracy. Although there are other pros and cons to consider as we discuss and illustrate numerically, our results highlight a nuanced landscape for the enterprise to integrate estimation and optimization. Our results are overall positive for practice: predictive models are easy and fast to train using existing tools; simple to interpret; and, as we show, lead to decisions that perform very well. This paper was accepted by Hamid Nazerzadeh, data science.
Bmi-1 directly upregulates glucose transporter 1 in human gastric adenocarcinoma
Authors: Guo Ying , Zhou Guangyu , Ma Qingjie , Zhang Li , Chen Jiwei 
Published: March 2022

Abstract
This study aimed to investigate whether and how Moloney murine leukemia virus integration site 1 (Bmi-1) plays a role in the regulation of glucose transporter 1 (GLUT1) in gastric adenocarcinoma (GAC). GAC and matched noncancerous tissues were obtained from GAC patients who underwent surgical treatment at the China-Japan Union Hospital, Jilin University (Changchun, Jilin, China). The human GAC cell line AGS and the gastric epithelial cell line GES-1 were used for in vitro studies. BALB/c nude mice were used for in vivo studies. The Bmi-1 and GLUT1 protein levels were significantly greater in human tissues from GAC patients and AGS cells in comparison with controls. Silencing of Bmi-1 resulted in significant decrease in glucose uptake, lactate levels, and GLUT1 expression. In vivo
18F-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging studies indicated that the nude mice bearing xenografts of AGS cells treated with Bmi-1-specific small interfering RNA (siRNA) had a significantly lower maximum standardized uptake value (SUVmax) in comparison with the control mice. Thus, Bmi-1 directly upregulates GLUT1 gene expression, through which it is involved in enhancing glucose uptake in GAC. The results also provide scientific evidence for 18F-FDG PET/CT imaging to evaluate Bmi-1 and glucose uptake in GAC.
Water hammer phenomenon in pumping stations: A stability investigation based on root locus
Authors: Al-Khayat Rasha Hayder , Al-Fatlawi Ali Wadi Abbas , Al-Baghdadi Maher A. R. Sadiq , Al-Waily Muhannad 
Published: March 2022

Abstract
In this article, a numerical model based on site theory is developed to study the stability of a pipeline system consisting of a valve, pipe, and surge tank. In the study, four parameters were studied to see how they impact the water hammer phenomenon. They are the pressure in the pipelines, the velocity of the flow, diameter of the conduit carrying liquid, and the liquid’s density. The equations are programmed, analyzed, and graphed using MATLAB. The stability analysis shows that the force of the water hammer is significant at low frequencies and for large diameters. The high frequency of a particular pipe is affected by the type of material the pipe is made from, the method of installation, and the friction coefficient of the inner surface. High frequencies reduce the impact of water hammer forces. Among the main parameters listed, it is found that the oscillations of liquids of low density are higher in the case of water hammers.
Cross-Frequency Brain Network Dynamics Support Pitch Change Detection
Authors: Samiee Soheila , Vuvan Dominique , Florin Esther , Albouy Philippe , Peretz Isabelle , Baillet Sylvain 
Published: March 2022

Processing auditory sequences involves multiple brain networks and is crucial to complex perception associated with music appreciation and speech comprehension. We used time-resolved cortical imaging in a pitch change detection task to detail the underlying nature of human brain network activity, at the rapid time scales of neurophysiology. In response to tone sequence presentation to the participants, we observed slow inter-regional signaling at the pace of tone presentations (2-4 Hz) that was directed from auditory cortex toward both inferior frontal and motor cortices. Symmetrically, motor cortex manifested directed influence onto auditory and inferior frontal cortices via bursts of faster (15-35 Hz) activity. These bursts occurred precisely at the expected latencies of each tone in a sequence. This expression of interdependency between slow/fast neurophysiological activity yielded a form of local cross-frequency phase-amplitude coupling in auditory cortex, which strength varied dynamically and peaked when pitch changes were anticipated. We clarified the mechanistic relevance of these observations in relation to behavior by including a group of individuals afflicted by congenital amusia, as a model of altered function in processing sound sequences. In amusia, we found a depression of inter-regional slow signaling toward motor and inferior frontal cortices, and a chronic overexpression of slow/fast phase-amplitude coupling in auditory cortex. These observations are compatible with a misalignment between the respective neurophysiological mechanisms of stimulus encoding and internal predictive signaling, which was absent in controls. In summary, our study provides a functional and mechanistic account of neurophysiological activity for predictive, sequential timing of auditory inputs.SIGNIFICANCE STATEMENTAuditory sequences are processed by extensive brain networks, involving multiple systems. In particular, fronto-temporal brain connections participate in the encoding of sequential auditory events, but so far, their study was limited to static depictions. This study details the nature of oscillatory brain activity involved in these inter-regional interactions in human participants. It demonstrates how directed, polyrhythmic oscillatory interactions between auditory and motor cortical regions provide a functional account for predictive timing of incoming items in an auditory sequence. In addition, we show the functional relevance of these observations in relation to behavior, with data from both normal hearing participants and a rare cohort of individuals afflicted by congenital amusia, which we considered here as a model of altered function in processing sound sequences.