bluuebunny/crossref_metadata_2025_split huggingface dataset:
170 An Integrated Voice Recognition and Natural Language Processing Platform to Automatically Extract Thoracolumbar Injury Classification Score (TLICS) Features from Radiology Reports
Authors: Bhandarkar Archis R. , Onyedimma Chiduziem , Jarrah Ryan , Fu Sunyang , Liu Hongfang , Bydon Mohamad 
Published: March 2022

INTRODUCTION:
Many predictive models have been reported in the literature for clinical outcomes after spine surgery. However, the real-time implementation of these predictive scores in clinical practice is limited by the time intenstive nature of manually abstracting relevant predictors from the electronic health record. Natural language processing (NLP) provides a framework to automate data abstraction for commonly used predictive scores in spine surgery.

METHODS:
We retrieved and annotated the radiology reports of all Mayo Clinic patients with an International Classification of Diseases(ICD)-9/10 code corresponding to a fracture of the thoracolumbar spine between January 2005 and October 2020. Annotated data was used to train an n-gram NLP model using machine learning (ML) methods including random forest(RF), stepwise linear discriminant analysis (sLDA), k-nearest neighbors (kNN), and penalized logistic regression (pLR) models.

RESULTS:
1,085 spine radiology reports were included in our analysis consististing of 868 to train our ML-NLP model and 217 for validation. Our dataset included 483 compression, 401 burst, 103 translational/rotational, and 98 distraction fractures. 103 reports had documented an injury of the PLC. The overall accuracy of the RF model for fracture morphology feature detection was 76.96% versus 65.90% in the stepwise LDA, 50.69% in the kNN, and 62.67% in the pLR. The overall accuracy to detect PLC integrity was highest in the RF model at 83.41% versus 70.97% in sLDA, 70.05% in kNN, and 67.74% in pLR model. Our RF model was implemented in the backend of a web application where users can dictate reports and have TLICS score features be automatically extracted.

CONCLUSION:
We have developed a robust ML-NLP model for extracting TLICS score features from radiology reports, which we deployed in a convenient web application that can be integrated prospectively into clinical practice and scaled to other commonly used predictive scores.
175 Extraforaminal Extra-articular Full-endoscopic Access with Foraminoplasty for the Treatment of Lateral Compressive Diseases of the Lumbar Spine
Authors: Sandon Luiz H. , Bergamaschi João P. , Defino Helton L. A. 
Published: March 2022

INTRODUCTION:
Although the use of lumbar pedicular extra-foraminal access has emerged as an option to minimize traumatic damage to emerging nerve roots, studies evaluating this strategy are scarce.

METHODS:
The following instruments were used for the analysis of the results: analog pain scale (EVA), physical disability index (Oswestry), and wellbeing assessment (MacNab) preoperatively (T0), 2 days (T1), 1 month (T2), 3 months (T3), 6 months (T4), 12 months (T5),and 24 months (T6) postoperatively.

RESULTS:
The most frequent diagnosis was herniated disc with stenosis of the lateral and foraminal recesses. The most frequent surgical level among patients was between L4-L5 and on the left side. Pain decreased significantly over time. There was a statistical reduction over the evaluated times for evaluating pain in the lumbar, gluteal, leg, and foot regions.

CONCLUSION:
Extraforaminal extra-articular full-endoscopic access with foraminoplasty is an efficient, less invasive, and safe procedure, very well indicated in cases of hernia and stenosis of the lateral and foraminal recesses, for patients with symptoms of radiculopathy, and for those who were unresponsive to conventional rehabilitation treatment or chronic pain management. It had a low rate of complications, most of which were treated clinically.
190 Brain Structural MRI Predicts Outcome of Radiosurgical Treatment in Trigeminal Neuralgia
Authors: Albano Luigi , Agosta Federica , Basaia Silvia , Castellano Antonella , Messina Roberta , Parisi Veronica , Barzaghi Lina R. , Falini Andrea , Mortini Pietro , Filippi Massimo 
Published: March 2022

INTRODUCTION:
Growing evidence supports the role of the central nervous system (CNS) in the modulation of pain in trigeminal neuralgia (TN) patients.

METHODS:
Thirty patients with idiopathic or classic TN, who underwent GKSRS and were followed for at least 24 months, were retrospectively included. Pre-treatment structural MRI and pre- and serial, post-operative clinical features were investigated. Fifteen age- and sex-matched healthy controls were also enrolled. Cortical thickness and gray matter (GM) volumes were assessed in TN patients relative to controls, as well as between patient subgroups according to treatment outcomes (initial responders/non-responders, patients with pain recurrence/long-lasting pain relief at the last follow-up). Clinical and MRI predictors of treatment outcomes were explored.

RESULTS:
Cortical thinning of temporal, prefrontal, cingulate, somatosensory and occipital areas bilaterally was found in TN patients relative to controls. No cortical thickness and GM volume differences were observed when TN initial responders and non-responders were compared. Patients who experienced TN recurrence after initial pain relief were characterized by thicker parahippocampal and temporal cortices bilaterally and greater volume of right amygdala and hippocampus compared to patients with long-lasting pain relief. In TN patients, disease duration and baseline cortical thinning of right parahippocampal, left fusiform and middle temporal cortices were associated with poor outcome after GKSRS at the last follow-up (R2 = 0.57, p < 0.001).

CONCLUSION:
The study provides novel insights into structural brain alterations of TN patients, which might contribute to disease development and pain maintenance.
197 Gold Nanoparticle Enhanced X-ray Nanotomography Reveals Region-Specific CSF Pathways Through the Brain and Spinal Cord that are Altered in Post-hemorrhagic Hydrocephalus
Authors: Pan Shelei , DeFreitas Dakota , Ramagiri Sruthi , Bayguinov Peter , Huang Hengbo , Tang Rui , Esakky Prabagaran , Strahle Jennifer 
Published: March 2022

INTRODUCTION:
Cerebrospinal fluid (CSF) is essential for the healthy development and function of the brain, but understanding the mechanisms of its distribution in and around the central nervous system (CNS) remains a major challenge. To address this need, we developed a new technique, gold nanoparticle-enhanced x-ray nanotomography (AuNp-XRM), to achieve micrometer-scale resolution visualization of CSF pathways across the entire brain and spinal cord of rodents with further applications to a model of interventricular hemorrhage/post-hemorrhagic hydrocephalus (IVH/PHH).

METHODS:
P4 rodents were injected with aCSF or hemoglobin to create the control and IVH conditions. 72 hours later, animals underwent MRIs to determine onset of PHH. Animals were then injected with 1.9 nm and 15 nm gold nanoparticles and imaged using XRM. Following XRM, the brains, spines and meninges were harvested for histology.

RESULTS:
Using AuNp-XRM, we demonstrate visualization of previously characterized glymphatic, cranial nerve, and choroid plexus-mediated CSF circulation patterns, and present evidence to further identify CSF interactions with the leptomeninges, choroid plexus, and parenchyma of the brain and spinal cord. We also identified an intraparenchymal CSF circulation that targets stem-cell rich and cholinergic neuronal populations. CSF distribution to these areas was mediated by flow of CSF through the paravascular spaces of perforators originating from the large blood vessels of the basal cisterns and was significantly decreased in an animal model of PHH.

CONCLUSION:
Our findings using AuNp-XRM show that cholinergic cell populations in the brain and spinal cord differentially handle CSF, and that PHH alters CSF distribution to these areas of the brain. These region-specific patterns of CSF distribution may have critical relevance to normal brain development, brain development following PHH, and other neuropathological conditions.
203 Opioid Reduction After SCS
Authors: Hatcher Stacy , Jacobs David , Air Ellen L. 
Published: March 2022

INTRODUCTION:
Spinal cord stimulation (SCS) is frequently used as a primary method to treat intractable back and extremity pain with the secondary goal of replacing or reducing adjunct opioid use. Our study investigates pre and post-operative changes in morphine milligram equivalents (MME) for patients who have undergone SCS.

METHODS:
Data was extracted from the Henry Ford Department of Neurosurgery RedCap spinal cord stimulator database. Descriptive statistics of means, standard deviations, medians, interquartile ranges (IQR) and percentages were computed for the outcomes of interest. Signed rank tests were done to compare pre to post measurements of MME. The testing level was set at 0.05 and all analyses were done using SAS version 9.4.

RESULTS:
There were a total of 241 cases included in the RedCap SCS database out of which 196 were included in our analysis. A significant reduction was seen in the use of opioid pain medication from the pre-operative MME measurement as compared to the 3-month postoperative MME measurement (median = 9.5, IQR = (0, 27.5), p < 0.001). However, the differences in opioid use between pre and postoperative week 6 and 2-year measurements were not significant.

CONCLUSION:
SCS has traditionally been used in patients with intractable back and/or extremity pain and potentially helps to decrease opioid use as the primary method of pain relief in these patients. Careful consideration should be given when choosing candidates for SCS implantation as well a long-term follow up to track post-operative MME use.
206 Real-Time, High-Velocity Prosthetic Finger Movements Using Brain-Machine Interfaces with Biomimetic Artificial Neural Networks
Authors: Willsey Matthew , Nason Samuel , Ensel Scott , Temmar Hisham , Mender Matthew , Costello Joseph , Patil Parag G. , Chestek Cynthia 
Published: March 2022

INTRODUCTION:
Injuries that cause hand paralysis are devastating, but brain-machine interfaces (BMIs) offer hope to those with lost function. Unfortunately, brain-controlled prostheses have yet to function at speeds similar to the native limb.

METHODS:
Two male rhesus macaques were implanted with Utah arrays in motor cortex and trained to perform a two-dimensional finger task using a manipulandum. The spike-band power, a low power proxy for spiking rate, informed a five-layer neural network decoder that is first trained in manipulandum-control mode. NN was then used to decode finger trials and further refined by the ReFIT technique developed for the Kalman filter. Over 4700 trials, across 8 days, were conducted using either the ReFIT neural network (RN), NN, or RK decoders, impemented without online hyperparameter tuning, and performance was compared.

RESULTS:
The RN decoder produced finger velocities, 1.35 ± 0.04 u/sec (mean ± SEM) for Mky N and 0.94 ± 0.04 u/sec for Mky W, that were higher than RK velocities of 0.55 ± 0.02 u/sec for Mky N and 0.39 ± 0.04 u/sec for Mky W, where u denotes arbitrary distance such that 1 was full flexion and 0 full extension. Averaging across days, trials were completed in 1270 ± 30 ms (Mky N) and 2220 ± 70 ms (Mky W) for RN vs. 1940 ± 50 ms (Mky N) and 3310 ± 130 ms (Mky W) for RK.

CONCLUSION:
Using an architecture loosely inspired by biological motor pathways, this novel neural network decoder substantially outperforms the current state-of-the-art by achieving higher velocities more similar to naturalistic finger movements.
207 Dendritic Cells Immunotherapy in the Treatment of Glioblastoma
Authors: Rehder Roberta , Lepski Guilherme A. , Barbuto José A. M. , Santos Patricia C. B. , Peres Nataly , Pinho Mariana P. 
Published: March 2022

INTRODUCTION:
Immunotherapy is gradually being established as a relevant adjuvant therapy against cancer. Cell vaccination is a promising strategy for the treatment of glioblastoma (GBM). CarT and dendritic cells (DC) have been associated with partial response therapy in recent publications.

METHODS:
Clinical data were evaluated including overall survival, disease-free survival, global health scales, and quality of life in neuro-oncology. Analysis of overall survival and survival after recurrence and after vaccination is presented. Immunological panel with CD4/CD8 T-cell counts and lymphokines count were obtained on each vaccination session.

RESULTS:
A significant increase in overall survival was observed in the vaccinated group (33.16 ± 9.42 months, versus 13.56 ± 0.95 months in the previous group control (log rank p = 0.0021). The median overall survival from the first recurrence for the vaccinated population was 8.1 ± 1.9 months, and 5.0 ± 1.4 counted from the start of vaccination. The immunological data strengthen the importance of Th1 response pattern for tumor control, and Th-17 pattern linked to recurrence.

CONCLUSION:
The preliminary data support the safety and possible efficacy of DC vaccination in increasing overall survival in patients with recurrent GBM. The immune data provide important insights on the mechanisms beyond tumor control and recurrence.
208 Proposed Revision to Meningioma Classification System to Utilize Methylation Status of EGFR
Authors: Kjos Ava , Yang Isaac , Duong Courtney , Anderson Roan 
Published: March 2022

INTRODUCTION:
Meningiomas are among the most common brain tumors, making up about 13-26% of all intracranial tumors. They arise from the arachnoid cap and most commonly appear along the lining of the skull base and the venous cavities. The current classification system for meningiomas was established by the World Health Organization (WHO) and designates tumors as WHO grades I-III depending on histological characteristics. While WHO grade does strongly correlate with tumor recurrence, it has serious shortcomings. In particular, some WHO grade I tumors, which are supposedly benign, end up becoming highly aggressive and recurrent. A more accurate method of classifying tumors to provide better insight into prognosis is needed. Epidermal growth factor receptor (EGFR) is a highly expressed protein in meningiomas that has been linked to angiogenesis and other tumor-promoting properties.

METHODS:
A retrospective chart analysis was first performed to gather clinical and demographic information for 291 patients diagnosed with meningioma and treated with surgical intervention. Primary tissue samples were available for 25 patients and an analysis of EGFR promoter methylation status was performed.

RESULTS:
A significant association was found between EGFR promoter methylation and tumor recurrence (p = 0.02176*). Of note, there was a 100% positivity rate for EGFR hypermethylation in patients with tumor progression within 10 months post-surgery (n =9). Every tumor sample classified as WHO grade II-III had EGFR hypermethylation (n = 10), as well as 7 out of the 15 WHO grade I tumors. In total, over half of the meningioma patients with EGFR hypermethylation had tumor progression within 10 months of surgery.

CONCLUSION:
These findings suggest that assessing methylation status of EGFR could be a valuable tool for identifying highly aggressive meningiomas and determining patient prognosis early in the game. This would allow for improved postoperative treatment regimens to be developed, reducing the chances of tumor progression.
212 Continuous Mapping of Brain Tumor Resection Progression During Surgery
Authors: Juvekar Parikshit , Bastos Dhiego , Bi W. Linda , Golby Alexandra J. , Frisken Sarah 
Published: March 2022

INTRODUCTION:
Maximal safe extent of resection extends survival for gliomas. Surgical adjuncts including neuronavigation, intraoperative MRI (iMRI), intraoperative ultrasonography (iUS), and fluorescence imaging can help surgeons minimize unintentional residual tumor; each with associated limitations including cost, availability, susceptibility to brain shift and complex tumor shapes.

METHODS:
During tumor resection, surgical instruments, including navigation pointer, ultrasonic aspirator, suction, and bipolar forceps, were optically tracked. Data was streamed to 3D Slicer (https://www.slicer.org/) via OpenIGTLink (http://openigtlink.org/) and 3D maps of the resection cavity were computed using instrument tip locations. iMRI was performed after substantial resection and used to evaluate the resection maps.

RESULTS:
In 25 of 28 cases where residual tumor was identified on iMRI, the ‘difference map’ obtained by subtracting the resection map from the preoperative tumor contour correctly ascertained the location of residual. In 18 of these 25, the difference map reliably predicted the extent of residual as well. In 3 cases, false-positive overlap >30% of the contoured residual volume was noted and likely attributable to brain shift or collapse of the resection cavity during surgery. Even in these cases, surgeons reported that the general shape of the resection map helped them mentally compensate for brain shift and identify potential residual in visually inaccessible regions. Additionally, we present solutions to overcome line-of-sight challenges in optical tracking during dynamic resection.

CONCLUSION:
Our real-time navigated tracking system reliably maps resection progress during surgery and can direct attention to residual. It operates synergistically with commercial neuronavigation without disruption to surgical flow and can, in conjunction with iUS, compensate for brain shift and resection cavity collapse.
302 Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients with Diabetes on Sulfonylureas: A Propensity Match Analysis
Authors: Catapano Joshua , Farhadi Dara , Rumalla Kavelin , Srinivasan Visish M. , Cole Tyler S. , Baranoski Jacob F. , Winkler Ethan A. , Graffeo Christopher S. , Jadhav Ashutosh , Ducruet Andrew F. , Albuquerque Felipe , Lawton Michael T. , Jha Ruchira 
Published: March 2022

INTRODUCTION:
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with an increase blood-brain-barrier permeability, disruption of tight junctions, and increased cerebral edema. Sulfonylureas has been associated with less disturbance in tight junctions and reduced edema following aSAH in animal models.

METHODS:
Patients from the Post-Barrow Ruptured Aneurysm Trail (PBRAT) databse from August 1st, 2007, to July 31st, 2019, were retrospectively reviewed. Initial analysis grouped patients into two cohorts: diabetes and no-diabetes. A second analysis in diabetic patients separated patients based on prescription of sulfonylureas on hospital admission. A 4:1 nearest neighbor propensity match (match for age, gender, Hunt and Hess (HH), Fisher Grade, aneurysm location, aneurysm size, aneurysm type, Charlson Comorbidity Score (CCI), and treatment) was performed. Primary outcome was neurological status at last follow-up, with a poor outcome defined as a modified Rankin Score >2 and a good outcome as mRS </= 2. Significance was established as p < 0.05.

RESULTS:
A total of 1014 aSAH patients were treated during the study period. Of these patients, 129 (13%) were found to have a history of diabetes on admission. Compared to non-diabetic patients, the diabetic cohort had an increase age (59, sD 14. vs 55, sD 14.1; p < 0.006) and a higher CC I(2.5 vs 1.5; p < 0.001). Patients with diabetes (N = 77, 60%) were found to have a significantly higher odd of a mRS >2 on last follow-up compared to non-diabetics (N = 43, 49%) (p = 0.02). In the diabetic cohort, 16 patients (12%) were found to be on a sulfonylurea medication. Following propensity score matching, diabetic patients on a sulfonylurea (31%, N = 5) were found to have a significantly decrease percentage of a mRS >2 on last follow-up compared to non-sulfonylurea patients (63%, N = 40/64) (p = 0.02). On univariate analysis, besides the administration of a sulfonylurea, a HH < 4 was found to be associated with a decrease percentage of a mRS >2 (49%, N = 28 of 57) (p = 0.04). However, on multivariable logistic regression analysis, only the administration of a sulfonylurea was found to be a predictor of a good neurological outcome (OR 3.4, 95% CI: 1.1-11.3, p = 0.04).

CONCLUSION:
Diabetes appears to be associated with poor neurological outcomes in aSAH patients. However, the poor neurological outcome in diabetic patients appears to be mitigated by the administration of sulfonylureas.
315 Incidence of Infections in Full-Endoscopic Spine Surgery: A Multicenter Study Including 1262 Patients
Authors: Prasse Tobias , Wagner Ralf , Mahan Mark A. , Kim Robert , Sivakanthan Sananthan , Telfeian Albert E. , Bergquist Julia , Bredow Jan , Kashlan Osama , Hofstetter Christoph P. 
Published: March 2022

INTRODUCTION:
Full-endoscopic spine surgery (FESS) is a rapidly growing field. There is emerging class I data that it results in equal or better functional outcomes compared to traditional surgery while minimizing approach related morbidity and perioperative complications.

METHODS:
569 women (45.1%) and 693 men (54.9%) were identified in our prospectively collected cohort at two different spine centers. Demographic data, complications in particular occurrence of infections was analyzed. The Charlson Comorbidity Index was used to quantify the comorbidities in relation to the patients’ age by predicting the 10-year survival.

RESULTS:
The average age of the patients was 56.6 years (±15.5), 100 cases were cervical (7.9%), 24 thoracic (1.9%) and 1138 lumbosacral (90.2%). The mean Charlson Comorbidity Index was 1.95 (±1.8). 68 patients (5.4%) took immunosuppressive drugs. 21 complications were found in 1262 cases (1.7%). None of our patients had a superficial or deep wound infection. Eight patients had dural tears (0.6%), of which one presented as a cutaneous fistula with delayed wound healing. Bacterial cultures and DNA tests were negative, there were no clinical signs for infection and the patient did not need revision surgery, but was treated by lumbar drain placement. Postoperatively, 3 epidural hematomas (0.2%), 2 transient ischemic attacks (0.2%), 2 hypertensive crises (0.2%) and one myocardial infarction (0.08%) were observed. Only 5 (0.4%) of the patients had a recurrent disc herniation.

CONCLUSION:
Full-endoscopic spine surgery is associated with a favorably low rate of wound-related complications such as infections or dehiscence. We hypothesize this is due to coverage of the skin edge by the tubular retractor avoiding spreading skin flora into the surgical area as well as constant irrigation of the operative field. Low rate of adverse outcomes strongly supports utilization of this technique when indicated.